The Urban Institute is out with a new report pushing for a triggered "robust" public option based on Medicare rates.

It’s easy to see how on first blush, this might be an attractive proposal. A public option based on Medicare rates would save billions of dollars and really hold down costs in an aggressive way. The problem is the trigger and the politics – or more accurately, the problem with this proposal is reality.

The policy arguments against the trigger are numerous, but boil down to this:

The logic at the heart of a trigger is that private insurance companies should be given one more chance to keep their monopoly on the system they’ve screwed up so badly.

A trigger says that some condition must be met in the future for a public health insurance option to be created in a state. That condition could be levels of competition or premium increases or affordability, but whatever it is, the situation on the ground in a state must measurably worsen before the trigger is pulled and a public option created. Why would we delay the public option and give private insurance yet one more chance?

People are going bankrupt and dying every day because they are uninsured or underinsured. Health insurance premiums are going through the roof. The private insurance companies already have a monopoly – with 94% of markets considered “highly concentrated” by Department of Justice standards.

As Senator Chuck Schumer said, "Any reasonable criteria for triggering a public plan has already been met."

But that’s if the trigger were actually designed to be pulled. It won’t be. That’s where we get into the politics.

I’m all for a robust public option. Evidence across the board shows a public option tied to Medicare rates would save a ton of money – both to taxpayers and to individuals – and it wouldn’t bankrupt hospitals or doctors like its critics say it would. It’s a good idea. (This is not to say that a public option based on negotiated rates can’t be powerful. Look at the VA, which negotiates some of the lowest drug prices in the nation.)

But lobbyists have so far prevented a robust public option from being considered in the Senate. And so, we should strive to deal in reality.

We could have an interesting theoretical discussion about, say, whether a trigger for a robust public option is better than an opt-in, but neither is likely to happen in the Senate. While we’re theorizing, I’d love to have a pony with my health care reform. Now that would be awesome. But I’m not going to get a pony when President Obama signs a health care bill.

In today’s Senate, a trigger is nothing but a race to the bottom. The trigger built into the Medicare Part D bill is instructive – it has never been pulled as drug prices have skyrocketed and seniors have suffered. If triggers are put into this bill, we’d end up with a trigger that can never be pulled, a policy that has actually been proposed as opposed to the robust public option which has already been voted down in committee.

Reality is, if there was enough support for a robust public option in the Senate that would actually come into existence, even with a trigger, then there would be enough support to create it immediately, or at least in 2014 when the Senate health care bill really takes effect. But there’s not, and the only trigger on the table is one designed to kill the public health insurance option.

That’s why triggers, any triggers, even magical fantasy pony triggers, must be opposed. Period.

(also posted at the NOW! blog)

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Jason Rosenbaum

Jason Rosenbaum

Writer, musician, activist. Currently consulting for Bill Halter for U.S. Senate and a fellow at the New Organizing Institute.