>> good morning from new york, i'm chris hayes. in sanford, florida today, thousands of protesters are expected to march on the police department there. and the biggest lottery in human history has a winner this morning and it is not you. at least statistically speaking. at least one ticket is a winner sold to someone in baltimore, maryland. someone for whom i've always had the greatest admiration. right now, i'm joined by the president for american progress and the department of the of health human services. tim carney returning to the program. senior political analyst. doctor claudia, chief medical

officer for the junior hospital of cook county, illinois and past president for the physicians. and akila professor of political science, former law clerk for the u.s. court of appeals. also great to have you here. we also have with us today some of the tier rankbroccoli. since this is my show, i'm mandating that we eat the entire thing. i'm compelling you. so yesterday, in secret, the nine members of the u.s. supreme court took an initial vote on the fate of the obama administration's affordable care act. the justice will be able to change their vote up until they announce their ruling which is expected in june. the 26 states suing the federal government insist that the law is unconstitutional, mainly on the grounds of the lost center piece, the individual mandate requires people to pay a fine and exceeds the constitutional authority of congress.

not since bush v. gore has a case drawn so much attention. here's justice anthony and paul clemeent, the lawyer representing those 26 states. >> i didn't take the time to figure this out, but maybe you did. is there any chance at all of 26 states opposing it and all of the states supporting it have democrat governors? is that possible? >> there's a correlation, justice. >> yeah. >> that correlation is no secret the court has a conservative majority with anthony kennedy with the main swing vote. the justices and law clerks who see themselves as good faith actors attempting to interpret the law and the general public who increasingly feel towards the court discrust and alienation. in 1988, 80% of the public said

they had trust in the pram court. last year, it was 46%. i want to start on this point. when we talk about the court and the role the court play ins our public life as an institution, there's sorts of two ways to think about it. it has this aura of the cloaked, you know, the cloaked priests who go to the temple and they read the inarids of the constitution and the metaphor was an umpire who calls balls and strikes. at the same time they say that, right, everything about america is getting more polarized. where people live is getting more polarized. congress is getting more polarized. so what i see happening is that that polarization inevitably comes into the court as well. and this whole pretense that drove me nuts, that somehow he was this disembodied being, unincouple behred and he would

sort of beam down into the text of the constitution and extract the meeting is preposterous. of course, it's a political body. it cannot help be but. . >> well, i would say that's a little wrong. we've had a history of justices in the past who were neutral -- more neutral arbitrators. i mean, the challenge of this week, and what i think was so -- as a person who went to law school, heartbreaking, actually, was that even in the questioning, the judges were particularly scalia was not even hiding his antipathy towards the goals of the law that. 's not his role. his role is to interpret the constitution and apply it instead of starkly talking about whether the law made sense or

not. and i think that's the challenge for the court eegs role going forward. >> yeah, johnny talked about the third days. a medicare expansion, i should say, that no lower court saw fit to hear arguments on. a medicaid expansion, sorry. the third day of arguments turn into free association. >> compactly. >> i don't know how i feel about healthy people subsidizing sick people. that's how health insurance works. >> i'm glad that you bring this up. i think this argument that your argue and nira's argument, i think a lot of it is about a preemptive attempt to have the stage set for a big freak out when the court rules that actually, you know what, it doesn't include in forcing people.

but the idea that presentation d precedence is, you know, we used to have a neutral court because we had liberal judges. that's the heart of a lot of this argument. i think in my mind, they created this right to perform abortions and to get an abortion at any point. that is nowhere in the constitution. so i just want to say i just don't buoyant to let the liberals go ahead and say this is all politicized. i guarantee you if you look at the way, specially ginsburg has riled vmt they are coming down. and none of the justices do that. there was an abortion case where one of the rulings was 9-0 against the pro-life group. that was petitions.

and, yes, i think etiology does trickle in. but i know the way this is coming across from chris hayes to these viewers. >> no, but let's -- >> my last point is if a precedent has steered the court very far to the left for a big part of the middle of the last century. , then some of it is wrong. >> there's a bunch of different ways of modelling or scoring ideology. there's something called dw nominate which a metric they use to try to score congress. this is a way of trying to score the court. and it shows that zigginging and zagging is the score on the medium vote of the court. and what you see is the sort of high water mark of what we think is a liberal court happening in the 1960s. and that now we have, according to this scorer, one of the -- if not the most con cebtive court

that we've had since the new deal. now, these are tricky things to kind of measure. what i want to get to, and i'd like to hear you speak on this, when we think about the court, at one level, there's the preposterous pretense of the disembodied umpire. on the other part, you have the sheer power to will. guess what, we got more votes, we're passing this. there eegs no pretense that they're trying to divine something other than the will of the people in that body. the court is somewhere on that spectrum, right? and i guess my question is where on the spectrum is it and does it move over time? is tim right that we liberals are trying to delegitimize the court or has it been moving from the umpire spectrum? >> so here's the similarity. majority rule. the five beat the four, whoever the five are just like in the house of representatives. now here's a difference. they have to give reasons.

they have to write opinions. to me, it matters a lot whether these opinions are plausible or not. and one interesting thing is where wl the four say we respectfully decent, but we understand the argument on the other side. or whether they say this is absolutely preposterous. and if the four say that, if that elena kagan says that and a lot of academics, many of whom are conservative say that, and this is different than the house of representatives. so a lot will depend on the reasons they give and whether they're preposterous or not. >> preposterous is something that i feel like scalia says about something that every decision dunnett go his way. but prior doesn't usually say

that. so to me, if it's 5-4, that won't be disheartening. but if it's 5-4 in a partisan way, it matters what five and what four. >> i want to talk more about that right after we take this break. c'mon dad! i'm here to unleash my inner cowboy. instead i got heartburn. [ horse neighs ] hold up partner. prilosec isn't for fast relief. try alka-seltzer. it kills heartburn fast. yeehaw!

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everybody has to buy food. so you define the market as food. therefore, everybody's in the market. therefore, you can make people buy broccoli. >> you say health insurance is not purchased for its own sake, like a car or broccoli. a car or broccoli aren't purchased for their own sake, either. >> the difference is that health insurance is the means of payment for health care. >> well, no, that's a significant -- >> and broccoli is not the means of payment for anything else.

>> it's the broccoli line of questioning that dominated the arguments that i paid that. i think that was one of the things who people are critical about the court was conducting its health, particularly the conservative justices were con terveive the like between the justice. i just want to read the charles frie, d quote who has been running around to every journalist he can find saying how out raged he is. he was saying i was apolled to meet a couple of them. i even heard about broccoli. and this is the broccoli talking point has a long lineage. it goes back to 2010. >> well, what the broccoli argument is seeking out, and i think this really gets at the ways that this isn't just partisan etiology.

it's seeking out the limiting principle. and i think a lot of the constitution as something if it created the government and the government should go arnold and try to solve the problems that it can solve. now, you know, i'm phrasing that in a lib rat way. i think it's not something that limits if government's power power, but it's the only source. if you say that the government does have the power, what is the limiting principle? and so the broccoli question is saying where -- if even if you're going to say the government can't forks you to buy broccoli, why can it force you to buy this and not that. >> i wanted to put a pin in that air yeah of pursuit of this. that's the heart, right? we're going to get to the substance. ewe said you wanted semg about the corlett and whether the court's legitimacy and sort of politicalization.

>> this is what i find surprising about conservatives who have, in the past, compla complained about jew dished activism. the concern that i have is not guilty not on the legal arguments. thigh seem to dominate their decision-making. and i don't understand weighed conservatives and judges replacing the role of congress and the president in the past become a little weary when a justice -- >> can i say something? in tim's defense, let mess say that cuts both ways. everybody starts talking about how important their democratic legislature is when they're being overturned. they're going to be -- they feared they're going to be on the wrong side of this.

i would say there is a difference. i would criticize a liberal judge who says i just don't like this law. at the end of the day, you undermine the supreme court when you do that. i know scalia, basically, when he talked about the courthouse prevail which isn't even in the law. >> you have, of course, taken out your copy of the constitution? >> i alcian carry it with me. >> do you want to respond? >> a couple of things. the oral argument is a testing ground. so, for me, i'm going to waiti and read the opinions. all of us are going to do that. if i had been asked and have a place on display abatcussions a the solicitor general should have pulled out.

and that's a schism question and then we'll get to broccoli. it says that congress should have power to regulate commerce among the states. is this a regulation? yes, it's about who pays. is this manges it different than broccoli. there are interstate spillovers involved in health care. thee days a week, i'm not in my home state. if i fall sick, you're gooks the take me to a local e.r. and the good people of new york new york are going to pay. thinned's a genuine interstate problem. but it's a problem in heathcare. my students, most of them come from out of state. you get a better job in some other state. and it's going to pay you more and you're goings to contribute more to your family and the economy. if you have a preexisting

medical condition, that new employer is not going to want to take you on vmt that is an impediment to interstate labor sow mobility. >> we actually have statistics about that, about how people stay in a job they don't want. and it stagnates the economy. and if they don't like their job, every cold becomes pneumonia. if they don't like their job, they're locked in. >> and one of the interesting things you said is actually, if you're going to look at original intent, it was precisely the goal of the commerce clause to make sure you do have this. >> so my problem with that is,

yes, it does have an impact on interstate commerce. or even an economic impact or whatever, then we have an interstate commerce clause that gives congress the cowhatever its wasn'ts. we're talking trebly that is simply wrong. i'll give you two cases that the supreme corlettcourt that are rightly sided. where one state is imposing on another state. so there was a law. it's called the zone act and it was struck down in lopez correctly because there was no interstate problem.

and the court in a 2000 case said that went too far. and we who are principled, say those are the limit. but this is easy and obvious in the court. >> you've very nicely teared up. . so nothing short of america as we know it rests on one boring part of the constitution. that's at the heart ophth the pram court's ruling on health care right after this. [ artis brown ] america is facing some tough challenges right now. two of the most important are energy security and economic growth. north america actually has one of the largest oil reserves in the world. a large part of that is oil sands. this resource has the ability to create hundreds of thousands of jobs.

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including exsolicitor general says it falls within congress's power of the constitution. that says congress shall have the power "to regulate commerce with foreign nations and among the several state." it's that second clause there that's the most important. now, any phrase that contains the word clause not modified by santa tends to trigger the brain that this is boring and arcane which is why i want to take a moment to explain why it's vital, even beautiful, sublime. and why conservatives have been trying to carve it into a much longer bat hmm. it is the interstate commerce clause of the entire american fell fair state. the atlas that holts it aloft. it is a heart on the attack of progressive govern nance. in one case, carter v-carter

crowley company, which imposed a let of regulations obama cole mines. and the supreme court agreed. despite the fact that cole was destined around the union, despite the fact that coal was a national market, this was one of several rulings that court his corp. kpoerp legendary switch in time that held nine. and from that moment until the 1990, the court more or less granted congress deference in deciding what was necessary and proper for it to do to regulate commerce. the clause became the legal bridge, in in some senses, to the modern incussed rail regulatory state. in 1964, an atlanta hotel owner

challenged the civil rights act saying it went beyond the powers given combers by the interstate commerce clause. the power to compel was well within congress' authority. of course, conservatives didn't like the civil rights act and a more recent wave has taken aim squarely at the latter. striking down a law that made it a federal crime to carry a gun within a thousand feet of a school. and this made people think we have entered a new era that suddenly we'd be back with the new deal because they felt they overreached. but then in 2005, the court was faced with a question of out lawing the cultivation of marijuana for personal, medicinal use.

and the court found that the federal government could do precisely that. here is none other than justice scalia explaining his own reason to vote the power to enact laws can only be exercised in conjunction with con gretchen hla-l regulation and extends only to those measures necessary to make the state effective. congress may regulate noneconomic intrastate activities only where the failure to do so can undercut interstate commerce. this is fairly close. that fault your to enact a mandate would entirely under cut its regulation. i suppose how committed we'll see.

what's at stake isn't just the piece of legislation known as the affordable care act. or the political fortunes of the president who made this his single domestic policy party.

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the supreme court argues with me better if they had bumper music, as well. the main event came tuesday when the key feature of the health care got its day in court. as we mentioned before, the individual mandate says everyone must buy insurance. it's originally a conservative idea. part of a search for a market-based alternative to the government that liberals.

individual mandate was first outlined in 1989 and adopted by the heritage foundation. in 1993, 20 republicans cosponsored a bill that included the mandate as an alternative. former house speaker and presidential candidate newt gingrich is one republican who has been on both sides of the issue. >> i think you've got to require everybody to have ininsurance or to post a bond. and i think that's just immoral. there are people out there who routinely pay their credit cards. because they think it's their duty. and then they get to health and they think for some reason, weighed do i have to pay for health. >> i am for the repeal of obama care vmt i don't think there's any effort to oppose a mandate on anyone.

>> you know, there's some cell phone video there. claudia, i want to turn to you on this. in 2006, massachusetts was the first to introduce the man kate. date. but for the single payer folks i know, the people on the left of the health care spectrum, they point out the same thing. the mandate is a consercerted i. what do you feel? >> what you're forcing people to buy defective or flawed insurance. i think that the insurance industry doesn't really add anything to health care. they don't practice medicine. we pay them a premium and then they tell them what we can and can't have. and the problem with forcing people to buy this insurance is that, you moe, still, 60% of all bankruptcies are rouletteing out of toothette.

so you know, the idea that we're going to force people to buy insurance will solve the problem in this country, you're really -- really, our problem is accepting the difference between a mandate and a right. do people have a right to health care? as a nation, we don't seem to have accepted that. >> the second point you make, about the insurance bankrupting people, that's in the era before they had things like community rating, which is whoop of the reforms, right? you essentially have to give people premiums that coincide with the totality of the risk pool. >> yeah, we're only requiring that the the snorenz cover 6% of you advances. you newlywed afford it. >> i want to play this for you.

claudia's point -- you basically said i don't think the solution is to make people buy health insurance. that perfectly core spopds to a candidate in 2008. and we have him making that point in the debate right here. >> understand that when senator clinton says a mandate rickets it's not a mandate on government to provide health insurance. it's a mandate on vainlys to purchase it. senator clinton is right. they have exempted 20% of the un insured. in some cases, there are people who are paying fines and still can't afford it so now they're worse off than they were. they don't have health insurance and they're paying a fine. in order for you to force people to get health insurance, you've got to have a very harsh, stiff penalty.

now, this is a substantive difference. but understand that both of us seek stow get universal health care. i have a substantive difference ht senator clinton on how to get there. you're really nailing it. and, in fact, i was looking through. >> you were working at exactly that moment. i remember spending months of my life on debates about the individual mandate. it was the single biggest domestic policy difference between the two remaining candidates and, in fact, you wrd on a phone call. >> yes,i was. >> with reporters saying this is a horrible precedent to set. you're really opening a pando pandora's box here? how do you feel having worked on that watching that clip of the president?

i think what was great was that people who had criticized the individual mandate, president and members of his team worked with congress and saw that eight states tried to do guarantee issue one state did it with a mandate, seven did it without. and that is -- you know, this is all about what works and what doesn't. and for those -- let me just say, for those people who we should not losesighted of the fact that preexisting condition and the arnt to ensure that we don't discriminate is why that're criticisms some people have is that there are a number of important insurance market reforms.

so i think we will be in a world -- >> an important one that says they cannot limit your care overall. and when you're a cancer patient the health insurance company netted say to you, okay, at this point, you no longer get coveracovrage. and that's why we will end the situation where people go into bankruptcy because of medical costs. and that's one of the things that are jeopardized by five justice it is. >> that was any factually done. but just very quickly. understand this depth spiral. to the is if you say guaranteed issue, you have to sell health insurance. the point is, people self insure who are healthy. so they don't join the sick pool.

what happens is someone says i got preying pregnant, i'm signir health insurance. >> and that's what insurance is. >> i mean, i understand. i get that. >> no, but that's not what insurance is. that's what social security or medicare or the welfare system are, okay. and no, listen. >> insurance today is based on that. >> the mandate is -- it's got a few prongs, but one is combating healthy people pay in a long more more than they ache time. >> it's not a durable, consistent -- >> but what stated is being illegal.

it would be neat buying a catastrophic plan that doesn't cover anything. and for a lot of healthy people, that's what would make sense. >> the reality is is that at any point in time, 20% of the population incured 80 neolyte of the cost. owned we need to subsidize the other 0%. >> more oban the future. when we come back. [ male announcer ] there are only so many foods that make kids happy. and even fewer that make moms happy too.

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by alzheimer's. this cruel disease is the nation's sixth leading cause of death, affecting more than 5 million americans. the alzheimer's association has been behind every major advancement and continues to lead the fight against alzheimer's. we won't rest until we have a cure. join us. go to alz.org. all right, tim, i cut you off a number of times. you're vastly out numbered. so i want to give you time at length to respond. >> well, okay. i'm not -- the first thing i'm not going to do is me, a journalist with only a bachelor's degree, try to engage a full constitutional law debate with you. but i need to plant a couple of flags for the viewers who are here saying oh, look, obviously this is the case. first is what this law does

constitutional constitutionally, that no other law has done before. at least is mandate participation in interstate commerce. and the necessary and proper cost with your thing that i don't know that i agree with scalia on that, but on the marijuana, the argument was that he had there that it was necessary -- it was actually necessary to do this. and the justices pointed out many way ins which you could solve the problem you're talking about where we can't have guaranteed issue and the community rating without the individual mandate, you could. there. >> reporter: other ways to do that. you could subsidize. there are ways to do it. and one of the thoughts is maybe what the constitutionalist was doing was limiting the ability of congress to do these little litting direct. more -- >> i've got an the slur.

>> big government interverneing. why this these haul had all 0on. in that gingrich, 2008 video, remember, and this i think gets at an important place where you and i agree, gingrich was being paid by many in the health insurance industry who all stood to profit from an individual mandate. and that was part of the process of the affordable care act was drug companies that liked it and hospital lobby and -- well, especially the hospital lobby and the insurers getting to the democrats and pushing the mandate. >> do you -- on the constitutional question, i sort of want to leave the flag planted. but do you agree with that? i think there was some during the debate, there was a little bit of kind of libertarian

right, sort of decenting left, kind of anticorporatist coming together. that basically this process and this policy landscape was essentially rigged by the urine campaignss. >> it's a 4$467 pillon we foule because lark what happens against the state massachusetts after enacting the state to subsidize the policies for people who couldn't afford them, found himself going to the insurance company sand saying listen, you guys can't keep raising the states. it's a huge windfall because it brings all the people into the new pool. it's good news, bad news. we are forcing people to buy products that they can't afford. and, as a result of that, i know you believe ultimately we ensure everyone. and i get that.

i agree with that. that you are going to have people who -- we won't bankrupt people. but i think that the insurance, you know, having to pay the deductibles and copayments de r deters people from necessary care just as well as unnecessary care. >> i do think it's important to recognize that there's a flag market today. and what the affordable care market does is actually improve the insurance market and heavy regulate the market in a sense that you can't have just dramatic out of pocket costs. you have to ensure that people have a good pricked that's reliable for them. it's a system that's bad for everyone. it's not just private insurance. it's important for people to recognize that. >> i want to bring in someone

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i want to bring in right now senator shelldon whitehouse, the senator published a report looking how the changes the way care is delivered. welcome, senator, how are you doing? >> i'm doing good. >> you're on the judiciary committee. i wanted to get first your impressions to watching the arguments as they unfolded this week? >> well, the focus on the mandate, really, stood out. and the democratic defense of it was kind of astonishing for somebody who has been in this from the very beginning and saw the mandate as a republican idea from richard nixon to john chafey to the heritage foundation. it was the insurance industry's demand to participate in this deal. the president agreed to it, so it came in. it had never been a part of the bill.

it was nothing that any of us campaigned for or fought for. frankly, if it falls, the insurance companies are going to have to go back to their states where their rates are regulated and either raise their rates or get a mandate at the state level where the mandate is perfectly appropriate and indisputably constitutional. so it seems to be kind of a little bit of tail wagging the dog, including the 45 seconds that we discuss teed in our report. >> it's a fascinating document. four of ten people either think the law has already been declared or aren't sure. so 40% of the people aren't sure if the law has been declared unconstitutional so far. but the most interesting statistic in the polling to me was the part of the affordable care act is that most people

know is the part of the affo affordable care act which is the least popular which is the individual mandate. the one part of it, the mandate, that's the least popular, is the one that people both know. does that represent to you a failure of salesmanship on the part of democrats in the administration? or -- and then i'll let you speak because i'm speaking for a lot here, is it the fact that in order to get this congressional budget office to score the bill in an appropriate window, the implementation had to be like they don't feel they know what's in the bill. >> i think you're right that there's an enormous amount of mythology about the bill. certainly, when you have, you know, chief justices comparing health insurance to broccoli, you're in kind of an unusual land. the only place that this has been declared unconstitutional is on fox news and, yet, as you

said, many people believe it to be so. and i would argue that there are probably more people out there who believe that there are death panels in the bill, which is imagina imaginary, than are aware of nearly a third of the bill being dedicated to delivery system, heathcare delivery system reforms that will improve the quality of care and billions of billions of dollars. that's one of the reasons i wanted to emphasize that part of the bill in the report. it is a huge part of the bill. >> you'll be happy to hear that we're going to devote most of the second hour to that. how health care is going to change under the act and get to a better health care system. for people -- there is a strain of liberal thinking that says -- for people that favor single payer, that says maybe the silver lining in the cloud here, is that if this way of providing universal coverage is rendered

unconstitutional by the court, then what justice kennedy said before oral arguments, that actually just a straight forward use of the taxing power to then, you know, create a single-paired system would be so squarely constitutional, that's the only way to go. and so finally, the day will come in which single payer, which has been on the horizon could be political and feasible, i want you to respond after we take this break. f little tests, but bounty basic can handle them. in this lab demo, bounty basic is stronger than the leading bargain brand. everyday life. bring it with affordably priced bounty basic.

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including the fact that a preferred risk policy starts as low as $129 a year. for an agent, call the number that appears on your screen. energy in america. we've got to protect the environment. the economists make some good points. we need safer energy. [announcer:] who's right? they all are. visit powerincooperation.com. >> good morning from new york. i'm chris hayes. here with president of center for american progress, tim carney at the washington examiner. dr. claudia better known as cook county to the people that use it. professor of law and political science at yale university and senator sheldon whitehouse.

senator, i keyed up a question to you about the silver lining being struck down about being possible single payer in our future. what's your response to that? >> i don't think that is very likely. i mean, we just came off of a session in the snit where we passed a highway transportation bill, something every american understands that would generate three million jobs that passed with 75 senators supporting it. and the republican-controlled house can't even get a bill to the floor, they're in such disarray and dysfunction. if they can't do the business of governing to pass a job-creating highway bill, the idea that they're going to effectively take on the insurance problems and health care seems a little bit of a stretch. so the bill answered two questions. one is how do you spread it in a fair way. and the other was what do we do to reduce the cost. i think the other would be how do you improve care and reduce cost in the system.

there seems to be a lot of agreement around that. >> in terms of things that you feel like you can get passed, the president had his weekly radio address with the buffet rule. my understanding is that you're introducing the senate version of that. is this essentially at this point, do you see this as something feasible to get passed? or is this kind of a political stake in the ground? >> i think it's feasible to get it passed. it may be difficult to get it passed on the first round. but you don't get to throw a second punch unless you've thrown the first punch. and there are very powerful interests, very wealthy interests on the other side of this. there are entire industries that have gimmicked the way they pay their people to give them amazingly low tax rates and basically gain the system and pay lower rates than regular americans do. so there's a powerful force on the other side. and i think the only way we get through the special interest pressure in washington is to call up votes, make this a

topic. have americans speak out. if you can go to buffet rule bill dot com, you can get registered to somebody that supports this. i think the american people is something that's going to have to come back to this. >> senator, i actually agree -- >> this is tim carney. >> i'm a conservative libertarian, but i actually agree with you that special interests are a problem when it comes to things like the buffet rule that are trying to get rid of a lot of these exemptions and these tax dodges. i don't like this, either. i want to get rid of them and lower rateds across the board. i do find it funny to hear you talk about the buffet rule being opposed by wealthy people. but the democratic congress and the republican congress are really big into creating new loopholes, new exemptions, no tax credits for this and that.

and president obama talks about tax reform. but he talks about adding new ones he does. are you interested having spoken with any republicans about a broader tax reform and then you can have a fight about it afterwards. look, there shouldn't be this many ways around it. >> yeah, absolutely. i think that that discussion is going on throughout the senate. i think there's a strong bipartisan support for it. as you know, even a very partisan congress came to its feet to a person, republican and democrat alike to applaud the president's call in the state of the union for tax reform. americans spend -- i forget the number off the top of my head, but i think it's 6 billion hours a year. and i think every american feels that all of those complexities

are for the benefit of people who get special deals. >> and companies that can pay 900 tax people, they've spent a thousand dollars. they have a thousand tax lawyers. one of my objections to that is that creates an incentive to spend money on your tax department. and that becomes more period of timeble than say coming up with a better refrigerator. >> absolutely. and it creates anomalies in the store where cvs pays 35% taxes. carnival cruise lines pays 0.8%. why is it important that a cruise line pay 150th? it makes no sense. >> i agree with tim that tax reform makes a lot of sense. but senator, don't you think

that so many americans are angry at the fairness of the tax system because middle class americans are asked to pay more? it eegs so much part of the discussion? >> absolutely. warren buffet has discussed how -- >> sorry, senator. >> warren buffet describes how he pays lower than his secretary. >> that's what a single truck driver pays in rhode island. the examples are piling up. and in edition to the buffet rule bill being good tax policy, it think it also extends a signal to america that we're not just here to help special interests. we're willing to stand up and do something that puts the tax code back right side up again so that people earning a quarter of a billion dollars a year aren't

paying a lower tax rate than their doorman and the guy who drives up to their house to deliver packages, than the police officer driving buy outside to keep the may boar hood safe. we ought to be able to send a signal that we can correct it. >> senator, law professor from yale, i had a question from you. >> i just wanted to share with you, i thaugt you might find it interesting and amazing, a piece of constitutional history. this is from over a hundred years ago. it's the 1908 democratic party plalt form. and here's what -- >> even before warren buffet was born. >> to collect a tax upon individual and corporate incomes. and here's the kicker. to the end, wealth may bare is proportionate share of the burdens of the federal government.

>> a long lineage. >> one of the arguments that gets made about the buffet rule. the president has made this promise he's not going to raise taxes on anyone making below $250,000. and so the focus is on the equity standpoint. i think it's indefensible gap between what the wealthiest pay. but that's not really where the money is in terms of raising revenue more broadly. are democrats going to have to articulate for raising taxes on the top 20%? >> i hope the trillion dollars in spending cuts that we have

already put into place or put into training to come into effect in the near future, that we'll be able to avoid that. but, as i said. when you're dealing with this, you're not just dealing with wasted revenues that are going to people who don't need it. the marginal dollar is not even noticeable to them. >> right now, americans are not getting a straight deal from the tax code. when somebody leaves in the build i building is paying a lower tax rate than the doorman, something is wrong with that.

>> white house democrat from rhode island, thanks for tell nging us. what's also at stake in the supreme court ruling and what no one is talking about. since before i could waeen pushing fot since before i could walk. [ sigh ] if only mom knew about kraft homestyle macaroni & cheese. i can dream can't i?

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tony soprano expressing his frustration. the confounding and maddening paradox. and this is something that senator white house just referred to, is that it is once so controversial and so poorly under. >> by the time the vote has taken place, not only i will know what's in it, you'll know what's in it because it's going to be posted and everybody is going to be able to evaluate it on the merits. polling on the popularity means that opinions haven't changed much as it was enact ed and ther latest polling the month, 41% supported it and 40% didn't.

this is the key thing. 67% say they venality effect id. they have not been implemented -- will not be implemented until 2014. there's a hidden story of the bill that has gone entirely overlooked. how the apple dramatically changed the delivery of the one of the things the affordable care act is trying to do. to me, this is getting lost. and i think one of the things that drove the out rage was a sense that this was a largely distribution. that this was taking a slice of

the pie and giving it to someone else, right? and there is a redistribution aspect of the bill, no question. but there's also a lot of win/win to be gained because the system is so terrible. but if you look at the die that, there's just a ton of stuff that we're not doing right. >> and physicians think that they've giving incredibly good care. i think we're going to really impact the health of our nation. we're so focused on getting someone to the doctor's office when really the big piece that's effective like chronic disease management is teaching people to manage themselves and how to educate them.

>> you're getting a lot of those 20%, right? you're getting people with chronic disease who don't have anywhere else to go. and it's expensive because there's lots of readmissions, right? what is the way to aprop that? >> it's expensive because people wait late. they can't afford their medications and they don't take their medications that they should. there's all sorts of things that practices that worry me. people say you have to have some skin in the beginning. there's good data and good studies to show that when people have to have a copayment, whether it's 50 cent or a dollar, or you're looking at medications that they repeated around 2005, is that people will decrease their utilization.

and then the access, we blame people for making poor choices. >> and one of the thing that is is in the affordable care act, we've had him on the program, he was a head of cms and was implementing a lot of stuff, all sorts of tools to get a hospital to do something like hire someone to manage the care. >> a lot of timings, people can't fig figure out what they should be doing. it's not just that things venality been implemented, but even that it was early on implemented availability for people who couldn't get coverage because they had chronic disease and they could be put into a risk pool. people didn't know that. they didn't understand how to access that. it's very complicated. and the public doesn't have a way of -- and putting it up on

the internet. >> let me say a few things about the system that we're trying to move to. the problems in the united states are that we pay more than any other country. and our people are sicker and we pay a lot more. one of the things that happens is we have a fee for service system. and we pay for every point of care and that creates incentives for overuse and volume. and not enough insent eaves for proper use of care. and so that's one of the reasons why we don't have it. >> when you say incentives schillings incentives for to provider, right? >> exactly. but also for the insured. the insurance plans have these low premiums. there's no cost.

the incentives are on both sides. >> that's actually false because over the last several years, we've had a dramatic expansion. it's almost impossible to see any place in which people aren't playing a significant amount of their income. >> but by subsidizing it and by hiding some of the cost, it's inevitable that you are taking away, you are externalizing the costs of seeking health care. and so you go in and you've got a doctor and a patient talking and none of them are talking about costs. and it's know wonder that the costs are going to sky wrk et. they're going to figure maybe they can get away with taking it every other day. so the more financial investment patients have to make, actually the poorer decisions they make.

so putting that in front there, you know, agree that fee for service is the most inflash nair way that we can compensate physicians for what they do. but i feel that making patients pay more is not the answer. >> and that's exactly right. the affordable care act threeed to balance that. but we should netted have put it like the republicans put its on the back of patients. and i hope we get to that. >> don has a piece he coauthored in journal of american medical association which he talks about the amount of waste. and it's a staggering number. a lot of that is poor quality. we'll be right back with dr. greg meyer. bobby. it's me marty.

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talking about health care equality and quality we get and give. joining us is dr. greg meyer at massachusetts general hospital. doctor, thanks for joining us today. >> thank you for having me as part of the conversation. >> i want you to respond. one thing i've noticed as a rteer, when you talk to citizens out there in the world, voters about the affordable care act, they say i don't really know. i don't really see that much this eegs happening in my life. if you talk to people who are running hoppeds, who are working for anyone within the health industry, they are saying we're doing tons of stuffaround the affordable care act. there's all kinds of things happening. is that true for massachusetts general hospital? and what does the act mean for how you deliver care there? >> absolutely. the impact has been dramatic. this week, the supreme court has had us all focused. but the reality is is that there's a lot in the act that

focuses on the quality of care. let me give you one example. earlier, you talked about the fact that a small minority of patients, whether or not you say it's 10% is accountable for 67% or 20%, the reality is a small number of barbeloids are accountable for the health kay costs and using our medical services. we have a program which was a demonstration project with medicare which looked at our 2500 sick eest patients. and what we did is we provided primary care doctors like myself with a care manager in our practice, with access to a pharmacist and with other services for those patients which allowed us to provide

better, more comprehensive care for them. the results? improve the patient's quality of care. we found that we were able to reduce by 20%. emergency room use by 13%. the physicians loved it. frankly, it made my job better because it allowed me to spend more time with the things that were important and getting support from others. and oh, by the way, it also saves 7% on costs. for every $2.65, for every dollar invested, we were able to save the government. so part of the affordable care act is to try to take program tis like that and expand them. >> explain to me how that's working. my understanding is that the

primarily is medicare. the government can use the affordable care act to try to get to better quality because every hospital had a lot of hospitals on medicare and the government can change the way it reimburses. is that the way this is working? and when you say you had a partnership with medicare, what does that look like? >> sure, so let me speak to the first part of that question. in terms of the fact that medicare is a huge leverage, it is. we see the same thing happening in our commercial contract, as well. in terms of how we were able to work with medicare, we were working on what was called the shared savings program. and the notion here is that as long as we could show that the quality of care was improved, we could share those savings with the government. and so there was an upside for

both the government in terms of improved care. >> i want to share this somewhat shocking statistic on hospital readmission rates. this shows the hospital readmission rates, and this is the readmission for medicare beneficiaries in the year 2005. this is the percentage of patients that are readmitted, right? and then this is the -- that's the days following discharge. and then this is the percentage -- this is the ones that are unnecessary, right, as potentially avoidable readmissions. i mean, the space between those two lines is the space of the amount of people that should be mitted. but the majority are being

readmitted for things that are avoidable. is that something you see day-to-day? >> absolutely. patients go home and they don't understand how they're supposed to take their medication or they come in because they didn't implement a treatment plan, a patient who gets readmitted because they didn't realize how important their diet was. he was taking all of his medication but he was eating too much potassium. someone having the time to sit down and explain that to patients. so having the care managers, and we're trying to do that at the county hospital. that's a huge piece of what we're trying to do. you don't have to be a physician or even a nurse to help patients navigate and understand what they do that impacts upon their illness or disease. >> dr. greg meyer, thank you so much for joining us today. we really appreciate it.

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so i want to come to the place of what our social contract will look like. that really is the core dispute here. >> small question. >> so we've got 30 seconds and -- no, but i mean, you know, what -- what do we owe to each other as part of what we do as a society? and i think that part of what was frustrating about watching the construction of the affordable care act for a liberal like myself, a social democrat i'll say like myself, was this kind of method that was constructed to get to the place that i feel that we want to get, in which we do say yeah, i don't

want to see it struck cowen. but it's the way in which this machine got built leaves a lot of room for gaming by private interest. >> and let me add that part of the reason you were talking about the unpopularity, oh, the benefits weren't put in for one. the real ten-year cost, if you begin next year, is probably going to be -- they said it cost under a trillion. the real ten-year cost is going to be 2 trillion. and, frankly, i think some of the bill's authors, i said, one of the labor mention committee said, look, this wasn't a cost control bill. this was a coverage bill. and in massachusetts, that created a cost explosion.

so there's lots going on. but the major social contract swish shoe is that it does basically turn the private health insurance market into the profit-taking middleman of redistribution system. and an average result to that is what's wrong with that? right now, i don't think that will be the consequence. it's what's essentially a single payer plan. >> you said before, i'll let you respond on the merits, but you said before you think this is headed to single payer inevitably. >> yes, i do. i do think that the regulations and the lever that hhs has to increase what they call the medical loss ratios to basically shrink and shrink and shrink the profits and the ability to control the rates, i think that will make it so the private insurance can't afford this and everybody will clamber.

>> and i'm not real hi sure where to begin. >> now you know how i feel. >> we could split time. >> let me answer the first issue about how i'll come back and respond to some of those sharks. first of all, the challenge we have is americans like their health care the way they receive it. >> they're scared of change. >> yes. but we could go through different versions. but the real challenge we have is that it actually makes sense for people to like them in the sense that they think that they can bargain more effectively in large groups. let me just remind folks, the individual mandate only applies

to people who don't have coverage today. and what you are doing is pooling the risk. just like today when you work at an employer and you're a young person, you already pay for old people. older people or sicker people. that's what the exchanges do. it's the same principle that works in private insurance. it really is just taking that bargaining power for large groups of people and allowing people that don't have health insurance today to have that. >> but why should your employer determine who your doctor is. i think it was a freak of history. it was a hung tax loophole that was created. so to say people like it -- it's what they're most familiar with. >> lots of accidents in history. ewe could tell -- you know, the united states having the borders it has is an accident of

history. the rio grande happens to be there. >> right. and i think the challenge we have is if the affordable care act was done, i know there's lots of friends on the left who believe that ultimately we would get the single pair. that will not happen in any congress that is coming in any time soon. i think conservatives who argue -- that's a more legitimate option. there's 32 million american who is will get coverage have to wait decade after decade because we're not going to do it. >> when you mention the basic social contract, the constitution, here's what we haven't been talking ab. we talked about intrastate commerce. and we talked about taxation and revenue and cost.

we're not talking about health care as a basic human right. here's a completely different argument that none of the justices and none of the advocates were talking about. congress, after the civil war was given sweeping power to protect the civil rights. constitutionalization. some people are bernell with preexisting medical conditions. bagsic medium health care. the 13th amendment says there eegs no savory. we're all supposed to be free. but are we really free if you have diabetes and you don't have access to the insulin? the rest of the world thinks as health care as a fundamental human right. when the civil rights act was

held, you had had a segment on that and they didn't call it human rights, civil rights, 14th amendment, 13th amendment. >> so what do we know now that we didn't know last week? my answers right after this. so we have ongoing webinars and interactive learning, plus, in-branch seminars at over 500 locations, where our dedicated support teams help you know more so your money can do more. [ rodger ] at scottrade, seven dollar trades are just the start. our teams have the information you want when you need it. it's another reason more investors are saying... [ all ] i'm with scottrade.

after apple asked the fair labor association to investigate, the group found workers work more than 60 hours a week for more than 11 days in a row. palestinian lawmaker appeared on this program to talk about the palestinian nonviolence moment. yesterday, he was injured when israeli forces tried to disperse

in jerusalem. he told us by phone he was struck in the head. and the correction on a story we related to you last saturday. we told you that wstd in shi can reported that the f.b.i. was analyzing audio tape. we were unable to confirm that trayvon made such a call and wls told us yesterday their report was a mistake. we are sorry we passed on bad information. we're talking about this week's developments on tomorrow's program. so what do we know now that we didn't know last week? well, after oral arguments before the supreme court this week, we know that many of the justices get their information from reading right wing blogs. even though the deal cut with nebraska senator ben nelson to secure his vote for the aca didn't end up in the final legislation. just seven years ago, while voting to uphold a federal law,

justice scalia thought the commerce law was so broad that commerce could nominate and undercut its regulation of interstate commerce. we know from the perspective of greg harper, the sweatshirt is a hat. illinois democratic congressman bobby rush took to the floor and this happened. >> racial profiling has to stop, mr. speaker. just because someone wears a hoody does not make them a hoodlum. the bible teaches us, mr. speaker -- >> the member will suspend. >> the member will suspend.

>> these words. may god bless -- >> the member is no longer recognized. the member is no longer recognized. the chair must remind member that is clause five of rule 17 prohibits the wearing of hats in the chamber when the house is in session. the chair finds that the dawning of a hood is not consistent with this rule. members need to remove their hoods or leave the floor. >> we also know no dress code in the world is powerful enough to stop people calling from justice. >> he has hired a lobbyist to make sure it clears whatever local zoning hurdles it might face. we know that matthew peterson has been paid $21,000 since 2008 to stay in the ear of local officials to smooth over their objections. we know it's an acute reminder of just how big money bends the wheel.

we know conservatives are turning away from science. according to a new study published in the april issue, conservatives, plrly those with college educations, have become dramatically more scopette hcl. the decline has been steepest for those with a college education. this is part of a broader crisis of authority the nation is going through as we distrust our pillar institutions, even those like science who have not produce d the wave of fall yours we've seen. figuring out out how to constitute this authority to take on the threats is probably the central challenge of our time. it's one i read about at length. and finally, with a viewer, we now know that the ah penlights

of marriage equality had an explicit strategy to drive a wedge between two democratic constituencies. whoa know know the national organization for marriage whose founder has appeared on this program sought to drive a wedge between gays and blacks in a sin hcl attempt. we know the opposite of wedge politics is solidarity. we know this has been on display in state maryland, washington and fortune alliance in favor of equality. what do my guests know now, ladies and gentlemen, after the week began? we'll find out after this.

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just a second my guests will tell us what they didn't know when the week began, but right

now, it is a preview of melissa harris-perry and what is come up this morning, melissa? >> well, chris, it means that i'm at work now which means that the pool for the mega millions did not work out. that said, we hit the jackpot with the lineup of guests. we are having in order to cap off women's history month an all women's show. so if you have ever wondered what the world would like like if women were in charge, we will try to answer that this morning. we will take a new take on the trayvon martin killing, and ask who should have been standing their ground. and also, did you know that jackie kennedy won an emmy while living in the white house? i will show you why. >> i did not know that. i was checking that out. thank you, melissa harris-perry. coming up next. now i want to know what my guests know now that they didn't know earlier in the week. >> what i know now sadly enough is that the conservatives have been ruling against activism for 30 years and particularly

justices with language in cases where they talk about the deference to the duly elected branches, the congress and the president, are willing to throw it aside for political antipathy for the goal of the congressional act which is what it seems like from the court press this week, and that is a sad state not just about the affordable health care act, but where the courts are today and whether the courts are becoming more and more political. so i hope that i'm proven wrong. >> i am on the side that the courts have always been political. tim? >> well, the bubble can be a harmful thing. you saw lin ga greenhouse and others saying that the presi p en gafrnlg -- engaging you to

have to participate in the greenhouse or lithway who had to bubble that out. the way that the harm to the left could have been donald verilli going up there to answer the question that we on the right have been constantly asking. if you can mandate this, what can you not mandate us to do? if you can make us do this, is there anything that the government cannot force us to do? is there any sphere of individual liberty left? that is the fundamental question, and that is all we are asking, but the left is not asking, because we are a bunch of tea party cooks, and maybe that is the result of him living in the greenhouse bubble. >> my theory on him quickly is that they had to both make a constitutional argument and political argument about the bill, and ththey did not want t assert powers that would hurt them, so yes, the government could demand that we eat

broccoli. what do you know? >> i didn't realize that the compl complexity of the health care act would be the single-payer act would be what every patient wants which is to be treated with dignity and respect and to have access to the health care that we deserve. how can we be the most powerful country in the world and not have great health care. it is so important to the quality of life. >> and what about you? >> well, building on what my colleagues have said, the oral argument was eye-opening. we are seeing that the polarization that is increasing everywhere in america, and it started in the house, and now it is in the senate, and it is in our presidential contest, and it has now come to the judiciary in a much more visible way than it has ever been before. when i'm growing up, and in high school, there are liberal republicans, and there are conservative democrats, and no

more. maybe the last really s significant liberal republican or moderate republican of any national significance was on the court. he is john stephens, and he stepped down a couple of years ago. and 5-4 is okay with me, but if it is 5-4 in a partisan which and bush v. gore was a unique situation, that is unique to me. and problematic. >> okay. thank you for joining me this morning to my panel. thanks for getting up, and thank you for joining us today for "up" and coming up next is melissa harris-perry, and join us sunday morning at 8:00 when we will have congresswoman carolyn martin and we will also talk about the effects of trayvon martin. thank you for getting up.

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