Why pulling the ‘trigger’ is a bad idea

WHY PULLING THE ‘TRIGGER’ IS A BAD IDEA…. Bloomberg’s Al Hunt told George Stephanopoulos that the trigger measure in health care reform may be “the compromise everyone has to rally around.”

Maybe, maybe not. We’ve talked before about the problems with this idea, but since the measure is lingering around, and may even generate more votes than any other approach, it’s probably worth re-stating the policy issues here. Jacob Hacker, who helped craft the idea of the public option in the first place, explained the other day why the trigger is the wrong way to go.

A workable trigger would, at a minimum, need to achieve three goals: (1) establish a reasonable and measurable standard for private plan performance that sets out clear affordability and cost-containment goals for a specifically defined package of benefits, (2) assess this standard in a timely fashion with information available to policymakers after reform legislation passes, and (3) if this standard were met, quickly create a public health insurance plan that would effectively remedy the situation.

The modifier “quickly” in the third goal is crucial: Runaway health costs are a grave and growing threat to federal and state budgets and to the health security of workers, their families, and their employers. Waiting longer than absolutely necessary for affordable coverage is certain to cause great harm. Indeed, it might actually compound the current crisis. Without an imminent threat of public plan competition, private insurers are likely to raise premiums in anticipation of the implementation of reform — as suggested by AHIP’s recent prediction of big premium increases if reform passes. Delaying a public plan may also jeopardize the cause of reform itself, because requiring Americans to buy unaffordable coverage has the potential to provoke a political backlash. (Polls show that Americans are more supportive of a mandate when they know they will have the choice of a public plan.)

In short, we cannot wait for a public plan — and one of the biggest problems with a trigger is that it virtually guarantees we will have to.

The whole idea of a trigger hasn’t gained any real traction in recent months, in part because it has so few fans. Republicans hate it — they oppose any competition for private insurers, even if it’s put off for some future standard — and Democrats are at least skeptical about it, for all the reasons Hacker explained.

What’s more, Ezra explained the other day, “One of the reasons I assumed Olympia Snowe’s trigger proposal was dead was, well, it looked dead. It was just lying there, unmoving. There were no meetings between Snowe and Schumer, or Snowe and Rockefeller, to try and craft a stronger trigger that would be acceptable to more liberal members. There were no modified proposals coming out of Snowe’s office, or statements from her spokespeople indicating a willingness to entertain changes. The White House kicked around some ideas internally, but none of them, so far as I or my sources know (or at least will confirm), ever saw the light of day, or even a dark room on the Hill.”

And yet, the idea still lingers, because Snowe still likes it.

Now, the talk over the last couple of days is that President Obama may actually prefer the trigger to the public option with the opt-out compromise. That may be true, but there’s reason for some skepticism. As we talked about yesterday, the issue here may be an entirely pragmatic one for the White House: Obama thinks a) center-right Dems won’t vote for reform without Snowe; b) Snowe won’t vote for reform without a trigger; so c) a trigger, while not ideal, will at least get a bill to his desk. The president is reportedly skeptical about whether a 60-vote Snowe-less majority is possible for the opt-out P.O. — not on policy grounds, but as a matter of legislative strategy — despite Harry Reid’s confidence that it will come together.

But as long as the competing strategies continue to play out, the inconvenient truth is, the trigger is almost certainly the wrong answer to the right question.