Trigger'd

We're nearing a real fulcrum point in the health care debate. The sensible centrists and the corporate whores are trying to sink the public option by instead suggesting that it only be achieved through a "trigger" that would be pulled if the insurers didn't provide a base level of care and access.

As a starting point for his bill, Mr. Kennedy favors a public plan that looks like Medicare, the government-run program for older Americans created in 1965, when he was a young senator.

By contrast, Senator Max Baucus, the Montana Democrat who is chairman of the Finance Committee, has been working for months with the panel’s senior Republican, Charles E. Grassley of Iowa, in the hope of forging a bipartisan bill, which would probably play down the option of a public plan.

Mr. Grassley opposes creation of a new government insurance program and says “we cannot afford the public health plan we have already,” referring to Medicare.

President Obama has championed a public plan, saying it would help “keep the private sector honest,” though he has indicated he will be flexible on the details.

House Democratic leaders, including three committee chairmen drafting the House bill, are close to Senator Kennedy’s position.

Democrats on the Finance Committee said Mr. Baucus was exploring a possible compromise. Under this proposal, the public plan would be created only if private insurance companies had not made meaningful, affordable coverage available to all Americans within several years.

Senate Democrats said they believed that Mr. Baucus might settle for this “fallback plan,” which could win some support on both sides of his committee, from people like Senator Ron Wyden of Oregon, a Democrat, and Senator Olympia J. Snowe of Maine, a Republican.

Obama met with both Kennedy and Baucus today before leaving for the Middle East. (UPDATE: Dodd sat in for Kennedy)

A trigger mechanism is simply absurd. The insurers have had decades to provide decent coverage and have demurred every time. They have shown themselves to be untrustworthy that entire time, including just last month, when they backpedaled on the cost controls they vowed to offer. Mike Lux, who has seen these battles up close, senses that this is the big proxy fight right now.

The insurance lobby has had multiple tactics for stopping the public option idea, which they despise because they know if regular folks have choice to go to a public option, insurance companies won't have the same ability to treat their customers like garbage when they get sick. The first tactic was just to try to kill the public option outright, and the good news is that they appear to have failed at that. This so-called trigger proposal is the second tactic: the idea is to write a "trigger" that will allow for a public option only under certain conditions, but write the legislation so that those conditions would never get met in the real world. It's a classic DC tactic, right up there with calling for a commission to study something. Olympia Snowe is carrying the insurance industry water on their trigger proposal, proposing triggers that would only get tripped in some fairyland none of us have ever visited.

The great thing for the insurance companies in a tactic like this is that it gives "centrist" Senators (centrist in Washington, DC usually means those who have taken massive amounts of campaign contributions from the affected industry) an excuse to help the insurance industry while looking like they are open to the public option that their constituents have been demanding.

Barack Obama and Democrats in Congress have gotten some good things done so far, and are building real momentum in getting us moving in the right direction on health care. But if conservative Democrats force the adoption of the trigger, it will destroy Democratic unity and doom health care reform, because progressives will start attacking Democrats rather than insurance companies. We really are at a critical moment.

Baucus himself stayed away from dozens of town hall meetings on health care out in Montana in the last week, mainly because constituents were openly hostile to his vision of sham reform. Most everyone at these meetings argued in favor of single-payer, and Baucus obviously has no interest in that. But adding this trigger would shut off the only way for a single-payer system to flourish, through a robust public option that can be scaled up. Lux describes it perfectly.

The Progressive Caucus in the House has really stepped up, declaring their votes on health care only available in the event of a public option. But they have not determined what form that public option will take. The public needs to demand action without Washington compromises. This is worth calling your Congresscritter about.

...I remain convinced that health care will really hit the rocks when we start determining how to pay for reform, but I'll leave that for a later post.

...The Maryland Women's Coalition for Health Reform is calling on AARP to support a public plan. Advocacy groups like this would be vital in this fight. It's yet another pressure point.