The Public Option Compromises: An Interview With Sen. Tom Carper
Sen. Tom Carper (D-Del.) has emerged as a possible dealmaker on the public option. As one of the Finance Committee's moderates, he's trusted by centrists in the Democratic Caucus. But he also voted for Schumer's public plan. His idea is to free states to add in whatever competitors they choose: A public plan, a co-op or even an expansion of the benefits they offer to state employees. We talked earlier this afternoon, and he made a lot of "Better Than Ezra" jokes, and at least one "Better Than Tom" joke. An edited transcript -- jokes removed -- follows.
Tell me about your compromise plan.
As a recovering governor, I’m interested in finding what works. Finding results. I’m interested in what works to rein in the growth of health care costs and improves outcomes. I want to diminish budget deficits and extend coverage to those who want it. One of the best ideas that’s come along is the concept of the Health Insurance Exchange.
If a state opened an exchange and didn’t have much competition or affordability, that state would be able to take various steps to introduce competition and improve affordability. One approach that hasn’t gotten much attention is creating regional Exchanges. In states A and B, there might not be much competition and affordability suffers. But states C and D have vibrant competition. Under the concept we’re voting on, insurance sold in state C and D could be offered in states A and B.
Let’s say that still doesn’t do enough. What could a state do to meet the needs of its citizens? One is the option in the Finance Committee plan, which is to establish a cooperative. The federal government would help seed that cooperative. Another option would be for the state to open up their state employee benefits plan. Another option would be that the state would simply create a state-run option that would be offered on their Exchange, or maybe the regional Exchange, that would potentially deliver lower costs and more affordability.
Does this have a trigger?
Sen. Snowe is interested in a trigger and we need to be mindful of her ideas. At this point I wouldn’t rule that out, but I want to encourage her to continue to think outside the box.
You spoke earlier about the need to restrain deficits and cut the rate of spending growth. Yet you voted against Sen. Rockefeller’s public option, which would have done a lot more to slow spending. The CBO estimated that a public option tied to Medicare, which described Rockefeller’s, at least for the first few years, could save $110 billion over 10 years. Why oppose it?
Even if I thought it was the end-all be-all, we couldn’t get it enacted. There are no Republicans and a number of centrist Democrats on record opposing it. It’s a good idea, but it can’t be enacted.
Another concern with your plan is the options would be state-by-state rather than national. Doesn’t that move us in the wrong direction? Isn’t the problem that the system is too fragmented and diffuse?
That’s an argument to consider. But there’s something to be said for choice and letting them tailor it for some states rather than for others. What might work well for a state in the Northwest or the Midwest might not work that well in New York or New Jersey.
If you were governor of Delaware, what would you do with this policy?
I’d want to see what kind of competition we had in our state and how that competition affected affordability. That would be the first thing to determine. The second thing would be whether we could create interstate compacts with logical partners, like Pennsylvania. And after we’ve done that, to say here’s where we are, and make a determination on where to go from there.
So you’re not biased in any particular direction?
I’ve said in the past I’m almost agnostic on the public option. I’m not agnostic on the need for more competition and affordability.
You spoke earlier about the importance of the exchanges, and the need to open them up to competition. But they’re currently limited to smaller employers and individuals. Do you support Sen. Snowe and Wyden’s efforts to open them to all employers and workers, respectively?
I understand Wyden is getting a fair amount of pushback from some large employers and organized labor. I think moving in that direction is a good idea. But I’m not sure if we should start from that point.
Photo credit: By Harry Hamburg – Associated Press
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