ANNOUNCER: From the heart of the nation's capital, "This Week" with ABC News chief Washington correspondent George Stephanopoulos, live from the Newseum on Pennsylvania Avenue.
STEPHANOPOULOS: Both sides called it historic, but while Republicans insisted that yesterday's vote to break a filibuster is the decisive vote on health reform, several Democrats said there was nothing final about it, simply a vote to begin the debate.
And let me begin our debate this morning by bringing in our panel. I am joined by Congresswoman Marsha Blackburn of Tennessee, Republican of Tennessee, Senator Tom Coburn, Republican of Oklahoma, Senator Ben Nelson, Democrat of Nebraska, and Congresswoman Debbie Wasserman Schultz, Democrat of Florida.
And, Senator Nelson, let me begin with you on this -- on this overall question. You heard Senator McConnell, several other Republicans yesterday saying this is the vote. And -- and a couple of weeks ago, you -- you seemed to agree. You were talking to our Jon Karl, and you said, if you couldn't live with the bill, then you wouldn't vote to let the debate begin. So that does mean that you can live with this bill?
NELSON: No. What I -- what I meant by that is that, if I thought the -- the vote -- the bill couldn't -- this was before I saw the bill, but I thought the bill couldn't be amended and couldn't be corrected and improved, then I wouldn't move -- vote to move it forward and move the debate. But when I saw the bill, I said, "This can be amended. It can be improved." And the -- the debate should begin, and ought not to stop the opportunity to improve the bill when it...
STEPHANOPOULOS: Just to be clear: If this bill -- if there were a vote to end the debate today, you would not vote to end the debate, to get this...
NELSON: I would have voted no. I would have voted no. I would have voted to end -- not to end debate. I would have voted no on a cloture vote to end debate.
STEPHANOPOULOS: So you wouldn't let it get off the floor?
NELSON: So I would not let it get off the floor. That's what that means at the -- that's the next round.
STEPHANOPOULOS: Senator Coburn, you also promised before the vote yesterday to read all 2,000 pages, yet you didn't do it. Is that a sign to you that just the handwriting is on the wall and you decided to fold?
COBURN: Well, it -- it didn't accomplish a purpose. What we're going to do is read the bill to the American public. I think when you'll be -- what you'll be seeing when we come back is us going through it section by section, explaining what it means. It was a symbolic gesture, but it -- it didn't work with what Senator Reid and Senator McConnell wanted to do. I understand that.
I don't think we lose anything in the debate. But the important thing is for the American people to understand that this bill doesn't fix what's wrong with health care. We're treating symptoms, not the disease, and it's really malpractice what we're doing.
The -- the -- the problem in America today with health care is it costs too much, George. And there's nothing to address that. And one out of every three dollars that Americans spend today doesn't help anybody get well and doesn't keep anybody from getting sick. So why would -- why would we not want to go and fix the problems in health care, not the symptoms that all the politicians play around with, but the real problems?
STEPHANOPOULOS: I want to get to the congresswoman, but, first, let me -- just answer that point. He says he doesn't do anything to control the costs.
NELSON: Well, you know, it doesn't do enough to control the costs; that's for sure. And we do need to address that cost containment. I'm very concerned about that. But I -- I certainly couldn't say it does nothing.
I think the effort on prevention, early detection, wellness, the workforce development for more primary care physicians, those will all be helpful in -- in reducing the costs of health care.
COBURN: And ask -- ask the question, George, why did -- do we have an imbalance in primary care physicians? Why is it there? Does anybody know? It's because we pay them 300 percent lower than we pay the sub-specialists. And so we don't do anything in that -- we're going to help pay for some of their education, but we paid -- we do nothing to change that balance. One in fifty doctors graduating last year decided to go into primary care. That's a disaster that has been caused by Medicare setting the prices.
STEPHANOPOULOS: So not enough for primary care, although, as you point out, there are more incentives for primary care education in this. But I want to bring the question to you, Congresswoman, is the -- the differences between the House and the Senate bills, some fairly significant differences over how to pay for the bill, over how abortion services are covered, on size, $1 trillion or so for the House bill, below $900 billion on the Senate bill, and, of course, on this public option.
So when you look at what the Senate is considering now, is that something you and the majority of Democrats in the House can go for?
WASSERMAN SCHULTZ: Well, what's important to focus on, George, is that there's far more that we have in common between the two bills than our differences. And while some of the differences are significant, all Democrats, whether it's a Senate Democrat or a House Democrat, are committed to health care reform and making sure that we can cover the people in America who are uninsured -- about 31 million or 36 million individuals are covered by both of these bills -- make sure we can provide security and stability to those who don't have health insurance, and that's really been -- that's been really underexamined.
We have, you know, about 85 percent of Americans who have coverage, and every year, whether you're a small-business owner or an individual, they have skyrocketing insurance premiums that this bill will get a handle on, both bills, and making sure that we can bring down and control costs.
And with all due respect, Senator Coburn, both of these bills will bring down costs and control costs and make sure that simply by getting rid of insurance companies' ability to -- to drop you or deny you coverage based on a pre-existing condition, creating insurance exchanges so that we can pool individuals and broaden the number of people that are covered and bring down the cost of their insurance, making sure that -- that folks have the ability to have their premiums set not based on gender, which causes women to have a 48 percent on average higher premium, but making sure that we have just a few items that are rated by insurance companies to bring down their costs.
STEPHANOPOULOS: You hear that case, yet not a single Republican in the House voted yes.
BLACKBURN: And with good reason.
STEPHANOPOULOS: Actually, I take that back. Congressman Cao from Louisiana...
STEPHANOPOULOS: ... one Republican.
BLACKBURN: And -- and -- and with good reason for not voting for it. We had a Republican alternative that actually would have brought down the cost of health insurance. CBO scored both plans. They said that our Republican alternative would have brought insurance costs per family $5,000 per year less, would have brought those costs down, and that is $5,000 less than the least expensive Democrat proposal. Now, we all agree...
BLACKBURN: ... there need to be reforms, that we all agree there need to be reforms in health care. But we know that putting this government-run health care that leads to a government takeover, it doesn't work. There is no test case out there that they can point to, no pilot project they can point to where a government-controlled health care system has brought down the cost, increased the access, taken care of those with pre-existing and chronic conditions, allowed portability, dealt with malpractice reform. Those are things we as Republicans are for, and unfortunately, their bill does not achieve what they are saying they want to achieve.
Look at what has happened when you look at the cost of Medicare. It has skyrocketed. What is it, 700 percent...
WASSERMAN SCHULTZ: It's important to know that what CBO also said, that their bill would only cover about 5 million, not even coming close to addressing the problem of the uninsured or the underinsured. It doesn't address requiring insurance companies, prohibiting insurance companies from dropping you or denying you coverage for pre-existing condition. It does -- it -- it allows for association health plans...
BLACKBURN: But what we did...
WASSERMAN SCHULTZ: Excuse me, Marsha. It allows for association health plans, which means that all the mandates, like for mammograms and making sure that women and people who need coverage in this country, all the mandates would be gone, and you'd go to the lowest common denominator.
WASSERMAN SCHULTZ: This is a bill that doesn't even come close to addressing...
BLACKBURN: That is incorrect.
WASSERMAN SCHULTZ: No, it is not incorrect. It's a bill that doesn't even come close to addressing...
BLACKBURN: ... what it does do is establish risk pools and reinsurance...
BLACKBURN: ... gets to near universal coverage.
STEPHANOPOULOS: ... because we heard something about some of the differences with -- with the House bill, and I want to press a little bit more on what your bottom lines are going forward. We heard your colleague, Senator Lincoln, say if the public health insurance option is included in the legislation, she will not vote to get it off the floor. Do you agree with that?
NELSON: It depends on what the public option is. I -- I am opposed to the public option of where the states have to opt out. I said I would look at a public option where states could opt in. But that -- that with the opted in, it wouldn't apply to every other state.
I -- I really think that state -- you can have state-based solutions in many instances where the states can step forward and take care of certain responsibilities, with some assistance from the federal government.
STEPHANOPOULOS: A second big issue, abortion funding. The -- the Senate bill is -- allows more public funding of abortions than the House bill -- than the restrictions under the House bill. If -- if that language remains, can you vote to get this off the floor?
NELSON: No. But I might not to get it off the floor because of other considerations, as well. Even if that -- even if that was perfected, where I could support that particular provision, if the public option is wrong, if the CLASS act is still in it, if -- if there are a whole host of other items that are the same as they are right now, I wouldn't vote to get it off the floor.
STEPHANOPOULOS: These are significant differences with -- with what the majority of Democrats in the House have called for. Can -- do you believe your colleagues will go along -- I know you -- you say there are basic areas of agreement -- but if on these key issues, Senator Nelson and his centrist colleagues win out, would this bill get through the House?
WASSERMAN SCHULTZ: But what Senator -- I don't want to speak for him -- but what Senator Nelson is not -- you don't hear him saying is that there isn't any room for negotiation or compromise.
STEPHANOPOULOS: On public option he said, but...
WASSERMAN SCHULTZ: Well, I...
NELSON: No, no. I mean, we could negotiate a public option of some sort that I might look at, but I don't want a big government, Washington-run operation that would undermine the -- the insurance that -- private insurance that 200 million Americans now have.
STEPHANOPOULOS: So Democrats are prepared to compromise again on the public option?
WASSERMAN SCHULTZ: We're going to sit down in the conference committee and make sure that we can hammer out the differences between the two Senate bills, which we have done in America since the founding fathers wrote the Constitution.
COBURN: ... three points. One, 61 percent of health care in this country is already run by the government. Name one that works well. That's number one.
STEPHANOPOULOS: Well, I think some would argue Medicare.
COBURN: No, it's highly inefficient, and it's going to be broke in three years. How can you say it's running well?
COBURN: Let me -- let me finish...
COBURN: Number two is, this -- this bill creates 70 new government agencies with thousands of new bureaucrats, with -- I'm talking about the Senate bill -- with 1,597 different instances where the secretary's mandated to write rules and regulations. If you think that isn't going to get between patients and their doctors, I have a whole lot of swamp land in Oklahoma I'd like to sell you.
The -- the third point that I would say is we can fix all these problems, but we have a government-centered approach that is already failing instead of a patient-centered approach. And we ought to be concerned about patients, not the government.
And -- and there's 11 studies out as of this morning that said both the House bill and the Senate bill will raise premiums, not lower them. There's -- that includes the Joint Tax Committee and the Congressional Budget Office, as well as nine other independent analyses.
So we -- do we all want to solve health care? Yes. Let's fix the real problem. Let's go after some of the $600 billion to $750 billion of waste that is not applied to truly preventing illness or treating illness...
STEPHANOPOULOS: ... I want to focus on one point that you raised, though. The Congressional Budget Office does say that, under this bill, premiums will go up.
WASSERMAN SCHULTZ: Well, there are different...
STEPHANOPOULOS: You're nodding your head, but...
WASSERMAN SCHULTZ: There -- there are differences of opinion as to whether or not the Congressional Budget analysis is correct on -- on the increase in premiums. But the important thing here is that I hope we can all agree that we have to get rid of the profit-driven, insurance company-driven health insurance system that we have, where it's insurance company bureaucrats, Senator Coburn, that are getting in between patients and their doctors.
To suggest that this bill will put government in between patients and their doctors is really disingenuous...
COBURN: ... private insurance denial rate is. Now, think about that. Medicare's denial rate on claims is twice -- it's 6.5 percent. The average insurance is 3.5 percent. I -- look, I've dealt with the insurance industry. I know how bad they can be. I don't want to eliminate them; I want to make them transparent and accountable.
WASSERMAN SCHULTZ: ... Republicans suggest that we should change Medicare...
STEPHANOPOULOS: I want to bring this back to...
WASSERMAN SCHULTZ: ... Republicans...
STEPHANOPOULOS: Excuse me for a second. I want to bring this back to another controversy we had this week over the cancer deadlines, because it connects to this point in the patient-doctor relationship. You and several others were critical...
STEPHANOPOULOS: ... of the -- of the guidelines saying that this is -- that under the president's plan, under the Democrat's plan, it's going to lead to more rationing. Yet the American Cancer Society says that the Republican alternative is worse, would do more harm than good, wouldn't give preventive services to anyone, and that under these bills, preventive care is encouraged and actually required by insurance companies. So isn't that an improvement?
BLACKBURN: Well, actually, it is not. And the guidelines that came out this week by the Preventive Services Task Force have a direct link to what would be offered if the House and the Senate bills were to go into law, if they were to be put into law.
And, George, this is exactly how it happens. If you go to page 1,296 of the House bill, the engrossed copy, and you began to read in title three of that bill, on preventive and wellness services, and you get down to section 2301, this is what happens. In section 3131 of that bill, it changes the Preventive Services Task Force to the Clinical Preventive Services Task Force.
Then, you go back and you see that that task force on preventive clinical services is tasked with rating A, B, C, D, or I all preventive services. Then you go back into section 222 of the bill...
BLACKBURN: Yes, I have read this bill. And that indicates what would be paid or covered. And this is where the actual link comes, and I'll read it for you. In section 2301, it says, "All recommendations of the Preventive Services Task Force" -- that's the group that did the mammograms -- "and the Task Force on Community Preventive Services, as in existence on the day before the date of the enactment of this act, shall be considered to be recommendations of the Task Force on Clinical Preventive Services."
STEPHANOPOULOS: So the guidelines -- the point is that the guidelines then...
BLACKBURN: They becomes the law.
STEPHANOPOULOS: ... would -- would become...
BLACKBURN: They become the law, the mandate.
STEPHANOPOULOS: ... would become controlling.
WASSERMAN SCHULTZ: No, they would not be.
BLACKBURN: Yes, they do.
WASSERMAN SCHULTZ: And what's unfortunate is that the Republicans, and Ms. Blackburn, have for the first time politicized breast cancer.
BLACKBURN: That is incorrect.
WASSERMAN SCHULTZ: That is -- no, it is not. And I'm a breast cancer...
BLACKBURN: No, it is incorrect.
WASSERMAN SCHULTZ: As you know, as a breast cancer survivor, Marsha...
BLACKBURN: That is incorrect. It's in the bill, Debbie.
WASSERMAN SCHULTZ: Excuse me.
STEPHANOPOULOS: Let her finish her point.
BLACKBURN: I have a great respect -- yes.
WASSERMAN SCHULTZ: As a breast cancer survivor, I came out against these -- these recommendations. Every major cancer organization has come out against these recommendations. The task force language in that bill actually makes sure that prevention -- preventive services like mammograms and colonoscopies and other cancer screenings would be free. The task force recommendations -- the language in the bill...
STEPHANOPOULOS: Well, Debbie, let me -- let me clarify this...
WASSERMAN SCHULTZ: ... that even more women would get access to...
STEPHANOPOULOS: Excuse me for a second. That -- that is true. But let me clarify a little bit, because under the -- the bill -- and we have -- we have the language, as well. It says that a group health plan and health insurance issuer offering the group (ph) shall provide coverage, but only under -- if the Preventive Services Task Force rates it as an A or B.
BLACKBURN: That's right.
STEPHANOPOULOS: And, actually, under the -- under the task force, they said that these mammograms for women 40 to 50 is rated C. So they actually wouldn't be covered. So you have a great expansion for a broad part of the population, but actually, these guidelines would be controlling for ages 40 or 50.
WASSERMAN SCHULTZ: ... task force's recommendations are simply recommendations. They...
WASSERMAN SCHULTZ: They aren't controlling.
COBURN: As a physician who's been...
WASSERMAN SCHULTZ: They aren't going to be -- they aren't going to be binding. They're recommendations.
STEPHANOPOULOS: Well, but the language here says they...
COBURN: Here's the question. Here's the question we ought to be asking. Do these recommendations make sense from a cost standpoint? Absolutely, from a cost standpoint, they're right. You look at the statistical analysis, they make sense.
From a patient standpoint, they're atrocious. And that's the problem with a bureaucracy stepping between a physician and their patient.
STEPHANOPOULOS: Can you weigh in on this?
NELSON: Well, absolutely. I -- I worry about a government-run plan that would be subject to recommendations that might be applied universally without respect to patients. I am concerned about that, not that you can't fix some of those concerns, but you can't fix every one of them, and I am concerned that if it's -- if it's turned over -- look, the insurance industry has its own challenges. And -- and many of those can be handled with transparency and by eliminating pre-existing conditions and rescissions and rating based on health and some of the other ratings -- gender ratings.
But -- but we're not going to -- if we can keep as much of it at the state level is as possible, you've got -- you've got patient's bill of rights, you've got all kinds of mandated coverages, and -- and this can be handled on a state-by-state basis. It gets lost in Washington in a big government-run plan, and I don't know what happens.
STEPHANOPOULOS: But if you don't have these kind of guidelines, how are you going to get the cost control you were talking about 10 minutes ago?
NELSON: Well, I don't mind guidelines and recommendations, but I don't want them to become the equivalent of rules and law.
WASSERMAN SCHULTZ: And we can't...
BLACKBURN: And it says "shall."
WASSERMAN SCHULTZ: We have to make sure that we're not forgetting about the people. And that's what the task force forgot about this week, is that we're not thinking about big, amorphous blobs of -- of people. Making -- these recommendations say that we can trade one life to save the angst and anxiety in a -- a larger group of women, and that's totally inappropriate, but that's also why major experts, medical experts, the cancer society, the colon foundation all came out against this, and that won't be...
BLACKBURN: Well, but still it's a mandate.
WASSERMAN SCHULTZ: ... controlling in the final legislation.
STEPHANOPOULOS: ... going to be changed?
WASSERMAN SCHULTZ: Actually, you know, I would invite you -- I would invite you...
BLACKBURN: Well, you know what? I think you and I need to work as -- together on a motion to instruct and get this language out of here, because on page 1,318, it does mandate it. It...
WASSERMAN SCHULTZ: Marsha, first, I would suggest...
BLACKBURN: ... says that the HHS secretary has to do this. So, you know...
WASSERMAN SCHULTZ: No, we have different interpretations, but...
BLACKBURN: ... Debbie is right when she says they forgot about people. Indeed, they did. But we have to realize, this group that made this recommendation, this isn't some outside group. This is a part of HHS. And when you look at the...
WASSERMAN SCHULTZ: It's an independent group. That is not accurate.
BLACKBURN: ... 118 -- when you look at the...
WASSERMAN SCHULTZ: It is not a part of HHS.
BLACKBURN: No, it is a part of HHS.
WASSERMAN SCHULTZ: No, it is not.
BLACKBURN: And when you look at what is going to happen with these 118 new bureaucracies with 62 directives that are given by the health choices commissioner on what insurance can be offered in this country after 2013 and what is going to be paid, you know that this is the bureaucrat in the exam room. This is how it's going to happen.
WASSERMAN SCHULTZ: Marsha...
BLACKBURN: And this is the first step.
WASSERMAN SCHULTZ: Marsha, there's an insurance company bureaucrat in the -- in between the patient and her doctor right now.
BLACKBURN: This is breast cancer. Well, and people don't like that, and we need to get rid of...
WASSERMAN SCHULTZ: And your bill -- your -- your alternative...
BLACKBURN: We need to get rid of all of those insurance bureaucrats.
WASSERMAN SCHULTZ: ... does nothing to...
STEPHANOPOULOS: I'm going to have to -- I'm going to have to stop this right now. And, Senator, before you go -- and I know this is your least favorite subject -- but Doug Hampton, Senator Ensign's chief of staff, has given an interview to "Nightline" which is going to air tomorrow night, where he says that you were an intermediary between him and Senator Ensign, and I want to show that for a second.
(BEGIN VIDEO CLIP)
HAMPTON: Tom Coburn said, "What I would do, Doug, if I was you is I would have them buy your home, give you $1 million bucks so you could get started over, and that's what I'm willing to help you negotiate."
(UNKNOWN): And what happened?
HAMPTON: John said, "No can do. Not going to happen."
(END VIDEO CLIP)
STEPHANOPOULOS: Is he telling the truth?
STEPHANOPOULOS: Flat no?
STEPHANOPOULOS: You did not serve as an intermediary?
COBURN: Oh, I did. No, there's no question. Look, my whole goal in this thing was to bring two families to a closure of a very painful episode. And there's no question that Doug called me and said, "Will you talk to John about solving a problem?" And so I called John Ensign and said, "Do you want me to talk to him?" He said, "Yes."
But, you know, the -- the question that's worrisome is, what is the motivation now for -- for this? Doug obviously asked to have some remuneration for the injury that he had. And on private sector, that happens all the time. But there -- there was no negotiation. There was, "I'll pass it along," or, "Yes, I won't."
STEPHANOPOULOS: Senator, thanks very much.
Thank you all very much.
BLACKBURN: Thank you.
NELSON: Thank you.