'Meet the Press' transcript for July 19, 2009

MR. GREGORY:  Right.  Let me get to the other priority here, which is coverage of Americans.

SEC'Y SEBELIUS:  Right.

MR. GREGORY:  Forty-seven million Americans, roughly, uninsured right now. Is universal coverage the priority?

SEC'Y SEBELIUS:  It isn't the priority, it's one of the priorities:  cost, quality, coverage.  All three have to be part of this fundamental reform.

MR. GREGORY:  So if there are, say, millions of Americans who are left uninsured, it would not stop the president from signing a healthcare reform bill?

SEC'Y SEBELIUS:  Well, I think that it--one of his goals, again, it, it's not one or the other.  He wants a bill that covers all Americans, that offers affordable, quality coverage to all Americans.

MR. GREGORY:  We have some experience with universal health care now in Massachusetts...

SEC'Y SEBELIUS:  That's right.

MR. GREGORY:  ...and they're taking a hard look at that, because on the issue of costs it doesn't appear to be going so well.  This is how the Wall Street Journal reported it on Friday:  "In 2006, Massachusetts adopted a healthcare law that was attain near-universal health insurance coverage...[b]ut the plan has done little to control costs, which are now 33 percent higher than the U.S. average and projected to grow faster than the rest of the country." Is that another flashing red light here?

SEC'Y SEBELIUS:  Well, I think--I've had a lot of discussions with the Massachusetts individuals, including the head of their retail association, who was very involved in passing the bill.  He said they made a fundamental mistake, they did this as two steps; they went for universal coverage, now they have a group back at the table revisiting the costs.  What the president has said from the outset is we need to do them both together.  We need to have this as a comprehensive reform that both covers all Americans, but also lowers costs.

MR. GREGORY:  But what are you doing to anticipate the result that you've already seen here, which is universal coverage, covering more people, subsidizing more people to get insurance...

SEC'Y SEBELIUS:  That's right.

MR. GREGORY:  ...drives up costs, does not bend the cost curve.

SEC'Y SEBELIUS:  Well, not unless you incorporate that at the outset, and that's why 16 of these proposals are already in.  We're going after fraud and abuse in a, in a fundamentally different way.  We know there are billions of dollars stolen out of the system every year.  It's why the president insistent on the public option.  One of the ways to lower costs...

MR. GREGORY:  The idea--public option of a government plan that competes with private insurance plans.

SEC'Y SEBELIUS:  Competing.  We have insurance companies right now who pick and choose not only who gets covered, but basically with monopolies in many parts of the country, drive the costs up.  We need some competition in the system to bring those costs down.

MR. GREGORY:  Right.  Because a public plan would necessarily be less expensive.

SEC'Y SEBELIUS:  Competition will lower costs.

MR. GREGORY:  Right.  But a public plan would necessarily, for it to, to work, would be less expensive for consumers.

SEC'Y SEBELIUS:  Well, I think it will...

MR. GREGORY:  Right.

SEC'Y SEBELIUS:  ...I think it will lower the overhead costs that are often 30 cents on the dollar, give some affordable options to small business owners and self-employed Americans and help jump-start this economy.

MR. GREGORY:  So why wouldn't everybody go to a public plan, then?  If it's less expensive, why wouldn't everybody choose that?

SEC'Y SEBELIUS:  Well, I think that a lot of people have coverage they like. I think what you'll see is private insurers will be competitive.  They will have innovative practices, they'll compete for benefit plans that may be more attractive.  That's what we want in a marketplace.

MR. GREGORY:  All right.  Let's talk about quality.  And you mentioned, if I like my insurance, I'm going to be able to hold on to it.  That's what the president talked about in his weekly radio address.  Listen to that.

(Videotape, Saturday)

PRES. OBAMA:  Under our proposal, if you like your doctor, you keep your doctor.  If you like your current insurance, you keep that insurance.  Period, end of story.

(End videotape)

MR. GREGORY:  But is that truth in advertising?  The AP did an analysis of this, and this is what they reported Saturday:  "It's a pledge beyond Obama's control.  His plan leaves companies free to charge their health plans," rather, "to change their health plans in ways that workers may not like or to drop insurance altogether." If an employer says, "We can't afford what we've got," a small business owner, they can change whether the employee likes it of not.

SEC'Y SEBELIUS:  Well, David, that is the--that's exactly what's happening in this marketplace.  We have 12,000 Americans each and every day losing coverage.  We have small business owners, over half of whom used to offer coverage, who don't anymore, who are being priced out of the marketplace. What the president is talking about is stabilizing employer coverage, making it easier for small employers to, first of all, offer coverage.

MR. GREGORY:  Mm-hmm.

SEC'Y SEBELIUS:  A lot of them tell me, "We can't compete for good employees because they'll go down the street to somebody who's got health benefits when I can't offer them." We got people locked into their job who would like to start a small business or work for somebody else.  We have parents terrified when their kids graduate from college, happy day, but they're suddenly uninsured and some of them uninsurable.  We have a system that absolutely doesn't work.

MR. GREGORY:  But it doesn't address the fact that if you like your insurance you may not be able to keep it, like the president says.

SEC'Y SEBELIUS:  Well, the employer market would be more stable in a new reformed healthcare system than it is right now, and that's really what the president is talking about, where employers would have help and incentives to offer coverage to their employees.  Small employers would have a tax incentive and be excluded from the pay or play, be able to stabilize that marketplace and be far more competitive than they are right now.

MR. GREGORY:  You can't have it all, though.  The president said no free lunches.

SEC'Y SEBELIUS:  That's right.

MR. GREGORY:  And what I have not heard from the president and I wonder what you would say to Americans, what is it that they have to sacrifice in order to achieve this goal of universal coverage?

SEC'Y SEBELIUS:  Well, I think both the House and Senate bills are contemplating some responsibility that both--that everyone would, would have a, a responsibility to have health insurance, that business owners would have a responsibility to provide health insurance and that the government would do their fair share.  We're also hoping that that personal responsibility extends to lifestyle; that in order to have a healthier America, a more productive America, we need to make some basic changes in what we eat, how much we exercise, getting our kids up off the couch, turning off the video games.

MR. GREGORY:  Right.

SEC'Y SEBELIUS:  But that's a personal responsibility that all of us can take.

MR. GREGORY:  But the government, in this plan, would say there are certain things we're not going to pay for.  Do Americans have to accept the fact that there's going to be some limit to what gets paid for?

SEC'Y SEBELIUS:  There's limits right now.  Insurance companies pick and choose every day who gets what benefits, who gets what drugs, whether or not you get the procedure your doctor ordered.  This notion that we're going to somehow ration in the--rationing is going on each and every day and it's done in the private market.  I think what has to happen is we know about 30 percent of the tests that are done don't make us any healthier.  We know that there are areas in the country where there's a redundancy of medical procedures, people readmitted to the hospital, other areas where there's high quality, low cost care.  That's what we want every American to have access to.

MR. GREGORY:  Let's talk about how you're--the, the, the other principle here, the president says it's got to be paid for, it can't add to the deficit. Let's talk about how you want to do that.  The House plan would levy a surtax on the richest Americans, and there's some concern about that even among Democrats.  This was The New York Times' analysis on Saturday: "Representative Jared Polis, a freshman Democrat from Colorado...said he worried that the new taxes `could cost jobs in the middle of a recession.' To help finance coverage of the uninsured, the House bill would impose a surtax on high-income people and a payroll tax--as much as 8 percent of wages--on employers who do not provide health insurance to workers...In a letter to the House speaker, Nancy Pelosi, Mr. Polis and 20 other freshman Democrats said they were `extremely concerned that the proposed method of paying for healthcare reform will negatively impact small businesses, the backbone of the American economy.'" Does the president support a surtax on the richest Americans to get this health care paid for?

SEC'Y SEBELIUS:  What the president supports is paying for this bill.  He has said that it will not add a dime to the deficit, that we won't pass it along.

MR. GREGORY:  But does he support this?

SEC'Y SEBELIUS:  He knows that the House has a plan to pay for it.  That's very good news.  The Senate has a...

MR. GREGORY:  But why won't he commit, Madam Secretary?  Why can't the American people know what it is he'll support?  This is a very concrete plan that is now moving its way through the House.

SEC'Y SEBELIUS:  I understand, David.  But as you know, there are basically five different plans in Congress right now and there are a variety of ways. What's the good news, this Congress and this president are committed to paying for this over time.  In the last bill, the Medicare bill in 2003, billions of dollars of new drug benefits were provided for America's seniors.  That's good news, they needed the drug benefit.  Not a dime was paid for, not an effort to put any money on the table.  so we are committed to paying...

MR. GREGORY:  But we're talking about this plan, we're talking about this plan.  But...

SEC'Y SEBELIUS:  And it will be paid for.

MR. GREGORY:  You say you're committed, but you won't say whether you support this surtax.

SEC'Y SEBELIUS:  Well, I think the ideas are in play.

MR. GREGORY:  All right.

SEC'Y SEBELIUS:  This is a very legitimate way to go forward.  The Senate is working on some other ideas.

MR. GREGORY:  Right.

SEC'Y SEBELIUS:  The president has put forward his ideas.  In all the plans, more than half the money to pay for this proposal is already in the system. It's money that is misdirected now to efforts that don't work very well.  So a lot of the money is really coming from savings and efficiencies from fraud and abuse from other areas and being directed to high quality, lower cost care.

MR. GREGORY:  Does the president believe if everybody benefits under healthcare reform, everybody should pay?

SEC'Y SEBELIUS:  Absolutely.  Absolutely.

MR. GREGORY:  He does?  Then why is it he doesn't support taxing benefits for employees?

SEC'Y SEBELIUS:  Well, he's always said from the outset that he's--back to the notion that you should keep your coverage if you have it, that that may dismantle the private market, that it is the incentive given to employers to provide coverage.  And what he--180 million Americans have coverage through their employee workplace, and a tax on those benefits may dismantle that market and then have people lose their coverage.  So he's reluctant to move in that direction without...

MR. GREGORY:  Even though that's consistent with the idea of if everybody benefits, everybody pays.

SEC'Y SEBELIUS:  Well, I understand.

MR. GREGORY:  He thinks that upper-income Americans should shoulder most of the burden.

SEC'Y SEBELIUS:  Well, not most of the burden.  As I say, half the money in all the plans is already in the, in the system.  There are a variety of proposals to raise revenue.  The House has one that's a very legitimate proposal.  The Senate is working on others.

MR. GREGORY:  Right.

SEC'Y SEBELIUS:  The Senate Finance Committee hasn't come out with their proposal.  He talked about a cap on, on itemized deductions that he still thinks is a very legitimate way to go.

MR. GREGORY:  Right.

SEC'Y SEBELIUS:  So there are a variety of proposals on this.  But it will be paid for, it, it will not add to the deficit, and that's very good news.

MR. GREGORY:  On timing, will the president meet his deadline?  There are Democrats who say, "We shouldn't have a fixed deadline to do this by the August recess, we need more time." What will his bottom line be?

SEC'Y SEBELIUS:  Well, I think he's, he's very clearly urging the House and Senate to stay at the table and work.  They're working very hard.  The August recess is looming.  The bills are--the good news is, you know, that this week America's doctors, through the American Medical Association, endorsed the health reform bills.  The nurses have endorsed the health reform bills.  The hospitals and drug companies and others are at the table.

MR. GREGORY:  Right.

SEC'Y SEBELIUS:  And we think this can be done.  The House and Senate are on track and on time, and we think that he...

MR. GREGORY:  He's urging, but not demanding.

SEC'Y SEBELIUS:  Well, I, I--he isn't a member of the House or the Senate.

MR. GREGORY:  Right.

SEC'Y SEBELIUS:  He's saying this is an important issue.  It may be the single most important issue to get our economy back on track, and the status quo cannot work.  It doesn't work.  It's bankrupting this country.

MR. GREGORY:  But it looks like that deadline could slip.

SEC'Y SEBELIUS:  Well, hopefully they'll get it done before the August recess.

MR. GREGORY:  Before you go, on the issue of swine flu, which is still moving throughout the country and around the world, the fall is a big concern.

SEC'Y SEBELIUS:  That's right.

MR. GREGORY:  Will there be a vaccine ready, if necessary, and how big of a hit do you think we'll feel in flu season?

SEC'Y SEBELIUS:  Well, we, we don't know how big a hit.  We're watching the Southern Hemisphere, which right now is in flu season, and H1N1 is moving.  So far it hasn't gotten more lethal, but the cases continue to grow.  We're on track to have a vaccine ready by mid-October.  We need to make sure it's safe, and so clinical trials will begin.  And we need to make sure it's, it's effective against this new novel strain.  So that's what's happening in the meantime.  And if the scientists say it's a go, by mid-October we will have a vaccine available and start with the priority communities.

MR. GREGORY:  We will leave it there.  Secretary Sebelius...

SEC'Y SEBELIUS:  Thanks.

MR. GREGORY:  ...thank you very much for being here.

SEC'Y SEBELIUS:  Nice to be with you.

MR. GREGORY:  Up next, the other side of the healthcare debate and a look at the upcoming vote on Supreme Court nominee Judge Sonia Sotomayor.  We'll be joined by the Senate Republican leader Mitch McConnell.  Plus, insights and analysis from our political roundtable, coming up only on MEET THE PRESS.

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