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We've Seen These Triggers Before

Re-importation bills have been passed a few times now, each time with poison-pill trigger provisions. Each time, politicians publicly pretend this is some great victory and expect consumers to buy the charade.
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UPDATE: ABC News reports that corporate Democratic Senators are now formally demanding Obama embrace the trigger concept.

Many are asking how "triggers" - i.e., legislative language only allowing a public option under certain circumstances - suddenly became the major "compromise" position on health care reform. To some, it (quite oddly) seems like an inexplicable mystery - like the idea came out of nowhere. Somehow, lots of political observers have forgotten that - as I show in my new newspaper column out today - triggers are the template that the health care industry has long been using to destroy any kind of reform. And if there's any subset of Democratic congressional lawmakers who should know that, it is the progressives.

Recall the effort throughout the late 1990s and 2000s whereby a group of congressional progressives and maverick Republicans waged a battle against the pharmaceutical industry for a bill to allow the re-importation of prescription drugs from other industrialized nations. It was (and is) a commonsense proposal - other industrialized nations allow re-importation, and that re-importation helps lower prices by allowing consumers to buy FDA-approved medicines at the lowest world market price.

As with public option polls, polls on re-importation showed Americans strongly backed the concept. 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?").

This trigger provision, of course, made sure re-importation 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 re-importation of medicine.

Now, just a few years after the pharmaceutical industry used the trigger concept to engineer that profit-protecting victory for itself, the idea is being resurrected by the same health care industry lobbyists who destroyed re-importation.

The obvious lesson is that despite the rhetoric surrounding them, triggers have been proven to serve one purpose and one purpose only - to protect the interests of the health care status quo. That's not a fact - that's historical truth proven every time an American walks into a drugstore and is forced to pay the highest prices for medicines in the world.

What's amazing is that, knowing this history, anyone could think triggers are even good politics. Re-importation bills have been passed a few times now, each time with poison-pill trigger provisions. Each time, politicians publicly pretend this is some great victory and expect consumers to buy the charade. And then each time consumers walk into a drugstore and get gouged on medicine, thanks in part to the legislative poison pill, consumers find out they've been duped by those same politicians.

It's no stretch to think that this is exactly what will happen if overall health care reform is destroyed by triggers - only on a much bigger scale. If Congress passes a health care bill and trumpets a public option that is undermined by triggers, consumers are very quickly going to find out what really happened. When there is no public option because those triggers were (as they will inevitably be) written to make a public option impossible (just like they were written to make re-importation impossible), consumers will realize they've been treated like gullible fools, and not just on one part of health care reform (prescription drugs), but on all of it.

At that point, my bet is you'll see a kind of anger that makes today's Glenn Beck-inspired tea parties seem mild.

There is, certainly, one sliver of hope in all this, and it rests with leaders of the Progressive Caucus. Many of them were in Congress and invested a lot of time and energy in pushing the re-importation bill (and rightly so). Thus, many of them know firsthand that the trigger mechanism is designed only to destroy health care legislation, and not to accomplish some higher goal. So maybe, just maybe, they will take that firsthand knowledge and use it to strengthen their own resolve to stand against triggers and vote against any bill without a robust public option.

Read the whole column here.

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