Posted on February 9, 2010
Sen. Lamar Alexander: 'I don’t see how you can pare back the current bill'
Sen. Lamar Alexander (R-Tenn.) was a co-sponsor of the Wyden-Bennett bill. As recently as July, he said "we should support legislation like the Wyden-Bennett plan I’ve co-sponsored" rather than the health-care legislation before the Senate. So it caught my eye when he began attacking the very idea of comprehensive legislation. We spoke this afternoon about the Wyden-Bennett bill, whether the Senate can pass large pieces of legislation and why Democrats can't pare their bill back with Republican support. What follows is a transcript with light edits for clarity and grammar.
Let me read this quote back to you. You said, "It is arrogant to imagine that 100 senators are wise enough to reform comprehensively a health-care system that constitutes 17 percent of the world's largest economy and affects 300 million Americans of disparate backgrounds and circumstances." Yet you also co-sponsored the Wyden-Bennett health-care plan, which was a much more radical reform than anything the Senate is currently considering.
I made an entire speech on this subject. I’ve come to the conclusion that the Senate doesn’t do comprehensive well. Watching the immigration bill and cap-and-trade and health care all fall beneath their own weight, I’ve come to believe we need to go step by step. On health care, I think that means just doing cost.
Presumably, you still believe Wyden-Bennett is good legislation. It sounds to me like you’re saying that the Senate is simply too broken to take on bills of that magnitude, or even far less.
That’s partly right. I sponsored Wyden-Bennet. In fact, I sponsored it twice. What I was trying to do with Wyden-Bennett was encourage bipartisanship. I wanted a solution that broadened access but used the private market. The central idea in Wyden-Bennett was that you rearrange the tax benefits and instead of dumping more people into public programs, you bring them into private insurance. As a former governor who struggled with Medicaid, I liked the idea of dramatically cutting the number of people on Medicaid rather than putting more people into it. The bill was also simple: 168 pages long or so. I said I had reservations and wouldn’t vote for it in its present form, but I wanted to encourage it.
But yes, as I’ve watched the Senate, particularly over the past couple of years, I’ve watched immigration, which had some of the best people in both parties working as hard as they could, as it fell of its own weight. Cap-and-trade fell of its own weight. Health care looks to be falling under its own weight. So I thought back on my own experiences as governor where I made efforts which went step by step. And recently, I had legislation called "America Competes," and I asked for 10 steps that would help us keep our position in the world and they gave us 20 and we passed most of them. We’d be better off if we set a clear goal and took discrete steps towards that goal. We can accomplish more that way.
On the question of comprehensive versus incremental reform, the premise of Wyden-Bennett is that we need to solve this problem or it will overwhelm us. And I don’t know anyone who believes we can handle cost in a non-comprehensive fashion. I don’t disagree with the premise that the Senate is broken, but if you guys aren’t going to fix these problems, then who will?
That would be the conclusion that a lot of people will come to. The way professors and academicians and lawyers approach a problem is to try to rationalize large areas of society and come to a general conclusion. But most people don’t live and work that way. If your roof has a leak in it, you don’t have a comprehensive plan for a new house; you fix the leak.
In health care, Republicans have suggested six specific steps in legislative form that would reduce cost. You can have a small-business health plan without reforming the whole system. Another step would be allowing insurance to be purchased across state lines. Another would be some form of legislation on medical malpractice. You might think of pilot programs.
But with all due respect, those solutions, and I’ve looked at them, are miniscule in comparison to the size of the problem. The thing about fixing the hole in your roof is that you actually have to fix it. These would fix a small fraction of the whole and the water would still get in and eventually your house will be ruined. In the House, your colleague Paul Ryan has come out with a plan that does deal with the cost problem, but it’s enormous, and it’s radical. Wyden-Bennett also dealt with cost, but it too was big and radical. Both of these were more radical than what the Senate is proposing.
You make a good argument, but let’s come back to another example. In 2005, at the end of a budget hearing, I was so discouraged looking at the federal budget and thinking that all we’d be paying for were war and health care and Social Security and debt and we wouldn’t be investing in ourselves, that I walked down to the National Academies and asked if you can tell me the 10 things we could do to ensure America retains our competitiveness. And we did two-thirds of them. That succeeded. Republicans have four steps on clean energy. It’s not cap-and-trade, but it’s four steps.
That seems like a good example of the problem, though. The science says that we have greenhouse gases that are sitting in the atmosphere and warming the climate. That warming is having certain effects on the landscape that are accelerating the process. If you don’t bring emissions beneath a certain level, the process accelerates out of control, as the ice caps are melted and carbon sinks open up and all the rest of it. At some point, you either solve the problem or you don’t. How does your theory deal with something like global warming? It’s like the roof. If you don’t patch the hole, the house still gets ruined.
Well, the four steps that we suggest actually help us reach the Kyoto goals for the year 2030. Step 1 was double nuclear power production. Two is offshore exploration of natural gas. Three is make half our cars and trucks electric in 20 years. And finally doubling energy R&D spending to make solar costs competitive. By our computation, we’d actually get where we want to go.
I’ve not seen your computation. But that gets to the conceptual core of my question: You’re saying your plan is doing enough. But you’re also saying there are limits on how much the Senate can do. It’s certainly possible to believe that there’s a difference between what we need done and what we’re able to do.
It could be. But I think it’s more the nature of the country. If we were Belgium or Denmark, we could do comprehensive things all day long. But we’re 300 million people. Anything comprehensive doesn’t seem to work very well. Over 30 years in public life I’ve had more success when I’ve tackled problems step by step. I was glad to endorse Wyden-Bennett as a starting point, but I said I wouldn’t vote on it.
But you liked at least part of it. The Senate health-care bill seems like Wyden-Bennett on the margins. If you were willing to build on Wyden-Bennett, which is a comprehensive solution, why not theSenate plan? Are they so different in theory?
I think they are. One thing is you can’t be sure what’s in the Senate bill because it's 2,100 pages long. You just know there are surprises in it. Two, Wyden-Bennett largely eliminates Medicaid. It gives people money to go into the private sector instead. The Senate plan adds 18 million people to Medicaid. The Medicare cuts are a big difference.
Is there anything in the Senate bill you’d keep? If Democrats came to you and said, fine, let’s pare this back, what would you tell them?
I don’t see how you can pare back the current bill. First, you have to take out the Medicare funding. Second, you have to take out the Medicaid mandates, and that loses more funding. Then you need to put the doc fix in. I think it’s biting off more than you can chew. I think this whole thing is conceptual and philosophical. I think thinking a small group of people are smart enough to impose, by law, a top-to-bottom change, is too much.
But you thought Wyden-Bennett was a good starting point. I understand you wanted to change it. But that was much more radical, including getting rid of Medicaid. So how do you square that with your belief that small groups of legislators shouldn’t attempt to reform this sector?
The Wyden-Bennett bill was simpler, with fewer surprises, and more straightforward. I liked it because it was bipartisan. I wouldn’t have voted for it. But over the past two years, I’ve looked at all these issues and come to the conclusion that the policy skeptics are right. We don’t do comprehensive well in the Senate. It’s not because we don’t do our job well. It’s because we’re such a complicated country.