Joining us now is independent Senator Bernie Sanders of Vermont. He‘s a member of the Senate Health, Education, Labor and Pensions Committee.

Senator Sanders, thanks for joining us tonight.

SEN. BERNIE SANDERS (I), VERMONT: Good to be with you, Howard.

DEAN: It seems clear to me that if these four senators are to be believed, the Senate can‘t pass a strong public option. So, I guess, I‘m going to first ask you, would you support the use of reconciliation to fix this?

SANDERS: Absolutely. That is one of the real options that we have.

Look, the facts are clear. The overwhelming majority of the American people want a public option. They want a choice other than a private health insurance company whose function in life is to rip them off and to make as much money as possible. The president wants it. The House of Representatives want that. The majority of the Senate wants it.

And I think it is wrong it took a handful of conservative Democrats and all of the Republicans are stopping that. So, reconciliation is certainly one opportunity and vehicle that we have.

DEAN: Bernie, you said this week that you would not vote for a bill that doesn‘t have a strong public option. Are there other Democratic senators who would join you in voting against a bill without a real public option?

SANDERS: I believe that there are. And it‘s important that we do this, Howard, because, I think, you‘ve made this point. If you do not provide competition to the private insurance companies, what is going to stop them from raising their rates outrageously and costing the federal government huge sums of money? What mechanism is in this bill for cost-containment? And I don‘t see it, frankly.

So, I think, we have to got remain strong for a public option, go to a reconciliation method, that‘s another way, or maybe scale down what we are trying to do and see if we can get 60 votes. And that would mean a significant expansion of Medicaid, a real focus on primary health care and the growth of community health centers and primary health care doctors. We can do prescription drug reform; stop the situation where we are paying the highest prices in the world for prescription drugs, the re-importation; negotiating with the drug companies on Medicare Part D; and insurance reform as well.

So, maybe we can get a consensus at 60 votes for a scaled down approach.

DEAN: In terms of insurance reform, specifically the bill, the current bill still allows insurance companies to gouge their customers charging them up to 300 percent more than their neighbor is charged. As you know in Vermont, we limit that to 20 percent above the cheapest rate, and that really works.

Is that going to be the kind of thing that could be addressed during the amendment process? And what do you know about that?

SANDERS: Absolutely. It is one of the things that should be addressed. It‘s just not fair.

What you‘re saying is, yes, you could prohibit-you can prohibit pre-existing conditions, but rates can be risen substantially and people would not be able to afford the insurance in any case. That is obviously an issue that should be dealt with. We‘re going to be introducing at least a dozen amendments myself and I think many other senators will have their amendments.

DEAN: So, Bernie, the Democratic Caucus has two independent senators in it, you and Joe Lieberman. Do you think you can convince your fellow independent that he ought to be supporting a real public option and real health care reform?

SANDERS: Probably not. I think that responsibility will rest with Senator Reid and millions of Americans who want real health care reform.

DEAN: Senate Republicans have vowed to launch what they call a "holy war" on health care reform. They have already promised to use every delaying tactic in the book, which is a very long book, of Senate rules.

How do you stop them from watering the bill down any further? And how can we get a real bill out after we‘ve come so far? This is the farthest we‘ve come in 60 years.

SANDERS: Well, Howard, you know, I think it is really an outrage. After eight years of Bush, where nothing was done while health care was deteriorating in America, 70 million lost their health insurance. Premiums almost doubled under Bush‘s years-Bush‘s eight years. They did virtually nothing, nothing.

And now that Obama and some of us are trying to do something, the best they can do is play the obstructionist role and trying to kill this bill. That‘s wrong. And it‘s really a sad day for America. They should join us for real cost-effective, universal, comprehensive health care. And it‘s a sad day for our democracy when these guys are AWOL on this important issue.

DEAN: If I were you, on your end of this question, I might not answer, but I‘m going to answer it anyway. Give a percentage. How optimistic are you that we are actually going to get a real health care bill with real public option through the Senate, through the House and signed by the president?

SANDERS: I don‘t know what-you know, if it will be scaled down or what. I think something will be passed. My view is it is better to have something that is strong and good and cost-effective than a bailout to the tune of hundreds and hundreds of billions of dollars to the private insurance companies who could raise their rates at any point.

So, at the end of the day, do I think we‘ll have something? Yes, I do. What it will be? Too early to say.

DEAN: Independent Senator Bernie Sanders from Vermont, thank you so much for your time.

SANDERS: Good to be with you, Howard.

DEAN: After all the talk about a public option, what happens if the Senate ends up with a bill that does not a robust public option? Will progressive members of Congress still vote for it and call that reform? We‘re going to ask now one of the leading progressives in the House, New York Congressman Anthony Weiner. That‘s next.

(COMMERCIAL BREAK)

DEAN: An update tonight on a story followed closely on THE RACHEL MADDOW SHOW. Bill Sparkman, a 51-year-old part-time Census worker was found dead in the Daniel Boone National Forest on September 12th. He was hanging from a tree, naked, bound with duct tape, with the word "fed" scribbled on his chest.

Kentucky State Police today concluded that his death was a suicide. According to police, Sparkman, who was battling cancer, staged the elaborate crime scene in a county that he felt had negative views towards the government to make it look like a homicide. Authorities also say that within the past year, Sparkman took out two life insurance policies totally $600,000, both of which did not cover suicides.

We‘ll be right back.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

REP. NANCY PELOSI (D-CA), SPEAKER OF THE HOUSE: Insurance companies are out there in full force, carpet bombing, shock-and-awe against a public option-so much so that when you ask people about the plan, they are uncertain about it until you tell them what is in it.

(END VIDEO CLIP)

DEAN: For months, top Democrats have hammered the insurance industry for its multimillion dollar full-court press to stop health care reform.

Now, as House Democrats wait on their Senate colleagues to pass a health care reform bill, they are looking on as a centerpiece of reform, the public option hangs in the balance. Thanks to largely to the insurance industry opposition.

Senate Democrats are divided. The caucus pits those who threatened to kill the bill and refuse to bring it up if it has the public option in it against Democrats who say they‘ll vote against a bill that further weakens the public option.

So, will it survive the Senate? And if it does not, what does that mean for its prospects in the House?

Joining me now is Democratic Congressman Anthony Weiner of New York.

Congressman Weiner, thank you for joining us.

REP. ANTHONY WEINER (D), NEW YORK: Thanks for having me. Appreciate it.

DEAN: So, are liberals in the House willing to kill this bill if it doesn‘t have a real public option? Not a fake public option like a trigger or an opt-in, or one of those kinds of things, but a real, strong public option.

WEINER: Well, one of the things to keep in mind here is that many of us have already compromised a long way.

DEAN: Yes.

WEINER: People like me wanted to have a single-payer system, Medicare for all Americans. We compromised to a strong public option for a very small number of people, the people in the exchange. We‘re probably close to negotiating away too much for progressives in the House. But, frankly, most people, you know, the thing that‘s most complicated to all of us is we listen to our colleagues in the Senate say it doesn‘t save enough money. And then the one tool that we have, or one of the tools, the public option, they say we want that out of there, too.

The problem with these negotiations is we do have a small group of Democrats who are arguing, essentially, an inconsistent thing. They want a lower cost, which the public option can provide, but they don‘t want the public option.

DEAN: So, how did we sink to this incredibly low point in this debate where there‘s not even any mention of the single-payer system? Even though about 50 million Americans are already in a single-payer system. It‘s called Medicare for people over 65. And another 25 million Americans are in a socialized government-run health care system called the Veterans Administration, which also happens to be the most highly-rated of all the health care systems in the country, both private and public.

How did we get to this point?

WEINER: Well, not to mention the Department of Defense which is also.

DEAN: Right.

WEINER: . a single-payer government and the Bureau of Indian Affairs.

We do it a lot of cases.

DEAN: Not to mention the 535 congressmen who have sort of hybrid system.

WEINER: Well, we have a hybrid system.

DEAN: Yes.

WEINER: We have essentially our own public option, many of us, because we‘re on Medicare.

DEAN: Right.

WEINER: I mean, not myself but there are a lot of members. I did a survey and checked every -- 150 members of the House and Senate are on a public option Medicare.

But here‘s a personal-let‘s not get too carried away with this whole notion how sunk-how far we sunk. It‘s still a good bill.

(CROSSTALK)

DEAN: The House bill is great.

WEINER: Well, look-well, great. I mean, it, too, is a compromise for many of us.

DEAN: But very solid.

WEINER: Yes, but the-and the Senate bill, I think, still, and we have a conference to get to. Look, one of the things that I‘ve argued all along, is that if we knew what people like Senator Lieberman or Senator Landrieu or Senator Lincoln, if they said, "Look, here are the things we want, we want cost-savings," we can give them cost-savings. We can have a stronger public option which negotiates the hold-down prices. Maybe do what Ron Wyden wants, which is like everyone going to the public option.

DEAN: Yes, I think that‘s a great bill.

(CROSSTALK)

WEINER: We can take something like the Medicare system, which has a 1.5 percent overhead and expand it to more Americans. We can do cost savings.

But we have to know what they want, and between the public option getting watered-down and the Stupak Amendment of attacking the rights of women, and by the way, putting government bureaucrats between people and their doctor, if those things stay intact, I don‘t think this has the votes to pass the House and that‘s regrettable because there are a lot of things to do that we all agree on.

DEAN: What about the Bernie Sanders‘ idea that he was talking about earlier, which is, if you can‘t pass this thing, don‘t try to reform the whole system, expand Medicaid, put in some money for federally-qualified health care centers and those kind of things.

WEINER: You know, I don‘t buy-and Bernie is great-but I don‘t buy the idea that we‘re transforming health care with this. I kind of wish we were. For the most part, the president is right, a lot of people are going to keep the insurance that they have, we‘re going to add some new standards and we‘re going to give some tax credits to people to buy insurance.

But what we really should be thinking about doing is taking something that works. And, by the way, is a bedrock Democratic program, the Medicare program and expanding to more Americans. Everyone understands Medicare because their parent or grandparent is on it and they like it.

DEAN: Right.

WEINER: We‘ve made some strategic mistakes, I believe. All that being said of where we are is, that if we Democrats think we‘re going to stand for reelection in 2010, having a watered-down public option or none, and having the Stupak language in there, we‘re going to find we might be doing more harm than good to our brand.

DEAN: Well, that‘s what I want to ask about, that would be the last question for me. More harm than good. At what point is this bill not worth passing?

WEINER: Well, it‘s interesting.

DEAN: And are you going to have the votes to make sure that to make that statement?

WEINER: It‘s a good question. I have this Web site, CountdownToHealthcare.com where I let people kind of weigh in each day. It started out focusing on Republicans. Now, it‘s focusing entirely on Democrats.

We have to realize we‘re getting very close to a point that we were in the summer, where the American people desperately want us to fight back and stand for principle and we‘re not doing it. I‘m convinced that Senator Reid and Chuck Schumer and Ron Wyden, and people like Bernie Sanders are going to do-are going to finally bring around those recalcitrant senators.

But if we keep watering this down much further, we‘re getting close to that point. But we don‘t want to let the enemy of the good. But it‘s got to at least be the good at the end of the day.

DEAN: And at some point, this is just, as Ross Perot once said, a giant sucking sound puling American taxpayer money into the insurance companies and we don‘t get anything for it.

WEINER: Well, there‘s three things we needed to do: provide insurance to people that didn‘t have it, provide better care for people that have insurance.

But that third thing, cost savings, the public option is how you do that. And we‘re starting to increasingly think that by throwing that overboard we‘re going to pass the bill. That‘s a bad calculation to make. We need the public option.

DEAN: Congressman Anthony Weiner, thanks so much for taking the time.

WEINER: Thank you. Appreciate it.

DEAN: Appreciate it.

WEINER: My pleasure.