what, guys, we're going to have you all back, maybe tomorrow. because this needs a lot more attention than it's getting. and it's getting a lot. welcome to a different take on a vital subject. vital because it matters to all of us. different because we're keeping this to a minimum. by now you've heard plenty of shouting about health care reform, but far less about what reform actually is and what it means to you. what changes, what doesn't? the benefits, the costs, and the costs of doing nothing. >> bank ruptsing families and businesses and we are going to fix it when we pass health insurance reform this year. we are going to fix it. >> by the end of this hour, you'll know details of what

president obama wants and how he says they're going to pay for it. also, what's in some of the plans going through congress right now. in plain english, the public option, co-ops, mandates, all those things some lawmakers say they can't live with and others say they can't live without. >> there are not the votes in the united states senate for the public option. >> in the house of representatives, without a strong public plan, even stronger than the one we reported out of committee, it would have a difficult time getting 218 votes. >> we are trying to stop the stampede of government takeover. >> by the end of the hour, this will all make sense. health care, president obama's extreme challenge and yours. all the angles in the hour ahead with david gergen, dr. sanjay gupta, pamela gentry, and cnn business correspondent

christine romans. david, some very big stacks of paper. i want to show our viewers these, which are the various house and senate proposals. david, you worked in the clinton white house. what is president obama doing differently? >> sanjay says he's read this. anderson, president obama has taken a very different approach from what president clinton did. mrs. clinton, co-captain of the team in the white house to write a bill, came up with a will that was even bigger than this and sent it to the hill. and congress essentially said, not written here, we don't like it and it fell with a thud. instead of doing that, rahm emanuel working with president obama and others, said let's have the hill write this this time. so president obama came out with a set of general principles, very vague, but general principles. and they left it to the congress to write it. >> so now we have several different plans being talked about on capitol hill?

>> right. and that's been a problem for everybody, because there is no one bill. instead we have this, and in fact there's going to be more. >> let's talk about what's been agreed upon in principle and what has not been agreed upon. sanjay, you are up for consideration for surgeon general. you talked to the president about health care in general. what are the general principles that have been agreed upon in all the bills? >> i read the house bill. lowering costs and increasing access. having said that, it's very expensive, no matter how you look at it. over a trillion dollars over ten years. these are the numbers we're starting to hear. when that sank in, people started to paying attention. also, this idea that people have to have insurance. for example, if you're uninsured right now but you can afford to buy insurance, you have to buy it. if you don't, you pay a penalty. you can't afford it, you might get subsidies. another big deal from a medical

perspective as well as policy is this idea you don't discriminate based on preexisting conditions. this has been a real problem because people simply can't get health care insurance because maybe they have money but if they have a illness, the premiums are way too high. so that seems to be condissent among these bills as well. the expansion of government programs, that income level may go up a little bit. again, if you look at the bill, that may be something consistent between the bills. and this idea of just subsidies. the idea that people come in and try and help people who can't afford it overall to get health care insurance. >> those are the issues that are more or less been agreed upon. what about the biggest ones that have not been agreed upon? >> this idea of the public option. this option that would be on the backs of taxpayer dollars to provide health care for those who don't have it. should that be a government-run program or should that be a

non-profit that's not government run such as co-ops. or no option like that at all and should this be insurance is the name of the game, we have the force the insurance companies to do those things, cut costs and increase access. how to pay for this has come up, because we've been covering this. how to pay for it has always been the issue. if you create a healthier society overall, you'll bring down costs. employer mandates is another issue. so do you have to provide health care insurance, what size company has to do that, what quality of health care insurance do you have to provide? i think the most interesting thing is the timeline. as urgent as this is right now, if you look at the timeline, it's very realistic that nothing will happen that people will notice until about 2013. and three years after that, until you see the full

manifestation of any of this. so this is not instant by any means and over the next couple of years, you probably won't see hardly anything. maybe some funding sources but that's about it. >> i want to bring in pamela gentry. you worked in health care under the clinton administration. this is really the first political test for barack obama. i want to play something that he said about a month or so ago. let's take a look. >> just the other day, one republican senator said, and i'm quoting him now, if we're able to stop obama on this, it will be his waterloo. it will break him. think about that. this isn't about me. this isn't about politics. this about a health care system that is breaking america's families. breaking america's businesses and breaking america's economy. >> president obama was responding to a comment by

republican senator jim dement of south carolina. >> senator mccain and senator obama both talked about health care reform during the campaign. now it's only the democrats that want to reform, not the republicans and it's really hurting him politically. >> christine, a lot of money. take a look at this number. estimated price of president obama's health care plan is a trillion dollars, that's estimated over ten years. a huge expense, arguments being made on both sides. some saying we can't afford to do this, the government's too big. others saying we can't afford not to do it because the medical system is broken. >> millions of americans are saying i'm paying as much for my health care as for my rent or very close and i can't go on like that. so you have a situation where you're talking about big dollars from washington if you do something and big dollar it is

you don't. and you have people on the ground who don't have health insurance who are going to the emergency room as the point of contact or going without important preventative care and it's costing the system more and more and more. we know that the health care system is inefficient and it's gobbling up a bigger part of our economy, of our dollar. and in terms of the trillion, this is what gets people so concerned. we're throwing around big numbers here. that even veterans covering how much washington spends can barely comprehend. >> some are saying that's a low ball number. >> this president has made a calculation this is the time to spend the political capital to do something. >> i think one of the reasons why a lot of americans are concerned is we know when we've had programs like this in the past, they've always wound up costing a whole lot more. medicare costs a heck of a lot more in part because a lot of new technology became available,

and the expenses went way up and up. same thing with prescription drugs under president bush, it costs a lot more. so the american people are thinking that's their opening bid. >> medicare was supposed to cost $9 billion by 2009 and it cost $67 billion. >> and i think one of the additional areas of disagreement is, the president himself said there are two real problems with the health care system. one is the number of people uninsured. but secondly is the cost and the costs have skyrocketed, the premiums have doubled since 2000. there is little in any of these bills that contains cost. >> next, the details you care about. your bottom line on health care reform. how will potential changes affect your cost and coverage, if they will at all? that's next. plus, other groups, powerful and well financed groups that also have a big stake in reform or in stopping it. talking about big pharma, insurance companies, doctors, and more.

ahead on "extreme challenges, health care." sfx: coin drop, can shaking

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we're back with "extreme challenges, health care." it's your health care we're talking about. our bill to pay. president obama's political leadership challenge. he's been trying to drive home the message that the way things are simply cannot work much longer. >> our system is not a health care system. it's more like a disease care system. we wait until people get sick and then we provide them care. >> here's how it would work, 164 million americans have insurance through work. they would keep their coverage, though companies could change their providers and plans the way they already do. premiums would likely stay the same. 14 million americans buy insurance individually. those with preexisting conditions often facing exclusions, denial, or crushing premiums. their premiums could fall under reform and preexisting

conditions would no longer affect coverage. 49 million are without insurance. they'd be required to buy it or pay a penalty. government help would be available to help pay for it. 81 million now have medicare, medicaid, or va coverage. medicaid may expand to cover more lower income families and medicare would largely stay the same. sanjay, who would most be affected if reform went through? >> i think it's the people who don't have health care insurance and can't afford it. it's interesting, and you just made the point, if you can afford it and you don't have it you have to buy it. >> they would be penalized? >> yeah. there will be some sort of penalty. this is already taking place in the state of massachusetts for example and some say it works pretty well. you have about 97% covered now in the state of massachusetts. some say it's not fair to penalize people that way. that's what's sort of on the table right now, however you look at it. >> the big breakthrough would be universal coverage. every other industrialized country has it. the second thing, what's been interesting about the obama administration has shifted the

argument over the last few weeks to talk about the benefits for the insured and that wasn't part of the original argument but it's now -- >> because people were saying, at those town halls who are angry, those are largely people who already have insurance. >> but there are two groups of insured. there are those who are working and they no longer face if this bill goes through the problem that if they leave their job and try to get new insurance, well, what if you had cancer in the past they won't insure you for a preexisting problem. or some people face the problem they think they have good insurance and they get sick and the insurance company says you made a mistake on your form and we're not going to pay you. there is a second group over 65 who show up at the town halls who are fearful they're going to get something worse. they think medicare is going to be affected in a negative way. that the way they're going to pay for this in part is to take it out of medicare, and they

think the quality of care for them is going to go down. >> they have talked this time about hundreds of billions of dollars in waste in medicare that can be removed but how you define waste exactly and how it would affect the care of people. >> do you think there's that much waste in medicare? don't you think it's going to lead to some changes in care? >> it probably has to. >> a politician always when they want to say they're able to reduce costs without hurting anyone, they always say there's all of this waste in government we can take out. >> ronald reagan. waste, fraud and abuse. >> exactly. >> hard to find. >> there are a lot of players in this game on both sides. how much influence do special interest groups have in obstructing health care reform? listen to what president obama said recently at a town hall meeting in montana. >> every time we are in sight of health insurance reform, the special estes fight back with everything they've got. they use their influence. they run their ads. and their political allies try to scare the heck out of everybody. it happened in '93. it's happening now. >> let's talk about specific groups that have an interest in either blocking reform outright

or changing it or limiting it in some form. big pharmaceutical companies. is there anything in the reform bills about lowering the cost of prescription drugs? >> the pharmaceutical industry which is not a party to the 1993/'94 effort is now with the white house. they want coverage. they want affordable coverage for everyone and they want co-pays to be reasonable and as mr. skeptic would say, that's because they're going to have this huge group of people able to buy. they have agreed to cut $80 billion out of their costs. interestingly, they're spending $150 million in advertising to push for health care reform. and a lot of people like robert reich, labor secretary of clinton, he smells a rat. and he says a lot of people are saying, look, they wouldn't do it if it wasn't good for their industry. >> why doesn't something like medicare do a system like the va does where they negotiate in bulk for the price of drugs? >> i was at the agency and that is just a nonnegotiable item. for some reason the pharmaceutical industry has managed to keep that at bay.

and they have convinced them that they need the extra money to do research and create new drugs and say no one else is doing that. >> that is true. the pharmaceutical industry has to spend money on research to bring new drugs to market. that's very true. it's always been a question of how much do they need and how do you get a fair balance here? and the reason that a lot of people are so angry is they think the administration cut a bad deal with the pharmaceutical industry. if the pharmaceutical guys have $80 billion over ten years, what the administration in return said is we won't go to negotiate these other drugs down now or bring in canadian imports. we'll tie our hands. and the left is off the wall about that kind of deal. it's not clear the white house can keep the deal in congress. >> and generic drugs, they're so much cheaper. 7 of 10 prescriptions are for generic drugs and they're 80% to 85% cheaper. it's amazing some of the stories

about collusion that occurs between a brand name drug manufacturer. >> oh, yes. >> they'll go to the generic manufacturer and say we'll pay you x amount of money so you don't make the generic. the generic company, they make their money but the public suffers because they don't have access to this generic. >> the industry i find has been most fascinating to watch in all of this has been the insurance industry. they have followed a very clever, smart, shrewd strategy. last time around the insurance industry was one of the villains -- one of the enemies of clinton care and helped bring it down. this time around the industry looked at the democrats winning in 2006 and said we're going to cooperate this time. they said we'll give up on preexisting conditions, any kind of discrimination and change all our rules voluntarily. just don't give us a public option. >> one thing they did ask for,

and this is all sort of predicated on a lot more people being insured if not everybody. >> right. >> the reason that's important is because a lot of the people coming in are these young, healthy people who will make the insurance company money. >> what may change in the politics is one of the biggest winners is the insurance industry. >> they're going to get more customers regardless how this happens. >> what about medical malpractice reform? a lot of doctors say they have no insentive to do tests. >> what's interesting is if you look at payouts first of all it's not a huge part of medical costs. the idea of defensive medicine might be. i want to order more tests to protect myself. some would say it's almost 15% of health care costs. >> that's pretty big. >> but you know what? i read that thing as i told david and i don't see much talk about tort reform. >> zero. >> nothing. and president obama gave a speech, anderson, you remember in front of the ama where in the entire speech the only time he got booed was when he talked about the fact that he's not

going to have caps on malpractice insurance claims. he said people have been wronged in some way by medicine, they deserve to be able to have their day in court and be rewarded. so you're probably not going to hear much about that. >> the trial lawyers are the ones who fiercely want to protect the right to sue all the doctors and are driving up costs but the trial lawyers are extremely allied with the democratic party. so the democrats will not take them on. if they want to make it truly bipartisan, one way to reach out to republicans is to say, let's do something about all these lawsuits that are forcing doctors to do -- practice defensive medicine. >> when we report about the american trial lawyers, they will say they don't believe the concept of defensive medicine exists. they say doctors don't say they're ordering the tests to protect themselves but in the best interests of the patients. that's the argument they're presenting. >> an ear, nose, and throat doctor told me here in new york if a patient walks in and says i would like an mri he does it automatically because he says if

i don't do it i'm worried i might be sued if anything goes wrong. so he said, if i had -- if they ask i have to do it even though i don't think it's a good idea. >> so if i go to the dentist and asked for nitrous oxide i'd get it just because i want it? let's talk about big business. most recently, a number of folks in the auto industry, look, they have to subsidize health care whereas they're competing against other people in other countries who don't. because it's government subsidies there. is that a fair argument? >> it's a good argument and something they've been making for years and years to no avail. the way you and i feel it is in this country you haven't had your wages go up because the companies are paying these extra costs for health care and passing that along to you. they're giving you more for your health care coverage and you're not getting it in your paycheck. you're paying for it one way or the other. >> even people who are employed and getting insurance through their employer if they think of what they were getting five years ago and what they were paying, whether a copay or what was coming out of their check and they look at where

they are now five years later, same employer, they'll find more is coming out of their check and their copay has been increased. what do they think it's going to be five years from now? >> a lot of people who have health insurance through work i think they don't get it that if they have a catastrophic illness it might not cover everything they think it is. when you look at the number of people who file for bankruptcy, the number one cause is medical costs. do you know what? almost half of those bankruptcies are people who had health insurance. so you're covered and you say i don't want health care reform because it's going to hurt me but everyone really is one step away, a catastrophic illness can really kill their family finances. >> we talk about change. what should stay the same and what actually works? we'll have that right after this.

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we're back talking about health care reform which we should remind you is in many different forms, many different bills being talked about on capitol hill. this is president obama's extreme challenge. we're talking about why making any kind of change from better or worse is such a challenge. people seem to hold contradictory notions on the subject. on the one hand, a recent opinion poll shows 83% surveyed are satisfied with their health care. on the other hand 77% believe major changes are necessary to make sure all americans have health insurance. so is this a case of change the system but leave me alone? or something else at work here? david gergen, what do you think? >> an interesting question. i think people very much, those 83%, are fearful that health care reform will mean reform for them in giving up something. whether it means they think 50 million people are suddenly going to start flowing into the health care system and they're not going to be able to see their doctor any more or wait weeks to see a doctor.

>> one thing at the town hall meetings, people saying can i keep going to the same doctor i've gone to and that i like? >> what we keep hearing is if you have insurance and you're happy you get to keep it. you keep your doctor, keep your insurance. probably work much the same as it does now for most people. for example if you have an in network doctor you pay a certain amount. >> no one can guarantee your doctor will continue with some form of insurance. >> which is true now. not all doctors take medicare for example. if you go to medicare and your doctor doesn't take it you would have to switch doctors which would probably be true with the public option as well. in that sense it would still be the same. >> there's this real big trust issue right now that we haven't seen in a long time. a lack of trust. when i talk to people on the radio show or we talk to people and ask them why are you so concerned or opposed to health care reform, it takes about three minutes to get to and they said they were going to buy the toxic assets from the banks and they didn't. you can see that people are

looking over the past year and they've been told one thing and something else maybe has happened and they think we're living in this world of big financial experiment and unintended consequences. >> there is also real and legitimate fear about the role of government in our society. i mean, that now this seems to be in many people's opinion one more thing that government is now, you know, getting further and further involved in. they own the banks. you know, they own the auto industry. >> i think what they're not understanding right now or what they're worried about is that what they have they're going to lose. whatever it is. what they have, they don't want to lose. >> it sounds like a lot of people are satisfied with medicare, right? but is medicare going broke? >> medicare is going to run out of money. >> that's called going broke. >> yes. it can't sustain itself. it was designed -- >> look at what medicare has become. >> right. and they look at that and they can see the good example and the bad example. the bad example is that program has not grown from really the

time it was created. it was created as an acute care program to take care of sick people in a hospital. >> i think one of the other aspects of this, anderson, is fundamental to who we are as a people. there are a lot of sociologists and historians who will tell you we as american people are just different. we're an outlier nation in many ways. our value system is different. we don't think like canadians. we don't accept government the way -- we aren't deferential to authority the way canadians are or in western europe. i think the clintons misread that some and i think president obama has misread that some. when you come and try to sell something big, big government to american people, they tend to be very very wary. it's been true throughout our history. >> do you think health care is different though? in the sense that if you say no one wants to live in a country where people die of preventible diseases, where people may not be able to get vaccinated. you show up at the emergency room and get turned away even with a life threatening condition. if that's the argument as opposed to it's not about any of us in particular, the country you want to live in --

>> i think there is no way the american people will ever accept a single payer system, a government-run health care system for all. i just don't think we're like the british or the canadians in that sense. that does not mean you can't have universal coverage or a very robust system in which poor people have a chance for protection and really have a chance for a decent life. it does mean that in the american system we tend to do that more through the private sector than through the public sector. >> i think that's why the single payer option was never on the table by this president. he knew that was not -- >> he did say if he had to do it all over again he would -- >> for those of you who don't know what you mean by single payer -- >> that would mean there is one place to go, one-stop shopping and that's for medicare. they pay, every claim goes to medicare. they pay every claim and there is no option. >> nobody has private insurance. >> nobody has a private insurance. what he wanted to leave on the table was that you'd have an option to use aetna, blue cross/blue shield and by the way one of the options would be a government option and that's the one getting so much talk now.

is the public option. >> in terms of other things that work, specialized medicine, high end medicine is something that does seem to be working in this country. the quality of care is very good. people come from all around the world to be treated in this country, things like brain surgery, heart surgery. you're a brain surgeon and you know about this. is that something that would be potentially affected negatively by reform? >> well, you know, it works really well for a certain percent of the population. not for everybody obviously because a lot of people don't have access. >> sure. >> if you look at what people are saying who are supporters of this, they'll say it won't be affected negatively, that people will still be able to get quality of care but it goes to the earlier point if you're trying to insure more people, cut costs, what effect will it have overall on the general level of access to these things. there are lots of areas where we're good at things. i mean, children's health care, innovation over all. heart disease. we cut down heart disease death significantly which is a leading killer of people in the united states. >> what about preventative care? everyone says oh, yes of course we should focus on preventative care.

it's more cost effective down the road, but there's not a lot of money to be made in preventative care. >> medically and morally it makes a lot of sense and people are trying to make the financial arguments as well but you're right. i think it's a little bit hard to make that financial argument for lots of different reasons. >> drug companies don't make money off people not doing something. >> well, even more, that involved more screenings and if we do more screenings on somebody, do you find something? if you find something, do you have to do a biopsy and take time off work? it's a little bit hard if you play it out to make the economic argument but having said that, it's still medically making sense to keep people from getting sick in the first place. >> one thing that's lacking that still needs to be addressed are the way you can provide rewards to people who look after themselves, don't drink or smoke to excess, because that leads to a lot of health care costs in this country. >> don't they get rewarded enough?

they're the ones who get better jobs and you're less likely to be paid as much as someone else you work with. >> the president talked about this thursday. the president said we want to see financial incentives for people for healthy lifestyles. we want to be, even cash financial incentives for people who are working out, who are taking -- he held up companies as an example that really push their -- >> i just talked to the head of the cleveland clinic which does not hire people who smoke. because they want to set an example. >> i wonder, you have people who have access to everything. the best insurance, they have money. and they're still overweight or obese. i think the idea of legislating through incentives or whatever else to change behavior is a tricky proposition. i just don't know if that'll work. >> but sanjay, we've managed to get people to buckle up. we've managed to get people to stop smoking to a considerable degree. >> what we haven't done is merged health care with public health. that's what we haven't done. and the types of things we're addressing now is getting vaccines or obesity or exercise,

those are public health issues and we've never merged those two in this country. >> how true is it that when you go to an emergency room in any city, no doubt you see people who are using that as primary care. correct? >> absolutely. no question. >> how much of a drain on the system is that? >> it's a huge drain. we were talking about massachusetts earlier. it continues to be a huge drain in massachusetts even though you have 97% of people insured. they're still using the emergency rooms as a first stop. >> even with 97% of the people? >> here's the problem. we don't have enough primary care doctors in the country. we're about 16,000 primary care doctors short. you have insurance now. if you can't find a doctor or find a doctor who gives you an appointment, it may not be as much value as you think it would be. >> at this point in many ways, anderson, the president started talking about this as health insurance reform instead of health reform. it is not comprehensive in the sense of trying to change the whole system. it is really focused more on insurance and how the insurance system works for everybody. >> which gets nothing to cost and actually lowering costs.

>> it doesn't get to the preventive side. it doesn't get to some of these other questions of lifestyles and how do you get more young people to become primary care doctors because primary care doctors are the worst paid doctors. and, you know, you have to change the incentives -- the >> it's called plastic surgery. >> plastic surgery. i'm sorry. i was -- i was stretching for it. when we come back, we're going to talk about the money. how is this going to be paid for? how much is all of this going to cost? we'll crunch the numbers. limb: dude that was sick! i've been hangin' up there for, what, like, forty years? and then - wham - here i am smacking the pretty off that windshield of yours. oh, what you're looking for an apology? well, toss another coin in the wishing well, pal. it's not happenin'. limb: hey, what's up, donnie? how you been? anncr: accidents are bad.

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here is perhaps the biggest challenge president obama faces on health care reform.

his challenge, our challenge and possibly the sharpest case to make against changing the system now, namely paying it. the price tag is immense. >> we will make sure that no insurance company or government bureaucrat gets between you and the care that you need. and we will do this without adding to our deficit over the next decade. >> here's my question. how come the democrats plan to save money will cost us more money? how come their plan to reduce health care costs will cost us trillions more in tax dollars? >> somebody will pay. the president wants it to be the wealthy, and as you heard at the top, he also warns the cost of doing nothing to rich and poor. it's getting larger every day. according to the nonpartisan kaiser family foundation the cost of insuring a family has more than doubled since 1999 and the portion picked up by you money straight out of your pocket, is up more than 117%. why has health care cost gone up so dramatically? >> think of hip replacements and

stints and statins and all of the things that you can do now that are expensive that you couldn't do ten years ago, 15 years ago. you have baby boomers aging. more and more people using more expensive care. you made a good point earlier. 20% is 80% of the cost and that's a big cost in one part of the -- one part of the demographic and that part of the demographic is only getting bigger. >> right. >> and it's worth pointing out, no one does it particularly well in terms of controlling the costs, either the public system, the private system, or other countries in the world. just about everywhere you have health care costs out pacing inflation just about everywhere you go. >> at the high end we deliver terrific care for people who can afford it. we're very, very good at that. but we do know we've got one of the least efficient systems in the industrialized world. that we spend far more per person and get less for it than other major industrialized nations. people in other nations pay less and they live longer. so the system needs to be changed.

the way you have to change that is probably to change the incentives for doctors to do all of these extra things. right now there are not enough kind of incentives to do just what's needed but no more. >> there's this term that gets thrown around, comparative effectiveness, which i think is really interesting. for example if you're taking a statin medication you want to know at the end of the day is this going to make me live longer? >> something like a lipitor. >> something like a lipitor. to reduce cholesterol. is it going to reduce my chance of a heart attack? is it going to do certain things? that's why you take the medication. you'd be surprised how hard that is to prove. >> everyone who has written one of these novels has something in there about saying best practices, you know, we're going to reward those making a difference. and again, the problem is going to be how are you going to measure it? how will you know? >> that's where the idea that someone will come between you and your doctor, also comes -- the comparative effectiveness study shows doing a stint doesn't make that much of a difference. you as a patient go and say i should get a stint, actually you know what?

it doesn't look like that big of a difference, anderson. you're not going to get it. >> the notion though that greater efficiency will somehow help us pay for this or more preventative care, that's not factually correct or that's not factually provable at this point. >> that's the way to say it. very good -- or very hard to prove that. medically, morally it makes perfect sense but from a financial, economic argument, it's tough to prove. >> the biggest blow the health care reform took was after they started writing the bill they sent it over to the congressional budget office to make an assessment. how much is this going to cost, and are we able to pay for it? the congressional budget office said this doesn't add up. you don't have the savings here you say you have. you're 240 short. you know, we can't say with surety that experiment nationwide is going to work. >> the issue of cost, of course, stirring anger at town halls. also phony fears, myths, things that aren't actually contained

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part of president obama's extreme challenge in pushing health care reform has been the game he tried to play knocking down myths that spring up about the various programs discussed. only it's not a game. >> i don't have any problems with things like living wills but they ought to be done within the family. we should not have a government program that determines you're going to pull the plug on grandma. >> senator grassley there took a fair amount of heat including tweets from his old gop colleague arlen specter for amping up the concern on illness in aging family members. there are a lot of fears but we have facts to meet them. let's start with the most controversial issue the idea of death panels. we talked about this a little bit. let's take a look. >> i understand a federal health board will sit in judgment of medical procedures and protocols to impose guidelines on all providers when to withhold certain types of care. >> for fact's sake is there any truth to that?

>> she is sort of overlapping two things. the idea of comparing effectiveness, determining what types of procedures will be funded, that sort of thing, with this idea of end-of-life counseling. they call it death panels. i mean, it's a hyperbolic term. >> no government official is actually calling it that. >> no. they call it end-of-life counseling and that conjures up the idea of a firing squad. i found it hyperbolic when he first heard it. but the idea that life counseling would be paid for as part of this and the two things about it was you don't have to accept end of life counseling and you don't have to act on it. i think it's very important. studies will show if you get end of life counseling elderly people are more likely to be less aggressive with their care after they hear about all that may be in store. >> in britain, for example, if you're elderly and you're 85 years old and you go in with a cancer problem, they may well tell you, we're not going to do surgery. you should just go home. >> aren't there already death panels in america?

there are insurance companies which determine who gets treated and what is going to be covered and what's not and those are life and death decisions. >> insurance companies also have limits on how much money they will spend on you. and if you reach that certain amount that they've designated, they're done. and so if you want to continue your life and you're out of money, i guess they would be put in that category as well. >> people bring up the idea of rationing, but rationing does occur already. i get these letters all the time from insurance companies saying you want to do a spine procedure on this patient. great, except we're not going to pay for it. it's a form of rationing. >> the other rationing that goes on is for people uninsured. they don't get certain types of care. >> let's look at another myth, whether illegal immigrants would be covered. >> i believe the polls show that most people are happy with their health care.

there's a few problems. the illegals. they shouldn't even be here. [ applause ] i would ask congress to do something to send them home so we don't have to deal with that. >> i have a simple yes or no question for you today. will you ever vote for a bill that gives non-u.s. citizens access to a taxpayer paid free health insurance? >> what's the answer? >> this bill will not provide insurance for illegal immigrants in this country. what i think is less clear to people is whether you're here as a non-u.s. citizen legally and my understanding is it will provide insurance for those people. >> if you're here legally. >> and if you're a child. children as well. but it gets murky if someone is married to an undocumented worker, what happens to that couple, what happens to their children? all of that gets a little murky. >> nobody is going to give illegal immigrants insurance paid for by taxpayers.

>> if it's an economic argument that uninsured people cost more money, because they show up in the emergency room, they use those services, if you're making the economic argument, it does make sense to cover everybody, because they're still going to utilize the health care system. >> politically impossible. >> let's look at the other issue that's drawn a lot of heat, abortion. listen. >> abortion is not health care! it is not health care! has not been! and ladies and gentlemen, fellow citizens, if this thing passes, you and i and every other american, whether we support life or not, will be paying for abortions. >> i did not want to pay for my health care plan that includes the right for a woman to kill her unborn baby. is it true that this plan is in the health care bill? >> senator mccaskill said that

no, federal money would not be used to fund abortions. is that true? there's this hyde amendment which makes it illegal -- it says no federal money can be used to fund abortions. >> except for incest, rape or the mother's health. >> it's a little confusing. i think what it says is federal funding through the exchange for private insurance companies won't necessarily fund abortions. so private insurance companies can say they won't but they're not forbidden. with regard to the public option, if that materializes, a lot of that comes under the authority of the secretary of health and human services. so you could potentially have federal dollars through the public option funding abortion. so that may be where the rub is. i spent several hours reading through these paragraphs to try and even narrow that down to that. >> there's no one bill for us to be able to point to and say -- >> i read that for nothing? is that what you're saying? >> what you read in fact could be meaningless. but certainly if it does turn out that it is possible to have

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back with the big picture on president obama's extreme health care challenge and what it means for all of us. where do we go from here? what happens next? >> well, anderson, we have a big drama that's unfolding the rest of the year. and i think what's been significant over the last few months is that a proposition that started with a lot of momentum just has now lost of -- lost a lot of that momentum. that resistance is growing. the same thing did happen to the

clinton health care plan. there was a widespread support for it in the beginning, and as the argument unfolded, support evaporated. >> do you think democrats go it alone? >> even if they do, the chances are growing that they will go for something more modest than what the president wants. i think it's -- and there is a growing chance we'll have complete failure. >> i think other people who are supporting health care reform, whether they were in the private sector or the public sector, they weren't very vocal. they just assumed this was going to roll along and information was going to get out there and people would understand what was benefiting them. the parts that were benefiting them and that didn't happen. >> but you have to explain to people what it's going to mean for their taxes and care and their benefits and their coverage and their own money. and we can't answer some of those questions because there's several different bills from the committees, we don't know what it's going to look like yet. and people just are skeptical that they're going to have to give something up. >> there is still a lot of support. >> we play a lot of clips from people who are not in favor of this, and these town halls have

stimulated a lot of that conversation. but this is different than '93 in that president obama has the support of pharma, they have the support of a-hip, the american health insurance providers, the american medical association, organizations that typically have not been supportive of health care reform. so this is different in some ways and tough to take the temperature of the country on this. we're seeing a lot of these outbursts. i think they sort of become emblemat emblematic. >> do you think there will be some reform? >> i think there will be something. >> do you agree with that? >> i agree with that. i don't think it's going to go away. business needs it as much as the public. >> david, you think it can go either way? >> i think we're almost on a knife edge on this, and i think the president has to now take charge of the conversation, and the negotiations, and not just leave it to a lot of other people. otherwise, i think the chances of failure will rise. >> it's been an interesting discussion. thank you very much. good discussion as always. thanks for joining us. wish we had a little more shouting, but that's how it goes.

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