'Meet the Press' transcript for August 16, 2009

SEN. DASCHLE:  Well, David, I—if you listen to his entire town hall meetings, I mean, every one of the different stakeholders come into the debate.  And as—and they should.  Obviously, there are very big concerns with regard to quality across the board.  But when we talk about insurance, we’re talking about too many people today who are the victims of our current system, who above and beyond anything else want to have the confidence in knowing they can buy insurance.  They want to know that they’re not going to be prohibited because they’ve got a pre-existing condition.  They want to know they can afford the premiums.  They want to know they’re not just one illness away from a bankruptcy.  They want to know, in other words, that we’ve got more stability and more, more ability to deal with the problems we’re facing in our healthcare system through, in part, the insurance system that we create. That’s what the president’s advocating.

MR. GREGORY:  All right, but what about that specific point about hospitals vs.  the insurance companies?

SEN. DASCHLE:  Well, obviously, he’s talking about hospitals.  He’s talking about the need for comparative effectiveness, he’s talking about the need for major change in the way we deliver health care, he’s talking about chronic care management and recognizing the importance of prevention; many of the things that, that hospitals are going to have to be a part of as well.  So I think it’s really, it’s, it’s imperative that you look at the entire context of, of this debate.  He’s going to single out insurance companies, he’s going to single out doctors, he’s going to single out drug companies.  He’s done all of that.  But I think everybody’s so, at least so far, of a mind that we’ve got, we’ve got to fix this system because the status quo’s unacceptable.

MR. GREGORY:  Senator Coburn, isn’t a big problem here an area of personal responsibility, and that is that you talk about healthcare costs, there is no consumer sentiment involved here.  It’s not like buying a car, when you know how much it costs and what it means to your bottom line.  Three-quarters of Americans get their healthcare benefits from their employers.  Most people do not pay their own—pay the bills for their health care.  They don’t know what it costs.  Look at this.  This is the average healthcare premiums provided to a, a family, this is from the Kaiser Family Foundation, $12,000-plus worth of premiums.  Your employer pays $9300 of that, the individual worker pays about 3300 of it.  People don’t know what the costs are.

SEN. COBURN:  There’s a disconnect, David, there’s no question, and so therefore we don’t—we don’t have a transparent market to price and quality, which I think everybody would like to see.  We would like to see it reconnected so that you have some personal responsibility.  The, the proposals before us really aren’t reform level.  What they are is more of the same. Now, Rachel just mentioned about how efficient Medicare is.  It’s not efficient.  The fraud rate’s anywhere from 15 to 20 percent.  If you add their true cost of overhead to their fraud rate, they’re about 7 points above what the average 10-K report, including profit, is for private insurance.  Now, they have a different motivation.  The point is, is any bill that comes through that increases cost is a failure, because we spend too much today.  We ought to be getting more efficiency.

MR. GREGORY:  Mm-hmm.

SEN. COBURN:  In other words, that—reconnect that economic.  We have one—I think—and Tom and I, I think, agree with this, we have way too much that doesn’t go to prevent somebody from getting sick and doesn’t help somebody to get well.  And how we redirect that?  You can redirect that with the government or you can redirect that by reconnecting, as you suggest, the economic consideration of an individual.  And we have a bill, the—there’s several senators in, that saves 70 billion the first 10 years and well close to a trillion dollars, plus $960 billion for the states in terms of doing just that.  In other words, we take Medicaid and put it into private care, where we’re really competing.

MR. GREGORY:  We’ve just—in our remaining time here, I want everybody to be heard on this.  I want to get to this final area that’s so contentious, and that is the idea of the public plan.  The idea here is that you’d have a public plan, a government plan that would be sponsored, give consumers choices alongside a private plan.

Senator Daschle, the president appears to be hinting that he’d be open to reform without a public plan.  Kathleen Sebelius, secretary of Home—Health and Human Services saying he would be open to these idea of a cooperatives rather than a public plan.  Does a public plan have to be in this reform effort for the president to sign it?

SEN. DASCHLE:  Well, if you want to control costs most effectively, if you want to make sure there’s adequate competition, if you want to keep the insurance companies accountable, if you want to do everything possible to give the American people as much choice as possible; if you want to do all of that, then a public plan should be a viable part of the plan.

MR. GREGORY: But will the president live without it?

SEN. DASCHLE:  Well, I can’t speak for the president.  All I know is he wants to get a bill done.  He’s going to go as far as he can to get that public plan, because he’s advocated it at every single stop.  But whether or not it’s there at the end of the day is something that only Congress can decide.

MR. GREGORY: Congressman Armey, is a public option competition, or is it an unfair fight?

REP. ARMEY:  It’s an unfair fight.  If you read the bill, they’ve built in taxes, regulations, administrations, requirements, fines, penalties that discourage the private option.  But we have 1300 private insurance companies in America.  If you want competition in the purchasing of insurance, just listen, just listen in to Congressman Shadegg from Arizona and let people buy across lines.  Why can’t I live in Texas, buy my insurance in Oklahoma?  What if I were—Michigan passed a law that says if you live in Michigan you can’t buy a car made in Alabama?  You’d think me silly.  But what you have now—so the fact of the matter is, let us have fair competition, my freedom to choose among the 1300 already existing private companies.  The government is what prevents that from happening.

MR. GREGORY:  Yeah.  Go ahead.

MS. MADDOW:  I don’t know what state in the country has secretly more awesome health care than every other state in the country.  I sort of feel like every state in the country is in the same pickle when it comes to out-of-control costs, dissatisfying coverage and a huge number of uninsured people.  That’s not going to be made better by allowing insurance to be bought across state lines.  I think that the private insurance companies would be really, really, really excited if what came out of this debate was a requirement that Americans buy more private insurance that they were dissatisfied with, that allowed them to be dropped for—precluded from pre-existing conditions...

MR. GREGORY:  Right.

MS. MADDOW:  ...all the other things they do.  There needs to be serious reform of private insurance, and the only way to get that is to have a public option that people can choose if private insurance continues to not insure our needs as a country.

REP. ARMEY:  You know, it’s...

MR. GREGORY:  Let me bring in Bruce Josten.  He’s the executive vice president of the Chamber of Commerce.  They have a perspective on this.

Sir, your, your organization, the Chamber, has been buying ads opposing a public option.  The CBO, the Congressional Budget Office, has done a study indicating that, in fact, the number of those in private health plans would go up if there was a public option.  They also say that about 11 million people would choose a public option, which is far fewer than opponents say would be the case.

MR. BRUCE JOSTEN:  Thank you, David.  We do oppose a public option because—in part because of what you just touched on earlier.  We have a long history of both Medicare and Medicaid under reimbursing doctors and hospitals, 70 to 78 percent of what private payers do.  Those under reimbursements ultimately then are cost-shifted back to the premium payers, which are the companies in America that you’ve pointed out in your show are providing healthcare coverage to the vast majority of Americans, over 160 million of them.

Now, with respect to the need for insure—insurance reform and healthcare reform, the business community is one of the strongest proponents and we have been for several years.  We ran, in fact, ads last year calling for reform and more choices and bending the cost curve on health care.  But when you under reimburse and it gets cost-shifted and you’ve got doctors practicing defensive medicine out of fear of liability, we’re corrupting the system.  So if we’re going to have a level playing field, a public plan is an uneven playing field.  It’ll destabilize private insurance.  And independent researchers in the healthcare analytical area, as well as CBO, have expressed concerns that many employees could migrate away from employer-sponsored cover because of that competitive cost advantage initially with federal government backstopping.

MR. GREGORY:  All right, Mr. Josten, thank you very much.  Senator Daschle:

SEN. DASCHLE:  Well, David, I guess the, the basic question is, are we building this new system for the American people or for the insurance companies?  I mean, that’s really the key question.  How will they be better served?  We have a public option for Medicare Part D today, 6 percent of the people participate.  I mean, there is a very small percentage of people that for all kinds of reasons have chosen the public plan when it comes to drugs. I think the argument is kind of interesting.  It is that, well, this is going to be so popular that people are going to leave the private sector and go to the public sector.  Well, that’s what choice is all about.  But I think what we’ve got to do is to ensure that we’re going to level the playing field. We’re going to make sure that the competition is fair.  But you’ve got a choice; either you’ve got to have the competition, or you’re going to have a regulatory framework, within which the private insurance industry is going to have to work.

MR. GREGORY:  Is it significant, Senator...

SEN. COBURN:  But there’s a big difference in what he said, though, on Medicare Part D.  You allowed nationwide competition of insurance.

SEN. DASCHLE:  That’s what we’re doing with this.

SEN. COBURN:  It—No, no, you’re not.  You’re, you’re regionalizing it.  Look at the House bill, look at the Senate bill.  You’re regionalize—you’re making it a state base.  The difference is, is in New Jersey the same thing that costs $600 in Missouri costs 9,000.  It’s because of mandates.  And what we need—and we all agree, we need more competition among the insurance industry. But the way to get it is to open up.

MR. GREGORY:  All right, let me—I want to ask you about a point of news, though, here today.  If the president is willing to accept reform without a public plan, without a public option, if he, if he can live with strong, you know, cooperatives that allow some choice for consumers, can that attract more bipartisan support?  Will Republicans sign on?

SEN. COBURN:  Well, I think, I think that there is potential for that.  I think the other thing that we need to remember is inside the House bill and inside the Senate bill is 87 new government programs requiring well over 150,000 new federal employees.  We can’t accept that, because that is government management of health care and not individual management.

I want to make one other point on, on the comparative effectiveness.  The problem with comparative effectiveness is it divides the loyalty of the physician away from the patient.  It takes what is important for you as my patient, and all of a sudden I’m looking over here because somebody here’s telling me what I can do rather than what I know...

SEN. DASCHLE:  This is...

MR. GREGORY:  Respond quickly, and then I want to...

SEN. COBURN:  ...rather than what I know needs to be done in your best interest.

MR. GREGORY:  Let me get a quick response.

SEN. DASCHLE:  Let me just say, this is just a Consumer Reports on best practices.  That’s what we’re talking about with regard to health care. Consumer Reports.

SEN. COBURN:  Then why...

SEN. DASCHLE:  And your question about bipartisanship, David...

MR. GREGORY:  Right.

SEN. COBURN:  Then why would they block a prohibition on rationing?

SEN. DASCHLE:  Nobody is blocking...

MR. GREGORY:  All right, hold on, I want to let Senator Daschle respond. We’re almost out of time.

SEN. DASCHLE:  I just—just to, to your point about bipartisanship.  The Bipartisan Policy Center—Bob Dole, Howard Baker and I—put together a plan that did exactly what we’re talking about.  They were very, very supportive of it.  And so I think there is, there’s a very good opportunity for us to produce...

MR. GREGORY:  Let, let me...

SEN. DASCHLE:  ...a bipartisan product in the Congress.

MR. GREGORY:  You said, you said it was 50-50 whether he’d get reform.  Is that still your view?

SEN. DASCHLE:  That’s correct.

MR. GREGORY:  It’s still your view, only 50-50.

SEN. DASCHLE:  Yeah.

MR. GREGORY:  Rachel, let me ask you this question.  What will progressives, what will liberals, the president’s base accept as reform?  Do the independent voters he’s courting out in Colorado and Montana need to be placated, a big part of his base, or not?

MS. MADDOW:  I, I, I mean, I don’t, I don’t think liberals monolithically feel one thing about this.  I think most liberals would probably prefer a single payer system, honestly.  But ultimately, if the president decides that he’s going to go with a reform effort that doesn’t include a public option, what he will have done is spent a ton of political capital, riled up an incredibly angry right wing base who’s been told that this is a plot to kill grandma, grandma, and he will have achieved something that doesn’t change health care very much and that doesn’t save us very much money and won’t do very much for the American people.  It’s not a very good thing to spend a lot of political capital on.

MR. GREGORY:  Tactically—I know you’re opposed to this philosophically, ideologically.  Tactically you were part of that fight in ‘93, ‘94.  You said it was crucial for Republicans taking over the House.  Does the president achieve something this time?

REP. ARMEY:  No, I don’t think he does.  And I think the fact that he’s now signaling his willingness to back off on the public option and put in the surrogate, which is the government-sponsored cooperatives, which is what we probably will be calling them “Freddie Mad” or, or “Fannie Mad,” as GSCs, as we know in the finance industry, are a horrible exercise in impudent practices.  But it’s interesting.  When we argued for years that we should have private cooperatives where associations could put together these purchasing risk pooling things...

SEN. DASCHLE:  Yeah.  Associations...(unintelligible).

MR. GREGORY: OK.

REP. ARMEY:  ...the—all the liberals were against that.

MR. GREGORY:  Right.

REP. ARMEY:  Now if we have government-sponsored cooperatives, they’re for it.  But don’t make any mistake about that government-sponsored cooperative.

MR. GREGORY:  All right.  I’m going to let that be the last word.

SEN. DASCHLE:  That...

MR. GREGORY:  Thank you all.  There’s a lot more on this obviously to come, and the challenge the president has is, is really making this a big issue of the day.

We will be back.  We’ll have a special Take Two with MSNBC’s Rachel Maddow, ask her some questions that our viewers have submitted via e-mail and Twitter. You can watch the MEET THE PRESS Take Two Web Extra.  It’s up this afternoon on our Web site.  Also, updates from me throughout the week.  It’s mtp.msnbc.com.

And when we come back, remembering the remarkable life and legacy of Eunice Kennedy Shriver.

(Announcements)

MR. GREGORY:  And finally here, in the heat of August and in the heat of the moment of this healthcare debate, the country marked the loss and celebrated the life of an inspirational woman, Eunice Kennedy Shriver.  She died this week at the age of 88.  Shriver was well known to many because she was a Kennedy, a strong sister to some very famous Kennedy men:  John, Bobby and Teddy.  She will be remembered, however, because of what she did for others. Shriver founded the Special Olympics in 1968.  She was devoted to helping those like her sister Rosemary, who had intellectual difficulties, what used to be called mental retardation.  Here she was speaking to Special Olympians.

(Videotape)

MS. EUNICE KENNEDY SHRIVER:  The world said that people with intellectual problems should not be seen in public.  Tonight you are part of the year’s largest sporting event, and the world is watching.

(End videotape)

MR. GREGORY:  Her daughter Maria this week at her mother’s funeral.

(Videotape)

MS. MARIA SHRIVER:  She was the real deal, a woman who did everything women aspire to.  She had a great husband, she had a great family, a deep, deep faith in God; and she combined that with being a fearless warrior for the voiceless.

(End videotape)

MR. GREGORY:  Tim Russert once asked Senator Ted Kennedy here whether his sister Eunice would be a good president.

(Videotape)

SEN. TED KENNEDY:  That’s what my brother Jack always said.  She said—he said that she was the, the best on it.  I—and Jack was always right.

(End videotape)

MR. GREGORY:  But she never ran for office.  Instead, she did what her strong faith in God called her to do:  She worked to make things better for others. I thought her son Robert said it well in a 2004 interview:  “My mom never ran for office and she changed the world, period, end of story.” We’ll be right back.

(Announcements)

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

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