• The Heritage Network
    • Resize:
    • A
    • A
    • A
  • Donate
  • Why the "Trigger" is a Bad Idea

    For most of 2009, President Obama, Speaker Pelosi and Majority Leader Reid have been obsessed with a “public option” for health care, which would create a government-run health care system that would eventually monopolize the industry and create the single-payer system liberals have long desired.

    Even when town hall protesters by the thousands jeered the concept; they stood by it. Even when poll numbers reflected a small minority of support; they stood by it. Even when study after study showed that millions of Americans would be forced out of their private plans, that it wasn’t paid for, and that it would lead to bureacratic rationing; they stood by it. But now, they have swiftly “compromised” by introducing the idea of a “trigger.” So what is a trigger, and why are liberals suddenly embracing this language?

    What is a Trigger? A trigger is a legislative tool that would put in place automatic benchmarks that if not met, would immediately unleash the government-run system into the market. For example, if 95% of Americans as defined by the bill, don’t have adequate health coverage by a certain date, the public option would be “triggered.”

    Is a Legitimate Process? No. What a trigger does is hold off the tough decision until future, uncertain circumstances. The public option would essentially become law today, but not go into effect until an undetermined time when economic conditions could be even worse. It is a travesty of democracy because it allows legislators to vote for a plan now, but passes the blame for the catastrophic consequences onto their successors.

    How Would ’95%’ Be Determined? Whatever trigger number they come up with would be difficult to measure with any accuracy. What if a state hits the target by “covering” 99% of healthy people who rarely need a doctor (e.g. young adults) but leaves the same percentage of its sick population uncovered. Imagine the complicated rules that states would have to comply with to ascertain if they reached the target without fudging in this way. And imagine the gaming that would take place by governors who either want a public plan (who would then work to keep coverage below 95%) or who strongly don’t (who would then inflate coverage). So who decides if a state meets the target? A health panel? The health Czar in the House bill? President Obama?

    Is This the Best Result for States? No. Who is to say what is the best approach for each individual state. Let’s say a state with a high uninsured rate like Texas (27% uninsured today) makes tremendous progress in expanding coverage using innovative market-based approaches not favored by the Obama Administration, and reaches 90% coverage. Is the Health Czar going to pull the trigger anyway and tell the state to stop what it’s doing and create a public plan instead? So states like, Arizona, California, Florida, Louisiana, Mississippi, Nevada, Oklahoma and Texas would likely be forced to accept a public plan no matter how much progress they had made. Meanwhile the main House bill waives ERISA protections to allow states immediately to put into place single payer systems. Quite a stacked deck!

    Will a Public Plan be the Right Approach 5-10 Years From Now? Nobody knows, but most likely the answer is no. Triggering automatic imposition of the House public plan in 5 or 10 years, or whatever the time is before the trigger is pulled, means you lock in one view of the solution rather than anything learned in the meantime. Had Congress enacted a trigger to save Clintoncare, the trigger would have forced states to implement HMOs at exactly the time everyone was moving away from that overly rigid version of managed care. We don’t want to repeat that mistake.

    Is There a Precedent for This? No. Some claim that the proposed trigger is simply what Republicans used as a fallback in the 2003 Medicare drug legislation, in case private plans did not emerge. That is absolutely untrue. The legislation actually prohibited a “governmental entity” or public plan as the fallback, stating that every plan sponsor must be a “nongovernmental entity.”

    Who is Best Able to Fix the Problems With Health Care? The states. There is a good reason we have a federal system. It works. Encouraging states to experiment helped us fix the welfare system. If the federal government wants to push states to improve coverage it can set agreed targets with individual states. The states can propose ways of achieving those goals – including removal of bureaucratic and statutory rules that block innovation. If states don’t reach goals then trigger a new agreement with the state on how to improve progress, with the federal government helping to make it happen. Don’t trigger a 10-year old off-the-peg public plan and impose it on the state.

    Posted in Obamacare [slideshow_deploy]

    32 Responses to Why the "Trigger" is a Bad Idea

    1. Bill San Antonio TX says:

      If the legislators go back to Washington and allow any language that includes a "trigger" then they have misread the fury of the American People.

      Trigger will result in a government controlled health care system. It will not take much of an excuse to implement it. It is just another means for the leftists to obtain their centralized control.

      The two Senators from Maine already helped pass a non-stimulus package.

      Americans are begging them not to fall for this tactic and sign on!


      Address the 4-10 million American CITIZENS who may have long-term health care issues and REFORM it.

    2. gsmcneal.com says:


      Your definition of trigger, while technically correct misses the more important point:

      Generally, when triggers are pulled someone gets shot. The question is thus "Who will get shot when this trigger is pulled?"

      The answer I fear, is the American taxpayer.

    3. Bobbie Jay says:

      this government has time to go out of their way to create code words. trigger is entrapment. This is in defiance of the people and unethical. this out of control government continues their ignorance of the people. All these wasteful, costly expenditures of this government is hidden funding of redistribution.

      It's funny how the president couldn't answer one question saying it was above his pay scale, yet, he interferes everywhere he shouldn't be, now. He can't do his job without an increasing staff of unaccountables…czars.

    4. J.C. Hughes, Texas says:

      The demagogue majority already have their tightening pull on the trigger of a potential civil conflict. I never thought our country would fall for a nationalized socialist's agenda much like the one that took 1930s Europe by storm. Similar propaganda such as "Our grand plan will protect families and children" are all nice words that don't mean a damned thing. It simply masks a political power grab that's shameful to say the least. As I've said in early blogs, the whole topic of healthcare reform never did belong at the federal level. If any legislation is to be pursued, it should focus on blocking the U.S. Congress from ever tampering with social issues that rightfully belong to the individual states and are supported by the free market.

    5. Pingback: Trigger Mechanism Compromise On Health Care Public Option « Quipster

    6. Pingback: » Financial News Update – 09/04/09 NoisyRoom.net: Where liberty dwells, there is my country…

    7. Pingback: Health Care Trigger Mechanism Negative Effects Of New Presidential Bill « Quipster

    8. David, Texas says:

      The issue is much deeper than health care or 'triggers.' It is quickly becoming a Citizen vs. Government contest, with triggers and government mandates as the weapons of choice.

    9. Darleen Shriver says:

      Until you can come up with a plan that WE THE PEOPLE agree on,leave it alone.


      Leave the health care as it is. At least we have choices. If you put any of your health care reform's into motion, every person that is seriously ill will slip through the cracks and die….

      I am not working to help pay for a plan that I don't agree with at all. My tax $'s should go to something that will help me not harm me.

    10. Chris, Arkansas says:

      On a lighter note….those liberals who are against gun control are now embracing the "trigger". Let's make one stipulation of embracing the trigger is they all have to join the NRA

    11. I'm Eric, WhoRU says:

      Where, in the common law, in Reason, or in the Constitution, is there any authority for any kind of government paid health care?

      As I don't have any natural authority to make you pay for my health care and as you don't have any natural authority to make me pay for your health care and as no one else has any such authority; and as all government authority is purportedly obtained from us, by our delegation or our authority to the government, how can the government possibly have any proper authority to do that which none of us have authority to do??

      Any kind of government health care is, quite literally, a crime! I am 75 years old; I have no government health care nor Social Security nor other socialistic "benefits". The best way to take care of your health is to eat properly. Most of those I see around me in town, are overweight and sickly because they don't eat properly!

      Paying for health care through taxation is literally, a criminal act. "Taxation", the word, is nothing other than a euphemism for armed robbery!

      Think about it!

      Voting your neighbor's money out of his pocked is a crime!

      Voting is a criminal act!

      Stop complaining about who is going to get government benefits and start doing something to stop this armed robbery!

      My mother would most probably not approve of this message.

      I'm Eric, WhoRU??

    12. Denise, CO says:

      Return to block grant (fed. to state) funding? With computers, determine the block grant deposit for medical facility's billing dept. to pay out according to a 'needs scorecard'% of payment: 0% patient pays all – up to 100% for Am citizen patient need? (2000) Beginnings and Beyond, Gordon & Browne, p.61:.."Head Start is the 'leading health care system for low-income children in the country'(Greenburg,1990), providing health and medical screening, and treatment for thousands of youngsters."…so why rush reform?…is gov't helping?…enabling? What is the 12-step recovery plan for constitutional-fiscal soberiety?

    13. Bob, Portland, OR says:

      It is all just another example of their desparate attempt to have "central Control" over us.

      Who would have guessed that America's real threat was right here on our own soil. Not the Russians, Chineese or even the middle east, but right here under our noses.

      Pelosi, Watson, Rangle, Frank, Wyden, Boxer, Feinstein, etc all want a Utopian America where they are in charge of the Central Control, and it would be utopian…for them. For the rest of us it would mean, no 1st or 2nd amendments, no prosperity, limited health care, no chance of advancement or improvement in life, no goals, no hope… depression.

      Our only chance for improving our lives would be our individual ability to prove to our new "massus" that we are loyal servants to them.

      They have made a mistake in underestimating the resolve and intelligence of the American people.

    14. Cindy, Oregon says:

      The Public Option Debate – What You Need To Know

      Pitting Profits against Patients is economically unsound, unethical and a conflict of interest. When you think about this, it is outright ghastly. We are paying billions for Insurance Industry advertising, exorbitant salaries and billions more for them to lobby against us to increase their profits and remove competition. Without a non-profit government run public option, prices will not be lowered; it would accelerate the increase in % of GDP spent on health care. This will force tax increases to an unsustainable level, heavily subsidize profits for the Insurance Industry, bankrupt our country and the Democrats will be blamed.

      The top 10 rated countries have universal coverage, require non-profit health care whether it's public or private sector, and have sustainable % of GDP. Singapore, rated 6th, has the lowest % of GDP and requires public to compete with private.

      Because of profit driven Insurance we pay between $3-6000 more per person than any other industrialized country, we don't have universal coverage and we are rated 37th as a nation for our Health Care (just above Costa Rica). Free Market means the Insurance Industry pits patient care against profit margin. The less treatment you provide, the more money you make. The more people you refuse to cover because of pre-existing conditions, the larger the profit margin.

      The Insurance Industry launched a full force attack against the public option. Why do you think that they are fine with the co-ops, or privately run public option, but adamantly opposed to a government run public option? It's because it would cut into their profit margin. Stocks for the Insurance Industry soared at the idea the White House might be willing to substitute co-ops or privately a operated public option, because neither are viable competitors.

      Republicans Compare a government run public option to Medicare. They state the obvious, that Medicare is going bankrupt. Medicare is going bankrupt because it is used to hold money paid in over decades, then at 65 when seniors need the most expensive care, we pay the bills. A government run public option is absolutely nothing like this. The services would be the same, but it is exactly like a non-profit private insurance without the advertising, exorbitant salaries, and billions to lobby congress.

      Republicans argue that “Europeans” have higher unemployment; in the “double digits,” and their % of GDP is growing faster. This is patently false: the top 10 rated countries for health care have unemployment rates equal to, or less than ours. They spend between 3.6% and 11% of GDP on healthcare. We’re spending 17+% of GDP on healthcare this year. If we had universal coverage under our for-profit model, it would skyrocket the % of GDP spent, financially cripple our citizens, and bankrupt the nation.

      Republicans want Tort Reform, saying it is key to lowering costs. It does not lower cost to consumers. It benefits Insurance companies and doctors at the expense of the patient. Doctors pay less for malpractice insurance, but it also spares them from high consequences in cases of egregious malpractice. The worst part of Tort reform is that it increases the Insurance Industry's profits. If a health insurance company is sued for refusal of treatment, or tests requested by a doctor for their patient, they will literally have zero consequences. Suggested is a limit of $250,000 per patient. Patients lose, doctors and the Insurance Industry win.

      Republicans want competition across state lines. It sounds great in theory. The problem is it becomes "a rush to the bottom." Insurance Companies will move to states with the least regulations. You buy insurance thinking you’re covered, as your state requires, but it's not required in the state where the insurance company is located. Patients get less coverage, outrageous "out of pocket" expenses, but pay the same premiums; this increases the profits for insurance companies.

      The Blue Dogs are insisting on Co-ops. This was tried from 1930's -1940's and failed; funding was cut off. They do not affect Insurance Industry pricing (GAO study done March 2000). Co-ops that become actual competition (e.g. blue cross/blue shield) are bought up and run by the Insurance Industry to keep prices steady. They remain non-profit but do not affect % of GDP or price to the consumer.

      Nothing prevents the Insurance Industry from buying up, buying out, or even starting co-ops to prevent real competition. They can claim co-ops "work" without decreasing their profit margin or "triggering" a government run public option.

      Now President Obama and the Insurance Industry, along with the Blue Dogs, are talking about a “trigger” for a public option. This is not anymore viable than a co-op. It would succeed as private insurance, but would be like any other non-profit Insurance. All “profits” are used for expenditures, advertising, lobbying, outrageous salaries, etc. and written off. They do not lower prices because that would affect the profit margin for the entire industry. If Obama and the Blue dogs allow this, we're screwed!

      Senator Kennedy would never have compromised on both single payer and the government run public option. His integrity would never have allowed him to trade our health, financial stability and our nation's solvency in exchange for repubican votes.

      The Insurance Industry will protect their profit margin, and the profits to come, at all costs. Republicans need money in order to take back congress and win the presidency. They need the public option to fail.

      The republicans are out for blood, and it will be this way until Obama is defeated. Stop the "bipartisanship:" It only works if both parties are honestly working together. The republicans are not, and they will not. They are literally out to destroy Obama, and the Blue Dogs are cooperating

      These Members of Congress are more concerned about elections/re-election than our health and well-being. They are complicit in lies and dis/misinformation in order to deceive the public for political gain that will compromise our health, financial stability, and our nation's solvency.

      The fact that 45-53% believe all these lies is their responsibility and it is unconscionable. Members of Congress who lie, or constituents who believe and propagate those lies, must never be allowed to dominate. If they are truly concerned about their constituents and our nations solvency, then they will vote for real reform, even if it means losing their jobs.

    15. Fred says:


      You sound as if you work for the DNC using "talking points"

      Conservatives are continuously being criticized as not offering or supporting a healthcare plan in order to fix the current healthcare system. Nothing could be farther from the truth.

      Opponents of HR3200 have suggested several plans designed to rectify problems in our healthcare system. The majority of voters support fixes to the current health care program. What people oppose is the nationalization of our healthcare system and being wrongly criticized as being “un-American” for opposing proposed reforms.

      What I don’t understand is the need to discard our entire healthcare system and adopt a system that has failed in all other countries. What conservatives propose is not to turn the entire system upside down, but address the areas that need to be reformed. The following are proposals to address the problems before doing anything else and give these changes enough time to be effective. To discard the entire system when a few improvements will provide the reform that is needed is ludicrous.

      · Reduce fraud, waste, and inefficiencies in Medicare and Medicaid, a potential savings of over $100 billion.

      · Tort reform is a must, a saving of another $60 Billion. It would also reduce the costs of defensive medicine practiced by many physicians.

      · Change the tax code. Allow individual ownership of healthcare policies by giving individuals the same tax credits that companies now receive.

      · Allow the purchase of healthcare policies across state lines.

      · Expand medical savings accounts for individuals (HSAs).

      · Remove coverage for illegal aliens except for true emergency treatment.

      · Support Retail Health Clinics.

      · Provide vouchers for the Working poor and Chronically ill.

      · Proved wellness and preventive care programs.

      · Cover pre-existing conditions based a specific outline.

      · Eliminate and reduce costly government mandates and regulations, the bureaucratic governmental excessive paperwork, forms and special requirements decease health care and increase cost.

      · Move from a paper based to an electronic health care system with privacy being paramount.

      .Why can’t Cobra be indefinite instead of the 18 month limit? The insured pays for it and there is no cost to government.

      All of these specific points and more can be accomplished with a little common sense and bipartisan involvement instead of overhauling a system that works very well for the majority and is not “broken”. Contrary to what many say.

      The perception is that Congress isn’t serious about reforming the current healthcare system, but is more concerned about expanding control over the American citizens. How else can you explain a 1000 paged bill that is tailored after other failed programs?

      All of these measures and more can be done as improvements of the current system without turning everything over to the government. There is too much government in the system now and that is part of the current problem. So, adding more government will not be the solution. We cannot pay for a government run option! There is no more money!

    16. April, Colorado says:

      Thank you Cindy. I agree with you 100%!

    17. Phil, CO says:

      I see that Cindy has been drinking the Obama Coolaide! Orwell's 1984 is here; it's just a little late.

    18. Chuck, Greenville SC says:

      Clearly any bill with a trigger will set the requirements for private plans impossibly high, thus guaranteeing that the trigger gets pulled. A trigger is a 100% ruse to the public option which would quickly become the only mandatory option available.

    19. Richard, TX says:

      Let us hope that the American voter remembers all of this in 2010.

    20. Jeanne Stotler, wood says:

      The first part of the Constitution states : We hld these truths to be self evident that all men are created equal, that they are endowed by their creator with certain unalienable rights, among them there are life, Liberty and the pursuit of Happiness. That to secure these rights, Goverments are instituted among men, deriving their just Powers from the Consent of the Governed, that whenever ANY FORM OF GOVERMENTbecomes destuctive of these ends it is the right of the people to alter it or abolish it. Maybe we should all get a copy of the constitution and mail it one to our senators and another to our Rep., just to let them know THEY WORK FOR US.

    21. Jules Battlefield, M says:

      The quick answer to this debate is to not pass anything that this administration and congress puts forth as health care reform, or anything else for that matter.

      The real answer is to isolate and define the problem areas and fix them. Of course, that would not benefit the present adminstration in their grab for more power over the people in this country. It would solve the problem for the presently uninsured. Which is what this is supposedly all about. NOT.

      Cindy and April, quit drinking the koolaid.

    22. Ben C, Ann Arbor says:

      Cindy and April – how about you move to Canada or England for five years then get back to us and let us know how it is going. In the meantime I will continue my Blue Care Network (a non-profit by the way)for my employees and fight like heck to keep the governemnt out of my wallet. When I was in Denmark a few years ago giving a speach and learned their tax rate was about 90% for "cradle to grave" government programs I said "No thanks, I like controlling my own life."

    23. Brad S,, Detroit, MI says:

      At what point in time did the words "profit" and "business" become poisonous and villainous ?

      I don't care what business you are in – you have to make a profit or you go out of business. If you go out of business, you and all of your employees don't have jobs.

      I have a couple of neighbors that are pharmaceutical reps that talk directly to doctors and health care workers all of the time. One of their colleagues was a former British doctor. Over here, they can run their offices like a business. Yes, they have to deal with insurance companies, and the heavy hand of government regulation, but essentially, they have to perform a good job or they will lose patients to another competitor. The British doctor said that the medical treatment over there is satisfactory and abyssmally slow. Why ? Because they just don't care. Why would you ? The government is now setting your wages. Why try harder ? It's not like if you do a better job, you will reap the rewards. EXAMPLE -

      "Well, look at the time ! It's 5 o'clock – time to go home."

      "But doctor, there is 12 people in the waiting room."

      "Tell them to come back tomorrow. I have a tee time in 20 minutes."

      Government does NOT create competition. Unregulated free market capitalism does. I am not saying the insurance industry does not need some kicks in the pants – follow this link to a good analogy about problems with the whole idea of health insurance – (http://www.youtube.com/watch?v=RpvhHY2_t7k ) – but DO NOT ALLOW our government to run any type of "Public Option" or otherwise. That's like having the referees at the football game playing on the home team. Who do you think is gonna win that game ?

    24. Rev. Eleanor, upstat says:

      I very strongly object to being counted as one of those without health coverage! I DO NOT WANT ILLNESS CARE. Will this be forced on me? or a fine levied? Besides having to pay for others illness care as a tax payer. How can I make government LISTEN?

    25. Jerry from Chicago says:

      A government run, public health care option, whether implemented now, by majority vote, or later, as the result of some "trigger" mechanism leaves us in the same place.

      To Cindy and April I would say "you are well meaning, but naive". Please don't talk to me about what the rest of "the industrialized world" does for its citizens. If it was so damned much, the rest of the "industrialized world" wouldn't be desparately trying to gain entry into the U.S. by any means possible.

      There are those who argue that health care is a right for all who reside in the U.S. And while they cannot point to anything in the U.S. Constitution that says this, they still believe it is a basic human right. If indeed this is true, then other equally important questions need to be answered. Is there a basic human right to food, shelter and clothing? To heat in winter and cool in the summer? To an education? To the earnings of others.

      At what point do these "rights" of others take precendence over an individual's right to keep what he has?

      The arguement today over government run health care runs far deeper than just health care. It runs to the very core of human nature. As long as there is anyone left in this country with a dollar, someone else will have their hand out asking for it. And you can count on there being someone else standing there telling you how you owe it to them.

    26. Charles Moore says:

      Cindy, from Oregon has much chat, most of which is Obama-prattle,she accuses those who are against a Socialistic/Communistic approach as being brain dead.

    27. Carly, Denver says:

      okay Constitutionalists consider this: life, liberty and the pursuit of happiness. Could one not offer an argument for healthcare as a right to "life"? I think one could – and it wouldn't be that hard to argue. May not like it or agree with it, but one could definitely come up with a valid and sound argument – a damn good one. Also, this right to "life" via healthcare requirement could be an ammendment to the constitution. Personally, I don't believe in "messing" with the Constitution -it should be treated as a sacred document, yet there have been amendments (17 excluding the Bill of Rights I believe) to it. Why stop now? Is the Constitution not a "living document"?

    28. Lynn B. DeSpain says:

      There is, without a single doubt, no cure for everyone to have Heath Coverage that would be equal and fair and effective for everyone!

      Just as Robert Heinlien said in his book,"A Stanger In A Stage Land", The only cure for Hemophilia, is to let all the hemophiliacs die."

      This would and surely is the only outcome of an Universal Health Care in America, is the death of Health Care.

      We each need to ask of our own States,"Why, with over 1,400 Medical Insurance Companies available do you only allow the choice of ten or twelve?"

      We need to ask the Federal Congress, "In an emergency, real or not, bleeding or just a cold or flu, do not all hospitals have to treat patients whether they have insurance or not, as Federaly Mandated?" The answer is yes! This is the exact reason so many hospitals have had to close, is the treatmen of the uninsured of which the majority are Illegal Aliens, and those who could afford insurance, but choose not to.

      Our Constitution guarantees us the right of the pursuit of happiness, not the guarantee! This includes Medical Insurance! The Promotion of the general health and welfare is the 'Free' Emergency Care'.

      Let not the politicians confuse you, remember, they work for you, they have to explain things to you until YOU UNDERSTAND.


    29. Paul Terry Stone says:

      The Liberal majority in Congress holds on to the public option even though it has been clearly expressed that the public doesn't want it because most of Congress doesn't represent the citizens of this country any more This country has the trappings of a constitutional country but is not one.

    30. Pingback: Speaker Pelosi Is Right About the Trigger « Prayer, News & Action

    31. Pingback: No Matter What the Name – It is Still Big Government – from Illegal Alien to Health Care Issues « Lighthouse Patriot Journal

    32. Pingback: Morning Bell: No Matter What You Call It, It’s Still Just Government-Run Health Care | Conservative Principles Now

    Comments are subject to approval and moderation. We remind everyone that The Heritage Foundation promotes a civil society where ideas and debate flourish. Please be respectful of each other and the subjects of any criticism. While we may not always agree on policy, we should all agree that being appropriately informed is everyone's intention visiting this site. Profanity, lewdness, personal attacks, and other forms of incivility will not be tolerated. Please keep your thoughts brief and avoid ALL CAPS. While we respect your first amendment rights, we are obligated to our readers to maintain these standards. Thanks for joining the conversation.

    Big Government Is NOT the Answer

    Your tax dollars are being spent on programs that we really don't need.

    I Agree I Disagree ×

    Get Heritage In Your Inbox — FREE!

    Heritage Foundation e-mails keep you updated on the ongoing policy battles in Washington and around the country.