Video: Panel examines politics of health care

  1. Transcript of: Panel examines politics of health care

    MR. GREGORY: We are back and joined now by the governor of Massachusetts , Deval Patrick ; former Speaker of the House Newt Gingrich ; Mayor Mike Bloomberg of New York City , of course; and chief foreign affairs correspondent, our own Andrea Mitchell of NBC News .

    Happy new year to everybody. Happy holidays .

    GOV. DEVAL PATRICK (D-MA): Happy holidays to you.

    MS. ANDREA MITCHELL: And to you.

    MR. GREGORY: This is a special discussion, a chance to talk about America , the next decade, and where the country is, where we're headed. But let's talk about where we are right now, which is that this country , because of the Obama administration, is on the brink of achieving pretty sweeping healthcare reform .

    Governor Patrick , as an ally of this White House and a governor yourself, what do you think the president has achieved here?

    GOV. PATRICK: Well, you know, it's very familiar to us, because it's, it's very much framed around an experiment that we've had under way in Massachusetts now for three years. And there are 97.5 percent of our population now covered with affordable, accessible health care . We still have to get the cough -- cost curve bent, and we've started down that path with a payment reform, moving away from fee for service to fee for outcome, quality control and so forth. But I think this is huge, and I think it does reflect this notion that, that health is a public good and good for us as Americans .

    MR. GREGORY: Newt Gingrich , there's no Republican support...


    MR. GREGORY: ...for this healthcare reform .

    REP. GINGRICH: None.

    MR. GREGORY: Why not?

    REP. GINGRICH: And not much support in the country at large. Well, you've got $513 billion in tax increases, $470 billion in Medicare cuts. You have a scale of, I think, bribery in the Senate we have not seen in our lifetime, with various senators getting all sorts of special deals in a way that I think the public is just appalled by. I suspect every Republican running in '10 and again in '12 will run on an absolute pledge to repeal this bill. The bill -- most of the bill does not go into effect until '13 or '14, except on the tax increase side; and therefore, I think there won't be any great constituency for it. And I think it'll be a major campaign theme. This is a bad bill, written in a horrible way, and the most, the most corrupt legislation I've seen in my lifetime.

    MR. GREGORY: Andrea Mitchell , the, the politics of this are, are fascinating. You've heard from the window of Ted Kennedy , Senator Kennedy , Vicki Kennedy , saying this is a bill he would support. Thirty million Americans will be covered here. There will be major insurance reforms. And yet, as Speaker Gingrich points out, there are moderate Democrats who know they are going to be in a tough spot politically for supporting this bill when you get to a midterm election next year.

    MS. MITCHELL: I think the politics are going to be very, very tough for a lot of Democrats , because the benefits are down the road. No matter how it becomes compromised in the long run, the benefits will be 2013 , 2014 , most of the perceivable benefits. And the costs are up front. Now, I think that that, that the White House has to frame this as expansion of coverage, 31 million more Americans .

    MR. GREGORY: Mm-hmm.

    MS. MITCHELL: And eliminating those insurance burdens. The, the lack of access to insurance coverage for children with pre-existing conditions, that's what they have to focus on. But if you look in the nitty-gritty of this bill, the unintended consequences and the fact that no one can really guarantee those cost benefits. What the CBO has done in its projections is assume...

    MR. GREGORY: Congressional Budget Office , they sort of score all of this.

    MS. MITCHELL: Congressional Budget Office scored this by assuming...

    MR. GREGORY: Right.

    MS. MITCHELL: ...all of the improvements that are written into the bill. But those have to first be worked out in the real world .

    MR. GREGORY: Well, let, let's talk about the status quo , Mayor Bloomberg . Something you've thought a lot about is how much do we spend on individuals in this country for health care , and what's the result on the other side? What's life expectancy ? And let's just put these numbers up here, because they're pretty striking. The United States spends more than most other countries, by a whole lot, $7200-plus per individual. And yet, the life expectancy is 78, far younger than countries that spend far less per person.

    MAYOR MICHAEL BLOOMBERG (I): Well, we're unwilling to ask the question, what we're getting for our money? And I think both sides of that graph you just showed really talk about it. We are spending more than we can afford. We will go bankrupt if we keep increasing medical costs at the rate we've been doing it. And life expectancy , arguably the primary purpose of government is to increase life expectancy , and we are not doing that. Instead, we talk about other things, some laudable, some desperately that we have to do. And I will say, I've given the president a lot of credit for taking on the issue; but it's Congress that's writing this legislation, and they are not willing to go near the things that will contain costs , which is immigration reform , tort reform , asking the question of whether or not we can afford certain tests and whether they really are cost beneficial. And we are not willing to work on the preventive things, fighting obesity, smoking, those kinds of things, or crime in the streets, which is another big influence on our life expectancy . But we're just not willing to talk those tough issues.

    MR. GREGORY: Governor Patrick , what are the hard choices that government is going to have to make in order to really reform health care ?

    GOV. PATRICK: Yes.

    MR. GREGORY: Not just healthcare insurance.

    GOV. PATRICK: Right. Yeah.

    MR. GREGORY: Which is to say, to really bend that cost curve , which is really not anticipated here in the first 10 years of this new bill. We are going to cover so many more people, which, which a lot of people think is a moral responsibility of government.

    GOV. PATRICK: Yes. Yes.

    MR. GREGORY: But how do we actually make hard choices?

    GOV. PATRICK: Well, I think, I think the mayor is on to some of these points already. The chronic illnesses that, that are responsible for 70 or 80 percent of, of healthcare costs , and how the -- how health is managed, not just the management of health insurance . I think the whole question of fee for service, which is a tradition in our healthcare system for, for decades and decades, where we pay for the amount of service and those 15-minute visits rather than healthy outcomes and a medical home is a, I think, the jargon that's now being, now being used. There are issues around the number of tests, very sensitive choices that individuals and families, and expectations that we all have about our ability to get any test for anything in the best hospital in world -- in the world at any time we want.

    REP. GINGRICH: Here's the great tragedy. The greatest health systems in the United States are cheaper than bad health care . The fact is, the Mayo Clinic , in its cost restructure, or if you go to the, the Gundersen Lutheran Hospital in La Crosse , Wisconsin , which is a similar system, Marshfield Clinic , all in the upper Midwest , we know how to have better health outcomes at lower costs .

    MR. GREGORY: The, the...

    REP. GINGRICH: But, but by the way, it's a fundamentally different approach than just -- than this fighting over insurance and payment system .

    MAYOR BLOOMBERG: You know, if you really want to object to something in this bill, number one, I have asked congressperson after congressperson, not one can explain to me what's in the bill, even in the House version. Certainly not in the other version. And so for them to vote on a bill that they don't understand whatsoever, really, you got to question how -- what kind of government we have. Number two, when they talk about bending the curve, as, as the governor said, bending the curve is a flimflam euphemism for increasing costs , but we're going to say we'll do it at slightly lower rate than we would have otherwise.

    GOV. PATRICK: That's not what I'm talking about.

    MAYOR BLOOMBERG: I understand that. But they are not talking about reducing costs , they're talking about chancing the first derivative.

    MR. GREGORY: Slowing it, right.

    MAYOR BLOOMBERG: Slowing the growth down. And when you look at where the cost savings are going to be, well, they're going to cut something out of Medicare and Medicaid . Now, anybody that runs for office will tell you, you don't do that.

    MR. GREGORY: Right.

    MAYOR BLOOMBERG: I mean, the bottom line is it's so politically explosive, it really would be a first time in the history of the world if they ever cut anything out of either of those two programs.

    MR. GREGORY: But, you know, Speaker Gingrich , your old -- your one-time nemesis President Clinton says healthcare reform becomes more popular after it gets passed; and therefore, Republicans , by not being on board at all in this process, could face some real political trouble ahead.

    REP. GINGRICH: Look, I, I think the more important this is, as the mayor said, the country faces real trouble. The country is going to face deficits it can't sustain, debt it can't fund, an economy that's noncompetitive and, and I think -- I believe everything we're doing right now will be fundamentally revisited. But, but I, I want to emphasize what the mayor said, because it's so important. When you start writing 2,000-page bills, you guarantee that no elected official knows what's in the legislation. It is a fundamentally flawed way of running this country . It's flawed in both parties. And I think part of why you're seeing the tea party movement and other behavior is, is that people are just angry about an irresponsible government imposing change that no elected official can understand.

updated 12/28/2009 2:03:44 PM ET 2009-12-28T19:03:44

House Democrats aren't optimistic that a government insurance plan, a central element of health care legislation passed in their chamber, will survive negotiations with the Senate.

While insisting "it's not dead," Rep. Chris Van Hollen of Maryland said Sunday he recognizes realities in the Senate, where Democrats had to scrape up every vote from their side to pass a bill — even one without a government plan to compete in the private insurance marketplace.

"Before the House was to give up the public option, we would want to be persuaded that there are other mechanisms in whatever bill comes out that will keep down premiums," said Van Hollen. "We've got to make sure that the final product is affordable."

Rep. James Clyburn of South Carolina, the No. 3 Democrat in the House and one who had appealed to President Barack Obama not to yield on the public plan, set out conditions for yielding himself.

"We want a public option to do basically three things: Create more choice for insurers, create more competition for insurance companies, and to contain costs," Clyburn said. "So if we can come up with a process by which these three things can be done, then I'm all for it. Whether or not we label it a public option or not is of no consequence."

Sen. Robert Menendez, D-N.J., underscored the divisions Democrats will need to bridge when negotiators from the House and Senate meet next month to reconcile the two bills. He said there will need to be more give on the House side than the Senate, which took weeks to find the 60 votes needed for passage.

"If we are going to have a final law, it will look a lot more like the Senate version than the House version," Menendez asserted.

The Senate's Christmas Eve achievement brought the nation closer than it's been for generations to a new order in health insurance.

Video: Gibbs: Health bill will reduce deficit It would eventually require nearly all Americans to get coverage, help many pay for it and restrict onerous insurance company practices such as denying coverage to people with pre-existing sickness.

But nothing will change for anyone until the House and Senate can settle on common legislation, pass it and send it to Obama to sign.

The high stakes have both parties hoping they can find a few converts from the other side. Nearly every Republican in Congress has opposed the measures.

"If some of the Republicans would come forward with suggestions — offer a vote or two, or three or four — to take away the need to have every last one of the 60 Democrats, you'd have a much better bill in accordance with the tradition of the Congress, especially the Senate, on bipartisanship," said Democratic Sen. Arlen Specter of Pennsylvania, himself a party switcher.

Republican Sen. Jim DeMint of South Carolina voiced similar hope, to opposite ends: "a few Democrats to stand up in the House that maybe didn't before and help us stop this thing."

DeMint, Van Hollen, Menendez and Specter spoke on "Fox News Sunday." Clyburn was on CBS' "Face the Nation" and CNN's "State of the Union."

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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