ObamaCare: Public option + trigger = exit strategy?
posted at 11:25 am on September 3, 2009 by Karl
There is a rumor (most likely floated by White House chief of staff Rahm Emanuel) that Pres. Obama is secretly negotiating with Sen. Olympia Snowe for a healthcare reform that would phase in a government-funded health insurer if private insurance companies fail to meet quality and cost benchmarks over a certain period of the time. Allahpundit scores this as an “Uh-oh,” but the devil is in the details.
Sen. Snowe has pushing the notion of a “public option with trigger” for months, and it has been the Left expressing dismay over the idea. True believers like Robert Reich say Snowe is fronting for Big Pharma and health insurers, with conditions that would be easily met by other pieces of the emerging legislation. Rahm Emanuel has been floating the trigger idea since January, again to the dismay of lefty groups like MoveOn. The left notes that congressional Republicans crafted a similar trigger for the Medicare prescription-drug benefit in 2003 — and it has never been triggered. For the left, the “public option” deferred is the “public option” denied.
However, it is a proposal that serves the administration’s interests. Pres. Obama reportedly would like not only to pass a takeover of health insurance based on an individual mandate, but also to get back some of the post-partisan image he had as a candidate. Some administration officials welcome a showdown with the left wing of the party to achieve these goals. The maneuver would also lure Blue Dog Democrats to the bill — and many Blue Dogs still expect to pass some healthcare reform bill.
This tactic carries its own measure of risks for the administration. The first risk is that the progressives continue to balk and refuse to vote for a final bill with a trigger. This seems unlikely, but most of them are from safe seats and plan to hold those seats long after the Obama presidency, so there could be some rebellion at the margin.
The second (and larger) risk is that a proposal designed to grab the center holds only a handful of votes. That is what happened in the dying days of HillaryCare in 1994. Those proposals never made it to any sort of vote.
The third risk is that whatever momentum is left for ObamaCare rests on the notion that politically, failure is not an option on healthcare reform. The theory that Democrats in swing districts are better off voting for an unpopular takeover of one-sixth of the economy has always seemed counter-intuitve. Now, Sean Trende has done a regression analysis of the 1994 midterm election showing that holding all other things equal, had Democrats gone ahead and passed HillaryCare, their losses likely would have been even greater than they were. Trende notes:
Right now, almost all of the 60 or so Democrats in Republican PVI districts have cast a controversial (in Republican districts) vote on Obama’s stimulus plan. Many of them have voted for cap-and-trade. Unless public opinion changes substantially, many of them will be pressured to cast an extremely controversial vote on the health bill. These Democrats don’t need this vote.
In short, the “public option with trigger” might appeal to Pres. Obama and Sen. Snowe, but there is no reason for Democrats of any stripe to adopt it as their own. That may be why similar healthcare compromises failed last time around.