or anything in the tax law that's going to help get rid of that kind of fraud? >> one of the strangest things to do is to luke at one of your insurance company bills or the things they sell you that says this is not a bill, but looks like a bill. what you see there's an enormous amount of negotiated pricing, and one side effect, there's a lot of mythical prices out there. i had to go to the doctor when i fell and hurt my shoulder. the initial price the company was going to pay for the sling was $18. you actually discovered the insurance company was paying $99. i'm hesitant to know what the net-net. if i could get cash from a patient rather than dealing with the bureaucracy of getting paid

by the insurance company? i would be happy to offer a discount for that. >> medicare and medicaid don't even pay the full amount they promised to pay. the state of illinois has such budget problems that they're not addressing, not blang on cutting spending down they're just not paying their bills, including reimbursements to people that provide the clinics and doctors and hospitals that provide care under medicaid to low income people. so they're having to provide coverage and not getting reimbursed by the state out of it. the state is giving them iou's or something, but you can't do anything with those. and that creates problems. have you incentives like this. boston general could probably bring on some health care experts and talk all day about the doc fix in the health care programs and the problems associated with being a doctor and pricing. there are no specific penalties for doctors under these provisions. so -- beyond sort of the generic

taxes we talked about already. >> we talked about tax penalties for businesses, small businesses. we also mentioned there were tax credits as well. here's a bear bones look. fill in the blanks so to speak. employ fewer than 25 full time workers with an average annual wage of $50,000 a person. it would cover at least half the cost of health insurance for employees with single coverage. and tax increases would increase to 50% in 2014. fill in the blanks. >> that means every business owner is going to have to sit dune with their hr person and insurance provider and maybe some of their employees, and figure out what they should be offering. and what needs to change. that was the intent of the bill.

intentions aren't everything. there can be unintended consequences. what if you have 49 employees and you don't want to hire the next employee to meet all these requirements. those are problems that i think we're going to see more. >> as far as sitting down with the employers in hr, what are the potential options for an employer then? >> if you currently have coverage that isn't as gold plated as is required under the law. or if you do offer coverage that's so gold plated that the insurance company will be passing a hefty tax on it, or if any of these other taxes will be applicable to you or your employees or insurance company or where you buy medical deswriss from or the state exchange, all depends also on the trajectory of the health care costs. if costs continue to escalate the way they have in massachusetts --

>> your take? >> i would say, remember one of the goals in designing the policy was to encourage employers to provide coverage. the way they're doing that for large employers is by hitting them with a penalty if they don't provide coverage. that is not a popular thing to do to small businesses in washington. so the idea to offer the small businesses was to offer them a subsidy as well, basically a carrot saying, please provide health insurance to your workers. >> venice, florida. are you there? >> caller: good morning. joe henchmen, i'd like you to consider this. before you make a statement about obama not making unemployment his main thing -- consider this, every time he's proposed something like

infrastructure, where did it go? it went to the basement, they hit it down there. nothing. the republican congress never gets the blame, it's all on president obama. obama has thrived countless times, he put his hand out, and jut like this kid down in florida, he swam in a canal where there were alligators and it hit his hands on. that's what the republicans do to obama. >> i'm not here to defend the republican congress. the president did make this the centerpiece his first term and he spent a year of effort on capitol hill and convincing the american people on this priority. not some others a lot of people on the left have made that a criticism too. it may make it hard er for him o to win re-election.

>> as far as the tax structure, one or both of you have mentioned what governor romney did in massachusetts. >> i think he's certainly going to try to avoid suggestions of that. probably the big difference is, it was done at the state level and there is done federally. i'm a constitutional lawyer, and certainly my view of the of the bill generally is that it's constitutional for a state to do it. you run into a lot of big issues. they don't have complete power to do whatever it wants, the way that a state can. so justice brandeis famously said our 50 states are the laboratories of democracy. washington state tried a guarantee issue without an

individual mandate. they required every insurance company to offer a plan to everybody that asked for one. they did not require an individual mandate. it was a catastrophe. massachusetts may be did something that works for massachusetts, but that's a different question about whether it works for the nation as a whole. i think that's -- if governor romney were here, he may say something like that. >> jacob on the republican line from south carolina. >> caller: now, the guy from florida, i wasn't going to make a comment but i have to refute what he was talking about, about the republican congress being obstructionist, because i've called for two days in a row, called for a long time. please don't cut me off. i have another comment to make. >> do you have a question as far as the tax structure when it

comes to the affordable care act? >> caller: yes. please, just let me try to refute the guy from florida's comment. >> quickly, please. >> caller: i will. i would like everybody to realize that for the last six years, this '06 election, harry reid and the democrats have had the majority of the senate. nancy pelosi came in in '06 and for two years they had a super majority in the house. the republican obstructionists have had one part of the congress for less than two years. so how in the world could they be obstructing president obama so much? >> and your question about taxes, sir? >> caller: my question about the taxes and the health care law in general is, it's a massive tax. it is a far left -- barack obama

is -- everything he's done in his presidency has been to annihilate capitalism. every measure he's done in the economic sense has obstructed growth in this economy. if people would just take a look at what he's done. these are are through the epa or through this health care monstrosity. >> we'll leave it there. >> again, when you think about the aca, you have to recognize that it's something that expands the federal government's role in health care. and in return, you get 30 million more people who have coverage, and in return, have you to levee some taxes to pay for that. and obviously you can have a great debate over whether that tradeoff makes sense or not. the bill that was passed tried to strike a compromise between the government taking a larger role while maintaining a private role in the insurance market.

the idea of the exchanges in each state, people will have a choice over the coverage they get. there's a debate over how much variety they can get. it was in essence an attempt to strike a compromise between two large views of politics of a larger government role versus a vibrant private role. >> my employer already says it's going to be cheaper to pay the penalty, if health care prices rise by 10%. is cost containment a consideration? >> most budget folks look at the bill and were disappointed about what it tried to do on the cost containment side. there are two reasons for that. one is, it wasn't aggressive enough. we haven't quite frankly figured out how to do cost containment in an intelligent way. we like to pretend we know the answers. the reality is, we're so flawed,

we are at a stage where we need to run experiments and figure out what works. if we with change the way we pay doctors to reward them for provided quality outcomes, you ought to be able to have better care and lower costs. we haven't figured out how to do that. >> we have a broken health care market right now. it's half government dollars half market dollars. people don't know what things cost. and a lot of people purchase health care services with somebody else paying for it. that's always a recipe for cost inflation. there's generically two ways where you might want to try to address reigning in costs. to give people more control over prices, things like hsa's and some of the reforms that dr. marron mentioned that may be tried on a state by state basis. another is rationing, whether

input specific having to call some government official to get approval for a procedure, or implicit by waiting line, a lot of long waits to get certain procedures the way they have in some european countries. this bill kind of did a tiny amount of both of those things but didn't address cost containment in either way. i think dr. marron is being honest when he said he was disappointed. a lot of people are upset there's almost no cost containment in this bill at all. >> jamie on the independent line. >> i think that a lot of president obama's views, they kind of get scattered and nobody really is the justice of what he's trying to do. i do hear a lot of folks calling in, and asking about the illegal immigrants and how the health care thing will apply to them. i think that in the past, president obama has addressed that. and what he said was, he said,

part of the thing is, the children of the illegals, i think it's pretty -- on both sides, i think everybody understands that they're not going to be going anywhere. the thing of it is, to make them tax paying citizens, and the way to change that is to make them tax paying citizens. i do also hear the younger americans, those in their 20s and that kind of thing, asking why should they have to pay into something when they're young and healthy, and they would rather pay it as a bill. that's fine when it comes to a fractured wrist or a broken finger, you can afford to pay something like that, what about when you receive things that are more life threatening, stomach cancer and these kinds of things.

>> since we addressed immigration, the immigrant question a couple times already, what about that younger perspective, that he talks about. how they'll react once they're faced with paying a penalty or not. >> so a lot of young people feel invincible and immortal. i remember feeling that way a while ago. and feel like the tradeoff between with money and insurance is such that they may get by self-insuring. i don't think that's actually the right tradeoff. you want to have some sort of catastrophic coverage, so if something bad happens to you, you'll be taken care of. the challenge is designing a system that allows younger folks to choose somewhat less expensive plans while allowing the overall shurninsurance mark work. >> this is so younger folks can stay on their parents health insurance until 26? >> that was part of the bill also. and it's one of the more popular aspects of the bill.

it will be a contributor to driving up costs. these are people that will be now consuming services without paying attentional premiums. so the insurance companies were willing to make that tradeoff, because the individual mandate was part of the bill. ultimately that will drive up costs, and as i've said a number of times, we have yet to see that the taxes that this bill will generate -- >> when do we get a sense of if this structure works or not? >> some of the taxes are in effect already. not some of the big ones, the individual mandate starts at 2014, about $95 a person. flat rate. it kicks in fully in 2016. and i think the -- almost all of the taxes by about 2018. a lot of's phased in overtime. right now, the big tax you're paying is the 10% excise tax if you go indoor tanning. >> huntsville, maryland,

democrats line. >> caller: huntsville, alabama. >> yes, sorry. >> caller: i'm on disability, medicare and -- which is $95 a month. i pay a 10% penalty, and it's been since '92. i want to know why is this penalty here. they don't know if it's a penalty or what? and how long do these penalties last? nobody said how long they last. it's got to be a time limit, they are making go all the way, as long as you're on it. i'm going to hang up and hear what you have to say. >> the one with penalty i'm aware of in medicare is, they do want medicare folks to sign up as soon as they're eligible. if they put off signing up for some parts of medicare that are voluntary, when you finally choose to sign up, you may face higher premiums. >> better win with, illinois.

you are next, james, independent line. i'd like to know, it seems a bit contradictory, this health care plan to me. you want to get 30 million people that are uninsured insurance. yet they have no money to get the insurance, now the irs comes in and taxes them or penalizes them, whatever how do you get money from people who can't aforward it in the first place to pay for it. i can't see the irs rolling up to then and saying, wei have to take your card away from you because you can't buy health insurance. now, on the other point of lowering the cost of health insurance, i think there should be a congressional hearing on the hospitals, the drug companies. and the insurance companies. what's your thoughts on this? thank you.

>> somethen we haven't talked before is there's a significant expansion in medicaid coverage included in the bill. how that will work at the state level has a little bit of a question mark around it now the idea was to expand quite dramatically the group of people who would qualify for assistance through the medicaid program to get them coverage. when you get above that level, moderate income folks, there are some subsidies in the bill that are meant to help people afford insurance that might otherwise be a financial challenge for them. and then as the caller describes, there's penalties that kick in there and go higher for higher income folks who the perception was could afford it if they had a little bit of a nudge. >> i think the caller raises some good questions, it's important to underline that we don't have a private health care system in this country. for children we have the federal chip program, we have medicaid

and medicare. we have state programs for veterans, the va, and now we have this health care system which carves up everybody who's left and takes some of those people. there's a lot of interlocking parts there. depending on somebody's situation, they may be eligible for va, medicaid, chip. there will be a group of people left over who make too much money to be eligible for medicaid but don't earn enough to buy insurance on their own. they're not young so they can't be on their parents' health care plan until the age of 26. and if they can afford -- they can't afford to buy insurance on their own because they can't afford the penalty, what do we do about that situation, i think it's a problem that a lot of critics had with the bill because it's sort of this piecemeal approach. there are a lot of people that prefer the broad stroke, let's have a public option, single pair system.

in many ways, that addresses a lot of those issues at a much higher cost. >> one with viewer says the government's going to get a health care tax credit, what's the point of a tax in the first place. sounds like a lot of irs salary and processing laws. >> the goal is to decide who it is you want to encourage to provide insurance through a subsidy. that would be low income folks and moderate income folks and small business. who you want to give a nudge by threatening with a penalty. that would be large businesses and folks with higher incomes. >> this is one of the problems we're concerned about, using the tax code for this manner. especially at the federal level, also at the state level too. where we're collecting taxes and giving back to some people who do things that we want to reward, and then we add additional taxes to people who do things that we want to discourage. and, of course, that gets captured by the political process, and the interest -- the special interests that want to

have certain tax provisions, that's a big reason why our tax code is so many pages, so many millions of pages and takes so much time to comply with. it's not so much complying with the rate or figures out what your income is, those are significant drivers of time and expense with our tax code. it's also, all of these little provisions, you get this, you do this, this happens to you. we use our tax code not just to raise revenue as we would prefer, but to change social behavior. >> tampa, florida is next. irene, republican line. >> caller: my question is, why do the hospitals have to see you when you get sick. all hospitals should be able to opt out of if, and make people be more responsible for themselves in all of the years, i don't hear anything about

people living better, taking better care. i had four children in the '60s, making a little bit of money. but i chose to do without things so i could have insurance for my children. i'm 66 years old. i had surgery in 1994, i gave my own blood before the surgery, i took my own medicine to the hospital. so it seems like to me, the piece missing, is that when you get wronged, you should realize if i get sick, i need to take care of myself as best i can. and if i have to make a sacrifice to buy insurance. i don't think the government should be just making all of us keep paying this tax for people that are irresponsible. >> i think you should be commended. you're a hero in my book. i think if a lot americans had the same attitude you did, we would have a lot less of a

health care problem in this country. i think it's a pr problem essentially for them as well as -- it sort of goes to our sensibilities. i think if you were to poll americans, and say, should hospitals be away to turn away with emergency cases it wouldn't be very popular, and i think politicians realize that. >> the tax care credit people with income between 133% and 400% of the federal poverty level are are eligible for subsidies. who does this affect? >> this is the tranche of people who are just above who would typically be on medicaid. we're talking about -- if you're very low income, like a homeless person or the low income person you'll get medicaid. if you have moderate income

levels from slightly above the poverty line to four times the poverty line, you get assistance from the federal government. if you're above that, you are on your own and face penalty. >> there could be a gap if a state declines to participate in the medicaid expansion. medicaid is up to 100% of the poverty level, if the state chooses to participate in the medicaid program, they can get money to cover part of the cost, up to 133%. part of the cost, not all of the costs. i think you were talking about earlier five governors said they will not participate. there are people who are between 100% of poverty level and 133% of poverty level will not be eligible for medicaid or subsidies. maybe that's a change that will have to be made to the obama care law in addition to the changes in corporate reporting and the changes in the class act

because they didn't work. >> columbia, tennessee mary, democrats line. >> caller: yes, i was under the impression that the original health care reform bill was to get an individual health insurance that everyone could buy into, and they couldn't get that passed, what was put on the table, we were supposed to go back and work at it, and make it better instead of just reform the whole thing. i work in a small business that has brought their insurance because it had two people that were sick within the business. and the health premium since 1995 shot through the roof. then they had to drop insurance on their own. i also work in the medical field, i can tell you the procedures i do -- what happened to me, the insurance company's premiums keep going up and up and up, but what they cover for the procedure went down and down and down, well, the money's

going somewhere. and where is the money going? wane if you google what the top insurance people made in 1995 and what they make today, i think it somewhat answers where the money's been going. >> thanks. >> the vision of the bill, small companies that run into a problem, each state will stand up an exchange. there will be subsidies for people who have qualifying low levels of income, and they'll be able to go by standardized policies. >> don from las cruces, until until. >> caller: i have an example of an american i'd like you to give

me some information on. this is an american who in 2010 made $20 million, he made no social security or medicare because he had all capital gains and dividends. under the new health care bill, you indicated that he would pay 3.8%. of course, this american that i'm talking about is mitt romney. so i'm -- given the income in 2010 and what he paid, he would pay how much on an income of $20 million with the new 3.8%? >> well, i -- if you're asking about governor romney specifically, he can defend himself, i don't know what his health coverage is, i imagine he has some pension covering him from when he was governor of

massachusetts. if you want to see how different income levels, different family sizes, all the different taxes affect you, you can do that on our website. >> not speaking to any individual's tax situation, but a hypothetical individual earning 20 million solely from capital gains i think would start paying tax years of about $750,000 a year in addition to what they normally pay. >> robert in georgia, go ahead. >> caller: yes. my main question is, and it seems to be, we're wok on all different kinds of taxes, and we're kind of skipping around the board. i guess the main thing i would like to know and the american people would like to know, the way i understand it, is. this insurance will not cost anybody who already presently

has insurance, it's not going to cost them any kind of mandate tax. which is not going to cost him any tax. that's what a lot of people are fearful about there, who do not understand. if they already have insurance, they're not going to be hit with the mandate tax. and there's only 1% of the whole nation will have to pay roughly speaking -- have to pay that kind of tax. and that's based off of the m s massachusetts law on their system. their health care system. that's all they've had to pay for tax up there, is about 1%. i always follow the same identical program. could you comment on this, please? american people can understand they will not have to pay if they already have insurance any kind of tax. >> leave it there. you're correct on the individual mandate penalty, if you have insurance, you will not have to pay that.