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?