"newsmakers," congressman linda sanchez, incoming hispanic caucus chair. we also have the editor in chief of "roll call." and we also have a congressional reporter with politico. thank you for being here. on thursday, the house approved legislation that would stop the president's executive action on immigration. they had also found to defund it in congress. what can democrats do? >> it is interesting because there is difficulty getting consensus within his own caucus. to avoid a government shutdown, the president will need a fair number of democratic votes to keep the government open, and in order to do that, there are members of the hispanic caucus who are willing to say that you cannot defund homeland security and put our nation's security at risk simply to keep the government open. i suspect that there will be a lot more negotiation.

they must have some leverage in that negotiation over not wanting to see a government shutdown happen. >> there is clearly some leverage for democrats. you see them supporting a bill that was funded through the rest of the fiscal year except for the department of homeland security which would be funded just maybe through february. >> there are infinite possibilities to how that will play out and whether or not they choose to split the two, that is up for negotiation from what i understand, so anything is possible at this point. but i think democrats are pretty strong in wanting to keep the government open and wanting to make sure that all agencies of the government are not -- they're funding is approved through the next year. >> congressman labrador, republican from idaho, set a few days ago that republicans should keep the shutdown as one of the tools in the toolbox. it is something that paid consequences for at the ballot

box. how close do you think it will get. really have a few days before the targeted adjournment date of december 12? >> there is a segment of the republican caucus that will try anything to abstract, sort of government by tantrum is how i would explain it. i do not think the leadership in the republican caucus is willing to go that far. the democrats have leverage because they will need democratic votes to pass a funding bill before we leave town next week. >> are you having those conversations with republican leadership given your new role? >> i am not the head of the caucus until next year, so i am

not having those discussions with those people right now. i suspect that the chairman is involved. >> on the broader issue of immigration, the congressional hispanic caucus has had an up-and-down relationship with president obama over the last few years on his record on immigration issues. so if you would survey his time in office, what letter grade would you give the president on how he handled immigration? >> i think he deserves a b+. there are areas where obviously we would like to have see more done on immigration. clearly, the president has been limited by certain legal precedents, but overall, he has been very receptive on that issue, far more receptive than the republican leadership in the house has been in their delay and stalling tactics and promising to work on comprehensive immigration reform, going back on that pledge, and essentially sitting on their hands and doing nothing but playing the blame game. the president understands the issue. i think he fundamentally

understands what is at stake for the hispanic community. overall, he has done a pretty decent job. >> how do you feel voters are going to be reacting to this? one of the big questions was whether the president would have done this before midterm elections and democrats lost the senate -- is the hispanic community glad to see what the president did, hoping he will go further, worried about congressional action? >> if you believe in polls, and there is some question as to whether or not they are really accurate, the polling information is based on how the questions are phrased. but if you are a believer in polling to give some indication of where things are, among the hispanic community, it hasn't gone up tremendously since his announcement of executive action. that is -- that has gone up tremendously since his announcement of executive action. and that is across the board politically with the hispanic community.

we are not monolithics. there are a variety of political viewpoints that the community as a whole has seen as very an official and positive. clearly, we are looking for a permanent legislative solution, and we are going to continue to push for that because that is what this country needs. >> when you look at other polls though, and americans seem to be divided about the president taking this action alone. i am wondering particularly about tensions between minority communities, african-americans and hispanics specifically. there seems to be attention there over jobs. do you hear about it? >> i do not. i think that is an argument people use to try to divide communities. i think there are far more common issues among the minority communities. if you look at voting rights, those with the supreme court decision did to gut voting

rights for latinos, hispanics, asians, and every other minority group, there is far more in common there than difference. in immigration, there are certain segments of african immigrants who are just as highly impacted as hispanic immigrants with respect to changes to immigration. and we have enjoyed tremendous support from the black caucus on the issue of immigration in congress. if you look at issues of civil rights, police abuse, and the list goes on and on, there are far more issues that we have in common. i think that is often used as a red herring to divide communities, competition for job scenario, but if you going to communities and talk to folks that are affected, i do not think that is really a true issue. i do not feel that people think they are losing jobs to immigrants, you know, because of the president's announcement of his executive action. if you look at who has been impacted, these people have been in the country for many years

and many have citizen children who go to school here. they contribute to their communities. they have been working for a long time, often at the margins, the informal work sector, not taking in payroll taxes or social security taxes. if you bring these people out of the shadows, it will be a net benefit for this country. adding immigrants to the labor force or getting them into the formal work sector benefits the country tremendously. >> tell our viewers what these folks will have to do in order to get this temporary status under the executive order, and what will they not get? >> it is important to remember that they do not get legalization or citizenship. they do not even get in the line for citizenship. all it does is it re-prioritizes who the focus of ice enforcement actions will be. all it says to a certain group of people who qualify, these people who is been in the country a certain amount of time

and either have permanent resident children or children that are citizens, simply all it does is take away the fear of them being deported. it re-prioritizes resources or they should be, which is ongoing after criminals and felons and focusing our removal proceedings to that specific group of people. so we're looking at reprioritizing not deporting and splitting up families, but going after the criminals and felons. >> would about government benefits, welfare, social security, medicare? >> many of those will not apply to them, although they will be given to a certain segment of the folks affected by the executive order, they will be given work visas to be able to work in this country legally. that is taking them somewhat out of the shadows, but they still will not have the full plethora of rights and responsibly these that legal or minute residents and citizens have. >> on the permanent legislative

solution, there is some discussion among house republicans about doing something next year. you have the homeland security chairman saying he wants to do a border security bill. you have chairman pete sessions talking about a guest worker program. they will want this in a so-called peace male step by step strategy -- in a piecemeal strategy. do you think democrats would be able to accept a solution that is piecemeal? >> i do not speak for all democrats, but i share probably the majority of democratic viewpoints, but i think we want to see a solution that is a long-term, permanent one and comprehensive. this is something we have been working on for more than a decade in congress. i have been in congress for 12

years could when i first got elected, i specifically wanted to serve on the judiciary committee to work on a comprehensive immigration approach. the republican tactic, which is a very shortsighted one, has always been to try to pick pieces out of it and try to fix those. but once you look at the whole immigration puzzle, it is like a spider web. once you tinker with one part, it has repercussions throughout the rest. so you really need to sit down and embrace the comprehensive approach. the piecemeal approach is not going to completely overhaul the broken parts of our immigration system. with the focus on border security, factually, there are fewer people crossing the borders. there are record numbers of applications because of the executive order. they will reprioritize towards keeping people from coming in.

we have spent aliens of dollars to make our -- spent billion of dollars to make our southern border strengthened, and i do not think there is much more money that you can throw at it unless you want to throw money at a problem in a very wasteful way. so this obsession with republicans that we need to -- i don't know -- throw alligators on the southern border and build a moat, again, i just think that is rhetoric that misses the mark. let's get our hands are on a complex problem. the work is already been done on that. again, this is not something we just took up this year. this is a piece of legislation we have been working on for more than a decade. so there is, oh, we will get to it next year or give us more time, and that is really just a stall tactic. i think there is a lack of ideas on their part about how to

thoughtfully tackle the biggest problems in our broken immigration system. >> given that, this is a really difficult problem because they will have a very different answer. they talk about it piecemeal approach because they do not like the comprehensive approach. two years of an all-republican congress at the very least with a democratic president, will anything get done? >> that will be incumbent upon the leadership in the house and the senate. we are elected to govern. their job will be to try to govern. i think it will be very telling. i think they are very much going with the majority that they have in the senate and house. if you look at the comprehensive bill that managed to pass the senate on an overwhelmingly bipartisan vote, it really took a lot of negotiation and a lot of give-and-take on both sides to come up with something that was acceptable to everybody.

nobody got 100% of what they wanted government, but people thought this was a game changer, a way to fix the system that both sides could agree. i suspect that next year with republicans in control of the house and the senate, there will not be those full brunt -- full-blown bipartisan discussions. it will be their members of their caucus meeting together to come up with piecemeal approaches and there will not be that sense of compromise. i think it is very telling that the way they want to go about immigration reform is piecemeal, and i think the way they want to do it is going to be in a take it or leave it manner and not really having a thoughtful discussion and not trying to get their hands around the problem. they want it to some politically acceptable for the constituents that photo to elected them. >> given that, is there more you expect the president to do by himself, by executive order? >> i do not know within the

legal conference what is left that the president can do. i know he is reviewing certain areas of enforcement that he can perhaps act on, but whether or not the legal precedent exists remains to be seen. the president has been dedicated to stay within the conference of the law. i do not know that there is much more the president can do. but i am hopeful that, by virtue of the fact that was the executive order is implemented, the country does not fall off the cliff into the ocean, and then people will see, hey, there is a really thoughtful way to do this and it does not have to be an all or nothing approach. that is my hope. >> we have talked a lot about republican divisions, their strategies, but there are some democratic -- not divisions really ideologically and not as many of them, but there is a sense that, with nancy pelosi as the top leader, steny hoyer, all

remaining on in their positions, it indicates that there is agitation among the younger and less senior members of the caucus. so how do you get at that? how do you tell someone who has been in congress, entering their seventh term, somebody that wants to be ambitious, maybe a tim ryan or someone like that, that decides to go to the senate, how do you get at taking people into leadership in a different way? >> that is interesting because i have been thinking a lot about that with respect to the congressional hispanic caucus. i will be the chairwoman next year. i know some of the implications of being a newer, younger member and really wanting to get involved in some of these meaty issues that i care about and affect my constituents. i think there are ways in which you can include younger and newer members, reaching out to them and inviting them to participate in ways that the

old, sort of, seniority-only system does not allow them much input or impact. my goal is going to be to try to utilize the talent of that newer and younger members, their passion and energy, and really put them in positions to be front and center on some of these issues that normally they are not given an opportunity to speak on. whether that is through events that we do in different communities or with the press, we will try to field our best teams and allow those members that have a vested interest in wanting to work together and pushed legislation through that they care passionately about and that affects their key constituents. and i think there will be, at some point, a big change within the democratic caucus in terms of how we utilize our members and how we field our best teams. i think seniority plays a role, and i think it should, but that does not mean that you walk out -- lock out some of the fresher faces and voices. >> to follow up on that, this is

a little inside baseball with the decision about who would be ranking member on energy and commerce. seniority won out there in that position. was that a blow to caging up that seniority system a little bit or do you see some hope that this new idea -- >> i think ranking memberships are interesting. i think more of it is about personalities. i think people genuinely think that seniority should count for something. probably the consensus in a majority of the caucus is that it should not be the sole determinant.

i do not think it was won simply based on seniority. folks who supported frank, it is the determined effort he does on messaging and the work he has done for years with members in the caucus. there have been instances in the last congress where members that were younger became ranking members over more senior members. i think that probably shift -- security is important, but let's look at other sectors, as well. as long as you continue, again, to not allow the full bench of the democratic congress to participate in areas where they really can contribute, i think people may start looking for alternate ways to become ranking members or who should be the spokespeople on particular issues. >> we have a little bit more than a five-minutes. i want to ask what your priorities are as the incoming caucus chair of the hispanic caucus. >> there are a number of areas in which i think we will really need to push for some progress for our community. definitely the area of voting

rights. i think the supreme court decision really impacts millions of voters and has the potential to very much disenfranchised communities. voting rights needs to be an area where we focus a lot of time and attention. immigration will continue to be one of those issues that will continue to percolate and that we may see some action or a tendon -- or attempted action on it, and we will be very involved in terms of what goes forward. standard & poor's recently published a report which is not a radical progressive organization, but it said one of the biggest threat of economic growth is the rising income inequality in this country.

that needs to be addressed. there are a bunch of issues. health disparities and i could go on and on. the does are probably in terms of issues that i am looking at, some top ironies. >> the recent decisions like grand juries in ferguson and new york, do they play into that? does that make it a higher priority for you? it's definitely in the areas of civil rights and voting rights, that is an area we will be very involved in in the upcoming term. definitely how our communities are policed and how we interact together as a society are questions that we cannot continue to ignore. i think there is this critical mass mounting and we need to look closely at these issues and figure out a solution that our communities are not torn apart by violence, and they are not torn apart and segregated. >> i know the chc pushes for diversity in presidential appointments. what do you want to push on that? >> definitely, i mean, we are pushing to try to make sure that the fortune 500 companies in this country and the government looks like the america of this

day. if you look at congress, for example, women make up more than half of the population. we are about 17% or 18% of elected representatives. hispanics are the fastest-growing ethnic group in this country, but we are underrepresented in congress. those continue to be issues we care about. we will focus on not just trying to diversify presidential appointments, but witness panels that testified before congress. as long as i have been here, most of the panels have mostly been white men that testified before congress on a host of issues, and i know that there are very qualified individuals from ethnic backgrounds. the same sort of demographic -- demographic gets asked to come and testify in hearings. there are appointments to the federal bench. there is a constant need to remind folks that there are stellar, outstanding, and eminently qualified candidates that are hispanics and they ought not the overlooked. >> you are a member of the special committee of the benghazi investigation and a report cannot after thanksgiving. you were appointed by nancy

pelosi. is there a timeline to do much more be on this? >> i will tell you that when i was asked to serve on that committee, i gave it a lot of thought. when i agreed to it, we were given binders with all of the reports that have been generated. i have read through all of them. there is very little information. many were done in a very bipartisan way.

benghazi was a series of unfortunate opportunistic events that piled on top of each other, equaling a tragedy. i know the -- a chairman said i would rather ask a question twice than not ask it at all. the nine reports that we have at our disposal that have been generated about this topic answer every question more than twice or three times. i do not think there is a lot of factual information that is left to be found. i suspect that the point of the select committee on benghazi is not so much the factual record, but to try to use it as a political message peace -- piece. unless something changes, i do not think there is much left. there are numerous committee reports with plenty of information.

>> do you know how much it is costing?

>> estimates were about $3 million as a budget for the select committee on benghazi. that could go even higher. i do not know the ultimate amount. to me, it seems like what should have been done is a report should have been read and an outline created of what is left to be investigated. we have been asking with a focus of the committee is or what you are looking at or what information you think is missing or not there. we have not received that. >> the congressional baseball game has been scheduled for june 11. as a member of the congressional women's softball team for the press, i have found it fascinating you do not play in the softball team but you are out there with your male colleagues on the baseball field. what is that like for you? >> well, you're half right. i started playing on the men's baseball because the women's softball team did not exist at the time. i played for many years and then the women's soft will team came into exist did -- existence the year i gave birth to my son. i played for two years after on both teams. to try to go back and forth, it became problematic. not to mention that hitting fastballs and trying to do those at different times during the week really messes with your timing.

[laughter] so i made the executive decision that i had to stick with one, and it is just a tradition that i played on the men's congressional baseball team, so i wanted to stay there. i also think it is symbolic to show that anything we perceive as the men's world or that men can do, women can do just as well, if not better here that think my batting average underscores that. >> are you asking freshmen women to come onto the baseball team? >> i am always scouting for good talent. but because of the women's softball team existence, it is very hard to get women to play on the men's team. it is just a comfort level that is higher with softball with other women. but it is really one of the greatest experiences in the congress. i enjoy it very much.

it is the way in which i have gotten to know a lot of my colleagues, including republican colleagues and friends i have made. >> thank you very much congressman linda sanchez. appreciate your time. >> my pleasure. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] >> we're back with our reporters. let me begin with what you heard about immigration and really the prospects for anything beyond border security in the 114th congress. >> i remember very clearly in 2006, it seemed like there was a real bipartisan effort coming together. president bush was advocating for that to her the message

remains the same from the two sides. republicans really want to take a step-by-step approach with border security. they say comprehensive is why we need to do it. she used the words spiderweb which i thought was interesting. for me, it sounds like two more years of nothing, two or use of rhetoric. in the presidential election comes into being, and when do you ever fix the actual problem when everybody agrees the system is broken? >> u.s. about the homeland chairman saying he wants to do border security legislation, but leadership did not bring it up in the 113th.

what have you heard about them pushing this in the 114th? >> if you ask them, they will say that the immigration is -- system is broken and we want to do it, but it is not at the top of their priority list for what they want to do in the 114th congress. you can push the border security bill, and it may be able to pass. anything beyond that, whether it is a guest worker program, whether it is so sort of legal fodder for the people here, very difficult to see that passing without help from democrats, and now democrats would clearly have leverage on that. >> would democrats work with republicans on immigration? >> republicans have not actually presented them with that, but they will be faced with it. we do not talk a lot about what would happen in the senate. the senate did pass a bipartisan comprehensive bill. you still have john mccain, lindsey graham, marco rubio, but you have a lot of democrats leaving. you have new republicans coming in who are unlikely to be as friendly to that sort of approach. without the house being a willing part in are in this, i do not know that you could pass that same bill.

>> last year, it was a minority of republicans that supported it, which is 14 senators. >> coming up to this week, congress' last week of the 113th congress, go through sort of what they are planning. >> a lot of it sounds like taking it right to the brink when you look at the terrible term and putting together all the spending issues with potentially different deadlines and pulling out homeland security funding. sounds like a lot of last-minute decisions on bills that my deciding thing the border and a lot of chaos while they are trying to get out of town and the government will shut down if they do not pass any funding bill. that will make as real busy. >> what have you heard about the tallies on the republican side

for going ahead and funding homeland security but just in the short term? there are some conservatives who said we are not voting for that. >> some conservatives want specific language that says none of the money can be used to implement president obama's orders. people say that is perfect recipe for a government shutdown. you can satisfy some conservatives with making sort of the funding leash for the dhs a little bit shorter, maybe january or february instead of march. >> what are you hearing? >> there will be sent chaos to do not forget, you'll have to raise the debt ceiling again come early next year. so it will start right over again. >> editor in chief with "roll call" and congressional reporter for political, thank you for your time.

gruber -- what went on behind the scenes in order to get the health care law passed he served as an advisor to the federal health care bill, as well as the one implement it in massachusetts. the hearing will be live tuesday at 930 a.m. eastern on c-span3. experiencebout his drafting the health care law. this is one hour. [applause] >> i appreciate your being here

at the town hall tonight. we have jonathan gruber to speak. he is an award-winning economist and director of the health care program. he was a key architect -- i heard of him alive when he was working in massachusetts helping the massachusetts people put together their reform. he has also worked with the administration and congress when they developed the health care reform legislation that was passed about two years ago. he is also the co editor of the journal of public economics, associate editor of the journal of health economics. he has published more than 125 articles, has edited six research volumes, is author of public finance and public policy, which is a leading undergraduate text. which is why he probably speaks with great authority about the law. he has written a book called

"health care reform: what it is, why it is necessary, and how it works." i think it is a very fast and very informative read. please give a warm town hall will come to jonathan gruber. [applause] >> thank you very much, and thanks, bob, for the kind introduction. i have about 10 minutes to start and there's a lot to talk about with healthcare reform. i will start with a little story. my sister lives here in seattle and this story involves her and she came -- the story involves her coming into the house and said, dad, dad, i need help, where is mom? and my father said, i don't know where she is.

where can i -- but can i help? she said, no. he said, what you need help with. she said math. he said, why can't i help you with it and she said, i don't want to know that much about it. [laughter] in that spirit, i will try to tell you not more than what you want to know. i am eager to hear your questions. i want to start by setting a little bit of background, which is understanding the importance of where we are historically and in terms of the numbers. we have been trying to do, the mental health care reform for about 100 years on an average of every 17 years. and we have always failed until 2010. and as we have failed, the problems have gotten worse. the number of uninsured in america continue to grow. we now have 15 million individuals. and the cost of health care continues to grow. health-care spending continued more slowly last year, but more

slowly still means increasing health care to about 18% of our gross domestic product. if nothing is done, by 2018, will spend four out of every $10 on health care. that may be good for the doctors in the crowd, but not really for the rest of us. and that is not feasible. we have these twin crises. in my book i represent them as a twin headed alligator up we are trying to deal with, and yet we have been mvet -- unable to decide how to deal with them. the real breakthrough came with governor mitt romney in massachusetts in 2006 when he signed into law a massachusetts health care reform, which took a new reproached -- a new approach that has not been tried before the i like to call incrementalism. meaning, leave people alone if they like what they have, but help them if the system does not work. the universalists are from the left, meaning getting to universal coverage. this was not a bit up and start over approach. it was recognizing that we need to keep the things that people like, but that we can get to universal coverage. he set up a system that i like to say is a three-legged stool. the first leg was ending discrimination in insurance markets.

to end discrimination we have a flawed system in america where people are just one bad gene away from bankruptcy. the second was to get away from mandate so that insurance companies could price fairly. and a third step was subsidies, so health insurance could be affordable for individuals under this mandate. this system was put in place in 2006 in massachusetts and has been enormously successful. we have covered about two-thirds of the uninsured in the state and have lower the cost by about 50%. and this is the basis for the affordable care act. the same basic structure as the affordable care act, but the affordable care act is more ambitious in two fundamental ways. the first is, and candidate mitt romney may not tell you this, but his bill was paid for by the federal government. we get reform in massachusetts and we did not have to raise taxes, as he will tell you. but what he will not tell you is that we did not have to raise taxes because the federal government paid for it. the federal government does not have that luxury. if we have to raise revenues. but that is one place we had to be more ambitious. the second is the bill in massachusetts is not really the second head of my two-headed alligator. it was not about cost control. it was not about dealing with this probably more important

problem in the long run, honestly, which is controlling health care costs. and i'm here to tell you that is okay. that is a lot harder problem. ultimately more important problem, but a lot harder problem, but a problem we are moving forward toward solving. we are not there yet the affordable care act moves forward in a number of ways to try to control health-care costs. it will not be the last word on cost control, but it will move us toward ultimately controlling health-care costs and not ending of spending 40% of our gdp on health care. i hope we will go through those details and answering questions that you have tonight. that is an overview for now. i would love to talk with bob and hear his questions and hear your questions. thank you. [applause]

>> thank you very much, jonathan. i think this is an interesting topic you brought up. obviously, a lot of us here care about our health care system, what looks like and feels like. you mentioned one thing in the beginning that has to do with incrementalism verses a broader sweep. could you speak a little more about why incremental this time, why not a broader sweep?

how can we meet our goals if we do not -- ? >> the pattern is interesting. in every round of health care reform the approach has moved to the right. we have moved from a single pair to a somewhat less single payer to the clinton, which had these regionally cooperative, but would still configure the health care system. this time around there are two fundamental problems that would reconfigure the health care system. the first is, most americans are happy with what they have. they wish it was cheaper, but they have a variety of choices. there are employer picks up most of the cost and they are happy. in american politics you do not get far by ripping up what makes to under 50 million people happy to make -- 250 million people happy to make 50 million people happy. we have bailed out industries much smaller than that. we are not going to wipe a $300 billion insurance industry. we had to bring them along to make this feasible. it led to a realization by many of a single payer system that was not happening in the in the near term, but that we could move to a system that is feasible and get us to the goal

of universal health-care coverage. >> that is very good. on a lot of us care about that. one of the issues i you brought up that is really important -- you said it was a two-headed alligator. you mentioned you were working on the access issues, but really, there's also the cost control. in massachusetts, you did not bite on that bullet, but you did in the national. what has to be done to make that successful? >> health control is really hard. i think the book is that it was like having to go over two hills. the first hill is scientific, which are frankly, there are a lot of good ideas out there. we do not know how to bend the so-called cost curve in a way that would not put u.s. health at risk. if we just that we are not spending more than 18% of gdp on health care, that would do it, but that would not be the solution. how you distinguish what does it and what does not?

the second is th this is a very hard problem to solve. anytime you pose something that can help control costs, it is easy for the opponents to attack it. our political system is not prepared to deal with this. my favorite example is -- many of you may remember in november of 2009, an independent set of doctors who recommend when your kid is immunized recommended that mammograms no longer be recommended for women in their 40's. this was not an economically this decision, but based on the false positives we were given early. the political system went haywire. the government wants to take away your mammograms was the headline.

this is not a government agency and they are not taking away anyone's mammograms. it is bad enough if you read the affordable care act, which i recommend that you do not, but in their it actually says that preventive screening is not covered for free. every american with health insurance now has the right to get preventive done for free. they literally could not bite the bullet and they are agreeing with that because of the political blow back. it is a long winded way of saying, we have got a long way to go before we're going to get to fundamental cost control. what this bill does is take a spaghetti approach to cost control. it throws a bunch of stuff against the wall to see what sticks. there are a number of different approaches, each of which is the best from experts. we're going to try them and see what works. >> how are we going to make sure we get there?

>> there is a famous statement from a nobel prize-winning economist, herb stein, who said, if something must end, it will eventually, we will not spend 100% of gdp on health care. i do not know how we are going to get there. i can tell you that it is unlikely we are going to get there in the way that england did, for example, where they said that no one over 75 gets transplants. that is not the american solution. i see it moving to an explosive two-tier health care system. -- explicit two-tier health care system. right now we have an implicit 2-tier health care system. all the bad statistics are driven by the people who are out of the health-care system. and right now, it is implicit. we need to move to an explicit 2-tier health care system where everyone is guaranteed good,

basic health care. we have to recognize that it is america and some people want to buy better health care, we need to let them in most european countries you can buy with your own dollars -- we need to let them. in most european countries you can buy with your own dollars better health care. >> you change topics quite a bit. you mentioned revenue, and how massachusetts was lucky. it had $350 million coming down the pike. the national bill does not have that. the national bill also raised a lot of revenue. and i think it is -- our deficit is decrease because of it. can you tell us about that? who gets taxed? who pays for it? >> president obama laid out the number one principle in this bill, that there should not increase the deficit. to make this work, we had to spend about $1 trillion.

we had to raise revenue to reduce spending. first, it cuts private health insurance that injured the medicare population -- that insured the medicare population. but we were paying $1.17 for medicare insurance. we raise about $300 billion by reducing reimbursement to hospitals that treat medicare patients. about half of it was costs and spending, but half of it was also increasing revenues. those come from two sources. one is the sectors that operate on this bill. there's the pharmaceutical sector, the medical device sector, the insurance sector, they will all pay new excise tax. the second is the new tax on the wealthiest americans, an increase in the medicare payroll

tax for families above $250,000. >> he mentioned the pharmaceutical industry, health insurance -- you mentioned the health insurance industry, the pharmaceutical industry, does this help them become better citizens? >> i think it does. the trade off with the political feasibility argument is that we had to bring private insurers along. i know that upsets a lot of people. the bill tries to keep them as good citizens in two important ways. the first is the so-called health insurance exchanges. right now, if you want to buy health insurance in the so-called non-employer market, it is hard to shop effectively. it is confusing, prices are high. this sets up an exchange for all non-employer in jurors will come to one place that will be competitive -- insurers will

come to one place that will be competitive and easy to shop. we have done it in massachusetts. i think it beats the pants off orbits. it is a terrific shopping experience. that is when competition can work its best. there will be new competitive pressure on insurers. blue cross and charges more than other insurers because they are blue cross. that is because people know them. and when they are on the shelf, they will say, why am i paying more? those benefits are the same. the second is the medical law regulation, which regulates and limits the amount of money they can have in profits and overhead. >> a want to get to a couple of parts of the bill but i think are important. one of them is the protections. many people do not trust the insurance companies and that is not just because of transparency, but how do we know that people do not have limits to keep them from getting pushed into bankruptcy or something else?

can you talk about the protections that are there? >> it is a great question. i think this is the most important part of the bill, and the least appreciated. most people in this room will have insurance on they -- from their employers or the government. we have to recognize that with 50 million uninsured americans, and in many individuals better in the non-employer market, they are facing enormous risk to their financial security. we are in a system in america in most states, such as this one, where you can buy insurance and the minute you get sick, you can be dropped. or in some states they cannot do that, but they will say, up to $1 million per month. it is totally legal. we do not have real interest. that is a fundamental failure of an economy as wealthy as ours.

it is crazy to put that much uncertainty on the public. blogger will you be kicked off because you are sick and blogger will be charged -- and no longer will you be dropped if you're healthy. >> we have community-based intervention, which i think are really important. if you look at the health of the committee, it is often times driven much more by what we do in our community as opposed to political intervention. what does the bill do to make a difference in those areas? >> the bill is trying to make a difference in those areas. it puts a lot of money and resources into community health centers to try to improve those centers to meet the needs of their communities. as i said, a lot of money for individual-based prevention. there is a lot of money for wellness and initiatives.

what the bill tries to do is not just to ensure people, but to built on the resources to improve people's health beyond medical care. >> i have spoken to a lot of people who are very upset about people getting a entitlements or a gift given to them. the issue of personal responsibility rises with the population of the time. how does this bill address personal responsibility? >> it is fascinating, because what is more personal about personal responsibility than an individual mandate? the genesis was in a conservative think tank. when mitt romney signed the bill in 2006 from on the podium with him was a spokesman for the heritage foundation saying how wonderful the bill was. because that is about personal responsibility. it is about ending the free ride for individuals when they are sick and to jump back out when they are healthy. this bill is trying to thread

the needle of using the individual responsibility, but not putting such a burden on people or for the affordable for example, an individual mandate, but we offer low tax credit. and we have an affordability extension so no one has to pay more than 8% of their income for insurance. if it costs more than 8%, you are no longer subject to the mandate. as you said to me in the greenroom, is as if you shot a bullet with are hitting somebody. we are trying to do this amazing bouncing ask that -- balancing act. >> you wrote a book that is a graphic novel. why? >> it couple of reasons. the publisher approached me and said it would be a great way to learn about the health care bill. i was very eager for people to

learn about the health care bill you read the polls and you ask people what they think about the affordable care act and they would say they like it. you ask them what they think about ending discrimination in the insurance market and 70% like that. what you make about making it more affordable to get insurance. 70% like it. they just did not understand. i thought a comic book was a great way to learn. my son was a great reader of this novel -- a graphic novel format. he convinced me to do it. >> but you did not have batman. >> i did not. >> i read it and i really enjoyed it. next step, who is the audience

for this book? who you think is more to read it? what difference does it make? >> i have in mind the audience being anyone who has an open mind about this bill. i do not think is going to change anyone's mind if their mind is made up. but this is a really radical transformation of our system. it is complicated. and i think there's a lot of misinformation and disinformation about this bill. i think this is appealing to two groups. one is the cautiously skeptical too cautiously supportive, but just unsure. they want to read it and learn and decide for themselves. i also have a particular audience in mind, which is the people who are inclined to like universal coverage, to like what a democratic president does, but feel like this bill did not get there. it did not meet their needs. they are just not satisfied. i am stunned with the number of self-described liberals who do not support the bill. i think a lot of that is the people not understanding what the bill does and what is in it. that is another audience i would

like to reach with this book. >> i will do one more question, but i'd like -- would like to open this up to the general audience. we have to devote microphones, one there and when there. if people want to start asking questions, feel free to line up. i want to go back to your area of rationing. and i will not call it rationing, but that is what the opponents of this bill call it. they are comparing what we're doing, whether it works or not. and you mentioned the two-tiered system. how are we going to approach health care in the long run in this country? there are limits to what you are going to do. as the different mechanisms are built in, are they going to take care of that? how are we going to make those hard decisions and how will we inform ourselves of the best way to do it?

>> basically, if we think about the coverage problem and the cost problem, the coverage problem, we sort of knew what to do. it was a matter of crafting it in a way that it would get through tough politically. the cost problem is much harder. it's because we just do not know. we do not know what will work scientifically and what will pass politically. health care is the single largest and single fastest-growing sector of the economy and we have no idea what works. it is crazy, right? what do you do in that situation? if you need to learn and research on what makes health care work. however, once you mention this bill, then that -- then people say, that means the government is going to ration my care. there is $1 billion to be

prepared this institute to study what works and what does not. but the results of that are not allowed to be setting insurance decisions. that is crazy. but that was the political compromise. the bill has in its dozens of pilots of alternative ways of organizing care. we have the so-called fee-for-service medical system where doctors essentially get paid more than they do. there is a famous quote about having a doctor decide how much medicine you take is like having a butcher decide how much red

meat. we assistant where doctors are paid based on how healthy you are, not -- we need a system where doctors are paid based on how healthy work, not on how they treat you. but that is hard to do. anytime you're going to control health-care costs you will be cutting someone's income. that is hard to do. what the bill does is to set up dozens of pilots to get us to around two. now we deal with the cost. >> here is the first question. >> i am definitely one of the liberals who does not understand the bill, so i am delighted about your graphic novel format. i pay out of pocket for my own health insurance because i am a self-employed. i recently became pregnant and i was delighted with group health until i became pregnant. once there was a series of tests that became recommended, i became mired in the quagmire of

of trying to estimate costs upfront. why is it legal for the health-care industry, for health care providers to not actually tell you up front exactly what you will be paying for a given service prior to getting the service? what ended up happening is that i pay double for what i was quoted initially. now i am fighting it. it is a quagmire. i would love your answer. >> i mentioned the exchanges. coming. is we standardized benefits in a way where you will see exactly what you are paying under each plan. you had a great question. what we need to do is an explicit description