There is a new public health insurance option "compromise" brewing from Senate Carper:

Even as Senate Majority Leader Reid seeks votes for a healthcare bill with a public option that states can opt-out of, Reid has allowed Sen. Thomas Carper, D-Del., to work on what one aide called a "Plan B" if Reid cannot line up 60 votes for cloture.

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In states where private insurers fail to offer affordable coverage, Carper said the alternative would permit them to set up a non-profit board, likely appointed by the president, to offer insurance.

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The plan would be a form of a so-called trigger option pushed by Sen. Olympia Snowe, R-Maine, and some Democratic moderates. Moderates have been meeting to coordinate some of their efforts on the overhaul.

This proposal, undeveloped as it is, will not meet the principles for a real public health insurance option: It won’t be national or available everywhere on day one.

The problems with trigger proposals and state-based public options – and Carper’s new "compromise" seems to include both – have been outlined before. Let’s go back through each of them in turn.

First, the trigger. Trigger proposals – proposals that allow a state to set up a public health insurance option if their insurance market fails to offer affordable coverage – would allow our health care system to get worse before fixing the problem.

Anyone proposing a trigger is assuming that the health care crisis right now is acceptable, and that it would need to get worse before it can be fixed. This is crazy. Millions in America lack health care coverage and die because of it. Businesses are getting hit with double-digit insurance rate increases, forcing them to choose between their employees’ jobs and their health. And insurance companies continue to deny and ration care to line their pockets. As Senator Schumer remarked when the trigger was first floated back in May:

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 blow 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.

We have a crisis, one that needs to be solved now. Waiting for the crisis to get measurably worse before allowing people the mere choice of something other than the private health insurance that’s killing them right now is irresponsible. Not to mention, as SenatorSchumer points out, triggers have been tried before and are designed never to trigger, truly making a trigger proposal a Catch-22 plan to kill the public health insurance option.

State-based public options, especially those modeled on the inneffective co-op proposal, are also doomed to fail. A public health insurance option will be asked to compete head-to-head with the national health insurance conglomerates, who have billions in the bank and total control over the marketplace. How do you expect a small, state-based public option to compete with that firepower?

As Igor Volsky at Think Progress explains [referring to Carper's older, similar opt-in proposal], state-based public options already exist, and they haven’t been able to put much of a dent in private insurance:

State-based public options would enter concentrated markets (already dominated by one or two private insurers) and lack the market clout to negotiate significantly cheaper rates or institute reforms that change the way care is paid for. Existing state-run employer plans (and Medicaid in many states) have already given up on the ‘public’ aspect of their plans and outsourced the work to private insurers. As a result, they have failed to significantly lower health care costs or bring any real change to the market place. In other words, like Carper’s proposal, they are ‘public plans’ in name only.

The principles for a public health insurance option remain the same – a national public health insurance option, available on day one, accountable to voters and Congress, and with the clout to set rates – and Carper’s new idea fails to live up to those principles. The proposal would do little to break the insurance industry’s monopoly, give people a real choice in their health insurance, or keep the insurance industry honest, all things a real public health insurance option would accomplish.

Majority Leader Harry Reid had it right when he decided to put a national public health insurance option in the health care bill he’s bringing to the floor of the Senate. The proposal he’s bringing forward most definitely can get the support of the 51 Senators it needs to pass, and provided no Democratic Senator joins Republicans to block a fair majority vote on health care, it can get the support it needs to pass cloture as well.

We don’t need compromises that don’t work. We don’t need triggers or state-based public options. We need a national public health insurance option that’s available on day one.

(also posted at the NOW! blog)

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