updated 3/11/2010 11:21:44 AM ET 2010-03-11T16:21:44

MR. DAVID GREGORY:  This Sunday, healthcare reform's final act.

(Videotape)

PRES. BARACK OBAMA:  I do not know how this plays politically, but I know it's right.

(End videotape)

MR. GREGORY:  The president makes one last push...

(Videotape)

PRES. OBAMA:  The United States Congress owes the American people an up or down vote on health insurance reform.

(End videotape)

MR. GREGORY:  ...but will members of his own party provide the necessary votes?  This morning we discuss the politics, the policy, and the endgame with Secretary of Health and Human Services Kathleen Sebelius. Then, the political stakes in 2010 and beyond for the Obama presidency--health care, an ethics scandal hurting two prominent Democrats, plus the great recession's crippling toll, the jobless rate is unchanged for February and housing has yet to rebound.  Can Washington find a way to work together to do some good?  Joining us:  Senator Orrin Hatch, Republican of Utah; former congressman from Tennessee, Democrat Harold Ford; E.J. Dionne, columnist for The Washington Post; and Rich Lowry, editor of the National Review.

MR. DAVID GREGORY:  But first, the final push for healthcare reform.  And joining us live here this morning, the secretary of Health and Human Services, Kathleen Sebelius.

Welcome back to MEET THE PRESS.

SEC'Y KATHLEEN SEBELIUS:  Thank you.  Nice to be here.

MR. GREGORY:  Endgame time, the president talked about it in his remarks this week.  This is what he said.

(Videotape, Wednesday)

PRES. OBAMA:  Every idea has been put on the table.  Every argument has been made.  Everything there is to say about health care has been said, and just about everybody has said it.

(End videotape)

MR. GREGORY:  He said it with a smile, but he's making a serious point. This is really the end of the line for the debate.  And here are two facts:  Most people who have health insurance like what they have, and a majority of Americans oppose this president's version of healthcare
reform.  So how, realistically, do you get this done?

SEC'Y SEBELIUS:  Well, I think, David, what we're hearing from people across America is that even people who have insurance are terrified about what's going on in the marketplace.  They're opening their statements, they're seeing these incredible rate increases, if they're not protected by a large employer, going on across the country.  We just got a Goldman Sachs analyst who said that the market competition is decreasing in this country, that in the individual market, in the small group market where small employers are absolutely caught, they have no choice; and they are getting increasingly frustrated.  So I think we know what doing nothing looks like, and it looks pretty scary.  Fifteen thousand people a day lose their insurance, and some of those folks are being actually priced out of the marketplace.

MR. GREGORY:  But, and that's usually the basis for the president saying the American people don't want us to wait.  But where is the evidence of that? Certainly, we can all talk to people who don't like their situation, who are worried or are going through very difficult times.
But, again, a fact is that a majority of Americans, after everybody has said everything, as the president said, don't support this administration's version of reform.

SEC'Y SEBELIUS:  Well, I think if you say, "Do you want," you know, "some massive bill," that people are a little unclear about what's in it given the amount of misinformation.  They say, you know, "We don't know. We're, we're unsure." You say, "Do you want rules to change for insurance companies?  Do you want them to have to compete in the marketplace?  Do you want some oversight?  Do you want some consumer protection?" They say absolutely yes. "Do you want a different marketplace where people can have some choice and competition just like the members of Congress have?" Absolutely yes.

You know, I had a meeting last week with five of the largest insurance company CEOs, and we talked to them about what in the world is going on, how in the world does somebody like Ms. Canfield, who the president cited, who's paying $6,000 in premiums, she's paid $4,000 out of pocket, her premiums went up 25 percent last year.  The company, on her behalf--she's put $10,000 of her own money on the table.  The company paid out about $900 in bills, and she just got a rate increase of 40 percent.  How in the world does that work?  How does that math work? And, frankly, we didn't get very good answers from the insurance companies.

MR. GREGORY:  And you're pushing for more answers, for more transparency.

SEC'Y SEBELIUS:  You bet.  You bet.

MR. GREGORY:  Well, what do you hope to achieve out of that?

SEC'Y SEBELIUS:  Well, I think at the very least, the American public has to understand what is going on.  What are the justifications for rate increases which are so far ahead of medical trends?  How much are the companies collecting in overhead profits?  How much are they paying their CEOs?  And how much are they actually paying in medical trends?  The insurance execs said to me, you know, "It's all about costs, and we're just sort of passing along costs." But that's not what their profit statements say.  When profits go up 50 percent from '09 to--I mean, '08 to '09, when they file $12.7 billion worth of profits and then turn around and say, "We need 40 percent rate increases," 60 percent in Illinois, we need at least to shine a bright light until we pass health reform and change the rules.

MR. GREGORY:  Let me bring you back to the here and now. I've spoken recently to a top ally of the president on healthcare reform who thinks there's about a 40 percent chance, ultimately, of getting this done. Where do you put the odds?

SEC'Y SEBELIUS:  I think we'll have the votes to pass comprehensive health reform.  A bill has passed the House with a majority, a bipartisan majority. A bill has passed the Senate with a supermajority.  That's never been done before.  What we're talking about, as the president said, is finishing the job.  And the urgency, the timetable is not about some congressional time clock, it's about what's happening across this country to Americans.

MR. GREGORY:  Well, but...

SEC'Y SEBELIUS:  It's about the squeeze.

MR. GREGORY:  ...but this, this is Washington; it is about a time clock for Congress.  You have set deadlines before and they have slipped.  Is a new deadline, the Easter recess, if it's not done by that point, will the president return to it?

SEC'Y SEBELIUS:  I think that we have to act on behalf of the American people. I hear from folks all over this country.  I talked to a dad in Chicago whose son, 11-year-old, healthy, bright, came--coming back from a soccer tournament, but born with a heart defect.  He had an operation at a month old, an operation when he was three.  This father, who is self-employed, runs a small consulting company, is paying $30,000 a year in health insurance premiums and doesn't know what happens next, needs some control over his own health security, over his family's security.

MR. GREGORY:  Understood, point taken.  My question is, does this have to be accomplished by March 18th, by the, by the Easter recess if it's going to get done?

SEC'Y SEBELIUS:  I think the president has called for an up or down vote. I'm confident that we'll have that up or down vote, and I'm...

MR. GREGORY:  You won't set a deadline, though?

SEC'Y SEBELIUS:  I, I have not set a deadline.  That's really up to the leadership of Congress.

MR. GREGORY:  But if it's not passed by the April break, is it realistic that it ever comes back?

SEC'Y SEBELIUS:  Well, I think it's realistic because the American people are desperate for something to happen.

MR. GREGORY:  So the president would come back to it if it doesn't get done by the break?

SEC'Y SEBELIUS:  David, I think what's going on around the country argues for a...

MR. GREGORY:  But I'm just trying to pin you down.  I think this is an important point about when it gets done,

SEC'Y SEBELIUS:  Well...

MR. GREGORY:  ...because the legislative calendar does influence policy.

SEC'Y SEBELIUS:  Well--right.  But the time clock is not about, again, a congressional ticktock.  What Americans want is something to be done, that's what I hear.  You know, as a former governor, governors work on a very specific timetable, they have to pass budgets, the legislature goes out of, out of session.  We've got to get things moving because there's an urgency about what's happening in people's lives.  And we're at the final chapter here.

MR. GREGORY:  Right.

SEC'Y SEBELIUS:  We need an up or down vote.

MR. GREGORY:  Final stab--yes, no or maybe?  Do you get passage by the Easter break?

SEC'Y SEBELIUS:  I think we'll have the votes when the leadership decides it's time to call for the vote, and I think health reform will pass.

MR. GREGORY:  The issue of what's at stake here, it's very interesting, the president talked about that.  The New York Post reported this on Friday--I'll put it up on the screen.  "President Obama pushed wavering House members to OK health-care legislation for his own political
standing and for theirs.  ... `To maintain a strong presidency, we need to pass the bill,' Obama told liberals, according to" one Arizona representative who attended the meeting. This is very interesting, "to maintain a strong presidency." Elaborate on that.

SEC'Y SEBELIUS:  Well, again, I think the president has laid out comprehensive health reform as a primary agenda item not because he doesn't have good health choices or because it's easy politically, but because he feels it's fundamental to fixing the economy and it's fundamental in terms of jobs, small...

MR. GREGORY:  It's fundamental to having "a strong presidency" is what he's reported to have said.

SEC'Y SEBELIUS:  Well, I wasn't in that room.  What I can tell you what--is what he's said...

MR. GREGORY:  But you work with him closely.  Are the stakes that high? Is his agenda in peril if he doesn't get this?  Is that what's at stake?

SEC'Y SEBELIUS:  Well, I think what's in peril is health security for millions of Americans.  What's in peril is the fact that small business owners currently are having to choose between hiring another worker or two or having health insurance.  They're losing employees to folks down the street who have bargaining power.  We have folks absolutely caught in jobs that they hate. They are terrified about leaving their position.  We are--actually have a handicap in the economy because we haven't fixed this massive health insurance system, and we've got to tackle that.  And I think that's what the president understands.

MR. GREGORY:  Deadlines have come and gone.  This has gone on longer than the president wanted or expected.  Ground has been lost.  What mistakes did the administration make in laying out the strategy to get healthcare reform?

SEC'Y SEBELIUS:  Well, I think the president, from the outset, was very hopeful that we would have a broad bipartisan coalition.  It's why I think months were spent in the United States Senate with six senators in a room--three Republicans and three Democrats.  Lots of good Republican ideas are in the bill--help for small business, tax credits, selling insurance across state lines, aggressively going after fraud and abuse. Unfortunately, those good ideas still haven't produced Republican votes. But the president wants to take the best ideas from Republicans and Democrats.  He will continue to do that, and he hopes, at the end of the day, we'll have some Republican votes along the way.

MR. GREGORY:  But what missteps did the administration make?

SEC'Y SEBELIUS:  Well, I think that there's no question that having, you know, an issue like this on the table is complicated, it's difficult. And sometimes, I think people got lost in the, in the weeds, if you will. There's a lot of technical issues here.  When people understand what's
in a bill--a new insurance marketplace giving small business owners and individuals the same choices that members of Congress have, new rules for insurance companies--and, David, this is a fundamental difference between Republicans and Democrats, they really don't believe that insurance companies should have more consumer protections, more oversights, that it
should change the rules. And I think, at the end of the day, that may be the dividing line where Republicans will not vote for a bill that cracks down on insurance company abuses, changes the practices that people are...

MR. GREGORY:  You have--you had unified opposition from Republicans.  Did you also have a breakdown in the president's and the administration's communication to the American people about what the goal was and how you get there?

SEC'Y SEBELIUS:  Well, I think that there--when you have anything that's this comprehensive, there are always strategies along the way that focus on things. And we spent way too much time and energy talking about what's not in the bill, trying to tamp down some of the, you know, wild rumors, wild accusations.  And I think now we've circled back to saying to people
the bill is pretty simple at the end of the day, more focus on wellness and prevention, better choices for folks.  The same choices that members of Congress have in their own health plan should be given to the people who pay those bills, should be given to the American taxpayers, and change the rules for insurance companies, lower the deficit, not only short-term $100 billion, but long-term over $1 trillion.  This is something that changes those cost estimates, at the end of the day, that really are handicapping the country's economy from moving ahead.

MR. GREGORY:  In any rollout of a big sweeping policy proposal like this, you set goals you set priorities.  When you were last on the program in the summer, the first thing we talked about was the president's number one priority, and he laid it out last June.

(Videotape, June 23, 2009)

PRES. OBAMA:  What I've said is, our top priority has to be to control costs. controlling costs, that's not a bill I can support.  It's going to have to control costs.

(End videotape)

MR. GREGORY:  And yet Democrats I've talked to, Republicans for sure, outside experts have said, frankly, this bill fails to adequately control costs. Warren Buffett, the billionaire investor, somebody that the president said he would listen to, spoke about the fact that it fails to really
tackle costs adequately in the healthcare system.  He spoke on CNBC this week, listen to this.

(Videotape, Monday)

MR. WARREN BUFFETT:  And I would say that one way or another, we're going to attack costs, costs, costs.  Just like they talk about jobs, jobs, jobs in the economy.  It's costs, costs, costs on this side. That's a tough job.  ...  I would try to get a unified effort, say, "This is a national emergency to do something about this.  We need the Republicans, we need the Democrats.  We're going to cut off all the kinds of things like the 800,000 special people in Florida, or the `Cornhusker kickback,' as they called it, or `the Louisiana Purchase.' We're going, we're going to get rid of the nonsense. We're just going to focus on costs, and we're not going to dream up 2,000 pages of other things."

(End videotape)

MR. GREGORY:  Why not focus at this point with the outcome uncertain and say, you know, "We're just going to do a bill that focuses on reducing costs, and then we'll come back to the idea of expanding access at a, at a point later on when it's more politically feasible"?

SEC'Y SEBELIUS:  Well I think we definitely learned a lesson from what happened in Massachusetts from the bill that former Governor Romney signed into law, where they pushed access, but didn't deal with costs at the same time.  And so it's why the president has been insistent from the outset that this deal with costs.  Every cost-cutting idea that every health economist has brought to the table is in this bill.  Massive changes in the delivery system, ways to discourage the kind of Cadillac insurance plans being offered into the future, a fairness in terms of who's paying for healthcare costs, less spending in the Medicare system for things that we know don't add to people's health outcomes but were oversubsidizing insurance companies, really aggressively going after fraud and abuse, which is why the president directed the attorney general and me to, you know, put together strike task forces. Additional ideas
are in there.  Every idea is on the table.

MR. GREGORY:  But you, but you don't, you don't deal with tort reform, which the president has talked about more recently.

SEC'Y SEBELIUS:  Actually, we do deal with tort reform.  That's just not true. He moved ahead on tort reform early on, directing me to...

MR. GREGORY:  Pilot programs is what you supported.

SEC'Y SEBELIUS:  ...put money out.  Well, but states are in various stages.

MR. GREGORY:  Right.

SEC'Y SEBELIUS:  And many states, like my own state of Kansas, have already passed full tort reform; others haven't at all.  This is really a state-level situation...

MR. GREGORY:  But whether it comes to...

SEC'Y SEBELIUS:  ...where we want to see the best ideas that work.

MR. GREGORY:  ...malpractice reform, whether is comes to...

SEC'Y SEBELIUS:  Which is in the bill.

MR. GREGORY:  ...subsidizing volume, whether it comes to, you know, salaries for doctors and so forth, do you really assert—do you disagree with Warren Buffett that this adequately bends the cost curve?

SEC'Y SEBELIUS:  Well, according to the nonpartisan accounting Congressional Budget Office, they say we get a--over $100 billion in deficit saving the first 10 years, and that ramps up as you look in the outer years to $1 trillion.  I think that's real cost-cutting.  I think that's real change in the deficit over time.

MR. GREGORY:  But where are the cultural changes to how expensive end-of-life care is, or how many tests are ordered by doctors, or the administrative costs, be them in hospitals or insurance companies?

SEC'Y SEBELIUS:  That's, that's all in there.  It's all in there. There's a huge amount of administrative simplification.  Getting to that 30 cents of every dollar that's not paid, paying benefits but currently has docs filling out a gazillion forms, and has insurance companies
providing billing over and over again.  We've got huge delivery system changes so that you no longer would pay hospitals if--one out of every five patients gets re-admitted in 30 days.  You pay for bundled care, which is a coordination between docs and hospitals.  Pay for medical
homes, follow-up care.  We know that not only are those good for patients, but they're hugely cost effective.  They're in the best healthcare systems in America, and that's the direction this bill goes. And it pays for health and wellness for the first time, preventive care.

MR. GREGORY:  But it--but even--but, Secretary Sebelius, even experts, people who run the Cleveland Clinic, or the Mayo Clinic, who have really been on the vanguard of reducing costs...

SEC'Y SEBELIUS:  Yes.

MR. GREGORY:  ...they say there's only the potential for some of these things to pay off in terms of you getting away from subsidizing volume. So how can you assert with such certainty that this bill measures up to the president's goal of bending that cost curve, of bringing healthcare costs down?

SEC'Y SEBELIUS:  Well, one of the things that we do, again, is change the insurance rules on the private sector.  That will lower costs for families, lower costs for businesses.  Everybody says that just having a new insurance marketplace, getting rid of the cherry-picking, allowing
insurance companies to go back and forth, not only streamlines administrative costs, but lowers costs overall.  And we run two of the major public health systems, changing the way Medicare pays for medical care, that we pay for quality and not any longer by the number of tests that you do, will help also drive the private market.  We've got every strategy, every idea that health economists that experts say works is in this bill, including a lot of measures, David, which the Congressional Budget Office doesn't count for.  They say maybe health IT, you know, the use of electronic health records pays off.  We know it does. It's in the system, they don't give credit for that.  We know that investing in health and wellness works.  If you have fewer diabetics in 10 years, if you have fewer people who smoke, if you have fewer overweight and obese Americans, that's going to lower health costs.  No credit is given to that.  So we get, right now, $1 trillion over two decades in health savings without even giving credit to a number of the programs that work.

MR. GREGORY:  I want to, I want to go to just a couple of more issues. One has to do with how this gets paid for, and that is tax, an excise tax on these so-called "gold-plated" or "Cadillac" plans.  But in the Senate bill, that's been put off until 2018.  And the reasonable question comes up, which is, do you really think a future Congress, which will be under
a lot of pressure not to raise $1 trillion worth of taxes, is going to withstand that pressure?  Or are you going to be left where, you know, because this Congress won't raise the tax now, they're going to put it off till 2018, so you're going to have all this spending and not get any
of the savings until 2018?  Isn't that unrealistic?

SEC'Y SEBELIUS:  Well, I think two things happen right away with the way this is designed.  First of all, it puts insurance companies, who pay the tax ultimately, on notice that this is coming, and they can begin to change the kind of policies that are in the marketplace.  What we want to do is change insurance company behavior which hasn't been very strategic
in terms of cutting costs.  And, in fact, as the Goldman analyst said, "They are driving up costs.  They have a market strategy that they're willing to dump customers and continue to raise costs." So changing their behavior, putting them on notice that this is coming.  If a future
Congress decided that this wasn't a good idea, the way the rules work, they have to come up with billions of dollars in, in substitute payment. This is subject to the PAYGO bill.  They don't just get to cancel it and, and march down the road.  So I think it, it is a good balance between
getting a very effective cost strategy as part of this legislation and putting people on notice so that their policies don't change overnight. This isn't imposed overnight, but they know it's coming, and we've got to change the structure.

MR. GREGORY:  The issue of abortion is one that has 12 Democrats who voted yes for the bill in the House previously saying that they're going to vote no now.  Leading that charge is Bart Stupak.  He's from Michigan, an anti-abortion congressman who doesn't want any federal money paying for abortion.  And this is what he said about the current status of the bill.

(Videotape, Wednesday)

REP. BART STUPAK (D-MI):  ...in the Senate bill--and that's where they're telling us the vehicle we're using--in the Senate bill, it says you must offer insurance policies that will be paid for by the federal government that covers abortion.  You must do so.  Also in that same language, if
you come in the Senate version, in the OPM, Office of Personnel Management, policies they'll be putting forth, you must pay--every enrollee must pay $1 per month into a fund to help fund abortions.  It's very clear.

(End videotape)

MR. GREGORY:  Will you make the fix that he's talking about so that there's no federal money paying for abortions?

SEC'Y SEBELIUS:  Well, there is no federal money paying for abortions, and that's just not my statement, it is what, you know, a legal analyst who has looked at the Senate bill, it's what the fact checkers who, who look at the statements say.  I don't think there's any disagreement, and Bart Stupak and--Congressman Stupak and the president want health reform. He has been a strong member of Energy and Commerce.  He's worked on health reform issues over the years, and, and he supports the president's notion about this. Congressman Stupak and the president agree that there should be no federal funding for abortion.  And I think, at the end of the day, they...

MR. GREGORY:  But they don't--yeah, but they don't agree about how you're getting this.  So what, what needs to be done to take him--he used to be a yes vote, he's now a no vote.  How does he become a yes vote again?

SEC'Y SEBELIUS:  Well, I think people will continue to talk to him.  I think that, that there is no question in my mind...

MR. GREGORY:  Just to try to persuade him that he's wrong?

SEC'Y SEBELIUS:  Well, I think, I think there's no question that the Senate bill does not provide any federal funding for abortion.  But in--at the end of the day, I think that we'll get to the point that there's agreement that there's no federal funding on abortion.

MR. GREGORY:  So he's just misinformed?

SEC'Y SEBELIUS:  Well, I think he's misinformed about what the Senate language actually does.  But he wants comprehensive health reform.  I know that he has this principled issue.  The president said from the outset this is about health reform, it is not about abortion.  We don't want to change the status quo.  There are very clear rules that apply across the board on federal funding for abortion coverage, and that's what we'll have at the end of the day.

MR. GREGORY:  All right, we will leave it there.  Secretary Sebelius, thank you very much as always.

SEC'Y SEBELIUS:  Thank you.

MR. GREGORY:  Up next, the political stakes of this healthcare debate, plus ethics scandals plague some prominent Democrats, and the economy's still struggling.  How will it all impact the midterm elections and the future of the Obama presidency?  Our roundtable weighs in.  Senator Orrin Hatch, former Congressman Harold Ford Jr., E.J. Dionne of The Washington Post, and Rich Lowry of National Review, only on MEET THE PRESS.

(Announcements)

MR. GREGORY:  Our roundtable weighs in on the politics of healthcare reform, the 2010 midterms, and the Obama presidency right after this brief station break.

(Announcements)

MR. DAVID GREGORY:  We are back, joined now by The Washington Post's E.J. Dionne, Republican Senator Orrin Hatch of Utah, former Democratic Congressman Harold Ford Jr., and Rich Lowry of the National Review.

Welcome to all of you.

OK, Senator Hatch, you just heard Secretary Sebelius.  So what's going to happen here?  Don't just be partisan, be analytical.  Is this victory, defeat on health care or something in between?

SEN. ORRIN HATCH (R-UT):  Well, it may be, it may be any one of those three, and it depends on whether they continue to abuse the rules.  You know, the filibuster rule has, has been around since, really, the turn of the last century.  And one person could stop, could stop the whole Senate since 1806, and there were a lot of Founding Fathers who voted for that.
On the other hand, the, the reconciliation rule, which they are going to use--in fact, I...

MR. GREGORY:  Right.

SEN. HATCH:  ...just had this quote from Senator Durbin.  He said, "We will be testing some reconciliation rules and provisions that have never been tested before." And I think that's exactly what they're going to do...

MR. GREGORY:  All right.  You, you...

SEN. HATCH:  ...and it depends on whether they can pull it off.

MR. GREGORY:  We're going to get to...

SEN. HATCH:  Sure.

MR. GREGORY:  ...reconciliation and that debate in just a moment.

SEN. HATCH:  Sure.

MR. GREGORY:  But E.J., where are we?  Same question.  Is this victory, defeat, or is there something in between that the president achieves?

MR. E.J. DIONNE:  I don't think there's anything in between, and I do want to get back to this reconciliation argument.

MR. GREGORY:  Yeah, we will.  We will.  Promise.

MR. DIONNE:  But I think the bill is going to pass.  I think that the bill will pass partly for political reasons.  The Democrats have to prove
they can govern.

MR. GREGORY:  Mm-hmm.

MR. DIONNE:  And if they--this is the centerpiece of their agenda. They've been fighting for this for generations.  If they can't get it now, I think they will get absolutely clobbered in the election.  But they're also going to get it passed because what underlies this are two
things:  One, this bill provides coverage for 30 million people, and that's really important; but the second reason is lots of people with health insurance now are going to lose it if we don't do anything.  There was a report out of Wall Street last week that showed that insurance
companies are jacking up their rates because, in a lot of markets, there's no competition.  And they're willing to lose some people, drop people from coverage because they can make more profit with higher rates. If we don't lose--if we don't do something about this system, a lot of
employers won't be able to afford covering their employees anymore.

MR. GREGORY:  Harold Ford, you've been in Congress.  This is also a question of process, not just reconciliation, which again, we'll, we'll get to is that budget measure.  How do the no votes become yes votes in the House?  There were 39 no votes among House Democrats and there could be 11 more that become no over this abortion language, which you heard Secretary Sebelius suggest--address.  How do they get the votes?

FMR. REP. HAROLD FORD JR.  (D-TN):  Two ways.  First, you were--Democrats in the Senate were able to convince some Senate Republicans--Scott Brown, Voinovich, Kit Bond and few others--to vote in favor of a jobs bill that Senator Hatch and Senator Schumer played a key role in putting together. You've got to find those areas and those instances where you can bring people over.  I think E.J.'s points are well-taken.  The only challenges--I think if there are votes for reconciliation--I know we're going to come to this in a few minutes...

MR. GREGORY:  Yeah.

REP. FORD:  ...but if there were votes for reconciliation, it probably would have already been done.  So the question is whether or not, if there are not enough votes to pass by reconciliation, do you reach out to those Democrats or do you begin to reach out to some Republicans?  When LBJ and the Senate Republican Leader Everett Dirksen worked to pass civil
rights legislation, they worked together.  It may be that the president and the team now can find ways to bring a few Republicans over.  And if you have to vote with the reconciliation vote, wouldn't it be amazing if you lost a few Democrats but picked up a few Republicans?  It might make it easier...

MR. RICH LOWRY:  It would be amazing.  It would literally be amazing.

MR. GREGORY:  It would really...

REP. FORD:  It would make it...

SEN. HATCH:  How about a miracle?

REP. FORD:  But, but, but I don't, I don't, I don't put amazing, I don't put amazing out of reach.  Warren Buffett was on one of our sister networks, one of NBC's sister networks this week, and said, look, if plan A, meaning the status quo...

MR. GREGORY:  Right.

REP. FORD:  ...is what we would have to accept, he's not for that; if plan B is the only option, he would take it, which is the Senate bill. But really, a plan C is needed.  It might be that a plan C, which is a reconciliation approach, could be adopted if we found ways to win some
Republicans over, hold on to the core of Democrats, and pass a meaningful health reform here.

MR. GREGORY:  The problem for Democrats here, Rich, is what I said to Secretary Sebelius.  The president said it, "Everything's been said." We know everything we need to know about this.

MR. LOWRY:  Yeah.

MR. GREGORY:  The public opposes the reform writ large.

MR. LOWRY:  That's right.

MR. GREGORY:  And that is what they're dealing with, they have a massive reform bill.  They can't pick it apart just yet.  What happens?

MR. LOWRY:  So they, so they have to try to force it through just on sheer partisan muscle.  They're going to come down with the full force of the party and, and the president on every single one of these members. And Nancy Pelosi's going to channel Ataturk and his famous order of the battle of Gallipoli:  "I don't order you to attack, I order you to die." And Democrats, they seem to think that if they pass this they're going to put it behind him. They'll really put it right back in front of them again.  This will be a debate for years because this bill has serious
legitimacy problems.  It--the partisan nature of the votes, the rotten deals that have been part of the process, now reconciliation on part of that--on top of that, and then the sheer unpopularity of it.  And Tom Daschle said long ago, "Do this in a bipartisan way." And I think he
cited the example of Australia, where they had very narrow votes for healthcare reform, and then it was repealed and they went back and forth and back and forth again until they got some sort of consensus.

MR. GREGORY:  All right.  So let's get to this whole business of reconciliation, which budget reconciliation means you, you have a separate bill here that would only need a simple majority, that would just deal with some of the spending provisions of health care.

You two, Senator Hatch and E.J. Dionne, had some words about this on the pages of The Washington Post, and let me--Senator Hatch, let me put a portion of what you wrote about reconciliation on the screen:  "This use of reconciliation to jam through this legislation, against the will of the American people, would be unprecedented in scope.  And the havoc wrought would threaten our system of checks and balances, corrode the legislative process, degrade our system of government and damage the prospects of bipartisanship."

E.J., your response on the pages of the Post included this:  "I'm disappointed in Hatch, co-sponsor of two of my favorite bills in recent years.  One created the State Children's Health Insurance Program.  The other, signed last year by Obama, broadly expanded service opportunities. Hatch worked on both with his dear friend, the late Edward M.  Kennedy, after whom the service bill was named.

"It was Kennedy, you'll recall, who insisted that health care was a `fundamental right and not a privilege.' That's why it's not just legitimate to use reconciliation to complete the work on health reform. It would be immoral to do otherwise and thereby let a phony argument about process get in the way of health coverage for 30 million Americans." Discuss.

SEN. HATCH:  Well, Democrats--this is not a fight between Republicans and Democrats in a real sense, it's between Democrats and the people out there. Fifty-eight percent of the people are against this bill and very few are for it.  The fact of the matter is they're going to abuse the reconciliation rules.  And let me tell you, the reconciliation rules have never been used for such sweeping social legislation like this.  This is one-sixth of the American economy.  It's sweeping in, in effect. There--and, and, and there have been three sweeping social bull--not
sweeping, but social bills that have been approved through reconciliation.  One was, of course, the, the welfare reform. That had 78 positive votes, but--huge bipartisan vote.  Another one was the SCHIP bill, my bill with Senator Kennedy.  That had 85 votes.  The third one was college tuition, and that had, I think, something like 78 votes.  The fact of the matter is, is that it has never been done before, it's never been used before.  To do this is just very, very dangerous.  It's going to cause an awful lot of problems.  And in the end, in the end, you're
going to--and let's, let's look at one other thing.  The Senate bill was passed.  Now, E.J. seems to accept the fact that the House bill was passed, but they're two different bills.  Now they're going to take the Senate bill, they say.  But if they had the votes, it would already have
been voted on.  They don't have the votes.  So I suspect they're going to manipulate the rules even further in ways that were never contemplated in order to get this dog through...

MR. GREGORY:  E.J....

SEN. HATCH:  ...this 2,700-page — 2,711-page dog.

MR. DIONNE:  Where to begin?  First of all, I find it astonishing that so many Republicans who, when President Bush surged troops into Iraq against the polls, said, "This is a courageous act." And when President Obama tries to push a healthcare bill against the polls, "This is a terrible
thing." This is not a consistent argument.  Several points.  First, the health bill that with--President Obama will sign got 60 votes in the Senate, because that's the bill the House would pass.  The only thing that's being talked about here are amendments that would be passed
through reconciliation dealing with money, which is in the tradition of reconciliation.

Second, Senator Hatch keeps saying this is unprecedented in scope and
that, you know...

SEN. HATCH:  It is.

MR. DIONNE:  ...you need bipartisan support.  There's a big chart in New York Times today put together by Tom Mann of Brookings, Norm Ornstein, and their colleagues.  In the--there are seven instances where reconciliation was used in cases where the bill got less--fewer than 60
votes, five of those were done by Republican Senates.  And I didn't hear Senator Hatch complain about that. Two of those involved President Bush's tax cuts, which added $1.7 trillion to our deficit.

SEN. HATCH:  It never...

MR. DIONNE:  Now, if that isn't significant policy change, I don't know
what is.

SEN. HATCH:  And if ever...

MR. DIONNE:  And there was no complaint about that.  So is Senator Hatch saying it's OK to use reconciliation to pass tax cuts for the wealthy, but it's just terrible to use it if you're going to extend healthcare coverage?  I say let's not talk about a phony process argument, let's
talk about the problems people have with health care.  If he wants to argue about health care...

MR. GREGORY:  All right.  Quick response, Senator, and then let me get the others in on this.

SEN. HATCH:  In every case except two they were--they, they had bipartisan votes.  In two of them--in 1993, Clinton's bill, yeah, they got a reconciliation bill on a purely partisan vote that Congress changed to Republicans.  The Republicans did the same thing in I think it was
2005, got a bill through just on a totally partisan vote, and it changed to Democrats. The fact of the matter is you can't...

MR. DIONNE:  Are you talking about bipartisanship or you talking about reconciliation?

SEN. HATCH:  You can't--no, wait, wait, wait.  You can't...

MR. DIONNE:  These were reconciliation bills...

SEN. HATCH:  That was reconciliation.

MR. DIONNE:  ...that picked up one or two Democrats.

SEN. HATCH:  You cannot ignore the fact that we're talking about the first time in history, sweeping social legislation will be passed, if they get their way, by a totally partisan vote.  One-sixth of the American economy.  If we do that, Katy bar the door, I got to tell you.

MR. DIONNE:  If the Republican Party were not sitting there being obstructionist--what Senator Hatch is saying is, if Republicans unite and say, "We won't vote for this," and you need bipartisanship, he's saying Democrats can't govern.  And if $1.7 trillion...

SEN. HATCH:  Well, they can't.

MR. DIONNE:  ...in tax cuts isn't significant, I don't know what is.

MR. GREGORY:  All right, let, let me...

SEN. HATCH:  One very...

MR. GREGORY:  Hold on, hold on.

Rich Lowry, the question here is whether this, this amounts to petty politics on either side, depending upon your point of view, or whether this is a leadership issue.

MR. LOWRY:  Process arguments like this are always festivals of partisan hypocrisy.  No one is so concerned as--with protecting the rights of minority unless they're in the minority themselves.  And some of the same liberal pundits who are saying reconciliation was--is a great process were defending the filibuster up and down during the Bush years.  So I, I
think the most important thing to know here, they no longer have 60 votes in the Senate, so they have to do an end run around this process.  And if reconciliation isn't so important to this, fine, let's do a conference committee, let's work out the differences and have the House pass it and the Senate pass it.  They no longer can do this--do that because the bill was rejected by the public, as demonstrated in Massachusetts, which took away the 60 votes majority.  So they need the end, end run.

MR. GREGORY:  Harold, final, final point on this piece of it, which is doesn't the president have a bigger problem if he doesn't get the reform he's after than on taking a hit politically for the process?

REP. FORD:  You're right, results are more important than process.  The only ideology a majority of Americans are concerned about right now is the result. Two, reconciliation is a rule that can be used and invoked in the Senate.  If Democrats have the votes, they should move forward with it.  What Senator Hatch is saying is very simple, that if you do that you run the risk of political backlash.  When Democrats did it in '93--it actually was the right thing when Clinton passed that '93 budget, because it helped us grow. Republicans did it in 2005, and there are other examples.  There might be a political switch.  But what I hear E.J. saying is that that's a risk that they're going to have to take.

MR. GREGORY:  Right.

REP. FORD:  At the end of the day, the country could care less about all of this.  They want an answer.  And at the end of the day, jobs will decide this midterm election more than anything.

MR. GREGORY:  I--E.J., I'm going to take a break, and we're going to come back and talk about some of the political fallout.  But I want to ask a substantive point that I brought up with Secretary Sebelius.  Number one goal in healthcare reform was to bend the cost curve to bring down costs. The likes of Warren Buffett and others have said, "It's just not doing it.  They should have really done a cost issue first, expand access later." What's truth, what's fiction on this?

MR. DIONNE:  Look, there are a lot of measures in this bill to hold down costs.  Some of them are painful, which is why it's hard to assemble votes for this.  There will never be enough cost controls for everybody, and the more you put in the more votes you lose.  I think--the CBO says that--Congressional Budget Office, says that over time this bill will reduce the deficit.  That's the evidence we have, and you can postpone insuring--you know, providing insurance for the uninsured forever if you just say, "Well, we got to fix everything else and then we'll get all these people insurance." On Rich's point about process, I went back and looked at all the columns I wrote criticizing the Bush tax cuts.  I never made a process argument about reconciliation.  I argued about the merits of the tax cut, and I think instead of talking about process we ought to talk about the merits of the health plan.

MR. LOWRY:  But you really, you did, E.J., you did write a very stirring column about the nuclear option in defense of the Senate...

MR. DIONNE:  That was...(unintelligible).

MR. LOWRY:  ...as an anti, as an anti-majoritarian institution.

MR. DIONNE:  That has nothing to do with--I believe...

MR. LOWRY:  And look, just one last thing...

SEN. HATCH:  I've got it right here.

MR. LOWRY:  ...E.J., the point you're saying if Republicans are united, the Democrats can't govern, is what they're saying.  It would have been relatively easy--and Senator Hatch would be an expert on this because he worked so closely with Ted Kennedy on health issues--to get 65 or 70 votes for a major healthcare bill in the Senate.  Not this, but $100 [billion], $200 billion more for Medicaid, for SCHIP, maybe some version of this Plan B we've seen reporting about that the White House--after Massachusetts came up with a plan where they'd cover just 15 million people at a quarter of the cost.  You do something like that and you would have picked off five or 10 Republicans in the Senate, but they didn't want to do it.

MR. DIONNE:  Senator Baucus spent months holding hand--Senator Baucus spent months holding hands with Senator Bauc--with Senator Grassley and Senator Enzi and got nowhere.

SEN. HATCH:  I, I, I...

MR. GREGORY:  OK, quick final point then I'm going to take a break. Senator:

SEN. HATCH:  I was a member of the gang of seven.  He was so restricted by the Democrat process that he couldn't really do anything for Republicans. So I had to leave just out of honor because I couldn't--I'd walk out of there and, and trash everything they were doing, so I left
out of honor.  The other Republicans gradually left, too.  There has been no real effort to try and get together on all the things we can get together on.  It's just been "take it or leave it," and that's been their attitude.

MR. GREGORY:  All right, we're going to, we're going to leave, we're going to leave it there.  We're going to come back, talk more about the politics with our roundtable for 2010 after this brief station break. Don't go away.

(Announcements)

MR. GREGORY:  We are back to continue our roundtable discussion with a lively bunch this morning.

Harold Ford, a lot of headlines politically out of New York this week, and one had to do with you in that you decided not to take on Senator Gillibrand and challenge her, her Senate seat this fall.  And you wrote an op-ed on Tuesday explaining, and part of it I'll put up on the screen. "The cruel twist, of course, is that the party bosses who tried to intimidate me so that I wouldn't even think about funning against Senator Gillibrand ...  are the same people responsible for putting Democratic control of the Senate at risk." Talk about a shot across the bow.  What are you talking about?

REP. FORD:  My party needs to understand that there is growing, if not a crescendo of concern about jobs, taxes and the economy.  There's great concern even with 36,000 jobs being lost, which is far less last month than months before.  But there's a concern if the platform, the growth platform going forward that will create new jobs and provide economic security for families is not there.  I, I want everyone to have health care, but I can assure you as someone who has spent two months traveling a state that is vital to the nation's economy, I would argue the global economy in New York City and, of course, New York State, voters are more
concerned about their own checkbooks, their pocketbooks, and their wallets.  I hope whatever happens on health care that we get it done. And if the focus can shift to how America grows going forward, how we maintain our leadership position globally, and, more important, how you
give the next generation of Americans a chance to compete and win in a global economy.  That's being voiced and articulated

MR. GREGORY:  But...

REP. FORD:  ...all across the state and...

MR. GREGORY:  ...who are the party bosses who are endangering the majority in the Senate?

REP. FORD:  I think there's been a unilateral focus on one or two issues that, again, don't necessarily rank at the top of where a majority of New Yorkers, I'd say an overwhelming majority of New Yorkers what they're concerned about.  And second, David, this restoring faith in government is often used in political campaigns, but in New York, with the dysfunction at the state level, with the concerns, legitimate concerns about the governor's ability to govern, the concern that many in New York have even about members of Congress, and then when you couple that with a backdrop, which is a massive backdrop of what's happening here in Washington, as much as I appreciate the conversation here this morning, it's intellectual, it's informed, frankly it's the right kind of conversation, but for most Americans they tune it out.

MR. LOWRY:  Oh, stop, Harold.  You're just buttering us up.

REP. FORD:  They tune it out because it's all about, it's all about a process that they want to know how does this process result in better opportunities and a better security and a better future for me?  That's what's missing.

MR. GREGORY:  Could you have won the primary, do you think?

REP. FORD:  I believe we could have.  But it would have been such a personal and ugly one, I did not want to find myself in the position of helping a Republican to win a seat in New York, which, at the end of the day, could determine the majority makeup of the United States  Senate at  the end of the year.

MR. GREGORY:  But now that you, now that you won't challenge her, do you endorse Senator Gillibrand?  Will you campaign for her?  Are you 100 percent behind her?

REP. FORD:  There'll come a time when all those questions will have to be answered.  I've not been asked, I've not spoken with Senator Gillibrand, but I'm a Democrat, I'm an independent Democrat, as I shared at the bottom of the column that you, that you put up for the singular reason that I believe that when people give politicians jobs, it's a very special responsibility.  And if you don't take it seriously, which is one of the reasons why I think Governor Paterson has to think very seriously about whether or not he can govern, because if you cannot govern, the very special responsibility voters have bestowed upon you, if you can't live up to it, you should put it aside and move on and allow someone else to do it.

MR. GREGORY:  Should the governor step down?

REP. FORD:  If he can't govern, which I don't know how as I think about it, as I assess it, I don't know how you govern in this, in this, in this arrangement, or for that matter in this climate.  When you consider that not only the dysfunction, but the fact that the budget is due in less than a month, when you consider the fact that almost half the voters in the state believe he should step down, how do you govern in that kind of an environment? It's a question he'll have to answer.

MR. GREGORY:  Well, let's talk not just about Governor Paterson, who, of course, is the governor of New York, is facing a number of investigations on ethics issues and whether he intervened into a domestic dispute, you've also got Charlie Rangel, Rich Lowry, who stepped down as head of the Ways and Means Committed amid ethics probes and an admonishment from the Ethics Committee. And Eric Massa of New York will be stepping down as well because of an allegation that he harassed a male aide.  What does this mean in this midterm year for Democrats in an already difficult climate?

MR. LOWRY:  Well, it just adds fuel to the anti-Washington fire, obviously. And I agree with what Harold was saying.  The, the very worst thing for a politician or for a political party is to--the appearance that they're not listening.  And I think that's the risk now to Democrats on health care because they're going ahead no matter what, and I think it's the risk on the economy because they haven't really pivoted the jobs, as President Obama put it at the beginning of the year.  And on the ethics, you know, it's beginning to, to look a lot like 2006, and I think Nancy Pelosi, she came in talking about the most ethical Congress ever, but really didn't have any commitment to taking on the old bulls in her party, which have been very difficult.  There's the late John Murtha, who personified the unseemly practices around earmarks. And you have Charlie Rangel, who I think's just a very sad case of someone who, who thinks he deserved a lifestyle beyond his congressional income and began to cut corners.  So human nature is taking its revenge.

MR. GREGORY:  Well, we're talking about performance as well, among Democrats and the president.

And, Senator Hatch, the Republican National Committee, the finance director did a PowerPoint presentation to donors and the like, and I'll put it up on the screen, and this is what it included.  This was the imagery of how to run against the Democrats.  It had this, this offensive picture of the president and socialism, where he's the Joker from the film, and had other unflattering images of Democratic leaders.  Is this the way Republicans are going to get back into power?

SEN. HATCH:  There's no excuse for that type of stuff.  I, I just don't agree with that type of thing.  You know, I, I think if more Democrats were like Harold Ford, we wouldn't have half the problems that we have today.  They're open--he's open, he's willing to discuss, he's willing--he realizes it takes two parties on very, very important legislation to, to, to make things work. I don't agree with that type of stuff and some--the way I understand it, some junior guy there raising funds tried that as a fundraising tool, and...

MR. GREGORY:  I don't know how junior he was.  He was a finance
director.

SEN. HATCH:  Well...

MR. GREGORY:  Do you think Chairman Steele...

SEN. HATCH:  That's junior to me, but the fact of the matter is...

MR. GREGORY:  Right.

SEN. HATCH:  ...that it shouldn't have happened.  I don't want to condemn somebody, but the fact of the matter is that I'm, I'm ashamed of that.

MR. GREGORY:  Should Michael Steele, should he--should Michael Steele remain as head of the RNC when this kind of thing is going on?

SEN. HATCH:  I don't think Michael Steele knew about that.  If he did, I would be very concerned.  I like Michael Steele.  I think...

MR. GREGORY:  You have confidence in him?

SEN. HATCH:  I do.  I think he's a very fine guy.  Yeah, there--he's made mistakes like everybody does, but, but he's a good face for our party.  I think he's articulate, he's smart, he has a lot on the ball.  He's going to get criticized no matter what he does, but he was one of the first to come out and say that was, that was irresponsible.

MR. GREGORY:  E.J., healthcare reform, whether it's success or failure, what's it going to mean for the midterm race?

MR. DIONNE:  First of all, I think when Harold Ford goes back to Tennessee and runs for the Senate, he's going to use that endorsement from Senator Hatch.

REP. FORD:  E.J., I'll, I'll--when I run again, it'll be from New York,
which is where I live.

MR. DIONNE:  I think you've got a very powerful endorsement in Tennessee. Healthcare reform, I think, really is everything for the Democrats this year because I think...

REP. FORD:  I agree.

MR. DIONNE:  ...you've seen a year in which they--the country's discouraged by the economy.  Any--I think any president would be in trouble--Ronald Reagan was in trouble with this level of unemployment. And they had, it was very hard to get through this Congress.  And
that's why I think it will ultimately pass because they've got to show they can govern.  And my view also is once you have a health bill that does particular things, people can say, you know, there are no more rescissions. Immediately, your kids can stay on the family health insurance policy till they're 26.  There are a lot of specific things in here that people can go out to defend.  You can only defend a proposal once it's out there.  And I think it'll be a much better debate when we can argue about a real thing and say what's this doing for people. And
yes, Harold Ford's right, jobs is the issue.

MR. GREGORY:  Right.  Senator Hatch, I have 30 seconds.  I do want to mention Iraq because it's an important day where there's elections in Iraq.

SEN. HATCH:  Yes, sir.

MR. GREGORY:  There has been some violence, as we've seen--we see the aftermath pictures of that.  Still a very delicate democracy.

SEN. HATCH:  It is.

MR. GREGORY:  Do you think the United States should stick to its timetable for complete troop withdrawal?

SEN. HATCH:  Well, let's put it this way, I think there's more evidence that this is working, more evidence that they're now--they now have a government, more evidence they are interested in voting, more evidence that, that this country can survive.  And we ought to do everything in our power to make sure that continues.  And I'm for doing that, just making sure that continues. It's a real good thing for the Middle East, and I am very supportive of it.

MR. GREGORY:  All right.  We're going to leave it there.  Thank you, everyone here, for this lively discussion.  And we'll be right back.

(Announcements)

MR. DAVID GREGORY:  That's all for today.  I'll be away next Sunday, but Tom Brokaw will be here in my place.  Among his guests, former senior adviser to President Bush Karl Rove.  He's got the new book coming out called "Courage and Consequence" about his time as a conservative and his time in the White House.  Plus a political roundtable, including New York Times columnists David Brooks and Tom Friedman.  That's right here next week.

If it's Sunday, it's MEET THE PRESS.

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