An Interview With Tom Daschle

Tom Daschle was almost the Obama administration's health czar before tax problems foiled his nomination. But in the months since he withdrew from the White House, he's not abandoned health care. This week, he was back in the news: He released a proposal for reform that was co-signed by Bob Dole and Howard Baker, and reports emerged quoting him saying that the public plan option could be sacrificed for the good of health-care reform. Last night, we talked about his new plan, his support for the public option, and whether Democrats should use the reconciliation process. A lightly edited transcript follows.

Tell me a bit about the genesis of this proposal.

The whole idea with the Bipartisan Policy Center is for four former majority leaders to come together and see what common ground we can find on common issues. This was one of the biggest projects we've ever done.

A lot of people will look at it and say, well, that's a bit late, isn't it? Why didn't they come to an agreement back when they were serving together?

I think the answer is, first, we didn't all serve together. Bob Dole and George Mitchell and I worked together on this 15 years ago and failed. The question is what we learned. And what we laid out yesterday was the answer.

The realization first and foremost that universal coverage was a goal we have to embrace wasn't true 15 years ago. But the real issue is that the three major problems in health -- access, quality, and cost -- have gotten so much worse than 15 years ago. We all agree now that whatever we propose will be superior to the status quo.

Reading the final plan, it struck me as a pretty pure collision of philosophies. It's what would happen if some smart Republicans and smart Democrats locked themselves in a room and hammered this thing out. How different was the process from the one you experienced inside the Senate? How much, in other words, are electoral, partisan and interest-driven incentives a force versus simple philosophical beliefs?

Something happens within the legislative bodies that changes the chemistry between parties and among members. I wish I knew what it was completely. I think it's true almost across the board that I've gotten closer to every leader who I worked with actively since I left. Bob Dole, Trent Lott, Newt Gingrich. I only wish you could somehow create that camaraderie and trust and friendship that seems to come so much harder when you're in active, combative politics.

What do you think about these CBO scores we've been seeing? Things seem to be hitting some snags in the Senate.

That's only a partial score. I wish that would've been better understood. It was only a partial score because it was only a partial submission. But scoring will always be a problem. First, we're confined to 10 years, and so many of the savings come after 10 years. So we've arbitrarily made it more difficult. I could make a very good case on a 20-year score, but it's not the budget rule, so no one will accept it.

You can get to neutrality. It is doable. But all of it involves pain. Political pain and policy pain, but nonetheless, you can get there. It just won't be easy.

One thing that struck me in all of the CBO scores is that -- you mentioned pain a second ago. If you don't make hard, tough, and painful decisions about policy -- decisions that affect the center of the health-care system -- then your proposal is scored as too expensive. Which also makes passage hard and tough and painful, and forces the hard, tough, and painful decisions of cutting coverage. It's a rock and a hard place.

That's precisely right. That's the problem. It is a rock and a hard place.

You made headlines the other day for dismissing the need for a public plan. Want to talk a bit more on that?

I don't know where that came from. We've been pushing back on that all day. I didn't say that. I have said emphatically I support a public plan. A Medicare-for-all public plan. Any federal plan. For all the reasons that have been made for years. It's important for cost, for choice, for competition, for popularity. I strongly support it.

What I did say is that I'm willing to compromise on most things to bring the package across the line. The plan we agreed to yesterday was that states could offer public plans with a federal fall back. That's not my first, second, or third choice. But given the concessions my colleagues made on universal coverage and an employer mandate and everything else, that's the essence of compromise.

To focus on that for a moment, for all the controversy around this issue, I think a lot of liberals don't understand why they should have to sacrifice it. After all, private insurers aren't exactly covered in glory, and a Wall Street Journal poll just today showed that three-fourths of Americans support the policy.

This is one time when it makes good politics and good policy. There are two groups primarily opposed to it. Many of the stakeholders view it as real cost cutting. As a result, they're worried about that competition. A lot of other stakeholders are concerned about feeling the effects of a cost constraint. I've said this, and no one has ever disputed it, that I've never seen a study that didn't say the public plan would reduce costs. And we hear so much about costs, and here we are taking it off the table.

The other group is this ideological group of Republicans and conservatives who see it as government intrusion they simply can't support. It's an ideological basis that I will never understand but that that's what it is.

When we talked long ago, you were a proponent of using the reconciliation process for health reform. What do you think of that now?

I think it's still the only real fallback legislative strategy we've got. We're going to try and work this through the policy track as long as we can. I think that gives us until September. But if it fails by then, we move to the budget process.

I think Kent Conrad brings up practical reasons why it's not our first choice. But I would take the reconciliation process, even with its shortcomings, over no process at all.



Photo credit: Charles Dharapak -- Associated Press Photo.