CNN "State Of The Union With John King" - Transcript

Interview

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KING: We begin this Sunday morning with the Senate's dramatic step to open debate on major health care legislation. It was a rare Saturday night session, and in the end, a big win for the Democratic majority, but just barely. Leader Harry Reid needed 60 votes and he got just that. All 58 Democrats and both independents voted aye on the motion to proceed. Every Republican voted nay. Their leader will join us in just a moment for an exclusive conversation about the Republican strategy going forward, but first, the many challenges still ahead for the Democrats.

Let's talk those over with Democratic Senators Jeanne Shaheen of New Hampshire, Sherrod Brown of Ohio, and, in his first Sunday show interview, Michael Bennet of Colorado.

Congratulations are in order on this morning for the Democrats, but you got across the starting line. Let's talk about what it will take to get to the finish line. And the big divide in the party still is over the public option. Three supporters of the public option at the table here. But you saw Senator Lincoln of Arkansas says, I vote to go forward in this debate, I don't like the public option. Senator Landrieu, I don't like the public option, at least in its existing form. Senator Lieberman has said he will not vote for a bill that includes a public option.

Senator Shaheen, to you first. Will you have to get that up to get 60 in the end? You had 60 in the beginning, but to have 60 in the end, will you have to go to a trigger or some other form and give up what you would like?

SHAHEEN: You know, first of all, I think it's important to again what a milestone it is for us, after 50 years of debating health care, that we are now finally on the floor of the Senate, going to be able to debate this issue is significant progress forward.

You know, I support a public option. I think it's important for us to get competition in the health insurance industry so we can lower costs for people. But there are a number of ways to do that. We're at the beginning of this debate, and I think we've got to see how it plays out.

KING: Senator Bennet, you want to go home -- you're on the ballot next year -- you want to go home and say, we did this. It's not only is it important, not only did we debate it, but we passed it. Will you have to give that up to get 60 at the end?

BENNET: I don't know. My sense of it, John, is that people understand that there's a requirement in this bill that they have insurance. What they're saying to me is, even though they didn't say this early in the summer, what they're saying now is I want all the options. I want a public option, I want a private option, I want nonprofit. I want to be able to make the choice that's in the best interest of my family. I think other people are going to be hearing that too.

So I think last night was a big step forward, because it allows us to debate not just this issue, but a range of issues around health care that the American people, you know, deserve to have. As Jeanne said, after 50 years of delay, delay, delay, we finally now have the opportunity to debate these issues on the floor of the Senate.

KING: Let me try asking you it as a yes or no. If in the end, you cannot get Senator Lieberman, Senator Lincoln, Senator Landrieu and you can't pass a bill without at least going to a trigger, would you make that compromise?

BROWN: I'm not going to answer yes or no, because I don't think we get to that.

I think what happens, John, is there are two weeks, three weeks, whatever, of debate. Senator Lieberman, everybody has a chance to offer amendments. I'm going to offer amendments on some pharmaceutical issues, because I think the bill could be strengthened there. I know that my colleagues are going to do the same on some other -- that and some other issues. So they will have their chance to do this. And I think, in the end, I don't want four Democratic senators dictating to the other 56 of us and to the country, when the public option has this much support, that it's not going to be in it.

And I echo what Michael said, is that people want every option. If we're going to -- if we're telling people you have to buy insurance, we shouldn't tell them they've got to buy insurance from a private insurance company.

But in the end, I think that all four of our colleagues surveyed this -- look at this bill in the end and say, I don't think they want to be on the wrong side of history. I don't think they want to go back and say, you know, on a procedural vote, I killed the most important bill in my political career. I don't think they want to be there on that. So I think in the end, we get them.

KING: I was just in Arkansas this week, though, and if Senator Lincoln cast that vote, this is the most important issue, I'm going to cast the vote -- she may lose her job. Do you think that if that's the calculation, she should do it?

BROWN: I certainly can't -- I don't know what Arkansas looks like. I mean, I'm not an expert on Arkansas politics. But overwhelmingly, the public option is popular. The people that don't like the public option are people that oppose this bill anyway. I mean, it really gives people additional (ph) choice. It bends the cost curve down. It injects competition. In southwest Ohio and Cincinnati, two insurance companies have 85 percent of the market. That means low-quality, high-cost insurance. Provide another option, like the public option, and you get better prices and better quality.

KING: We've got some time to air this out. So let me give each of you, take a minute. You say you're going to have an amendment. Tell me how you would like to make this better.

BROWN: I would start on the pharmaceutical issue, that we need drug reimportation. We neat direct negotiations with the drug companies for Medicare to bring prices down, the same way the VA does, the same way most countries do. We need a generic path for biologics, where it's just too expensive for some of these new drugs like Herceptin and these biologic drugs which are an increasing percentage of our health care dollars are going into these biologics. They can be $20,000 to $50,000 to even $100,000 a year. There's no competition, no generic competition. Those are some of the things I would start with.

KING: Senator Bennet?

BENNET: I think there are three things that are all related to cost, because no matter where you fall out on public option, not a public option, the thing that our working families need more than anything else is to end these double-digit cost increases that they're having every single year with health insurance. So the first is to make sure we really have done all we can do to change the Medicare incentive structure so that we're driving quality and we're driving lower cost. I think, second, we need to do a much better job of making transparent what things actually cost. No one knows in this country what it really costs to get a knee replacement. No one knows what it costs to get other medical procedures. And they can't compare across a range in the geographic area. So I think that's very important for consumers and for providers.

The last piece is administrative efficiency. You know, our insurance companies and doctors have to fill out -- the doctors in particular -- multiple forms. The coding is all screwed up in a lot of ways, and people -- and it just isn't as easy as it should be. People are spending 30 percent of their overhead just trying to get paid by insurance companies. I think there's more we can do to streamline that too.

SHAHEEN: I agree. I think we've really got to address cost as part of this bill, and how we deliver health care to people. I have -- I agree with Sherrod's comments about the pharmaceutical industry, especially now as we see increased prices. There's more we can do there. I have talked about a current drug labeling laws that need to be changed so that there's more competition with generics.

And I also think we've got to do something about emergency room care. We've talked about how to improve emergency room care to reduce costs.

But that's what we've got to do in this bill. I was talking to a businessman from New Hampshire over the weekend, and he's got something called Highliner Foods (ph), it's a fish processing plant. He said that he can't afford the cost of his health insurance, and so he's got three choices. Either he can go out of business, he can automate, or he can go overseas. None of those choices are good for New Hampshire, good for America, or good for workers.

KING: Let's talk about how we pay for this. The Senate bill would cost about $850 billion over 10 years. Here's how it's currently paid for in the proposal before you. A 40 percent tax on so-called Cadillac insurance plans, those that cost over $8,500. $436 billion in Medicare savings or cuts depending on how you look at it, and we can talk about that. Increase in the Medicare payroll tax for those making over $250,000 a year, and a 5 percent tax on elective cosmetic procedures, already lovingly called the botax here in Washington, D.C.

As you know, a number of these proposals are quite controversial, and your friends in the labor movement particularly don't like the Cadillac insurance plan tax. Here's what Jim Hoffa, the president of the Teamsters, says. "This provision is really a massive tax increase on the middle class by calling it a tax on insurers. But it is naive to think that insurers won't pass this tax directly on to workers. The idea that this tax will curtail rising premiums is just dead wrong." Is Jim Hoffa right?

BROWN: Generally, he is.

KING: Will you (inaudible) that proposal? BROWN: I would prefer that we look more at the version that the House did on a surtax on people making $500,000 a year or more. Even with the House proposal, I know we're talking -- when you talk about either bill, but even with the House proposal, it's still -- the tax rate is still significantly less for upper-income people than it was before the Bush tax cuts for the rich that were unpaid for and caused us huge budget, in part, with the war and the Medicare privatization, that caused these huge budget deficits.

BROWN: And I know that Mitch McConnell, when he speaks after this, is going to spend a lot of time talking about the budget deficit.

But it's the Mitch McConnells of the world that voted for the war and didn't fund it, voted for the tax cuts for the rich and didn't fund it, and voted for the Medicare privatization and didn't fund it. That's why we're in this situation and the economy we have.

So it's just important as we listen to Mitch in the next segment that people kind of keep that as a...

(CROSSTALK)

KING: I will remind him of that point, but the Democrats are in charge now.

BROWN: I understand that. That's why were...

KING: They have the White House and both branches of Congress.

BROWN: That's exactly right. We're in charge now. And Jeanne Shaheen and Michael Bennet and I, all of us, have made sure this bill pays for itself. We're embarking on something very new and very important, this health care bill. And we've all committed that it be paid for, something that hasn't happened in 10 years.

That is no longer business as usual. And that's why -- that's one of the reasons why this bill is the right way to go.

SHAHEEN: And it's not just that it's paid for, it actually is going to reduce the deficit over the next 10 years by about $130 billion. That's real progress.

KING: And to make that happen, if you read the Congressional Budget Office analysis, if you talk to interest groups around town, even those who support you, academics, they say you have, you know, the $400 and something billion in Medicare savings. And some people call it cuts, other people say this is waste, fraud, and abuse, let's make a run at this.

But what we do know will happen is that next year and the year after, whether it's the hospitals, the hospices, the senior groups, will come back saying, this is too hard on us, this is too hard on us, give us some of that money back. Will you all commit today that if you pass this bill and it sets that target to save in Medicare, that you'll say no when they come back. And you may have to cast the tough votes against your friends saying, no, we committed to doing this, it is the key to bending that curve, and you will make the tough votes?

SHAHEEN: But, listen, I think there's a lot of misinformation about where the cuts from Medicare are going to come from. They're basically from two places. One is we're going to make private insurers who offer Medicare Advantage plans pay the same amount that everybody else is getting under Medicare. There are significant savings there.

And then the hospitals have said, we're going to be able to charge less for Medicare, because we're going to have a lot more patients, because a lot more people are going to be insured. And then there's a third provision that I think is reflected in a number of ways in the bill that Michael and I have been working on, which is hospitalizations, and making sure that people on Medicare, when they're let out of the hospital, are able to stay out because they've got better transitional care.

BENNET: I would say, John, I think it is critically important that we maintain the fiscal discipline that's represented by this bill. We maintain it as the bill works its way through the floor and also in the years to come. Because one of the things that people are really cynical about here is whether Washington actually can pass a piece of legislation and pay for it.

You know, they're worried about -- they don't like the existing health insurance system, that's clear, but they're very worried about our capacity to make it even worse. And so for those of us that are proponents of reform, I think we carry a heavy and very appropriate burden to make sure that we really are paying for it, not just in the near-term, but in the out years as well.

BROWN: And there are a number of components to this bill that aren't even counted in terms of cost savings, the discharge procedure, the first 30 days out of the hospital that Michael and Jeanne -- or that several are working on in the Senate, where a dietitian or a nurse or some home health care person spends -- monitors and stays with those people in those 30 days, continues to talk with them, that's not reimbursed now.

And there are ways of doing that. That will save a lot of money. The checklist that the physician at Johns Hopkins, Peter Provost, developed that saved hundreds of millions of dollars in Michigan. That's not counted in the savings.

All the wellness and prevention parts of the bill that Senator Harkin wrote in our Health, Education, Labor, Pension Committee that Michael and I sit on, all of that will be additional cost savings that are not so-called scored, too much inside-the-beltway...

(CROSSTALK) KING: Let's take a quick break -- let me take a quick break, we'll be back. Plenty more to talk about with our senators about what's in the health care bill for you. Don't go anywhere.

(COMMERCIAL BREAK)

KING: We're back with Democratic senators Jeanne Shaheen of New Hampshire, Sherrod Brown of Ohio, and Michael Bennet of Colorado.

Let's talk about another tough issue in the health care bill. And Senator Bennet, I was listening yesterday on the floor when you were talking about your views on this, and that is, how should abortion be dealt with national health care reform?

I want to show our viewers, here's what the Senate bill before you right now does. It bars the use of federal funds for abortion coverage. The public man that would be created could provide abortion coverage, but money from the premiums must cover the procedure, not tax dollars.

The exchanges that would be created in each state must have one plan that includes abortion coverage and one that does not. And people who receive federal subsidies to buy insurance could choose a health plan that covers elective abortions. But, again, the private insurance would have to make sure that money comes from premiums, not federal tax dollars.

Here's what the House bill does in contrast. It is much more restrictive on this issue. It bars the use of federal funds for abortion coverage. The public plan would not provide abortion coverage. And private plans in the health care exchanges could not provide abortion coverage. People who receive federal subsidies to buy insurance could not choose a health plan that covers elective abortions.

I heard you on the floor yesterday saying the House goes too far. Again, in the end, would that be a make or break for you? We're going to have to cut a deal at some point if you get this bill through the Senate. And some people say, oh, if there's no public option, that's not good enough, I'll walk away. What about on abortion?

BENNET: I don't think there's any reason to change what the long-standing policy has been from the federal government about...

KING: But what if the reason is, you don't get a bill unless you do?

BENNET: I think -- I don't know, John. I don't think we will get that bill and I think that it would be very unfortunate if we did. We shouldn't be using health care reform to rewrite long-standing policy from the federal government on abortion. It's just not right. It's not the place we should be doing it.

I think the Senate bill strikes a very good balance. It's the balance that we've had for many years around this issue. And I think there are also very important things in the health care legislation that deal with long-standing issues around discrimination against women in a way health care is provided and insurance is delivered.

And I think that's where we should end up. I don't see a reason to be where the House is on this issue. KING: Well, let me talk to you about the process a little bit. If you look at the front page of The Washington Post today, "Sweeteners for the South." To get Senator Landrieu's vote, just to proceed, just to go across the starting line, language was inserted in the bill that gives her state up to $300 million. To get Senator Nelson's vote, the leader agreed to drop a request that you take away the antitrust exemptions for insurance companies.

This got us to day one of the debate. Is this the way to do things? The central promise of the Obama campaign was to change the way Washington works. That's Washington as usual, is it not?

BROWN: It is and it isn't. I mean, I -- this bill is extraordinarily complicated.

BROWN: This legislation is -- you know, as Jeanne said at the outset of the show, 50 years, you could maybe even say 75 years -- Franklin Roosevelt attempted it, Harry Truman really attempted it in earnest...

KING: But is it important enough to buy votes?

BROWN: I don't say it that way. I think there are a lot of things that we all go to the leader and talk about things in our state. And news reports sometimes aren't accurate about what might have been done for somebody or what might not have been done for somebody.

I want to see this bill pass. Nobody likes these kinds of -- any kinds of deals. I think anything that's done needs to be in the best -- in the best interest of those states and this country. I think those probably helped, if that, in fact, really happened -- I have no way of really knowing if it did. I suppose that helped a lot of people in Louisiana that don't have insurance, and so I think we move forward.

We do what we need to do, within ethical bounds. We do what we need to do within practical bounds. Keeping this, as we've all said, keeping this bill, keeping the costs down and keeping this bill budget-neutral or better, as Jeanne points out.

KING: Does it make it harder to do that? Does it create a climate if you're on the fence, legitimately on the fence, you think, all right, well, maybe I want to be a good Democrat and swallow my pride or swallow an issue or two and vote for this in the end, but I'm going to get something for it, and that's going to cost money?

SHAHEEN: Listen, in the end, this is going to be a compromise. It's not going to be a perfect bill, but it's going to be a very important starting point. And I think it's important to point out that this bill is not just about how do we deliver health care in a way that is more cost-effective, because families can't afford it anymore, business can't afford it anymore, and the economy can't afford it.

But it's also about how do we do it in a way that improves people's health and their lives. And, unfortunately, we're spending more money right now on health care in this country than any other industrialized nation. And yet, we're not healthier. And so we've got to change the way we do things. And that's what this legislation is about. BROWN: John, 400 Ohioans every day are losing their insurance. And you know, the Republicans, it was amazing last night, 39 Republicans, every Republican that voted, said, we shouldn't even debate this. We shouldn't even move forward. We shouldn't even have a chance to go to the floor and offer amendments to improve it. 400 Ohioans every day. You know, dozens of Coloradans and New Hampshire -- people in New Hampshire -- I mean, we need to do this, and we aren't hurrying it. We've taken the whole year, and not to mention 75 years, and this is done right, and we need to do what we need to do to get this bill enacted, and it's just so important.

KING: We saw this week how hard it will be to bend that cost curve in the example of when the mammogram study came out and the pap smear study came out, and you had groups outside of the government but affiliated with the government saying, change the policy on mammograms. Make it 50, not 40 for the screening, the pap smear thing. Do you believe -- use this dustup as an example -- when it comes to evidence-based medicine, comparative research, that we need -- do you believe we need that to bend the cost curve, but what's going to -- it's going to be men for prostate next, or somebody's vision test after that?

BENNET: I do, and I think that we've got to -- this bill does a very important thing, which is it gets some of those decisions out of the hands of Congress. You were just talking about how, doesn't this look like it's the same old thing? You know, the same old political, inside-Washington, D.C. special interest game? And it does look like that to a lot of people. This has been about moving the ball down the field, getting through to a place where finally we can now debate the bill comprehensively, end to end, and Americans can see whether or not this is something they want to support, which I think is great.

And I think it's very important as part of that, that we get, for example, out of the hands of Congress, making these decisions on a one-off basis about how people are reimbursed, for example, for oxygen. I mean, you can imagine what lobby day looks like for oxygen in the United States Congress. People come in and say, you should use this much oxygen at that price. It has nothing to do with patients, it has nothing to do with the quality of care, or comparing a certain kind of treatment in one place to another. And I think that if we can establish an infrastructure to really do that in a thoughtful way over time, not only can we bend the cost curve, we can take the politics out of it, and the quality of care will improve as well.

KING: I want to move on to some other issues. Before I do, I want to try one yes-or-no question on you, a new senator who's on the ballot next year in a tough state. If you get to the final point and you are a critical vote for health care reform, and every piece of evidence tells you, if you support that bill, you will lose your job, would you cast the vote and lose your job?

BENNET: Yes. KING: All right. That tape will be held -- I hate to tell you that, but that tape will be held right now. I want to move on. There's a lot of criticism this week. We saw unemployment in 29 states went up. In two of your states, it went down a little bit. In one of your states, it went up a bit. In 29 states, the unemployment rate inched up again. And there's been a lot of criticism of the president's economic team, including from Peter DeFazio, who is a Democrat. And he said this, Congressman Peter DeFazio. "It's pretty embarrassing for a Democratic administration and a Democratic Congress to be identified with total attention to Wall Street and nothing for Main Street and jobs. I still support the president, I just think he's being poorly served by his economic team."

Some Republicans went further and said Secretary Geithner should resign.

Is this administration and its economic team in touch, in sync with the people of Youngstown and Cincinnati and Cleveland at this moment, or more in touch with Wall Street?

BROWN: I think the president is. I think that the vice president is. I think the advisers are mixed. I spoke with secretary -- I was with Secretary Geithner at the Treasury Department this week at the small business summit, Senator Warner and I with a bunch of small-business people with Karen Mills, the administrator of SBA, and Secretary Geithner. And I took him aside and said, we need more focus on manufacturing, we need an industrial policy. Manufacturing creates middle-class jobs, and there's not been the -- there's not been a manufacturing policy in this country for forever, really. And the former presidents haven't had it, and -- and President Obama's moving in that direction. I mean, Ron Bloom and others in the administration really are beginning to focus on that. So I think they've turned a corner. I think, particularly next year, the focus is all about creating jobs, and I think we'll begin to see changes.

BENNET: What's staggering to me about this is it's not just that we're in the worst recession since the Great Depression, although we are. It's also that in the last period of growth, working families income in the United States actually declined during the Bush recovery. So our working families are trying to recover not just from one recession, but two. This is not just a short-term issue about stimulus. It's a long-term issue about where we're headed with this economy. And I think we do need to turn more of our attention to that.

I think we need to do much more to get small business access to loans again so they can start hiring again. We haven't done a good enough job at that. We really do need to turn our focus in a very meaningful way to Main Street.

KING: And as he makes that point, he says we, he's being polite. Does the president's team need to do a better job?

SHAHEEN: Sure. I think we all need to do a better job. I voted against the TARP funding because I thought we weren't holding the financial community accountable enough for how that money was being spent. So I think we've got to look now at what more we can do. Both Sherrod and Michael made the point, we need to make sure business gets access to credit. We need to have a manufacturing policy. We need to do more to give business access to international markets so that they can export more. So there's a lot more we need to do. We need to invest in our infrastructure, and I think the president and his economic team recognize that, and we've all got to work together and work harder.

KING: Senator Shaheen, Senator Bennet, Senator Brown, thanks for coming in on this Sunday morning. Appreciate it. We'll continue the conversation. We've got a long way to go here on both the health care and the economic front.

And up next, the Republican perspective on health care, Afghanistan, and more from the Senate Republican leader, Mitch McConnell. Stay with us.

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