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Stage Set for Christmas Eve Health Care Clash

With Senate Democrats on the cusp of passing the most sweeping overhaul of the nation's health care system in a generation, Democrat Sherrod Brown of Ohio and Republican Lindsey Graham of South Carolina speak with Gwen Ifill about the merits of the bill.

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    We have our own debate now on the merits of the Senate bill and what it might take to get a final bill to the president's desk.

    Sherrod Brown is a Democrat from Ohio and is a member of the Senate's Health Committee. And Lindsey Graham is a Republican from South Carolina. He's a member of the Senate's Budget Committee.

    Gentlemen, we just heard Ben Nelson, the famously sought-off senator from Nebraska, say this weekend that this is not about whether the health care system gets fixed, but the way you fix the health care system.

    So, was this, as Harry Reid, Senate majority leader, put it today, the grand compromise of the Senate, or was it just backroom dealing at its worst?

    Senator Brown?


    It was a — it was a good compromise. I don't like some of the deals that were made. I don't like the deal that was made on abortion. I think that that compromises a woman's right to choose.

    I think that — I don't like that the — that the public option is no longer in or the Medicare buy-in. And I don't like some of the other things.

    But, overall, this bill makes a big difference. It strengthens Medicare. It provides tax incentives to small business, so they can begin to cover their employees. Most small businesses want to do that.

    I think this legislation is important when you look at the insurance reform. Immediately going into effect next year when the president signs it is no longer allowing a child to be — a child with a preexisting condition to lose the insurance for the family.

    I mean, that — we're going to prohibit that. No more discrimination between where women pay more in — pay more for the same policy as a man has, no more lifetime limits, where someone gets sick and their health care costs are so high that the insurance company cuts them off.

    And in terms of Medicare, we're going to be giving annual checkups, close the doughnut hole, so seniors won't pay so much out of pocket for prescription drugs. And this, for the first time, unlike the 2003 drug company, insurance company bill that President Bush pushed through, this bill actually lengthens the life expectancy of Medicare. So, the deals notwithstanding, this bill is good for the country in so many ways.


    Senator Graham, let's pick up on that. Is this bill good for the country, or are your objections to this bill about what's in it, as Senator Brown just described, or is it the way it was done?


    Oh, I think it's both.

    I mean, this whole idea that we were going to do business differently resonates with the American people. And I think we kind of let them down here. We were going to have transparent negotiations on health care. They were even going to be on C-SPAN, according to President Obama.

    At the end of the day, what happened was, they got the 60th vote behind closed doors. There was no Republicans in the room, no Democrats, really. And this is the old way of doing business on steroids.

    And the Nebraska deal, it is not going to go well with the American people. I'm going to have a hard time going back to South Carolina and say that our Medicaid rolls are going to expand by 500,000 people. And I have got 30 percent of my state is African-American, a lot of low-income people, a lot of particularly low-income African-Americans. My state is at 12 percent unemployment.

    The matching portion for South Carolina is going to increase by a billion dollars. But, if you live in Nebraska, the new enrollees in Medicaid there will be paid for by the federal government in perpetuity. I don't think most Americans feel like that's a change that we can believe in.

    But that's just one problem. The assumptions in this bill to get it to reducing the deficit is not going to happen. We're not going to cut Medicare by $470 billion. Four years ago, we tried to reduce it by $10 billion, couldn't get the votes to do that. So, that's an illusion. And there's $247 billion of doctor cuts to come over the next 10 years. And we're going to forgive all those. So, that wasn't factored in.


    Senator Graham, there are a lot of Americans out there who look at this and say, this is what happens all the time on Capitol Hill. Deals are cut. People benefit. What's unusual about this one?


    Oh, I think what's unusual about this is, the American public is tired of that way of doing business.

    And they elected to President Obama to change that. What happened to this change you could believe in? The one reason I think he won, more than all others, is, he presented a fresh face, a new way of doing business. And, at the end of the day, we have let the public down. We're going to pass a bill that changes one-sixth of the economy on partisan lines.

    When Medicare passed, there were 21 no votes, 79 yes votes. When Social Security passed, there were only six no votes, Americans With Disabilities Act eight no votes. So, I think what the American people are going to look at the Congress and say, this is not change.


    Senator Brown, Ohio benefited from some of these special provisions in this bill. Were the ends worth the means?


    The ends are — the issue is what — what this bill means to people in Ohio.

    And my — in my state, 390 people every single day, from Toledo to Cincinnati to Dayton to Youngstown, 390 every single day lose their insurance. Across the country, 1,000 people are dying every week because they don't have insurance.

    If you're — a woman with breast cancer is 40 percent more likely to die if she doesn't have insurance than if she does. That's why we need to move now, why the delay tactics from some of our colleagues I think are — simply don't serve the public interest.

    In this legislation, ultimately, 31 million people are going to get insurance under this legislation. I go to the floor every night, almost every day, and read letters from Ohioans, most of whom were pretty satisfied with their insurance a year ago, and then either they had a child with a preexisting condition, or they lost their job, or they had an expensive illness that caused the insurance company to — they call it rescission, to rescind their insurance. And now they're hurting.

    And we have an opportunity to fix this. And this bill does this. It's not perfect by a long shot. It would do better with the public option. It would do better with the Medicare buy-in. And it would do better — we could do better on the prescription drug issues to get drug prices down a whole lot better there.


    May I ask you…


    And we weren't able to accomplish all that.


    May I ask you to respond to something Senator Graham just said about costs? The president said today this is going to bring the deficit down. The whole goal early on was to bend the cost curve, so that the actual cost of staying insured when you are insured would go down. Is the Senate bill, as written, would it do that?


    I think it makes major steps towards doing that.

    Unlike the 2003 Medicare privatization bill that was written by the drug and insurance companies, there was no — you know, I give Senator Graham credit. He voted against that. Not many Republicans did. But that bill — that bill wasn't even paid for, not even attempted to be paid for. This one is.

    And the Congressional Budget Office, which is — plays it straight. I mean, the people on the losing team always complain about the referees, but the Congressional Budget Office says this bill will — will produce in the first 10 years a surplus of $130 million — excuse me — billion dollars and the second 10 will produce a surplus of about $800 billion.

    So, it clearly goes in the right direction. There are some other things we could do. I think it does a lot of good pilot projects and cost savings, because this can't be cost savings imposed from Washington.




    It has got to be best practices coming from physicians and hospitals and other health care providers that really know how to do this.


    Let me ask Senator Graham about that.

    Is this heading in the right direction, in your opinion?


    No. Medicare is going to go in bankruptcy in 2017. We have taken $470 billion out of the system, not to save Medicare from bankruptcy, but to create new government programs that are going to explode in cost down the road, like the CLASS Act. And I will talk about that in a second.

    So, it's hard to find a Medicare doctor now. Hospitals and doctors are having a hard time making on the reimbursement levels that exist today. If you take $470 billion out of the system, you're going to compromise health care for seniors. And, at the end of the day, we need to reform Medicare for Medicare's sake, not take money out of that system to create new government programs.

    We're not going to cut Medicare by $470 billion, in my view. And this will not be paid for. The assumptions in this bill will never become reality. The $247 billion doctor fix, the cuts to come for doctors, 21 percent next year, we're not going to let that happen.

    So, at the end of the day, the CLASS Act, a new federal government entitlement program where the federal government will sell you long-term health care insurance, collects premiums for five years, $72 billion worth. Then it starts paying out benefits. And the CBO says it will create a cost explosion to the deficit.

    Senator Kent Conrad called the CLASS Act, which is in this bill, a Ponzi scheme of the first order that Bernie Madoff would be proud of.

    So, that's one program in the bill that's just going to blow a hole in the deficit.


    Well, do you think that that's one of the most overlooked areas of the bill? Or are there others?


    Yes, I would say that's the most overlooked bill.

    And the idea that we will do what we say we're going to do with Medicare, there's no history in the Congress of reducing Medicare by a little bit, much less $470 billion.

    At the end of the day, Sherrod and I agree on a lot of things, preexisting illnesses. I'm on the Wyden-Bennett bill, seven Republicans, seven Democrats, mandating coverage. And that's hard for a Republican, that you would have to be covered, but we will take tax deductions away from business, give them to individuals, buy private health care, buy health care in the private sector, and, if you don't have money, we will subsidize.

    That's the way I want to go. And this bill doesn't do that.


    And, yet, Senator Brown, there's no public option in the bill that passed the Senate, and it does exist in the House.

    There are stringent restrictions on what people can spend on abortion. But that is even tougher in the House bill. Do you imagine that the Senate bill will stand as it is? Can you imagine that, when there's such differences with the House?


    Well, I think there will be some significant changes. I mean, there will be some changes, whether they're significant.

    I think where they may be significant is the tax on so-called Cadillac health care plans. I don't really call them that. But that's way the media report them, and — and where people that have high-quality health care plans have to pay taxes on them.

    The president promised in his campaign — actually criticized John McCain for that. And, so, I think that is part of the Senate bill. I hope it's not coming out of conference committee, because those are people that have negotiated union plans, but not just union plans, have negotiated good health insurance, given up wages to do it. They shouldn't pay taxes on it.

    And I would also say that I hear all this about Medicare. And I appreciate Lindsey's comments. But the AARP and the AMA wouldn't be supporting this bill if it didn't have — if it were not doing the right things for Medicare and not doing the right things for attracting physicians and to covering — and to treating Medicare patients.

    So, I think this is the right way to go in Medicare. It gives Medicare beneficiaries — as I said, it gives them physical — they will have annual physicals. They will have colonoscopies, and mammograms will be available. And it — again, it lengthens Medicare life expectancy by 10 years, something that no one has really focused on doing in this body for many, many years.


    Senator Graham, looking back on this now, was bipartisanship ever possible for this bill? Was it always going to come down to 60-40? Was it always going to come down to every single Republican being against it and every single Democrat being for it?


    No, Olympia Snowe voted for the Finance Committee bill. She is on the Finance Committee. She voted for the bill out of committee.

    And it just fell apart. I can't explain it, really, quite frankly. I'm on a bill, seven Democrats and seven Republicans, that would mandate coverage, where everybody would have to be coverage — covered, and you allow the tax code to be used to make those purchases.

    I don't know what happened. I can't explain it. I don't know how we went to the point that all the negotiations broke down, and Ben Nelson was dragged off in a room somewhere in the Capitol, and they come up with this cockamamie deal for Nebraska to get the last vote.

    And $518 billion in taxes to pay for this bill, you will never convince me that that's not going to be passed on to the consumer. There has to be a better way than raising $518 billion of taxes and cutting Medicare.

    And if you're selling supplemental insurance policies for Medicare patients, your business just got a lot better, because the services available to seniors are going to go down. And if you're the AARP, you're going to have a lot more customers than you did before.

    And only one in five doctors work for the AMA — or support the AMA.


    Senator Lindsey Graham, Senator Sherrod Brown, you all still have some more votes ahead of you. We will be talking to you again. Thank you very much.




    All right.

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