Newt Gingrich, Howard Dean Debate Health Care

Newt Gingrich, Howard Dean Debate Health Care

By This Week - August 9, 2009

GEOERGE STEPHANOPOULOS: Hello again. Health care may be the most personal issue Washington confronts, and this week there was plenty of evidence to back that up.

Town halls on health care went viral. Members of Congress everywhere got tough questions. Some got shouted down. As the rhetoric heated up, we even heard Nazi Germany invoked.


REP. NANCY PELOSI, D-CALIF., SPEAKER OF THE HOUSE: You be the judge. They're carrying swastikas and symbols like that to a town meeting on health care.

LIMBAUGH: There are far more similarities between Nancy Pelosi and Adolf Hitler than between these people showing up at town halls to protest a Hitler-like policy.


STEPHANOPOULOS: And with that, let's have our own debate with two men at the center of the conversation, former House Speaker Newt Gingrich and former Vermont Governor and DNC Chair Howard Dean, also the author of a new book, "Howard Dean's Prescription for Real Health Care Reform."

And, Mr. Speaker, let me begin with you. I wonder, are you comfortable with the tone of these town meetings? As you know, Democrats have said that a lot of this grassroots activity is manufactured AstroTurf, and they say the goal is to shut down conversation, not encourage it.

GINGRICH: You know, I -- I spent 20 years doing town hall meetings. I once had 800 machinist members on an Eastern strike for three hours, and they got to shout all they wanted.

I thought Senator Tom Harkin was the model this week. His staff got nervous. They wanted to close down the meeting. And Harkin said, no, these are Americans. They have every right to talk. And he just listened, and he engaged, and he conversed.

People are very, very upset. They're upset because the stimulus was passed unread. They're upset because, at 3 o'clock in the morning, Pelosi introduced a 300-page amendment for an energy tax increase and voted on it at 4 the next afternoon. They have this sense of a thing -- of a machine running over them.

And so there's -- there's a substantial number of people who are genuinely upset. The American way is let it hang out, talk to them. Members ought to go back home, hold as many town hall meetings as you have to, let people get it out of their system. And by September, we could have a genuine dialogue in this country.

STEPHANOPOULOS: And I know your allies, Governor Dean, have been -- have been saying that this is just all, you know, paid for, people recruited by lobbyists here in Washington, but you can't create -- you can't force people to go out to a town meeting. You can't manufacture that kind of anger, can you? DEAN: Well, there actually is a lot -- there is a lot of orchestration. There's the Brian MacGuffie memo, which actually tells people to do -- do what they're doing, which is sit in the front, jump up and interrupt. You know, one -- one thing...

STEPHANOPOULOS: He's got like 23 friends on Facebook, though.

DEAN: Well, yes, but he's also -- there's a lot of other organizations, including some pretty reputable companies, who are -- formerly reputable companies that are financing all this stuff.

Look, I'm with the speaker on this. I think you want to have dialogue. I think shouting people down doesn't create dialogue, and it's not really -- not really dialogue.

But, you know, the true thing is, you know, I disagree with the speaker. You've got the spectacle of Republican congresspeople running around handing out stimulus checks which they voted against the stimulus. The stimulus has done good things.

It's cut -- CBO estimates that it's cut the reduction in the GNP by at least 1 percent -- that's a significant number -- and that the stimulus is going to do better things.

So I disagree. I don't -- I think this is a handful of angry people who've been angry for a long time. Don't forget: The Republican playbook for a long time was get people angry. They succeeded. There are still a lot of angry people. I think they're out -- vastly outnumbered by the people who really want something done about health care reform.

STEPHANOPOULOS: So you disagree -- you disagree on the stimulus, but you -- and you also disagree on health care with this whole idea of whether or not to have a public health insurance option in the bill. And, Governor Dean, you've said that health reform is not worth having...

DEAN: Right.

STEPHANOPOULOS: ... without this. And your organization is actually running ads against Democrats who don't support the public...

DEAN: That's not -- that's not my organization.

STEPHANOPOULOS: Democrats -- you found it. You were a founder.

DEAN: I founded it. I don't run it anymore. I do some consulting work for them.

STEPHANOPOULOS: Let me get to the ads then, because one of the Democrats you went after was Ben Nelson .

DEAN: I did not go after him, just to correct you.

STEPHANOPOULOS: Democracy -- Democracy for America went after him.

DEAN: And I've talked to Ben since that, just so...


STEPHANOPOULOS: OK. Well, let's see the ad.


(UNKNOWN): Now I hear that Ben Nelson , the senator that I voted for, is leading the charge to delay health reform this summer. That's exactly what they want. The health and insurance companies that have given Senator Nelson over $2 million know that, if they can stall reform, they can kill it. I have to ask: Senator, whose side are you on?


STEPHANOPOULOS: I want to hear about you talking to -- to Senator Nelson, because, as you know, the White House has been pretty angry about these ads. President Obama says it's counterproductive, yet your allies are not stopping.

DEAN: There are a lot of people who are very upset about the incredible reach that the insurance company has. Look, this bill -- the CBO scores it at $60 billion a year on the House side. I think putting $60 billion a year into the health insurance industry is insane. I really do.

And so you want a public option. Look, we've -- what the president wants to do is very straightforward. Sixty -- or roughly sixty -- fifty or sixty million Americans have what Newt has called socialized medicine or government-run health care. They're over -- over 65. They're Medicare. That's what Medicare is.

Now, what Obama is essentially saying is, "Let's give the choice of getting into a system like that or staying with what they have to the American people." So if you're voting against having a public option, what you're voting against is something that 72 percent of Americans in two polls want, which is the choice. Most of them aren't going to sign up for the public option, but they think they have the choice.

Why shouldn't they have the choice? Why should the health insurance companies have that choice?

STEPHANOPOULOS: What's the answer to that question?

GINGRICH: Well, first of all, the government option we're talking about -- let's look at where government runs the health system entirely. The Indian Health Service is a disaster. Medicaid is so corrupt and run so badly -- we just published a book at the Center for Health Transformation called "Stop Paying the Crooks," because our estimate is that government fraud between Medicare and Medicaid is between $70 billion and $120 billion a year.

STEPHANOPOULOS: Veterans care works pretty well.

GINGRICH: Veterans care is the one system that actually works reasonably well. But the others do not. I mean, Medicare is basically a private system with a government funding.

An amendment was offered in every committee to have the -- to have the members of Congress and their staff in any government option as a mandate. And if this is good enough for the American people, it's good enough for the politicians. In every committee, the Democrats voted no. Now, why is it they want to insist on a government-run system for -- for people other than the Congress, but the Congress and their staff would be exempt?

Second, it's not -- it's just, I think intellectually not honest to suggest that this is going to be a matter of choice. The way the bill in the House -- and we're talking about a specific bill -- the way the bill in the House would work, if your company didn't offer any insurance, they would pay an 8 percent tax on their personnel cost.

For most companies, that would be a net savings of 3 percent, 4 percent or 5 percent. One estimate by Lewin Associates (sic) is 131 million Americans will lose their private insurance and be pushed into a government plan.

STEPHANOPOULOS: Governor Dean, those arguments seem to have taken hold, at least in the Senate, where even Democrats say you're not...

DEAN: Look, let's be fair. Lewin Associates is owned by a health insurance company. So let's -- let's -- let's -- the CBO, which I think is a more reasonable organization, says 5 million or 10 million people are going to end up there.

STEPHANOPOULOS: Depends on the amount of subsidy...

(CROSSTALK) DEAN: Second of all, what the speaker didn't tell you is, let's just suppose you get forced out of your employer-based system, which I think is unlikely, but let's suppose that you do. You've got a choice. The government will pay your subsidy to either go into -- based on your income, either to go into the public option or a private option. Nobody is forcing you in to the public option.

Now, a third thing is that nobody talks about is this bill is terrific for small business, and the Blue Dogs made it a better bill, and I hope (inaudible) gets through, it gets even better.

Right now in the House bill, if you have a payroll, if you're a small business with a payroll of less than $500,000, you have no responsibility whatsoever to give your employees health insurance. That now becomes a subsidy based on your income, and then you can choose either a private or a public sector.


DEAN: This is -- this is choice. This is real choice.

STEPHANOPOULOS: That's in the House bills, but the Senate has made it pretty clear they're not going to include this public health insurance option, at least as contemplated in the House bill. The most they're going to get is co-ops...


DEAN: No, actually, the Senate Finance -- this has already passed four out of the five committees. The Senate Finance Committee has said that, not the Senate Health, Education, Labor and Pensions Committee.

STEPHANOPOULOS: Well, but you need 60 votes to get it through.

DEAN: We need 51 votes.

STEPHANOPOULOS: So you're saying...


GINGRICH: But if you want to see why the -- why a substantial number of Americans are very frightened, that's a good example. The Senate rules on passing reconciliation were clearly designed for budget items.

If we're now going to try to rewrite 17 percent of the economy, life and death for every American, by pretending that massive health reform is a reconciliation item and ramming it through with 51 votes, first of all, I don't think -- I think a lot of Senate Democrats (inaudible) I think the idea of stripping the Senate of its ability as a Senate to operate with some sense of discretion and ramming through something on this size will go down very badly with many senators, will go down very badly with much of the country.

But I -- I talked to Senator Grassley as -- as late as yesterday, and he made quite clear that he believes there will be no government plan and there will be no rationing in any bill that the Senate passes and that he would certainly not in any way support that. And I think Grassley's very key to Republicans.

STEPHANOPOULOS: Let me follow up. Senator Baucus, the Democratic chair of the Finance Committee, seems to agree on that, and he's produced a draft that gets to 95 percent coverage, 94 percent, 95 percent coverage without a public option. Why wouldn't that be good enough?

DEAN: Let me just say, A, there's no rationing in any of these bills, so we don't have to worry about that. Secondly, 95 percent coverage is good. That's terrific. The problem is, you can't afford it unless you have a public option. There's no cost control on that. Again...

STEPHANOPOULOS: He says it would come in under $1 trillion.

DEAN: Well, the House is at $60 billion a year, and the Senate would be at $100 billion a year. I don't think -- look, here's the problem with -- this is why I think the public option is so important. The fundamental problem is that Medicare has gone up around 2 percent over the rate of inflation. That's bad. But the health care -- the private sector has gone up at two-and-a-half times the rate of inflation for 30 years. Our economy is uncompetitive because we have an employer-based health care system. Now, I'm not advocating getting rid of an employer-based health care system, because a lot of employers like it and people in it like it. But I am advocating giving people the same choice that Congress has.

STEPHANOPOULOS: I want to get to -- really quickly, because I want to get to another issue here...

GINGRICH: Well, I just want to say, this is one of the great tragedies of how we've approached this, this year. Cost control doesn't work. I had a major hospital tell me last week they would literally go bankrupt under the House plan, because if you apply the kind of cost control without real health reform, it doesn't work.

At the Center for Health Transformation, we've outlined health reform after health reform that would save hundreds of billions of dollars, but it's fundamentally different than the way Washington thinks. And it's -- it's very frustrating to watch people -- when you say cost control, you're either ripping off the hospitals, you're ripping off the doctors, or you're ripping off somebody because cost control defined by the government means somebody gets...


DEAN: Wait a minute. You -- you -- not you personally -- but the Republicans have had times over the last -- since the last time we tried this, was 15 years, where you had the president, the House, and the Senate, and nothing happened.

GINGRICH: And they failed. I agree.

DEAN: So, OK, so we've got to do something.

GINGRICH: I'm not defending that.

DEAN: We think this will work.

STEPHANOPOULOS: One of the other claims being made about the bill -- and it's related to cost control -- is an -- and opponents are spreading the idea that the president's plan will encourage euthanasia. Most recently, Sarah Palin , on her Facebook page yesterday -- I think it was Friday night actually -- said that, "The America I know and love is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama's ‘death panel' so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,' whether they are worthy of health care. Such a system is downright evil."

Now, as you know, Mr. Speaker, the president called that outlandish. He said...

GINGRICH: But why -- why didn't you put up what Dr. Zeke Emanuel said? Because Dr. Zeke Emanuel, who's the chief adviser to the president and brother of the chief of staff, said in writing... STEPHANOPOULOS: He's not the chief health care adviser. He's written three articles between 1996 and 2008 that include some of those phrases...


GINGRICH: ... standards.

STEPHANOPOULOS: Those phrases appear nowhere in the bill. The only thing...


STEPHANOPOULOS: ... but let me just explain what's in the bill and then get you to respond to that. The only thing in the bill is they would allow Medicare to pay for what they say is voluntary counseling on end-of-life issues.

GINGRICH: I think people are very concerned, when you start talking about cost controls, that a bureaucracy -- we don't -- you're asking us to trust the government. Now, I'm not talking about the Obama administration. I'm talking about the government. You're asking us to decide that we believe that the government is to be trusted.

We know people who have said routinely, well, you're going to have to make decisions. You're going to have to decide. Communal standards historically is a very dangerous concept.

STEPHANOPOULOS: It's not in the bill.

GINGRICH: But the bill's -- the bill's 1,000 pages of setting up mechanisms. It sets up 45 different agencies. It has all sorts of panels. You're asking us to trust turning power over to the government, when there clearly are people in America who believe in -- in establishing euthanasia, including selective standards.

DEAN: Well, look, this is something Newt and I agree on. I don't want somebody in between the doctor and the patient. I don't want the possibility of losing your health insurance. I don't want people setting standards or denying care. That's all what we have now under the private health insurance system. That's what happens.

Look, I've practiced -- I've practiced for 10 years. My wife is still practicing. Never once did I have a Medicare bureaucrat tell me what I could or couldn't do for a patient, but all the time we have bureaucrats from the insurance companies calling up and saying, "We're not going to cover this, and we're not going to pay for that, and we're denying coverage of that."

The system we have right now is broken. We need to fix it. I think giving the American people some choices about how to fix it makes sense.

STEPHANOPOULOS: OK, we're going to have to end it there.

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