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CBS "Face The Nation" - Transcript


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So we pick up with four members of Congress now who were there. Senator Coburn is in Tulsa
this morning. The rest of our guests are in the studio.
REPRESENTATIVE STENY HOYER (D-Maryland): Good morning.
BOB SCHIEFFER: So I guess Majority Leader Steny Hoyer in the House, I guess the first
question is to you and it's simply what next?
REPRESENTATIVE STENY HOYER: Well, first of all let me say about this meeting that we had.
I thought it was real extraordinary. I don't-- I can't remember a similar meeting held by any
President certainly in the thirty years I've been in Congress. And I think an awful lot of the
American public watched it. I talked to a lot of people last night and the day before that had
watched it. Hopefully, there was a better education. It was a civil discussion--a substantive
discussion. And I think the American public got the impression that very serious debate and
discussion and there were differences.
BOB SCHIEFFER: But what now?
REPRESENTATIVE STENY HOYER: But there was an agreement that we needed to have
health care reform--that seemed to be a universal agreement. So as a result of the work that
has been done, we're going to move ahead to try to make sure that all Americans have access
to affordable, quality health care. We think that's essential. We think it will bring down costs. We
think it will improve the health of America.
BOB SCHIEFFER (overlapping): But do you have any--
BOB SCHIEFFER: -- better sense today than you had then that you're close to even having the
votes? Congressman Ryan over in the House said this morning on television that you just don't
have the votes over there in the House right now.
REPRESENTATIVE STENY HOYER: Well I don't think we have the votes in terms of-- of
specific proposal because there's not a specific proposal on the table yet. The President has
made some suggestions which I think reflect--
BOB SCHIEFFER (overlapping): When would you have this specific proposal?
REPRESENTATIVE STENY HOYER: --discussions between the House and the Senate.
I would think within the next couple of weeks, we're going to have a specific proposal and start
counting votes to see whether or not those proposals can pass either the House or the Senate
or both and send something to the President.
BOB SCHIEFFER: Senator Coburn, your Republican leader in the Senate, said just this
morning that as things stand now, all forty-one members of the Republican Party in the Senate
would vote against health care reform. Do you see that changing any way?
SENATOR TOM COBURN (R-Oklahoma): Well, I think it could change if we start it over and we
actually worked and treated the disease that is plaguing American health care. The disease is
cost. And until we put in the incentives to change the dynamics--the market dynamics, the fraud
dynamics, the defensive medicine, that's two hundred and fifty billion dollars a year in defensive
medicine costs. What we need is not more government; we need more market-oriented, patient-
centered health care rather than government-centered health care.
BOB SCHIEFFER (overlapping): And that--
SENATOR TOM COBURN: So I think if we move to something like that we could-- you could
get some votes.
BOB SCHIEFFER: Well that-- that seems to be where the divide is. The Republicans want less
government the Democrats seem to think that this problem can be solved with more
government. But let me go to Senator Conrad. He's the chairman of the budget committee in the
Senate. Do you see any chance that this divide can be bridged, Senator?
SENATOR KENT CONRAD (D-North Dakota/Chairman, Budget Committee): I actually do. You
know, my-- my impression was very much different than the lead-in here. I thought there were
wide areas of agreement. Senator Coburn talks about focusing on cost. I believe that's essential
because we're now spending one in every six dollars in this economy on the health care. If we
stay on the current course, we're going to spend one in every three dollars. That's totally
unsustainable. That's going to break the bank of the government, of families, of businesses. So
we've got to do something and we've got to begin now. Senator Coburn just mentioned a series
of things that need to be done. Many of them are in the bill. This is a market-oriented approach.
The government doesn't run health care. This is not single payer where the government would
run it. This is based on private insurance delivered through state exchanges which was
originally a Republican idea. And the best estimates we have is that it would reduce the deficit,
reduce premiums for the vast majority of people. So it's a beginning. Senator Coburn has said
we got to do more and he is right. And that's what we ought to focus on. What are the additional
things we could do that might bring us together.
BOB SCHIEFFER: Well, let me just ask Congresswoman Blackburn because you had some
ideas about what--
REPRESENTATIVE MARSHA BLACKBURN (R-Tennessee) (overlapping): Absolutely.
BOB SCHIEFFER: --could be done as the next step. What are they, Congresswoman?
REPRESENTATIVE MARSHA BLACKBURN: I-- I think that what we need to do is look at
starting again and addressing what the American people want to address. They want to make
certain that we take a focus on cost containment and do some work there, that we look at
across-state-line purchasing, look at what you could pull out of the cost of health care if you
address medical liability reform. Now with all due respect to the Senator and to the majority
leader, Bob, our problem is this: What they want to do is let the government have-- the federal
government have the overshadow of all of this and-- and make the decisions of what the states
can do. What we're saying is we don't need more government in health care, we need to free
people up and let them get outside of this and make decisions--
BOB SCHIEFFER (overlapping): Well, one of the things--
REPRESENTATIVE MARSHA BLACKBURN: --that are going to be best for their families.
BOB SCHIEFFER: One of the things you talked about during the summit was you said people
ought to be allowed to buy insurance across--
BOB SCHIEFFER: --across state lines.
BOB SCHIEFFER: You had some fairly startling figures of how much they could save.
REPRESENTATIVE MARSHA BLACKBURN: Well, and that's exactly right. And in my state of
Tennessee the bulk of my constituents live within fifteen miles of the state line. And when we
checked our border states today before we insert competition, they could generally save about a
thousand dollars from being able to get past that stop sign at the state line. So, you know, we
were looking at what would happen with people in New Jersey. If they went over to
Pennsylvania they could save twenty-four percent. They could save seventy-four percent if they
went to Wisconsin. And they were able to purchase there. What we need to do is insert that
competition. Our state legislators are for this. Our governors are for this. Let the states have--
BOB SCHIEFFER (overlapping): Well, let-- let me just say--
REPRESENTATIVE MARSHA BLACKBURN: --the regulation on it not the federal government.
BOB SCHIEFFER: --Steny Hoyer if he's for it.
REPRESENTATIVE STENY HOYER: Bob, I think as the President indicated in this forum that
competition across state lines certainly was an appealing idea. It's got some complications in it
because it's historically been run by the states, as-- as we all know. But we thought that that had
some-- some merit to it. In fact, we believe the exchanges facilitate that happening. And, in fact-
BOB SCHIEFFER (overlapping): But why don't you make it happen?
BOB SCHIEFFER: Why don't you make it happen then?
REPRESENTATIVE STENY HOYER: Well, we believe the exchanges facilitate that happening.
We also believe that we want to pursue small business co-ops that was talked about in terms of
letting small businesses come together so they can have a large group rather than a small
group. Very frankly, that's what the exchanges are about. That's what access to the exchanges
for small business do. Let me make a-- a point about cost that Marsha raises because clearly
cost, as Kent Conrad pointed out, is going to be driving this debate. We cannot sustain the cost
curve that we're on. One of the things that we know that Marsha whether you compete across
state lines or within the state, you're paying about eleven hundred bucks for people who aren't
in the system because they're getting uncompensated care. What we try to do is to ring that
cost out. And as a matter of fact, as Kent pointed out, there are lot of things that Tom and
Marsha indicated in this form that we had that we agree with. One of which was getting
vigorously after fr-- fraud, waste, and abuse in the system. And we've put substantial investment
in both bills to do just that as the President has proposed as well.
BOB SCHIEFFER (overlapping): Well, I know that's what Senator Coburn talked a lot about--
BOB SCHIEFFER: --and, in fact, the President nodded in agreement on-- on several of the
things that Senator Coburn said. He said we need to put, what was it, Senator, undercover
agents into the hospitals to find out--
SENATOR TOM COBURN (overlapping): Undercover agents.
BOB SCHIEFFER: --where the fraud is going on. What-- what was that about?
SENATOR TOM COBURN: Well, Bob, let me-- let me go back and just summarize for a minute.
One of our problems is we don't spend too much-- too little on health care. We're spending too
much. We spend twice what any other country spends. And the very idea that we would create
another 1.3 or 1.4 trillion dollars worth of expenditures over a ten-year period when we're not
addressing the real disease. We have over a hundred and eighty billion dollars worth of fraud
every year in the health care system. That is second only to the defensive medicine cost. So if
you had a bill that just did those two things, you went after and changed the tort system and you
went after fraud you could cut everybody's health care costs in this country about fifteen, sixteen
percent. We-- and that's all you need to do to start. So the cost, if we-- we can't have a bill that
adds more cost to health care and more government. The government is responsible in
controlling sixty percent of the health care today.
BOB SCHIEFFER (Overlapping): Well, let-- let me just--
SENATOR TOM COBURN: If more money-- if more money and more government were the
answer, we would have fixed health care a long time ago.
BOB SCHIEFFER: Let me just ask Senator Conrad then why not just do those two things,
SENATOR KENT CONRAD: Because it's not-- it's not enough. Look, Senator Coburn is right, I
believe, that reforming the tort system would help. But the Congressional Budget Office tells us
it's pretty modest--fifty billion over ten years when we're going to be spending thirty trillion over
that period of time. So, yes, it's positive, but it doesn't solve the problem. Fraud would help. We
think there's probably ten, maybe even fifteen percent fraud--
BOB SCHIEFFER (Overlapping): Attacking fraud would help.
SENATOR KENT CONRAD: --in the Medicaid system. Yeah, attacking fraud. Going after fraud
would be very useful to do. But it doesn't solve the problem. Tom said himself we're spending
twice as much per person as any other country in the world. And we're in a circumstance as a
share of the economy we're spending far more than anyone else and we can't afford it. So yes
cost has to be a central concern. But do you know what the experts told us? The experts told us
the thing that would really matter is reforming the delivery system, instead of paying for
procedures, to pay for quality outcomes. And in the Senate bill, we begin that very approach.
The accountable care organizations like Mayo, like Cleveland Clinic, that are effectively
controlling cost and getting the best quality outcomes, would be given an incentive to have other
systems adopt their best practices. That's in the Senate bill.
BOB SCHIEFFER: All right. I'm going to take a-- let me just take a break here and we'll come
back to this point and talk about some of the practical things that are going to have to happen at
the Capitol if anything either does get done or doesn't. So we'll be right back in sixty seconds.
BOB SCHIEFFER: We're back now with our panel. Steny Hoyer, there's been a lot of back and
forth. Senators say the House has to go first. Some in the House are reluctant to go before the
Senate goes. Are you, number one, willing to go first and don't you have to?
REPRESENTATIVE STENY HOYER: We-- whether we're willing or not, we have to go first if
we're going to correct some of the things that the House disagrees with, correct, change so that
we can reach agreement, the House will have to move first on some sort of corrections or
reconciliation bill, which follows the process that the Republicans followed sixteen out of the last
twenty-two times it's been done for very major pieces including their tax cuts, which were really
a more--
BOB SCHIEFFER: You're talking about you're going to-- that Senate is going to have to do it by
what we call reconciliation--
BOB SCHIEFFER: --a parliamentary term.
REPRESENTATIVE STENY HOYER: It's a parliamentary term, but it's simply a process that the
Senate adopted to allow it to deal with in an expeditious way issues that relate to the budget. It's
called reconciliation, a fancy term, been used frankly more by Republicans than Democrats, but
used by both parties and-- and accepted as a good--
BOB SCHIEFFER (Overlapping): Okay. So let's ask Senator Coburn, you'll be over there in the
Senate if the Senate-- if the leaders there do decide to try to do this by reconciliation. What will
Republicans do if that happens, Senator?
SENATOR TOM COBURN: Well, I don't know what we'll do. The first thing is there will be a
fairly significant amendment process that will have to go through. But I'd make-- I'd make a
couple of points on reconciliation. Welfare reform happened with reconciliation. Half the
Democrats voted for it. The Bush tax cuts happened with reconciliation. Twelve Democratic
senators voted for it. You didn't have a real partisan issue on those times that it was used. You
know, the-- the danger of what's happening right now in terms of using reconciliation is the
purpose of the Senate is going to be defeated. And that is to bring consensus to big issues in
this country so that we have a reasoned and thoughtful approach and that the American public
buys into it. If you use reconciliation on this health care bill, as we see today, what you're going
to have is a thumbing of the nose at the American people. They don't agree with it. We need to
change it. We're willing to work to get it changed to where we don't have a massive increase in
the government influence in health care.
SENATOR TOM COBURN: As a practicing physician for over twenty-five years, Bob, I have
seen the reason we have a shortage of primary care doctors in this country today is because of
Medicare's pricing mechanism. We have too much government. We don't need more. We need
(Cross talking)
SENATOR KENT CONRAD: Bob, let's just understand the question of reconciliation-- question
of reconciliation. I have said all year as chairman of the Budget Committee, reconciliation
cannot be used to pass comprehensive health care reform. It won't work. It won't work because
it was never designed for that kind of significant legislation. It was designed for deficit reduction.
So, let's be clear. On the major Medicare or health care reform legislation, that can't move to
reconciliation. The role for reconciliation would be very limited. It would be on sidecar issues
designed to improve what passed the Senate and what would have to pass the House for health
care reform to move forward. So, using reconciliation would not be for the main package at all. It
would be for certain sidecar issues like how much does the federal government put up to pay for
the Medicaid expansion? What is done to improve the affordability of the package that's come
out of the Senate?
REPRESENTATIVE MARSHA BLACKBURN (R-Tennessee) (overlapping): It shouldn't be done
at all.
SENATOR KENT CONRAD: But it would not be used. Well, that's not a--that's not a
reasonable position to take, Congresswoman. We know that repeatedly for health care certain
provisions, for example: children's health care, the CHIP Program was done through
reconciliation. Cobra for people who lose their jobs that was done through reconciliation.
BOB SCHIEFFER (overlapping): Well, let me--
REPRESENTATIVE MARSHA BLACKBURN (overlapping): On this issue you should not do
SENATOR KENT CONRAD (overlapping): So, on minor issues-- on relatively minor issues, it's
totally reasonable.
REPRESENTATIVE MARSHA BLACKBURN (overlapping): But this is not a minor issue.
SENATOR KENT CONRAD: Well, health care reform at large would not be--I've just said.
Health care reform the major package would not be done through reconciliation. That would be
unreasonable. But that's not going to happen here.
BOB SCHIEFFER: What were you going to say, Congresswoman?
REPRESENTATIVE MARSHA BLACKBURN: Well, I-- I think that on the reconciliation issue, if
they had the votes, we wouldn't have had the summit. And, if they try to go through
reconciliation, it will be a change in semantics. Instead of the American people saying stop the
bill or kill the bill its all going to be about repealing the bill. That's not the kind of discussion that
they want. And, when we were talking about the expanded Medicaid coverage, we rolled the
dice on this in Tennessee over a decade ago; made the gamble that near-term expenditures
could be offset by long-term savings. Those savings never materialized. And, that's from a
Democrat governor in our state. And, as we have all watched it, savings never materialized in
Tennessee. They didn't materialize in Massachusetts. They didn't materialize in Maine. It is not
going to yield the savings that you're expecting an expanded coverage program to--
BOB SCHIEFFER (overlapping): Let me-- let me--
BOB SCHIEFFER: Let me just throw this in because I'm not sure the White House has the
same understanding of this as you do because the woman, Nancy DeParle who is kind in
charge of Medicare over there at the White House-- I mean health care over there at the White
House said this morning on Meet The Press. She thought that an up or down vote would be the
way to go on this. So, obviously, she's talking about trying to do it through reconciliation,
SENATOR KENT CONRAD: I-- Id say this to you, bob. I have said all year, I-- I am chairman of
the committee in the Senate. I think I understand how reconciliation works and how it can't work.
The major package of health care reform cannot move through the reconciliation process. It will
not work.
BOB SCHIEFFER: It will not work.
SENATOR KENT CONRAD: It will not work because of the Byrd rule, which says anything that
doesn't score for budget purposes has to be eliminated.
BOB SCHIEFFER (overlapping): All right.
SENATOR KENT CONRAD: That would eliminate all the delivery system reform, all the
insurance market reform, all of those things the experts tell us are really the most important
parts of this bill. The only possible role that I can see for reconciliation would be to make modest
changes in the major package--
BOB SCHIEFFER (overlapping): Okay.
SENATOR KENT CONRAD: --to improve affordability, to deal with what share of Medicaid
expansion the federal government pays. Those kinds of issues, which is the traditional role for
BOB SCHIEFFER: All right. Let me just go quickly around the table here and we literally have
about twenty seconds here. Senator Coburn, do you think at this point that health care reform of
some sort is going to pass? Or is it dead?
SENATOR TOM COBURN: I don't know the answer to that, Bob. What--
BOB SCHIEFFER: Okay. Senator Hoyer. I mean, Mister Hoyer?
REPRESENTATIVE STENY HOYER: I think so. You said some form. I hope a comprehensive
piece of legislation passes because the American people want it. Notwithstanding what Senator
Coburn said. They don't like the process--
BOB SCHIEFFER (overlapping): Yes or no?
REPRESENTATIVE STENY HOYER: --but they want the reform.
REPRESENTATIVE MARSHA BLACKBURN: No. The-- the people do not want it.
BOB SCHIEFFER: No? All right.
SENATOR KENT CONRAD: Well, we simply--
BOB SCHIEFFER: Times up. Yes or no?
SENATOR KENT CONRAD: We have to do it. We have to-- we have to-- we have to do it
because were on an unsustainable course.
BOB SCHIEFFER: All right. Thanks to all of you. Back in a minute.


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