constitution has an engine to be harnessed for social progress. liberals on the court -- i use that word very advisedly -- have been playing defense for a long time may be because they all speak for a majority. it relates in part to personalities of the individuals and also realities of the confirmation process i talked about. somebody who has deeply progressive roots, activist routes you might say. not very likely to get nominated or confirmed. on a more liberal side of the court, mainstream middle of a road people. on the conservative side there has been some social science

research that has identified this court as the most conservative center of gravity on the court we have seen in many decades using certain metrics and we have a couple of these in the air and we see where they land. it is not that they agree on everything. originalism only carries them so far. they may be united in certain policy points of view that reinforce one another as they served together. it is still a pretty young court and we will see where they will take us. >> having said that are there

any reproductive rights cases coming the before the justices? given composition of the court and the tenor of the contraception debate going on in america what do we think is the future of roe vs. wade? >> i think the future is in the balance. there are not currently five votes to overturn it. there are five votes to uphold it. or what has become in recent years. but the whole notion of reproductive rights as they were once understood is under a great deal of stress. there are some lower courts that have upheld most recently in texas ultrasound law. i don't know whether the reproductive rights and centers of that law are going to take an appeal of that case, i don't

know whether that would be advisable. this is an area where things are hanging in the balance. because of the way you frame the question, this last year or two in the legislatures of the country we see dozens and dozens of antichoice measures and some of them brush back by voters or legislators. this is very contested territory. the court has finally balanced. >> thank you very much. we can let you relax. had a very good conversation.

thank you very much for wonderful talk. [applause] >> booktv is 150,000 twitter followers. follow booktv on twitter to get publishing new the, scheduling of dates, author information and talk directly with doctors during live programming. twitter.com/booktv. >> up next on book macgillis discusses "landmark: the inside story of america's new health-care law and what it means for us all". a series of essays written by the staff of the washington post. it is about half an hour. >> we turn our attention to the new health care bill that was passed into law recently and joining us at the table is alec mcginnis of the washington post.

here to talk about a new book. the washington post put out a book "landmark: the inside story of america's new health-care law and what it means for us all". you can see my note attached to the book. there are a couple stories in the paper about this health care bill. this is one from the washington post. 18 states the kline to run for high risk insurance pools. what is going on? >> guest: one of the first provisions in the bill across the country, sort of a temporary thing. a bridge to get as to the main provisions of the bill. basically people with preexisting conditions in trouble right now. can't get plans. they are ready to go to high risk pools that have been set up. the high risk pool is a problem. and it will be very tricky to set up. might not be enough money and

some states are resisting. >> 18 states are declining who. a lot of states are concerned that if funds run out they could be difficult choices. reducing benefits, raising premiums or limiting enrollment. >> this has arisen because they waited until 2014 to implement the main parts of this law. they had to figure out a way to take care of people in worse positions until then. this is not ideal solution. you are taking all the sickest people and putting them into a pool which is not the way insurance is supposed to work and on top of that states that are opposed to this bill forcibly saying we won't cooperate. this could get -- >> host: alec macgillis is one of the co-authors of this book "landmark: the inside story of america's new health-care law and what it means for us all". here to talk about the law and what it means and what is being

implemented now and what it means for doctors' leaders the hospitals and medicare. the phone numbers will be on your screen. what of questions about the impact of this. let's start with what it means for doctors. >> guest: doctors are interesting. doctors did are not going to see as much impact as a lot of people thought they should. this what did not do as much as it could have to take on sort of the cost problems on the provider side. the cost problem we are facing among hospitals, doctors, drugmakers. the law is focused on the insurer's. so doctors are going to see some sort of more peripheral impact, more money for doctors to go to primary care. more money to help them with their medical loans or what not. they will be encouraged over time to change the way they work

to get into networks where they are working together instead of working in small practices. working more on salary rather than fee for service which is the way most of our health care is delivered now. a lot of ways doctors because they had such a powerful lobby in washington really avoided a more direct impact than they could have had. >> host: that story featuring the book says there's an emphasis on primary care. >> guest: there is the big concern when you expand coverage as we are doing in this bill that you are going to have a problem of lack of access to primary care. more people coming into the system and not enough doctors to go around. the bill does provide substantial amount of money to encourage doctors to go into primary care to serve in underserved areas. that is not the main thrust of

the bill. >> host: for doctors the big concern was reimbursement. here's a tweet from one of our viewers. h h s challenge medicare broke, medicare at 40% to the number of seniors and the house bill cut $50 billion. what will be cut? >> guest: the cuts in medicare. there was a lot of concern during the whole debate. the cuts in medicare were agreed to by hospitals and doctors and come to about $150 billion over the first ten years. they are calling them cuts is a misnomer because every year doctors and hospitals get more for medicare to account for inflation and rising costs. they are agreeing to a smaller increase in medicare reimbursement than they would have otherwise gotten. they agreed to this because they realized they didn't they might have taken a bigger hit.

this was their deal to avoid the public option. doctors and hospitals, people assumed the insurers were most opposed to the public option, government run insurance plan people could have bought into. doctors and hospitals were just as opposed because that would have meant lower reimbursements for them in all likelihood. >> host: talking about the impact of this health care law and a lot of debate about what it will do. alec macgillis is the author of a new book on the law. on the republican line, our first phone call. go-ahead. you are on the air. >> caller: this is sheila. >> host: my fault. go-ahead. >> caller: the high risk pool in georgia, our insurance commissioner said that he sent a

letter to kathleen sibelius saying that george was not going to approach this state. i am one of those people that need insurance because of preexisting conditions. is the federal government going to take that over? >> they are. he was the first commissioner to say he was not going to be along with setting up the high-risk pool in his state. was another aspect of the state's rights opposition we are seeing which has mostly manifested itself in people being saying they're going to sue about this mandate. if the insurance commissioner came out and said he was not going to help with this high risk pool kathleen sibelius' said the federal government would be able to sort of do that if there's a provision in the law that high risk pools will be -- states will not be left without them just because a

state is refusing to cooperate. there is more of a problem with states that are not being cooperative when it comes to the big part of the law in 2014 when we start getting new marketplaces called changes that the states are going to set up where people buy insurance. if states are being grudging and not opposed to this law there will be a tremendous problem. deron not helping to set up a good exchanges in their state. >> host: martin on the republican line. >> caller: if the federal government forces a state to violate on their religious beliefs by violating the establishment clause by forcing them to fund abortion they're breaking the tenth amendment to the constitution. >> guest: they end up in

complicated language. there is really great uncertainty about how this will play out. a lot of people closely at the language. there will be very little abortion coverage provided in these plans that are going to be offered on these new exchanges. that companies can offer plans that include abortion coverage on the exchanges and market places where we are going to buy insurance that people who buy into those plans have to write jeopardy -- separate checks and make separate payments in their payments to go to the ball to of their coverage and very small payment like $1 amount for something to go towards the abortion coverage and a lot of people think this will be so unwieldy for the insurers to implement and a lot of people will think this is crazy. what do i have to write two checks for my insurance plan? even young guys blink of little older women, everyone has to write two checks that there might not be a market.

people will think this is weird and an appealing. quite possible you will see very little abortion coverage in these plans. it is worth noting that most private insurance plans to they do include abortion coverage. people don't realize it but chances are if you are getting coverage through your employer that coverage may include abortion coverage. >> host: where it is the list of these rogue 18 states? i want to call these governors. do these dates -- are they legally able to opt out of these high risk pools? >> with a can opt out and that is what we're seeing but it is somewhat overstated as a problem because the federal government is able to set up these schools on their behalf. the bigger concern with high risk pools is whether they're going to work. they set aside $5 billion over four years until the main part of the bill go into effect.

some states do have high risk pools on their own and we're spending $2 billion a year to cover 250,000 people in high-risk pools. it is not an ideal way to help people in this interim period. there is a reason this is not a permanent solution. is not very good solution. >> thanks for c-span. i had a few quick points. first of all i was curious about the tax rate that i see, big industry receiving. for an individual like myself that purchases my own insurance are wonder if i would get a tax credit for the premium that i hay because my employer doesn't supply insurance or provide it. also i wonder why the delay was implemented. it seems the states would are

juxtaposing themselves against the bill. i wonder if it is an insurance giveaway and how will affect pharmaceuticals? >> guest: you make a good point. people who buy insurance on their own have to pay for their insurance on a post tax basis. you don't get that benefit people do when they get insurance through their employers but the idea with this new law is you are still going to be paying with after-tax dollars but if your income is below a certain level you're going to get help to by your insurance. sort of a recognition that you are not getting shafted a little bit in the existing tax structure you will be getting subsidy that people who get insurance -- not sure what your income is but family up to $88,000 a year of income are going to be getting subsidies to purchase insurance on a sliding

scale going up to that income. the question about the delay -- this implementation, is going to be a real hassle to set this system up and give themselves time to implement it. another part is that they had to delay to make the numbers work. by waiting on the main parts of this bill they reduce the cost of the bill over the first ten years of the bill and so there is a little bit funny numbers stuff going on and finally on the pharmaceuticals they were really the industry that right from the start tried to get in to be at the table and to they pay a lot in ads supporting the bill and they were a key supporter of it. in exchange they avoided getting

what they were most worried about such as importing drugs from canada and also letting medicare by drugs -- medicine in bulk for the drug benefit. the one thing drug companies did which will help people is the doughnut hole in the drug benefits. a lot of seniors don't like -- is going to shrink over time. they're getting a $250 check in coming weeks. seniors will go into that doughnut hole and get a check to help them with that problem right off the bat. >> host: carol on the independent line. you are on the air. >> caller: good morning. nice to see you. i am curious about all these people who call in about they don't want their taxes going toward abortion, so afraid of this but they take my taxes all the time for work that i am

morally opposed to. i wonder how they can justify that and if they have an argument that would hold up. >> host: curious about anything? >> caller: i am curious about so much. i wonder how these people think that they can get out of paying taxes because they think some of that might be going toward abortion. >> host: healthcare reporter can't answer that question. in massachusetts, eddie on the republican line. >> caller: i don't consider it a reform at all. it is more of the same. all it is going to do is ensure more people. we have twice as many wires as we have doctors. the beauty of europe is they consider a doctor or hospital as

sacrosanct, you don't bite the hand that feeds you. don't go there and sue them please. >> you are right. there is some language in the bill regarding toward reform. twenty-five million -- can't remember the exact number -- to encourage states to set up new pilot programs to deal with the problem of malpractice and beyond-you said you don't see this bill has reform. there are a lot of people who think that is true in a broader sense, that this bill did a lot to help covering the forty million americans who don't have coverage but it really did not do enough about reducing costs. not just the malpractice issue. beyond that there's a lot in

this bill to get as to use health care to reduce our utilization of health care and with we use of health care but not a lot to reduce the price we pay for health care. the price we pay for all the things we get when we go to the -- >> host: phil on the democratic line. >> caller: i would like to ask all the people that call in and say they can't -- the government can't force them to buy insurance. if they're involved in a car accident with their wife and child they can reach in their glove compartment and pull out $50,000 and give it to the hospital? >> guest: this can be one of the big points of this law. people make it a mandate that everyone has to have insurance. this is the heart of the law. this idea that we are making insurers -- forcing insurers to behave better to cover everyone and stopped doing the things

they do that we don't like but in exchange they get all these new customers because we require people to have insurance. the idea that if you don't get insurance than you are shifting the cost to everyone when you do get sick. the argument against the mandate is car insurance but -- i have to get insurance the don't have to get a car. if i am human i have to get insurance to cover my health. but from the implementation of this law the way it is supposed to function it is really important the mandate work and people don't find ways to skirt it or just pay the penalty. the penalty is not very big some people pay the penalty to get out of it. if a lot of people don't get insurance it may not work because then you have insurers having to cover somewhat older and sicker people without the benefit of having those younger and healthier people in the pool. that is the only way it will

work. to get everyone into the pool. >> host: what is the deadline for insurance companies to start accepting young adults on to their parents' insurance? >> that provision is in the coming month. into your 26 birthday you can stay on your parents's plan which is a big deal for families. the biggest provision, the one that says it all, everyone including young people have to have insurance doesn't start until 2014. >> host: some companies have started to accept young adults. >> guest: just for ease of transmission they're doing a already. that is a tangible thing for a lot of people. >> host: helen on the independent wine. >> caller: do you have a handle on how many new bureaucratic agencies are created by this

bill? >> guest: good question. the main agencies that will be implanting it are the ones we have now. health and human services department, medicare and medicaid department. the actual exchanges in market places-it could be a problem in states where political leadership doesn't like this bill and it won't be very motivated to make it work. in massachusetts which passed a model of this bill in 2006 it took a lot of effort to get their version of the exchange working and we had by partisan political support around the bill including governor mitt romney, republicans signed the bill.

you have a real consensus around it. everyone was on board to make it work. now try to do this in states like texas, arkansas, alabama, georgia. states that don't have much in insurance regulation and all, something they don't do much. and have much capacity for but also where there's real political resistance to doing it. that is going to be more of a bureaucratic concern than bureaucratic bloat to the federal level. >> host: this viewer is asking if insurance companies will offer multi family discount. mandate to have insurance, will this create a new market? >> guest: the premise is you get more people into the pool. that is the idea. right now problem is people who try to buy insurance on their own have a hard time because

insurers can just reject that if you have a preexisting condition or charge a ton and the rates are very high because the pool is not big enough. you only have people in the pool who think they need insurance. if this doesn't really work the way insurance is supposed to work the hope is you create this new healthy, busy marketplace and eventually if it will work the long-term hope is you will get more and more people into this exchange over time. they might become the base of our insurance system. >> host: surely on the republican line. >> caller: everywhere i go, i go to a lot of places, i hear a lot of people complaining they paid into this system all their life and now they have to worry about medicare. we're going to lose our

medicare. they keep saying how much money is taken out of medicare. people are so upset about this. >> guest: facts are it is more complicated than that. the biggest impact is medicare recipient is going to see at negative impact, people who are in medicare advantage plans which are plans run by hmos, by private insurers to get money to provide this medicare like product. these plans are getting their subsidies cuts. they're getting less money from the plans. they will stop offering plans or maybe make the plan less appealing by cutting out what comes with them like free membership and stuff like that. people with medicare advantage plans might feel a pinch. the real hope is medicare -- getting slightly lower reimbursements over time than they otherwise would have but

they have to find ways to deal with that and the other reforms in the bill that are meant to change the way we deliver care or get us to be less efficient, the hope is those reforms will help them with slightly lower in vestments. as i said before unless you deal with a doughnut hole problem lot of people do, that will go away under this bill for the next few years. that doughnut hole is going to shrink not to nothing but almost nothing. >> host: richmond, virginia on the democratic line. go ahead. >> caller: my comment is more in line with being a question. i understand that the states want to sue the government, they don't have to be mandated or not to be mandated or not questions. if the citizens of that state want to participate can the

citizens sue the state? >> guest: good question. in a sense the best response for these states where the political leadership is not being cooperative with the law is pure political pressure and it is really a matter of trying to change the political leadership in your states if you don't like the way it is acting. and we will have to see how that plays out. is possible if instead of leadership of the state keeps being uncooperative that they might start to hear from their constituents. people saying we need help. we can't get insurance. it won't make sense if these benefits are going to our neighbors the next state over. we want these benefits too. so stop doing it. also worth noting that it is possible these challenges of the