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Shields and Gerson Review Road Ahead for Health Reform

November 20, 2009 at 12:00 AM EDT
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Syndicated columnist Mark Shields and Washington Post columnist Michael Gerson, who is also a senior research fellow at the Institute for Global Engagement, break down the biggest stories of the week, including health care reform moves in Congress and President Obama's pondering of a new Afghan strategy.

JIM LEHRER: Now: the analysis of Shields and Gerson, syndicated columnist Mark Shields, “Washington Post” columnist Michael Gerson. David Brooks is off tonight.

Mark, are there going to be 60 votes tomorrow night for the health care bill to go to the floor of the Senate?


JIM LEHRER: Did I say House?

MARK SHIELDS: No. The Senate will not consider it unless there are 60 votes. So, there will be 60 votes.

JIM LEHRER: Do you agree?

MICHAEL GERSON: Absolutely. I talked to Republicans on the Hill today. They fully expect that Democrats will vote to consider health care, even if they are not sure what the details are going to be.

JIM LEHRER: Why would the Republicans not vote to consider it at all?

MICHAEL GERSON: Well, I think that there is a party-line discipline on this issue. They believe that the approach is fundamentally flawed, not just at the margins. So, there is very little…

JIM LEHRER: So, why debate it?

MICHAEL GERSON: Right. Exactly.



JIM LEHRER: What are the major obstacles going to be to get from past tomorrow night to actually to get to enact something by the Senate first and then beyond?

MARK SHIELDS: Oh.Well, certainly, Jim, the — there are differences, significant differences, but I don’t think life-or-death differences between what passed the House and what passed the Senate. It will come down to financing. It will come down to the exact form of a public option, that is, a public plan that is available to provide insurance or compete with the private insurance companies.

But I think that, quite honestly, that Senator Reid has maneuvered this quite well. And I think that he has a disciplined Democratic majority behind him. They do fervently want to get Republican support. Senator Snowe, they really — that has been important…

JIM LEHRER: From Maine, yes.

MARK SHIELDS: … just that sense of bipartisanship.

But that may not be. I think the will is there and I think the imperative is there to pass it in the Senate.

JIM LEHRER: Do you see 60 votes? In other words, it will still take 60 votes to finally enact something in the Senate, even after it gets on the floor. Do you see 60 votes?

Obstacles in the health care debate

Michael Gerson
Washington Post
There are a number of obstacles, and they get progressively higher, because the House could make votes that were largely symbolic on abortion or other issues... the Senate really doesn't have that option.

MICHAEL GERSON: You know, starting the debate is the easy part.


MICHAEL GERSON: Ending it with cloture at the end is the hard part. And you need 60 votes to do that. That is absolutely true.

And there are a number of obstacles, and they get progressively higher, because the House could make votes that were largely symbolic on abortion or other issues, because they knew it wasn't going to be in the final bill. The Senate really doesn't have that option, in a certain way. It becomes more real in this.

Abortion is going to be an interesting thing to watch, because, somehow, Senator Barbara Boxer and Ben Nelson, who has a 100 percent pro-life record, on the Democratic side, are going to have to agree on something. That will be interesting to watch.

Financing is going to be interesting, because there's a lot of new taxes in here that come from Medicare payroll taxes, OK? The difficulty there is, a lot of people who want to do Medicare reform eventually would like to use that money to do Medicare reform, not to spend it on the broader health care plan. So, it's actually undermining future reform on these issues.

And a lot of the cost that is projected by the CBO here is really, I think, based on tricks. I mean, the real costs don't start until five years into this budget window, which makes a lot of the discussion about cost really underestimating the cost when it is fully phased in.

JIM LEHRER: You see obstacles similarly?

MARK SHIELDS: I don't. I mean, I do dissent with Michael on the House. The House would not have passed the bill without the Stupak amendment. They had to get...

JIM LEHRER: That is the abortion amendment.

MARK SHIELDS: That's right. One out of four Democrats in the House is pro-life, so they could not have passed it, because they were not going to get any Republican votes. They had to pass it with Democratic votes.

JIM LEHRER: That amendment prohibits the use of federal money to fund an abortion.

MARK SHIELDS: To fund an abortion, except in the case of rape, incest or the life of the mother. And that -- it takes what was the Hyde language, which has been approved annually every year by the Congress since 1976, and incorporates it in.

And that's where the question becomes whether public money can be used in any form. And the Hyde -- the Stupak amendment, the Hyde language forbids any public money being used. And whether in fact to purchase abortion coverage, you are going to have tie a separate rider under the plan, that's going to be the debate.

JIM LEHRER: So, there is still a long way to go on that...



MARK SHIELDS: There is. But Nancy Pelosi, who is pro-choice, persuaded the pro-choice caucus to go along. And we will find out. Harry Reid is sort of modified pro-choice/pro-life, mostly pro-life. We will see how effective he can be in uniting his caucus.

Government's role in health care

Mark Shields
Syndicated Columnist
The Republicans got a -- were given a gift, an opening.

JIM LEHRER: Michael, the discussion that we -- that Margaret just ran on the testing, particularly exclusively here in this case of women's health issues, how does that -- does that have anything -- do you think that is going to play in, either directly or indirectly, into this overall health care debate?

MICHAEL GERSON: Well, it was a total coincidence, but I think it does have a consequence when it comes to the health care debate.

The reality is, we have got a system that in many ways is inefficient and chaotic, a health care system that, you know, doesn't spend money correctly. But when government comes in and rationalizes that system and says these are best practices, OK, it raises questions about the role of government in a variety of decisions.

You know, in a new system where the government takes a more central role, would these kind of best practice decisions, you know, have a broader influence? Will they be affected by the cost control, you know, imperative that government will face? So, you know, it raises these questions at an awkward time.

JIM LEHRER: As one of the doctors told Margaret, she didn't want the government making these decisions about the test.

MARK SHIELDS: I mean, that -- the Republicans got a -- were given a gift, an opening. This commission, which was totally apolitical, appointed by President Bush, 25 years, its membership, they...

JIM LEHRER: You're talking about the mammogram...

MARK SHIELDS: The mammogram. They came up with their plan, and with no sense of timing as to what is going on in the country.

And the Republicans on the Hill, who don't have a plan of their own, said, hey, this is a great opening. What we will do is, we will say, this is a -- now, let's be very blunt about it. One out of eight American women gets breast cancer. Everybody knows or is related to somebody who has suffered from breast cancer.

And the one sense of control that women have had is regular early mammograms and self-detection, and both of which are sort of undermined and sabotaged by this report. And, so, no wonder it created an understandable stir and anxiety in the country, and especially among women.

Frustration with the economy

Michael Gerson
Washington Post
Unemployment is the main political problem in America. And the members of the House, Democrats, are going to go into 2010, and they need a real message on this.

JIM LEHRER: Speaking about -- this is a segue, Michael -- speaking of anxiety, what do you make the anxiety within the Congress, even among some Democrats, about Secretary -- Treasury Secretary Geithner, and what is going on in the economy and in the financial system, and a little bit toward the whole Obama administration about this?

MICHAEL GERSON: Well, it does reveal that there is a certain disconnect between the major issues in a lot of congressional districts, including Democratic congressional districts. They're not really talking about climate change very much.

They are talking some about health care. But they are mainly talking about jobs. Unemployment is the main political problem in America. And the members of the House, Democrats, are going to go into 2010, and they need a real message on this.

So, there was a mini-revolt, including among the Black Caucus in the Congress, that says, look, you guys aren't messaging correctly on the -- or sufficiently on the jobs issue. You are talking about things that aren't as directly relevant to my constituents.

JIM LEHRER: Do you read it the same way?

MARK SHIELDS: Well, I don't think it's limited to Democratic districts. I think the...

JIM LEHRER: Everybody.

MARK SHIELDS: I think it's everybody. It's universal.

And it's not only jobs and unemployment, which is an overriding concern. We have double-digit employment.

JIM LEHRER: Unemployment, yes.

MARK SHIELDS: There a total disconnect, if you will, between the prosperity and plushness of Wall Street and the pain of Main Street. And so people...

JIM LEHRER: That is what they brought out with Geithner. That's why they're...


JIM LEHRER: They are more than just upset. They are angry.

MARK SHIELDS: They are angry. And they look at the government economic policies, and they say, what got us to this point of chaos and crisis? It was the big banks and Wall Street. Who are the beneficiaries of the economic policy? The big banks and Wall Street.

And who is paying for it? The people of the country who are unemployed. That is the anger. And I think that the sense that Secretary Geithner has not been as forceful enough in regulation or any of that, I think that is part of it.

And the other thing is, Jim, there is always a sense of a punching bag in any administration. Nobody wants to take on the president. It was Don Rumsfeld that they took on. And I want to say -- got to get rid of the president, take on Rumsfeld. Well, Geithner is playing the Rumsfeld role right now.

Obama's Afghanistan decision

Mark Shields
Syndicated Columnist
It better be forceful, it better be precise, the measures of success better be there.

JIM LEHRER: Yes. What about -- about Afghanistan, the president's upcoming decision on that? Is he going to make it soon, do you think? I mean, is it time, has the time come, do you think, to kind of get over it?

MARK SHIELDS: He has said that it would be within, you know, basically I guess we're talking about days now. And I think...

JIM LEHRER: Does that become a problem for him, just the timing of it, regardless of what it is?

MARK SHIELDS: Well, he's being -- he's gotten some criticism from sources that don't expect to criticize the president the past, in recent past.

But, no, I think it is necessary for him, when he makes the decision, that it better be clear, it better be forceful, it better be precise, the measures of success better be there, the objectives, the timetable, exactly what we are there for, what we are trying to achieve, I think.

And there has to be a pay for it, Jim. We are now looking at $1 trillion that we have spent just on the battlefield in Iraq and Afghanistan, none of it funded.

JIM LEHRER: Michael, how do you read this decision-making?

MICHAEL GERSON: Well, it's been next week, the decision's supposed to be next week, for months now. It keeps being put off and off.

And the process itself, which was supposed to be a model of deliberation -- they invited cameras into the meetings to show, we're deliberating on this -- has become pretty much a mess, a very dysfunctional process.

JIM LEHRER: A lot of leaking going on.

MICHAEL GERSON: A lot of leaking of whole classified documents to discredit one side or discredit the other side, which is a real disservice to the president.

But it reveals a growing gap between military and civilian. It shows fights in Afghanistan between our ambassador and the head of the -- you know, McChrystal and Eikenberry, our ambassador there, which I think is a very bad sign. And, so, I think it's revealing tensions in a very dysfunctional process. He has to make a decision soon.

MARK SHIELDS: I'm confident he will make a decision. I mean, this is not the first administration to leak. The leaker in Washington always leaks to get either himself elevated or his position heard.

And everybody in Washington, as Ronald Nessen once said, nobody believes an official spokesman. Everybody believes an unidentified source.

So, I mean, I think that is what we have got going on right now.

JIM LEHRER: Same thing as before?

MICHAEL GERSON: I don't think so. And these were -- these are very, very serious leaks in a national security team that's very divided, designed to discredit -- discredit other members of that team, and determine the outcome.

That's different than just self-serving leaks. That's very serious.

MARK SHIELDS: It is a full and free debate, which we aren't used to on matters of national security.

JIM LEHRER: All right. Thank you both very much.

Thank you again. Good to see you, Michael.

Thank you, Mark.