other? >> thank you for the opportunity. it's a real pleasure to be here with norm and dean, both of whom i respect, and today, agree with. [laughter] >> now that everything has been said, i guess not everyone said it. i'll try to put my own interpretation on this. i do think it's easy to over interpret the election results for several reasons. and to over dramatize that the potential impact on health reform. first of all, the people who voted last week are not the same as the people who will vote next time. there are many fewer of them, many of the demographic groups were much less represented as is typical in mid year, and i think the -- to pick up where gene left off, the election isn't the one we just had, it's the one e will have in 2012.

it'll be a different electorate. the second point is most voters today, perhaps understandably, say they are confused by health care and what is in the act that could affect them. there are many messages during the campaign. unfortunately, from my perspective, many were designed to scare people, especially seniors. but it's understandable that there's confusion. it's a complicated act. it comes into being piece by piece. so the next two years will be an opportunity to help people understand more clearly how it might affect them. i don't think that you can say there's a mandate out of congress to spend a lot of emergency on health care. i think there's a mandate to spend a lot of energy on the economy. i think there's a poll in the paper this morning that shows that a small minority want

congress to focus on health reform as opposed to the economy. i think that's going to play itself out the more that people try to focus on health care and people at home might say, well, okay, what about jobs? and cogress is going to have to respond. i also think there's no manda at all for an alternative approach to health reform. you can see that from the polls. they -- elements of alternatives are not particularly popular. and many provisions of the affordable care act are popular. so you have an act that's very interdependent in it's design. it would be extremely difficult to start polling it apart without as dean said either raising premiums or increasing the deficit substantially. i think as people start to

confront that, we are going to see more and more caution about anges. i also think that politically, provider groups are still quite supportive of the act. doctors, hospitals, insurers, drug cmpanies, where still supportive of the act. i think there's good reason for all of those people to be supportive and those interest to be supportive. i think again that'll tend to temper the debate. i do think that the benefs of the act have not yet been appreciated. particularly for people who need improvements the most. the people who are chronically ill, the people who are frail, childre i mean there are some very important advances in the legislation that would seriously improve the situation of people who are quite sympathetic to the public.

and the more attention that they get, in terms of that provement, i think the more impact that will have on the tone of this debate going forward. i would conclude in much the same way that dean did, in that the real battle here is not so much about legislation in the next couple of years and not really about appropriations, but really about all of the hearts and minds in the american public. investigations are going to be a tool. but that can happen on both sides of this debate. and the election that matters is going to be 2012. when i think we'll know the answer after that as to what the future is for health reform. >> okay. thank you very much, john? we are now at the point where we are actively oliciting your questions. let me just say we also have had even before we knew that there would be c-span coverage, we've

arranged a teleconference for reporters who are outside of washington, d.c. and we've given them contact information so that if they have a question that they would lake to have -- would like to have asked, we will try to get it responded to. i'll remind you that the e-mail address to send your uestion is questions -- with an s --@allheah.org. have a microphone. please identify yourself. >> my name is mark, i write for medical device daily which telling you something about my orientation. the medical device tax of 2.3% pails in comparison to a lot of similar issues in connection with health care reform. i guess the question here is

whether it's going to sort of disappear into the weeds there. some members of the senate from minnesota, for instance, klobuchar ad franken have obviously orientations. is it just too small compared to the other things to garnr any attention for the next two years? >> i think one answer is republicans are oing to try to get some traction by having individual votes on individual pieces. every part of the revenue component of this is going be attacked, and some of it will be attacking tax increases. and clearly with an attempt to lure some democrats over. we may get some votes. my guess is they are more symbolic than real votes. that either this will be in the context of bills that will end up possibly being filibtered by democrats. in some cases, you may get republicans joining a hand full of democrats to support something. and the core of democrats will

say we're not going to let that happen. others will move into a conference and try to take care of it there. which may mean more potential gridlock and an ability to come to an agreement or it may get to a presidential veto. but i'll probably be a little -- i'll be immediately surprised if that medical device tax got removed. >> i'll just add -- two quick things. i think the mdical device tax points out two interesting sort of broader questions. i think that become issues that republican leadership is going to have to grapple with. one of which is, you know, how do these -- how do any attempts to change th bill at all -- how are they positioned? so, you know, i think that republicans and the democrats who support modifying or repealing that would be probably less successful by portraying that as something that's going to help an individual industry

by relieving a burden from devices or other folks. but as i sort of implied earlier, i think that a number of those industry fees and the device taxes is one the clearer examples. i think it can be portrayed as things that are going to, you know, increase the cost of under lying products, and, therefore, translate into higher as opposed to lower premiums as one the goals of the ill. i think how that vote and others get positioned is really important. i think the other thing, we don't completely know yet and norm and john may have a view of this, but in the past, under at least republican control, for many tax cuts, pay as yougo budget rules generally did not apply. it'll be interesting, when you look at the republican caucus now in the house and senate, to me it's unclear. will they say they have to pay

for tax cuts or not? if they don't, and they hold the sort of traditional republican view, we have to pay for new spending, but tax cuts are returning money to the american people, if they don't have to offset those, i think it makes it easier to have a vote that pulls over some democrats to reduce the impact of those fees. one thing -- none of us talked about. i think one the over riding messages coming out of this election. we saw this earlier this week with the initial propro sal from the entitlement commission is the concern about spending. that's going to have to be balanced against all of the things that might need to be offset potentially. >> do you think that the republican rule changes that are now under consideration are going to make it easier to do that. is that what you are eluding to? >> i haven't been privy to that.

norm may know. >> yeah. they are talking aout their own sort of first of all adeptation of the you cut plan. they are will advice from callers and listeners all around the country. they are clearly not going have a paygo that includes revenues. how in the end you reconcile that with the desire to reduce deficits and debt remains a big question on the table. it's a question that has now been brought into full relief. as have some of the full issues of medicare and social security. alan simpson and mr. bowles have put things out there that are creating discomfort in both parties. >> and you raise your -- well, we have someone here now. >> hi, i'm julia mcdowell, i'm the editor of the college of

american pathologist. can you talk about how you see the new congress dealing with the physician payment sgr issue? >> well, i'll take a crack at this. this is one of our top priorities to reassure seniors that they will have continued access to their physicians. and we certainly hope that the lame duck session will tackle this. it's an area where because it's new spending will probably have to be offset elsewhere. i think the only reason that i'm not more confident of the result is not because of the desire to extent the sgr, it's the uncertainty about what the offset would be. and how possible it would be to go forward. but we are pushing very hard to get congress to act very quickly on this. because they need to do something by the end of november

in order to prevent disruption. >> you know, the democrats in congress now in a lame duck are going to be tempted to kick this can off into january. precisely for the reason that john mentioned. they can't just let it drop. because it brings, you know, somethinclose to catastrophe for physicians and for access in coming months. but i think they'd rather leave the very difficult choice, because there will be a paygo provision o spending for what to dowith what is a substantial sum of money to the republicans in the house to deal with. >> yes. >> i'm jim of health reform week. one the provisions in the reform law that seemingly could be somewhat vulnerable could be the insurance exchanges since they don't start until 2013. i'd like to ask the congress what they think the congress either by funding or other means

that would interfere or prevent the changes from starting up in that year. >> i'll take a first crack at it. i mean i think -- i think again with -- to john's comment that so much of the bill is interlocking and the exchanges are clearly, you know, one of those mechanisms. are they absolutely essential? probably not. but they are clearly are integrated with things like the forum and subsidies. i start with the premise that any change, other than things like on the marge -- margin but important, like the 1099, the president is going to be resistant and veto if it gets from the senate to the desk. i would say given that there are some kind of wolesale repeal of even the exchanges is going to be unlikely.

what i woulday is as the governors begin, they are already under way to sort of look at legislation, look at the guidance that maybe coming with washington and with republican governors picking up more seats at the state level and republican controls more gislatures at the state level. i think what you may well see, this is another very interesting area in terms of the role of the states. they have a huge role in terms of implementation with the exchanges and other things. you might see it bubbling up from the state level. real concerns about some of the regulatory requirements and other things that might be dictated to the extent that they have flexibility to make changes. to the extent they feel like they don't have flexibility to make changes. i think what yo might see if the issues get ripe enough is some surgical strikes or targeted attempts to maybe make some changes to the exchanges. i remind folks that again sort of the leaning republican house alternative, there was a form of

exchanges there. it's not a -- it's not necessarily a democratic idea. but the details as in many of these things are very different. >> yeah, just quickly. there are two states today with exchanges, massachusetts and utah. they are very different. one is more regulatory approach. one is more passive. and i think that's the question going forward is which model and since it is a state by state decision, i dont see this being relitigated as the federal level. >> i would say the one caveat is we're going to see some guidance based on press reports and other things in the coming weeks from the administration. i think again to the extent that the governors feel that the requirements are too strict, you know, the alternative is to just say we're not going to do this and let the federal government do this. that maybe an option. the extent that they want to do this and keep control, i think you could see them saying we think it's a good idea. we want to go forward. the rules that we are laboring

under from the law or regulation or both are too onerous. we want to see the change. >> a couple of dynamics here, they campaigned in a very hostile way to the health plan have really talked about boxing up the exchanges. not using money or their discretn. it's going to be an interesting channel, i think, in many of the states to figure out how you can keep from disrupting your own citizens and make your political point beyond filing lawsuits or amicus briefs. it's actually more of a republican ways. in some fashion to bear. the main republican alternative has been we don't need any of this. we have to let people shop across state lines. buy insurance across state lines. the real danger i it works in the way the credit card works. the race to the bottom.

you just look for a state that as the least cumbersome regulatory offer, the poorest plans. and the alternativeo that might be if you did get some bipartisan give and take is to return to the national exchange as one option here. that, i think, in a world where parties actually talk to one another, might be on the table. since they don't talk to each other, it's probably not. >> okay. we've got gentleman right here. then i've got a couple of questions from around the country. go ahead. >> gregory talkman from the pi sheet which is frm the pharmaceutical industry. two questions, one similar to the question on devices. what drug provisions that you see might be targets going forward? and second question related to the patien center of outcomes research institute, how much is that? and do you see any changes that

might be attempted to that body? >> let me say to our panelist, we've had a request from one the reporters on the phone to identify the panelist before they speak. who would like to take a crack at that? >> that would be me. this is dean rosen. i think with respect to the to - to many members, if you look at debate, there was general agreement among the republicans in looking at research. there were concerns about some of the individual provisions. i would say, you know, that probably is on the list. but i'm not ure it's at the top of the list. i think if you look at the boards and commission that are out there, i would put the independent payment advisory board above the outcomes research institute as something that would be more likely to be targeted. but again we'll see. new members are gng to come to

washington in a couple of weeks and they will have their views on how they want to proceed. with respect to ther provisions on drugs, i would say maybe two things, and john, who is at the tabl and a lot of the bargaining and discussions might have a different view on this. i think that with the device tax, it was clear that that was really done not with a whehearted agreement of the device industry, but the fees on the pharmaceutical industry was a different matter. it was part of a negotiated settlement so to speak. i think that one maybe less likely to be undone. and certainly the industry might be less likely to go to congress and, you know, remember we'll still have a democratic senate and president. those were really the two party that is drove the agreement. let's undo what we agreed to. i think that's probably less likely. what i would say is that there are a number of provisions in

the past that one of the things that pharmeutical industry was able to do very skillfully, i think, was to keep out of health reform a laundry list of things th cou have hurt the industry more and i think one open question is whether some of those things, particularly given republican control are mild and maybe back on the table. in the sense there maybe democrats who are congress that might want to do it. there might be new republicans that have different positions than republicans in the past have had or others in the name of deficit reduction that are maybe open to ideas that they might have foreclosed in the past. for example, you saw the deficit commission proposal, again, just a proposal earlier this week, proposed to extent the medicare rebates to thelow income population in the medicare program. so maybe in the name of budget sangs and others, there maybe more receptivity to those kinds of ideas even in a congress

that's now divided. >> this is john rother, i could ju dd i thought it was significant that the ceo of glaxo came out calling for health reform to go forward. i certainly agree with dean's point. this is a negotiation in which the industry won quite a few concessions. and if this issue is reopened, i believe they may end up doing worse. particularly in light of recent price increases that are going to look unppetizing to anyone concerned about the deficit and the cost of health care. i think there will be -- if they reopen this, i think there will be -- more pressure on the industry rather than less. >> yes, norm. >> this is norm ornstein. always keep in check we're always at a populous anger.

it's the search for scapegoats. it's a dicey or delicate time, i ink, for everybody in the various industries. the danger that you are labeled the next scapegoats. it doesn't necessarily happen because you are the greedy bastards, sometimes you are a first one in the line of fir that's what happened to the health isurance industry. it's also gointo be -- i think, going to put some pressure on the white house. because the temptation there is to push the blame off and sometimes it's deserved. but you can lose allies in this process who have helped you get through this if you are not a little bit careful. but the industries, and i think this is the pharmaceutical industry, i think any objective observers would say came out quite well in there. they were smart to get in early. they got a lot out of it. billy took a lot of flak from

many within their own industry who didn't understand that he knew what she was doing. i just would hve a hard time imagining they would be foolish enough to reopen this in a way that would bite right back at them. >> yes, sir? >> merrill with the fiscal times. you raised the possibility there could be some tweaks in the president himself after today in the pre conference say we may look at the 990 issue in the $600 that small businesses will have to file forms. are there some other things, i'm specifically thinking about the mandate that democrats might decide might be worth taking a look at. this is after all, the economic industry in which the insurance industry is a primary receptor. is there the possibility that democrats would peel off and do that.

president obama, as candidate obama, didn't back the mandate. >> i do think this is actually is one the biggest problems to start with the republicans have. because the temptation is going to be to go after the mandate. americans don't like mandates of any sort. but you can't do that and keep the other provisions that are popular without having a lot that unraveled. and you maybe right. some democrats might join in out of mischief. the insurance industry would be the first up to the plate saying you can't do something like this. takin a look at the mandate, and taking sme adjustments, including, taking a look at some of the penalties for not gettin insurance are adequate to the task maybe in the light of the massachusetts experience and others. that's something that you may want to start to look at now even before you actually implement it and then do over

sight. >> this is dean. i would say i have a different political take than norm. i think the mandate is a bigger problem. if the republicans in general don't want the legislation to work, i'm not sure why they would care if one the provisions that was really unpopular kind of unraveled the entire ball of yawn. i'm not sure there's as much risk in that they are invested that may give them an opening to come in and do something more likely -- more there likely in the future. i'm not sure there's the huge political risk expect to the extent that it may raise cost under the current structure. they don't buy into the current structure. i would add i think there's some other things in there. we talked about the individual mandate. and there's -- that's essentially, you know, a tax enforced. there's also a whole series of corporate taxes in here. you know, not quite a mandate, but a pay or play kind of

requirement. even for those employers that are offering coverage. those are going to be at the heart, the substantive provisions that's going to be at the heart. which is what are employers doing to response to taxes in the future or maybe a penalty that's less than keeping their coverage. you've seen some of this already with retiree coverage. i think to the extent that maybe -- that mightbe vulnerable again. the president may veto it. where you can see in the name of corporate tax and overall cost of doing business where you might be some attempts to go after those and losen restrictions n other things that are constrained to a extent in the law. >> we'll have a quick comment. i do not think the insurance industry is the major beneficial reof the mandate when it's paired with the minimum loss ratio that will get tighter over time. i do think the people who really win because the mandate are older people who are age rated against today, sick people who

are excluded today, people who are suffering because of the failure to bring everybody into the same pool. if we eliminate the mechanisms to do that, we' going to have a very difficult time protecting the people that we most want to protect. >> and this is norm just getting back to dean's commen i think what i would be afraid about if i were republicans, if you go after that provision, and it unraveled, that means that you take away the popular parts of te bill that people are looking for. and your the ones who did it. so it's a little bit of a danger there. it can unravel in a way that causes some level of chaos and it will be petty clear what caused that chaos. >> would it unravel quickly enough to happen before the 2012 election? you think? >> well, some parts of it could. this bill was designed for a

variety of reasons. to try to provide goodies before the disruption occurred. you can imagine, especially if you have a clever president. just as we saw with the shutdown that ended in 1995, you can make sure it's causing pain to people in a way that there's a direct connection with the actions that immediately proceeded it. >> i would just add one thing that dean rosenthat we haven't touched on either. which is the state lawsuit that is are going forward. and, you know, i think initially, there were a lot of smart legal scholars and others who discounted them. the fact is a couple of those cases are still alive. you know the one thing that we don't know, the courts are inheritly unpredictable place. you may well see the results of those lawsuits having some impact on how these are written. i think that would be a nightmare kind of scenario for the president to have the

outcome of a court case thrust really a popular issue back and have them have to defend it, and th we -- i'm sure we'll probably see the larger repeal effort first. and it maybe that the republicans wait for the jut come. i'm not sure they will. they may wait for the outcome, or at least more clarities among the lawsuits before acting on the individual mandate. becaus i think we can't discount the ptential impact that those might have too. >> i gree with dean. and i do think we all ought to be looking ahead. here's one substantial possibility. whatever happens at the district court level, this issue is going to the supreme court. we know that. and the part of the bill where the constitutionality is most endangered isthe mandate. that's the core of the constitutional case. it's an over reach of the commerce clause too force people to do things that th don't want to do. there's a strong case to be made

that's especially given that the burden for those who don't have insurance calls on the rest of us because it adds to the cost of health care that the rest of us have to pay. but i can imagine a scenario where a 5-4 vote in the supreme court with the predictable five over turns a major act of congre, an initiative of the president that takes us right back to the court of 1933, '34, '35. and a constitutional confrontation in a way that has unpredictable outcomes, not in terms of the policy, but the politics. the idea that they do this is going to be portrayed in a political arena in a way that goes beyond whatever happens in the health cre bill. >> let me take a question.

this is from sarah at myth -- politico who's listening. it gets back to something norm and dean have mentioned. that's notion of the potential shutdown of a governmental agency like hhs. the question as written is we know that mitch mcconnell has said it would not come to that. but she's curious if you think the influx of new members who want to repeal, aggressively, would lead to this kind of a situation? how likely is it? >> well, this is dean rosen. i guess my view that i don't think it's likely. but, you know, like everything else and divided government it might be possible. you may not have -- one difference that i would, you know, remind everything that in the last shutdown, republicans controlled the house andthe

senate. this time, there maybe attempts to sort of work things out a little bit more out of necessity because you are going to be -- before it gets to the president to force a shutdown, you are going to have to have some agreement between the house and senate on what they are sending down pennsylvania avenue. but i think, i might answer and just take a bit of a broader view which is, you know, we're -- i think one caveat for the whole discussion today is that to an extent, almost all of us in the room are focused on health care iss and i think back to the lesson that i think democrats have not quite got yet out of this election which is it was about jobs. it was about the economy. and i think norm said thi earlier. health care, i think, is a very clear example of a lot of things that voters were reacting to in this election. it's not the only thing. it's probably not job one. so i think that we have to

remember that. i think as a result of that, i think, you know, leader mcconnell and others were, had i thought a great deal of humilities coming in and saying, we have to remember th election was a part on referendum on the president, and not necessarily a vote for the republicans. in the me way, while the republicans need to raise this, keep it alive, and do what they said they were going to do, and have to balance the need to not look like we are focusing the entire nt bill on health care. there are a lo of things that are connected which are a big deal as well. >> this is norm. you know, i would -- we've a fw potential scenarios here. let me start with what i thought was an extraordinary comment from the likely incoming speaker john boehner for election eve. either he hasn't read his

constitution in a while, or didn't get terribly adequate civics education back when he was growing up in oio, or he has a different point in mind. because the constitution says it's the congress that sets the agenda. it the president that disposes. but we are going to get into a kind of elaborate blame shifting game here over who's actually in charge and who's responsible for some of these problems. we know that republican leaders are trying t don play those expectations not just for the public at large, but for the new members coming in. they want to manage the new members, rather than have the my members manage them. they don't have government shutdowns, because the president has the advantage under those circumstances. the fiscal year that began october 1, not a single appropriations bill. we have a continuing resolution that expired on september 3. it's not clear we are going to be able to get through the lame duck session.

you move that into january or february, you are going to have a lot of determined new members who want to take a meat ax to spending. and the idea that you keep last year's level going for a substantial period of time is not something that we are looking for. that's one to place for a potential shutdown or disruption. it might be a short one. itmight not. the debt limit, the ceiling will get reached sometime around march or april. we have new members oming in that they simply did not vote to increase the debt limit. the only way they will vote to increase is if we've already radically cut the size of government. that's what precipitated the shutdown at end of 1995. and it might come much earlier. then we get the issue of health care. its not the dominant issue. dean is right. i think we all agree on that. as they attempt to use the appropriations process to limit

the funding, limit the spending for implementation of different elements of the plan. : we are not going to cave on this one. we have to keep going at the same level. and we will shutdown in another -- number of agencies. there are things that people will want, and we do not want

them to get disrupted. there are very interesting politics in play. they do not want to force certain things happening where they are not in control of the own members. >> federation. next -- and good observation. and we have a next comments coming from someone with the huffington post. >> can you speak to have a proposal will affect future healthcare? [laughter] >> this is norm ornstein. 's hard to the courts of the commission's proposal is the co-chair, the chairman's mark

right now which in part may reflect the act they don't have 14 votes at this point for anything and of course it would be a minor or even a major miracle if they ever did get 14 votes out of the 18 members of the commission who really do span the entire political spectrum there were a few things about it that were striking. one is an attempt to put a cap as a percentage of gdp on spending and heth is included within it. the other is it basically accept the health care plan and moves to make adjustments from within that and that is one of the main reasons that some of the republican conservatives members of the commission and people outside have been critical of. within that it also tries to take some of the provisions that are in the bill designed to bend the cost curve and tighten them up and make them more firm, and, you know,rom that perspective i would view it as a very constructive approach. it takes some things that

perhaps weren't as tough in the bill as they could have been and made them tougher. there will be a lot of people who don't like the approach to health care who don't like the idea that you start by accepting that status quo. >> didn't i see somewhere in there there was a public option -- [inaudible] >> but i think that norm is right about the effect that it probably pulled me get out of the commission. but i think the one thing to kind of keep an eye on is just because it doesn't get a super majority vote doesn't mean these ideas are dead forever. if we look at the medicare commission that came out of the 97th balanced budget act and some of the proposals including the drug benefit and some of the competitive elements with medicare raising the part b premium and other things were things that live on, and a number of legislators who participated in that became

interested in those ideas. here it's hard for me to see this hanging together, and i think as norm pointed out, one of the fundamental to walls from a number of republican standpoint is that it does sort of deal with some of these other things like speeding up or putting more teeth in that doesn't deal with things like shoulde be, you know, expanding medicaid to 133% of poverty and tacking on a trillion dollars of subsidies to a new health care spending at a time of fiscal concern. i think there will be an issue and on the democratic side we saw jan schakowsky and others come out in opposition on the tire plan, and durbin. so will be interesting to see if the floor ideas of capsnd on a macrolevel continue to be part of the debate. >> i would like to add on. one as you can on deal with a deficit without dealing with health care long term. health care is the problem long

term. and the sooner we get serious about it, the better. the affordable care act made some important steps but it is by no means the whole answer. so why do give the co-chairs some credit for at least not ducking on the issue. however, i do object to the specific proposals, particularly the ones that would cost shift more on to the beneficiaries because that doesn't do anything but lower the burden health care and the economy from taxpayers on to sick people which is really regressive and not the way to keep health care affordable for people going forward. in fact it's just the opposite of the intent behind the affordable care act. so i think while they should get credit for being willing to take on health care, i really think they made a misstep in how they

recommended doing it. >> we've got this gentleman and somebody over here, too. yes, go ahead. >> hi, i'm david -- and david vandenberg from tax analysis and wanted to follow-up on something you quickly discussed earlier and thatis the 1099 filing requirement. the president hs indicated a willingness to revisit it. do you anticipate anything being done about this in the lame duck or the 112th and -- talk about that. >> that's a gonner, but the interesting question that remains is how do you replace the revenue. and i think the preference -- it's not clear how much they are going to be able to do in the lame duck. they are already talking about narrowing the focus. there are some big issues that have to come up because harry reid promised during his campaign to bring up the dream act, for example, and there are

other things close to the finish line where there's actually been broad support, the food safety act for example, maybe the disclosed act as well. they would like to do this now actually. they would like to get something that is widely viewed as noxious of the table but they've got to find another funding source for it, and i haven't heard much on the front. okay? yes. >> hi, doug trap withamerican medical news. this might be a good closing question. republicans played the role of the minority much of the last congress. can they still do that in the next elections or do they have to actually produce some results to justify, you know, having more numbers in 2012? >> well, norm, actually we have a couple of models here that are going to be interesting ones to see which one actually prevails. one is the 1995, 1996 model and

that's the model where republicans started having swept back into power in the first house in 40 years. new gingrich viewed himself at the beginning as a parallel or even replacement president. we saw a year of confrontation of acrimony that culminated in the shutdown and loebsackand then basically a year of harmony and cooperation, where newt persuaded his colleagues that their primary goal w to get a second consecutive term in the majority in the house, and if that meant working with the president and making things better for him, so be it. and they both won. now, you could imagine another model, and that other model is one which is basically 2008. democrats took back the majority in congress in 2006. we had a couple of years where not much happened. it was the democrats who pushed

proposals out there. the president -- they were either filibustered in the senate by republicans or vetoed by the president. but the unhappiness over a lack of significant action continued to focus on the president, and was the president's party, despite the fact the other party had congress, that suffered massively in the election. i don't know how this woks out. my guess is that we may find a third model developing. it may be one where voters say for the fourth time in a row to call the ins and throw them out and throw the louts in it. it could well be one where the present basically is able to portray the republican party in a split congress and the cheers the third model, 1948, where harry truman after republicans won 55 seats in the house taking

a majority in 1956 portrayed them as they do nothing congress, he won the election and they lost 75 seats. which of the three models prevails i don'tknow. and some of it will depend on what happens in the economy. some of what will happen to the could depend on the leadership and whether obama can send of his own left because what characterize his one-tm president is they are challenged from the base in the primaries and they are weakened in that sense. it is very much an open question, and as to whether republican leaders can fend off the rottweilers who are on the right is going to be another challenge. >> i would just add -- i would just add that i think we will see a number of things, a number of proposals that will come from the house. and this is one of the reasons

that i began with the importance of how you read the election mandates messages, what ever you want to call them, and i think onef the clear lessons that came through a limited spending, limited government and the advantages for republicans in the tea party being so aggressive and animated and the candidates really running within the republican party wasn't helped sharpen the focus of the message, and i think that's part of the message that will come out and you see these proposals that were already said they are going to vote once a week on something to turn the size of government. i agree with norm and john there is going to be a balancing act as there is with any leadership and there was in the democratic leadership when you have a majority it means you have a diverse caucus and they have to deal with the fact, but i think as long as they are responsive to will be interesting to see whether some of those proposals get blocked by a democratic

senator get vetoed by the president come and the one thing i would say is that as much as that has to do with how the president either forces the issue or overreacts and at least from what i've seen the last couple of years i think this president is a very different president an either president clinton, and while i wasn't around in the truman administration, president truman. it will be interesting to see how he reacts on this lesson and as much as going to depend on how he is able to shape the issues and i think republicans will try to force legislation using the house when they do have a majority to try to put forward things they view as responsive to the electorate. >> just one footnotes here. every elected official is going to be judged on one thing in two years, and that's whether they help to get the economy back and helped people get jobs back. and if that doesn't go well, i don't think any of the rest of it really matters. so i think that let's get real

here. health care is not going to be the main reason people are elected or not the ext time around. it's going to be about the economy and it's going to matter a lot who looks like they've been constructive and who have not. >> although i will say just to add a thi it is worth remembering that the two parties have a very different definition even on java's of what their response as, and so why don't think what we will see this time around is republicans agreeing that the way to, quote on quote come get the country moving again or create jobs is by spending a lot more government money to do that in the form of stimulus or other things. and so i think they will have a set of proposals, but they will look very different from what the democratic congress has done and have to do with things like lower taxes and so whether there is any room tomeet in the middle on those will be an open question. >> just one rosy scenario on that front.

i could actually see an agreement on the stimulus package that would cut across the lines. and the agreement that i would imagine is one where we sit and infrastructure bank, a public-private partnership that's already got broad bipartisan support. it's the only way you're going to get an infrastructure the business community really wants investment in this area. and couple of with a payroll tax holiday and you could actually get broad bipartisan support for something that might or might not work, but that would not just have dramatically contrasted views of how you deal with the economy. whether any of that works in an economy i suspect is going to continue to move slowly just because that is what happens when the economy is go down with a financial crisis it doesn't create the kind of recovery and job growth that you have as a traditional recession is anybody's yes. >> okay. we have time for one more quick question.

>> can't hoover, american city business journal. i have a question on the 2012 election as well, going back to what you all were sitting in the beginning. let's assume the president obama loses the reelection as the republican president and let's assume republicans control both the house and the senate, and then let's also assume in the meantime health care reform has proceeded according to plan. what would then have been in 2013? would there be a full-scale repeal? what they will back what has already been done or how will that play out under that political dynamic? >> how's your vision around the corner? [laughter] >> two reef reena, what with president obama do -- what would president romeny do? >> with republicans in control things -- >> secretaries hhs rosen.

>> or somebody qualified. >> but i thinkthat, you know, two years is a long time, but i think the depth of the concerns and opposition to the current health reform always hard to overstate within the party. just look what all the candidates campaigned on and with the leadership is saying and they are relatively in sync. so i would suspect that there would be attempt to scale back, you know, outright repeal and scale back major portions. again, i would remind folks that doesn't mazzoleni for republicans that there is no health reform, that there is no subsidy, there's no insurance reform. the would be the case the president would try to make. but i think, again, if you look at the proposals they have been across thetate lines, medical liable because some of the other things. you can keep those ideas and whether they were d whether they are popular or not popular but they have a set of ideas and

my sense is they would try to replace those ideas with ones that are now on the table. i think that the challenge that they would have politically if they are in the majority and this is -- i don't think we know how the issue makes the comics will change over time is at least right now you have this resounding message about spending, and i think, therefore, it makes it easier to portray a significant medicaid expansion, for example, at a time states are already under enormous fiscal pressure as something if he were to repeal the expansion were scaled back that expansion is something that could be done in the name of, you know, fiscal relief of the states or something that could be done to address the deficit, but the with the message challenge and a substantive challenge, and there would still be great need obviously to people who don't have coverage who need subsidies of lower-income and so what is the

alternative it then becomes important. the repeal part in some ways is easy. it's been replaced part that . would continue the effort to repeal it and replace it with something else. >> let me take a crack at that. number one, we already see that issue playing on the republican side with a number of punitive candidates tripping into mitt romney for the massachusetts plan. and we have an overly what i would u.s. of course the great irony because i view the affordable care act as basically an amalgam of romney care and the durenberger, grassley, dole, chafffey to the clinton plan of '93, '94. this isn't a moderate republican plan or what used to be with a group of people who are now an

endangered -- under the endangered species act i suspect. but it will play out through the primaries. what we also know is in the process of going after the democrats' plan or obama's plan, and we are seeing now we've had republicans move into a position of not only defending every dime of medicare spending into perpetuity but also defending the employers and the coverage that they are now providing to people. where the plan that john mccain put at the table, which is has been the core conservative republican plan knocks the pins out from under employer provided coverage by turning that tax deduction into a voucher and then letting people go out and buy insurance. it's moving away from the employer provide system. there's a lot of good substantive reasons to want to do that, but i think what you're going to find as republicans in the process of trying to block

or discredit the obama plan have boxed themselves ino a corner in terms of what alternatives they can pursue without creating a very significant blow back probably the most efficient way you can do thgs and if you notice the simpson plan deals with taxes by broadening the base dramatically and removing that ta break dramatically lowering of rates so that's out on the table is probably a good thing to do. i think a lot of people would save a step back objectively and work creating a new health care system you wouldn't run it through employers who have no expertise or interest in the intermediaries but when you are out there singing with the clinton -- lt obama plan is going to do is remove the precious wonderful protection how do you move back to that or segue into that quickly so you find some struggle with the beginning of the republican will of a threat to figure out what

approach they would take. do they go laughter what they really want to do which coradicts what they've been saying the last couple of years, or do they go with some incremental change is the kind of thingwe are seeing out there now, a lot of veterans across state lines provide a few subsidies ad vouchers here and there it's not an easy place to be. >> we are going to convene these three gentlemen to and a half years from now to follow up on this conversation and find out which direction the rosy scenario have either direction might take. but we just thank you all for being here and think those of you watching and listening around the country. a special thanks to our colleague at the johnson foundation for making it all possible and i'd ask you to join me in thanking our panelists for insightful and mind stretching

look at the futu [captions copyright national cable satellite corp. 2010] [captions copyright national cable satellite corp. 2010] >> next, live, your calls and comments on "washington journal." then chuck hagel takes part on a policy toward iran. then remarks by the former president of pakistan. >> in an ideal world the fact that there were people shorting the mortgage market would have sent a signal everybody is

saying there are martin investigators who think this thing is going to crash and burn. but you couldn't see that but you can see it in the stockton. and because -- stock market and you were not betting on real mortgages but the casino version of a mortgage. >> in 2003 she wrote about enron and the smartest guys in the room. this week she will talk about the current financial crisis and future of the american economy in "all the devils are here."