The Trouble with Triggers

Tom Carper (and other Senators) have been hyping a “fall-back trigger” for implementing a Public Option for health insurance reform. The Public Option has strong progressive support and is one of the last big questions to settle in this process.

Timothy Noah over at Slate has done interesting reporting on the history and effectiveness of legislative “trigger” options. And apparently legislative triggers turn out to be legislative duds. Offering the legislators who support them an interesting camouflage — a way to look wise and considered on a proposal by voting for the promise of a review and implementation of an alternative if the current solution is not working. Except in practice, these triggers are routinely ignored by Congress. Take the prescription drug trigger that Carper routinely holds up as an example:

In 2003, when Congress added a drug benefit to Medicare, it worried that its new program to provide coverage through private plans subsidized heavily by the government would prove ineffective. But a trigger to end the program focused only on whether these private plans would serve all regions of the country, which they did. The trigger failed to address the real problems that emerged: fraud, abrupt changes in formularies and drug charges after beneficiaries signed up, and high costs. Meanwhile, a separate trigger in the bill required the president to address projected shortfalls within 15 days of receiving notice that 45 percent or more of Medicare funding was drawing down general revenues. Congress would then appropriate the necessary additional funds under an expedited procedure. But when President Bush notified Congress in 2006 that the 45 percent threshold had been exceeded, Congress did nothing. The threshold has been exceeded every year since then. Congress continues to do nothing.

So Carper holds up as a middle of the road option this trigger scheme, when if fact, it doesn’t quite work for the example he is so very proud of.

There’s more, too — David Sirota has written in his column and over at Open Left how “triggers” killed the effort to allow reimportation of drugs:

a group of congressional progressives and maverick Republicans waged a battle against the pharmaceutical industry and for a bill to allow the reimportation of prescription drugs from other industrialized nations. It was (and is) a commonsense proposal – other industrialized nations allow reimportation, and that reimportation helps lower prices by allowing consumers to buy FDA-approved medicines at the lowest world market price.

[…] So rather than kill the bill outright, the congressional Republican leadership and the industry hacks in both the Clinton and Bush administrations came up with a “compromise.” The bill could be passed and the celebratory press releases could be written, but only if the underlying legislation quietly gave the Secretary of Health and Human Services the final trigger power to ultimately implement the reform. Specifically, the Secretary would have to certify that imported medicines were 100 percent “safe” (at the time, the drug industry was pushing the lie that imported medicines from places like Canada were totally unsafe – prompting one honest Republican governor to ask, “where are the dead Canadians” from all the supposedly unsafe medicines).

This trigger provision, of course, made sure reimportation was never implemented at all, as no HHS secretary has agreed to sign any certification. As this New York Times story showed, the trigger was a well-calculated poison pill written by the drug industry. Hence, Americans are still legally barred from wholesale reimportation of medicine. […]

And as Sirota notes, ABC News is reporting that Carper and other Dems are advocating this “trigger” business with the President:

“If there is no meaningful competition after a couple of years, we would create competition through a public plan,” said Sen. Tom Carper, D-Del., in an interview with ABC News. “I think that could end up being the compromise because it bridges the differences between those who are for a robust public option and those who are adamantly opposed to a public option.”

“I raised it with the president,” Carper continued, referring to his public option with a trigger proposal.

So I think we have our answer about Carper and the Public Option. He is a NO vote and is hiding behind this trigger to avoid saying NO.