Meet the Press Netcast   |  September 13, 2009

Durbin, Cornyn, Dean, Gingrich, roundtable

The Health Care Debate. The President has made his case to Congress. What's next? We have an exclusive debate: Assistant Majority Leader Sen. Dick Durbin (D-IL); Sen. John Cornyn (R-TX); Fmr. DNC Chairman Dr. Howard Dean; and Fmr. House Speaker Newt Gingrich (R-GA). Plus, insights and analysis on how the Obama administration is faring with its many political challenges with our roundtable: CNBC's Erin Burnett; author Joshua Cooper Ramo; and NBC's Chuck Todd

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MR. DAVID GREGORY: This Sunday: Has the president retaken control of the healthcare debate ?

PRES. BARACK OBAMA: The time for bickering is over. The time for games has passed.

MR. GREGORY: But Republicans aren't backing down.

Unidentified Man : This isn't the way that you get people to cooperate with you. You don't say that, "If you disagree with us, we're going to call you out."

MR. GREGORY: Is there room for compromise, or will this be a partisan bill? How will reform be paid for, and can it all be done this year? With us exclusively: Assistant Majority Leader, Democratic Senator Dick Durbin of Illinois ; Republican Senator John Cornyn of Texas ; former Democratic National Committee Chairman Dr . Howard Dean ; and former House Speaker , Republican Newt Gingrich .

Then, the loss of civility in Washington .

REP. JOE WILSON (R-SC): You lie!

MR. GREGORY: Is the political middle ground gone for good?

Plus, the economy . A year after the financial meltdown, why mounting job losses may be the biggest of all the challenges facing the White House . Insights from our roundtable: anchor of CNBC 's " Street Signs ," Erin Burnett ; Time magazine contributor, author Joshua Cooper Ramo ; and NBC 's political director and chief White House correspondent Chuck Todd .

But first, the debate on health care . Joining us, Senators John Cornyn and Dick Durbin and former House Speaker Newt Gingrich and former DNC chair Dr. Howard Dean .

Welcome to all of you. A lot to get to.

I want to start with you, Senator Durbin , and get right to it. In light of the president's speech this past Wednesday, what specifically will be achieved on health care this year?

SEN. DICK DURBIN (D-IL): I think we can pass healthcare reform . I really believe the American people are ready for it. We're closer to victory now than we have ever been. And I hope that we understand that failure to pass this healthcare reform this year will make things overwhelmingly worse. Those who are opposing us, those who are criticizing us really don't have an alternative. They would stay with the current situation, which leaves families with health insurance with the uncertainty of its cost and the uncertainty of whether coverage will be there when they need it, and millions of America with no protection at all whatsoever when it comes to healthcare insurance . We can do better. And I hope that the Republicans will join us. We've opened the doors to them in the HELP Committee in the Senate ; they had hearings that went on for hours and hours, and Chris Dodd chaired it. They accepted 161 Republican amendments. At the end of the day, more than half the amendments were from the Republican side, and still not a single Republican senator would vote for the bill.

MR. GREGORY: So...

SEN. DURBIN: We need their help, we'd like to have it.

MR. GREGORY: Are we talking about large-scale reform achievable this year?

SEN. DURBIN: Yes, I believe it is. We've got to understand that just taking small steps at this point won't stop the obvious increase in healthcare premiums, which are making it very difficult for individuals and families to pay for health insurance and a lot of businesses are dropping health insurance . And we also have to understand , the insurance industry is fighting this tooth and nail. They understand that real health insurance reform is going to make sure that they can't be denied coverage for pre-existing conditions, there won't be caps on the amount of money that can be spent in a lifetime, that health insurance companies won't abandon you when you need them the most. Those are the kind of reforms that Americans desperately need.

MR. GREGORY: And the White House is sending a not so subtle signal, the vice president saying on the "Today" program this week there will be a bill by Thanksgiving . Will the Senate , will the Congress meet that deadline?

SEN. DURBIN: I believe we can, and we hope that we'll have Republican support to do it. Despite the best efforts of Chris Dodd on the HELP Committee , as well as Max Baucus on the Finance Committee , only three Republican senators have really stepped up to this point. I hope that they will be with us, they'll work with the Finance Committee to pass a bill. But our doors are open. As the president said, anyone who'd like to step forward from the Republican side and help us write this bill in a constructive, positive way, we need their help.

MR. GREGORY: Senator Cornyn , is this a Democratic-only bill?

SEN. JOHN CORNYN (R-TX): Well, I hope not. Republicans would like to see healthcare reform to bring down the costs and make it more accessible to more people who currently don't have health insurance . But I would, I would respectfully suggest that the president's first got to convince members of his own party with this proposal. He's laid out what he called his plan during his speech before a joint session . No one has seen his plan, and what he described is not reflected in any of the bills that have been voted out of House or Senate committees so far. He has at least 13 senators, by my count, who disagree with him on the so-called public option or

government -run plan, and about 90 members of the House -- either Blue Dogs , the conservative Democrats , or liberals -- who disagree with what that bill should look like. We'd like to work with the president and Democrats to try to come up with a commonsense solution. I would suggest that this is a case where the 80/20 rule applies, that 80 percent of this we could probably agree with as long as people would agree to leave the 20 percent we can't agree with for another day.

MR. GREGORY: But, Senator , you're being a lot more diplomatic here this morning. You, you went much farther; you said the president played lip service to the idea of bringing Republicans on board.

SEN. CORNYN: I agree. I think that -- I think he has. Because when he's talked about let's deal with waste, fraud and abuse, something that Speaker Gingrich I know has worked on and I've introduced legislation to do, people want to see exactly what the savings can be from that before they agree to some big plan, a big expansion of government , unfunded mandates on the states through Medicaid expansion and huge cuts in Medicare , which is currently unsustainable.

MR. GREGORY: But, but, but you say only lip service . And the White House says, "Wait a minute, in this speech , in the president's plan he's giving a nod to malpractice reform , to tort reform , expanding insurance pools." That was Senator McCain 's idea during the campaign. The idea of capping a tax exemption on, on employer plans, fiscal triggers. You know, the White House says, "When do Republicans stop moving the goal post and say he's actually hit something here"?

SEN. CORNYN: It was a good speech . But he said -- he described what he called his plan, and so far we have not seen his plan. There's a difference between campaigning, giving a good speech , and actually governing. And I think we're seeing that disconnect here. Because the president needs to work with us to make hard decisions in order to solve the problem , not just give a speech .

MR. GREGORY: Do you concede, those are Republican ideas that he outlined in the speech ?

SEN. CORNYN: Those are good ideas. I'd like to see them reflected in legislation.

MR. GREGORY: OK. But you -- so -- and if they are, that's something you could vote for?

SEN. CORNYN: Well, I certainly would support those. I'd want to see the entire picture. I don't see how we can agree to cut $500 billion out of Medicare , which is currently scheduled to go insolvent by 2017 . I disagree we should raise taxes on small businesses that are a primary job- creating engine in our economy . So let's see what the whole package looks like. But those are good ideas.

MR. GREGORY: All right, let me bring in Gingrich and Dean here.

And, Dr. Dean, let me start with you. How is the president doing now leading this fight for healthcare reform ?

DR. HOWARD DEAN: I think that Democrats -- I think he did two things that he had to do. He showed he was a strong leader. And presidents, regardless of the issue, the American people

want to see a strong leader in the presidency. That's the most important thing. The second thing he did is he, he unified the Democrats . And he's going to have to have those. We're not -- at the most, we're going to get three Republican senators and probably no Republicans in the House to vote for this, so the Democrats have to be together.

MR. GREGORY: But can you say he's united Democrats yet? You've got about 10 to 12 moderate, more conservative Democrats who are saying, "We're not there yet."

DR. DEAN: Well, I don't think so. I mean, by my vote count, we got 51 votes in the Senate to pass healthcare reform with the public option . So, you know, we'll...

MR. GREGORY: Yeah. That'd be ramming it through. That would be a reconciliation strategy...

DR. DEAN: Look...

MR. GREGORY: ...and...

DR. DEAN: I -- you -- in this audience, I think we can talk about ramming stuff through. Newt 's been the speaker. Republicans and Democrats both rammed things through. The -- at, at the end of the day, the American people want a bill. And it's -- they're not going to care if it's reconciliation or if, if it's ramming it through. What they want is a decent bill that makes sense to them.

MR. GREGORY: All right, let me get an opening thought from you, Speaker Gingrich . You said this week the president had to make a decision: Show up as president or as a partisan. Who showed up?

FMR. REP. NEWT GINGRICH (R-GA): Well, I think he was about 80 percent president, about 20 percent partisan. I think the partisan parts didn't help him. I think what he did on Monday in giving the campaign speech didn't help him. But, but the big difference -- and I'm going to go back to what Senator Cornyn said. I can go through the president's speech and find a lot of things that I like. Then I go to the House Democratic bill and I don't find a single one of those things reflected in the legislation. Now, they, they literally had voted down efforts to make sure that health insurance only went to people who are legally in the United States . So they would have to go back and have very significant changes, which I think would split the Democratic caucus. And I think part of the reason you saw some, some real anger about the speech is he kept describing things that had been explicitly not put in the bill on the House side, and the House bill has no resemblance to the president's speech . Whether or not he can get Speaker Pelosi to agree to rewrite that bill I think is very doubtful. So I'm not convinced yet as president that he's capable of leading his own party.

DR. DEAN: I'm going to disagree with that, if I can, for just a second. First of all, it says in the bill that undocumented aliens can't get health insurance reform . What Newt 's talking about is something that said and they have to show proof or something of citizenship. We're, we're talking about small details here. The other thing is I'm going to strongly disagree with Senator Cornyn . This bill is remarkably helpful to small business . Small businesses less than 25 employees in the Senate bill don't have to have -- pay anything for health insurance ever again.

Less than half a million dollars in the House bill. And this is a -- Blue Dogs put this in. Payroll -- don't have to pay health insurance ever again. That's a huge boost for the people who create 80 percent of all the new jobs in America .

MR. GREGORY: All right.

DR. DEAN: And that's never talked about, and it ought to be talked about. This bill is a big boost for small businesses .

MR. GREGORY: All right, I want to, I want to get into some of the issues. But I want to ask Senator Durbin quickly here, on the vote count, do you have Senator Snowe ? Do you have 60 votes?

SEN. DURBIN: Listen, I'm not going to presume any Republican senators at this point. Senator Baucus is working with Senators Grassley and Enzi and Snowe and others. I spoke to him over the weekend. He's reaching out to other Republican senators. Some of them understand this is an historic opportunity. In terms of the Democratic side, we're going to work closely with our members, too. They have to be set aside that this bill is going to help them, help their states and help this nation. But the fact is we are not going to miss this opportunity. We invite the Republicans to join us for this historic opportunity. If they do not, we are still going to go forward.

MR. GREGORY: Let me ask you about a key policy provision here, what's gotten so much -- taken up so much oxygen in the room in this debate , and that is the public option , the idea of a government plan in these exchanges that would compete with private insurance plan. The president stood behind the idea of competition, keeping the insurance companies honest. But this is what he said about the public plan Wednesday night.

PRES. OBAMA: The public option is only a means to that end, and we should remain open to other ideas that accomplish our ultimate goal.

MR. GREGORY: Senator , that was an important statement. Is the public option now buried and gone?

SEN. DURBIN: No, it's not. I support the public option , but I also think the president stated it correctly. What we're looking for is real competition. Understand , the health insurance companies hate this public option , as Dale Bumpers used to say, like the devil hates holy water , Because it means that there's going to be a force in place there that is going to put in competition and keep costs under control . The so-called Lewin Group that's been quoted by many senators on the floor about how this is going to get out of control happens to be an organization that is owned by the United Healthcare Group , a health insurance company . So they've been discredited. The fact is that we understand that putting in a public option means that people will have a choice in markets where there are only a handful of private health insurance companies and people have nowhere to turn...

MR. GREGORY: But, Senator , it can't pass the Senate , can it?

SEN. DURBIN: ...they have to have an affordable choice.

MR. GREGORY: It can't pass the Senate .

SEN. DURBIN: Well, it -- I wouldn't go that far. I would say at this point that the House of Representatives includes a clear public option . I don't know what the Senate bill will look like coming out of the Finance and HELP Committee . But we've got to have -- at least be true to the principle the president said: Make sure there's competition for these private health insurance companies. These companies do not want the competition, but if we don't have it the prices will not come down.

MR. GREGORY: All right. But, Dr. Dean...

DR. DEAN: Yeah.

MR. GREGORY: ... White House officials I've spoken to have been very clear, saying that the left in the Democratic Party has overshot the runway here, overstating the importance of a public option . Did the president put it away?

DR. DEAN: I don't think so at all. I'm, I'm with Dick on this. Look, the president said yesterday that if you can find another way around it to control the insurance companies' costs , that would be fine. There's another way. There's two countries in Europe that have universal health care without -- and it's entirely run by insurance companies. But they treat the insurance companies like regulated utilities. If the insurance companies would prefer to be treated like regulated utilities, we'd drop the public option in a heartbeat.

SEN. CORNYN: Well, first of all, the president can't keep his promise that if you have what you like now that you can keep it with a public option or government -run option . It's not just the Lewin Group , it's also the Congressional Budget Office . They've said depending on the shape of the final plan, it could be eight to 10 million , it could be as many as 119 million according to the Lewin Group . Anyway, you cannot keep what you have if you like it now, so the president can't meet that promise. And secondly, I think our goal ought to be let's give the American people the same kind of choices that members of Congress have when it comes to buying health coverage . Right now there is no, there is no public plan for members of Congress . You get a choice between various insurance coverages that suit your family's needs and at a price that you want to buy it at. So I think that ought to be our goal. This whole ideological fixation on the public option is just that, it's not a practical solution to the problem . We're ready to work with practical solutions to cover people, to bring down the price, but not a government takeover.

MR. GREGORY: Speaker Gingrich , let me bring you here and let me just shift a little bit about the speech on Wednesday night, and that is the tone and the tenor of some of the opposition to this. Congressman Joe Wilson has gotten so much attention this week for his outburst this week calling the president a liar in the, in the House chamber. Does he galvanize Republican opposition or does he hurt the party's image?

FMR. REP. GINGRICH: I don't think either one. I think the -- you may remember that in 2005 Democrats booed President Bush when he proposed Social Security reform . And there were dozens of Democrats booing him. It didn't seem to be a very big issue that year. The fact is, the country 's looking at the speech and the country 's asking about the speech . And a good example is what Howard Dean just said. When you, when you say to me no small business under 25 employees will ever again have to buy -- pay for health insurance , I want to know who's going to pay for it . I mean, this country -- you're going to get to the economy later on. This country 's facing $9 trillion in increased deficits. The average American is thinking, you know, life doesn't work like this. You -- the idea that every small business in America is going to be able to somehow magically wave a wand and in perpetuity we're going to be given free health insurance ?

DR. DEAN: I didn't say free.

FMR. REP. GINGRICH: Well, then, where's the money coming from?

DR. DEAN: There's the -- the way, the way the bill works is a government subsidy, and then you go out and choose what kind of health insurance to...

FMR. REP. GINGRICH: So where does the government money come from? Who's going to give the government the money to give me? I have a, I have a couple small businesses , and my small businesses could easily meet this.

MR. GREGORY: Right.

FMR. REP. GINGRICH: As a small business owner, I'd love to have free health insurance .

DR. DEAN: It's not free.

FMR. REP. GINGRICH: Ah.

DR. DEAN: Employees have to pay something for it.

MR. GREGORY: All right. I want to get to deficit question, but I just want to finish up on Congressman Wilson . And I'll ask you, Senator , does he hurt the image of the GOP , or does he become the face of the opposition? You're helping to run the campaign for Senate Republicans next year. Where would you like to see him rank?

SEN. CORNYN: Well, there's a time and a place for everything, and that was not the time or the place for that kind of comment. But, you know, the Democrats have done a pretty consistent job of trying to demonize the people who show up at town halls, anyone who disagrees with their proposal. This is not the time to be demonizing anybody, calling anybody names on either side. This is a time to try to work together to solve a practical problem . And we stand ready to do that if the president will meet us halfway.

MR. GREGORY: Let's talk about the deficit . And the president made a very important pledge during this speech on Wednesday.

PRES. OBAMA: I will not sign it if it adds one dime to the deficit now or in the future. Period.

MR. GREGORY: Senator Durbin , a hard pledge to meet when you've got House legislation that already does that, it already breaks the deficit . It can't be paid for over 10 years, according to the CBO . Here's a Washington Post editorial this morning having to do with where are the details, does the math work:"When politicians start talking about paying for programs by cutting `waste and abuse,' you should get nervous. When they don't provide specifics -- and when the amounts under discussion are in the hundreds of billions of dollars -- you should get even more nervous." How does this get paid for without adding to the deficit ?

SEN. DURBIN: Members of Congress should take the president at his word, he will not sign a bill that adds to the deficit . He walked into the White House and inherited a $1 trillion-plus deficit from the Republican administration because they had fought a war in Iraq they didn't pay for, the gave tax breaks to the wealthy they didn't pay for and they had a prescription drug program under Medicare they didn't pay for. This president said that's over, and members of Congress should take that seriously. Now, I disagree with The Washington Post . The fact is, under Medicare now we are providing multibillion-dollar subsidies to health insurance companies for something called Medicare Advantage . The health insurance companies said to us, let us run Medicare . We can show you how the government 's not doing it efficiently, we can do it at a lower cost. Guess what, it's not at a lower cost. We are subsidizing private health insurance companies to provide the Medicare benefits that we can provide at a lower cost. That has to change. That subsidy has to end. That is the kind of savings that can come back into the system to help small businesses provide health insurance and help those with lower incomes pay their premiums in America .

MR. GREGORY: How does...

FMR. REP. GINGRICH: Well, first of all...

MR. GREGORY: Speaker Gingrich , how do you keep that pledge?

FMR. REP. GINGRICH: ...listen care -- first of all, listen carefully to what he just said. He just said to the senior citizens of America , "We're going to take hundreds of billions of dollars out of Medicare and we're going to divert it to people who aren't senior citizens ." Now, this is part of why you're seeing these town hall meetings . People who are on Medicare Advantage in rural America are getting a quality of health care they never got before. I just got an e-mail from somebody at the Gundersen Lutheran Clinic in La Crosse . They're on Medicare Advantage . They don't want to be forced to give this up. And it's interesting; the president says on the one hand, nobody has to give up anything. But by the way, if you're a senior citizen on Medicare Advantage , we're going to take a couple hundred billion dollars away from you. I think this, this section you showed of the president is an example of why we are in the kind of debate we're in right now. I don't believe most Americans believe it's possible to have the plan he wants and not see the deficit go up; unless he's going to propose, in the middle of the deepest recession since the Great Depression , massive tax increases which would further deepen the recession.

DR. DEAN: First of all, the money is not being taken away from senior citizens , it's being taken away from the insurance companies who are responsible for a lot of them problems in the first place. Second of all, it pains me deeply to see one of the great optimists, which is House Speaker Gingrich -- you are. I mean, we agree on a lot of stuff . And the great -- the thing we have in common is America can do anything. Every other democracy in the world has a healthcare system that covers everybody and we don't. Of course we can do this. How ridiculous.

MR. GREGORY: But, Dr. Dean, you have said, when you were running for president in 2004 , people have to understand that you got to pay for it .

DR. DEAN: That's right.

MR. GREGORY: If you want that coverage , you've got to pay for it .

DR. DEAN: And the president is paying for it...

MR. GREGORY: And how do you not raise taxes ?

DR. DEAN: And two-thirds of the money that's being -- when President Obama talks about taking $500 million out of Medicare , that's not taking $500 million -- billion dollars away from seniors. That's taking the waste that the Republicans have been talking about for years, the abuse that the Republicans have talked about for years, the stuff that the insurance companies are getting for profit over and above what their services are. They're -- two-thirds of this bill is paid for with savings. And if you don't think the savings are there, then how come we spend 17 percent of our gross national production on health care and, and the Canadians, the British, the French, all of whom insure everybody, spend about 10 percent? There is so much fat in this system , we can pay for it .

SEN. CORNYN: David , we've got to be honest about the cost, and so far we haven't heard the president be clear about the cost. The Senate Budget Committee estimates that the House bill will cost not $1 trillion, but $2.2 trillion. The HELP Committee bill, the Health , Education, Labor and Pensions Senate Committee bill is estimated to cost $2.2 trillion over a full 10-year budget window. We need to be honest about what the cost is, what the pay forwards are going to be in terms of tax increases, cuts into existing programs that are already very fragile and not, and not going to be solvent by 2017 , and then I think that's what is making people nervous. That's why people are speaking up and expressing...

DR. DEAN: Right.

SEN. CORNYN: ...their concerns.

MR. GREGORY: Well, Senator Durbin , look, you're in the Senate leadership . Can you say unequivocally that taxes will not have to go up in order to pay for a $900 billion healthcare reform plan?

SEN. DURBIN: Of course not. That's irresponsible. What the president said, if we're going to need new revenue, and some revenue will be needed, it'll come from those who can afford to pay. He's talked about tax increases for those making over $250,000 a year, a tax increase on health

insurance companies for certain policies they sell. I mean, those are, those are the realities of the situation.

And let me tell you, I've heard this song before from Mr. Gingrich and from others that we just can't do it, that America 's incapable of doing it. But Dr. Dean has it right. This is our chance. If we don't do it this time, we won't have a chance in my lifetime and the situation will get progressively worse. Let us face up to the reality and do this in a responsible way.

MR. GREGORY: Let me bring up another issue that I think has a lot of people worried. I've spoken to some people this week who, who asked me, they're trying to figure out the details of this plan, and they say, "Let me get this straight. So if I'm not old enough yet to afford Medicare , the president says I've got to buy health insurance . He's going to mandate that I buy health insurance . Maybe I've lost my job. And can I afford what it is he's suggesting? Can I afford to buy insurance if I'm mandated to do so?" The National Journal has this headline in an article that it had:"At What Price ? It's one thing to require everyone to have health insurance . It's quite another to make sure everyone can afford it."

Speaker Gingrich , is that a real concern here?

FMR. REP. GINGRICH: Sure. If you look at Massachusetts , they now have the most expensive health insurance in the United States . it was an interesting, noble experiment , and the fact is it's going to turn out to be very expensive. You know, James Carville had a sign in 1992 , "It's the economy , stupid." It was right in the middle of the Clinton campaign headquarters in Little Rock . This White House ought to put that sign up in the Oval Office . Everything they do should be designed to get this economy growing again, to create jobs again. And what they're doing is they're layering whole new layers of theoretical reform on an economy which is still decaying. And I think it's very dangerous. The reason small businesses aren't excited about this opportunity for free health care is that they've figured out who's going to pay the tax to pay for the free health care . It's the small business owner who's going to have his taxes or her taxes go up dramatically in order to pay for the government 's free health care .

MR. GREGORY: Well, and I want to say on this point, Dr. Dean, the point of it, if, if you're forced to buy insurance as a family...

DR. DEAN: Right.

MR. GREGORY: ...and you can't afford it, the government says, "OK, we're going to give you subsidies. We're going to pay for it for you."

DR. DEAN: Right.

MR. GREGORY: But in order to make the bill less expensive, you have to cap those subsidies. You can't do it for everybody.

DR. DEAN: Sure. Look...

MR. GREGORY: So there's still a lot of people who may not be able to afford it.

DR. DEAN: David , we have universal health insurance , essentially, in my state for everybody under 18 years old. The reason we -- the way we did that is that we didn't use, use a mandate. We used Medicaid as a substrate, raised the, the, the reimbursement to primary care physicians , got a, got a waiver, and we -- for 480 bucks you can pay for, you can pay a premium and every kid in your family'll be insured for under 300 percent of poverty. People over 300 percent don't get a subsidy. I think that's what's being talked about in the bill.

And let me just say one thing about Massachusetts , which was put in by a Republicans governor and a Democratic legislature. I think the jury is out. I agree with Newt , it is too expensive and it is a problem . But they're down to 2 1/2 percent uninsured. That's comparable to some of the European countries . It's an extraordinary achievement. So look, I think -- I actually argue that it's- -one of the reasons it's so expensive is because they didn't have a public option , and if they had, their costs would be under better control . That's my argument. I -- the speaker would probably disagree with that one. But it -- the fact is there are a lot of these state experiments that are going on, some of which are successful and some of which are problems. They're going to have to be changed around a little bit. And I think we can learn. We're going to have the exchange mechanism that they developed from Massachusetts in the big bill , and I think that was -- that is a good idea.

MR. GREGORY: But ultimately, Senator Durbin , to keep costs under control , can you achieve universal coverage ?

SEN. DURBIN: I think we can get close to it. And I also want to add here that there's a hardship deferment in the bills that are being considered for those who, in extraordinary circumstances, cannot have health insurance . And there's also a cap of 13 percent of your income that you would pay in premiums, and help for those who can't afford it. I mean, we're doing everything in our power to bring everyone under the tent. Because understand the current system ; the uninsured people today show up at the hospital sick, they are treated and their costs are passed on to the rest of us. The average family pays an additional $1,000 a year in premiums just to cover the uninsured. This notion that we...

MR. GREGORY: But, but, Senator , let's just be clear what we're talking about. If you're in your 50s and, and you can't qualify for the subsidies, under the Senate plan, the Baucus plan as it's called, the insurance companies can charge you, at that age, a higher premium than they would a younger person without insurance .

DR. DEAN: That's a big problem . That has to...

SEN. DURBIN: The Baucus plan...

MR. GREGORY: That's a big problem , you say, though.

DR. DEAN: Yeah. You cannot do that. They got to have -- you have to have community rating in this bill. We did it in our state 50 years ago.

SEN. DURBIN: But, but...

DR. DEAN: It works great.

MR. GREGORY: All right. But finish the point doctor -- Senator Durbin .

SEN. DURBIN: Well, I can just say that the Baucus plan is now being debated and goes back to Dr. Dean's point, the rating questions are critically important, gender questions and questions of age and whether or not you smoke. Those are important questions. But the bottom line is we've got to understand everybody has to accept the personal responsibility of health insurance . If you are opting out and saying, "I, I have to exercise my freedom here. I'm not going to have health insurance ," and then turn up sick, guess who pays for it? The government or other people who are insured. We've got to bring everyone in the system for their own good...

MR. GREGORY: Look...

SEN. DURBIN: ...and the good of everyone in this country .

MR. GREGORY: I've just got about a minute left. Senator Cornyn , let me turn you on the, on the question of politics, because it's a huge question in this fight. What are the consequences of doing nothing here for the Democrats , and what's the upside as you look down the road in the midterm elections for Republicans ?

SEN. CORNYN: I don't think doing nothing is an option . And indeed we've said -- I've said here today that we have probably 80 percent, whatever the number is, of things that we could probably do in terms of insurance reform and providing lower cost access to health care , providing coverage .

But I think Dr. Dean makes a good point. What works in Vermont , in a relatively homogeneous population, a small state , may not work in a big state like Texas with 24 million people, with a large number of people who are not American citizens who, who are living there and who would not be eligible for this plan according to the president. So one size fits all is part of the problem . And I think we ought to offer flexibility at the state level to have state -based insurance exchange, to let people buy and have the same choices that members of Congress have among private plans and not undermine the private insurance market and provide a pathway, ultimately, to a single payer system , which is my, my concern and, I think, borne out by some of the experts.

MR. GREGORY: Senator Durbin , the political consequences for Democrats if reform does not get through this year is what?

SEN. DURBIN: Listen, this president has committed to this issue like no other president before him. He said he'll spend every penny of his political capital to get this done. That's the kind of leadership that we need and that's a feeling we left with from the House chamber the other night after the speech . We're going to pass healthcare reform . We may not have another chance. We've got to seize this opportunity, otherwise we're going to have overwhelmingly negative results if we don't do it.

MR. GREGORY: Before you go, the other issue is Afghanistan that is dividing Democrats . Senator Levin was quoted as saying this in The New York Times : "The leading Senate Democrat on military matters [ Armed Services Committee Chairman Carl Levin ] said that he was against sending more American combat troops to Afghanistan until the United States speeded up the

training and equipping of more Afghan security forces ." Is there a split? Do you support sending more troops to Afghanistan ?

SEN. DURBIN: No, I don't. I agree with Senator Levin . And I think that the president is going through a re-evaluation with our new General McChrystal as the commander of the NATO forces. I think at this point sending additional troops would not be the right thing to do. I agree with Senator Levin .

MR. GREGORY: Has the president made a determination that is politically untenable to try to get Congress to approve sending more troops?

SEN. DURBIN: I can't say that. I will tell you the president has not asked for troops, at least not to my knowledge. At this point we should follow Senator Levin 's suggestion. Let's get it right on the ground, let the Afghans bring stability to their own country . Let's work with them to make that happen.

MR. GREGORY: All right, I'm going to let that be the last word. From health care to Afghanistan , thank you all very much.

And up next, the fight over healthcare reform rages on while the Obama administration also struggles to save the economy . Insights from our political roundtable: Erin Burnett , Joshua Cooper Ramo and Chuck Todd , only here on MEET THE PRESS .

MR. GREGORY: Inside the politics of health care and the economy after this brief commercial break .

MR. GREGORY: Welcome back. We are joined by CNBC 's Erin Burnett , NBC 's Chuck Todd and author and Time magazine contributor Joshua Cooper Ramo .

Welcome to all of you. Well, so much to get to here. First let's talk about the health care . Chuck Todd , the politics of this thing; is the president back in control of this debate ?

MR. CHUCK TODD: Well, I think he is in more control . He did unite the Democrats . I mean, that was the -- I think if he had -- the single most important thing he had to do with that speech on Wednesday was to get Democrats rallying behind him, and I think that he did accomplish. The most fascinating thing, and I go back to, to the roundtable, Senator John Cornyn , a member of the Republican leadership , he's not the first one over the last couple days to say this, but suddenly this new -- it's a new talking point about, "We agree on 80 percent of what the president said in there." We -- you just saw Speaker Gingrich said a very similar thing. So it's as if the Republicans have decided, OK, they made their point, they obstructed, you know, or whatever you want to call it, over, over August, now they have to shift gears a little bit and look like they're -- they want to work with them. The question is, you know, is there really a middle ground ? Is that a real thing, or is this a political tactic because Republicans themselves realize you can't just be against

something, you got to show some give here. And it is interesting to see the shift in the tone among Republicans ...

MR. GREGORY: Right.

MR. TODD: ...at least in leadership .

MR. GREGORY: Well -- and in fact, Cornyn saying that there were good ideas that the president supported, he conceded those were Republican ideas, but he doesn't yet see them in the legislation. That's what he's waiting for.

MR. TODD: Right.

MR. GREGORY: Now, whether he's ready to sign on and vote for that, that may be a, a bit of a stretch.

MR. TODD: But just to see that rhetorical shift tells you...

MR. GREGORY: Right.

MR. TODD: ...that they know that it's not good politics just to be the party of no. You can't do that.

MR. GREGORY: Well, let's -- you're talking about organizing Democrats or rallying Democrats . What about the Republicans here? Because one of the big headlines out of all this was Congressman Joe Wilson calling the president a liar. He did apologize once the leadership made him do it. And yet he released this Web video in, in concert with the fact that he's raised a million bucks for his campaign. And this is what he said in that video.

REP. WILSON: This occurred after a month of town hall meetings and deeply emotional conversations I had with constituents who are as passionate as I am about this issue, who fear a government takeover of health care will reduce the quality of care and increase the cost of coverage . On these issues I will not be muzzled. I will speak up and speak loudly against this risky plan.

MR. GREGORY: And he is not the only one. Look at the streets of Washington , D.C. , yesterday, a huge crowd of protesters protesting the president's healthcare plan, other government policies. They see this as the expansion of government under President Obama .

Also, people carrying signs, Erin Burnett , saying "You lie." I mean, there is some...

MS. ERIN BURNETT: Uh-huh.

MR. GREGORY: ...grassroots organization and rallying behind not only Congressman Wilson , but this opposition as well. The Republicans are still united on this front.

MS. BURNETT: Mm-hmm. It certainly seems that way. I would say from the business perspective, though, you know, Newt Gingrich said they need to focus on the economy and getting jobs. And I think it is fair to say health care is central to that, and getting it done is crucial. You know, 58 percent of small businesses said they didn't give raises last year because healthcare costs were going up so much. You look at some of the numbers for big companies, and they're actually saying 30 percent of them are going to lay people off to pay for health care .

MR. GREGORY: Hm.

MS. BURNETT: This comes on a week we found out incomes are back to levels they were in 1997 . Health care is central to the economic debate , so getting something done is crucial. And maybe the step you're talking about, that the Republicans are starting to say they're going to get something done, moves us in the direction of getting something.

MR. GREGORY: Does Wilson galvanize Republicans ?

MR. TODD: Boy, I think he did. And it's hard to imagine that his apology was real now...

MR. GREGORY: Yeah.

MR. TODD: ...when you start looking at what he did: the Web video .

MS. BURNETT: Mm-hmm.

MR. TODD: The fact that he's, you know, "I will not be muzzled." The fact that he would not go down to the well, well of the House floor and apologize. So looks like Democrat -- it's interesting, he's almost going to call the bluff of the House Democratic leadership who said, "We are going to introduce a resolution." They introduced a new rule, a disapproval, and that's censure or not, these other things, but whatever. Clearly, though, Wilson has decided he's going to grab onto this, you know, excitement that is there among about 10, 10 to 15 percent of the Republican base. The question is, how does the Republican leadership balance keeping the, sort of the anger on the right? We saw this with the Democrats when their -- when the anger was on the left. But figure out how to channel the anger on the right into something that's productive, so that it's not...

MR. GREGORY: Joshua Cooper Ramo , the big question about reform is what's the nitty-gritty here? And the president had this response when he talked about some of the areas of disagreement on Wednesday.

PRES. OBAMA: And while there remain some significant details to be ironed out, I believe...

MR. GREGORY: That was the understatement of the night. Washington Post on Friday:"Details Still Lacking on Obama Proposal . White House Unclear How Some Far-Reaching Goals Would Be Met ."

MR. JOSHUA COOPER RAMO: It's the big challenge for the president in terms of leadership right now, which is he's sketched this very ambitious, broad outline, he's got to stick in these details. But it's vital that he get this thing passed. So this is the challenge for him: He's got to find a way to reach compromise that allows him to still look like he's leading. It's not simply a matter of winning here, it's how he wins. It's how he comes out of this that's important.

MR. GREGORY: And, you know, broad outlines. Yes, the president provided a road map , Chuck , but there are crucial details. I mean, you heard some of it on this idea of, of the mandate, you know, how you subsidize people to keep the costs down. Ultimately, as one White House adviser said to me this week, everything in this debate is about cost.

MR. TODD: Well, the only good news for the White House , I think, is as the details are being ironed out, in a sense, the rest of this month they have an opportunity to take the focus off of health care . And they actually need that. They need to turn the spotlight -- I know we're going to talk later about the economy . Well, this is economy week as far as the White House is concerned. You know, I heard Gingrich -- Speaker Gingrich say, you know, the White House should have a sign up. Well, you know what, Rahm Emanuel does says that to -- he yells at a lot of reporters and say, "No, we're not focused on health care , we are focused on the economy every day," because they do know ultimately they're going to be judged on that. I think taking the spotlight off of health care this week, when it comes to the economy , next week when he's at the U.N. General Assembly and all this stuff ...

MR. GREGORY: Mm-hmm.

MR. TODD: ...actually gives some breathing space to Congress to start working on some of these details. And if that's the case, if that happens, that probably pushes the ball farther down the road than if we were all...

MR. GREGORY: Right.

MR. TODD: ...on top of them every second.

MS. BURNETT: You know -- yeah.

MR. GREGORY: And, and, Erin , it's, it's about the economy , it's about paying for healthcare reform , as I just said.

MS. BURNETT: Mm-hmm.

MR. GREGORY: You had a town hall meeting at CNBC this week with the Treasury Secretary Tim Geithner , and the question of taxes came up front and center. Let's watch a portion of that.

SEC'Y TIM GEITHNER: So as you heard from the president last night, we're going to do healthcare reform without adding a cent, a dollar to our future deficits. And we're going to make sure we do it in a way that helps bring down the growth in the long-term healthcare costs so that our long-term deficits are lower. It's going to be a hard thing for us to do.

MS. BURNETT: Will taxes go up?

SEC'Y GEITHNER: I, I want to, I, I want to do it -- let's do it -- let me, let me do it this way. I want to do this carefully.

MS. BURNETT: As long as you answer the question, then you can do it anyway you'd like.

MR. GREGORY: Talk, talk about the squirm, Erin Burnett .

MS. BURNETT: I know. It was a moment.

MR. GREGORY: Did, did he answer the question?

MS. BURNETT: He, he tried to not answer the question, and in doing so I think he actually did. What he did was come out and say, "We cut taxes for 95 percent of Americans in the stimulus bill, and the burden of tax increases, if they come, should be on the remainder; i.e., the top 5 percent. It is clear taxes are going up, and I think the question is when? Maybe Chuck has a better sense of timing. But what I hear from economists on Wall Street is, yes, they're going up. Maybe they can get through the midterm elections , but probably not all the way through a full re- election cycle. So that's where this is going to come through. I mean, if you look at the deficit and you taxed everyone in the top five at 100 percent, you wouldn't get rid of it.

MR. GREGORY: Hm.

MS. BURNETT: So the math just doesn't work and tax increases are going to come in some way, shape or form.

MR. GREGORY: And this is the question about where can the president stick to this pledge of not taxing the middle class when it comes to health care .

MR. RAMO: Yeah. The whole premise, of course, is you can fix this from inside the system . But the overwhelming lesson of all these reform projects is that's impossible to do. And so this is why the specifics are so important.

MR. GREGORY: The public option aspect of this, before we take a break here, is this dead and gone, Chuck ? Or isn't it?

MR. TODD: No. I think this trigger, this idea of a trigger -- and to explain that quickly, it's this idea of, of having a threat of a public option so that it would never go away, but the threat of a public option , of the government starting an insurance program to then compete with private insurance . If it always is there -- I talked to one policy guy inside the White House who said,

"You know what, when you actually have a gun to the head of the private insurance industry , they do keep costs down." They do keep, you know, they do act like good citizens, good, good, productive citizens. If you ever take away the gun to their head, then they don't. And they, they cite a couple of times when it happened in the early '90s and in the '60s, a couple of times that it happened. So I think this trigger is where this thing is headed. It's how you keep -- look, if Olympia Snowe is the one who suggested it...

MR. GREGORY: Right.

MS. BURNETT: Right.

MR. TODD: ...it tells you how you get to 60 votes in the Senate .

MR. GREGORY: All right. We're, we're going to take a break here. We're going to come back and talk about the future of the economy , the future of our financial system in wake of this financial collapse. We'll be right back. We'll do that after this brief station break.

MR. GREGORY: And we are back to talk about the economy . And as much as we've been talking about health care , some might say that it is unemployment that is America 's dirty little secret . And, Joshua , you have written the cover story for Time magazine . This is the cover:"Out of Work in America : Why double-digit unemployment may be here to stay and how to live with it." And this is what you write, it's very interesting:" America now faces the direst unemployment -- employment landscape since the Depression . ... And if the result is that we're stuck with persistent 9 percent to 11 percent unemployment for a while -- a range whose mathematical congruence with that other 9/11 is impossible to miss -- we may be looking at a problem that will define the first term of Barack Obama 's presidency the way the original 9/11 defined George W. Bush 's. Like that 9/11, this one demands a careful refiguring of some of the most basic tenets of national policy . And just as the shock of Sept. 11 prompted long-overdue reforms in intelligence and defense, the jobs crisis will force us to examine a climate that has been deteriorating for years." This is scary stuff .

MR. RAMO: Yeah, it's terrifying. And it resembles a lot of the other elements of the economic crisis , which is things that sort of defy what the experts tell you. The best prediction -- when they were coming up with a stress test for the banks, the best prediction of what unemployment would be this year was 8.9 percent. We passed that in the spring. And so this is another one of these things that just sort of seems to be cascading beyond control . Last week we had the dubious honor of passing Europe in terms of unemployment, which has, you know, long been sort of the pride of the United States ; well, at least we're not Europe . What's going on seems to be a fundamental shift in the economy and the nature of how jobs are created and why they're created, and that suggests that things could actually get much worse.

MR. GREGORY: And that is -- it's a frightening prospect and one, Erin , that the White House has not anticipated. They put out their own projections about where unemployment would be, and it has exceeded that. So as they talk about four million jobs created or saved, they're not dealing with this kind of persistent unemployment that would lag behind any recovery.

MS. BURNETT: Right. And if you look at transformative periods in American history , you know, we went from being an agricultural economy , for example, to an industrial one, and you saw that big shift in jobs. That's what it seems like they've tried to identify, that we're in the midst of one of those shifts. We've been using -- losing manufacturing jobs since 1980 . This has been, to your point, a very long process. So what comes next? They've identified that as alternative energy . That's going to be where it comes from. We're going to do retraining. But there's a huge question mark as to whether that's possible. And when you look at where the leadership , by the way, in that area is coming from, it is clear it is coming from China . All the main areas and all -- not just the jobs, the innovation has actually come from there. So if it's alternative energy , it's very unclear how we capitalize on that and get job growth.

MR. RAMO: And it may be a piece of -- you know, it's likely to be insufficient. In the three great periods of tremendous job loss -- the 1930s , the 1980s and today, periods when we were up to 10 percent unemployment -- the main difference between the 1980s and those other periods was the '80s, when growth restarted, people got jobs. Today, many of the jobs that people have lost are never coming back, and we're just not seeing any sort of attempt to deal with that. We need a massive rethink of the way we deal with unemployment in this country . People talk about this idea of, you know, what does Obama do after health care ? Well, I think it's got to be unemployment. You've got to have some really imaginative approach here that says we're going to change what it means to be unemployed in America and we're going to change the way jobs are created.

MR. GREGORY: Not just job retraining, which is what we've heard for over a decade.

MR. RAMO: Right. Retraining 's a part. But, you know, one of the problems, you look at the retraining stuff , you retrain these people for six months to get jobs that they're usually out of in one or two years. The kind of retraining that's necessary is the stuff that goes on for one or two years, that pays for you to have internships...

MS. BURNETT: Right.

MR. RAMO: ...to manage really high-level skills. It's a totally different conception of the way that the economy works. But it's the kind of thing we need to do. Between 1999 and today there have been no new net jobs created in the U.S. economy , and the Fed is calling for very limited job growth in the next five years. You're looking at 15 years without job growth. That's not a way to have a powerful country .

MR. GREGORY: You know, it's interesting, Chuck , the political challenge here is that just like health care , when you talk about the economy , fundamental change is so difficult to pull off politically. In other words, in health care , getting to the root cause of what's driving health costs upward. In this way, if you -- if the president is facing, in an election year, 9 to 11 percent unemployment, that's a huge problem .

MR. TODD: It is, because it's an easy symbol to grab onto. I mean, you know, you go into politics, fortunately or unfortunately, that it's the simple thing that an electorate digests. And that will be the simple thing, this idea of unemployment. You know, it's why every election expert you talk to, when they try to predict 2010 or 2012 , they'll say, "You tell me what unemployment is and I'll tell you whether he wins or -- he wins or loses, or how bad the margins will be on either

side." So I think, look, they know it, they know it's this. I go back to something. It's like, you know, I went to one White House official and said, "OK, so, you know, this is health care week," and he says, "No, it's always the economy ." And you know the person I'm talking about.

MS. BURNETT: Mm-hmm.

MR. GREGORY: Right. Yeah, yeah.

MR. TODD: He's like, "It is always the economy . It is always it. It is always it." But you go to this thing, you know, and, and this crisis about unemployment, it's not just that we have this -- it's because more people are trying to get back into the work force . Don't forget, people are aging to a point and people are working now past 65.

MS. BURNETT: Right.

MR. TODD: And that's -- that, like, adds to the problem . You know, there's another issue here, right, where people are staying in their jobs and so younger folks can't replace them. So it is a...

MR. RAMO: This is, by the way, one of the records we hit last week is the record number of people who -- long-term unemployed, people we've been out of work for more than 27 weeks. We've never seen that number before.

MS. BURNETT: But when you take it, this unemployment issue, and you go back to the tax issue, that's where you start to say, what are we going to do? I mean, we are projected, by the Obama administration 's numbers, to be spending more than we take in in this country through the year 2019 . We are expected to borrow 40 percent of our budget next year. Taxes are only accounting for 27 percent of the budget. So as you come into that election cycle and you're looking at an employment rate that is so elevated, and you're looking at an unsustainable fiscal situation, it comes down to this: Are you going to be forced to raise taxes in the midst of what is a severe employment recession, if not more?

MR. GREGORY: The president's on Wall Street tomorrow giving a very important address about the future rules of the road for Wall Street . Here's the cover of The Economist magazine:"One year on, what's changed?" Joshua , what's changed?

MR. RAMO: You know, not a whole heck of a lot in terms of the amount of risk taking, the culture of risk taking. In fact, we're talking about the difficulty of trying to reregulate industries, the financial service industry's been a great example of that. You basically have the same kind of activities going on, the same kind of speculative activities occurring that were occurring a year ago. They're not any easier to regulate. The exposures throughout the system are as large as they've ever been. And the risks we face today, that you and I face even though we're not in the financial industry, because we're all networked together, are shared. What has changed, reality, is not very much.

MR. GREGORY: Erin:

MS. BURNETT: It's interesting. Some conversations with, with officials at Treasury, they actually think the biggest risk right now is the banks are taking too little risk.

MR. GREGORY: Hm.

MS. BURNETT: So it's very unclear. I mean, that's their perception. Obviously, when you look at it from the ground, it would seem that what you're saying there is that in a sense very little has change. But this reform that they're pushing through, that's, I think, what the president's going to be talking about tomorrow when he speaks on Wall Street . It is unclear exactly what would change as a result of that. There seems to be a lot of argument over who's going to get the regulatory authority as opposed to what exactly they're going to regulate. They say we're not going to have systemic risk , but nobody really knows exactly what that means. So it, it...

MR. GREGORY: And when...

MS. BURNETT: Yeah.

MR. GREGORY: And a year ago we were talking about housing.

MS. BURNETT: Mm-hmm.

MR. GREGORY: Are we in much better shape in terms of housing?

MS. BURNETT: I think that is the elephant in the room . We, we -- it has really gone on the back burner in terms of the dialogue, but it is crucial. There are some who say housing prices could go down another 25 percent. We found out this week that all these mortgages that were suppose to be modified, people who are underwater, Bank of America only is modifying 7 percent of the eligible loans. So we have a real issue in housing. Right now you're looking at potentially half of American mortgages are going to be underwater, where the mortgage exceeds the value of the home, within the next year and a half. And when you combine that with a lack of income growth, it's hard to see how the consumer gets out of it. So I think you're going to start to hear -- and maybe you know more about this than I do -- the White House rhetorically talking a lot more about it, and extending those homebuyer credits.

MR. TODD: You know, the president himself has identified that that program is not working. He has admitted it.

MS. BURNETT: Mm-hmm. The mortgage modification one.

MR. TODD: He has admitted that that is not working the way they had designed it.

But two things on this financial regulation that I find fascinating, just on the political front. One, the administration wrote the bill. You know how they bragged about, oh, they're going to let Congress .

MS. BURNETT: Mm-hmm.

MR. TODD: I talked to one person who said, look, they don't have -- Congress doesn't have the capacity to write a really smart financial regulatory reform bill. So that, that was number one. The second thing about it that's interesting is just how I think you're going to see the president

latch onto it because Republicans , everybody seems to agree you've got to have more regulation on this front. But the one unattended consequence is going to be this. Congress a lot of times reforms the last problem , and it's always that unintended consequence ...

MS. BURNETT: Right.

MR. TODD: ...what new loophole is created. We've seen it with campaign finance reform for years, where Congress is always reforming the last issue and doesn't know how to anticipate the next issue.

MR. GREGORY: All right. Well, the -- one -- my question about New York tomorrow for the president is does he call Derek Jeter to congratulate him on passing Lou Gehrig ? He's got more hits than any other Yankee .

MR. TODD: I'm sorry. Wait, wait, wait. I'm...

MR. GREGORY: He's a great guy.

MR. TODD: I'm sorry, love Derek Jeter , but only the Yankees , only the Yankees can somehow brag about not getting to 3,000 hits. I'm a baseball fan, you're a baseball -- 3,000 hits is the mark. Hey, Derek Jeter ...

MR. GREGORY: He's going to get there.

MR. TODD: ...call me in a season and a half when you get the 3,000.

MS. BURNETT: Wow. He sets the bar high.

MR. GREGORY: All right. Wow. I awakened the giant there. All right. Thanks...

MR. TODD: I'm sorry. Only the Yankees do that.

MR. GREGORY: Thanks very much to all of you. And we'll be right back.

MR. GREGORY: That is all for today. We'll be back next week. If it's Sunday, it's MEET THE PRESS .