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ink from chase. rwick, w affordable say1o brea tí6 and >> pl !1tion is going todv khe federal a strong signal that theyzc rely matchme. we do reporting aboutt isow the chief(f staff. td no exact ioint. johnoehner after the ect o has anaying t cit when our nationaebtiend it aaffordcteen c on table keep tit's g play. entitlements on a ole need on on t ussion we're going to month, but t ultimate f i but medicaid is the mostco tire hñuealth caructure. if me pto look f>> an ad t e) at projecti in medicare hat a fund a >> c t ining is the singl the conservative opponents ofaca conservative skeptics have critiques about cost control. you see these sort ofservatives going to materialize, and single payer people say no, single payer is the only way to get the kind of cost control you want. i'm curious, whether you think we're going to see the cost being projected. >> well i'm very skeptical that the aca cost controls are going to be effective. you know we could save $500

million if we just did allow us to cover everyone including the people we're leaving out. the cost control that we're -- the infrastructure isn't in place with the aca. >> you're saying on the delivery side? >> on the delivery side. >> and don, this is what you have worked on right? this is what you have done your life's work on. but also at cms is making sure the infrastructure is developed tls that are being projected? >> yeah, that's right. there is no question that a simplified system of payment would save money right off the top. but politically we don't seem to be able to go there right country is committed to a pluralistic system. ink the good news in the ñaca is theleurism approaches to state is rather exciting. oregon with coordinated care organizations, massachusetts is trying a global cap, arkansas is pushing bundled payment to the limit. t they're going to do if lets them proceed. maryland has an all payer system they're going to experiment more with.

vermont may go single payer. so we're going to see quite a bit of learning in the next few years as the states struggle with costs reduction. >> that is really interesting there is aot of room for experimentation at the state level to see what is going to get the costs down. >> i mean -- >> a ton, yes. >> the one nice thing about having by far the highest health care costs in the world is that it seems like there are a large number of9 options that you could pursue that would produce a now there are lots of countries that have significantly lower costs than we do. there. >> is a lot of space in between too. >> everyone has lower costs than we do. >> one more reason i think that medicaid is actually probably going to survive more than people think is the biggest sort of pot of money where you think the cuts are going to go because no one wants to touch social security is probably medicare. and if you do things on changing the amounts of benefit that medicare people forget one of the big things medicaid does is it helps poor seniors. and seniors are the most v% expensive to care for. so you're going to wind up having to have more medicaid money to cover those seniors. >> i want to ask about where you think the politics of this will

go as we start seeing implementation. because that's the real question there is this window where we pass the law, but it hadn't been implemented. so people still have their feelings about the law, that passed it as opposed to the thing it was delivering. and i'm curious to get your thoughts at the table abo once it starts being part of people's lives, right after this break. if you think you missed out on black fridaye depot, think again. black friday prices are still here. instore and online right now. where prices have been cut chopped, and sanded... ...on the most powerful tools that cut... ...chop... ...and sand. so we, or somebody on our list can do the same. more saving. more doing. that's the power of the home depot. get a special buy on a ryobi 2 piece lithium ion kit for just $99. a regular guy with an irregular heartbeat. the usual, bob? not today. [ male announcer ] bob has afib: atrial fibrillation not caused by a heart valve problem a condition that puts him at greater risk for

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this weekend, get the best deals on the best devices on the best network. exclusively at verizon. one of the effects of the affordable care act i think from the political perspective is a it begins to be implemen short-term and the democratic party i think in the slightly medium term will own everything that happensu guys did this thing. you passed the affordable care act, and then if you're not liking your insurance company or your doctor. there is a big been taken politically here which is that you made this great point before jacob. look employers were shedding the trend of shedding coverage was happening before the act. but after the act, people are going to say that's the affordablehealth care inflation was going up way above regular inflation before the act. if that continues you passed the act, it didn't work. i wonder what you think the politics of this looks like as

it begins to become implemented. >> i think the democrats, they've been waiting to have something to crow about. there h anow there is going to be big steps. it's true there are going to be messy moments. but people will be getting coverage. medicaid will be will be achievements to talk about. the irony is that everything that made it really hard to pass the act may now shift to be favorable toward implementation. so the gridlock the difficulty of changing law works in favor of the affordable care act the fact that we had these insurance companies spending millions and providers groups spending millions, now they're going to have vested interest in key elements. it's not going to be pretty but it's going to be very different. the fact that the president was reelected means that there is a real change. this is a momentous shift in the politics of the aca. >> i think also if look at a state, like let's say a south carolina. let's say they don't participate in the exchange and the federal government directly runs them. if people have a positive

experience of the affordable care act, they're not going to say well my governor did a great job. they are being directly aided by the federal government. so i wonder if conservatives are not undermining their own argument for smaller government conservatism by letting the federal government take care of people, federal. >> if you set up the exchanges well and people have a good experience of it then they're going to be popular, and if you don't that. >> won't be. >> yeah, there is a lot of good for people in the law. coverage under age 26 for kids, the prevention benefits i think over 30 million people have used these now. insurance companies underuch more restrictions to reduce the overhead costs. these should be noticed. i think the biggest vulnerability here, chris, they have to do with the exchanges. they are really difficult to set up, new information systems, complex enrollment procedures. i think one of the attacks is going to be trying to starve them. i hope that goes well. >> that's a really good point. >> i think the big challenge is

going to be on the cost side. >> yes. >> this law takes even more of the responsibility within the economy of health care costs on to the federal government's books. over time those costs are going to be unsustainable. the cost control parts are going to become more and more important over time. as it goes forward, we're going to have more and more of the don berwick show. and i like the don berwick show. but i think a lot of people don't, because that's the part where they're saying we're not going to give you this test because really you know, the test isn't useful for you. >> and there is peer reviewed evidence that shows this test is not useful. and you say gosh darn it i want the test. >> exactly. that's the change we're going to have to have. we would have needed it even if we didn't take on a greater government share of the costs. >> we shouldn't kid ourselves that isn't going to be necessarily popular in all moments. >> oh, i think it's going to be unpopular. >> donald berwick of the don berwick show, the man who just stead on our air, they're really pushing bundled payments to the max, that's super exciting about the arkansas former administrator for the centers of medicare and medicaid services

joy reid josh baro from bloomberg review that was a great conversation. final thought on what i am grateful for this thanksgiving, up next. sometimes what we suffer from is bigger than we think ... like the flu. with aches, fever and chills- the flu's a really big deal. so why treat it like it's a little cold? there's something that works differently than over-the-counter remedies. prescription tamiflu attacks the flu virus at its source. so don't wait. call your doctor right away. tamiflu is prescription medicine for treating the flu in adults and children one year and older whose flu symptoms started within the last two days. before taking tamiflu tell your doctor

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♪ in just a moment what i'm grateful for this thanksgiving. but first, a correction on something i said during my story of the week last sunday. while detailing the growth of

the surveillance state in the context of former cia director david petraeus's demise i showed a graph illustrating the rise in u.s. government requests to google for user information. i said that the 7,969 requests google received from january to june of this year did not come with a warrant. that is not entirely accurate. google does not break out the number of government requests it receives by type or by how many come with a warrant and how many do not. it's likely that several types of the requests google gets such as court or wiretap orders would come with a warrant, while many other requests would not. i regret the error. usually we do now we know in this portion of the show. but since we just celebrated thanksgiving, which also happens to be my favorite holiday, i thought i would take a moment to observe the very important ritual of expressing gratitude. one of my favorite people on twitter, feminist hulk captured the potential of giving thanks this way. gratitude is first step in

recognizing privilege. the next is battle oppression that prop it up from hulk's companies beginnings to now. to say i'm thankful i have a job and health insurance is to force us to question why that is a blessing at all. and so with that in mind, i am thankful for the opportunity to have spent thanksgiving with my wife and my child and my extended family, a source of joy unavailable to many of our troops including 68,000 americans currently serving in afghanistan and the families both american and afghan of those who have died in the 11 years of war there. i'm thankful to live in a place where we have access to clean water and electricity, and we do not sleep away are the windows for fear of stray bullets. and we do not worry about the rocket fire overhead or a mortar shell, or a mortar strike destroys the home we have fled. i am thankful i can feel some measure of control over my life and my future and not feel as though my fate is in the hands of remote powerful forces armed to the teeth pursuing their own objective and wreaking havoc in

my own life. i'm thankful for all of the civil servants who day in and day out work to provide the kind of basic goods that are the underpinning for other kinds of human flourishing. from those at the federal aviation administration who oversee commercial air travel that keeps 25,000 flights a day safe and hasn't had a fatality in three years to the tax processors of the internal revenue service who quite literally make the rest of governance possible, to the men and women who run our municipal water treatment facilities and the unionized workers of the new york subway system who somewhat miraculously got the system back up and running in astonishing short order after sandy flooded many of the subway's stations and tunnels. i am thankful for this job, which i love, and the opportunity to do this work. and i am inordinately grate to feel the crew here with "up with chris" as well as the staff. jonathan larson kim harvey todd cole sal genteel, allison koch tera metzer diane seamus

matty fox, henry melche guthrie, and scott rocco, al of whom do imaginative, rigorous uncompromising journalism each and every week. and finally all of us that work on the show are extremely grateful that there are viewers out there like yourselves who watch the show and argue with it and send me e-mail and tweets both occasionally enraged. i'm genuinely thankful to live in this stranger ra in which technology puts us in close contact with our critics, their occasionally brutal criticism forces to constantly think hard what we're doing here on this show, and whether we are living up to the potential of this medium and the wonderful privilege of being able to talk to you every weekend. so thank you for being so engaged. and thank you for joining us today for "up." join us tomorrow sunday morning at 8:00. we'll have democratic congressman steve cohn. we're also going to be talking about the situation in israel and gaza and the crazy news out of egypt, mohamed morsi who is the new prime minister there

emerging as one of the most fascinating world figures in the world. one day he helps negotiate a ceasefire in gaza and the next declares himself essentially a unilateral dictator. we're going to dive deep into that. look at the outcomes of winners and losers from the gaza situt susan rice and the future of foreign policy in the second term. we'll see you tomorrow at 8:00. thanks for getting "up." with the 2-in-1 swiffer sweeper, a great clean doesn't have to take long. i'm done. are you thinking what i'm thinking? ♪ give me just a little more time ♪ okay. all right. oh! [ female announcer ] the 2-in-1 swiffer sweeper uses electrostatic dry cloths to clean better than a broom. and its wet mopping cloths can clean better than a mop in half the time so you don't miss a thing. mom, have you seen my -- hey! hey! he did it. [ female announcer ] swiffer. better clean in half the time. or your money back.

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