including, by the way, imf payments, in exchange of an agreement of reform, but would also commit -- this is not restructuring done up front, but the real legal restructuring or reprofiling if you like or change of interest whatever you call it comes after let's say two or three years of a period during which the program is carried out. so there is this experience that's been successful for a group of low income countries. it's never been used forever a middle income country p p i wonder when you make the debt payment, you run out of money, and you don't have the time now to build the whole program. that way you could have the time to build up the program, and in the meantime debt program is

relieved primary surplus goes down and at the same time, the creditor community and international institutions would not write off any part of your debt in a complete way or agree to any change in interest rate in the time way. >> this is such a radical proposal i didn't think about it myself. our proposals are by comparison. if this is good to me, i can assure you i'm going to look at it firstly with this belief, and then a few minutes later, with glee. and satisfaction. we don't need that degree of generosity from the creditors. if we get it, we'd be very happy. what we need is to stay faithful to the spirit of the 20th of february agreement at the euro group level that allowed greece

to be the author or coauthor of the reformed agenda and we'd like to get down to work and discussing the actual bills that go through parliament with the reforms, pushing for this, instead, however we hear there has to be a comprehensive review, the kind that never happens in the last two years. it has to happen within a few weeks of our governments being elected, but nevertheless, we go along with that, and what would be i think, very previous would be to separate the conditional conditionalties for closing the final review of this current program on the basis of four or five major reforms that need to be done and can be done in the space of the next few weeks. let's face it, it's a time frame we face and do what you suggest by the end of june, again, fairly soon, but nevertheless, prepared to do this, by the end of june come to an agreement about the long term. now, that is what we are

proposing. that's what we've been rightful of the beginning to effect. the separation, therefore of the current review from the medium and long term is i think, essential for avoiding the accident and creating circumstances for greece's government, which would, by the way, say a few things on the optimistic note, if we make this, and i believe we will, and i'm greatly encouraged by what was said in the whole conversation an hour or so ago. if there is a declaration similar to mare owe draghi's of 2012 that the euro zone does whatever it takes to remain indy visible, and at the same time there is an announcement of an agreement between greece and the international partners on a

number firstly, fiscal matters, let's agree on appropriate fiscal surpluses that are not exorb tapt as they are now, substantial investment packages in the european investment bank a way of writing off nonperforming loans from the banking sector, and clog the credit circuits privatization policies aimed at development and social security and safety and others, and debt restructure proposals with no haircuts and in the end gives more value back to the creditors, and at the same time attack the -- what i call the trilogy of sin in greece, which is procurement, bureaucracy, the political system, the way that has a cozy relationship with the ag gark ki

that plays a toxic role in society and always have done. at the same time, we have reforms that calculate down to the level of product markets, supermarkets, then down to pharmacies if we need to but let's be patient before we attack all the rent sources. these are things i believe we can agree upon in one amp. the announcement of the agreement will unleash such a wave of optimism about this. remember, asset prices in greece are on the floor. suddenly, greece will be a great field for bargain hunting. there's going to be such a relief amongst greek investors amongst foreign investors, and we have the capital in growth industries that we can do the

one thing we have not managed to do, and that is create an export-led developmental model that would be void by this initial enthusiasm and which will be refeeled immediately after that by a never ending sequence of great reforms. this is what we are striving for. it will be a great shame if this agreement is not concluded in the next few days weeks. >> thank you. >> we have to leave the room at 4:00. okay. let's see. what i will do if it's okay, take a few together, okay? the lady up front. please identify yourself. >> thank you very much. i'm greek, and i'd like to thank you for the terrific analysis. i would like to ask request that they address the question to the

policymaker because you're a member of the government who started your journey, and as we know, a popular party and the cities and know our families from our friends in greece, that day after day, greeks are waiting and the government is related to development. i would like to ask you do you have any ploem any development, a measure that this government took since january 2015? thank you very much. >> a gentleman there in the middle. >> thank you very much. i'm a professor assistant professor at john hopkins next door. i have actually, a question for you as a politician. i think we agree with the economic analysis, and i think

d.c. is your most favorable audience you're going to get, but as a politician, are you worried that being right is not going to be enough? the political economy is that the ret is you're one against 18 in the eurozone. how are the 18 other euro zone countries going to sell the concessions they are going to make to your government if they are going to meet you one fifty of the way? thank you. >> the gentleman all the way to the back there, yes, right there. >> i've been an observer of the greek economy for 30 years off and on and i have a suggestion regarding ones you find sensible in dealing with the state-owned enterprises, and the suggestion that before you sell off the family jewels that you consider making them more productive by

eliminating patronous jobs going on for 30 years or longer, and specifically you fire non-performing employees with very high salaries. in comparative private sector increase in contrast to many other countries, but they have extreme job security, and on top of this, give the jobs to the youth of greece which has 60% unemployment. and then to attract forp ineign investment, consider eliminating restrictions on mass dismissals. >> we'll take through. you answer this -- a few more? okay. then you'll have the floor. lady in the back there. i'm trying to keep jendle balance. >> thank you very much. i'm from bloomberg tv africa. we know that a lot of economists bet on the fact that greece is

going to leave the euro zone. that's what we are hearing. what do you do to ensure they do not leave, and the madame this morning said that all rules state there's no delay in payments, and we also heard from the german finance minister earlier that gives you advice to ensure you stick to the reforms. how do you plan to ensure you're not going to be compromised but instead ensure that you are going to compromise as much as you can without putting the greek economy in danger? thank you. >> one more. yes, you. zblimt subject to the imf friends in the room, there have been cases of arrangements conditional on future performance, so it is not an undone thing that some payments are either refinanced or delayed. >> thank you very much. the question is a follow-up to what all the colleagues said

before. it goes to the essence of negotiations taking place, and it seems to me and, you know reading the papers and trying to talk to some of the actors involved, that the piece that's missing is not so much the flexibility and trying to find a slightly different compromise on how to achieve the goals that you want to achieve, but the lack of specificity. basically, how i understand it your euro zone partners and the institutions involved are showing some kind of flexibility flexibility, but because there's been a break down in trust, what they want to see is not so much generic goals formulated, but more specific actions to be taken, or at least the beginning of actions taken. these can sort of help restore

the trust that's been broken probably over the past few year, not due to your actions, naes necessarily, but due to all the things that happened since 2010. what's your response to that criticism criticism? thank you. >> your turn now. >> yep. right. your questions. policies. what are we suggesting? actions. well, i did allude to some before, but, of course i did not get a chance to you know, each one of these topics would take half the whole lecture but the example i gave of privatization, so our policy of developing public assets in con sanction with privateers with minimum investment standards, when it comes to the railways,

right, now that is a very clear policy of saying that we are going to build a partnership with a private sector. we will allow them to manage it. we will give them a majority share holding but they have to ensure minimum investment, minimal environmental standards. that's policy. i could -- i don't have the time, but i could give you a lot of different examples on this talk to you about all right, here's ideas regarding the tax system. for instance in greece, we have the particular privilege offing with a country with extremely high tax rates and extremely low tax takes. so how do we intend to tackle this problem? there are ways of doing it. we have been in the process. again, you have to realize that our sovereignty's severely circumscribed by the negotiation. in almost everything that we are

introducing as ideas we've been told that it has to go through the filter of the negotiating process. that's slowing us down. we are much keener than it seems to legislate and put these actions to the policies in practice. on the question of your question because it is related on the question of lack of specificity. let me answer it just directly. our original suggestion was that we sit down and specify three, four, five bills that need to be introduced, particularly reforms, and indeed, we said to them, to build trust, this is the only way we know how to do it. let's agree on three majors that need to be taken, and you take them, and you watch the limitations, and you pass judgment on us depending on that. we did not get anywhere because

we were told that the review has to be comprehensive. everything has to be discussed. my fear is that when you discuss everything, you're not discussing about much. okay? so the -- you see, let me share another source of frustration with you. we entered into these negotiations. we constantly ask for narrowing down the talks, the specifity that you're referring to, and we present proposals, ten page, 20 page, 100-page proposals not discussed because we have comprehensive review that's effectively an avalanche of questions and questionnaires about this, that, and the other. it's not the same thing as talking about specific policies, okay? and then the international press is becoming full of reports that we have no proposesals. in situation where if we reveal

proposals, that's breaching faith. please consider that. on the questions that you asked me me, is it action to succeed? i don't know of any way in which i can argue in something i believe is wrong. consider this to be my personal failure as a politician. in this case, i'm very happy for you to say i'm not a good politician, but i'd rather tell you what i think should be done instead of using subterfuge. politicians signed the dotted lines and played games and made commitments they never intended to uphold. that did not work very well. maybe the truth would work. not that i have the monopoly for that, but i tell you what i truly believe in. even though i train as a game

theorist, this is not a game for me, personally speaking. and let me also just because you also asked the question how will you convince the team, and i don't believe it's as simple as that. appearances are deceptive. there's a great deal of commonground. there's something else happening here. there is a kind of e kwul lib yum that's not founded on genuine unity over conviction that everybody's on the right track and our suggestions are wrong. as of adam smith, the brewer and the butcher, you do not speak to him of the needs but address them on basis of the interest. so we are always try to couch our arguments in terms of what's in the common interest of europe

because we genuinely believe we're not in this for the greeks but to maximize the average european. it's the only strategy i'm willing to pursue. there was a question about state interprize enterprises. >> oh, yeah. >> and jobs that are secure and highly paid and effect efly reproduce this is one ambition that i share. firstly, before i get to it, let me say that we have many fewer state enterprises than we do some years ago since you've been an observer. privatization is not a process that's going to happen.

it's already happened to a large extent. very few state enterprises exist. all right? telecommunications, for instance, gone. the port authority partly gone. we are in the process of considering, you know, we -- there is a chance it's happening for the remaining and we'd be very happy to see the development of the railway system in conjunction with private partners and management teams that come from outside. but you are right not so much for state enterprise but the whole greek pure rocktykbureaucracy, the greek public sector. it's clear in order to do what you say we have to effect the system of proper valuation. under the previous governments affected was a travesty. i know it from firsthand that in some of these occasions the people fired were the most younger, and then ones kept were the better connected ones.

we know this from universities, don't we? [ laughter ] that systems of valuation are a double-edged sword. they great not just a system of migration, but a system of power. sometimes when the wrong people use it in order to propagate their own power, the result is precisely the opposite of what we intended. we have to do it carefully. we're working on it. timely, what would i do to stay in the euro zone? we are going to compromise, compromise compromise without being compromised. >> you choose the last two questions. very quick. >> one over there, and the gentleman here over here the -- stand up. >> very quickly. >> short. >> i work in local government, and we are looking at models that use collective impact for a rising tide raises all boats. it's compromise, but it's

collective impact. it's cross after collaboration of nonprofits private sector and public sector and we're having good success with that, and i'm in fairfax, virginia, outside of washington, d.c. there's interesting progress made on social impact bonds. >> over here. >> how confident are you that if there will be an agreement you'll be able -- the agreement with the institutions, that everyone hopes that groemt is approved by parliament? >> with we reach an agreement, it will be approved by parliament. [ laughter ] i got a question i'm familiar with it's a very good idea. first, we have to conclude this negotiation to get down to work. >> okay. we have to close. i'm very very grateful -- no, please stay so the minister is escorted outside first. that's the rule. many, many thanks to all of you,

and many thanks, and i want to predict there will be an agreement. [ applause ] the senate finance committee has a meeting tuesday on u.s. trade policy. the witnesses are u.s. chamber of commerce president tom donahue and afl-cio president richard trumka. they will consider legislation for international trade negotiations live 10:00 a.m. eastern on c-span. at the same time here on

c-span3, the subcommittee hearing on ways to improve efficiency at the state department and make its operations more transparent. the state department's inspector general will be testifying. again, that's live 10:00 a.m. eastern. she was considered modern for her time call mrs. president, and outspoken about her views on slavery and women's rights as the prolific writer, she provides a unique window into colonial america and her personal live. abigail adams sunday night at 8:00 p.m. eastern on "first ladies: influence and image examining the public and private lives of first ladyies and impact on the presidency" sundays at 8:00 p.m. eastern on american history tv on c-span3. as a compliment to the series c-span's new book is available, "first ladies: presidential

historians on 45 iconic american women" providing stories of the fascinating women creating an illuminating, intertaping and inspiring read available as hard cover, e-book through your favorite bookstore on or line book seller. next a look at the u.s. health care system with former house majority leader eric cantor and kathleen kathleen sebelius part of a discussion dealing with technology. this is an hour. good evening, everyone, i'm director of nyu washington, d.c. and happy to welcome you to the auditorium. tonight, we are honored to host

the forum for discourse in the public square which provides nyudc for thoughtful discussion of controversial topics and issues. special thanks to the foundation for the support of the program. we are grateful for the institute of public health arming the next generation of health pioneers with the critical thinking skills, accum accumand approaches to address the world's most pressing health problems. join me in welcoming the dean of public health and nyu director of public health introducing our topics and special guests. [ applause ] >> thank you michael for the kind introduction. good evening, everyone, delighted to welcome you to the development of discourse on the public square cosponsored by

nyudc and institute of public health and thank you for the support for this important event. if the goal of our forum is to explore elements of a law of which americans disagree, the affordable care act is a case in point. last month, the foundation reported the narrowest margin of difference yet with 43% unfavorable and 14% in support of it. one thing about which we probably can all agree is that the situation that prevailed before the passage of the aca was not a good one. over 70 million americans lacked health care coverage, and millions more were under insured with little access to prevention services. tonight's discussion will help us all better understand the nuances of this intensely debated act, but first, this complicated law deserves a very brief health reform 101. for that i turn to my long time friend and mentor joseph a.,

former secretary of health education welfare under president carter and previously the chief domestic policy adviser. there's an an ul lime nating story to recount here, one told in four distinct chapters, a winding tale of health care access for all americans. chapter one, the years before world war ii during which health insurance itself was actually quite rare. following the second world war, yun yours and large employers began covering health insurance for union members and employers. chapter 2, president truman was the first president to make a truly concerted effort to pass coverage for older americans and poor, but defeated as socialized medicine and he settled for a few amendments to the social security act. the mills act in 1960 covered poor people and older people, but while it was meant for the rural poor dollars allocated were cop souped by high population states like

california, massachusetts, and new york leaving sponsors disend chanted. from the time of troouman's effort forward, medicare medicaid was part of the democratic platform but yielded nothing in terms of legislation. then chapter three when president johnson was elected soon was elected or aappointmented after the death of president kennedy, he said we'll fight for medicare as long as we have breath in our bodies. using the failure of the mills act and other issues surrounding the lack of coverage for americans, they were able to pass medicare and medicaid linked to the welfare system. urn medicare part b, doctors were protected from socialized medicine allowing compensated by fees. they were represented by the american medical association that did then and still does oppose socialized, quote, socialized medicine. president johnson traveled to missouri, the birthplace of president truman's wife, bess to sign the bill into law in

which they were given a ceremony of the first two medicare cords: the recent expansion of medicare protected the pharmaceutical industry and some content the aca protects the health insurance industry by skirting an efficient approach to ensuring the nation an expansion of medicare or single payer approach. finally, we are now in chapter 4, raising the question did the path we set for ourselves then result in a series of finances? first, a bonanza for the doctors and hospitals, the pharmaceutical industry, and now for the insurance policy industry itself. or was it as others argue, just the american way? so here we are tonight traveling a long route to near universal access to health coverage, something enjoyed by the citizens of every other developed country in the world. but we now stand in a cross roads with a pivotal supreme court decision on king in late june and election on the horizon

in november. will we stay the course? if we do not, what's are the implications. for that discussion, we tern first to two people who arguably know more about the aca than most on the planet. first, i want to welcome secretary kathleen sebelius who served in health and human services from 2009 to 2013. she also served as governor of kansas from 2003 through 2009. secretary is a staunch support of the aca and honored to have her with us tonight. we are also privileged to have the former house majority leader, eric cantor serving the 7th congressional district of the senate of virginia in the u.s. house of representatives from 2001 to 2014. congressman cantor is a strong voice in opposition to the aca. on a sad note, congressman cantor's father passed away over a week ago. congressman, we convey our

sympathies to you and your family. finally, it will take a strong moderator to guide this discussion. [ laughter ] >> i got to go. >> steve mcman professor is suited to the challenge. steve is an attorney and cofounder of purple strategies llc, got a start in politics on the senate and political staff of the edward kennedy and worked on dozens of senate gubernatorial and mayor campaigns across the country. he's also served in senior roles in three presidential campaigns including that of president obama. he was a commentator on "hardball," and "andrea mitchell reports," he was on nbc evening news abc world news tonight, the today show, cnn, and fox news. please join me in a warm nyu welcome for steve mcmahon, secretary sebeiluisebelius and

congressman cantor. >> on behalf of nyu i actually teach here, american public opinions, too bad those of you who are students will not be here next semester because that's when i teach. thank you very much for coming. the course i teach talks about politics, public opinion, and moving and shaping of public opinion and how public opinion flows. there's nothing more controversial in politics over the past five or so years than the aca. beginning with the path to passage to implementation. i wanted to start with the notion that president obama came into office with which was this notion that democrats and republicans could work together on matters of great importance to the country. and i think early on in the administration, there was contentiousness around -- there was contention around the stimulus bill, and the next bill

thing on the agenda was the aca, which took quite a while to negotiate and pass. so i wanted to ask you both, was that dream or that vision of bipartisanship something that was not possible in washington in the political environment today? either one can start but i would like both of you to address it. i know democrats were frustrated that the president took so long frying to get republicans support or some republican support. it seem eded possible for a period of time, but it was passed on a very partisan party line vote. so, mr. leader, if i could start with you was it possible or is it possible in washington today to get something like this put together and passed on a bipartisan basis? >> well, see, first of all i say yes, but unfortunately that did not happen in the case of the aca.

as you rightfully suggest we were in a contest back in 2009 where the president had just got elected, obviously, his star collection, the nation's first black president, came in after the country had just experienced a horrific jolt in the financial markets we passed the stimulus bill, not a bipartisan affair, for a variety of reasons if you want to get into that. there was, certainly i think a commitment by all of us to want to try to address and to improve the situation of health care in america. and i want to start any discussion about health care in the country and i know the secretary spent a lot of her times and years trying to make sure that this system we have here, despite what the international numbers say, like

oecd rankings and the rest, i would still contend that no matter where you live in the world, if you can afford it you will come to the united states for health care if you are sick. that's the condition, though if you can afford it. when the president first started his discussion with us on the hill back in 2009, i remember that he had convened a session, and i know the secretary was probably there at the white house, and we were there with the premise that we had to do something about the cost of health care, and the cost because the government being the largest payer of health care could not afford it. the taxpayers could not afford it, and businesses where people outside government programs get their health care through the employer plans, they were also saying that it was becoming too expensive. it was that premise that brought us all together. i think what happened later as

we got in the spring months and june, there was a divergence, if you will and rather than that being the priority, increasing the cost to increase the access it was in my opinion, a sole focus on how to we guarantee universal coverage no matter the cost? i know that that would not necessarily be the view shared by the white house, but from what the input we wanted to have, it was just unfortunately not integrated into what happened resulting in the aca passing the way it did. so a little context. >> well, it's not coming as a shock -- i know it will not to the former leader that i have a slightly different perspective on the early months, but i do want to start with a moment of personal privilege. we have two great health leaders here, now the dean of the public policy school at nyu but served

with me as head of one of the great agencies kind of the think tank at hhs and peggy hamberg who stepped down as fda commissioner who i had the great privilege of working with for five and a half years, so i wanted to give them a shoutout by i would go back a little bit further than where leader cantor started where the president talked about universal health care on the campaign trail. it's one of the things he committed to from the moment he announced office. he said the next president of the united states a president able to sign a universal health care bill in the first term so this was not a surprise. come pained about it all over the country, and i would say that the aca really had three goals, and they were talked about a lot, and one was

insurance for the portion of the marketplace, a slice unensured entirely or did not have affordable coverage in the workplace, and most americans who worked for government, big jobs, who were poor or old had health care but a slice of the market did not. access for those folks, affordable access. as leader cantor said, was definitely a cost control because in the united states and comparing to other developed countries, we spend two and a half times per capita what anybody spends and our health results are lousy. we have great care for some of the people some of the time, but in terms of great care for everybody all the time? we are not getting good bang for our buck. that was, i think, number two, not only better care, but also lower costs and i would say the third was a real opportunity for

the first time to focus on delivery system reform and what is it that we can do for population health, how do we get people in the united states to change the pattern of living sicker and dying younger than most of our competitors. you know the aca had five different committees writing bills, having hearings three in the house, two in the senate a lot of hours of testimony, a lot of amendments with the hope that it would be a piece of bipartisan legislation. amendment after amendment after amendment was adopted in hopes that this would bring people together and i think the president was frustrated. i know a lot of us who spend a lot of time on the hill testifying working with individual members who are frustrated that at the end of day, it became a very partisan issue, ape it was passed with a

partisan majority, and it had a lot of near death experiences, not the least of which was when scott brown was elected to fill ted kennedy's seat, and the vote was gone, and at that point, looked like nothing was going to pass, and i have to add another piece to the scenario you know, the president said in 2009 that you can't fix the economy without fixing health care. in spite of internal pressures within the white house senior advisers said do something else anything else. pass a bill that ensures 20 of your favorite children you know -- [ laughter ] pick three older people who you like get them insurance, just get out of the space because it's too -- as we heard earlier you know, 70 years of contentious debate tried and failed over and over again, and

a lot of people felt this was the wrong time and place. i think he was pressing it. unlike the economy, he was looking at in 2009, the stock market doubled, and we have the strongest month in month out job growth seen in decades, we have consumer confidence back the american economy is thriving, and health inflation is the lowest in 50 years so i would say putting the bed on the contentious process was a good bet to make. was it partisan because of partisanship or partisan because of a principled point of view that people had they disagreed on. for instance, look at the what the republicans proposed, the

hatch bill, the senate, many elements of the hatch bill include things in the aca, and yet republicans want to refeel the aca and vote routinely to do that, but they embrace elements of the aca. which elements. aca, mr. leader is there broad agreement on? which elements of the aca do you feel and republicans feel like need to be fixed or changed? just to make sure you don't think i'm going easy on the secretary, there has to be things in the president's bill if you go back to do it over, you would do differently or improve or change now, so if you could, after the leader provides an answer, if you could address that, that'd be great. >> you know, i sort of mentioned in the beginning some of the -- or the substantive or policy differences that began to diverge, and or to come about, and it started with this notion of cost being the priority, and i think that is derived from basic policy differences. you know, you never can divorce

the policy all the way from the politics in this town, but the basic policy difference started with the notion that the government compels you to do something, and in order for that to be the case, the government needs to define what compliance with that mandate is. that is where the fundamental difference starts with republican position and the democratic position, and it is about the mandates. it is about the insist tans that washington knows best and what health care and mandated benefits have to be present in people's plans. you know, this goes back to the proverbial situation where, you know, i remember i had a constituent in his 60s, single, and he had written in saying that he got one of the letters that his insurance policy coverage was being cancelled because of the aca, and then he

found out what it would cost to get the new coverage with obamacare in place, and he said well, wait a minute, why do i have to pay that? why do i need fertility coverage, you know, at age 61 when he's, you know, single, and, again, that just points out the case that when you move to define what compliance was at mandate is a real problem. i think fundamentally there's a real issue with republicans are, and rejecting what the promise was and where the democrats are. now, you say what's in there that republicans support? i said that i don't think anyone should tolerate rejection of coverage to someone with a preexisting condition. we went about a different way in

addressing the issue. there's high risk pools, funds set up at state levels. if they were adequately funded could play the part, if you will, of the reason why there was a mandate. reason why i think some of the reason why there's a mandate in the obamacare bill was that you didn't want people running naked with no insurance and then all the sudden coming in swooping in, and getting the insurance. so it would mess up the actuary tables. >> do they go together? if you cover anybody without discrimination with respect to a preexisting condition, don't you have to require the younger healthier people, the folks running naked as you say, to get in the system? >> no, i don't think you have to have the mandates. this is where berwell will be very -- the discussion that the supreme court comes down with, if the court overturns the subsidies in states where there is not a state sponsored exchange, you know then the two sides are going to have to work

with one another if there's going to be resolution here. i think that it's fair to say republicans are not going to accept a mandate. as you can tell now and the secretary spoke about attributes of health care costs and, you know, listen it's early. health care costs contribute to the fact they have not gone up because we have not had the economic growth that we would like to have in this country. we still have projections at growth at 2.3% when historically it's been 3.2% growth. i don't know that right away we can say that the aca brought about all the savings but i would say if the parties come together, what republicans will say it they are not going to be for a mandate. we don't have mandates in effect now. i mean honestly, we have a light enforcement of some of the employer mandates or some of the individual mandates. you have the employer mandate for the mid sized companies if

you will, 50 to 100 employees. that's put off until next year, and because of that the individual mandate is lightly enforced, and, i mean, these kinds of provisions are what i call sort of your vegetables while the dessert was the coverage of the kids who are 26 and under under your parents' plan, preexisting coverage kinds of things i think both sides support. there will be -- you know again, dependsing on what the supreme court says, an opportunity for the sides to say, okay we're not getting everything we want but we have to start over. >> okay. what about some of the vegetables he refers to? do we just need to eat our vegetables or is there something to do here? >> well, i think, again the vegetables came from the heritage foundation which is hardly a liberal group. the mandate issue was a long time republican concept. it was in governor romeny's bill in massachusetts. it was there for a very specific

reason. i hate to sound too much like a geek, but i spent eight years as an insurance commissioner, regulating an insurance market and what i know from watching state after state after state is that if you pass a bill like new jersey did, like washington state did, like a varz of states did, which has community ratingsings, no preexisting condition, no differentiation in price based on health conditions and you don't have a balanced risk pool, rates are unaffordable. in fact, in washington state which was one of the first to do it, snurper just left the market. they said fine. for two yoors, they literally had no insurance coverage for small business owners and for individuals. it really does tie together. if you want to get rid of preexisting coverage which i agree everyone says they are for, and unless you want to have a singling payer plan, if you want the private insurance industry to survive you have to

tie that to a balanced risk pool, everybody in. some people get sick. some people won't. i find that story about the gentleman who did not want maternity coverage or fertility coverage coverage, my guess is his drug plan has viagra. he did not get out of it entirely. [ laughter ] if you don't want gender rating, legal up until the affordable care act meaning that women in this market, again, talking about a small market now, if we work in a big employer or the government, we've had a situation where there's a package of benefits. take the benefits, pick and choose, but nobody said, okay, i'm young, single, i don't want maternity coverage in mine and you have it. that means that women are charged more than minen, and women in the market up until the affordable care act was passed could be charged 50% more than men, and many plans did not

cover maternity coverage at all so women were not just paying more, but paying out of pocket for coverage they needed. insurance is about again, benefits that some people use and some people will not, but if you, again, do not believe that gender rating is something insurance companies should be allowed to do, and people say we're against that then you have to have a package of benefits that applies to everyone. this is hardly the perfect bill. i would be the first to admit it. it is, as i said, was drafted by five committees, and it was -- we had a snapshot of what the perfect bill could look like. >> talking about romeny care, are you? >> i am not. that was a great template. done at the state level. once the house and senate passed bills, there was a period of negotiations between the house and the senate bill that the president actually was at the table with sleeves rolled up leaders there, going through

every aspect of the bill, and there were different approaches. the massachusetts senate seat was lost. you then had to refrequent to reconciliation, which is a procedure that only allowed some things to be considered and other things not and i think at the end of the day, there are a lot of things that have to be fixed. the individual man dane sbeept effect this year for tax, and it is fully in effect exactly the way it was written and the employer mandate will kick in by, frankly, for an employer folks who have 50 or less employees are exempted from the law anyway. that's the way it was written. that's about 94% of the employers in this country. for those with more than 35050 employees, they are in but they offer health insurance anyway. so things around administrative

burden had to balance, what the packages of benefits arement. right now, every state has state mandated they passed included in their state benefit package which does not make a lot of sense, but we have now the big biggest arm right now is that there are lots of millions of people in america who are too poor to afford health insurance because they are in a state that did not expand medicaid in the way that the supreme court determined the medicaid decision. we have now millions of people in the country who do not qualify for anything in a catch 22. there's a lot of opportunity to work together. a lot of exciting things. i hope we get to this in the delivery as much area where there's a lot of agreement of private employers insurers providers, payers and others

that we need to have move away sfaz possible from fee to service for a value based proposition. there's a lot of exciting work underway, a lot of agreement, and i think a lot of opportunity to move forward. i just hope at some point we stop, and i would agree, we got one additional supreme court case, maybe once this is decided, we can stop relitigate relitigating the past and move to the future. >> so you mentioned the supreme court case, and i want to get to it in a minute, the bending of the cost curve, that seems to be occurring already. maybe as a result of obamacare or maybe as a result of other things that the leader mentioned. could you give the audience here, in particular the students, a quick summary of what's at stake in the case in five words, and what do you think might happen the supreme court says you can't have these exchanges funded the way they are funded? >> actually there's four words. established by the state.

those are the key words, and the plaintiff has put forward and argument that suggests that only states that set up their own health exchanges are entitled to subsidies for those con sitwents, 17 states. so in 34 states, if the plaintiff's prevail in this case, the subsidies which make insurance affordable for now about 8 million people who have signed up for coverage, would cease to exist. but that's just step one. the subsidyies go away. the affordable care act also has a provision in it that if you fall below a certain level and insurance is not affordable even with the subsidy there's no requirement that you purchase insurance. those, for instance, in a state that has not expanded medicaid

who are at poverty level do not have to buy insurance in the private market. if you take away the subsidy, there's an indigitalal, you know, six to 8 million people who have unaffordable insurance, and they drop out of the market entirely. insurance policy companies meanwhile, have assigned risk pools based on new customers have projected rates based on customers, but they would have existing customers who stay in the market place. a lot of people purchasing individual coverage not on the mark, and then rates skyrocket. you would have a domino effect not skrus for the individuals losing coverage but everyone else in the individual market in the state. that would be jep news diezed and private insurance companies see their portfolios in grave jep day pretty quickly. i would say having been there

for not only all the debate, all the testimony all the hearing, but led the implementation there was never a conversation, suggestion, testimony, amendment, discussion, either during the passage of the bill or certainly any regulation we wrote, any conversation that i had with my former colleagues, governors around country that said, oh by the way, if you don't set up your own ex-change your citizens will not have coverage and i think it is a -- it's difficult to read what is a national frame work a national law, a national mandate, national coverage and say that this was the sbintintent, but that's what the plaintiffs suggest. >> leaders of 34 states do not have -- they have not establish established their own exchanges or operate their own exchanges so if what the secretary suggests is correct if the supreme court ruled that this funding mechanism was not

constitutional, doesn't that put extord their pressure on governors of the states, most republicans, and what do you think would be reaction and how would washington come together or not to solve this problem? how could it? >> and that will be i mean as the secretary said maybe this would be the last court case or court challenge because if the court comes down the side against the proponents of the law, then we'll see whether the administration comes together to work with republicans on the hill, or if not, do they go around to work with the governors in the legislatures of the states because they have to then, i assume, comply with a holding by the court saying they have to establish an exchange, and so it could very well put pressure there as well. but, you know, i think that if you take a step back and, you know, we had a medicaid decision

as the sec trar points out that was not consistent with what the president and the administration wanted to happen as well, and so you've seen a lot of states, and i know mine in virginia has not expanded med cay, and if you look at the numbers under the aca, at least i think if, secretary, if i'm correct half of the participants now are under aca are medicaid participants. i know talking to the provider community, it's difficult for doctors to stay in business at medicare reimbursement rates. there needs to be a realization there that's not a sustainable situation either. look, if the court comes down and says i think what you will see is a real unraveling of the law, the way the secretary said that if there's no longer affordable insurance plan for a lot of people, millions, they are going to go without as well

as insurance companies facing a knotty situation in some instances. that goes back where can you go? the republicans are not going to support a mandate. the secretary talked about if you're going to have community ratings, the law that obamacare is, then yeah, maybe that's where you need a mandate. that's where the republicans are not coming from. they are not saying that you need to go and establish these bands of ratings and -- >> if you get rid of preexisting conditions, you need amended. >> no, but what i'm saying the construct of the law right now is that there is a severe inflation cost in benefits that washington decided needs to be in the plans. secretary says yeah, well, now the states on top of that have mandated benefits. that's a problem. that increases cost. that's the problem. you have washington mandating

that. we have to work on that. there are. we have to get to the kinds of things that are trending now in the health care market place. as cms just recently came out and said that we want quality based payments. we want to have bundled payments. we. those things that i think everyone is for, recently passed fix, absolutely went in that direction. >> you took my next question, which was a rare but hopeful example of a bipartisan deal the fix, that fix, medicare reimbursement rate, and it also changed the way health care is provided in a meaningful way in terms of incentives and reimbursements correct? >> well, the sustainable growth rate, the sgr, is about doctor pay. captions copyright national cable satellite corp. 2008 captioning performed by vitac