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Time to Make a Deal
A Conversation With Lindsey Graham, Dealmaker

Sunday, August 9, 2009

Sen. Lindsey Graham was the sole Republican on the

Senate Judiciary Committee to vote in favor of Sonia

Sotomayor. A few days later, he co-signed an op-ed in The Washington Post with six Senate Democrats and four other Senate Republicans that began, "We refuse to let partisanship kill health reform." If there's a deal to be made on health care, he'll probably be at the center of it. Graham (S.C.) spoke with The Post's Ezra Klein about reform, the pitfalls of

bipartisanship and the difference between buying a car and having a heart attack. Excerpts:

Is there a deal to be made here?

The bargain that will eventually be made is that Republicans will give in to the idea that every American should have coverage mandated, like car insurance. There's resistance to that because it runs counter to some of their doctrine. But Democrats need to understand that there won't be a public option anytime soon, if ever. Every big issue gets boiled down to one phrase. The public option in many ways has become to health care what "amnesty" was to immigration or "privatization" was to Social Security.

Why is the public plan the central fight in health-care reform?

My belief is that no private-sector entity can survive over a long period of time competing against the government. The public option will be written by politicians. It will be generous. Nobody in my business worries about the bottom line. Eventually the public option will dominate the marketplace because the political forces are different than the economic forces in the private sector. Eventually, the private sector will give way. We already have Medicaid and Medicare. The private sector covers the middle. If a public option becomes part of that mix, you'll have the whole deal covered by the government. That's why I'm against it.

If you could start from scratch, would you scrap Medicare?

No. Medicare was a safety net for those seniors who couldn't afford coverage. I buy into the idea of everyone having health coverage. You can have the public-private partnership in retirement. You can have a government-run system for those who are needy. But above that, it's best for the private sector to cover people. There's still a government role. The government helps people buy their health care in the private sector. To me, that's proper. I don't mind helping people be covered in retirement. We're not going to get rid of Medicare, and there's no reason to get rid of it.

It seems that day by day the negotiations in the Senate are becoming more poisonous. But it's hard to tell the people who are negotiating in good faith from those who are trying to delay the bill and hand the president a defeat.

You gotta flush them out. There's two ways to fix a hard problem in Washington: You make people afraid of opposing you, or you get them rewarded for helping you. There's no fear of opposing Obama's public option, and the reward is for opposing it. Right now, Republicans feel no political exposure from opposing the president's health-care initiative. Now, there are some people making a career out of saying no. But over time, they won't be able to sustain their position because health care needs to be reformed.

The compromises we've seen lately are a funny sort of bipartisanship. The deal that gets cut simply trims the ambitions of the legislation. Can health care escape that?

I think health care is so personal. The immigration problem is a complex problem, but people don't live with the consequences of it day in and day out like they do with health care. Climate change is more of a theoretical problem. But every year we fail to reform the health-care system is another year where neither the government nor the private sector can pay the bill. The growth rate of medical costs is unsustainable in the private and public sector, and that's why there will be a bipartisan solution eventually. The Republican and Democratic Party won't be able to say no forever without the public rebelling.

Where could a compromise make the bill more rather than less ambitious?

The number one thing you gotta remember is you can't look at health care as if nothing else has happened in the last seven months. We've had a downturn in the economy. We've spent a lot of money. The stimulus has been successfully attacked for being more government than jobs. Deficit politics are taking center stage in a way I've never seen. I think there's a consensus around three things right now: Health care is unsustainable as it is, and everybody deserves to have some coverage. We're spending enough already and should spend it wiser. And we're afraid of losing choice, and we don't want the government to come in and ration care. Those things have stuck on health care.

If the deficit politics are so powerful, where do you see an opportunity for cost savings?

The basic problem with health care is this: Have you ever asked a doctor how much it costs to get treatment? I haven't either. You ever gone to a hospital and asked how much they charge for surgery? But somehow we gotta get people believing that once you pay the deductible, it still matters how much money you spend. Third-party payment is unique to health care. It makes the consumer two or three steps removed from their purchase. Cost containment to me is trying to tie the consumer to the service. When I go to get a car, I can walk out of the dealership. But if I have a pulmonary embolism and am on a gurney, it's hard to comparison shop.

Can I be my own critic here? Lindsey Graham is wrong when he suggested a health-care purchase is the same as buying a car. I realize that. We have an entitlement mentality to health care that we don't have with a car. There is no belief in America that everyone deserves cable television. When someone says they don't have cable TV, I don't worry much. If they don't have health-care coverage, I do worry. We have to understand that a hybrid system has to be built around health care. Most Americans understand we're going to cover the poor and the elderly and the downtrodden. Every American family should have some form of coverage so they don't become bankrupt if it becomes sick.

Would you vote for the Wyden-Bennett bill if it came to the floor tomorrow?

Yes. There are a couple of things I'd like to see changed, if possible. But yes.

Why?

You know, this is not smart politics for Ron Wyden. He comes from [Oregon,] a very blue state. He's getting the crap kicked out of him. I wanted to jump on this bill like I wanted a hole in my head. But he is so persistent. He was willing to say to Bennett and me and others that he'll get off the public option. I wanted to help him. A guy like him is necessary. A guy like [Utah's Robert] Bennett is necessary. There's a comfort zone in politics where you just say no to the other side and it'll be okay. But the country is changing. Those who step out of that zone will be rewarded. We're a ways off yet, on immigration and health care and Social Security. But the day is coming when the people like Ron Wyden will be seen as the solution and not the problem.

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