Sunday, September 20, 2009

Olympia Snowe and the Audacity of Cost Control

Over five hundred amendments were suggested to the Baucus bill today, which is frankly a little bit disappointing -- I had hoped that one of the other committee bills would be getting more attention for the simple reason that most of them are better bills.

There's one amendment that I'm really interested in, though -- Olympia Snowe's amendment to create a public health plan as a 'safety net' if insurance costs don't decrease in the coming years. This isn't, I don't think, as good as having a public health option -- but it's certainly better than the Baucus bill itself, which does nothing to control costs. One of the things that the bill reflects, though, and I think that this is the reason that this amendment is canny and smart, is that insurance industry costs are under the control of the insurance industry.

It's pretty simple, but it's something that those that insist on the free market don't usually get. When an insurance company has a monopoly, or an 'agreement' with the competition, or when it simply realizes that people can be persuaded, shamed or tricked into paying more money for fewer services, that insurance company will raise rates. This is not the invisible hand: this is someone coming to a meeting with a PowerPoint that ends, " if nobody figures out what we're doing, then we can safely raise premiums by 9% in the next year." What limits this -- even in the current system -- is government. We regulate what is fair and unfair to do. The most profitable attitude for an insurance company would be to promise you a bunch of stuff, take your premiums, and then never pay for a dime of your care. And that happens -- except when we make it illegal.

The triggered public option would be another kind of regulation for insurance companies. It would require them to keep costs down, which they have the power to do, and if they failed, it would punish them by opening government competition. In doing so, it would insure that costs were at or below some particular level.

Unfortunately, a triggered public option wouldn't create (absent the trigger) an insurer that people could trust -- it would be fairly easy for insurance companies to keep profits high by surreptitiously cutting benefits every time they cut costs. There's simply no good way to get your health insurance from an entity that has shown itself to be overwhelmingly untrustworthy. Additionally, the 'trigger' part of the public option is just a bone thrown to those untrustworthy industries. If the public option is effective in keeping down costs, and if it can ensure that people pay a rational amount for their health insurance, then why don't we have it now?

All that having been said, there's been a lot of talk about Senator Snowe being an important moderate, and I have to say this amendment really does represent something in between the two sides. This is a very large, very rarely traveled, and very necessary territory in the Senate debate, and the people of Maine should be proud of their representative for having the courage to go there.


  1. Hi Nick and Mattlo,
    Excellent blog! I have a political blog that deals primarily with health reform or the lack thereof. I think a public option is key to keeping costs down - and I really don't think a 'trigger' will get the job done. I mean, what would be the conditions for a trigger? Millions of uninsured people? Insurance price hikes of 10% or more a year? A monopoly by the big insurance companies? We're there already, right?

  2. Hi, Lesley,

    You're absolutely right: there's no way that a nation whose infant mortality rate is worse than Slovenia's isn't 'triggered'. I just think that Snowe's attitude -- that even the threat of a public option can bring down cost -- shows that it's the right policy for the nation.

    Thanks for directing me to your blog -- when you become governor, I can say I was your political ally way back when...