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Jonathan Gruber

A professor of economics at MIT, Gruber specializes in health care. He was involved in the development of Mitt Romney's Massachusetts health care plan -- aka "Romneycare" -- as well as the Affordable Care Act, or "Obamacare." This is the edited transcript of an interview conducted by producer Michael Kirk on June 13, 2012. (33:13)

A professor of economics at MIT, Gruber specializes in health care. He was involved in the development of Mitt Romney's Massachusetts health care plan -- aka "Romneycare" -- as well as the Affordable Care Act, or "Obamacare." This is the edited transcript of an interview conducted by producer Michael Kirk on June 13, 2012.

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    So, your background, please.

    I'm a professor of economics at MIT. I helped Gov. Romney develop the Massachusetts health care reform, or Romneycare. I then worked with the Obama administration and Congress to help develop the Affordable Care Act, or Obamacare.

    So let's go backward. Mitt Romney is the governor of Massachusetts. He's had a little bumpy ride at the very beginning of his administration. And then for reasons that you will explain to me, he and the state government of Massachusetts decide the notion of, I guess, universal health care. That's a rubric that is kosher to use?

    The term I like to use for what we did in Massachusetts is "incremental universalism," incremental borrowed from the right, meaning, let's build on what works in the health care system, because for most people, the health care system does work; "universal" borrowed from the left, meaning, let's get to universal coverage. And that is why I was successful. Previously everyone had been stuck either on the universal side or the incremental side. We were the first place to really pilot marrying those two, and it worked.

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    When you say the right, what do you mean, "the right"?

    Conservatives who believed, essentially you've got a system which works for most Americans. If you've got health insurance from employer or the government, the system by and large works for you.

    But it doesn't work for a significant minority of Americans. If you don't have insurance from your employer or the government, you are subject to a nefarious, non-group insurance market where your insurance can be denied to you if you are sick, your rates can be raised for no particular reason through the roof, or you can just be kicked off insurance if you get sick. Basically, in no meaningful sense is insurance available if you don't get it from your employer or the government.

    But most people do get it from their employer or the government, so it works. And the right has been saying: "Well, it works for them. Let's just tinker around the margins with making the private system work." The left has been saying: "Look, there are 70, 80 million Americans for whom the system doesn't work. Let's transform it. Let's transform the whole system to fix it for them." That was too bold because the other people were happy. So you have one side that wants to redo everything, upsetting the apple cart for most Americans, another side who wants to ignore the minority that's not helped. And the idea was to leave those who have well enough alone happy and come in and help the minority that don't.

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    Let me ask you to define two words that go together as a phrase: "free riders." What is that?

    So basically you have a health care system where you have a law called EMTALA; I forget what it stands for [Emergency Medical Treatment and Active Labor Act]. And basically what this law says is that if hospitals want to get Medicare reimbursement, which every hospital does -- that's a major source of financing at any hospital -- they have to be willing to treat anyone who comes to their emergency room regardless of insurance status.

    What that means is that it essentially provides sort of a form of catastrophic coverage if you're a young, healthy person. You know, when I was a 25-year-old guy, I never needed to go to the doctor except if I got hit by a car. ...

    However, the fact that I didn't have health insurance meant that if I ever got sick, then suddenly my costs would be borne by someone else, because suddenly I would go to the hospital. I would get hit by the car. I go to the hospital, and now I can't pay my bills, and the hospital has to pass those costs on to someone else.

    So in that sense I'm a free rider. It's a technical economic term. It means someone who doesn't pay the cost, their expected costs. I'm a free rider. I'm not paying in advance for care I'll ultimately use.

    Mitt Romney's big selling point, as he was preparing to sell health care reform, was: "Look, a lot of the uninsured in Massachusetts can afford health insurance. They could afford it if they were willing to buy it. But they are not because they are free-riding on the system. They just wait until they get sick and then [are] getting coverage."

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    Why health care reform appealed to a 'CEO-style governor'

    What brings him to this moment where he's prepared in any way to look at it, to think about it, consider it, take it on? Because it doesn't seem like the kind of thing a CEO-style governor would embrace or mount as an issue to take on.

    Actually, that's wrong. I mean, what really appeals to him as a CEO-style governor was that the pieces were aligned to make this work. And the pieces were the following: First of all, we had a relatively low uninsurance rate, so it would not be as expensive to cover the uninsured as in other states.

    Second of all, we had already done one of the hardest steps, which is we reformed our insurance market to not allow insurers to discriminate against the sick. Now, we had done that doing nothing else, and the result was we had destroyed our insurance market, and we can come back to that. That's why you need a mandate. But in some sense we had already taken that step. But as a result we had this sort of destroyed insurance market.

    Third, we had a major source of financing in place, which we had formerly had a pretty powerful senator named Ted Kennedy who had been delivering about $400 million a year in slush funds to our safety-net hospitals that the Bush administration was threatening to take away.

    The Romney administration, to their credit, went to Washington and said, "Can we keep this money if we use it to cover the uninsured?" And the Bush administration, to their credit, said yes.

    So those pieces pulled together made a really interesting opportunity to actually cover the uninsured and fix a broken, non-group market on the federal dime. And that was a really unique opportunity, which I think Romney as a kind of management consultant was excited to take advantage of. ...

    And how do you get to the game, Jonathan?

    Well, how does a nerd get in a game like this? Through numbers. Basically what happened was I was hired by the state. In the year 2000, we had this crazy thing called the surplus. You may not have heard of this term recently. And so the federal government actually gave grants to states -- and states were in good fiscal shape as well -- gave grants to states to try to figure out how to expand health insurance coverage.

    The state came to me and asked me to build a model to help understand how alternative ways of expanding health insurance coverage might work, what it might cost the state, etc. And I did that.

    By the time the model was done in 2001, we were already in the tank fiscally, both the nation and as a state. And I sort of did this report that went nowhere.

    Then in 2003, 2004 -- I don't remember exactly when -- I got a call back from Amy Lischko, the woman who hired me to do this report, who ran the policy shop in the Romney administration, saying: "Hey, look! The governor is thinking seriously about doing major health care reform. You've got this model already in place to help understand with Massachusetts. We want to bring you onboard and have you help us figure out if this going to work financially, how many people we're going to cover, what's going to work." So I was sort of the numbers guy.

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    RomneycareRomney as Governor

    We've heard that he is also a numbers guy, loves them, needs them. They are his life blood. Was he?

    I don't know. You know, once again, I was only in one two-hour meeting with Mitt Romney, so I don't claim to know him well.

    What I saw in that meeting was someone who really felt strongly about the moral case for ending this free-rider problem, someone who really felt strongly of: "Look, there are all these free riders. If we bring them into the system, we can both get them to contribute and lower insurance prices because they are healthy. And we've got this federal money. This seems like a good thing we should make work."

    My job was just to see if the numbers added up, and I think he was excited they did. And in particular, I like to think that I contributed to the case for the mandate. I think he felt strongly the moral case for the mandate. I think I sort of provided the financial case for the mandate, which was to say to him two things: First of all, we can't get to universal coverage or even close to it without a mandate. And second, actually coverage becomes much more efficient with a mandate. To show him that if he did the plan he was considering with no mandate, it costs two-thirds as much as doing it with a mandate but only covered one-third as many people, and that's because the healthy stayed out, and the healthy are cheap.

    So I think that sort of fed into his notion of kind of, "Gee, this is a kind of efficient way to cover the uninsured."

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    Romney and the mandate

    OK. Let's define mandate.

    The mandate was the requirement that people have to buy health insurance.

    You mean, you've got to do it.

    You've got to do it or pay a penalty.

    And that's a big idea.

    That's a big idea that really grew out of leading conservative thinkers in the early '90s as an alternative to the employer mandate. So the term "mandate" traditionally applied to employers, the notion of requiring employers to offer health insurance. As a conservative alternative to that idea in the early 1990s, Stuart Butler, who is at the American Enterprise Institute, a conservative think tank, and Mark Pauly, who was an academic at Wharton and sort of a conservative health economist, separately and together developed this idea of wouldn't it make more sense to have an individual mandate, to require individuals to take the responsibility for their own health insurance coverage?

    This is a very conservative idea: Let's put the onus on individuals, responsibility. And it grew out of that.

    It briefly was popular in the early '90s and then was kind of something in the background. But it has always stayed around as this sort of this conservative notion of here is the right way to do health care reform.

    And that, of course, presumably would appeal to a Republican governor.

    Oh, it did. It absolutely did. I mean, it was the way -- it tied in directly with his aversion, his free-rider problem. I mean, he said, "Look, we've got --"

    So basically, when I think of what Romneycare was, I like to think of it as a three-legged stool. The first leg is reforming insurance markets, ending the ability of insurers to discriminate against the sick. As I said, we had already done that in Massachusetts. We are one of seven states that tried that in the 1990s. In every state, the same thing happened, exactly what an economist would have predicted -- total disaster, because if you tell insurance companies you can't charge the sick more than the healthy, but you tell people you can buy insurance whenever you want, the insurance companies say: "Wait a second. People aren't going to buy it until they are sick, and I'm going to have to charge a high price." When the price is high, the healthy don't buy, and it becomes a self-fulfilling prophecy.

    And in Massachusetts, the typical individual health insurance policy in 2006 cost about $8,000 a year, and the typical person buying it was about 55 years old. Basically, the market was broken.

    So that's why you need the second leg of the stool, which was the individual mandate, the requirement that people come in and buy health insurance. What that does is by bringing healthy people into the pool, it fixes that problem, brings the prices down. And that was the second leg of the stool. It both had the sort of moral component that Romney seemed very interested in and kind of ending this free-rider problem and the financial component of fixing this broken market by bringing healthy people in and by bringing the price down.

    But you can't have the mandate without the third leg of the stool, which is subsidies. At the time we are considering this, a family health insurance policy in Massachusetts cost about $12,000 a year. The poverty line for a family is about $22,000. You couldn't tell a family making $22,000 you have to spend $12,000 for insurance. That is both inhumane and impolitic. So the third leg of the stool was subsidies, to make health insurance affordable for low-income families. And that three-legged stool became Romneycare.

    And the subsidies came from?

    The subsidies came from rededicating money the feds were already giving us to pay for the uninsured. So it was a neat rededicating of funds so we didn't have to raise taxes. That was sort of another thing in my modeling, was that basically Romney had figured out that for about $700, by rededicating money we're already spending and taking money from the federal government, we could spend about $750 million. And my goal was to say could we do it for $750 million. And my model said we could.

    I'm proud to say when the final bill came in it was about $750 million. I'm pretty pleased that worked out.

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    So when Romney hears that you've got this model that verifies that "Hey, this is a good idea," and you say it at the meeting, what's he like when he hears it?

    Like a real wonk, just very excited: "Wow! Isn't this cool? We can cover the uninsured. We don't have to raise taxes. We can end the free-rider problem. Isn't this neat?" So that's why I sort of reacted negatively to your idea that it didn't seem like a CEO thing. I don't know about CEO, but he was very much in management consultant mode, like: "Here is a problem. I can solve it. Isn't that neat?" -- sort of engineering almost mode.

    Engineering in what sense?

    Just in a sense of kind of, you know -- I teach at an engineering institute -- in the sense of kind of, that's what engineers do. They are faced with constraints; they try to solve a problem. He seemed excited that faced with the constraints he was facing, he could solve this problem.

    So you could imagine him sitting at Bain & Company and under other circumstances. This was not unfamiliar territory to him.

    Not at all.

    One of those guys who just --

    Exactly.

    -- runs his hand down the thing and says, "Argh, I like that."

    You know, I was very impressed. I came out of that meeting. I went home and told my wife and said: "As a Democrat, I'm very scared. This guy could be president." He was really very smart, well-spoken, and just really seemed to know his stuff and was very impressive in person.

    Did they have good people around the table?

    That's what was very interesting. His financial people were wonderful. Tim Murphy is really the guy you should be talking to, sort of one of the unsung heroes of this. He was his main point person to make this happen. Amy Lischko -- I worked with terrific people.

    His political people were actually opposed. I mean, basically the meeting largely consisted of him arguing with his political advisers. His political adviser was saying, "We don't think this is such a smart thing to do," and Romney is saying: "No. Check it out. I can do this. Isn't this neat? I can make this work."

    So actually, I was not that impressed with his political advisers because I didn't like what they were saying, but he sort of shot them down.

    You keep saying this was "neat." Did he actually use the words, "This was neat"?

    I don't remember. No. But that was sort of -- he had a bit of a "Gee, golly gee" attitude about [it]. "Isn't this cool? We can make this work." ...

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    There is a big moment where the bill is signed. Take me there. Describe the environment. I know you were there.

    I was there. I was very excited. I got to bring my wife. That was really neat. I was one of several people Romney actually thanked in his speech, which was really cool, a very proud moment for my wife. That was very exciting. It was this big podium and was all -- Ted Kennedy made a joke about hell freezes over. "I thought hell would freeze over before I would work with Mitt Romney." And Mitt Romney said, "I can't believe I'm working with Ted Kennedy." And they all laughed and hugged. And then they had a speaker from the conservative Heritage Foundation, which is a very conservative think tank, speak about what a wonderful validation of conservative principles this was. And it was all wonderful. And everyone was super-happy.

    Daniel Webster looked down upon it all.

    It was great. It was just an absolutely thrilling moment.

    And the meaning of it? Suddenly does the word spread around the United States in California and other places that, "Hey, something cooked in Massachusetts. Maybe it could work here"?

    Oh, absolutely. I mean, it sort of had the feel of "Nixon goes to China" moment, like here is a Republican governor working with a Democratic legislature to have this bipartisan, middle-of-the-road solution. And almost immediately I was called by Gov. [Arnold] Schwarzenegger's office in California. I spent the next year trying to do the same plan in California that just flounders on fiscal straits and political straits in California. But once again, Schwarzenegger thinking, "I'm sort of a middle-of-the-road Republican; I can do the same thing here."

    And I worked with a number of other states. People were very excited about this idea. But pretty quickly states came to realize that without the leg up Massachusetts had of this federal money, this huge federal slush fund that we had, without that leg up it wasn't going to happen. Then a number of states were interested. They were excited about elements, but they said, "Look, we just can't afford this," just like Massachusetts wouldn't have been able to afford it on our own.

    I think there was a lot of excitement and interest, but it just wasn't going to work fiscally without more federal support. ...

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    How Obama decided to pursue health care.

    So now let's do Obamacare. So a few years go by and what? Your phone rings again?

    So what happened is I had been working in a number of states, notably California. Some others had tried. And it was clear not much was going to happen without federal leadership.

    And then Obama gets elected, and on his health advising team is a number of my friends from the Clinton administration who worked on health care reform round one. I like to think of it as sort of the preseason of what became the ultimate -- I don't want to demean the amazing amount of work that went into that, but these are veterans of those wars who were now on the Obama team saying: "Look, we have the opportunity to do what we were unable to do under Clinton and get this done. We think the Massachusetts model is the way to go. We would like you to come help the administration put the numbers together just like you did for Massachusetts."

    So I went down shortly after the election. I worked with the transition team to help put the numbers together for the administration. And then, essentially, most of 2009 I was really on loan from the administration to Congress, particularly the Senate Finance Committee, to help them put the numbers together on what became the finance committee bill, which really became Obamacare. Yeah, that's what I did.

    How much did you feel like the Obama people -- I mean, did it feel like the kind of thing they had to do? They just felt like: "We need a big one. This is a big one. Let's get it going right away"? What was the impetus?

    No, no, I think they were very much torn about what the big one would be. They tried energy first. I think this was not a foregone conclusion that this is what they were going to do. I think they really came in curious and interested.

    You know, the big moment early on was when President Obama sent his first budget, he put a marker in it. He said, "Look, I'm going to set this aside for health care reform." ...

    This was a big leadership moment for him where his advisers as far as I know were split -- much as Romney's advisers were split -- on political grounds on whether this was the right thing to do.

    And the argument against it?

    Too bold. America is not ready. You know, look elsewhere. Basically political, just political expediency.

    The economy is crashing. Let's pay attention.

    Yeah, political expediency.

    And the arguments for it?

    The argument for it were a, this is sort of something he'd run on, and this is sort of a longstanding Democratic goal; b, we had the example in Massachusetts. And, you know, obviously it is self-congratulatory to believe this, but I really do believe and I've been told it wouldn't have happened if we hadn't succeeded in Massachusetts.

    And it's important to understand that we were a success in Massachusetts. And by the time he's considering this in 2009, what do we know? We know we covered over 60 percent of the uninsured. We know we lowered premiums in our non-group market by 50 percent. And we know we had done so with about two-thirds public support. So we had that under our belts. So I think that was another thing of saying, "Wow, it's an example we can point to that worked, a framework that worked."

    I think the third thing was that he really felt that ultimately, if we were going to control the government, that he knew that the long-run fiscal problem facing the government is all health care. ...

    If you add up everything we promise to spend in Medicare, Medicaid and everything versus what we were going to collect in taxes, we were, over the distant future, $100 trillion in the hole. Eighty-five trillion dollars of that was Medicare and Medicaid. The entire fiscal health of the U.S. is about health care costs. That's it. Social Security a little bit. Nothing else matters. You know, I like to say in the U.S. there are only two issues that matter, global warming and health care costs, because either way we are under water.

    Basically, the entire fiscal future of America was about controlling health care costs, and Obama realized that if he was going to start to tackle the deficit, start to tackle this problem, he had to take on health care costs, and that this law could be the vehicle for doing so.

    And we didn't do that in Massachusetts. This was a new step, ambition. So the idea was, look, let's make this the vehicle not only to successfully cover the uninsured, building what we did in Massachusetts, but to make this the vehicle for the first time to really take bold, new steps on cost control and start that ball rolling as well. ...

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    Obamacare's conservative roots.

    This is an idea that, as you say, in Massachusetts its genesis, at least some of its genesis, is from the Heritage Foundation and others from the right. How did the Obama people feel about the fact that it had lineage, its DNA was partially from the right?

    You know, look, I'm a Democrat; it's clear. But I think objectively, this to me shows why I think President Obama is a better leader than President Romney, which is Obama had an idea which wasn't from his lineage, saw it was the right thing to do, stuck by it and did it and has defended it in the face of enormous criticism.

    Romney did the thing that -- not that it wasn't bold and brave -- but then his party, for no reasons other than craven politics has switched on it, and he has completely caved. And look, this was a conservative idea that worked. How could you possibly deny that idea from your lineage that actually worked?

    You know, it is so rare that we have a bold idea we can run the experiment on, right? We actually ran the experiment on a theoretical concept. We ivory-tower types come up with concepts like this all the time. Here's one we came up with that we tested, and it worked. And yet the minute President Obama adopts it, the entire Republican establishment flips and says, "Oh, this was a bad idea," Romney with them. And that to me is just an incredibly distressing statement about both Romney and the Republican Party.

    Whereas Obama, who was opposed to the mandate in the election -- I mean, Hillary [Clinton] adopted it. And in the election -- in the campaign, to be fair, I was a Hillary supporter, not an Obama supporter, because I liked Hillary's plan better because I believed in the mandate. Hillary had the mandate in her plan; Obama did not. He was explicitly opposed to it. He actually criticized her for it.

    Then he gets elected. And to his credit he gets a lot of people, including myself, telling him, "Look, you cannot make this work without the mandate." And he says, "OK, let's do the mandate." And his advisers say, "This might not be the right thing to do." And he says: "You know, this is what the experts are telling me needs to be done. Let's make this happen." And so Ted Kennedy, who had been opposed to it, he came into that side. Obama came to that side because they saw it working. And ultimately that is what pragmatism is. You see what works, and you do it. ...

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    So were you ever in a room with Obama?

    Yes, twice.

    Tell me. Take me there.

    So the first time was in, I don't know exactly. You know, if I knew at the time how important it would be, I would have written down the date. It is like late 2006 maybe. It was right before he announced he was running. So maybe it was earlier than that, maybe spring 2006, right before he -- when people sort of knew he was thinking about it but he hadn't announced yet. I went down, basically did a tutorial for him on what we had done in Massachusetts and how it would work and basically thinking about expanding it to the national stage.

    Where were you? Where was it?

    This was in his Senate offices.

    And what was he like then?

    He was very interested. It was really just an information session. He was really interested in learning. He clearly was not interested in little incremental things. He wanted to be bold. That was clear. He said, "Look, I want to do big changes." He was really interested in what we had done in Massachusetts. The evidence wasn't in yet by the time I was meeting with him, but he was interested in what we had done. ...

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    So, OK. You have been in a room with this cool idea, with Mitt Romney at one time and Barack Obama at another time. You, of all the people I've talked to in the last week, can tell me how -- and you had the same -- so for me it's a petri dish you've got here, right?

    Right.

    So what's the difference between the way each man reacted to your ideas?

    Well, I think the contexts are very different. I'll answer your question, but the caveat is the contexts are very different obviously. With Romney it was a decision meeting, where he kind of knew what he wanted to do. I was coming in, giving him the validation to do that. Obama, it was purely a sort of educational meeting. He was not the expert on health care that, say, Hillary Clinton was. He was there to learn.

    So with that in mind, I think that it's basically what you would think from seeing them. Romney is more formal. Romney was a little bit more -- yeah, just a little less casual, a little more formal.

    And I just felt a more relaxed around -- Obama was a little more relaxed. I think he took a cigarette break halfway through. That is back when he was smoking a lot. He would check his BlackBerry occasionally. He was just kind of casual, interested in learning, very humble. Obama is very humble. Once again, I'm not saying Romney isn't, but it was very much a situation where, as I said, Romney was very much Romney arguing against his advisers with my playing the role of sort of supporting numbers guy. ...

    And Obama was a quick study, had a kind of quicksilver mind about it?

    Yeah, yeah, absolutely. You know, I don't know how smart Romney is. I mean, in that room he was clearly very -- I really appreciated what he was advocating for, whereas Obama was more of an intellectual discourse. And yeah, he was a super-quick study. He really understood it. Very good in terms of -- if I was saying something he already knew, he could cut me off without seeming rude, you know, kind of like, "Yeah, I know that," but not in the kind of "Shut up," very kind of like: "OK, I know that. Now what about this?" I mean, very much kind of debating, interested but absorbing and not trying to act like he knew more than he knew, and just really interested in learning.

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    The next time you see him?

    The next time I see him is summer 2009. The big issue there is that he really wants to make sure I'm moving forward on cost control. I think that at this point he sort of knew we had a good plan on coverage, but he was worried on cost control. So we had a meeting in the Oval Office with several experts, including myself, on what can we do to get credible savings on cost control that the Congressional Budget Office would recognize and score as savings in this law.

    And that was a meeting -- it was very exciting, once again, because the economists in the room all said the number one thing you need to do is you need to take on the tax subsidy to employer-sponsored insurance. We need one minute of background on this. The way employer-sponsored insurance works is, if you get paid in wages, you get taxed. If you get paid in health insurance, you do not. ...

    So this tax subsidy economists have been railing against for decades, it's super-expensive. We forego about $250 billion per year in tax revenues. It's regressive -- the richer you are, the bigger tax break you get. And it's inefficient because it causes people to buy excessive health insurance. So everyone in the room said, "You want something that is real cost control that we know it will work, go after this."

    Now, the problem is, it's a political nightmare, ... and people say, "No, you can't tax my benefits." So what we did a lot in that room was talk about, well, how could we make this work? And Obama was like, "Well, you know" -- I mean, he is really a realistic guy. He is like, "Look, I can't just do this." He said: "It is just not going to happen politically. The bill will not pass. How do we manage to get there through phases and other things?" And we talked about it. And he was just very interested in that topic.

    Once again, that ultimately became the genesis of what is called the Cadillac tax in the health care bill, which I think is one of the most important and bravest parts of the health care law and doesn't get nearly enough credit. I mean, this is the first time after years and years of urging -- and the entire health policy, there was not one single health expert in America who is setting up a system from scratch, would have this employer subsidy in place. Not one.

    So after years and years of us wanting to get rid of this, to finally go after it was just such a huge victory for health policy. And I'm just incredibly proud that he and the others who supported this law were willing to do it. ...

    Is there a difference in the Obama you see in 2006 and the Obama you see, especially in the summer of 2009? ...

    You know, I would have thought -- in one case I'm sitting in his Senate office; in the other I'm in the Oval Office. One case he is just a senator, and the other he is the president. He is just so relaxing to be around. It was not stressful. It's just people going by. I was a little nervous. It's the president, after all. But he's just kind of interested in what people had to say.

    The way these meetings work is everyone gives their little five-minute spiel, and then he would make a comment or two, and they would go around, and then we would have a discussion.

    And he had a couple of remarks after everybody's, and he was clearly interested, and he was clearly thinking about it. But once again, it felt sort of like an academic meeting, not academic in the pejorative sense, academic like in the academy. It was just a fun, intellectual conversation. ...

    If you really want to see publicly how Obama works, then the key thing to do is watch that Blair House meeting. That, to me, is one of the proudest moments. That was an incredibly intellectual exercise where Obama sat in front of a bunch of people, including people very opposed, and held his own and discussed the policy issues and really, he is just a smart guy and interested in getting it right.

    That was the Obama you recognized?

    That was the Obama I recognized, yes.

  14. Ψ ShareThe battle for the health-care bill.

    And that, they say, is when the tide turned a little bit, when he finally said: "I'm going to step into this battle. I'm going to face the demons. We're going to confront it. And I'm going to take a public position."

    ... Obama desperately wanted a bipartisan bill. Originally there were at least three Republicans very seriously interested in this, and the framework was in place. It was ready to go by early summer. But the Republicans -- it was just about wrangling, getting them onboard, working out the details. Things looked very close. And his hope was to have something ready by Labor Day.

    But then the August recess happened, and they went back to their town halls, and the Republicans got great cold feet and said, "We can't sign onto this," which was a travesty. ...

    At that point the administration realized: "Wait a second. We are not going to get a bipartisan bill. We've got to really work on this." Max Baucus [D-Mont.] wasn't willing to admit that. Max Baucus was the key player, head of the Senate Finance Committee. And he worked another, like, six weeks trying to get the Republicans to come along. And finally Obama said: "Look, we're just going to push this. You know, Baucus, this isn't working. We are going to put our own plan in, and that is going to put pressure to make the ball roll forward."

    And it rolled forward, you know, probably six to eight weeks later than it would have had they recognized earlier: "Look, we are just not going to get Republicans on this. We just have to go forward."

    Well, and then there was a man named Scott Brown.

    And that was a real stressful point. So basically, the night before Christmas it passes the Senate. The House had already passed their version, which was even more to the left. We're like, "This is great." I went on vacation with my family. We celebrated. This is the greatest thing in the world. We're so excited, you know, and my wife said, "Are you sure, Jon?" I said, "Look, unless someone dies or somehow some Republican wins in Massachusetts, we're fine."

    Well, lo and behold, we had a pretty awful candidate for Senate who didn't know the Red Sox from the Blue Sox, and Scott Brown wins. And now we've got a problem because now we can't get back to 60 votes in the Senate. ...

    Now you've got a problem. And this is where Obama showed his leader[ship]. I mean, this is I think one of the incredibly proud moments, which is at that point a lot of people said: "Well, good try. But you know what? Salvage the things people like, and cut and run, because the truth is, you just can't get this done. Look at those town halls. It is so unpopular. You just can't do it."

    And, you know, someone used to say to me, it's sort of ironic that if you look at John F. Kennedy's book called Profiles in Courage, they were all about times politicians didn't listen to the public and did what was right, not what political expediency would say. And this was a profile in courage. I mean, he basically said: "You know, look, this is the right thing to do. We are going to do it. I'm going to fight for it." ...

    Of course he and the Democrats paid the price for those hard votes in the midterm election.

    You know, they did. It is so unfortunate, the misunderstanding about this law. I've actually written a comic book, a graphic novel to try to explain the health care law that has actually sold pretty well and it's done pretty well, just because people don't understand this law. ... And it's sufficiently complicated that, you know, anything that takes two sentences to explain in America today will be shouted down by a one-sentence lie. And it takes more than two sentences to explain the Affordable Care Act, and so people can lie.

    In my comic book I have monsters representing the myths about the health care reform. You know, this is not socialized medicine. In fact, it expands the private health insurance sector.

    This is not a federal takeover. There is a huge role for states in implementing health care reform. There are all these lies that opponents just realized they could put out there, and it was a complicated enough bill that they could get away with it. And it's unfortunate that it has worked out that way. ...

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