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rose communications this is charlie rose. >> rose: welcome to the broadcast. we're live tonight from miami, new york and washington. earlier today president obama held a bipartisan health care summit with top congressional leaders in washington. the seven hour meeting designed to reach a legislative compromise comes at a critical point for the president's top domestic priority. polls show eroding support for pending reform proposals and supported waivering among democrat in congress. the partisan divide on this issue is apparent today in exchanges between lawmakers. >> we don't think all the answers lie in washington regulating all of this. so the problem with the approach we're seeing that you're offering which i do believe, senator, is very different than what we're saying, is we don't want to have to sit in washington and mandate all of these things so what you are-- is you are defining exactly what kind of health insurance people can have.

you're mandating them to buy the kind of health insurance. >> 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. >> let me just make this point john. because we're not campaigning any more. the election is over. >> i am reminded of that every day. >> and i can tell you the thing that i have heard more than anything over the last six or seven months is that the american people want to scrap this bill. they've said it loud, they've said it clear. >> john, you know the challenge i have here, and this has happened periodically, is every so often we have a pretty good conversation trying to get on some specifics. and then we go back to, you know, the standard talng points that democrats and republicans have had for the last year. and that doesn't drive us to an agreement on issues.

>> rose: president obama ended the sum wit a vow to press ahead with comprehensive reform. >> we can to the have another year-long debate about this. so the question that i am going to ask myself and i ask of all of you is, is there enough serious effort that in a month's time or a few weeks time or six week's time we could actually resolve something. and if we can't, then i think we've got to go ahead and make some decisions and then that's what elections are for. >> rose: joining me now from new york is joseph califano, former secretary of health, education and welfare during the carter administration. mark halperin of "time" magazine. in washington former senate majority leader bill frist, he was a heart and lounge transplant surgeon before he entered politics. and ezra klein of the "washington post". with me in miami at the public television station facility is donna shalala,

she served as health and human services secretary during the clinton administration. and she is now president of the university of miami. i am pleased to have each of them here. we begin with bill frist who knows the legislature well. i want to talk about three things this evening. number one is what happened today. number two, what happens next. and number three, where does this lead health care, where does it leave health care at the end of the day. so i begin with you, bill frist. tell me what happened today and your assessment of it. >> well, charlie, it was a remarkable day, i thought. and i say that based on the 12 years that i spent in washington. very similarly to where these senators are today. what was different today, i didn't see it in six years with president clinton or six years with president bush, is a president of the united states taking directly to the american people for seven hours a very good debate, a very

intelligent debate, a very substantive debate. and yes, there was partisan rhetoric thrown in and some jabs here and there. but the fact that the american people, and indeed the world could watch for seven hours very thoughtful ideas, good substance come forward, i think was a great tribute to the process. i say that and here we are now about four or five hours after it ended, and those seven hours really generated no change compared to where we were early this morning or yesterday. i think the president made it clear that-- that he wanted to listen. he did listen. but i don't think anybody was convinced in that room, and it may have been some benefit to the american people, but there's been no change in the politics. and i think that as you mentioned in the set-up, the trends have been a loss of support for comprehensive reform to the point that the ma skbrort of-- majority of people in this country do not want the bill that was passed by the senate and by the house.

>> rose: donna shalala, what did you think? >> i thought it was a marvelous discussion, certainly the give-and-take. but you could see the differences between the two parties, between their philosophy of government, and on very specific issues. i thought the most remarkable thing was how the president listened and kept bringing people back to the substantive discussion. i think do i think changed any minds? i doubt it between the two political parties. but it was an important discussion that needed to take place. >> rose: joe califano in new york? >> i guess i think from the president's point of view, it was probably a plus in the sense that it certainly lays the groundwork to position himself as somebody i'm listening, i like to hear it all. but we've got to get on with this thing. and it's the predicate that's needed to really put the heat on the democrats in the house and the senate to move with the bill, to press

nancy pelosi, for example, to get enough house votes, to pass the senate course if that's the court they ultimately take. i don't think anybody's mind was changed. i think the differences are truly fundamental, both as donna says in what the role of government is, but also in how you would deal with health care and we can talk about the substantive bill later. but the politics of it, i think for him, a plus in terms of how he positioned himself. >> rose: and for republicans? >> for the republicans, i think you know, they come through as wanting to stop it all and start all over again. and i think he wanted to say, you know, you had a whole year. they never got across the point that they made in other contexts it seemed to me t that they really weren't part of that discussion. that the democrats put this together themselves. i think he trumped them on

that, very effectively. >> rose: ezra klein, tell me what happens next. >> what happens next is that the summit in itself isn't a vote. and we don't know how much it changed public's opinion. what everybody is waiting to see that there is this pool of conservative house democrats. and nobody knows who quite who they are or quite what they want. but they are sort of the ones skittish right now. and they don't know if they can get them back because they don't have the abortion language they had in the original house bill. and they pretty much need to see if the votes were there the genius of the summit, the thing that really did happen before the summit, because in that sort of period of chaos in late january, it gave everybody something else to look at while democrats sort of got their feet back under them. while nancy pelosi an harry reid figured out the next step and figured out reconciliation. let everybody watch the summit instead of the legislative maneuvering. so things are more in line for them than a couple weeks back. but now they have to carry this momentum forward and really see if their votes are there. >> rose: mark halperin, i should say, has a number one

best-selling book in the country, game change. so he knows a bit about politics. what did the democrats expect to accomplish with this, mark? >> well, go back to two things that occurred before today. one is that the reason barack obama spent the first year of his presidency trying to pass this is because he thinks it's right, he thinks it's necessary, and he thinks if he doesn't get it passed in this first year plus, he won't pass it as president. and that's one of his big goals as president. the other thing to go back to is the loss of the senate seat ted kennedy's senate seat in massachusetts. from that day, just a few weeks ago, the white house faced a choice along with harry reid and nancy pelosi which was could they find a way to quickly, relatively quickly finish this off by moving forward, having passed the big bill rather than having failed. today was an attempt to say to the republicans in and the country, this is your last chance to get on board with us. make this either bipartisan or politically supported. i don't think either of those things occurred. i don't think they increased their public support today. they certainly didn't get republicans onoard. now the question is, can

they do something legislatively that jams through an all-democratic bill that still very big and move on. can they convince those conservative democrats in the house and some in the senate that it's better to move on having passed something unpopular but historically important as opposed to failing. >> rose: can they afford to fail going into the mid-term elections? >> once the bill, once they lost the public debate in the fall of last year, they were headed towards passing something that was going to be unpopular. so the argue that they made is once we pass it we'll make it popular because we will explain to people what it is. i don't think that's necessarily true. i think it's admirable that they are going forward because they believe in it. even though i think either way they are in a tough position in the midterms. my guess is that they are right. they will be in a stronger position if they pass it but not much. and there's a lot of risk involved in passing it. >> bill, the republicans wanted to talk about process in part today. the president said let's not talk about process, process, let's talk about health-care reform and content.

when you talk about process the word that comes up is reconciliation. is that likely to be the route the president takes? >> charlie, the american people, the majority of the american people now are not for this comprehensive bill. they're for health-care reform in addressing the uninsured and the cost issue. but not for the version that the house passed and the senate passed. and that is principally for three reasons. we heard the government issue today, and it's a real issue out there today. 50% of healt care today is paid for by government. what the american people right now or the majority of the american people more government scares them. number two, is the cost. talked a little bit about that today. a trillion dollars at a time that the unemploye unemployed-- unemployment is sky-high, that costs are going up three times faster than inflation, deficits of 1.4, 1.6 trillion dollars. this cost issue of another trillion dollars cost in a system scares people. but the third issue and the issue that wasn't talked about today that president obama who i thought did a great job for the most part

tried to push process aside, but in truth process is the third issue that this bill has lost its support. it was there with the cornhusker kickback t was there with the deals cut with the pharmaceutical industry, the deals cut with the hospital industry. the sort of back room deal its that back before 24 hour media coverage could be done. the american people don't like that today. and i say that because that's the powerful reason of why people are rejecting this bill. now that also leads us into the real question of reconciliation. it is an arcane senate budget rule, it's only been in existence for about 30 years now. it's used to limit debate and to lower the threshold of passage of a bill. and the senate standard bill takes 60 votes to pass. a lot of people don't understand that. if it is 60% of the senators need to vote for a bill. what reconciliation does and very rarely, we vote maybe four or 5,000 times a year,

it may be used once a year, it dollars that-- lowers that threshold from 50 to 60 votes on budgetary issues, never, never major a compreheive legislate-- legislation, especially legislation that is purely partisan. so if-- it jammed. you kept hearing that word jam today. you heard lamar alexander open up and say just take it off the table. and it's because you do lower the threshold, take a major bill, you do jam it through at a time the american people don't want the bill. i do think that would be rejected and it would be a huge rebill onby the american people. >> rose: what do you think of the reconciliation process? >> well, the reconciliation process has been used for health care before. it was used for cobra. it was certainly used for the children's health insurance plan. it's been used about 22 times in a dozen years. it doesn't bother me because it gets the majority of the votes to have it pass. what is archa sick not reconciliation but the whole ideahat you have to have

60 votes to stop debate. that seems strange to people that believe in democracy. i happen to disagree with my good frid bill frist about whether the american people really like the bill. when you break it down into pieces, explainhat each piece is, there are actually for it. as for back-room deals, let me say something about that. because i've always thought this argument was kind of funny. the fact is that the whole process was messy because it was transparent. it's the opposite of back room deals. you want to talk about back room deals, talk about the deals they made when they passed the drug benefit for senior citizens. they completely adjusted hospitals for south dakota. when dow it in the back room, in fact, no one knows about it. all of these deals have been totally transparent. >> rose: then why do you think support for the bill has been declining? >> well, because there's been this drumbeat of two

comprehensive, too scary. and you do that and then you point to the fact that its-- that the people are confused about the bill. but that's not unusual in big bills. >> rose: but the president has the biggest pulpit in the country. >> he does. but even on these large bills, there's a classic idea in american political science called the negative coalition. it's so easy to beat a comprehensive bill because every one that has one objection to the bill gets together with someone else. they build a negative coalition. and then beat a bill that way by getting together on the one thing that they don't like. and then they pull themselves together and beat the bill. when you go out and explain to the public what is in the bill, they're for almost everything that is in the bill. does it require-- . >> rose: in the bill passed by the senate. >> in the bill passed by the nate. that's the centrist bill from my point of view. >> rose: and the bill that would you support. >> yeah. i think the big challenge is how fast they can implement it.

because i think you overcome some of that opposition after you pass the bill if you can implement it immediately. as soon as seniors find out that their doughnut hole is closed, as soon as governors find out that 100% of their costs on medicaid are going to be going to be covered by the government, you begin to change the politics am but more importantly, we can eliminate preexisting conditions, we can eliminate caps. we can cover 30 million people who desperately need health insurance for themselves and for their families. we can do all of this with private companies, with private insurance companies. i just-- and do all the waste, fraud and abuse, try to contain some costs initially. this bill is really about coverage, though. so i think we have a chance but it has to be done quickly and the implementation has to be done very clearly. >> rose: do you agree with that, joe califano? >> i think the reason the support has been declining for the bill is truly the fear that it will cost too much. i think that we forget that

80% of the people do have coverage and most of them like their coverage. they like their doctors. they all want to control costs. but they want to be damn sure that if they get sick or their mother gets sick or their kids get sick or their wife gets sick, or their husband, they can get all the care they need. and somehow or other there has been a real sense that that might, i think, people fear that that might not happen. i think also you constantly fight with health care. there is a safety net. it's an incredibly expensive safety net. it's the emergency room. it's the fact that anybody in this country that is in desperate shape does get care. i think, i hope and that the president work its hard to try and peel off some republicans. because i think a bill this kpri kated is not self-executing. you need people generally to

support it. you need the states to support it you need the doctors to suprt it. you need the hospitals to support it. people forget, you know, when he passed medicare in 1965, even though we had half the republicans in the house and the senate on that bill voting for it, we had enormous trouble. the doctors didn't want to support it. we were so concerned the doctors came in to see lyndon johnson in the cabinet room. they were coming to say-- he was, you know, we may not support medicare and lbj said before they could even get off the ground, i need your help. i have a war in vietnam. i don't have anybody to take care of civilians. i have military doctors. will you all volunteer. and they said yes, we'll have doctors volunteer. and he called in the pless. and he announced that. and the first question from the press which everybody was asking in washington was will the doctor its-- doctors join the medicare program. and the lbj turned to the med of thema he turned and

said will they join the medicare system, they are willing to give their lives up for the country, of course they will support the land. that is how to get it done. but people forget the fear that they wouldn't get aboard. and i think there is a lot of concern about that in the context of a sense that a bill is, you know, rammed down the throat. i agree with donna. i mean i always thought, you know, in those days we didn't-- the only time they used the filibuster was to try and block the civil rights bills. all that other great society legislation passed by 51 votes. >> rose: ezra, tell me what the president should have done, might have done differently, and therefore what he has to do now in terms of how he changes minds in washington. >> i think there was a lot less opportunity for this to go another way than people sometimes think. donna can obviously speak to this more than i can. but president clinton did it differently. he had a much more executive focus, he began with a speech rather than saving his intervention for later on. he took it mostly away from congress, built the bill in

sort of this executive process. and you know everybody said that was a terrible idea, you need to let congress do . so obama let congress do it, then of course people watched congress, they hate working congress work. congress is awful to watch work. and so athe end of it they hated that too. i mean the thing with health-care reform, as some of our other panelists can say better than i can is we have been trying to get this done for a very long time. and we are not a country that trusts either our government or more worryingly, i think each other, to do big things. but you know, people don't like this bill very much. >> rose: is that it, ezra, because it's too comprehensive, is the problem that it was too comprehensive and people don't like to do big things? because i always hear this argument that if, in fact, the president had done it more piecemeal and had started small that he would have been able to add later. donna doesn't agree with that at all. >> no, i don't. i actually, but it's complicated to do big things. we've done it a few times in social policy. in each case there was an agreement about what the problem was, and an

agreement about the solution. and in the case of social security, in the case of medicare and medicaid, i mean it wasn't easy to take those giant steps. but you do have to have that kind of consensus. i think that the mistake that was made was they didn't do it in january. when they had the 60 votes to do it in january. and they lit that time-- . >> rose: what delayed the process? >> you know, it was just there waan assumption that massachusetts was not going to go the other way. and people were on vacation. they just, the problem when aryou trying to take a giant step is you have to clearly explain it. you have to build a consensus. but you also have to move it quickly, particularly in an age of transparency. you can't let the messiness lay out over a long period of time. but look, we are where we are. this is a very important bill. i believe that the elements, each one of them need to be connected with each other. you can't eliminate preexisting conditions

without having universal coverage. you can't eliminate the caps. i mean look at what happened in california. it's incredible that that increase, that was be increase in the individual market because people who were healthy pulled out. >> rose: mark-- should the president -- >> there is a tendency to overstate how comprehensive this bill is here. this is much less than what clinton po proposed, what nixon proposed. it does much less than people think. everybody has had a big incentive to overstate it, democrats how good, the republicans how bad, the media how interesting. this bill will spend about 4% what we spijd on health care in an average year, covering two-thirds of the uninsured t won't solve the cost problem. it won't affect pretty much anybody with real employer based insurance, you or me. it is building a system around the margins of the current system. it is really a trimming of ambitions. and i don't think it's got either credit or sufficient deriggs for that. it won't do enough and we're ter pied it will do too much. i think we have backwards.

>> rose: bill frist, should the president have compromised on medical malpractice, on tort lawsuits? >> you know would have been interesting. i think everybody has sort of agrees that this is purely a partisan bill, 100 percent partisan bill. when we passed medicare modernization act we had 74 votes for that, that was the last big health-care bill back in 2003 for prescription drugs. we had 74 votes coming out of the united states senate. at that point in time just as an aside, my caucus came to me as majority leader, and as the majority leader who decides about this reconciliation. and they said we got the presidency, we got the senate, we got the house. why don't we go ahead and use reconciliation, lower the threshold from 60 to 50 votes, limit debate. and i said no. and i id no because i felt it was important to be bipartisan. and this bill is not. 60 vote partisan votes in the house completely partisan. now obviously people can say the republicans didn't come on board, but it is very rare that you can't pick off

somebody from the opposite party, or two or three or four. the one issue that would have done that is if the president, and he didn't give anything really today. he said let's do it administratively. but if the president had put a significant tort reform defensive medicine, frivolous lawsuit provision, in the bill back a month ago or two months ago, i'm absolutely convinced we would have picked up three or four or five republicans. really changing nothing else in the bill. >> and he might have picked up a few republicans but he would have lost a lot of democrats. let's be real about the financial forces here. i mean the lawyers have an enormous impact on the democratic party. >> but the point -- >> they didn't buy into this bill. in any way, shape or form. they spent more money lobbying than anybody in the health industry did in order to protect themselves. i think charlie, it's also important, president obama does not have the kind of power for example, that somebody like lyndon johnson

had. he doesn't, the senators and congressman can now raise their own money. they don't depend on him for that he doesn't have that kind of clout. and he's got-- and he has the cost hanging out there. said to be a trillion dollars. it's probably going to be twice that when congress moves along and doesn't take the half million-- half billion dollars out of medicare and they keep giving the doctors increases as they have. i remember with johnson one of the economists on the council of economic advisors gave a two-year projection of medicare and medicaid. i thought lyndon johnson would come over the white house. he said joe, call him up, gardner agoly and tell him i don't want any projection. we don't need any projections. obama has to live with these projections now. and they're devastating in terms of scaring the hell out of the people and the moderate members in congress. >> rose: mark halperin, tell me what people inside the obama administration and from the president to rahm

emmanuel, the chief of staff and david axelrod, the political advisor, what are they saying about the way they have handled this and what they have to do now? >> well, there is a lot of frustration. they think the republicans are just being recalcitrant and aren't paying a political price, that the press is not holding them accountable. they are frustrated also with the fact that if it hadn't been for the loss of the massachusetts senate race they probably would have passed this. and so that was not, they believe, their primary responsibility to watch over that race. and there is general concern that a lot of bad things can happen now if this goes down. if they can't figure out a way to pass it. number one, on the substance and the president made this point repeatedly today and it is what frustrates him most of all that republicans won't come on board, is all the problems having to do with cost, having to do with business, ability to insurance people, all of those problems will still exist if they give up on this. and that's a big problem for america's competitiveness around the world. that is the reason why going

into this, one of the big advantages he had was a business labor coalition of people in fortune 500 companies saying we must do something to solve this. that's gone away to a large extent, that's a problem. the white house is also concerned that this raises questions amongst democrats on capitol hill about their general coetence, their legislative strategy. there is going to be an every democrat for him or herself mentality if this goes down. because the enterprise that they joined hands on rejecting republicans, basically saying the liberal chairs and the liberal leadership is going to be in charge here with the white house, that went down and so now as they approach dealing with jobs, where they had some bipartisan success but i think that's going to be difficult, or anything else on obama's agenda t will be very difficult to keep that coalition together and the only alternative is to bring republicans in and that going to be a big challenge for them. so i would say there is still a little bit in denial but they recognize that they have a really tough position now. without success it gets even

tougher. >> rose: one of the things that i have seen written looking at what is going to be appearing in the papers tomorrow is that what came out of this clearly was that republicans, some are writing, did not want health-care reform. they didn't think the country wanted it. and they didn't want it. do you agree with that, bill frist? >> you know, i hope not. we've got 30 million people uninsuranced in this country. and the uninsured, if are you uninsured you're going to die sooner. and it's a truth. it's a fact. you eventually get care but it's way too late. and with the cost and with the spending that's going up much faster than inflation, jobs t can't be sustained. this new backdrop of the deficit, of 1.4, 1.6 trillion dollars is primarily driven by medicare and medicaid. all of which is driven not by health insurance or single payor or even what we talked about today, but which in large part is driven by behavior, lifestyle, by socioeconomic

causes, by k through 12 education, none of which is addressed in the bill itself. so i think that we do have to come back to reform. i think based on what we saw today, that comprehensive, as lamar alexander said, we don't do comprehensive well in his opening statement. what comprehensive health-care reform as defined by the democratic partisan, because it was only 60 democrat, senate bill is dead it is dead. so i think the real challenge is what we do over the next three months, the next six months to address these problems that we as citizens, as policymakers here in washington, as government officials have an absolute, and i would argue, moral, not just economic but a moral obligation to address. >> we do, we have done comprehensive well. a bill w all due respect, you're an ecoof the people that said we couldn't pass medicare if we are going to cover everybody over 65, it's too tough. >> no. >> 45 that is 30 years ago t is 30 years ago, it's 30

years ago. >> rose: . >> let me finish, please. if we are going to cover the poverty level or the medically indigent in the original medicaid bill. >> it is 2010, it is a different world, it's a different world, it is a different world. >> rose: . >> i spoke to lamar alexanr about his point on this last week, about that he come to the conclusion we don't do comprehensive well. i called him about this because he was a very big supporter of thewideen bennett bill which was much more effective health-care reform bill which was last year sometime. at the very first white house health care summit, we had one about a year ago, he said to the president, have you thought about just passing the widen bennett bill which i cosponsored and other people cosponsored. as the process worry, he said i never supported that bill in the first place. i just thought it was a good process. and did you hear a lot of that. i think there is a tendency for people to become more skeptical of government when they are not the ones running it. and that can be a bit of a

problem. we're talking about tort reform a moment ago. mark, i think it was your magazine t was time that reported that in an early meeting with republican leadership obama put it on the table. he said look, if i give you tort reform what will you give me. they said we're not prepared to deal on this, mr. president. so i think that there is -- >>. >> rose: isn't it part --. >> rose: it seems to me-- go ahead, mark. >> with most maddening to me about this is that if you took senator widen, senator bennett, bill frist, lamarre alexander, chris dodd, barack obama, put them in a room, took the politics out of it and said write a bill that will solve the problems that big business need solve, that labor would like solved, that the country needs solve, i have no doubt that they could write a ll that the president would be enthusiastic about, that bill frist would be enthusiastic about. obama was supposed to be the leader who could drain enough politics out of this that such a process could take place. it's not even close to that. not even close. >> rose: what happened? even though we've said it before, tell me what you think, mark, since i agree

with you, what you just said, that there is a commonality on some basic issues about this. so what happened? >> i think the president starting with the stimulus bill but then on health care, decided to try to pass a bill that was at the centre left of the democratic party, not the center left of the country. and republicans simply couldn't swallow the fundamental orientation of the bill. and they, and the white house decided again to their credit in the sense that this is what they believe, that that was the way they wanted to go as a legislative strategy, to not say to henry waxman and nancy pelosi and others we're going to pass a bill that will have bipartisan support, that's a risk and tricky, but that would have been, i think, the right way to do it and the way obama as a candidate suggested he would try to do it. >> rose: but that's what he tried to do in the senate. >> well, they did try to he limited extent in the senate. but in the end, you know, it is absolutely the case, and the white house frustration is justified, that there were members of the senate who would have compromised on the merits but faced

political pressure not to. and they caved. it's absolutely the case. but this is-- that, the white house gave up and this is where it's lead them. liberals will say they had to give up because the republicans were never going to deal. but this where they are now. and to pass it on these terms without any bipartisan support, i think is a mistake, a political mistake for sure, but it's a substantive mistake even more seriously. >> the substantive part of mistake is very important on that. that is why i hope he can get some republican support. this bill will not be self-executing. this is-- this is asking all kinds of peoe in our society is, state governments, local governments, insurance companies, doctors, nurses, hospitals to do all kinds of things. and you can't just say the secretary shall, and it's done. i mean i think you go all the way back to harry truman, and you had the power-- there is-- the bill is the power to persuade as well as a law. >> rose: donna.

>> look, i-- . >> rose: let donna comment. >> i live in a real world. >> rose: don't we all. >> where the doctors at the university of miami provide health care in the safety net hospital of miami. that safety net hospital is in deep trouble tonight because of the number of uninsured people have gone up in our community. and the safety net hospital simply can't afford to take care of all of them. every state in this country is seeing major increases in their medicaid bills. need a bis people that are uninsured, that eliminates preexisting conditions, that gives people real access to drugs. and makes sure that they can get up every morning and their kids will be covered with health insurance. this bill covers every major element that need its to be covered. and i believe that there is

wide spread consensus when you explain the bill to people. i do believehe politics has overwhelmed it. i hope that the president decides to go forward. because i think in the end it does everything that we need to do for coverage. it doesn't do everything we need to do for cost containment. but if you look at our experience, you start with coverage, and then you move to cost containment. >> rose: let me speak to ezra, you know this stuff well. how did the idea get across the country, perhaps it was built on other things that happened in washington because of the economic crisis we were facing and the stimulus program and the bailouts and all of that. but the notion took hold that this would contribute to, it was too much and too rich and was spending too much. and you would have thought that the president would have appreciated that and been able to weight in on that debate. what happened? >> i would say there are a couple of things. number one is i don't think people fundamentally, the government pays for what it

does. and they have reason for that, right. in the 20000s there was a lot of passing big bills like the medicare prescription drug benefit and tax cuts that were simply not paid for. people began to believe that when the government spends it borrows. number two, i think that they fundamentally believe that, you know, if are you covering more people it is going to cost more. now they are right about that. the administration would say well, we're getting savings, we're paying for it, we're going to cut the deficit, that's all true too but people don't really understand that, fundamentally, it's a question of cost, i mentioned $50 billion say big numb. but in the final thing, i think is important to other parts of our conversation too, the president has a lot less power than i think we like to think in changing public perception. he gave a speech now and then but gives too many of them, people tune out. early on he was table to do town hall its and abc nobody watched. we tend to talk about all of this in terms of him and how he should do it. and how could we have better drained politics out 69 process. i'm really unconvinced. whenever i try to get people to get specific on that it gets really, really hard to

get in there real fast. there is much that could have been done. we have had a recent history in this country where over and over again the minority parties found success in destroying the majority party central initiative. social security reform in 2005. the clinton health-care plan in 1994. and it's probably goi to work again, but so long as we have these incentives built not system t isn't clear what exactly the president can do. because fundamentally we have a congress-centered system, not a president-centered system. >> rose: let me turn this, i want to broaden this out in a moment in terms of the way washington is working these days and the criticisms that are taking place. but before, i want to just go around with everybody that is with us this evening and ask this question. because republicans in this summit said they wanted to start all over. that is what lamarre alexander said, that is what so many of the people who spoke said. we have to start all over. the president is to the going to start all over. my question and i will begin with you, bill frist, what advice do you-- should the

president, what should the president do? >> yeah, first of all i disagree with what was implied earlier. the outcome would have been very different if the president, because he is so good at it, had gotten involved six months, five months, four months earlier in articulating and in listening instead of doing it today, he is that good and he came that close. it passed the senate t passed the house. but now we got 60% of america saying stop. we don't want this bill. it would have been very different. so the president is going to have to lead on it and i basically, i have already said although nobody agrees with me, i don't think, that comprehensive health-ce reform in the way it's been defined is dead. but basically i would spend the next four to six weeks which is his time line, and say okay, i get the message. we don't do anything about cost. spending is going to keep going on up. we do the access issue so let's start from scratch. let's take three things. number one, the insurance issues, preexisting illness, some caps, the sort of issues that we talked about today. number two, general

agreement on the health exchange markets that are state regulated, somebody can come in and choose the insurance plan which best meets their needs. it has an element of competition, and number three, i would say there is general agreement on today, the whole idea of tax credits for small businesses to be i believe to offer that health-care reform. i would take those three issues, i would go forward and say this is step one, this is the down payment, i got the message, i've learned my lesson. we'll go on to other issues now, economic issues, jobs, six weeks from now but let's at least do that. >> rose: joe califano, what should the president do? >> i think he should try and get more than bill frist is talking about. i think-- i think he should maybe pick up on what mark's suggestion earlier, put the right people in a room and say i'll take half a loaf. i'll take ten or 15 million people that we can cover. i will-- i will, but we have to-- we have to expand the coverage. and i will pick up a lot of these other pieces that you

are interested in. i think that is probably something like that should be doable. what i don't know how to measure, charlie, and maybe mark is the best person around this table to measure it, is how shredded the relationships are between the, your pointabou dysfunction, between the democratic and republican leaderships in the house and the senate. but i would try and get half a loaf. i would try and get as much as coy get. i wouldn't-- i would get the things bill frist is talking with about but i would really insist on increased coverage. i think this is critical and it's something on which you can get business and labor together because of the whole competitive issue that mark is raising. they want that. >> donna what should the president do? >> well, i wish i had the kind of confidence that bill frist did. and i have enormous respect for bill but i have not seen the

republican party present alternatives or in a serious way discuss any of the things he has on his list. they didn't say it today. they didn't say it last week. they didn't say it a month ago. they never put a real plan that would really cover large numbers of people that would provide insurance reform. and the fact that we haven't heard it before, that every time the president said put your ideas on the table, what we heard was really marginal kinds of things. with the single exception of tort reform, which i happen personally to be in favor of. and i wish this bill had more tort reform. my party clearly lacks enthusiasm for that particular issue. >> rose: it's not politically viable within the party. ezra, what should the president do? >> i think they should try to pass the bill. i honestly don't think there is a very high likelihood that a plan b work. i don't think there is energy in the legislature. i don't think there is much time. these guys are all going home to campaign soon, we're in an election year to go back to the original

committees, try to get them back together. deal with the fact that liberals hate you for capitulating on the bill, deal with the fact that the right for election is going to hammer you for it. i think they have a eve odds chance of still passing this, about 40% on the betting market, i think that is not a bad estimate. i think they should go forward. >> rose: you are saying take the senate bill to the house. >> take the senate bill to the house, get your fix-it is reconciliation which the president has proposed, and try to pass your legislation and sell it which is pretty much what the president said he was going to do at the end of his remarks today. he said look, you know, we realize there is an argument over whether or not it is a popular but that is what elections are for. we think we can sell this, so pass it, sell it, get something done. >> rose: mark, can he do that, is that what he should do? >> it pains me to say it because i think if it's done, if it's done and not done well, then it will be really bad for the country, as i said before. but i agree with ezra, what ezra says and what i think secretary shalala is suggesting, with one addition. he should do everything he can to get support from republicans and business leaders outside of congress.

because i don't think you are going to get support from republicans it in congress. but this must be blessed by as much of the country. maybe the ama, maybe some of the medical lobbying community, the business side of the medical field. fortune 500 executives, as many people as can get pass it, and say this isn't perfect. it's bad that it was done in a partisan way it was unfortunate, but he's got to go forward. both bause i think the politics will be better for his party, but also because it's the right thing to do, it's because of what he believes. this is what he ran on. if he doesn't do it now, i don't believe he ever will, even if he serves two terms. >> rose: mark, your magazine had a cover story saying washington is frozen or whatever it was that they said on that cover story about what is wrong with washington. what happened to washington? is it simply the filibuster or is it the absence of bipartisanship, the kind of often cited relationship that tip o'neill had with

ronald reagan andll of that. >> a big part of it. it is the absence of comedy and personal relationships between the leaders. it is the political media culture, the freak show culture i have called it for a while, which really celebrates and amplifys extreme voices at the expense of doing things in the public interest. it is the jerry mannedering district it is all the things we talk about all the time testimony makes washington a more bitter and partisan place and the united states makes it detached from the united states. but that what controls the two parties in washington. and in a lot of state capitals as well. and it does paralyze washington to an extent that we are seeing now in this first year of his presidency. and again if he can't find a way to fix it, it will dominate his presidency as it did for most of the presidency of both bill clinton and george w. bush. >> rose: would -- >> would you add money to that? i mean money is so important in washington now. so much time is spent. money has so much power that individual constituencies, probably in health-care area as well as others have the ability to veto anything

that really hurts them. i mean money plays a role it never played before. every subcommittee chairman has a source of funds from the people he's regulating, legislatively, not from his constituents back home. and i think money is as big a factor as anything else, mark. >> and the other, absolutely. and the other thing which relates to a lot of the other issues, is the absence of moderates. you know, when evan bayh announce he's leaving because nothing gets done, he's one of the few people in either party left in the senate who is willing even attitudinally to work across the aisle. and there is fewer and fewer of those people in the senate. there is almost none of them in the house. any more. in either party. and you look at someone like senator frist's friend lamarre alexander. he's worked with democrats his whole life both in washington and in tennessee. and yet because he's part of the leadership in the republican party, he doesn't have much of a record of doing it, because there's no one to work with on the other side and because of the penalty he would pay if

he crossed the line. >> i don't know if people read evan bayh essay in "the new york times" about why he is leaving and what should be done. but i think is really a remarkable document on this argument. and he does something very interesting in that, he says all the things we know is happening because we are polar azed because of the media, because people don't know each other. and he's got some ideas for fixing that, he's got this idea for all the senators of both parties to have a lunch together. but he pretty much says in the meantime, we have to recognize that the country is the way it. it is as polarized as it is. the media is national, and it competive and it fast and it is scandal-oriented. and we have to also have a system for getting things done. and so he argues we should bring down the filibuster to 55 votes. he argues that we should not have quite so many nominees who have to go through senate appointment. he has a couple of different pieces of this but he pretty much says until we can get our country to where we like it to be, we need rules that are realistic for the world in which we live. and i think there is a lot of wisdom to that. >> rose: bill frist, you

listened to what people said about washington. you left washington. >> i know i did. and i am one of the few who said i'm going to go for 12 years and no matter where i am, i'm going to leave. and i think something can be said by having not necessarily term limits but people who come and don't spend a lifetime here in this environment. the only thing i would add to the list is the impact that media has had. i came in 1994. did stay for 1 years. and over that period of time, and never has been great since i've been here. every time you go on a show, there aren't many charlie rose shows there are no charlie rose shows except for this one. but just about every other show that you go on, is probably driven by their dollar, the advertising dollar, a different dollar than joe was talking about, but are you basically told we need tension. we need conflict, we need the sort of at you, the sort of cross-firemen tallity and that is what we need on. that is what you get asked back if you do. you have a 24 hour seven

coverage we talked a little bit about in terms of process and people seeing what used to go on all the time here. and people just are offended but it, but it's also this coupled tension that feeds media, yes, cable, but not just cable. just about every show that is out there today. >> let me-- donna on the same point. >> well, you know. >> stephen: secretary shalala. >> i loved efan's bayh's piece on washington and why he was leaving government. i thought it was also a very sad piece. and i thought of catherine graham, actually when i was reading his piece, because i love mrs. graham who was a publisher in "the washington post". because she had such respect for politics. but real respect for the presidency and for the institutions in washington. and she brought people together from different parties. when i was in washington i had a wonderful working relationship with senator frist. and we were from different

parties. but we were always looking for a way in which we could keep moving. >> rose: what happened? >> it's a combination of everything. and in many ways we need more grown-ups there. that break down these barriers, no matter what the differences are in substance. i actually thought today was a wonderful day. because the president got everybody talking, kept bringing them back to substance. i would hire him in a minute as a full professor to run a great seminar but i thought he-- the fact that he kept bringing people back kept trying to break down the ideology to get them to talk about substance t was a good day for washington. >> rose: but at the same time i think he said, you know, we don't need another of these. subsuggested why don't we do more of this. and he said we're not going anywhere. we're not getting anything done. we're staying on talking points and we're not getting alot done. >> but when they got off of talking points, in the few times they got off a talking point i thought it was very useful. >> rose: let me begin by -- >> the parties have also

become ideaological. they used to be liberals in the republican party and conservatives in the democratic party. and that no longer exists to the extent it did in those days. and let me give you a little capsule example of how dramatic the differences are. when we were on johnson's staff, our instructions were you treat everett dirkson the same way you treat mike mansfield. you treat jerry ford the same way you treat speaker mccormick. is that conceivable today, mark, in washington. >> it's inconceivable. it runs counter to the tway is, and with all due respect to secretary shalala, i thought today was a manifestation of everything that is wrong in washington today between the two parties. i thought yes, the president, i thought did a good job under the circumstances. but there is no, the president today treat john boehner the way he treats nancy pelosi. he did not. and it's not his fault, it's

the culture in, that exists. but i thought it was all posturing. it was all theatre for the purposes of the base of each party. >> the president just makes it worse. s there is a political scientist francis lee and she did this wonderful look and looked at how likely we would get a party-line vote when the president takes a position. she looked at it for economics, national security. but also what are called nonpartisan issues, things like should we go to mars. if the president takes a position on an issue, the chance of a party-line vote goes up from between 20% to 60% depend on the issue. and that holds across-the-board. and the other piece of it is we are spending more and more of our time, congress is spending more and more of its time on the president's agenda. so essentially the more the president steps out, the more these things nationalize and the more the other party pretty much has to take the opposite side if they are going to win the next election. so i think the increasing president is part of the problem and not the solution. >> rose: let me close with the following things.

i would love to do a quick, we have less than four minutes here, assessment of where you think the president is at this time and i will begin with you, ezra. >> where he is in terms of his. >> rose: presidency. >> i think he is in i a troubled place. i think that everything depends on health care for him now. what he did today was he doubled down. cohave said we're going pare back the bill. we could have said maybe we will back off, he could have said what senator frist put out, that we should just go back to the drawing board. none of it happened. he said this is a good bill t is what we need do-to-do and we're going to do it. he pretty much gambled at least his first two yes on this bill passing. whether or not this is going to be wise, remains to be seen. but i have a lot of-- i think there is something to be said for putting the presidency on accomplishments rather than what appears to be the easy political way out. >> rose: joe califano, the obama presidency is in trouble. >> i think he's in trouble but i think-- think health care is important. if he could drive it through, he says he wants-- he's

willing to be a one-term president. if he can be a great president. but i think more important than anything else for him now is the economy. he-- what happens to jobs, what happens to the economy, if i were the president, that is where i would put all my chips because that will determine whether he has the power to get anything else done. >> rose: would you, joe, have delayed health-care reform until you had been able to convince the country that you are making serious progress on the job. >> i don't-- i think in retrospect, sure, he should have gone with jobs first, and shown that, and maybe built a tremendous support on that. but you know, in the carter administration, we went with welfare reform first and we waited on health care. and we lost health care. we might have gotten health care if we had proposed it before teddy kennedy and the clinton administration. >> rose: in clinton they went with health care befor before-- assessment of where the president is, less than

a minute. >> you have to understand that he's in much better shape than the president i worked for at the end of his rst year. so given the nature of the country at this point in time, the terrible economic disaster that we're in that he inherited, i think he's actually in better shape than anyone could have expected. i do think he's a strong president. and we'll see it on health care. >> rose: and has skills. >> real skills. >> rose: all right, mark, quick 30 second assessment. >> he needs some victories. he needs some job creation. he needs people to be afraid of him. and most of all he needs people to see that he has an argument, a theory of the case of how to turn america around, particularly in terms of the economy. >> all right, thank you very much. i want to thank in new york joseph califano, former secretary of health, education and welfare. man with an actual center on addiction and substance abuse. mark halperin, "time" magazine, game changes number one best-seller. ezra klein, "washington post" and columnist, bill frist, former senate majority leader, a physician

and here with me, president donna schlaya-- shalala president of university of miami. former secretary of health and human services thiss with an interesting day to watch what happened in washington. we look at what is going to unfold now with all of the consequences we have talked about. thank you for joining us. and my great appreciation to the people at public television in miami. good night. captioning sponsored by rose communications captioned by media access group at wgbh access.wgbh.org s