The following is an Atlantic Interview with Tennessee Sen. Lamar Alexander. Selected by GOP leaders to speak for their party at last week's health care summit, Alexander argues President Obama must "start over" on the issue, and:
- admits Republicans and Democrats "switched sides" on trusting the states to handle medical malpractice reform
- says if health care passes, "a campaign...to repeal it" will dominate the rest of the year
- refuses to repudiate any element of the Tea Party movement, including the John Birch Society.
BRIAN GOLDSMITH: Besides starting from scratch, is there anything the president could do on health care that would satisfy you and fellow Republicans?
BRIAN GOLDSMITH: But Warren Buffet also said he'd vote for the Senate bill over the status quo.
SEN. LAMAR ALEXANDER: He did, but I wouldn't. We need to start over and focus on costs. And we have suggested a number of steps repeatedly that we believe would be good first steps towards reducing health care costs such as allowing small businesses to pool their resources and getting rid of the lawsuits against doctors that drive up costs and allowing people to buy insurance across state lines.
BRIAN GOLDSMITH: Some economists say purchasing insurance across state lines could lead to a race to the bottom. In other words, the states with the lowest standards would get the most business.
SEN. LAMAR ALEXANDER: You could say that. As a former governor, I recognize that kind of talk because that's the kind of talk that you hear from people who've gone to Washington and think only they are ethical and knowledgeable and the governors and legislators aren't.
States compete in virtually every other area, whether they have the best universities, what their admissions standards are, what their labor laws are, what the quality of their roads is or incentives for other companies. And they ought to be allowed to compete in deciding what an affordable health care insurance premium is.
BRIAN GOLDSMITH: On medical malpractice, the Democrats would say as a good federalist, this is a states' issue. And the president does include incentives for states to experiment with different forms of malpractice limits.
SEN. LAMAR ALEXANDER: Well, the parties switched sides on medical malpractice, and suddenly the centralists become federalists and the federalists become centralists. I mean, I've watched in Tennessee where the trial lawyers have kept in place a situation which caused, in half our counties, pregnant women to have to drive to the big cities to get prenatal health care. I've come to the conclusion this is an area where the federal government needs to step in in order to get a result.
BRIAN GOLDSMITH: Isn't the president's health care proposal quite similar both to the Dole plan when President Clinton proposed health reform and to Governor Romney's plan in Massachusetts?
SEN. LAMAR ALEXANDER: Well, in the first place, the president hasn't proposed a bill yet. He has an eleven page memorandum on the web. We don't know what the bill is or how much it costs because the Congressional Budget Office says it doesn't have enough information to tell us. All we know is that it's primarily based upon the Senate bill that passed on Christmas but that it costs more and has more subsidies.
I don't know the details of the Romney and the earlier bill, but I do know the details of the Senate bill that passed on Christmas Eve. And the problems with it are it has a half a trillion dollars in new taxes and a half trillion dollars in Medicare cuts.
BRIAN GOLDSMITH: And of course the White House would say, we turn in the legislative language and the Republicans attack it for being 2,000 pages, and then we turn in an eleven page memo and they attack it for being too short.
SEN. LAMAR ALEXANDER: No, we're attacking them for two things. One is their specific proposals, which I just outlined, and second, their approach. The better approach is to focus on reducing costs and go step-by-step toward that goal.
BRIAN GOLDSMITH: Would you favor putting a ban on discrimination based on preexisting conditions in a bill?
SEN. LAMAR ALEXANDER: I would if I understood exactly how much it would cost and where the money would come from. One of the areas where Republicans and the president agreed on Thursday was there are a number of insurance reforms that we would like very much to see. They can be very expensive. And we want to make sure that we can afford them.
BRIAN GOLDSMITH: From 1981 to 2008, 16 of the 21 reconciliation bills that passed have been Republican bills. How would you respond to the criticism that whatever party is in power wants it, and whatever party is not in power hates it?
SEN. LAMAR ALEXANDER: Well, there's truth to that. Both parties have used it. But it's also true that most of the time it's been bipartisan. As Senator Byrd says, running health care through the Senate like a freight train is an outrage because it basically turns the Senate into the House, into a majoritarian institution.
If you can pass the bill that rewrites 17 percent of the economy by majority vote then you don't have one house where a consensus is required to protect the rights of the minority. The reason Lyndon Johnson wrote the civil rights bill in Everett Dirksen's office was after it was passed he didn't want the country to immediately try to repeal it, which is exactly what will happen if they try to jam this bill through with a bare partisan majority.
BRIAN GOLDSMITH: But major social changes have taken place with reconciliation--like welfare reform, like the Children's Health Insurance Program, like COBRA. And unlike the two Bush tax cuts, which passed through reconciliation, the Congressional Budget Office has scored health care as deficit neutral.
SEN. LAMAR ALEXANDER: Well, but my point was not so much reconciliation. It was the partisan nature of it. All those items you mentioned were bipartisan. And if people look at Washington and they see a controversial issue and they see one party jamming it through they're likely not to accept it. If they see both parties trying to make it work they're likely to accept it. That's the big difference here. It's the partisan power grab.
BRIAN GOLDSMITH: Democrats say they've already passed health care under normal procedures in the House and the Senate. They're just modifying it slightly via reconciliation.
SEN. LAMAR ALEXANDER: Well, they haven't finished their work on it. That's a clever argument. But here's what I hope Democratic House members consider. If they jam this through with a partisan vote after the American people have so clearly said, through polls and elections and public opinion surveys, "We don't want it," they'll be saying to American people, "We don't care what you think, here it is."
And I believe that on the day it passes, there'll be a campaign begun to repeal it which will dominate the rest of the year and which will define every single race for Congress in November despite the fact that the real issues for the country are jobs, terror, and debt. So I believe that it is a political kamikaze mission for the Democrats to jam it through in this way without bipartisan support.
BRIAN GOLDSMITH: Do you think that the current state of the economy is President Obama's fault?
SEN. LAMAR ALEXANDER: Hopefully the government is always small enough that the economy can survive despite what Washington does. I'm growing wary whether that's true as we keep having Washington takeovers of banks and student loans and car companies. But as time goes on, President Obama is going to have to stop blaming George Bush for every problem America has and start accepting responsibility himself.
BRIAN GOLDSMITH: Do you think that the Tea Party movement is playing as big a role in the Republican Party as the media portrays, and do you think that movement is good for the Republican Party?
SEN. LAMAR ALEXANDER: Well, I don't know about the first question, but the answer is yes to the second, because for any broad-based political party our job is to persuade at least half the people we're right if we want to be a governing party.
And I would rather be the party that captures the ferment of the moment than a party that's running against the ferment of the moment. And the ferment of the moment is symbolized by the Tea Party movement, which is saying too much spending, too much debt, too many Washington takeovers.
BRIAN GOLDSMITH: But I'd imagine you would repudiate some of the more extreme elements in the Tea Party movement like the John Birch Society.
SEN. LAMAR ALEXANDER: Where did you come up with that? The John Birch society still exists?
BRIAN GOLDSMITH: Evidently they do, and they were welcomed and helped sponsor the CPAC Conference.
SEN. LAMAR ALEXANDER: Maybe they do. Look, I don't go around endorsing organizations. I go around trying to persuade people that I'm right.
BRIAN GOLDSMITH: But do you think there are any elements inside the Tea Party movement--for example, the John Birch Society--that are beyond the pale, that are too extreme? Or would you embrace all of it?
SEN. LAMAR ALEXANDER: I really don't know how to answer a question like that. This is a big complex country. Those of us who are elected to office state our positions and attract support where we can find it. I don't go around announcing every day who I don't like and from whom I don't accept support.
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