A trigger for the public option - a plan to kill the public option
Posted on September 4th, 2009 by Jason Rosenbaum in Profits Before People
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Those that want a trigger for the public health insurance option are saying, "Let's give the insurance industry one more chance to clean up its act." We've been there and done that, fifteen years ago.
That was the same argument the insurance industry made in 1994 and we've seen what happened since. Premiums are rising four times faster than wages. People are going bankrupt at the rate of one every 30 seconds due to health care costs. 95% of the insurance markets around the country are anti-competitive. And 14,000 losing their coverage every day.
They didn't clean up their act last time, and they won't this time. And this time, an individual mandate will require us to purchase insurance from these very same companies while we're waiting for the trigger to be triggered, if indeed it ever is.
When the idea of a "trigger" for the public health insurance option was floated a few months ago, I and others explained why the proposal was not a public health insurance option and not health care reform. In fact, a trigger would be nothing but a win for the insurance industry because it serves to kill the public health insurance option outright. The case is the same now that it's being floated again.
Why? There are a multiple reasons.
1. By any rational measure, triggers have already been triggered
Finally, given the depth of our health care crisis, with bankruptcies every 30 seconds due to health costs, 95% of the insurance markets around the country being anti-competitive, and 14,000 losing their coverage every day, haven't requirements to trigger a public health insurance option already been met?
Chuck Schumer put it best when he said (emphasis added):
"Some who have been skeptical of a public plan have been calling for a "trigger," that would introduce a public plan some time down the road if certain conditions were met. Today's report [on the non-competition of insurance markets] blows away the idea that we should wait for a trigger. Today's report seems to suggest that any reasonable criteria for triggering a public plan has already been met.
After all, if we were to write a trigger into comprehensive health care reform, what would it look like? The main criteria would be market share and premium price. This report today shows that in many states, both conditions have already been met. Premiums are high, and either one or two insurers dominate the market. As we've seen with Medicare part D, a trigger option has so far meant no public option at all."
A trigger proposal asks America to wait for the health insurance crisis to get worse before fixing it.
We already have skyrocketing prices. Insurance is already unaffordable. Insurance companies are already gouging us for more and more money while denying us for more and more care.
Trigger conditions around the country have been met. These companies need some honest competition. And the only way to give it to them is a national public health insurance option, available everywhere on day one.
2. Triggers as proposed would make the public health insurance option non-functional
The proposal for the trigger indicates that:
…a new government corporation would offer health insurance in any states where affordable coverage was not readily and widely available from private insurers. The corporation would not be part of the Department of Health and Human Services, although federal officials would serve on its board.
The public insurance plan would be offered in any state where fewer than 95 percent of the residents had access to affordable coverage.
The problem here is similar to the problem with the co-op. Under a trigger, public health insurance plans would be created, but only on a state-specific basis. You've have different plans popping up at different times around the country. In short, the public health insurance option would be fragmented.
For example, in rural areas with few choices for health insurance, the situation is stark. People will be forced to buy unaffordable insurance from the only option (private plans) available in their area, all because their state doesn't meet the requirements for a triggered public health insurance option. It's discriminatory.
And, this fragmentation means the public plans created under this proposal wouldn't have the clout to compete with private insurers. Think about it: Private insurers are national mega-corporations, with huge amounts of cash and predatory business practices. They already collude with each other and with providers to drive out smaller players or force them to play by their rules. How would a state-based public option be able to take them on?
3. Triggers will never be triggered
We've tried triggers before. In fact, we have a trigger in place in the Medicare Part D program. It hasn't done anything to stop big PhRMA from gouging seniors:
[Medicare Part D] didn't help a large minority of the senior population deal with drug costs because of the massive "doughnut hole" problem. There are millions of seniors caught in the so-called doughnut hole, where thousands of dollars in annual prescription drug costs must come directly from their individual pocketbooks, or they will go without the often life-saving medications.
The legislation had a "trigger" built in to supposedly protect consumers and taxpayers against huge cost increases in the program. If the bills became too large, a "public option" would kick in and tell Big Pharma what's what. Unsurprisingly, that threshold has not yet been reached.
As a result, Big Pharma got a big windfall (a whopping $3.7 billion in the first two years alone) from Medicare Part D.
Tim Foley at Change.org continues the argument:
The trigger may be set up so, in effect, it never happens, similar to the Medicare Part D trigger that would have created a public prescription drug plan – but never did. The threshold would be low enough that it could be easily, and superficially, met. Throughout those “several years,” the insurance plans would receive all of the uninsured who enroll through a National Health Exchange, pocketing what we can hope are generous government subsidies, with very few changes to their behavior.
What the trigger does, in effect, is tell the insurance industry the exact bare minimum it must do to keep the status-quo. The insurance industry will undoubtedly step right up to that line but not cross it to avoid a public health insurance option in that state, and they will undoubtedly lobby to change the trigger minimum so they can keep up with their practice of turning your health into shareholder profits.
Plus, that trigger will be set at a lower level than current conditions, allow the insurers to make even more money at your expense. It's a win for them, but not for you.
The trigger will never be triggered. Instead, the trigger proposal is a plan to kill the public health insurance option outright.
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A trigger for the public health insurance option would create underpowered public plans that would be swallowed whole by the insurance industry. A trigger would also tell the insurance industry the exact minimum level of care and service they need to provide (a level worse than they provide now) before they face competition, giving them incentive to stay at that level and no better. That trigger will never be triggered - instead, it will kill the public health insurance option. But most importantly, a trigger wants us to wait for our crisis to worsen before we fix it.
That's not a compromise. That's not even a rational proposal. Waiting for the crisis to get worse does nothing but help the insurance industry at the expense of our wallets, our health, and our lives.
The trigger kills the public health insurance option. It is not health reform. It should be rejected.
Hi!
I just wanted to thank HCAN for hosting the rally in Chinatown yesterday — I'm fully triggered and it encouraged me to write my congressmen, make calls, and contact friends.
Some of my pictures are up here:
http://publicoption.blogspot.com/2009/09/la-health-reform-rally-9409.html
Great shots, glad you came!
The trigger is as useless as teats on a Hummer H1.Insurance companies only look at the bottom line - profit!
" My Sister Died Today WITH Health Care Coverage
Could NOT Afford Life-Saving Medicine "
KAREN'S STORY
(written Sept. 1, 2009)
By Greg Jones
Blacks4Barack
National Director
Last Wednesday, my only sister was taken to emergency because of difficulty breathing. She's had a history of numerous illnesses ranging from lupus, seizures and osteoporosis but this particular visit was more related to her asthma, or so she thought. After being seen by the physician it was determined that her breathing difficulties were worse than anticipated as she was diagnosed with having a case of pneumonia. Feeling blessed to be able to get immediate medical care Karen was of the ranks of the fortunate known as the insured, meaning that she does in-fact have health care coverage which she acquired after being declared medically disabled after her thirty third seizure.
Yes, it took thirty three seizures, 5 appeals, 4 years and 3 lawyers but Karen Jones (Cleveland, Ohio) was finally declared disabled and was granted full disability which included full health care coverage, far from an easy feat but quite reassuring to Karen as she continued on through life. Unable to work due to her disability, Karen lived alone off of the $563 disability check each month as best she could, regularly robbing Peter to pay Paul, but all along able to make ends meet from check to check, and doing so always with a smile.
Even though times were really harder than Karen lead others to know she was thankful for the roof over her head, her access to medical care when needed, her monthly check and the ability to basically survive, which may be the reason that she developed the characteristic of never asking for help from others regardless of how much she may have needed it at times.
So she didn't like the fact that she had to trouble a neighbor to take her to emergency on Wednesday but she just couldn't breathe well. After the diagnosis that pneumonia was the culprit Karen signed the final papers as her prescription form was being handed to her. "Get this filled, take 4 of these per day and this will clear up your breathing" were the directions given as Karen prepared to go home, wheezing profusely along the way. The neighbor takes her directly to the pharmacy which is where Karen is told that this much needed medication will cost her $197. It's the end of the month, funds are extremely low, and Karen is far from having an extra couple hundred dollars laying around, so she goes home, takes some extra inhales from her breathing machine, and decides to toughen it out until the first of the month, just a few days away, when she'll get her next check and have the money to buy her medicine.
Being a prideful, independent woman Karen continues to tough it out each day never showing to others her true discomfort or need. All day long on Thursday and Friday Karen constantly thinks to herself how much she wishes she had been able to afford to buy the medicine as she does a mental countdown to the first of the month with every inhale through her machine. "I shouldn't have paid the light bill…I should have bought less food" are just a couple of the thoughts that haunt Karen as she figures ways she could have had the much needed money. And on that Friday night as she lay in bed she takes a few extra puffs from her breathing machine to get her through the night.
On the early eve of Saturday morning around 4:30 or so, Karen Jones, my only sister, died, age 51. Apparently, around 4:00 she had severe difficulties breathing, strained to call a neighbor who immediately got dressed and came down to the house, knocked on the door like crazy but there was no answer. Feeling great concern a call was made to the police who quickly arrived, gained access into the house, and there lie Karen, dead on the floor, beside her breathing machine.
Although we all were well aware of Karen's history of sicknesses I never expected my sister to die at such an early age. Of course I am of great sorrow and pain over the loss of my sister but I am also very angry with our health care system. I am angry, no actually in shock by the fact that my sister, Karen was declared to have full health care coverage through her disability benefits. But since it did not cover her medication, which she could not afford to buy out of pocket, my sister died with this so-called full coverage. What kind of full coverage does one really have if they are forced to pay for expensive medications out of their measly $563 monthly check ? I truly believe that if my sister had had her medication she would be alive today. It is absolutely disgraceful that our health care system has the gall to claim they are supplying full health care benefits to the disabled while simultaneous depriving them of the very medicines needed for survival.
Believe it or not, you could say Karen was actually one of the lucky ones only needing one medication compared to others who frequently need 2 and 3 medications, at costs which exceed their entire monthly check. So many who are sick, struggling and classified as fully covered are are in fact struggling helplessly, going without vitally important medications.
Throughout the health care reform debate many have argued that there is no need for strong reform of our system. Most others though do recognize the severe need to reform health care coverage in our country so that we no longer have 47 million Americans who have absolutely no health care at all. 47 million who do not have the basic right to get medical help when they are sick. This is sad and pathetic. Recently, an organization, RAM, known for offering free medical care in the Amazon has been forced to offer their services right here in our country. In Los Angeles, in Iowa and other U.S. locales, hard working Americans who can't afford health care coverage line-up by the thousands for free, much needed health care, similar to scenes in third world countries.
And while we must make certain that health care reform addresses the needs of the uncovered we must also make certain that we address the needs of the category now known as the under-covered. These are the people who have health care coverage but for one reason or another, tend to find out the hard way, usually when they are sick, that their coverage wasn't as 'full' as they thought.
Of course, it will haunt me forever as to why my sister didn't pick up the phone and ask me for the money, but folks that know her know, that's just Karen. And there are millions of other Karens out there, in desperate need and dire straits, but too independent to ask for much needed help. It is our responsibility, our duty to do everything we can to help the 47 million uncovered and the additional millions of under-covered to have the basic right to true health care coverage.
I hope my sister's passing did not include suffering. And now, even more, I hope that we all across this great land, will unite, do the right thing and pass a strong health reform bill which includes a strong public option so that we can curtail the suffering of millions more ahead. We must fight for the 47 million and the Karen Jones's of America. This is a battle that must be won !
Greg Jones
Blacks4Barack.org
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(While politicians including President Obama debate over dollars, protecting insurance companies and politics this puts a human face on the true need for strong health care reform in America. Please share Karen's Story)
Contact: Greg Jones
Blacks4Barack@yahoo.com
216/323-3527
To Read/Share Original Article visit:
http://blacks4barack.blogspot.com/2009/09/my-sister-died-today-with-health-care.html
Greg - I don't know you but I know the loss of losing a beloved family member because she wasn't insured and diagnosed with a catastrophic disease until it was too late. I am so sorry for your loss.
It is so unfortunate that Congress in general disregard the plight of their fellow Americans in the working class. READ OUR LIPS…WE CANNOT AFFORD THE COST OF HEALTH INSURANCE. STOP SENDING FALSE MESSAGES TO VOTERS WHO DO NOT HAVE THE TIME TO RESEARCH THE FACTS AND THEN BELIEVE YOUR CLEVERLY DISGUISED COMMENTS AS BEING FACTUAL "Trigger is nothing but a way to keep insurance companies in the health business, and of course funding politicians campaigns." There are certain things that should not be run by private industry: Health Care; Utilities; Gasoline. They are all in the category of necessities and should never be conducted by "For profit companies". In fact if the post office was run by the private sector, I'm sure a letter would cost about $10 to mail. Since those opposing the single pay plan say that our Government cannot handle this, we would all be willing to take the same health coverage congress has and pay their outrageous premiums of… $0000.
There is nothing wrong with a "trigger" as long as it is done properly. Let's pass a single payer plan. Then provide a trigger for the insurance companies to kick in after five to ten years if the single payer plan isn't working.
Herman Holtzman
No More triggers!
The Insurance agencies are literally bleeding this contry to death!
A public option is needed now!
I personally know 3 elderly persons in my neighbor hood that had to mortgadge their homes to pay to be in a nursing home.
Compound that by millions of Elderly Americans across this Nation.
I can't even imagine the amount of money that the insurance companies will reap from the people, enough is enough!
If the public health option would disapper because of the trigger, then we Sikarin Hospital also think it should not be called health reform.
The "trigger" is a ruse. The health insurance companies will wriggle out of those constraints by dragging the whole concept through the courts, further delaying health care reform. The health insurance industry has had more than 15 years to fix their punitive policies and practices ever since the Clinton administration nearly passed universal health care. The health insurance industry knew it had dodged a bullet at that point in time and had the opportunity to reform — knowing this issue would not go away — but they chose to conduct business as usual. Why? The insurance industry is no more willing or able to regulate itself than the banks or the auto industry. It's like accepting a ride to cross a river on the back of a crocodile and expecting it not to eat you. Health insurers are all corporations so they cannot be driven by efficient, fair delivery of affordable health care. Corporations are driven by profits. My question is, how in the world could our Congress be so neglectful as to entrust something as important as the health of their constituents to entities driven by profit? The "free-market" theory hasn't worked for health insurance just as the "trickle-down" theory didn't help the economy under Reagan. Why do we keep thinking the Republicans have modern solutions for modern problems? No more delays, no triggers, no hollow tactics like benchmarks, or timelines. I'd like to see Congress open Medicare to anyone over 18 or 21. Even better, I'd like to see the health care protocols already in place under Veteran's Administration used as the template for a public option. Then all the closed hospitals can be equipped and re-opened to provide health care. The "for profit" insurance companies have proven that what they offer is actually "wealth" care for their CEOs, not health care for those who pay the premiums.
I think the "trigger" has been pulled, and 18000 people have paid the price for waiting for the private insurance industry to change.
The public option is an agreement among Americans to create a pool that doesn't reward failure but gives us access to preventive care and medical treatment.
You can't ask us to continue in a relationship with an institution that has denied us coverage and made a profit from it in the process.
Pass the public option, or more than Senate seats will be at stake in the next 4 years.
We either get a public option or we get no reform. If the president does not insist upon the inclusion of a public plan we must take to the streets!
I'm saddened by the story of Karen passing away because she couldn't afford her overpriced medication. It's a tragedy. And that very scenario happens over and over again every day because of the greedy insurance and pharmaceutical companies. And Congress does nothing to stop them. Very few of the representatives in Washington care at all about the rest of us. All they care about it getting re-elected. Most of their contributions are from insurance companies, so why would they vote against them? They have no morals. They don't care. Members of Congress get to choose their health insurance. The rest of us have to suffer with overpriced, unaffordable, do little to nothing coverage, and we're supposed to be happy with it? Having no coverage or not enough coverage is a life and death struggle to stay alive for millions of people. Meanwhile, Harry Reid and his commitee toss a public option back and forth like it's all a game. Willing to give up everything to cater to one lone republican who won't vote for a bill with a public option in it anyway because it's not what she wants! Well la de da. I live in Maine and I'm telling Olympia Snowe that she's not all that. Her 15 minutes of fame are up. The best thing she can do for this country is to either vote for the bill, public option and all, or get out of the way!
The real truth about our country. It is sad when someone works for a company and retires after 30 years of loyal conmittiment to it and then loses everything they work for and our goverment let it happen. Some one should know that this is happing. I just found out that we cannot afford to take our medicine for five months because we fall in a doughnut hole and afer spending 575 more a month for insurance we can fix the problem so I guess our goverment just wants us to die before the first of the year. It is such a rude awaking that I cant even enjoy the the last few months of this year.. Lind Morris