Give Wolf Blitzer of CNN credit for a hard-hitting question in his interview yesterday with David Axelrod before Barack Obama’s speech to the joint session of Congress. In fact, Blitzer didn’t just ask Axelrod a tough question, he kept coming back to it when Axelrod proved incapable of answering it. The big $64 trillion question? If Obama wants competition in states where one insurer dominates, why not just allow insurers to sell policies across state lines? Er …. maybe because they don’t really want competition at all? (via Duane Patterson)

BLITZER: Including what they call the cooperative option, a series of health insurance cooperatives that wouldn’t be the public option, but would be some — something in between? Is that — is he going to get into a detail like that and say he likes that idea?

AXELROD: He will acknowledge the fact that — that there is that idea. There’s the idea of putting a trigger on the public option so that it goes into effect at some date when it’s clear that — that a market is uncompetitive. There are a number of ideas. But what is very important is that we have the kind of competition and choice that will help consumers. In many states in this country, there’s one insurer that dominates the entire market. In Alabama, one insured dominates 87 percent. In North Dakota, there’s one insurer that dominates…

BLITZER: So why not break down…

AXELROD: …the market almost completely.

BLITZER: Why not break down the state barriers and let all of these insurance companies compete nationally without having to simply focus in on a state by state basis?

AXELROD: Because we are trying to do this in a way that advances the — the interests of consumers without creating such disruption that it makes it difficult to to move forward.

BLITZER: Why would that be disruptive? If Blue Cross and Blue Shield or United Health Care or all of these big insurance companies, they don’t have to worry about just working in a state, they could just have the opportunity to compete in all 50 states?

AXELROD: But insurance is regulated at the — at this time, Wolf…

BLITZER: But you could change that. The president could propose…

AXELROD: …state by state.

BLITZER: The president could propose a law…

AXELROD: That is not…

BLITZER: …changing that.

AXELROD: That is not endemic to the kind of reforms that we’re proposing or that…

BLITZER: Why not?

AXELROD: …that…

BLITZER: Why not?

AXELROD: …we think — we’re proposing a package that we believe will bring that stability and security to people, it will help people get insurance, it will be — it will lower the costs and that can pass the Congress. And that has to be the test. We’re not into a symbolic expedition here. We’re trying to bring real relief to hardworking middle class people in this country. We believe the plan that we’ve outlined will do that.

BLITZER: Because I want to move on, but if the president wanted great competition — greater competition — he could say let’s change the law and let these health insurance companies compete nationally.

AXELROD: I’m not sure, Wolf, that that would — that that would end the debate that you asked me about in the first place. And, you know, I think that the idea that he’s proposal will promote that. Others have other ideas. But they are not central.

What’s central here is that we get fundamental insurance reforms that will protect people, put a cap on their out of pocket expenses if they have preexisting conditions, make sure they get insurance if they get sick, make sure they don’t get dropped off insurance and will a pool where people who can’t get insurance today — you know, if you don’t have insurance through your employer, it costs you three times as much to get insurance today. Most people can’t afford it. Most small — small businesses can’t afford to insure their employees. A lot of people won’t start a small business because they can’t leave their insurance.

Our plan would help cope with that.