Obama's Finger on the "Trigger"

I have repeatedly expressed my skepticism about Barack Obama's commitment to "real" health care reform - and by "real" I mean reform that includes a strong public option, such as "Medicare for all".  Further reason for skepticism emerged on Friday afternoon.  Amid encouraging reports that the vacillating Senate Majority Leader Harry Reid is now leaning in favor of including some form of public option in the bill that will go to the Senate floor, came news from Talking Points Memo that Barack Obama is weighing in against it.  He is reportedly pushing Republican Senator Olympia Snowe's half-baked "trigger" proposal, under which a public option would be deferred for five years and implemented only if the private health insurance companies fail to bring down insurance premium costs themsleves.  Some pundits expressed shock; I was about as shocked as Inspector Renault when confronted with evidence of gambling in Rick's Cafe.

The trigger is objectionable for several reasons.  First, for every year that the status quo continues, up to 45,000 Americans may die because they lack adequate health insurance.   Delay is no longer a morally acceptable solution.  Second, the political reality is that the trigger is essentially a delaying tactic intended to stymie the public option indefinitely.  Republicans are well aware that if Democrats are successful in passing a strong public option - Medicare for all, for example - it will quickly become as popular as the original Medicare program.  Even should Republicans regain control of Congress in the near future, tampering with Medicare for all would be political suicide.    But a trigger is readily amenable to tampering; cost containment targets can be adjusted, compliance periods extended.  However, the best argument against a trigger was provided by the health insurance industry itself.  Shortly prior to the Senate Finance Committee vote, health insurers released a report, commissioned from PriceWaterhouse Coopers, purporting to prove that premiums would rise significantly should the Finance Committee bill (which does not contain a public option) become law.  The integrity of that report leaves something to be desired - to say the least - and was apparently a crude attempt to pressure the Finance Committee to increase the penalties that would be imposed on individuals who fail to purchase private health insurance.  But the report conclusively refutes any expectation that may previously have existed that the health insurance industry will be able or willing to contain premium costs absent a strong (and immediate) public option.

Support for a strong public option remains as strong as ever among voters and most Congressional Democrats now seem to be getting on board - thanks to the persistence of Nancy Pelosi, Anthony Weiner, Bernie Sanders, Chuck Schumer and others, but no thanks at all to President Obama.  Having watched from the sidelines for months, why is he now throwing his diminishing political weight behind the "trigger" proposal and against a strong public option?  Apparently because he is obsessed with obtaining a "bipartisan" solution, even if "bipartisan" translates to a single Republican vote and fails to deliver the real health care reform he promised on the campaign trail.    This may be bad news for the Democratic party and for the nation as a whole.  But it should come as a relief to anyone still genuinely concerned that Obama is pursuing some secret socialist agenda that will destroy the country as we know it.  We're not likely to see any of that  - unless, of course, he can persuade Olympia Snowe to get on board.

Addendum: Notes from the Garden State. 

 I was surprised recently to see a slick TV campaign commercial touting the health care record of New Jersey Democratic Senator Robert Menendez.  The ad exhorts viewers to call the Senator's office to say "thanks for standing  up for seniors and fighting for their Medicare".  I was surprised for several reasons.  First, notwithstanding right wing rhetoric, Medicare benefits have never been under serious threat in the current health care debate.  Second, although New Jersey is currently embroiled in a depressingly uninspiring gubernatorial campaign, Mr. Menendez does not have to defend his Senate seat until 2012.  And third, while Senator Menendez, to his credit, voted in favor of a public option amendment on the Senate Finance Committee, his more visible contribution during the Committee stage was to vote with the Republicans against a Democratic amendment that would have lowered the amount the Federal government pays for medication for dual-eligible Medicare and Medicaid patients.  The proposal, by Senator Nelson, would have eliminated the current "sweetheart" arrangement that prohibits the Federal government from purchasing these drugs in bulk.  (Obama also let it be known that he opposed the amendment, having earlier cut a backroom deal with the pharmaceutical lobby pledging to preserve the current arrangement.)  In addition, despite the overarching requirement that the Senate Finance Committee bill should not increase the deficit,  Menendez successfully sponsored an amendment to provide generous tax credits for biotechnology firms.

So who is paying for the TV ads praising the Senator's efforts on behalf of health care "reform"?  An organization called the HealthCare Institute of New Jersey, which describes itself as " a trade association for the research-based pharmaceutical and medical technology industry in New Jersey."  In other words, the same crowd that will benefit directly from Menendez' votes on the Senate Finance Committee, and that also contributes generously to his campaign kitty.  

The Wall Street Journal recently reported on the efforts of some senior Democratic proponents of health care reform to skew the legislation to support special interests and enhance their own chances of re-election.  The extent to which these provisions survive in the bill that goes to the Senate floor will be the true test of Harry Reid's leadership.