ABC "This Week With George Stephanopoulos"
Host: George Stephanopoulos
Guests: Secretary Of Health And Human Services Kathleen Sebelius; Former Massachusetts Governor Mitt Romney (R)
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MR. STEPHANOPOULOS: Hello again. It makes up almost 20 percent of the economy, impacts every single American, and fixing health care is President Obama's top domestic priority. Congress could have its first votes on reform this week, and the president kicked off his lobbying effort on radio and YouTube yesterday, promising that every dime of his plan would be paid for.
PRESIDENT BARACK OBAMA: (From videotape.) Real reform will mean reductions in our long-term budget, and I've made a firm commitment that health care reform will not add to the federal deficit over the next decade.
MR. STEPHANOPOULOS: And for more on this, let me welcome the secretary of health and human services, Kathleen Sebelius. Good morning.
SEC. SEBELIUS: Good morning.
MR. STEPHANOPOULOS: Let's begin with the bottom lines of the president. So far, he's been making the broad case for health care reform. Says it's up to Congress to fill in the details, but he just said he has a firm commitment not to increase the deficit. Does that mean that the president will veto any legislation that is not fully paid for?
SEC. SEBELIUS: I think, George, he is very serious about having health reform this year and having it paid for. And what is going on right now is exactly what needs to happen. Congress is fully engaged in figuring out the details of this proposal, working closely with the president, and he's already put on the table - the president has put on the table about $900 billion. Some of that's saving from existing programs that we've used to drive quality and expand coverage, and other from a proposal that we alter the minimum tax, that we go back to the deductions of the Ronald Reagan era for the richest Americans, minimize the itemized deductions, and come up with about $300 billion. So he's very -
MR. STEPHANOPOULOS: But the Congress has rejected - hasn't acted on those cuts -
SEC. SEBELIUS: Well, they haven't - they haven't even started to really discuss how they want to pay.
MR. STEPHANOPOULOS: Well, they made it pretty clear what they think about that tax proposal, and some say that the savings that the president outlined will be very difficult to realize as well, so I'm just trying to get a sense. You say he's very serious. If every dime of this is not paid for, will the president say, no, that's not good enough, Congress, and send it back?
SEC. SEBELIUS: Well, I think absolutely, he wants a bill that's paid for, not to increase the deficit at a time when we are looking at looming deficits. The problem is, though, we can't sustain the current system. This is not just paying for the future. It's also the fact that doing nothing has a huge cost. It's crushing businesses. It's crushing families. Our workers are less competitive. We can't sustain the system that we have right now, so the status quo is not an acceptable alternative, and Congress knows that. The providers know it. The hospitals know it. That's why people are at the table, working this year on health reform.
MR. STEPHANOPOULOS: And if it's not paid for, he'll send it back?
SEC. SEBELIUS: I don't know the detail, but I think what he wants is for Congress to pay for it.
MR. STEPHANOPOULOS: He wants Congress to pay for it, but you're not willing to say right now - you're not willing to make a veto threat right now?
SEC. SEBELIUS: I don't think veto threats at any point are particularly helpful. What's better is to come to the table and get something done.
MR. STEPHANOPOULOS: How about on the question of taxes? You mentioned the president's proposal to shave those deductions for wealthier Americans. During the campaign, he was very critical of the idea of taxing health care benefits for those who have them right now, and you were quite critical when you talked to the Congress last month.
SEC. SEBELIUS: (From videotape.) Eliminating the tax write-off, which was a component of encouraging employees to offer coverage in the first place, has a huge potential of destabilizing the private market and leaving more Americans uninsured.
MR. STEPHANOPOULOS: But Senator Max Baucus, the chairman of the Senate Finance Committee, came out of a meeting with the president last week and said the president is willing to consider this idea. Is that true?
SEC. SEBELIUS: I wasn't in the meeting with Senator Baucus, but I've talked to the president a number of times, and he feels strongly that 180 million Americans have employer-provided health care, that taxing those benefits may indeed discourage employers from offering health care to their employees - exactly the opposite of what we want to do in the future.
And it would mean, for many Americans that they wouldn't keep the health plan that they have and they like, the doctors that they have and they like.
What we want to do is fix what's broken. And currently, employer- based health coverage is working pretty well for millions of Americans. So anything we do in the future needs to build on that system that provides benefits.
MR. STEPHANOPOULOS: But there seems to be an emerging consensus, especially in the Senate - Senator Baucus, Senator Grassley, a Republican, and others - Congressman - I mean Senator Wyden and Senator Bennett, and they seem to think this is the way to get a lot of the savings.
So, again, is the president saying he doesn't want it but he might accept it or there's no way he's going to accept it?
SEC. SEBELIUS: Well, again, I wasn't in the specific conversations. I think what's happening now is exactly what needs to happen as they engage in writing the bill that will mean health reform this year, and that's putting some details together. And that dialogue will go on about how to pay for it.
The president has proposed a payment of savings and, as you say, shaving the deductions off the wealthiest Americans.
He still feels that that's a better alternative than some other -
MR. STEPHANOPOULOS: But he's not going to get that. I mean, there's just no evidence that he's going to get that. All the major leaders on the Finance Committees and the Ways and Means Committee have said that's not the way they want to go; they want something else.
SEC. SEBELIUS: Well, I think, then, you know, that discussion will continue in the House and the Senate. But, again, what we don't want to do is have at the end of the day a tax on benefits that actually says to employers it's better to dump the benefits that you have; it's better to put those employees in the private market without employer-based coverage. That's a bad direction to move.
MR. STEPHANOPOULOS: Is there a way to reform the treatment of those health benefits - the tax treatment of the health benefits without eliminating the complete deduction?
SEC. SEBELIUS: Well, I think that's what the Senate and House members are looking at: Is there a level above which you could tax; is there some kind of breaking point where it might be acceptable policy?
But, at this point, the president feels strongly that there are some other alternatives to pay for this.
What's unacceptable is the status quo. And there are lots of people on Capitol Hill who feel if we just don't do anything, it will be okay. It will not be okay for businesses and families and government.
MR. STEPHANOPOULOS: Probably the biggest flash point right now is this whole notion of whether or not to have a public health insurance plan to compete with the private insurance.
SEC. SEBELIUS: Right.
MR. STEPHANOPOULOS: And that is drawing the most fire from Republican senators. Take a look.
SEN. JOHN THUNE (R-SD): (From videotape.) The American people are starting to connect the dots and see these as, sort of, gateway drugs to the government takeover of health care.
SEN. LAMAR ALEXANDER (R-TN): (From videotape.) It's like putting an elephant in a room with some mice and say, "Okay, fellows, compete." After a while, the elephant has taken over the room and the only choice is the elephant.
MR. STEPHANOPOULOS: To back that up, we'll look at a study from the Lewin Group, a respected health care group, that says that if this public insurance option paid Medicare rates, 70 percent of those now getting private insurance would migrate into the public plan, and that would be - basically, it would swallow up the private plans.
SEC. SEBELIUS: I think there's a lot of dispute about the numbers that the Lewin Group used. And also, there hasn't been any decision about what rates would be paid.
What the president's said all along is we want a level playing field. But having some competition and having some choice for consumers is a good thing. I don't think it's any surprise that insurance companies would rather have a system where everybody must buy coverage and there are no competitors so, you know, they get 50 million new customers.
MR. STEPHANOPOULOS: Doesn't the public plan only make sense if it actually does pay lower rates than the private plans so that it's lower in cost?
SEC. SEBELIUS: I don't think you have to pay lower rates. I think what you have to do is maybe cut some of those overhead costs and have innovative strategies.
What consumers will have is choice. And in lots of places in the country, absent a public option, absent some kind of competitive option, people would have no choice.
There's one dominant company and that really doesn't drive innovation; it doesn't drive much in terms of quality care. And that's really the goal at the end of the day.
We know that higher cost doesn't translate into higher quality. And what we want to do is have highest-quality, lower-cost care for all Americans.
MR. STEPHANOPOULOS: The political problem with the public option is that, right now at least, Republicans don't seem eager to sign on. All but one Republican member of the Senate Finance Committee has said public option. And to bridge that gap, Senator Kent Conrad, Democrat of North Dakota, is proposing a different kind of a system, co-ops, like - that would be similar to rural electric co-ops, rural telephone co-ops.
These people could band together, create their own health insurance cooperative. And he says that could be the alternative, the compromise, instead of having a full-blown public plan. Is that something the president is open to?
SEC. SEBELIUS: Well, I think that the details of exactly what that looks like are still being developed, but I think Senator Conrad has come forward with a creative idea, recognizing that choice and competition are good in a marketplace. A health insurance marketplace where people have some choices and have competition to keep prices down is actually a wonderful strategy, and that's really what the health insurance exchange is about: stabilize what we have but also create a system where Americans can have affordable coverage. You share the risk and you move forward.
MR. STEPHANOPOULOS: Yet you've got other Democrats like Speaker Pelosi who say that's not a public plan. So, again, I'm not sure I'm going to get - have any more luck on this. But I am trying to figure out, when the president looks at this, does he say, "I want a public plan, and it must be in the final bill," or "I'm open to other sorts of alternatives?"
SEC. SEBELIUS: Well, I think the discussions right now are serious ideas around the table from all sides. He has laid out pretty clearly and I think reinforced his support for a public option to a letter to Finance Committee members. He talked about it in a radio address. He's, you know, continuing to do that.
I don't think it's a surprise that the president supports a public option. He thinks choice is good, thinks competition is good.
And, frankly, George it exists all over the country. State employee health plans in 30 states have private options side by side with public options. It works well. It provides some choice. It exists in children's health insurance programs. So the notion that somehow this public plan can't work and it will drive the private insurance market out of business is just not very accurate.
MR. STEPHANOPOULOS: And he's going to insist on it?
SEC. SEBELIUS: I think he is, making it clear he - that's a direction he thinks will be beneficial for the public and for - to make sure that costs go down. And that's a central belief of his. This has to lower costs for everyone.
MR. STEPHANOPOULOS: Secretary Sebelius, thanks very much for your time this morning.
SEC. SEBELIUS: Thank you.
MR. STEPHANOPOULOS: Let me now bring in, for Republican a perspective, former governor of Massachusetts Mitt Romney, also a former presidential candidate.
Let me just start, right out there, Governor, with the public option. Is that a red line for Republicans? If there's a public option in this plan, should Republicans reject it?
MR. ROMNEY: Yes, of course they should. Let's start out from the very beginning, which is Republicans recognize and have said for a long time we've got problems in health care; we need health care reform.
And, you know, we took that on in Massachusetts. We decided we wanted to get everybody insured. We've done that. I understand that the president considers his plan, in some respects, following the model of Massachusetts.
Let's learn from our experience. And that is, we got everybody in our state insured. Some 98 percent now are covered by insurance. And we did not have to put in place a government plan.
We have competition in the health insurance market. There are hundreds of health insurance companies that all compete with each other. We don't need to have the government get in and create a health insurance company in order to have competition. We've already got it.
And let's be clear, here, George. This is not about getting competition in health coverage, which is already there. This is instead a Trojan horse. Barack Obama, when he ran for office, said he's in favor of a single-payer system. He's said it for years. This is a way of getting government in the insurance business so they can take over health care.
It's the wrong way to go. And every single Republican and every thinking Democrat who knows something about the private sector would realize the wrong thing for America is to get government into the health care business.
MR. STEPHANOPOULOS: Except, Governor, you bring up the Massachusetts plan. And you're exactly right. And most studies have shown that Massachusetts has done a very good job of expanding coverage with this plan, but has not done as good a job of controlling costs.
And some say that's because of the absence of a public plan. Alan Sager, professor of health policy at Boston University, has said that health spending per person in Massachusetts has increased faster than the national average in seven of the last eight years.
MR. ROMNEY: Massachusetts is an expensive state to do a lot of things. But the key thing I can tell you is this: what's happened to the health insurance premium for people buying insurance in Massachusetts? It's been cut in half.
For an individual, a young male, let's say 35 years old, buying insurance in Massachusetts for themselves, the premium has been cut in half since our plan went in place. So the cost of buying insurance is down. And that's the course that you have to have for the nation. Look, the idea that you have to get government into an enterprise in order for that to become competitive makes no sense at all.
If it made sense, we'd have a government trucking company, a government automobile company, a government clothing company, a government farm company. That just is the wrong way to go.
We could get our private industry to create better products and better services. That's what's happened throughout our economy. That's what driven our economy to be the most powerful in the world. We do not need government in the health market.
MR. STEPHANOPOULOS: It has worked for Medicare. It has worked for veterans' care, hasn't it?
MR. ROMNEY: Oh, it's worked terribly. I mean, look at something like Medicaid. When Lyndon Johnson signed Medicaid, he said this is going to cost about $500 million a year. Now, it costs $500 billion a year, 1,000 times more.
Now, I realize there's been some inflation, but not that much. The wrong way to go is to get government into an entity in our economy as large as health care and expect anything to occur besides a Trojan- horse effect of a single-payer system crowding out the private markets. It would be terrible for hospitals, awful for doctors, and ultimately it would be a disaster for the people in America because they wouldn't be able to choose private plan.
MR. STEPHANOPOULOS: I actually said Medicare, not Medicaid, and a lot of experts believe that Medicare has helped eliminate poverty among the elderly. But I want to move on to national security. You saw those Iranian elections yesterday. A great deal of protests in the streets. Some suggesting that this election was stolen from the opposition. I want to show you what Secretary Clinton had to say about the elections yesterday.
SECRETARY OF STATE HILLARY RODHAM CLINTON: (From videotape.) The United States has refrained from commenting on the election in Iran. We obviously hope that the outcome reflects the genuine will and desire of the Iranian people.
MR. STEPHANOPOULOS: What do you think of the administration's response to the election so far and how would you respond?
MR. ROMNEY: Well, first of all, the comments by the president last week that there was a robust debate going on in Iran was obviously entirely wrong-headed. What has occurred is that the election is a fraud, the results are inaccurate, and you're seeing a brutal repression of the people as they protest.
The president ought to come out and state exactly those words, indicate that this has been a terribly managed decision by the autocratic regime in Iran.
It's very clear that the president's policies of going around the world and apologizing for America aren't working. North Korea is not just saber rattling. They've taken the saber out of the sheath. Iran is moving headlong towards nuclearization. Russia is on the same course they were on. And all of the apologies that he provided to the Europeans have not led any of the European nations to provide additional support for us in Afghanistan.
Look, just sweet talk and criticizing America is not going to enhance freedom in the world.
MR. STEPHANOPOULOS: Others have argued, Governor, that the president's speech and the president's outreach is one of the things that led to Hezbollah being defeated in the Lebanese elections last week. And one of the things that led to such an outpouring in the streets in opposition in Iran. Do you dispute that?
MR. ROMNEY: You know, I can't tell you what led to the people running into the streets in Iran. I hope, in fact, that they're very anxious to see new leadership in that country. But I can tell you that the results are what I'm interested in. Is Iran still pursuing nuclear weaponry? And there's no question about that.
And one aspect of what the president said may have been well received in Iran, but I think it was poorly received in Israel and around the world. And that's when - well, actually, he made a 180- degree flip from what he had said during the campaign. During the campaign, when he spoke to AIPAC, he said he would do everything in his power to keep Iran from having a nuclear weapon. And then he went to Cairo and said that no single nation should have the ability to deny another nation the right to have a nuclear weapon. That is an 180-degree flip of a dangerous nature. I'm sure it was welcome in many streets in the Arab world and in the world that's most - including the Persian world, Iran as well. But that's not right for America. That's not right for world security.
MR. STEPHANOPOULOS: I believe the administration has said that they believe that Iran could have the right to nuclear power with appropriate safeguards, but not a nuclear weapon.
But what would you do now then? If you were president - you know, it's not just President Ahmadinejad in Iran who said that he believes Iran should have a right to nuclear power. It's the supreme leader. It was - every candidate in the race said that Iran should have a right to pursue nuclear power.
MR. ROMNEY: We don't have any question about nuclear power, and that was not the statement that the president made that was most offensive. It was his statement that no single nation should have the ability to deny another nation the right to nuclear weaponry.
Now, of course with regards to nuclear power, we have no problem under the Nuclear Nonproliferation Treaty for nations to pursue nuclear power. And in the case of Iran, it's pretty clear that's not what they're doing. When you sit on a lake of oil, you're not looking for a new source of energy. They're obviously developing this technology for military purposes. And offers were made, including by Russia, to provide the necessary nuclear material for nuclear power, and the Iranians turned that down. So let's not pretend or give in to the Iranian way of thinking, that somehow this is about nuclear power. It's very clearly about nuclear weaponry. And you also see, of course, the same kind of outrage coming from North Korea.
MR. STEPHANOPOULOS: Let's talk some politics right now. There was a Gallup poll this week, polling Republicans about the leadership of the Republican Party and asking who speaks for the Republican Party. And none of the above got more votes than anyone else, but Rush Limbaugh 10 percent, Newt Gingrich 10 percent, Dick Cheney 9 percent. Is it healthy that these three are seen as, by Republicans, the top spokespeople for the Republican Party today?
MR. ROMNEY: Well, I think it's very helpful to have a lot of voices, as we do. As you know, when you have the White House, you've got one single voice that speaks for your party. When you don't have the White House, you got a lot of people coming forward that speak and express their views. We have a lot of people with views that are very consistent on a number of issues. It's a good thing. You're seeing great senators come forward, congressmen, governors. Some new faces. I was just with Chris Christie in New Jersey, running for governor there. Bob McDonnell in Virginia. I think you're going to see some more voices come forward, and that gives our party the kind of energy and passion I think we're going to need to pick up some seats in the 2010 elections.
MR. STEPHANOPOULOS: But you're also facing a demographic problem. Mike Murphy, the Republican strategist, points this out in Time magazine this week. He says the Republicans are facing an ice age. And what he points to is the fact that in the last election and if you look at polling today, the Republican Party is losing young people. It is losing Latinos. It is losing well-educated Americans. That this really is a time, that if the Republican Party doesn't reform, Mike Murphy says, it will die.
How specifically should the Republican Party expand its outreach right now, become a more inclusive party for those voter groups that it is now losing?
MR. ROMNEY: Well, what you don't do is try and change your principles. But what you do is make sure that you're communicating your principles in an effective way to the audiences of America that are listening. Hispanic-Americans ought to be voting Republican. We're the party of opportunity. We're the party of keeping taxes down. We're the party that want people to have choice in their schools and choice in their health care.
MR. STEPHANOPOULOS: But as you know, over the last couple of years - let me just interrupt right there on Hispanic-Americans - a lot of Hispanics saw the Republican Party as the party trying to keep Hispanics out of the country. Whether it was fair or not, that was the impression. How do you counter that?
MR. ROMNEY: You got to make sure that you fight very hard to get your message through. And you're right, George, in many cases, the people on the opposition said that Republicans were anti-immigrant, which - nothing could be further from the truth. Republicans celebrate immigrants coming legally into this country, even becoming citizens. I was at a big rally in Iowa, someone stood up there and said I just got sworn in as a U.S. citizen. The crowd stood up and cheered. We're a party that loves legal immigration.
But like most Americans, we're not wild about illegal immigration. We want to cut back on illegal immigration so we can keep legal immigration thriving and robust. So those are messages we have to make sure that we communicate effectively, and recognize our opposition will try and muddy the waters and make us look like we're something we're not. But we need to do a better job, and that's one of the advantages of having so many voices out there right now. We can find people who can get that message across.
MR. STEPHANOPOULOS: And how about you personally, looking back at your own campaign - and it certainly seems like you're keeping the option open to run again. Looking back at your last campaign, one of your top New Hampshire supporters, Tom Rath (ph), suggested to National Journal that your problem was you lost what was your strongest selling point, the ability to be the economy's Mr. Fix-it. Do you agree with that analysis? And do you think it's something you have to fix if you're going to run again?
MR. ROMNEY: Well, you know, there are a lot of times that I can sit back and look back to my last campaign and say, what could I have done better. And I'm sure Tom Rath makes a good point there. I wouldn't argue with him. There are a number of things I probably would have done differently if I had the chance to do it again. But that's not the way life works. You look forward.
MR. STEPHANOPOULOS: Okay.
MR. ROMNEY: And I'm spending my time looking forward. I think it's critical at a time like this that we bring more balance to Washington. With an issue like health care on the docket, for instance. In Massachusetts, when we dealt with that issue, we spent two years, Republicans and Democrats, coming together. We got - in the vote of the legislature, it was 198-2 to pass our plan. Senator Kennedy and I were there at the celebration of our plan. We did something on a deliberate and comprehensive basis that involved both parties.
We're not doing that in Washington. Republicans have been pushed aside. We need to see if we can't bring more balance to Washington. And I'm going to fight to do that in the coming year or two.
MR. STEPHANOPOULOS: Okay, Governor Romney, thanks a lot. We look forward to having you back.
MR. ROMNEY: Thanks, George.