In all the swirl of developments and speculation surrounding the treatment of the public option in the House and Senate (Jon Cohn has a good current summary here), one bit of commentary today stands out. The originator of the public option, Yale professor Jacob Hacker, has a New Republic piece on the ¨trigger¨approach that pretty much condemns the whole idea.
Hacker offers a fairly long and complex critique of trigger proposals that merits a full reading, but he basically makes three key points: (1) “affordability” provisions in all the trigger proposals vastly undershoot the actual affordability of total health care costs, and fail to take future medical inflation into account; (2) any “triggered” public option that doesn´t rely on the Medicare infrastructure probably won´t work, particularly if it´s phased in slowly; and (3) “triggers” are, in the Senate at least, typically linked to regulatory structures that give states too much leeway in letting private insurers off the hook for offering affordable universal coverage.
His conclusion is pretty categorical:
Added to the Senate bills, a trigger would represent a backdoor way of killing the public health insurance option that a majority of Americans (and U.S. Senators) support. It is way past time to trigger real competition for private plans that have failed to ensure affordability or cost restraint for decades.
The practical effect of Hacker´s likely-to-be-influential critique is two-fold: it could stiffen the resolve of public option advocates in the House to insist on a “robust” public option with no trigger and national rules, and could also make the “state opt-out” approach the only acceptable compromise for these advocates, on the theory that creation of a strong national public option is the key objective, even if fighting to keep it in place in the states over time proves to be a struggle (as I personally think it would be).