Sebelius, Rockerfeller, Landrieu and Pawlenty on "This Week"

Sebelius, Rockerfeller, Landrieu and Pawlenty on "This Week"

By This Week - September 13, 2009

STEPHANOPOULOS: And let's begin our own debate here in the studio. I'm joined by Kathleen Sebelius , the secretary of health and human services in Kansas. She's joined here in the studio by Democratic Senator Jay Rockefeller, Democratic Senator Mary Landrieu, and Republican Governor Tim Pawlenty of Minnesota.

And Governor Pawlenty, let me begin with you, because after the speech on Thursday night, the president says he's going to get this done. After the speech on Thursday night, you suggested perhaps invoking the Tenth Amendment, which reserves powers to the states, if indeed this does pass. What exactly are you saying? There is a movement to actually nullify health care if it passes?

PAWLENTY: Well, George, in the legal sense, I think the courts have addressed these Tenth Amendment issues, but more in the political sense, in the common sense arena, we need to have a clear understanding of what the federal government does well and what should be reserved to the states.

We have essentially Obamacare that's been deployed in two states in major ways. One is in Tennessee. We have a Democratic governor, Phil Bredesen , said hey, look, we tried this cost savings as a way to fund a major overhaul of health care; it didn't work. He's in the news this morning saying, you know, don't go down that path.

We have another state, Massachusetts, who tried essentially the same thing. They have the most expensive health care in the country. They have increasing waiting lines, and it's not working.

STEPHANOPOULOS: So just to be clear, are you suggesting that any parts of the plan as the president has laid it out are unconstitutional?

PAWLENTY: Well, I wouldn't go so far as to say it's a legal issue. I was raising it as much as a practical matter, that there are some things that the federal government shouldn't do, doesn't do well, and should leave to the states.

STEPHANOPOULOS: Secretary Sebelius, what about that? The governor says there's two places that a form of what the president is calling for has been tried, Tennessee and Massachusetts. He says they haven't worked.

SEBELIUS: Well, I think that -- first, good morning, Governor Pawlenty and senators. I -- Tim and I were elected in 2002 and reelected in 2006, and I haven't seen him in a while.

As he well knows, the Tennessee experiment is really different from anything that's been talked about here. It's something that really was an attempt to make a vastly over-expensive Medicaid system work. It did crash and burn. It's different than any place in the country, I would suggest, that has done a much better job at expanding care and holding their costs.

In Massachusetts, they readily admit that they expanded care and didn't look at the cost side of the puzzle, which is why I think the president continues to suggest that anything we do, it has to bend the cost curve. And as he said to Congress the other day, even if you bring down the rising health care costs .1 of a percent, you save $4 trillion over the first 10 years of the plan. So bending the cost curve has always been part of what Congress is talking about, and it's impossible to do a state at a time. We need a national strategy.

STEPHANOPOULOS: And I want to get to that in a second. But first, let me bring in the two senators on the issue that has divided Democrats so far, this whole issue of the public health insurance option.

Now, Senator Rockefeller, I know you have said that this is a critical component of the health care plan. You heard the president on Wednesday night. He says he supports it, but you can't sacrifice the entire bill for the sake of this public option. Can you vote for a bill without a robust public health option?

ROCKEFELLER: If there were a good alternative, I would certainly have to look at it.

STEPHANOPOULOS: What's a good alternative?

ROCKEFELLER: I haven't found one. See, that's the whole point. People talk about a cooperative plan, health co-ops. And I called the head of the national association really early, and he said it's great on water, it's great on farm, it's great on electricity, et cetera, but it really doesn't work for health care. There's fewer than 20 in the country, and there are only two that really work, and one of them is in Washington, the other is in Minneapolis, in Minnesota. And both these senators from Washington are voting for a public option.

ROCKEFELLER: So it doesn't -- it hasn't had a future. It goes back to the ‘30s and ‘40s. And I just don't think you can take the chance. You have to start a national thing, all of the way up, or would you do it state-by-state, which would be harder.

STEPHANOPOULOS: So what's the problem with the public health option?

LANDRIEU: Well, many of us believe, George, that it will undermine the private insurance system. And that's one of the criticism of the direction that the House of Representatives took. Because 55 percent of those covered with insurance today are covered through a private insurance model, 45 percent are covered through a public model.

So, many of us would like to take the president at his word, which is, let's not completely revise the whole system. Let's build on the strengths.

Now I'm with Jay in the sense that if we can find a middle ground here, where we can keep insurance honest, regulate insurance companies, no American supports unregulated insurance companies, so that there is competition in the market, we can maybe achieve the goal through a different way.

STEPHANOPOULOS: One of the different ways that has been talked about, and then I want to move on to other subjects, is this proposal put forward by Senator Olympia Snowe of Maine, which would say, let's give some time to see if the president's health insurance reforms work to bring down costs, increase competition, if not, then we'll have a trigger which will set the public option a few years down the road.

LANDRIEU: And I have to say, I think both Jay and I can agree that what Democrats want -- and I'm hoping that some Republicans will join us in this effort and not just leave Americans out there with a too-expensive system that they have and a system that's going to crash and burn shortly if we don't do anything.

I hope that we can agree that we've got to have a reformed market where individuals can buy insurance that's affordable. Where small businesses get a chance. These small businesses, 27 million of them, George, are basically out on their own.

STEPHANOPOULOS: So can you support the Snowe trigger?

LANDRIEU: I can support potentially a fallback, but only if the private sector is allowed and given a great opportunity to get this right. I believe they can.

STEPHANOPOULOS: How about you?

ROCKEFELLER: I think that's too easy an answer with all...


ROCKEFELLER: Lots of love.


ROCKEFELLER: I mean, I said I didn't think there were any good alternatives. And if you're not going to vote for something, then you have to do something about insurance, because they have been very rapacious about ripping off consumers. We have done a lot of work on that to show that, and had whistleblowers come forward.

But I'm not dispassionate on the public option.

STEPHANOPOULOS: You're going to keep fighting?

ROCKEFELLER: Yes, I am going to keep fighting, because it's probably not going to attract more than -- it will probably attract less than 5 percent of the American population. And, you know, Tim -- the governor will say, it's going to track over 100 million. It won't. It won't.

But it's an option. And the very fact that it is there says to the other insurance companies, hey, if we don't bring our costs down, because the public option doesn't have -- they just live on their own premiums...

STEPHANOPOULOS: Another controversy -- let me bring in -- go on to another subject, another controversy the president brought up the other night was he said that no federal dollars will be used to fund abortions.

And this is connected to the public option, Governor Pawlenty, because many supporters of the pro-life movement, anti-abortion activists have said, no, that's not true. That the public option that is being considered so far in the House will actually fund abortions.

PAWLENTY: Well, there's an easy way to resolve this. There's a dispute. So just be clear in the bill. If the president is embracing the idea that public monies and public systems won't be used to fund abortions, then we should say that.

And the pro-life perspective on this has been viewed by both and the AP as having merit. So this is not something that people are just making up. There's legitimate concern about it. But it can and should be clarified.

STEPHANOPOULOS: Secretary Sebelius, what's wrong with that, making it explicit in the bill that no public funding should go toward abortions? SEBELIUS: Well, I think that's what the president intends to do. There's no intent to change the language that's in the current Medicaid statute, which has been there for years and provides insurance to millions of Americans.

And in fact, recently the Catholic bishops came out, after the president's statement, saying that his statement about what he intends in the plan, that no public funds would go to fund abortions, and the fact that he has come out firmly for insuring all Americans and saying it's a moral issue as well as an economic issue, and they endorse moving forward.

So I think that, you know, the legislative language will reflect what the president has just said.

STEPHANOPOULOS: So you're saying it will go beyond what we have seen so far in the House and explicitly rule out any public funding for abortion?

SEBELIUS: Well, that's exactly what the president said and I think that's what he intends. That the bill he signs will do.

STEPHANOPOULOS: I see you nodding your head here, Senator Landrieu, I know this has been a concern of yours.

LANDRIEU: It is a concern of mine. And it's a very important issue. But the bigger issue -- and I agree with the secretary that the president will make this clear...


STEPHANOPOULOS: So that language has to be made clear? It's not there now.

LANDRIEU: It's not there. But the bigger issue, George, is that this country, neither the government, families or businesses can afford the current system that we have. The rates are going through the roof. For small businesses, for families, we're predicting in our state, and I don't know governor, if this is your state, but it could be as much as 50 percent average household incomes are going to have to go affording health insurance.

We must do something. And people complain about the expense of the Iraq war and the expense of the Afghan war. You could wrap all of that expense together, George, and it will cost only 40 percent of what we spend on health care every year. So it's cost. And for Republicans or for people to say, or some Republicans, not all, that we don't need to do anything, or try to get us off on tangential subjects, not that abortion isn't important, I think is wrong. We've got to stay focused on pulling down cost for business.

PAWLENTY: George in fairness, the Republicans agree, we all agree, that the current system is unsustainable and it's broken. And we're not focused just on one or two issues. We all agree on that. We have a legitimate difference of opinion about how to fix it. We have ideas and suggestions. I don't think it's a good idea to transform one-seventh of the nation's economy on a partisan basis with just Democrats. The president should embrace Republicans and try to get this worked out bipartisan. Every major entitlement program, with all due respect to senators, that the federal government has taken over, is on a pathway to bankruptcy. Medicare, social security. Why would we trust them and give them another one to run? This is going to cost more not less.

STEPHANOPOULOS: I want to bring Senator Rockefeller in. But before we do that, just to underscore this, the president addressed that concern on Wednesday night when he talked about the need to control the deficit and a deficit trigger. Take a look.


OBAMA: I will not sign it if it adds one dime to the deficit now or in the future. Period. And to prove that I'm serious, there will be a provision if this plan that requires us to come forward with more spending cuts if the savings we promise don't materialize.


STEPHANOPOULOS: Senator, are Democrats willing to go along with a very hard trigger there, again, another kind of trigger? You know, this was tried under the prescription drug bill, and even though the cost continued to expand under prescription drugs, the trigger to control the cost was never pulled.

ROCKEFELLER: Well, first of all, we have no choice. I mean, the Medicare, the president's also promised not to spend a dime for the Medicare trust fund. And the reason for that is, Medicare is going to start going broke in 2017, which is like the day after tomorrow. So yes, I'm totally willing to take on cost-cutting. And yes, it will be painful for a lot of folks. But not for seniors. Not for seniors. And we do that --

PAWLENTY: Proposed in Medicare system, in part, that's what people have been talking about. You have been a proponent of protecting Medicare over the years. And now the cuts that have been proposed are much deeper, much longer than anything than you were concerned about previously.

STEPHANOPOULOS: Let me bring up the secretary...

LANDRIEU: Governor Pawlenty is...

STEPHANOPOULOS: Let me just put a question, because it's on this point, the president and Senator Rockefeller and others have said this is not going to hurt seniors who receive Medicare. Yet, about $622 billion of the cuts come out of Medicare and Medicaid. How can you take that much from the program without hurting beneficiaries?

SEBELIUS: Well actually, they don't come out of the benefits side and what they'll do is stabilize the trust fund. So bringing down the cost of Medicare overall does just what Senator Rockefeller has just suggested, which is extend the life of the benefits into the future.


The prescription drug plan that the governor just referenced is an exact example of what we're not going to do with this bill going forward. When Congress and the prior administration passed the prescription drug plan several years ago, they didn't pay for it, not a dime. It was not suggested by the administration to be paid for. They prohibited the Department of Health and Human Services for even negotiating for drugs.

So Medicare overpays for drugs right now. Part of the savings is bringing down those drug costs and pharmaceutical companies have agreed to do that. We overpay by about $140 billion for Medicare advantage plans. About 14 percent more than fee for service. Every beneficiary pays even if they're not involved. And they don't deliver more benefits. We overpay for durable medical equipment because we don't do competitive bidding and we're getting very serious, for the first time, I would suggest, ever, on fraud and abuse.

George, we just had $2.3 billion settlement with Pfizer, which will directly go back to the Medicare trust fund and the Medicaid trust fund for their illegal marketing of drugs. And we've had sting operations in Detroit and in Houston. So, there are ways to get savings without not only not jeopardizing seniors benefits, but making sure that we keep our commitment to seniors.

STEPHANOPOULOS: Let me bring this to Senator Landrieu, because I know you have been especially concerned about the impact on the deficit. Is the kind of trigger the president outlined enough to calm down your concerns?

LANDRIEU: Well, we're going to continue to talk about the trigger. And because it may be. But again, those of us that are against public option are against it because we think it will undermine the private sector. We're not willing to go there. But we are willing to support coverage for all Americans that's affordable, that's based on a private model.

But, George, on Medicare, I thought the president did a very good job on this, and he needed to in his speech, because people that are in Medicare -- and it's a large segment -- think that we're going to save money in Medicare and then give it to everybody else. The president made it very clear, that we're going to do a better job of managing Medicare for the benefit of the people in Medicare. And I think that's important. And then use other ways to address the...


STEPHANOPOULOS: ... the point addressed by Governor Pawlenty and others, who have said that if you're taking some of these subsidies away from the Medicare Advantage program, it is inevitably going to hurt those people who are using it.

LANDRIEU: Well, it's not taking away, it's making it better. In other words, we're spending more money in that program than we need to. So, if we figure out the way -- and Jay's really an expert on this, actually -- if we figure out a way to spend it better for the seniors, that's what we're trying to do.

STEPHANOPOULOS: Let me bring in Governor Pawlenty, and then back to Senator Rockefeller.

PAWLENTY: We know what happens when the federal government does this or something like it. Medicare, Medicare, Medicaid, they are broke. They are on a pathway to being bankrupt. We are the laboratories of democracy at the state level. States have tried this. And the question that we're raising, amongst others, is what happens when the money runs out? This will be a financial monstrosity. The money will run out and you'll see a reaction like in Minnesota, where we've had to pare back, like in Tennessee, a Democratic governor saying, "do not go down this path. We tried it. It doesn't work." And the federal government's track record here, not with respect to these senators, but the federal government as a whole, is abysmal. And it will not work. We know this from the past.

STEPHANOPOULOS: Senator Rockefeller?

SEBELIUS: George, Medicare has been a rousing success, though, for 43 million seniors.

PAWLENTY: Financially, financially I'm talking about.

SEBELIUS: It's a rousing success. 40 years ago, we had no coverage for seniors. They went into their later years with not any ability to pay medical bills. I can't imagine anybody -- now we have to get a handle on the costs and we're serious about doing that.

PAWLENTY: I support Medicare and Medicaid, but it has to work financially, Secretary, and we know...

SEBELIUS: But that's exactly what we're trying to do.

PAWLENTY: ... it's on a pathway to bankruptcy.

STEPHANOPOULOS: Senator Rockefeller.

SEBELIUS: So we all agree.

ROCKEFELLER: Good choice. I agree even more. What you have to do if you're going to bring down costs, but do it wisely, is you don't let the Congress, the people in the Congress, the House and the Senate, having lobbyists looking all over them -- and lobbyists can play a big role, unfortunately -- deciding who's going to get reimbursed, what providers are going to get reimbursed how much under Medicare. Hospitals, doctors, the rest of this.

We did this -- Dave Durenberger and I did this, from your state, in 1989 with something called resource-based relative value scale. And that's a fancy term for saying the specialists were getting paid too much. Ophthalmologists, for example. General practitioners, who we need out in the country, in rural states like yours and mine and hers, they should get paid more. And that's a judgment that you don't...


PAWLENTY: ... will cost more, not less.


ROCKEFELLER: It will cost less.

STEPHANOPOULOS: I got to move on to another issue right now, and that's the issue raised by Congressman Wilson the other night when he heckled the president. He has apologized, but he has not backed down from his fundamental point, Congressman Wilson, and I want to show him here in a second. Says that the bills simply aren't clear on not covering illegal immigrants.

(BEGIN VIDEO CLIP) WILSON: I noticed that the Democrats have defeated the amendments that would provide for enforcement and the verification of citizenship. And so when the president said this, I knew what he was saying was not accurate. I do apologize for speaking out, but what was said was not accurate.


STEPHANOPOULOS: So, Secretary Sebelius, he was referring of course to the House bills, which did not make it clear that the illegal immigrants would not be able to get some of the public health insurance option. Can you just clear up some of the confusion here and say exactly how the president will make it clear that illegal immigrants cannot get any of the benefits under this bill?

SEBELIUS: Well, George, we do it right now in the Medicaid system. The language will be clear when the final draft is written. The president is very clear, and Congress, in both the House and the Senate, have made it clear that they do not believe that folks who are here illegally in the country should have access to the new health insurance exchange. That will be very spelled out. That's what the House voted on. There may be some dispute about should the language have said X or Y, but there is a section in the House bill, as Congressman Wilson well knows, that says that very explicitly. I think the Senate may reinforce that, and I know the president is very serious about it.

ROCKEFELLER: And I think everybody agrees on it.

SEBELIUS: I think this is a red herring. There is no disagreement.

STEPHANOPOULOS: Everybody agree now?

PAWLENTY: Well, there's a missing piece here, George. And even if you have language that says illegal immigrants will not be a part of this program -- unless you have the enforcement mechanism in place, it doesn't mean much. In Minnesota, we have laws that say illegal immigrants won't get many services, but unless somebody actually checks, guess what, they show up and they get the services.

STEPHANOPOULOS: There's been a study done by the House Oversight Committee that showed these Medicaid provisions, they spent about $8 million to enforce and they caught eight illegal immigrants.

PAWLENTY: Well, clearly, though, if you have a law that's unenforced, it isn't much of a law. So first of all, if the secretary is saying we're going to have a provision in the bill that says illegal immigrants will not be covered, that's progress, but we also need to make sure we can back that up with proper enforcement.

STEPHANOPOULOS: We're just about out of time. I'm sorry and I apologize, because I've got to get to one final subject with the secretary before we go. And Secretary Sebelius, that's the issue of the H1N1 swine flu. You know, there's been some real concern that the vaccine isn't going to be available to most Americans by the time the peak of flu season hits. And I wonder if there's anything to report on that this morning.

SEBELIUS: Well, George, last week, we got some very good news from our clinical trials and the clinical trials from manufacturers, that, first of all, we're looking in all likelihood at one dose, not two, for healthy adults. That's great, which means we'll have a lot more vaccine.

We also have seen a robust immune response within 10 days, instead of three weeks as was feared. And we're on track to have an ample supply rolling by the middle of October. But we may have some early vaccine as early as the first full week in October. We'll get the vaccine out the door as fast as it rolls off the production line. The earliest doses are probably going to be targeted to health care workers and other high-priority groups. But the one dose means that people will be able to have a robust response within about 10 days of getting that first shot, and that's incredibly helpful.

STEPHANOPOULOS: Just to be clear on that, originally you thought that the vaccine was going to be in government warehouses by about October 15th. Now you expect it to be there the first week of October?

SEBELIUS: Well, not government warehouses. What we're talking about is the vaccine will roll immediately to distribution sites that have been identified by Governor Pawlenty and his colleagues across the country. Every state has a plan saying these are the sites to get the vaccine as quickly as possible into people's arms. That's where the distribution will go.

So, the first week in October, we expect some of the vaccine to begin to roll, and by mid-October, to have the kind of supplies we were talking about. But we may have some available earlier. And we'll get it out to states as fast as it comes off the production lines.

STEPHANOPOULOS: So the first Americans will actually be vaccinated in the first week of October?

SEBELIUS: That's what our hope is. Yes.

STEPHANOPOULOS: Secretary Sebelius, thank you all very much. I'm sorry, Senator, we're out of time.


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