talking earlier about what states do. a lot of states already do it. this, by the way, goes to the other difference that we have when it comes to interstate purchase of insurance. actually, this is a republican idea, been championed by the republicans. we actually agree with the idea that maybe if you getor regional markets and national markets as opposed to just state- state-by-state markets, you might get more choice and competition. people might be able to say, gosh, there's a great insurance company in nevada and i live in new york and maybe i can purchase it. that's actually something we find attractive. so do you guys. but, again, the one difference, as i understand it, and the reason you're not supporting the approach that we take is what we say is there should be sort of a minimum baselined benefit. because if not, what ends up happening is you get a company set up in nevada -- let's assume there were no rules there, there

are no protections for the woman who has breast cancer. they go in to new york, they offer pretty cheap insurance to everybody who's healthy. they don't offer the same insurance to people who aren't so healthy or have pre-existing conditions. they drain from new york all the healthy people who are getting cheaper rates but now suddenly everybody left in new york who doesn't qualify for that cheaper plan is in a pool that's sicker, older and their premiums go up. so, what we've said is, if we can set a baseline, then you can have interstate competition but it's not a race to the bottom. rather everybody has some basic care. now, these are legitimate arguments to have. i just want to point out that this issue of government regulation, which we're also going to be talking about with respect to insurance, is very different than the way this has

been framed during the course of the debate over the last year, which is government takeover of insurance. this is not a government takeover of insurance. what it is is saying let's set up some baselines, use the private sector and pooling and make sure people get a better deal. so, jim -- then we're going to move on to the next topic, but anyone who wants to pick on what we just talked about, obviously, can return to that as well. >> thank you very much, mr. president. mr. president, ladies and members of the congress, the two cost containment issues that i don't think have been sufficiently vetted here today, let me set this up. i'm sharing with you a conversation i had yesterday with the administrators of the dillon -- mccloud health care center in dillon you've become

quite familiar with, mr. president. they told me that their emergency room activities have doubled over the past several years. they were looking for some assistance to expand the size of that emergency room. when i began to question them as to why, in this small county -- not in my district -- they've had such a doubling, what it turns out is that they told me that 31% of the people that they treat in that emergency room are not there for emergencies. they are there for primary care. now, they said to me that some of these people do not have health insurance. but many of them do have health insurance, but they cannot

afford the $1,500 to $2,000 deductibles that they would have to pay if they were to go to a private primary care provider. so, they are now treating people who have employer-based health care that they cannot use, they're holding that for some catastrophic event, but they need some assistance. now, i think that no matter what kind of plan we develop, there will be many people left uncovered and we need a safety net for those people. i believe, for one, we are to provide that safety net and to take care of all those people who may be uncovered and those people who have $2,000 deductibles with primary care is

for a significant expansion of community health centers. and we have not spoken about that yet today but i know that your proposal, mr. president, both the house and senate plans have that in them. and i do believe that that is very, very important. we have more than a 40-year experience with these health care centers and i do believe that no matter what we do, there ought to be a significant expansion of those health care centers. secondly, mr. president, a lot of other things have been said about what i have on this paper. one other thing i would like to mention, and it has to do with people who really cannot navigate the system, people who work very hard.

they know what they need for themselves. but i was reminded of that, when we talk about putting together restaurant owners who will design plans for their members, i would hope that when we start designing plans for the members of small businesses, let's keep in mind that the employees of those small businesses are not negotiating these plans. they are at the mercy of the small business owners and the question is whether or not the plans are sufficient, that they will not fall into the same category that these people with $1,500 to $2,000 deductibles. finally, mr. president, this morning i was doing one of these call-in shows on c-span. a gentleman called in and was very, very emotional. he said to me that he was

getting ready to have transplant surgery. but he was told by the hospital that because he's on medicare that his post-operative treatment was going to be limited to three years. after that, he will have to find some way to pay. this man was very emotional today. what we're doing here fixes that. and i do believe that we ought to really be honest with american people. we talk about what we're doing with medicare. we're trying to make sure that medicare is there for that man and so many others who will find themselves in this position. >> okay. i think this has actually been a very useful conversation.

what i'm going to do is move on to the next topic, but maybe after we break for lunch and come back, i want to go through some areas where we decided we agreed. i know the abuse is a good example. some areas where we still disagree. one thing, jon, you shook your head when you said people would be able to choose the better plan because the notion is that people are mandated. actually, any insurance you currently have would be grandfathered in, so you could keep. so, you could decide not to get in the exchange the better plan. i could keep my acme insurance, just the high-deductible, catastrophic plan. i would not be required to get the better one. if i chose to get the better one, it would be 14% to 20% cheaper than if i were going into the individual market. i just wanted to clarify. >> mr. president, if i could clarify, that's for a very limited period of time, number

one. secondly, the incentives are set up so that employers would drop you from their coverage because it's cheaper for them to pay the fine than to continue to pay the insurance. so, they wouldn't be able to keep what they have. and, third, there are still mandates in the legislation as to what you can do with what you have such that it doesn't end up being the same coverage. so, with all due respect, i disagree. it's just a fundamental disagreement between us. does washington know best about the coverage people should have? or should people have that choice themselves? pay a little less, get a little coverage or pay a little more and get a little more coverage. >> any time the question is raised as to does washington know better, i think we're tipping the scales a little bit there, since we know that everybody is angry at washington right now. i think that -- so, it's a good way of framing -- it's a good talking point, but it doesn't actually answer the underlying question, which is do we want to

make sure that people have a baseline of protection. and this topic of the insured market reforms is, i think, a good additional example of what may be philosophical differences but what we may have in common. rather than go through the problem, because i think everybody understands out there people with pre-existing conditions not being able to get insuran insurance, people coming up with -- bumping up against lifetime caps and suddenly thinking as a family i met in colorado, they thought their child was covered. suddenly, they hit the lifetime cap and they started having to scramble to figure out how they paid the additional costs. we are all familiar with these examples. i just want to go through areas where i think we agree on insurance reforms, or at least some republicans and some democrats agree. i think we agree on the notion that you can't just drop somebody if they've already purchased coverage. looking at your bill, jon, the

idea you ban -- we agree on expanding coverage to a certain age. some people say up to 25, some people say up to 26 but we basically agree on that concept. we agree on no annual or lifetime limits. we agree, philosophically, that we want to end the prohibition on pre-existing conditions. the thing we'll have to talk about is how do you actually accomplish that. there may be a disagreement as to whether you can do that without making sure that everybody is covered. but that's something that we can talk about. in addition, though, there are some other insurance be reforms that have been proposed by the house and senate in their legislation that i think we should explore. and maybe we can narrow the gaps there and come up with even a longer list of areas that we agree on. so, what i do is -- i want to

make sure that mitch doesn't give me a time clock tally again, let me first go to mitch. i don't know who wants to make the presentation with respect to insurance reform. >> mr. president i would like to yield to dr. bistonti. >> thank you, mr. boehner. thank you, mr. president. i come at this as a physician, cardiovascular surgeon, over 20 years of practice doing open heart surgery dealing with patients who have come to me with very, very challenging cases at very difficult times in their lives. along with my colleagues, dr. cobert and dr. varaso, we bring a wealth of experience in dealing with insurance companies and these everyday problems that so many american families face. we all agree -- we all agree that we need insurance reform. there's no question about it. the question is, how do we do

it? now, we've all been through a long year, town hall meetings, telephone calls, e-mails. it goes on and on. one thing that has become very clear, the american people have spoken out very loudly, very clearly. they want us to take a step back and go step by step with a common sense plan that really brings the costs down for american families and small business owners. they want insurance companies to treat them just like they treat the labor unions and large companies. it's been a resounding message we've heard over and over. so, how can we achieve all this? well, we talked about some of it. one of the things we ought to look at is how do you simplify streamline and standardize all the paperwork that's involved? i can tell you as a doctor, and my two colleagues who are physicians will know, it takes you away from patient care. it interferes with the doctor/patient relationship.

it runs up costs in medical practices and it's a real issue. so, i believe -- i think we can all agree on that. we need to address that issue. a second area is how do you really promote choice and competition? we've all talked about it. we've had a lot of discussion already on those issues. we put forth a plan earlier in the year during debate that actually the congressional budget office showed that it brings down the cost of premiums up to about 10%. actually, for individuals seeking -- families seeking insurance in the individual market, those cost savings could even be higher as opposed to the bill we have here, where we've had some discussion already, and mr. camp has already outlined, as well as mr. kyl, that this bill would actually raise premium costs. we talked about small business health plans.

you know, again, i ran a small business as a medical practice. when i wanted insurance, when those premiums were going up in double digits every year, i would call an insurance agent. they would come in. we had very limited choice, very limited. and the costs kept going up. >> you are watching msnbc's live continuing coverage of today's bipartisan health care summit at blair house. good day, everyone. i'm andrea mitchell in washington. it has been quite an extraordinary morning here in washington, watching president obama open this summit, bringing democrats and republicans to the table together to discuss the stalled efforts in the fight for health care reform after a year of gridlock. the president opened by saying we all know that this is urgent. he set the tone by telling those in the room this is not political theater. we pretend the cameras aren't here. republican senator lamar alexander countered for the republicans and said we believe we have a better idea, and his idea was to start over. linda douglass, director of

communications for the white house, joins us from the north lawn. they tried to exchange ideas on cutting costs. there didn't seem to be any area of agreement. >> boy, andrea, first let me correct that. you gave me a promotion. i'm director of communications for health reform. i don't want to take dan piper's job. >> i'm always glad to promote you. we need more women in big job. >> we do, indeed. areas of agreement, actually, andrea, i would disagree with that. health insurance system. they believe in small businesses being able to pool together to

spread the risk and lower the costs for small businesses that are going to be purchasing health insurance. they agree that there have got to be strong provisions to crack down on waste and fraud. the president's own proposal includes a number of specific republican proposals. they agreed on all of that. one thing they seem not to agree on was whether there should be a minimum standard of benefits for americans buying health insurance so that there are common sense rules that consumers can rely on so you know what you're getting from the insurance companies so that the insurance company doesn't decide how long a woman getting a c-section stays in the hospital. that woman and her doctor get to decide. there was disagreement there. we believe there should be some minimum benefits that you know you can expect from the insurance company. >> linda, how do you get past the roadblock disagreement, profound disagreement where the republicans say that the bills that are on the table, democratic bills and the president's proposal to merge those two, house and senate,

bills, are not starting points? that we should not take what's already on the table, that we should start over? that's their starting off point. >> yes, it is. as they well know -- first of all, health insurance premiums are, you know, rising. they doubled over the last decade three times faster than wages, out-of-pocket expenses went up by a third. insurance companies around this country are hiking premiums by double digits. 40% requested hike in california, ten times higher than health care spending. there's an urgent need. they clearly acknowledge that. the congress has been working on very good proposals that passed both houses already all year long. these are proposals that lower costs, shift power away from insurance companies into the hands of consumers, start to reduce the deficit. health care spending is pushing our deficit up. they want to make sure there's stability and security so that everybody can buy affordable health insurance. we're talking about a big middle

class tax cut for health care for middle class families to afford health insurance. these are ideas the president believes we should be moving forward on. >> of course, they also say that they disagree with the cost projections. they don't disagree that there's a problem, but they don't think that the president's plan will bring costs down. they think it will be far more expensive than the white house, even the cbo has acknowledged. and they don't think that the cost benefits are there in the program as the white house does. >> well, you know, the congressional budget office, as you say, the nonpartisan objective analyst who has looked at all these provisions has found, number one, in terms of the big picture, it reduces the deficit by more than $100 billion, around $1 trillion in the next decade. in terms of real people's premium costs, the congressional budget office found thatç premiums would go down in the individual market where you buy your own insurance, for small businesses, even for people who get insurance from a large

company and for most americans buying in the individual market there would be a tremendous reduction in premiums because most of them would get tax credits to help them purchase insurance, like a 60% reduction is what he was saying for those americans, most of them who would be getting some kind of tax credit to help them purchase insurance. there's a tremendous reduction in premiums. >> linda douglass, proving once again she deserves all the promotions that the white house can give her. thank you, linda, from the white house lawn, across the street from blair house. >> thank you, andrea. democratic strategist michael feldman and pat buchanan. you've been watching the white house and republicans going back and forth. first of all, pat, your take on how this -- the republicans are at a certain built-in disadvantage, i should say. it is the president's turf. he is the chair of this. how do you think they've countered that in the way they've presented themselves? >> the audacity of hope against the party of no.

but, andrea, i am astonished at how well the republicans did and how wise and savvy mitch mcconnell was. as soon as it was thrown to him saying, mr. president, lamar alexander is going to present our case. i thought lamar did the best job i've seen him do in a long, long time. >> tennessee senator, former governor, and communications secretary under george bush 41. >> they didn't buy the car last year, it cost too much. we need a new model. let's go piece by piece. and then he went after reconciliation as a terrible thing. sure enough, harry reid comes up and, three times, you're entitled to your own opinions, my friend, lamar. you're not entitled to your facts. frankly, it was a terribly partisan moment for the democrats. you went back to the republicans and tom colburn was very good, he had good ideas. obama himself agreed about these

undercover patients going in, and schumer. president's opening remark were terrific. the republican party has done itself well and credit not only goes to lamar and colburn, but mitch mcconnell who strat enjoysed this and realized they had a tough time in baltimore. i think the democrats are the ones on the defensive. >> well, mr. feldman? >> i agree with a lot of what pat se". i think it was smart to have lamar present the case rather than mitch mcconnell. he is a better face. are they going to have a debate or actual meeting of presenting ideas. is this going to be a discussion or talking points? you've seen the contours of how this is unfolding. the president says look, let's get something done. here is my ideas. bring me yours. the republicans who, i agree with pat, are doing a masterful job of the rhetoric, are very carefully trying to drive the

process into the ground. we'll see. they may actually come to an agreement on a few ideas. we've seen we've got to scrap this and start over. that is code for actually killing health care. >> i've never heard the undercover patient thing going into doctors and see if the doct doctors give them all these extra tests. schumer said that's a terrific idea. the president said you have some good ideas. >> they won't have a bill if there's no way forward on a bill, according to the republicans at least, pat, then none of these ideas will see the light of day. >> that's the key. is there legislation? linda outlined areas and so did pat, where there are beginning to be agreements. can that be the basis on what they can pass? >> the obama/reid/pelosi bill, republicans won't go for that. but they've got a lot of ideas and there is a lot of common ground. >> former human and health

social services joins us now, served under bill clinton, in the clinton administration. donna, thank you very much for joining us from university of miami. you've been watching so far today as they exchange ideas, but you also understand where politics -- sort of where the rubber meets the road politically. do you something something coming out of this that will result in real legislation and health care reform, something you worked on very hard during the clinton years? >> i do. i don't know whether they're going to get bipartisan support for the bills that the democrats tend to probably move forward with, but certainly you can see the major areas of agreement, whether it's fraud in the system or paperwork problems, or the need to cover people in the individual market to make sure you eliminate pre-existing conditions, give them a way of reducing costs so that small businesses can provide health

insurance. all of those require subsidies. at the end of the day, i want to hear from the republicans how they would cover the number of americans that are uninsured. they're not all in small businesses. they're not all going into the market and buying individual policies. the democrats areç talking abo covering 30 million people. that's where the expense is, unless you get them covered, you really can't do things like eliminate caps, pre-existing conditions. a lot of things you need to do. there certainly is a lot more agreement than the public has heard up until now. though still the theme of let's scrap the bill and start again is there. you also hear the fundamental issue of the role of government. this is something that pat buchanan would resonate with. should the government have a framework around health care? should it make a difference where you live on the quality and access you have to health

care in this country? particularly if the government, if taxpayers are funding it. democrats believe that he should have that framework. i'm not so sure republicans believe that you should have that framework. that's a fundamental debate in american politics and in american history. we believe that if someone is born into a poorer area, if the government is going to provide health insurance, the quality of that health insurance ought not to differ from one side of the country to the other. and that's a really important discussion that is underlying a lot of what we're hearing today. >> donna, let me ask you about the students that you're surrounded by, that you lead at the university of miami. one of the fundamental differences is the issue of a mandate. the president has backed off of that, but without a mandate to require these young, healthy people, to opt in, doesn't that not create a big enough insurance pool of healthy people to lower, eventually lower

costs? >> well, i think what the president has said is that you have to have catastrophic insurance, at least to protect your family if something horrible happens to you. i happen to believe in the mandate, because i do believe you need healthy people in the system. the most important thing is not to let people go in and out of the system, because when you feel that you're healthy -- that's what's happened to the individual market in california. i mean, one of the reasons for those increases -- not all of the reason, but one of the reasons for the increases that everybody is denouncing now is because healthy people, feeling the economic crunch, are coming out of those individual markets, left with people that aren't as healthy and, therefore, the costs go up in those individual markets. >> right. >> thought we ought to be able to figure out and agree upon. >> donna shalala, thank you very much from the university of miami. we go back to the summit now, john mccain weighing in. >> there's 330,000 seniors under

medicare advantageç in my home state of arizona. they're deeply concerned about that. they're deeply concerned about the carve outs for vermont, massachusetts, hawaii, michigan, connecticut. $100 million for a hospital in connecticut. what -- why -- why should that happen? they don't understand it. and at the town hall meetings that i conduct all over my state, people are angry. we promised them change in washington and what we got was a process that you and i both said we would change in washington. so then we got into the special interests, whether it be the hospital association or the ama or others. one that was particularly

egregious, and i won't go through the whole list, was pharma. pharma got an $80 billion deal for which they ran $150 million worth of ads in favor of, quote, health reform. their lobbyist was here at the white house and was reported to say in the media, "a deal is a deal." and part of that deal was that there would not be competition amongst pharmaceutical companies for medicare patients. the other -- among others, was that the administration would oppose drug reimportation from canada, a proposal that you supported in the united states senate. >> john, can i just -- >> can i just finish, please? >> yeah. >> and christmas day, i believe it was christmas, the majority

leader said, quote, a number of states are treated differently than other states. that's what legislation is all about. that's compromise. compromise is not the word for that. so, when my constituents and americans now who overwhelmingly reject this proposal say go back to the beginning, they want us to go back to the beginning. they want us not to do this kind of legislating. they want us to sit down together and do what's best for all americans, not just for some people who live in florida or happen to live in other favored states. they want a uniform treatment of all americans. so, i hope that that would be an argument for us to go through this ç2,400 page document, reme all the special deals for the special interests and favored few and treat all americans the same under provisions of the law so that they will know that geography does not dictate what kind of health care they would

receive. i thank you, mr. president. >> look, let me just make this point, john. because we're not campaigning anymore. the election is over. >> i'm reminded of that every day. >> yeah. so, we can spend the remainder of the time with our respective talking points going back and forth. we were supposed to be talking about insurance. obviously, i'm sure that harry reid and chris dodd and other s who went through an exhaustive process through both the house and the senate with the most hearings, the most debates on the floor, the longest mark-up in 22 years on each and every one of these bills would have a response for you. my concern is that if we do that, then we're essentially

back on fox news or msnbc on the split screen just arguing back and forth. so, my hope would be that we can just focus on the issues of how whoa actu we actually get a bill done. and this would probably be a good time to turn it over to secretary sebelius who -- >> can i say, mr. president, the american people cared about what we did and how we did it and that's a subject that i think we should discuss. >> they absolutely do care about it, john. and i think that the way you characterized it, obviously, would get some strong objections from the other side. we can have a debate about process or we can have a debate about how we're actually going to help the american people at this point. and i think the latter debate is the one they care about a little bit more. so, kathleen, why don't you just address some of the issues related to insurance reform?

there's some agreement here, but i know that on the republican side, there are a couple of concerns about rate purview, the issue of setting up some benchmark standards that insurance companies have to abide by. some people may think that those have been a little bit too aggressive. you've been both a governor as well as an insurance commissioner. maybe you can talk a little bit about uhq you've seen at all those different levels and how you think we can best move forward to protect american fami families. >> well, thank you, mr. president. i know there are lots of people who want to comment on these topics, but i don't think there's any question -- i think there's a lot of agreement that the current insurance market really fails way too many people. it is a system that is not a market for about 40 million americans who are either in an individual policy or in a small group policy, have no choice.

there is no competition, according to the american medical association in their study yesterday, 99% of the market in metropolitan areas, 75% of the markets across the country are very skconcentrated which means they're monopolies, they're not markets. so we've got a trap. and i think the rules allow people to be locked out from the front end if you've got pre-existing conditions, allow people to be thrown out with a stop on benefits during the course of a treatment or when your policy expires and you're supposed to renew, you're dumped out of the market, or to be priced out, which is going on across this country. there's been a highlight of a couple of rates, but double-digit rates across the country on top of double-digit rates on top of double-digit rates and people have no choices. so, the common areas, i think, of agreement, high-risk pools.

there are lots of states across the country running high-risk pools. as an insurance commissioner, we ran the high-risk pool in kansas. it is a strategy that's been in place for almost 30 years in many states. 200,000 people total in the entire united states are in high-risk pools because they're so expensive that they really don't offer anything -- when you put all the sick people together and you say, okay, you get to buy a policy and you get no help with that policy, it is a death spiral. you will always have the highest costs and, on top of that, the highest costs and you've got the sickest people who are already paying the highest costs for treatment. they don't work very well. they are a stop gap measure that the house and senate have proposed to get people from here to a new market. i think what -- the exchanges have a lot in similarity with the health plans that have been

talked about by the house and senate. there's a big difference. it's not a washington difference. it's a state difference. state insuranceç commissioners across this country have unanimously opposed health plans for decades. and they feel that it takes people -- it isn't the pooling that's objectionable. it's the fact that there is no consumer protection, that there is no ability to apply common sense rules. and we had the drive-by deliveries in kansas, cleveland cliniced out of the hospital after having a baby only to be remitted with jaundice and dehydration. it's not a particularly good idea. getting rid of pre-existing conditions, getting rid of caps on yearly benefits, ideas that have been accepted by both.

setting up a new marketplace. giving small business owners and individuals choice and competition in the private sector, but making the private sector operate on a different set of rules, including having some loss benefit analysis. how many of those dollars you heard senator coburn eloquently talk about 30 cents of every dollar that goes to pay for expenses other than medical costs. a loss benefit analysis and medical ratio would do just that. how many of your dollars are you actually spending on provider care, on prescriptions, on treatments? and how much is going to overhead, ceo salaries and advertising to try to get a handle on rates. having some rate review, having some transparency and some opportunity to have people make choices and make companies compete with one another and not separate the marketplace.

i think the most dangerous part of the system right now is having people -- having insurance companies pick and choose who gets coverage and who doesn't, based on your health condition. it's a lot cheaper to insure people who promise never to get sick. i watched it as insurance commissioner. but segregating that market is not insurance. it's not pooling a risk. your proposal, mr. president, gets back to the fact that there would be a pool. there would be an opportunity to pool that risk and have the people that have the negotiating powers as governor and senator alexander, i am a former governor. we both ran our state employee health pools -- i don't know about tennessee, but in kansas that was the largest pool in the state, 90,000 covered lives. we had a lot of negotiating power. we could get aç pretty good de on a couple of companies competing on hospital rates, on doctor rates. that's what this kind of pooling mechanism and new exchange would give everybody, and it's a set

of standards that made sense. >> mr. president? >> yeah. >> mr. cantor, please. >> eric? >> mr. president, thank you very much for having us and staying with us for the six hours. appreciate that. i don't know if you will, after the six hours or not. >> let me just guess. that's the 2,400-page health care bill. is that right? >> actually, mr. president, this is the senate bill, along with the 11-page proposal that you put up online that really i think is the basis for the discussion here. but i did want to go back to your suggestion as to why we're here. and you suggested that maybe we are here to find some points of agreement to bridge the gap in our differences. and i do like to go back to basics. we're here because we republicans care about health care just as the democrats in this room.

when the speaker cites her letters from michigan and the leader talks about the letters he has received, mr. andrews his, all of us share the concerns when people are allegedly wronged in our health care system. i mean, i think that is sort of a given. we don't care for this bill. i think you know that. the american people don't care for the bill. i think that we demonstrated, you know, in the polling that they don't. but there is a reason why we all voted no. and it does have to do with the philosophical difference that you point out. it does have to do with our fear that if you say that washington can be the one to define essential health benefits, there may be a problem with that. and that's the language in section 13.02 of this bill. it says the secretary shall define for people what essential health benefits are. but in the spirit of trying to

come together, let's try and say if we assume that washington could do that, could really take the place of every american and decide what is most essential, what would be the consequences? and that's also where we have a big difference in this bill and what would happen. first of all, the costs. jon kyl laid out the tremendous costs in the nearly trillion dollars of this bill. and i don't quite know, because cbo said it couldn't assess how much your additions would cost. there are plenty ofç taxes on income, now you suggest investment income should be taxed. we have additional taxes on medical devices and the rest. what is the consequence of that? we know there are consequences that small businesses will feel because of the impact on job creation. but also, mr. president, when we were here about a year ago across the street, you started

the health care summit by saying one of the promises you want to make is that people ought to be able to keep the health insurance that they have. because as we also know, most people in this country do have insurance and an overwhelming amount of people do like that korchl, it's just too expensive. the cbo sent a letter, i think it was to leader reid, about the senate bill. and in that letter, it suggested that between 8 million and 9 million people made very well lose the coverage that they have because of this, because of the construct of this bill. that's our concern. as we are in the market, in the section of this discussion about health insurance reform, i know, mr. president, you have suggested strengthening oversight of insurance premium increases, because we want to make sure that they're on excessive insurance premium

increases that take place. the problem is when you start to mandate all of the essential benefits, there are going to be some insurance premium increases. none of us really want to see them. but if you stop them, who is going to pay for it? well, then we get back to the fact that businesses won't be able to pay for it and people are going to lose their coverage. i guess my question to you is, in the construct of this bill, if we want to find agreement, we really do need to set this aside. and we really do need to say, okay, the fundamental structure is something we can't agree on, but there are certainly plenty of areas of agreement. and because i don't think you can answer the question in the positive to say that people will be able to maintain their coverage, people will be able to see the doctors they want in the kind of bill that you're proposing. >> well, let me -- since you asked me a question, let me

respond. the 8 to 9 million people you refer to that might have to change their coverage, keep in mind out of the 300 million americans we're talking about, would be folks that the cbo, congressional budget office, estimates would find the deal iç the exchange better, would be a better deal. so, yes, they would change coverage because they've got more choice in competition. let's be clear about that, point number one. point number two, when we do props like this, stack it up and you repeat 2,400 pages, et cetera, the truth of the matter is that health care is very complicated. and we can try to pretend that it's not, but it is. every single item that we've talked about on the republican side, if we wanted to exhaustively deal with fraud and abuse, would generate a bunch of pages. i point that out just because, you know, these are the kind of political things we do that prevent us from actually having

a conversation. now, let me respond to your question. we could set up a system where food was probably cheaper than it is right now if we just eliminated meat inspectors. and we eliminated any regulations in terms of how food is distributed and how it's stored. i'll bet in terms of drug prices, we would definitely reduce prescription drug prices if we didn't have a drug administration that makes sure we test the drugs so that they don't kill us. but we don't do that. we make some decisions to protect consumers in every aspect of our lives.

and we have bipartisan support for doing it. because what we don't want is a situation in which suddenly people think they're getting one thing and they're getting something else. they're harmed by a product. what secretary sebelius just referred to, which is not a washington thing -- in fact, state insurance standards in many states are higher than anything that's done in washington, is as a consequence of seeing consistent abuses by insurance companies and people finding themselves helpless to deal with it. now, we can't have a philosophical disagreement about how much insurance regulation is appropriate. what you've indicated to me, just based on the bills i've seen is you guys believe in some regulations. you already said you did. you believe in making sure that you can't just drop somebody with coverage.

now, if you don't have a law there, let me tell you, that happens all the time. i've got a bunch of stories in here of folks who thought they had çinsurance, got sick. the insurance company goes back and figures out a way to drop them. i'm not making this up. i'm not trying to just add to the pages of that bill. it's in response to an actual problem and you guys have agreed to it. so, philosophically, at least, on a whole range of issues, you agree we should have some insurance regulation. my suggestion had been we try to focus on what are the specific regulations, since we agree there have to be some -- what are the specific ones that you object to. let me close by saying this. pre-existing conditions is one that, theoretically, we all say we agree on. theoretically, everybody thinks it's a bad deal if my wife's had

breast cancer, i lose my job, i now try to buy insurance and they say, you know what? if we're going to -- we can't cover you, because your wife has a history of cancer. we all think that's a bad deal. there are two options, two ways of dealing with that. one is what kathleen raised, which is a high-risk pool. you could say, you know what? you can go in there and buy it in a big high-risk pool. by the way, you could probably set up high-risk pool without having as many pages in the bill. and it's an option that's been around for 30 years. here is the problem. what happens is the reason that all our rates, as members of congress or as elected officials are pretty low, there's such a big pool, millions of federal workers and as a consequence any single one of us has cancer, any single one of us has a child with a disability, our costs are spread out over millions of

people and so all of us are able to keep our rates relatively low. even though if any individual in that situation was trying to buy insurance, it would sky rocket. that's the concept of pooling. you get the healthy people and the young people alongside the not so healthy and the older people. we're all spreading our risk. each of us don't know at any given time what might happen. maybe our kids is the one who gets diagnosed, heaven forbid, for something. as a consequence, we insure ourselves by making sure that we're also insuring somebody else. when you get into something like a high-risk pool, what happens is that all the sicker, older people are in that pool. all the younger people, they end up getting really cheap rates and, overall you could say that's how the market works. it's a good thing. there's more choice. there's more choice for the young, healthy person, but not for the personç who, heaven forbid, got sick.

now, on pre-existing conditions, we've got a similar situation. the challenge we have -- i would love to pass a law that said insurance companies, you can't exclude people based on pre-existing conditions. the problem is what they'll say to you is, you know what? what prevents somebody from not buying insurance until they get sick and then going in and just buying it and gaming the system? so, we've tried to respond to a difficult problem by saying, let's make sure everybody has some coverage. without that, it's hard to do. i just wanted to respond to, yes, we've got a philosophical objection, but let's not pretend that any form of regulation of the insurance market is somehow some ownerous burden that's going to result in terrible things happening to consumers. that's a good thing. >> mr. president, if i could respond. >> please. >> we, again, have a very difficult bridge to gap here,

because i know that this is something that we don't want to look at, but these are, as you say, the complexities of what this is about. when you start to mandate that everyone in this country have insurance and you lay on top of that, now the mandates that we all would like to see in a perfect world, there are consequences to that. we just can't afford this. that's the ultimate -- that's the ultimate problem here. in a perfect world, everyone would have everything they want. this government can't afford it. businesses can't afford it. that's why we continue to say, go step by step, trying to address the cost and ultimately we could get there. we're asking that you set aside this mandated form of insurance regulation -- this mandated form of health care regulation and let's go back to things we can agree on without this trillion dollar attempt here. that's all. >> i think the cost issue is

legitimate. whether we can afford it or not, we'll be discussing that. i think that's an entirely legitimate discussion. >> mr. president, can i have ten seconds, little more than ten seconds? >> go ahead. >> if you agree that you can't be dropped, there has to be dependent coverage there's a lifetime cap, then, in fact, you acknowledged it's the government role. the question is how far to go. this idea we have a fundamental philosophical difference, you're either in or you're out. you either say government can't do it, none of it or they can do some of it and we argue how much. >> the cost issue is legitimate. we're going to address that. >> mr. president, if i could, it's not just -- it's the cost issue, but it's being driven by the fact that you got in the bill, which i assume that your proposal supports, that the secretary define what a health benefit package should be. >> only in the exchange. only as part of the pool that people who don't have health insurance would buy into.

if you're -- you wouldn't -- if you were working at a big company that already has a big pool, then -- but, you know what? i want to make sure, because, eric, we're going to end up in a back and forth that cuts everybody else out. i've got on the democratic side a couple of people that want to speak. there are probably a couple republica republicans. we're already over time. i've burned some of it. i apologize. i'm going to go to luis, then -- >> to mike enszi. >> i'll go to tom harkin and back to dave. so i've got five speakers and i don't have a lot of time. go ahead. >> thank you, mr. president. thank you to all my colleagues. i am pretty succinct and timely. i won't take up a lot of time but sure do have to say some

things. pre-existing condition absolutely has to go. it is cruel, capricious and done only to enhance the bottom line. >> as members of this summit go back and forth, arguing about who has taken more time, and the president apologized for taking too much time out of the democratic side, louise slotter, is speaking. mike pence joins us. you've been watching from the hill. it's the president's turf. they're in his court. eric cantor brought the senate bill, most remarkable exchange, i think, so far was between the combatants from the 2008 campaign, john mccain and barack obama. what's your impression? >> my impression is that, you know, this is a good government. it's bad tv. i mean, the reality is while we were promised a serious negotiation where the president a few weeks ago said that he was going to bring various parties together and look for areas of common agreement, you know, what

we're seeing here from the president forward is just a restatement of the positions that the administration has cf1 o the democrats in the! senate and house have taken. republicans are doing their level best to try to convey that the american people want this administration and democrats in congress to get the message, scrap the bill and start over with a clean sheet of paper. but, i've got to tell you, i'm not impressed with what we're seeing. for all the president's, you know, repeated, somewhat condescending statements, he said to john mccain the campaign is over and we have to get away from talking points. all we've gotten from the president is talking points. we got the president restating the bill that he dumped on the american people on monday and the american people want to scrap and move on. >> let me ask you. let's say there were talking points from the president and his colleagues, the democrats. what is not a talking point from

what everyone from lamar alexander presented very nicely, but the talking point from the republican side has been let's start over. so, do we ever get past those two sets of talking points? >> well, you know, i think it's up to the party that's in the majority and the party that's in the oval office to decide whether we get past it. and it really all begins with the president being willing to start with a clean sheet of paper, which he obviously is not willing to do. i think what millions of americans, those that haven't tuned it out today, were hoping to see was a serious conversation about common ground. if the president sat down and said look, we've had bills. you've had bills. let's write across the top of a piece of paper what we could agree on and everybody kick in and look for some modest, incremental, step-by-step measures, i think it would have been a very productive couple of hours. instead the president started out with a long monologue, defending his government takeover of health care.

i have to tell you, the real winner today is "the price is right." i have to think millions of americans saw this as tv land and not a real negotiation and tuned over to another channel pretty quick. >> i appreciate your television critique. when we talk about health care and the actual substance of what's been going on, isn't he saying -- isn't the president saying if you look back at what's happened so far today, didn't he say let's figure out areas that we can agree on? >> right. >> aren't they saying let's come up with a smaller package? >> yeah. >> he's not saying let's go back to the senate bill, even though eric cantor brought the whole senate bill. >> when did he say let's go to a smaller bill? he didn't rule out reconciliation. harry reid denied he was talking about reconciliation, certainly would be news to most reporters here in washington. that's almost all they've been talking about, is forcing the senate bill orç some version o obama care 2.0 through on a

simple majority. the president says he has an open mind. i haven't seen any evidence of that. the american people have seen almost a professor with a petulant group of students. he has repeatedly interrupting republicans. he has repeatedly jumped in and felt the need to answer every time republicans outline our desire to allow americans to purchase health insurance across state lines, allow businesses to have small business association plans, pass tort reform. time and time again, the president is stepping up and essentially rebutting each of those. i don't see much evidence of an open mind here. what i see is a lot of political posturing, a lot of sentimental statements by democrats around the table that all seem designed to where they can throw their hands up in the air and say to the american public, we tried but now we're just going to have to ram through that government takeover of health care that these republicans aren't willing to help us with.

>> mike pence, i'm going to put you down as a no as to whether you think this has been a good idea. thank you very much, congressman. >> thank you, andrea. >> good to see you. joining us now, as the summit takes a break, i think they're going to take lunch, advice president and president will go back across the street to the white house and the members, other participants will be given a buffet lunch in a side room. joining us now, elijah cummings of maryland, member of the congressional black caucus and task force on health reform. thank you so much, congressman. don't know if you heard all that congressman pence said, but i suspect you have a different point of view. >> i do. what my colleague said is upsetting to me. i listened to it. the president is bend iing over backwards to reach out a hand to the republicans. congressman pence, i guess he's reading from his talking points. ou