'Meet the Press' transcript for Sept. 6, 2009

MR. DAVID GREGORY:  This Sunday, going for broke on healthcare reform.  After the divisive debate of the summer, the president will detail his plan before a joint session of Congress this week and try to regain control of the debate. While liberals in his party demand a public option, centrists and Republicans oppose it.  Is there room for compromise?  We'll ask the man behind the president's message and new strategy, senior adviser David Axelrod.

Then the hard choices and political realities as the president pursues his agenda this fall.  Health care and the economy, Afghanistan and terrorism eight years after the 9/11 attacks.  With us, former mayor of New York City and 2008 Republican presidential candidate Rudy Giuliani; the chairman of the Democratic Leadership Council, former Congressman Harold Ford; New York Times columnist Thomas Friedman; and special correspondent for NBC News Tom Brokaw.

But first, the president's senior adviser, David Axelrod, joins us now live.

Welcome back to MEET THE PRESS.

MR. DAVID AXELROD:  Thanks, David, good to be here.

MR. GREGORY:  So here is the state, the landscape that the president now faces on health care.  A poll this week shows a majority of Americans oppose, 51 percent, Republican leaders in the past few days have been saying if the president's going to speak before Congress, it's time to hit the reset button and start over.  Will he?

MR. AXELROD:  Well, look, first of all, understand that when people hear the details of where the president wants to go, bringing stability to people who have insurance today and security for them and helping those who don't have insurance get insurance, they support this plan.  So the president has an opportunity on Wednesday to speak to the nation and the Congress on this.  I think that he'll engender great support for where he wants to go.  We've been through a long debate now.  All the ideas are on the table.  It's time to bring the strands together and get the job done for the American people here.

MR. GREGORY:  Is this his plan that he'll present on Wednesday?

MR. AXELROD:  Well, I think there are elements--look, all the ideas are on the table, David.  The president set forth principles at the beginning of this discussion at the beginning of the year and now all the ideas are on the table and the president will say we agree on 80 percent of this, let's, let's do the final 20 percent, let's get the job done, and here's how I think we should do it.

MR. GREGORY:  But if Americans are confused, if they think this healthcare plan is negative, if they're scared by it, some even think it's socialism, what's the one thing that Americans will come away with on Wednesday?  What will they know about this plan?

MR. AXELROD:  Well, I think they'll come away with a clear sense of what it is and what it's not.  What it is is a plan that, again, will give more security and stability to people who have insurance today and it'll make it easier for those who don't to get it.  You said in your open the president's going for broke.  The idea here is to keep the American people from going broke as a result of soaring healthcare costs that have doubled in the last 10 years, risen three times the rate of wages.  We want to bring security to the people who have insurance so that they're not thrown off their insurance if they get sick, so that if they lose their job or change their job, they'll still have coverage, so that people with pre-existing conditions can get insurance.  That's what the American people need to know.

MR. GREGORY:  Let's talk about ideas on the table.  The big one is the so-called public option, a government plan that would be alongside private insurance plans to try to create competition and drive down costs.  This is what the president said back in July about the public option.

(Videotape, July 18, 2009)

PRES. BARACK OBAMA:  That's why any plan I sign must include an insurance exchange, a one-stop shopping marketplace where you can compare the benefits, costs and track records of a variety of plans, including a public option to increase competition and keep insurance companies honest, and choose what's best for your family.

(End videotape)

MR. GREGORY:  Does the president stand by that statement?

MR. AXELROD:  You know, he certainly believes that a public option within this exchange would be important.  Let's, let's, let's focus on what the issue is.  There are 10...

MR. GREGORY:  He said it must be included, David.  He said it must be included.

MR. AXELROD:  He said there must--he said there must be a, an exchange where people can get insurance at a competitive price.  He believes in competition and choice.  The public option is a, is an important tool to help promote that where there is no competition.  He still believes that.  But here's the problem, David.  If you don't have insurance today, if don't have insurance through your employer and you need to get a policy, it costs you three times as much, on the average, as it would if you had employer coverage.  People simply can't afford it.  One of the ways--so we want to create a pool in which people who don't have insurance, and small businesses, can go and get insurance at a competitive price.  And a public option would be a valuable tool within that group, that package of plans that would be offered, private and public.

MR. GREGORY:  I just want to be clear here because in his statement, he was unequivocal.  He said it must be included.  A public plan must be included. Is he now signaling that he would compromise on that if you could still have some measure of competition?

MR. AXELROD:  Well, first of all, you'd have to take the whole statement.  He believes that a health insurance exchange where people can go, small businesses, people who don't have insurance can get insurance at an affordable price is still essential to any health reform and he believes a public option would be an important part of that package.  He hasn't changed his view.

MR. GREGORY:  This is what the House speaker says, Nancy Pelosi.  She draws a line in the sand.  She says the following, "Any real change requires the inclusion of a strong public option to promote competition and bring down costs.  If a vigorous public option is not included, it would be a major victory for the health insurance industry.  A bill without a strong public option will not pass the House.  Eliminating the public option would be a major victory for the insurance companies.  We have rationed care, increased premiums and denied coverage." Does the president agree with the House speaker?

MR. AXELROD:  Well, he certainly agrees that we have to have competition and choice to hold the insurance companies honest.  We have to have insurance protections for folks who have insurance, so they can't do the kinds of things that they've done in the past, arbitrarily throwing people off their insurance if they have a pre-existing condition or if they get seriously ill.  He agrees with all of that.  The idea here is to bring more security and stability to people who have insurance and to help those who don't have insurance get it at a price they can afford.  The public option within that exchange is certainly a valuable tool.

MR. GREGORY:  The reality is as a political matter, you cannot get Republicans to sign on nor can you get moderate Democrats, maybe 10 or 12 of them to sign on if the president fights for the public option.  True or false?

MR. AXELROD:  Look, why don't we let the president speak and make his case and then we can have this discussion.  I believe that there's enormous consensus around a broad number of issues that would make a great difference for people who have insurance and people who need insurance and we have to build on that.  And I think the president will be able to do that on Wednesday night and we'll go from there.

MR. GREGORY:  What about the idea of a trigger, which is to say that you can introduce a government plan into states if the private insurance market doesn't succeed at driving down prices?  Does the president think that's an idea worth considering?

MR. AXELROD:  Well, I'll let the president address the specifics on Wednesday, David.  But again, the goal here is to create competition and choice.  There are markets where there are insurance companies that, that have 90 percent of the business, states in this countries.  So it's very difficult to discipline the insurance companies on price and on the quality of care. Competition would do that and give the consumers a better break.  He's for promoting competition and choice.

MR. GREGORY:  So a trigger is still possible?

MR. AXELROD:  Well, again, I'll let him address this.  He believes the public option is a, is a good tool.  Now, it shouldn't define the whole healthcare debate, however.  There are, you know, the insurance guarantees that are in there for the 160 million people who have employer-based coverage are absolutely essential so that they have, you know, the ability to hang on to their insurance if they get seriously ill and not get thrown off.  If they have someone in their family with a pre-existing condition, they can get them covered and so on.  We have to--that there's a cap on out of pocket expenses so if you get sick, you don't go broke.  These are the that health reform would bring to people who have insurance today as they hold on to the policies that they have.

MR. GREGORY:  Let's look at the president's political standing over the course of this summer as this debate has raged on.  Among independent voters, these are the voters you know well, who actually delivered the presidency to Mr. Obama, and the numbers have flipped now.  Since July, his approval rating overall among independent voters down to 43 percent.  Did the administration lose control of the healthcare debate?

MR. AXELROD:  Now look, this is a difficult issue, David.  We knew that. We've been trying to solve this for four decades and the problem's only gotten worse as Washington dithered.  But the reason it's difficult is because it inspires great passions and we, we knew that.  But let me tell you something. The president of the United States is not sitting there reading his poll numbers.  The president--the numbers he's reading are the 12 million people who've been excluded from insurance in the last few years because they have a pre-existing condition.  He's reading letters from people who have lost their insurance simply because they became seriously ill.  He's worried about the continued doubling every 10 years of healthcare costs and what that means for families and businesses and the government itself.  Those are the numbers that he cares about.  That's what he's focused on and he believes that if you do the right thing, you solve problems, that the rest will take care of itself. So you know, we're going to forge forward, get this done.  It's going to be an advance for the American people and I think ultimately that will, will, will pay great dividends politically.  But that's not the motivation.  Solving the problem is what we have to focus on.

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