Steny Hoyer, Kent Conrad, Marsha Blackburn, Tom Coburn on CBS' 'Face the Nation'

CBS'S "FACE THE NATION"

FEBRUARY 28, 2010

SPEAKERS: BOB SCHIEFFER, HOST

REP. STENY H. HOYER, D-MD.

SEN. KENT CONRAD, D-N.D.

REP. MARSHA BLACKBURN, R-TENN.

SEN. TOM COBURN, R-OKLA. PASCALE BONNEFOY, GLOBAL POST

[*] SCHIEFFER: Today on "Face the Nation," yet another natural disaster. This time an earthquake in Chile where hundreds are dead. And what next on health care reform? Is it dead or can something actually be passed into law? We'll get the overnight news and the latest pictures of the devastation in Chile. Then we'll pick up on health care where the Washington summit left off with House Democratic Majority Leader Steny Hoyer, Democratic Senate budget chairman Kent Conrad, Republican Congresswoman Marsha Blackburn and Republican Senator Tom Coburn. I'll follow with some thoughts on the mysteries of curling. It's all next on "Face the Nation."

And good morning, again. The news from Chile this morning is horrendous, but it could have been worse because many of Chile's buildings have been built to withstand earthquakes. Still, the damage has been widespread and extensive. The epicenter of the 8.8-level earthquake was near the city of Concepcion, a city of 200,000 people. The police say the death toll at this point is more than 300. But that is bound to go up. We have established contact with Pascale Bonnefoy, a reporter for "Global Post," an international news service. She is in Santiago. Pascale, you were in your hotel in Santiago or in your home last night when all of this happened. What was it like to go through this?

BONNEFOY: It was terrifying. I was in my home on the second floor in my bedroom. We were all sleeping. The house started to shake, then rock, then jump up and down. We didn't even make it downstairs. We heard neighbors went to the streets, but we just couldn't make it. And we just stood there grabbing on to the walls and trying to stand on foot while things were crashing down here. We were hearing glass and things thumping and everything crashing. We had no idea what the damage was. It seemed to last forever. It was actually two minutes. But it really did last forever. We were jumping up and down.


SCHIEFFER: You are in Santiago. Most of the damage apparently from what we can tell is in Concepcion. Do you have any idea of how widespread it is across the country?

BONNEFOY: Yes. In Santiago, it's pretty much under control. I mean, there's the old section in Santiago center. There was housing damage. About 80 percent of the population here already has electricity. We don't, for example, my neighborhood doesn't. The metro is partially restored as of today but down south it's been disaster because the coastal line was completely wiped out. And we have to take into account this was the last weekend of summer vacation, so there were a lot of people at the beach during this weekend because work starts again tomorrow and school started this week. It's not going to anymore but it was going to.

There are ships in the main plaza. There are containers from ports already next to residential areas. All the coast lines were completely wiped out and that's the most affected area. There are towns that are basically on the floor now. There's no local government functioning because there's nowhere to function from. So definitely it's Concepcion, Talcahuano, which was completely wiped out, which is a fishing port, and other smaller cities, they're completely on the floor.

And not flooded. We see waves that were several meters high or 10 meters high that went well into the urban center.

SCHIEFFER: All right, Pascale Bonnefoy of "Global Post," thank you so much.

And of course if we do get more information we'll bring it to you. The big tsunami that was supposed to hit Hawaii, of course, did not happen. The waves were not nearly as large as they were thought to be.

In the meantime, we're going to turn now to the health care debate. As we now know, the president famously brought together members of Congress Thursday for the health care summit. It didn't seem to change very many minds but it did underline how far apart all sides seem. So we pick up with four members of Congress now who were there. Senator Coburn is in Tulsa this morning. The rest of our guests are in the studio.

So I guess Majority Leader Steny Hoyer in the House, I guess the first question is to you and it is simply, what next?

HOYER: Well, first of all let me say about this meeting that we had. I thought it was extraordinary. I can't remember a similar meeting held by any president certainly in the 30 years I've been in Congress. I think an awful lot of the American public watched it. I talked to a lot of people last night and the day before that had watched it. Hopefully it was a better education. It was a civil discussion, a substantive discussion. And I think the American public got the impression that very serious debate and discussion and there were differences.

SCHIEFFER: But what now?

HOYER: But there was an agreement that we needed to have health care reform. That seemed to be a universal agreement. So as a result of the work that has been done, we're going to move ahead to try to make sure that all Americans have access to affordable, quality health care. We think that's essential. We think it will bring down costs. We think it will improve the health of America, and...

SCHIEFFER: But do you have any better sense today than you had then that you're close to even having the votes? Congressman Ryan over in the House said this morning on television that you just don't have the votes over there in the House right now.

HOYER: Well, I don't think we have the votes in terms of a specific proposal because there's not a specific proposal on the table yet. The president has made some suggestions which I think reflect discussions...

SCHIEFFER: When will you have in those specific proposals?

HOYER: ... between the House and the Senate.

I would think that within the next couple of weeks we're going to have a specific proposal and start counting votes to see whether or not those proposals could pass either the House or the Senate or both and send something to the president.

SCHIEFFER: Senator Coburn, your Republican leader in the Senate, said just this morning that as things stand now, all 41 members of the Republican Party in the Senate would vote against health care reform. Do you see that changing in any way?

COBURN: Well, I think it could change if we started over and we actually worked and treated the disease that is plaguing American health care. The disease is cost. And until we put in the incentives to change the dynamics, the market dynamics, the fraud dynamics, the defensive medicine -- that's $250 billion a year in defensive medicine costs, what we need is not more government.

We need more market-oriented, patient-centered health care rather than government-centered health care. So I think if we move to something like that, you could get some votes.

SCHIEFFER: Well, that seems to be where the divide is. The Republicans want less government. The Democrats seem to think that this problem can be solved with more government.

But let me go to Senator Conrad. He's the chairman of the Budget Committee in the Senate. Do you see any chance that this divide can be bridged, Senator?

CONRAD: Actually, I do. You know, my impression was very much different than the lead-in here. I thought there were wide areas of agreement. Senator Coburn talks about focusing on cost. I believe that's essential because we're now spending one in every six dollars in this economy on health care. If we stay on the current course, we're going to spend one in every three dollars.

That's totally unsustainable. That's going to break the bank of the government, of families, of businesses. So we've got to do something and we've got to begin now.

Senator Coburn just mentioned a series of things that need to be done. Many of them are in the bill. This is a market-oriented approach. The government doesn't run health care. This is not single-payer where the government would run it. This is based on private insurance delivered through state exchanges which was originally a Republican idea.

And the best estimates we have is that it would reduce the deficit, reduce premiums for the vast majority of people. So it's a beginning. Senator Coburn has said we've got to do more. And he's right. And that's what we ought to focus on. What are the additional things we could do that might bring us together?

SCHIEFFER: Well, let me just ask Congresswoman Blackburn, because you had some ideas about what could be done as the next step.

BLACKBURN: Absolutely.

SCHIEFFER: What are they, Congresswoman?

BLACKBURN: I think that what we need to do is look at starting again and addressing what the American people want to address. They want to make certain that we take a focus on cost containment and do some work there, that we look at across-state-line purchasing. Look at what you could pull out of the cost of health care if you addressed medical liability reform.

Now with all due respect to the senator and to the majority leader, Bob, our problem is this: What they want to do is let the government -- have the federal government have the overshadow of all of this and make the decisions of what the states can do.

What we're saying is we don't need more government in health care. We need to free people up and let them get outside of this and make decisions that are going to be best for their families.

SCHIEFFER: Well, one of the things you talked about during the summit was you said people ought to be allowed to buy insurance across state lines.

BLACKBURN: Across state lines, right.

SCHIEFFER: You had some fairly startling figures of how much they could save.

BLACKBURN: Well, and that's exactly right. And in my state of Tennessee, the bulk of my constituents live within 15 miles of the state line. And when we checked our border states, today, before we insert competition, they could generally save about $1,000 from being able to get past that stop sign at the state line.

So, you know, we were looking at what would happen with people in New Jersey if they went over to Pennsylvania, they could save 24 percent. They could save 74 percent if they went to Wisconsin. And they were able to purchase there.

What we need to do is insert that competition, our state legislators are for this, our governors are for this.

BLACKBURN: Let the states have the regulation on it, not the federal government.

SCHIEFFER: Well, let's -- let me just ask Steny Hoyer if he's for it?

HOYER: Bob, I think, as the president indicated at this forum, that competition across state lines certainly was an appealing idea. It's got some complications in it because it's historically been run by the states, as we all know. But we thought that that had some -- some merit to it. In fact, we believe the exchanges facilitate that happening.

SCHIEFFER: Why don't you make it happen?

HOYER: Pardon?

SCHIEFFER: Why don't you make it happen?

HOYER: Well, we believe the exchanges facilitate that happening. We also believe that we want to pursue small-business co-ops, that was talked about, in terms of letting small businesses come together so they can have a large group out of a small group.

Very frankly, that's what the exchanges are about. That's what access to the exchanges for small business do.

Let me make a point about cost that Marsha raises because, clearly, cost, as Kent Conrad pointed out, is going to be driving this debate. We cannot sustain the cost curve that we're on.

One of the things that we know that, Marsha, whether you compete across state lines or within the state, you're paying about $1,100 bucks for people who aren't in the system because they're getting uncompensated care.

What we try to do is to wring that cost out. And as a matter of fact, as Kent pointed out, there are a lot of things that Tom and Marsha indicated in this forum that we had that we agree with, one of which was getting vigorously after fraud, waste and abuse in the system. And we have put substantial investment in both bills to do just that, as the president has...

(CROSSTALK)

SCHIEFFER: Well, I know that's what Senator Coburn talked a lot about.

HOYER: He did talk...

SCHIEFFER: The president nodded in agreement on several of the things that Senator Coburn said. He said we need to put, what was it, Senator, undercover agents into the hospitals to find out where this fraud is going on? What was that about?

COBURN: Well, Bob, let me go back and just summarize for a minute. One of our problems is we don't spend too much -- too little on health care; we're spending too much. We spend twice what any other country spends.

And the very idea that we would create another $1.3 trillion or $1.4 trillion worth of expenditures over a 10-year period, when we're not addressing the real disease -- we have over $180 billion worth of fraud every year in the health care system. That's second only to the defensive medicine cost.

So if you had a bill that just did those two things, you went after and changed the tort system and you went after fraud, you could cut everybody's health care costs in this country about 15 percent, 16 percent.

And that's all you need to do to start. So the cost -- if we -- we can't have a bill that adds more cost to health care and more government. The government is responsible and controlling 60 percent of the health care today. If more money...

(CROSSTALK)

COBURN: If more money and more government were the answer, we would have fixed health care a long time ago.

SCHIEFFER: Let me just ask Senator Conrad, then. Why not just do those two things, Senator?

CONRAD: Because it's not -- it's not enough. Look, Senator Coburn is right, I believe, that reforming the tort system would help. But the Congressional Budget Office tells us it's pretty modest, $50 billion over 10 years, when we're going to be spending $30 trillion over that period of time.

So, yes, it's positive. But it doesn't solve the problem. Fraud would help. We think there's probably 10 percent, maybe even 15 percent fraud...

SCHIEFFER: Attacking fraud would help?

CONRAD: ... in the Medicare system.

Yes, attacking fraud. Going after fraud would be very useful to do. But it doesn't solve the problem.

Tom said himself we're spending twice as much per person as any other country in the world. And we're in a circumstance, as a share of the economy, we're spending far more than anyone else, and we can't afford it.

So, yes, cost has to be a central concern. But do you know what the experts told us?

The experts told us the thing that would really matter is reforming the delivery system, instead of paying for procedures, to pay for quality outcomes.

And in the Senate bill, we begin that very approach. The accountable care organizations like Mayo, like Cleveland Clinic, that are effectively controlling costs and getting the best quality outcomes would be given an incentive to have other systems adopt their best practices. That's in the Senate bill.

SCHIEFFER: All right. I'm going to take...

BLACKBURN: Bob...

SCHIEFFER: Let me just take a break here, and we'll come back to this point and talk about some of the practical things that are going to have to happen at the Capitol if anything either does get done or doesn't. So we'll be right back in 60 seconds.

(COMMERCIAL BREAK)

SCHIEFFER: We're back now with our panel of Steny Hoyer, there's been a lot of back and forth, senators say the House has to go first. Some in the House are reluctant to go before the Senate goes. Are you, number one, willing to go first and don't you have to?

HOYER: Whether we're willing or not, we have to go first if we're going to correct some of the things that the House disagrees with. Correct, change so that we can reach agreement, the House will have to move first on some sort of corrections or reconciliation bill which follows the process that the Republicans followed 16 out of the last 22 times it's been done for very major pieces including their tax cuts which were really a more --

SCHIEFFER: You're talking about that the Senate is going to have to go and do it by what we call reconciliation, a parliamentary term.

HOYER: It's a parliamentary term, but it's simply a process that the Senate adopted to allow it to deal with in an expeditious way issues that relate to the budget. It's called reconciliation, a fancy term, been used frankly more by Republicans than by Democrats but used by both parties and accepted.

SCHIEFFER: OK so let's ask Senator Coburn. You'll be over there in the Senate if the Senate -- the leaders there do decide to try to do this by reconciliation. What will Republicans do if that happens, senator?

COBURN: Well, I don't know what we'll do. The first thing is there will be a fairly significant amendment process that will have to go through. But I would make a couple of points on reconciliation. Welfare reform happened with reconciliation. Half the Democrats voted for it. The Bush tax cuts happened with reconciliation. Twelve Democratic senators voted for it.

You didn't have a real partisan issue on those times that it was used. You know, the danger of what's happening right now in terms of using reconciliation is the purpose of the Senate is going to be defeated. And that is to bring consensus to big issues in this country so that we have a reasoned and thoughtful approach and that the American public buys into it.

If you use reconciliation on this health care bill as we see today, what you're going to have is a thumbing of the nose at the American people. They don't agree with it. We need to change it. We're willing to work to get it changed to where we don't have a massive increase in the government influence in health care.

As a practicing physician for over 25 years, Bob, I have seen -- the reason we have a shortage of primary care doctors in this country today is because of Medicare's pricing mechanism. We have too much government. We don't need more. We need less.

(CROSSTALK)

CONRAD: On the question of reconciliation, I have said all year as chairman of the Budget Committee, reconciliation cannot be used to pass comprehensive health care reform. It won't work. It won't work because it was never designed for that kind of significant legislation. It was designed for deficit reduction. So let's be clear.

On the major Medicare or health care reform legislation, that can't move through reconciliation. The role for reconciliation would be very limited. It would be on side-car issues designed to improve what passed the Senate and what would have to pass the House for health care reform to move forward. So using reconciliation would not be for the main package at all.

It would be for certain side-car issues like how much does the federal government put up to pay for the Medicaid expansion? What is done to improve the affordability of the package that's come out of the Senate?

BLACKBURN: It shouldn't be done at all.

CONRAD: But it would not be used. Well, that's not a reasonable position to take, congresswoman. We know that repeatedly for health care certain provisions, for example, children's health care, the CHIP program was done through reconciliation. COBRA, for people who lose their jobs, that was done through reconciliation.

(CROSSTALK)

CONRAD: On relatively minor issues, it's totally reasonable.

BLACKBURN: But this is not a minor issue.

CONRAD: Well, health care reform at large would not be -- I've just said, health care reform, the major package would not be done through reconciliation. That would be unreasonable. But that's not going to happen here.

SCHIEFFER: What were you going to say, Congresswoman?

BLACKBURN: Well, I think that, on the reconciliation issue, if they had the votes, we wouldn't have had the summit. And if they try to go through reconciliation, it will be a change in semantics. Instead of the American people saying stop the bill or kill the bill, it's all going to be about repealing the bill. That's not the kind of discussion that they want.

And when we were talking about the expanded Medicaid coverage, we rolled the dice on this in Tennessee over a decade ago, made the gamble that near-term expenditures could be offset by long-term savings.

Those savings never materialized. And that's from a Democrat governor in our state. And as we have all watched it, savings never materialized in Tennessee. They didn't materialize in Massachusetts. They didn't materialize in Maine. It is not going to yield the savings that you're expecting an expanded coverage program to -- to yield.

SCHIEFFER: Let me just throw this in because I'm not sure the White House has the same understanding of this that you do. Because the woman, Nancy DeParle, who is, kind of, in charge of Medicare over there at the White House -- I mean, health care, over there at the White House, said this morning on "Meet the Press" she thought that an up-or-down vote would be the way to go on this.

So, obviously, she's talking about trying to do it through reconciliation, Senator.

CONRAD: I'd say this to you, Bob. I have said all year, I am chairman of the committee in the Senate; I think I understand how reconciliation works and how it can't work. The major package of health care reform cannot move through the reconciliation process. It will not work.

SCHIEFFER: It will not work?

CONRAD: It will not work because of the Byrd rule which says anything that doesn't score for budget purposes has to be eliminated. That would eliminate all the delivery system reform, all the insurance market reform, all of those things the experts tell us are really the most important parts of this bill.

The only possible role that I can see for reconciliation would be make modest changes in the major package to improve affordability, to deal with what share of Medicaid expansion the federal government pays, those kinds of issues, which is the traditional role for reconciliation in health care.

SCHIEFFER: All right. Let me just go quickly around the table, here, and we literally have about 20 seconds here.

Senator Coburn, do you think, at this point, that health care reform of some sort is going to pass? Or is it dead?

COBURN: I don't know the answer to that, Bob.

(CROSSTALK)

SCHIEFFER: OK. Senator Hoyer?

(LAUGHTER)

COBURN: ... health care reform that they have on the table...

(CROSSTALK)

HOYER: I think so. You said "some form." I hope a comprehensive piece of legislation passes because the American people want it. Notwithstanding what Senator Coburn says, they don't like the process, but they want...

SCHIEFFER: Yes or no?

HOYER: ... reforms.

BLACKBURN: No, the people do not want it.

SCHIEFFER: All right.

CONRAD: Well, we simply...

SCHIEFFER: Time's up. Yes or no?

(LAUGHTER)

CONRAD: We have to...

(LAUGHTER)

We have to do it because we're on an unsustainable course.

SCHIEFFER: All right. Thanks to all of you.

Feb 28, 2010 11:29 ET
Source: CQ Transcriptions
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