March 19, 2010
MS. IFILL: We’ve said it before and we’ll say it again. This weekend, this very weekend, we’ll be the turning point on health care. We’ll tell you why we might actually be right this time, tonight on “Washington Week.” The president –
PRES. BARACK OBAMA: We keep on going. We are going to get this done.
MS. IFILL: – is revved up.
PRES. OBAMA: The time for reform is right now, not a year from now, not five years from, not 10 years from now, not 20 years from. It’s now. And in just a few days, a century-long struggle will culminate in a historic vote.
MS. IFILL: But Republicans say the fight will continue to November.
REP. JOHN BOEHNER (R-OH): The American people do not want any part of this. And if anyone thinks the American people are going to forget this vote, just watch.
MS. IFILL: Yet, one way or another, Congress is poised to act with some noes slowly turning to yes.
REP. DENNIS KUCINICH (D-OH): I’ve decided to cast a vote in favor of the legislation.
REP. JOHN BOCCIERI (D-OH): Yes, I will be voting yes for the bill.
MS. IFILL: Between now and Sunday, every arm will have been twisted, every possible dollar spent, and every rule invoked in a debate that spilled into the streets.
Richard Ledford, small business owner: It’s not perfect, but it’s a good step forward in reform efforts.
Perette Godwin, opposes health care reform bill: Healthcare now, let’s pass a bill. I think the wrong decisions are being made. I think we’re going the wrong direction.
MS. IFILL: We look at the week with the reporters covering it: Peter Baker of the “New York Times,” Jeanne Cummings of Politico, and Karen Tumulty of “Time” Magazine.
ANNOUNCER: Award-winning reporting and analysis, covering history as it happens, live from our nation’s capital, this is “Washington Week” with Gwen Ifill, produced in association with “National Journal.”
ANNOUNCER: Once again, live from Washington, moderator Gwen Ifill.
MS. IFILL: Good evening. And so we approach the end or the beginning. Maybe, perhaps, probably. If there is anything we’ve learned after decades reporting around this table and writing about efforts to overhaul the nation’s health care system, it’s that nothing ever seems to be a done deal. Yet and still the signs are there. The president canceled a high profile foreign trip to be around for a final vote. House Speaker Nancy Pelosi has put her leadership and her arm-twisting reputation on the line. And the measure’s opponents are really, really unhappy. Just listen to it all.
PRES. OBAMA: I don’t know how passing health care will play politically, but I know it’s right. Teddy Roosevelt knew it was right. Harry Truman knew when it was right. Ted Kennedy knew it was right. And if you believe that it’s right, then you’ve got to help us finish this fight.
REP. BOEHNER: Now, listen, I know the president’s doing a hard sell on this bill, telling Democrat members that his presidency is on the line. But this vote isn’t about saving the presidency or saving a politician. This is about doing the right thing for the American people. And so Americans are jamming the phone lines here on Capitol Hill. They’re screaming at the top of their lungs to say, “stop, just stop.”
SPEAKER NANCY PELOSI: The American people have played on the turf of the insurance companies for far too long; it is now time for them to play on the turf of the American people.
REP. PAUL BROUN (R-GA): I have three simple questions for Ms. Pelosi. Are you so incompetent that you’re going to ignore the Constitution of the United States, use tricks, deceptions, bald-faced lies to try to ram down the throat of the American people something that they do not want?
MS. IFILL: It’s been like that here for a week. And as the House draws closer to Sunday’s critical vote, we thought it would be worth it tonight to talk about what’s in the plan, what’s not, who’s for it or against it, and why, and what the outcome will do for or to the Obama presidency. We have a great roundtable here to begin to get the answers to those questions, starting with Karen. So Karen, as the bill stands now, what will change?
MS. TUMULTY: Well, first of all, what we are likely to see in the next few days is the passage of the Senate version of the bill, which would then send it to the president’s desk. It would become law. But that’s only the first step. Then some revisions would be made, but this is the most crucial vote. What would change? Not a lot in the first couple of years.
The first two to three years, we would see some changes in insurance rules. If you have a child who’s 26 years old and doesn’t have insurance on their own, they could stay under your policy. We’d see some tightening of getting rid of some of these preexisting conditions. But starting in about three years, we would see a vast expansion of coverage. Thirty million people would find themselves with insurance, about half of them by an expansion of the Medicaid program and the others through setting up these new insurance marketplaces, where people could go and essentially shop for insurance. They call them exchanges, but they’re sort of like shopping malls if they work right.
Beyond that, over the next five or six or seven or 10 or even 20 years, if this bill works as advertised, what we would see is a transformation of the health care system. And what the president and the Democrats are promising is that instead of working on just a lot of medicine, it would be more geared toward making sure that the money we spend on medicine is effective and provides better results.
MS. IFILL: Now, you’ve just said some important words, “if the bill works as advertised.” The advertising and the efforts and people saying exactly, Jeanne, diametrically opposite things about what this bill would or would not do, that seems to have been dominating this debate for the last week.
MS. CUMMINGS: Absolutely. You look at poll numbers. They don’t make sense. You look at the advertising and they’re confusing because there’re conflicting messages that people send. And that’s not unusual in the lead up to a major vote like this. We saw it with – when Medicare passed. There’re all these dire and ominous predictions about what would happen if it passed. Other major initiatives faced the same kind of heated rhetoric around them.
To be honest, I think what the Democrats are counting on is that these terrible things that the Republicans are predicting will happen won’t happen. And in the short term certainly they won’t happen because, as Karen said, some of the most sweeping reforms don’t come until later. And so some of the opposition to the bill will ease because all these really scary things don’t happen.
MS. IFILL: Or they will at least be able to focus on the little things that do happen and tell compelling stories about them.
MS. CUMMINGS: Well, and the alternative is that any little bad thing that happens to them that would happen to them in the health care system anyway, they’re going to blame on health care reform, whether the legislation had anything to do with it or not. So we have a lot of shaking out to come from this, in part because the advertising has confused the debate for voters.
MS. IFILL: Peter, we saw the president just now doing one of his trademark revved-up, fired-up, ready-to-go campaign speeches and we saw him push back and then cancel this big, long planned trip to Indonesia and Australia by way of Guam on the way. How important is it to this White House and to this presidency that he win this battle?
MR. BAKER: Well, it’s hard to overestimate just how important it is. And they’ve made it important by, of course, cancelling the trip and by focusing so much attention on it. Had they made this one of many different big priorities and they lost, that would be one thing. They have put everything into this. The president has been on the phone with dozens and dozens of members. He has basically said “my presidency” – whether he actually said these words and he’s made clear that his presidency is on the line. I went back and looked at all the public remarks he’s made in the last five weeks since the battle of Marjah began in Afghanistan, about 100,000 words. And in 38 speeches and public remarks over that five weeks, health care has come up – he’s used the words “health” or “insurance” about 750 times. He used the word “Taliban” zero times. He has put all of his public energy and attention on this vote.
MS. IFILL: And everything else is waiting in line on deck circle waiting for health care to get –
MR. BAKER: Well, that’s right. Look, if you’re a congressman and you’re taking this risk to vote on a bill that you might have to pay a price for, success matters. Are you going to then take another vote on the next one down the road, on climate change, on financial regulations, on other things that might be of controversy if you don’t feel like it’s going to lead to something that you can brag about before your voters?
MS. TUMULTY: What’s extraordinary, though, is it’s on the line because Barack Obama chose to put it on the line. At the outset of his presidency, there were advisors saying, “look, you’ve got the economy is a mess. You’ve got a lot. Don’t take this on.” And every opportunity over the past year when he’s had the choice to scale back, he instead has pushed forward.
MS. CUMMINGS: Well, another thing that’s been interesting this week is, as Peter said, his engagement level was very different this week, cancelling the trip. He has told you he set deadlines before, but he’s moved them. This time, it’s serious business.
MS. IFILL: Or they’ve been moved for him. I’m not sure it’s always his idea.
MS. CUMMINGS: Exactly, but he has never canceled a trip or really gone out of his way to try to hold one of those deadlines either. This time he’s there, sort of locked arms with Pelosi and Reid, as they march up to the end here. And what has been amazing this week is how the Left has been reawakened. For months the Left has been in a fight with itself over the public option, over the Cadillac plan, all these bits and pieces of the provisions that are inside the bill, while the opposition had a very simple, united front. Scrap it, start over. It’s a government takeover. Very simple messaging. What was really striking to me this week is that the Left has been reignited in this. And that could affect polling very easily because some of the fall off from President Obama is among Democrats, who’ve been frustrated by the lack of action.
MS. IFILL: And that made liberals like Dennis Kucinich get aboard all of a sudden. He’d been also holding out for a more expansive bill. He’s Mr. Single Payer where he’s up to him. And instead, here he is, ushered to the White House for four separate meetings and in Air Force One.
MS. TUMULTY: Yes, Dennis Kucinich had gone so far on the left that he’d ended up on the right. (Laughter.) Basically because he said the bill wasn’t liberal enough for him, I think he ultimately decided that he would take what he could get instead of what he wished for.
MR. BAKER: Well, this is a different vote than November, when the House passed their first version. In November, if you didn’t like certain aspects of the bill, you could vote no on the theory that it could get better, that you were leveraging the next stage in the Senate or the Conference Committee. This is it now. If you want health care to pass, this is your moment to vote for it. If you don’t want to pass, this is your moment to vote against it. It isn’t coming again.
MS. IFILL: There’s a lot of leveraging going on and it’s a perfect storm in so many ways. There is the political perfect storm about the midterm elections, which the president claims we only care about politics, but come on, they’re politicians. So there is that. There is a perfect storm with issues, things like abortion, which will never go away and which have played a pretty significant role, Karen, in Nancy Pelosi’s ability to get to 216, the number of votes she needs to get this passed, right?
MS. TUMULTY: Well, ultimately, though, because of the way they structure this vote –– and it’s not worth getting into the weeds here – she was not able to do anything to satisfy the people who were objecting to some of the abortion provision. So essentially, she had to write off some of those votes and go forward without them.
MS. CUMMINGS: And one development this week that I think is going to prove highly significant is a break in the Catholic advocacy class because the bishops were driving that, although they had the Right to Life Committee behind them as well, which is non denominational. But the nuns that service at the hospitals came out in favor of reform.
MS. IFILL: And at least one congressman tonight cited that.
MS. CUMMINGS: That’s very important. We’ve seen editorials in Catholic outlets that have endorsed reform with long explanations about how it’s acceptable for the bishops to sit at a lofty moral level and evaluate these things, but it’s also okay for those people who’re in the churches, who are in the clinics, who are on the ground to see how this could benefit people. That, I think, can help break up the Stupak coalition that has been such a problem for –
MS. IFILL: The Democratic congressman who’s been leading this. Okay, so another big thing that helped to peel off a couple of votes – and every couple of votes count – and that’s the Congressional Budget Office numbers. They – everyone was looking for a price tag and how much this was going to cost. And that was going to be a big talking point for Republicans. “We still haven’t seen the official number,” the Republicans say. But the number that’s come – that’s been circulated is $940 billion, short of the trillion they were afraid of number, even though close enough, and the emphasis from the White House – White House was it would bring the deficit down. How do you spend all this extra money and bring the deficit down?
MR. BAKER: Well, you spend all those money and bring deficit down by taxing people, particularly wealthier people, who make more than $200,000 a year through increasing their Medicare payroll taxes for instance. You’re going to have this Cadillac or high cost insurance plan tax – people who get – their employers pay for a particularly wealthy insurance plan. They’ll be taxed higher. And you make cuts in Medicare spending over the next 10 years. And that’s where all this rubber begins to hit the road. You talked about if this, if this. The law of unintended consequences in Washington, of course, is such that you could expect that even if this were to pass, we’re going to be back here, talking about how to adjust the things they didn’t anticipate year to year –
MS. IFILL: Well, let’s talk about unintended consequences. You say that employers pay more. Doesn’t that get passed on then to consumers? Don’t they just pass on their extra costs?
MS. TUMULTY: Every economist that I have talked to about this will say that the fact is you cannot bring 30 million new people into the system without spending more on health care. The idea, though, is that once they are in there, once everybody is in, you can begin to start doing things that make healthcare itself more efficient. And the first thing that you have to do is stop paying doctors and health care providers and hospitals according to how much care they give. And instead, make the payments a little bit more based on outcomes and quality. And again, economists will tell you that this is a difficult thing to do if everyone is not already on the system.
MS. CUMMINGS: Well and there are other – there’re two other points on this cost issue that I’ll throw out there. First of all, where do you spend it to save it? Setting up these exchanges isn’t free. You’ve got to set them up. You’ve got to get them operational. It will cost money to get those things up and running. And then the second thing that I do think has been very much lost on the public is, as I understand it, the goal here is to curb the rise of health care costs.
MS. IFILL: Bend the curve.
MS. CUMMINGS: Bend the curve, but that doesn’t mean they don’t stop going up. And that’s something I think a lot of the voters have not fully been educated on, which is something that the Democrats could see to come back and haunt them.
MS. IFILL: One other thing that seems – apparently they say it’s going to be missing from this final version are all of the deals, all of the special deals – they’re all alliterative – you noticed that? It’s the Cornhusker compromise? It’s the –
MS. CUMMINGS: Oh, there will be deals.
MS. IFILL: – kick back, yes, but there will be deals. So how do you – how could they conscience that when it was such bad backlash?
MS. TUMULTY: Well, because the deals that were included in the bill were – they made the whole process so ugly that people began to focus on the process as opposed to the outcome. The kinds of deals that I think you’re likely to see are not going to be embedded in this bill. They are going to be – do you want the president to come help you raise some money? Do you want him to come and campaign for you? Is there some other piece of legislation that you would like to see? That sort of thing. And there will be plenty of that and has been going.
MS. CUMMINGS: But there will still be things that people can characterize as deals within, but I think one of the distinctions they are trying to make – for instance, Louisiana still will get – will qualify – for additional assistance –
MS. IFILL: But everybody else could qualify as well.
MS. CUMMINGS: – because every single county in the state has been declared a disaster area. So any other state that suffers to the degree that Louisiana did from Hurricane Katrina could qualify for the same thing. So it’s deals like that that they look unique, but they actually could apply across the board, where they are singularly unique, which applies to a bank in South Dakota that is receiving its own waiver because it is the only bank in the United States that is state owned. And so it is –
MS. IFILL: North Dakota.
MS. CUMMINGS: – North Dakota, thank you. So it is a truly unique, unique situation. So we’ll see –
MS. TUMULTY: Although that deal, I understand, is going to get jettisoned because it has gotten so much attention.
MS. CUMMINGS: Yes, it’s gotten, right.
MS. IFILL: What are they calling it? The Bismarck Bailout? They haven’t –
MS. CUMMINGS: Itty-bitty one.
MR. BAKER: This is what happens when you are dealing with razor edge vote counts here. If you need 216 – you’re the 216th guy or woman, you can ask for almost anything. And you even saw it today. People, in the last minute, bringing up complaints about Medicare reimbursement rates in Oregon, as an example. And there’s all this discussion: could this blow things up at the last minute? It’s really very, very complicated to put together this kind of coalitions, even within just one party.
MS. IFILL: If you’re a Democrat tonight, you talk about this in terms of the poor child who will not get coverage or you talk about it in terms of long-term impact. If you are a Republican tonight, you’re talking about the process. You’re talking about the way in which they’ve gotten this done. Ramming it down throats, we heard John Boehner say. Are we going to see that right through – not only through the vote, but also even after this vote, even after the Senate bill is fixed. Or is this going to be an issue about how it got done that’s going to carry through.
MS. TUMULTY: We are already seeing it. We’ve seen a vote in Virginia to exempt themselves from one of the key elements of the bill, which is the requirement that everybody have insurance they way they have auto insurance. I think there are something like similar measures in something like 37 states. There is already a well-funded movement to repeal this bill, even though it hasn’t even passed yet. Yes, we’re going to –
MR. BAKER: Some of the tactics lend themselves to 30-second ads that’s saying, “Look how they tried to pass this. They tried to pass it without voting on it,” and so forth and so on. They’re all parliamentary. They’re mostly not really meaningful in terms of the actual outcome, but both sides are trying to play these games, where they’re trying to be able to argue that we did it this way or that way. That makes the whole process look bad.
MS. CUMMINGS: The Republicans are promising to make this an issue in the fall. And as Boehner said, if you think anybody is going to forget this vote, here’s warning: they won’t.
MS. IFILL: We’re not going to let them.
MS. CUMMINGS: Right, but I am skeptical that at least the messaging that we hear today can be sustained six, seven months from now. I don’t think reconciliation is going to mean a whole lot to people come October.
MS. IFILL: But if you are Betsy Markey, the congresswoman from Colorado, who changed her vote from no to yes –
MS. CUMMINGS: That counts.
MS. IFILL: – that counts because you become the next Marjorie Margolies-Mezvinsky, who famously in 1993 voted to support Bill Clinton’s stimulus package and was booted out of this.
MS. TUMULTY: Although she changed her vote on the floor. And that was a little –
MR. BAKER: The thing is like all these members who are coming out now -- “I wouldn’t want to be the last member to say I’m going to vote this,” because then you’re the one who is the decisive vote.
MS. CUMMINGS: But a big difference is –
MR. BAKER: Even though there are 216 decisive votes.
MS. CUMMINGS: But a big difference is and an unknown here is whether the Obama White House can turn around public opinion on what this bill is. And this has been done before. And one White House, the Bush White House, was successful, previous White House was not. So it’s up for grasp. If they can turn –
MS. IFILL: If the headline the next day is, “President enacts historic health care bill” instead of “messy, terrible race to the finish, immediate 2010 midterm election consequences,” then the fight continues, even after that.
Thank you everyone. Shockingly, I know, there’s so much more to say and you’ll be there to say it. We’re leaving you a few minutes early again this week, so you can support your local station, which in turn supports us.
I’m also making these health care reporters go back to work. Keep up with us pbs.org/washingtonweek, where you can drop us a line. Watch our online-only Webcast and read more of our panelists reporting. And even take a look at my blog. Keep up with daily developments every night on the PBS “NewsHour.” And then we’ll see you around the table again next week on “Washington Week.” Good night.