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Senate Debate on Health Care Will Put Lawmakers to the Test

November 23, 2009 at 12:00 AM EDT
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While health care reform passed a key Senate hurdle over the weekend, the legislation still faces a full-scale floor debate. Judy Woodruff asks former secretaries of health to preview the road ahead for President Obama's top domestic priority.

JIM LEHRER: Now: the road ahead for health care reform.

Judy Woodruff has our story.

JUDY WOODRUFF: President Obama voiced hope today that his campaign for health care reform was nearing completion.

U.S. PRESIDENT BARACK OBAMA: I updated the Cabinet on the progress that we’re making on the health insurance reform legislation that’s moving its way now through the Senate, and reiterated the urgent need for us to get to the finish line.

SEN. CHRISTOPHER DODD, D-Conn.: Are there any senators who wish to vote or to change their vote?

JUDY WOODRUFF: It took a party-line vote Saturday night to squeeze past the latest obstacle. By 60-39, the Senate agreed to begin debate on Majority Leader Harry Reid’s health care reform legislation.

It aims to extend health coverage to an estimated 31 million uninsured Americans, at a cost of $848 billion over the next decade. After the vote, Leader Reid acknowledged, he still has a lot of work to do.

SEN. HARRY REID, D-Nev.: The road ahead is a long stretch, but we can see the finish line. We have the momentum that’s going to keep this process moving, I have no doubt.

JUDY WOODRUFF: In fact, Reid needed sweeteners just to get Democrats to move the bill this far, including $300 million in federal aid for Senator Mary Landrieu’s home state of Louisiana. And Landrieu warned she might not support the bill in the end.

SEN. MARY LANDRIEU, D-La.: My vote today should in no way be construed as an indication of how I might vote.

JUDY WOODRUFF: Moderate Democrats holding the critical swing votes generally object to the concept of a public option.

Arkansas’s Blanche Lincoln:

SEN. BLANCHE LINCOLN, D-Ark.: Let me be perfectly clear. I am opposed to a new government-administered health care plan as a part of comprehensive health insurance reform.

JUDY WOODRUFF: By Sunday morning, there were more signs of cracks in the Democratic coalition. Appearing on NBC’s “Meet the Press,” independent Democrat Joe Lieberman of Connecticut said he agreed to let debate begin, but vowed again he will not vote for a final bill that includes any new government-sponsored health insurance.

SEN. JOSEPH LIEBERMAN, I-Conn.: The public option in Senator Reid’s bill will actually charge more for insurance than the average charge by health insurance companies. But I can tell you one thing I’m sure it will do. If we create a government insurance company, it’s going to run a deficit. And it’s only the taxpayers who are going to pay for it.

JUDY WOODRUFF: Still, New York Senator Charles Schumer and other Democrats insisted that, if anything, the public option needs to be strengthened.

SEN. CHARLES SCHUMER, D-N.Y.: So, you need to inject some competition into the insurance industry. The best way to do that is a public option. And the program that we have put together is set up by the government, but then it’s on its own. There is no intent for it to compete unfairly against private insurance.

JUDY WOODRUFF: On the other side of the aisle, Republican senators promised their all to kill the bill. Minority Leader Mitch McConnell spoke Saturday night.

SEN. MITCH MCCONNELL, R-Ky.: We’re going to do anything and everything we can to prevent this measure from becoming law.

JUDY WOODRUFF: Democrats like Dick Durbin of Illinois shot back, they want Republican help, but said they will go it alone if need be.

SEN. RICHARD DURBIN, D-Ill.: We are going to move forward. After Thanksgiving, everyone will have had a chance to take a close look at this bill on the Internet. And we can start this debate. I hope it will be a meaningful one and a positive one, not a filibuster-loaded debate, where we really don’t get down to the basics.

JUDY WOODRUFF: The Senate is scheduled to begin debate on the health care bill next Monday.

And now to help put that debate in context, we are joined by two former secretaries of health and human services. Donna Shalala served in the Clinton administration from 1993 to 2001. She is now president of the University of Miami and a professor of political science. And Michael Leavitt worked under President George W. Bush from 2005 to 2009. A former three-term governor of Utah, he is founder and chairman of his own consulting firm.

Thank you, both, for joining us.

Donna Shalala, to you first.

Based on what you know now, do you believe that health care reform legislation is going to pass this year?

Why reform will pass

Michael Leavitt
Former Sec.of Health and Human Services
I think something will pass. I'm just not certain what will be in it. I don't think it will be as robust as the two bills that we're seeing right now.

DONNA SHALALA: I do. I do because millions of Americans don't have health insurance. And we can't be competitive as a nation unless we have a very strong work force. So, I think we're going to get it, even if we have to do it just with Democratic votes.

My deep hope is that there will be bipartisan support in the end for the bill. But we're going to have a major debate. And that's good.

JUDY WOODRUFF: Michael Leavitt, what do you think the prospects are?

MICHAEL LEAVITT: Judy, I think something will pass.

What will actually be in it, we don't know yet. There's deep concern about the cost of this, deep concern about what it does to the health care of those who have insurance already. There's deep concern about the cost of it. I think we will have -- I agree with Donna Shalala -- I think we're going to see a substantial debate.

I think something will pass. I'm just not certain what will be in it. I don't think it will be as robust as the two bills that we're seeing right now.

JUDY WOODRUFF: Michael Leavitt, staying with you, what would health care look like in America if -- in this country -- if the bulk of this were to pass, become law?

MICHAEL LEAVITT: Every American needs to have affordable health insurance. That is not the debate here. The question is, how can we achieve that? So, I believe, if we had the ideal world that we would all like to see occur, we would see every American having an affordable, basic insurance plan.

We would also begin to see real debate on how to reform the system, how to change the system, so that what we do have is high value and better and more affordable as a cost element, and not breaking our country and making it impossible for us to do a lot of other things that we need to do in addition to health care.

JUDY WOODRUFF: Secretary Shalala, Michael Leavitt's essentially saying these are things that need to be done, but that's not what's being debated in this bill.

DONNA SHALALA: Well, the majority of the bill is about coverage.

And, first, you have to do coverage. It covers up to 94 percent of Americans will have health insurance, finally. There are some cost-containment measures. And, in fact, if we get more people covered, we will stop this cost shifting, the cost of those of us that have good insurance. That will help.

But Mike Leavitt is right. The next phase of health reform has to be moving from fee for service, for example, to other kinds of cost-containment measures. And Secretary Leavitt has spoken eloquently about things we need to do. This is a first step, an important first step. I believe the coverage first is the way to go.

Chances for a public option

Donna Shalala
Former Sec.of Health and Human Services
All we're saying here is, those that don't have insurance ought to have a way to get it.

JUDY WOODRUFF: Michael Leavitt, do you believe that some form of government-sponsored public health insurance option is going to survive here?

MICHAEL LEAVITT: In the long run, I do not.

I think that the American people don't want the federal government to be involved more in their lives, particularly their health lives. May I suggest I think Donna Shalala is correct, in that this debate started out about 50 million people who didn't have insurance. It's now become about the 250 million who do and the things that will occur to their insurance when we essentially put the entire system under the guidance of the federal government and increase the cost to everyone.

The debate has shifted away from just how do we care for those who don't have insurance to the impact that this law could have on those who do.

JUDY WOODRUFF: Donna Shalala, you agree with that?


Two hundred and fifty million people with insurance are now getting deep government subsidies because their insurance is exempt from taxes. All we're saying here is, those that don't have insurance ought to have a way to get it. Eighty percent of them get up every day and go to work. We're talking about them and their families.

They tend to be low-income workers. They need subsidies. They need it in another way than using the tax system. They need direct subsidies to be able to purchase insurance. We believe that every American ought to have insurance. Mike and I both agree on that.

We also believe that we ought to have more cost containment. This is a terrific first step. I believe we're going to take that first step and that a lot of the debate is very much about coverage. We ought to reassure people, if they have good insurance, they're going to be able to keep it. But, right now, they're paying for all those people that don't have insurance. We ought to find a way to help those who don't have insurance.

JUDY WOODRUFF: Michael Leavitt, why isn't that the way to look at this?

MICHAEL LEAVITT: Secretary Shalala has indicated the things on which we agree. And there are many. We do need to have affordable insurance premiums for everyone.

The part that -- where we disagree is that we should go about it by changing the entire system in a way that would put radically more under the insurance of the federal government and increase the average cost of a family of four by $3,100. That's what the Senate bill would do.

And those who do have insurance would be paying dramatically more, and we would be doing nothing to deal with the real problem, the urgent problem, which is the escalating cost to all of us. And we could make certain that every American has access to an affordable insurance policy, and we could do it in a reasonably short time, if we deal with that problem, and not changing radically the entire system.

We need to deal with those who currently don't have insurance. And I believe we will have to have the government involved in doing that. And then we need to deal with the cost issues and make certain that the cost is coming down, because, the higher the cost, the fewer people that can afford it.

Infighting among Democrats

Donna Shalala
Former Sec.of Health and Human Services
There are Democrats that have honest disagreements with this bill. They may not like the public option. They may not like the level of subsidies

JUDY WOODRUFF: Donna Shalala, what about that? And while you're answering, why is this such a hard vote for some Democrats?

DONNA SHALALA: Well, there are Democrats that have honest disagreements with this bill. They may not like the public option. They may not like the level of subsidies -- the same on the Republican side.

I don't agree that this is going to cost those of us who have health insurance more. What will cost us more is if we don't cover everybody in this country. Unless we all participate in the health care system, there's no way in which we're not going to continue what's been happening.

Every time an American with health insurance goes to the hospital, they're paying for those who can't afford to pay. And we have to find a way to cover everyone. Once we do that, we will be able to take, I think, fairly dramatic steps to get some cost containment.

This bill does some of that already. Already, we have moved in an area that Mike Leavitt has been very eloquent on. And that is the I.T. systems, the health I.T. systems. We need to know what the numbers are, so we can analyze where we can contain costs.

Those of us that are employers need to do that every day. But, frankly, I can't afford the insurance that my employees want, because in that insurance is the cost of the uninsured. And, so, unless everyone has insurance, everybody steps up and is willing to pay something for insurance, we're not going to be able to get the kind of cost containment we expect.

JUDY WOODRUFF: Secretary Leavitt, you want to comment on her point about costs?

MICHAEL LEAVITT: Well, the number I was quoting, the $3,100, is drawn essentially from the CBO report that allocates how $850 billion would be spent. That money is being spent in some way.

It's either being allocated through premiums, or it's going to be allocated through taxes. And this bill would essentially take money away from those who are young and who are healthy, and give it to those who are not so young and who are unhealthy. And then it's going to put the federal government more in control of the whole thing and raise the costs for everyone.

There's a better way to approach this.

DONNA SHALALA: With all due re...

MICHAEL LEAVITT: We need to have...

JUDY WOODRUFF: Go ahead and finish, Secretary Leavitt.

DONNA SHALALA: Go ahead, Mike.

JUDY WOODRUFF: And then we will have Secretary Shalala comment.

DONNA SHALALA: Absolutely.

MICHAEL LEAVITT: Go ahead. I made the point.

DONNA SHALALA: Look, the whole essence of an insurance system is that those of us that are healthy and in many ways young pay now, so that, later on, we will be able to have the kind of coverage we need when we do get older and sicker.

So, it's absolutely true that young people will pay for insurance that they may not use. That's true in every employer's health insurance plan. It's true at the University of Miami, in which our younger workers barely use the insurance that they're paying for.

That's a fundamental philosophy of insurance. But it's also an American philosophy. Those of us that are younger and more able pay more, so that others who can't pay have equal opportunities. Health care ought not to depend on how old you are or where you grow up or what your income is. It ought to be available in the private sector -- I agree with Secretary Leavitt on that point -- in the private sector for every member of our society.

MICHAEL LEAVITT: And Judy, I would simply make the point we are in agreement on the essence of insurance and how risk is spread. But, when you turn it over to control of the federal government, this bill demonstrates, it just becomes substantially more expensive.

We're talking about spending nearly a trillion dollars in additional dollars to cover a relatively small group of people. We can do this and do it much less expensively, and we can do it in a way that will drive the quality up and the cost down, if we were to focus on quality and giving people information and making certain that everyone is covered.

The secretary and I agree on many points of this. The basic issues on which we disagree is the degree to which government needs to be involved and how much we can afford.

Chances for a bipartisan bill

Michael Leavitt
Former Sec.of Health and Human Services
I believe bipartisan legislation is both possible and preferred.

JUDY WOODRUFF: Secretary Leavitt, I'm going to end with a political question.

And that is to both of you.

And that -- to you, it is, what do you think it will take to get some moderate Republicans -- or any Republicans, for that matter -- on board with this legislation?

MICHAEL LEAVITT: I believe bipartisan legislation is both possible and preferred.

But it will require that we have an honest debate, where Republican ideas are brought to the table, and a big national debate that includes many ideas. It's not unreasonable to expect that the party that has taken over Congress will charge the hill with all of the ideas that they have wanted to employ over the course of the last many years. What is, I think, unreasonable is to think that we would enact them all without a big and honest debate.

JUDY WOODRUFF: And political question to you, Secretary Shalala. What are the odds that that would happen?

DONNA SHALALA: Well, we have been -- the Democratic Party has been having a conversation with the Republican leadership in the committees for months and months and months.

With all due respect to my very distinguished colleague, who I agree with on most things related to health care, Senator Grassley and Senator Baucus and their colleagues have been talking for months, trying to get agreement in a bipartisan manner.

Unfortunately, they haven't been able to do that. I hope, the way Secretary Leavitt does, that this conversation will continue. There's no question in my mind that the Republican leadership will be heard, that individual senators will be heard, as this debate comes to fruition. And that's good for our country.

I like the way President Obama has conducted this process. I like the fact that it's been open and transparent, and there's going to be public debate on these issues. They're too important to do them behind closed doors.

JUDY WOODRUFF: Well, we appreciate the conversation with both of you.

Secretary Donna Shalala, Secretary Michael Leavitt, we appreciate it.

JIM LEHRER: Our Patchwork Nation blog this week looks at why Americans aren't more engaged in the health care debate. That's on our Web site,