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Encore: Health Care Reform Debate

Aired August 22, 2009 - 21:00   ET


LARRY KING, HOST: Two extraordinarily gifted Americans join us now to discuss the health care question, in Raleigh, North Carolina, Elizabeth Edwards, senior fellow at the Center for American Progress, primarily focusing on health care issues, she is the wife of the former Democratic vice presidential candidate John Edwards, and The New York Times best-selling author of "Resilience."

And in Madison, Wisconsin, Tommy Thompson, who was the secretary of health and human services under President George W. Bush and is the former Republican governor of Wisconsin.

Elizabeth, in an interview last month, you said you thought substantial -- substantive health care reform would be enacted.

Do you stand by that?

ELIZABETH EDWARDS, SENIOR FELLOW, CENTER FOR AMERICAN PROGRESS, AUTHOR, "RESILIENCE": I still do. I'm incredibly optimistic. And I think the American people are still in favor of health care reform, despite the assault they've had of a lot of hyperbole and misstatements.

And people know, in their real lives, that -- that they need -- that they're going to need change -- we're going to need change in health care, nationally and in their own communities and in their own families.

KING: Tommy, in an interview with Dr. Val Jones, the CEO of Better Health -- that's a medical blog or education network, in February, you said, "you can bet your bottom dollar that the health care system that we know today is going to be changed so considerably that I doubt you'd recognize it a year from now."

Do you stand by that?

TOMMY THOMPSON, FORMER SECRETARY HEALTH & HUMAN SERVICES: I stand by it because it already has many changes. In the stimulus package, there was a comparative equivalence. There was $20 billion set aside for electronic medical records. There is a lot of other projects that have been already passed that's going to transform health care in the future.

The truth of the matter is, and I think the question you're getting at, is what about the Barack Obama legislation and what the Democrats are doing in Congress?

I think the Democrats are going to have a very difficult time passing a comprehensive bill unless they want to bring in the Republicans and scale back and have a really comprehensive bipartisan bill. And that's what I'm hoping they will, because I believe that Elizabeth and I both agree that there needs to be comprehensive health care reform in America.

But the kind of comprehensive health care reform is what really is going to be the most important item. And I hope that it's a bipartisan one that I think can be passed energetically and have a great deal of support in the country.

KING: Elizabeth, can that happen without the government being involved in kind of a quasi insurance company of its own?

EDWARDS: Can we get -- can we pass health care reform?

We can pass health care reform without having what is commonly referred to as a public option, which means that to compete with your private insurers, with UnitedHealthcare or CIGNA or Aetna...

KING: Right.

EDWARDS: ...or Blue Cross/Blue Shield, you would have the federal government also offering you the option of insuring yourself through the government plan.

I think it would be a huge mistake to -- to pass any kind of reform without a -- without that public option for a lot of reasons.

One is that one of the things we want to do is make certain that we're providing to 46 million Americans who are uninsured, to 25 million who are underinsured, a way of getting reliable, transparent, and cost-effective accessible -- cost accessible insurance.

And the way do you that is to make certain that you're going to have that option. And so far, the private sector has not provided it. I mean, we all know that. Insurance premiums are now $15,000. Next year, $18,000 might be the average. And in 10 years, $36,000 a year for a normal family.

If we want to have -- if we want those to be controlled, we're going to have to have a public option.

KING: Tommy the Republicans have fought that. Why? What's wrong with a public option?

THOMPSON: Well, if you want to really ruin health care in America, have the government run it. And everything Elizabeth said I -- I have difficulties agreeing with, because a public plan is really the tantamount to saying that health care has failed in America, we're going to turn it over to the government to run and regulate.

The innovations that Elizabeth wants for breast cancer and I want for breast cancer in America will be short-circuited. The new kinds of innovation of medicines will be put on the back burner. There will be, certainly, a reduction of reimbursements. The private health insurance companies would more likely have to be retracted and reduced.

Ninety percent of the people like their health insurance. That's going to be changed, because when you put the government in and have a public plan in the government, you're going to have a shifting. And you will -- and even Obama says, you know, that we're going to allow people to have their same health insurance. You can't with a public plan, because it's going to be a shift.

And if you want comprehensive health care, a public plan is going to be tantamount to having a partisan Democratic plan that I think is going to fail.

KING: Elizabeth, why is the current operation, forget the pun, so -- so deficient?

EDWARDS: Well, I'd like -- I want to answer that. But I'd also like to respond...

KING: All right.

EDWARDS: ...because I think that what Tommy is saying is -- the governor is saying is that it's -- or things that you cut...

THOMPSON: It's Tommy, Elizabeth.

EDWARDS: OK. Thank you, Tommy.

That is the mistaken kind of language we hear, that a public option creates a government-run program. What -- another part of what he said, though, if you listen to it, 90 percent of people are happy with their insurance.

We have 46 million people who are uninsured who would like to have insurance and we have maybe 10 percent who are unhappy with their insurance and might be looking for something else.

Those are the people who are going to be moving, perhaps, to a public option. You're not going to see some huge shift in -- in the number of people who -- who go to private insurers.

Private insurers do a good job of innovation, Tommy and I agree about that. But they don't do such a good job of keeping their administrative costs down and keeping the costs of their insurance down.

And when the health executives are paid $30 billion a year -- and we had at least two major CEOs of health insurance, you can be pretty sure that the health insurance costs for those policyholders are going to be higher than they need to be.

And so if we can keep those administrative costs down, maybe we can -- maybe it will have a good effect for both of them. Maybe the government will be required to be a little more innovative and maybe those insurance companies would be forced to keep their costs down.

KING: I want to have Tommy respond to that right after the break. More of Elizabeth Edwards and Tommy Thompson, right after this.


KING: Tommy, in response, can you say the insurance companies in America are doing a wonderful job?

THOMPSON: No. Of course I -- of course I can't. There's some that do a wonderful job, some do a poor job.

But let's face it, if you put the government in here, in which they don't have to have a -- make a profit, they're going to be able to undersell any private health insurance company and they're going to take away the business...

KING: So wouldn't we benefit from that?

THOMPSON: And it -- no, we wouldn't. If a company has -- is going to want to keep their own health insurance but knows the government is selling their health insurance cheaper, companies are going to migrate towards that. And you're going to see a demise of the private health insurance industry in the country.

And if you want the government to control health insurance, which Democrats want and I think it's a terrible mistake, look at Medicare. It's going broke. Look at Medicaid, breaking most of the states because of the cost.

Look at Social Security. Everything the government really runs has not really measured up.

KING: But those things you mentioned...

THOMPSON: The private health insurance, we can make the...

KING: ... all the time...

THOMPSON: We can...

KING: Tommy, those things you...

THOMPSON: ... make the changes, Larry.

KING: Don't you think the public likes Medicare...

THOMPSON: We can make the changes on private health insurance...

KING: ... and loves Social Security?

THOMPSON: Oh, sure people do. But the truth of the matter is, they're going to broke. Medicare is going broke this year. And we can fix the health insurance industry. I'm not saying that the health insurance companies are perfect and should not be changed. We should.

We should allow for guaranteed issuance, allowing people to come in. We should be able to cover all of the uninsured in America and do it in a competitive and free enterprise manner. That's the way to have bipartisanship and that's the way...

KING: All right. Why couldn't that...

THOMPSON: ... to fix the health care...


KING: Why couldn't that work, Elizabeth?

EDWARDS: Well, because that's what we've been trying and it hasn't worked. And it always seems our costs go up and up. The costs have doubled since 2009 -- 2000 to 2009. The cost of our insurance has gone up 119 percent, more than doubled.

It's causing bank -- people to file bankruptcy. Sixty-two percent or 61 or 62 percent of the people who file bankruptcies cite medical costs as a substantial part of the reason why they -- why they had to file bankruptcy.

It is clearly not working. We're on a track right now where we could be paying, in 10 years, for our health care system overall, $40 trillion. We're going to have to get a hold of this. We can't -- and Tommy knows this. We can't stay on the same path we -- that we've been on.

And the very idea that if the government does haven't to make a profit, therefore they're going to be able to under price the insurance companies, there are plenty of non-profits.

HealthNet Colorado did a -- has done an analysis that said it didn't make any difference whether it was a profit or a non-profit company, that the price that they were offering this to consumers was the same -- all too high. And we need -- so we need somebody to be able to come in and put some downward pressure.

KING: Let me...

EDWARDS: You know, Federal Express and -- and UPS do fine in competition with the U.S. government.

KING: All right. Let me get call in.

Orlando, Florida, hello.

CALLER: Yes. I'd just like to ask Tommy Thompson, if my premium went from $500 a month five years ago to $2,500 a month today, does he feel that's fair?

THOMPSON: I've got to know what kind of coverage you've got, whether you changed it, who you've got it insured with. I'm not saying that it's fair or unfair. I don't know the facts.

But I want to tell you something. I want to come back to this private versus public. You know, you -- this is the issue that really is affecting whether or not we're going to have health reform.

KING: Right.

THOMPSON: I want health reform in America. And the way to do that is to look at the things that bring us together and we can reach a bipartisan thing and it's going to really help transform health -- health care in America and health insurance.

Number one, let's have something to do and change the system from a disease system to a wellness system. Let's do something about chronic illness. Let's manage diseases. Let's do something about the kinds of things like diabetes, like cancers and so on, that we can really impact and reduce the cost of health care.

Seventy-five percent of the cost goes into chronic illness. And we can really change that by doing that. It can be done on a bipartisan.

Let's have the electronic medical records. Both parties want that. That's another 10 to 15 percent that we can take out of the cost, hold down health insurance and the premiums and still improve the system.

Let's do things about cessation of smoking. All of these things can be done on a bipartisan basis. And we can fix the health care, we can reduce the costs and we can make it much more efficient. That's what needs to be done in America.

KING: And we'll take a break and be right back with Elizabeth Edwards and Tommy Thompson. Don't go away.


KING: We're back with Elizabeth Edwards and Tommy Thompson. The debate over health care reform has gotten fierce. We've seen town halls turn into town brawls.

This from an event held by Congressman Barney Frank, watch.


UNIDENTIFIED FEMALE: Why do you continue to support a Nazi policy, as Obama has, expressly supported this policy...


UNIDENTIFIED FEMALE: ... why are you supporting it?

FRANK: When you ask me that question, I am going to revert to my ethnic heritage and answer your question with a question: On what planet do you spend most of your time?




KING: Elizabeth, is all of this deflecting away from the real -- the real debate?

EDWARDS: I think that it is. I mean, you've seen the -- and I think that Tommy would probably reject some of the language that you've seen used to hype up crowds and some of the posters that you see.

We don't -- this is -- we are not unplugging grandma, as Senator Grassley said. We don't have death panels, as Senator Kyl said.

These kinds of language, of course, generates an enormous amount of anger, an enormous amount of fear, when we have, as Tommy and I, can have reasonable discussion about the benefits, you know, from my perspective, or the disadvantages, from his perspective, of a public option, which seems to be the center of the real controversy here.

We agree about almost everything else, but this seems to be the center. And we could have a reasonable discussion, but not when you use those kinds -- that kind of language.

KING: Tommy, would you agree?

THOMPSON: I think the language has gotten out of control. I think both sides -- I think Marty -- Barney Frank just come out and says what planet do you live on?

I mean if I was an elected official saying that to my constituents, I would be a little upset with my constituents...


KING: But if the constituent just said your president was a Nazi...

THOMPSON: Well, I'm saying the rhetoric is bad. But I think elected officials have got to temper their remarks, too. And it's just -- you know, it's both sides.

I mean, it happens that, you know, that a lot of hyperbole, a lot of accusations are going on. But the truth of the matter is it's the American way. Americans should have an opportunity to influence legislation. And this legislation, Americans feel, are being crammed down their throats. They're upset about it.

They're afraid of the spending. They're afraid of the trillion dollars more in deficits. And they feel, and I think rightly so, that the government is spending way too much money and we've got to get it under control.

I agree with Elizabeth and myself -- I think we, Elizabeth and I could sit down and have a very constructive dialogue about public versus private. And I don't think we'd reach, convince each other, but I think we could certainly come out and articulate the issues.

And I think that we -- Elizabeth and I could come up and I think Democrats and Republicans. I think that's what we should do.

KING: But why don't...

THOMPSON: I think we should set aside those poison items and get down to try and influence a transformation of health care. Cover the uninsured. Fix the insurance companies. Do something about chronic illnesses. Give a tax credit so individual poor people that are the uninsured or the underinsured can buy health insurance in America...

KING: Why don't...

THOMPSON: ... and we would fix this problem.

KING: Why don't both parties appoint the two of you to sit down in a conference room, come out and whatever you decide is it?

We'll be back with more right after this.


KING: Elizabeth Edwards, you have breast cancer. Tommy Thompson, your wife and daughter both had breast cancer. For both of you, how does that affect your thinking in this?


EDWARDS: Well, you know, a lot of people who have breast cancer come up to me. And one of people who came up to me in Cleveland in 2007 was a working mother, who said she was afraid for her children because she couldn't go to the doctor despite the fact she felt a lump in her breast.

And she was whispering in my ear because she hoped that in America, you still had the power to whisper in the right person's ear and get the kind of changes you needed.

It is -- it is unconscionable that in a country of this wealth, a working mother cannot afford to buy the health insurance that will protect her and allow her to be a -- continue to be a good mother to her children.

KING: Yes. One of the keys, Tommy, is health a right? Do we have the right to health?

THOMPSON: I -- I really believe we do. And I agree with Elizabeth, we should have health insurance for mothers. And there's many ways to do it. A tax credit for low-income individuals to purchase health insurance would save so much more money and be the right thing to do.

Many new companies and innovation like Instead, and sexually- transmitted diseases could break the barriers. There's companies like Liazon, which the guy asked me what about going from $500 to $2,500. This company can set up policies that everybody can be covered and hold down costs.

There's so much innovation out there, Larry, that's good for breast cancer patients, for individuals like my wife and daughter, who have had it, like Elizabeth still does, that we should be able to put the kind of dollars in research in order to do that. And we can fix the system.

Let's not damage the system by bringing in a public plan that is going to, I think, hurt and prevent really revolutionary transformation of health care in America.

KING: All right. What do you think is going to happen, Elizabeth?

EDWARDS: I hope that -- I was with Tommy the whole way, until the last thing he said, which I think is more of this fear-mongering. People need -- 14,000 Americans lose their health insurance every single day. And they lose it because it's too expensive.

So unless we put a -- create a provider that's going to have cost accessible health insurance, which is apparently not going to be possible with these private insurers -- I mean, it's not possible today.

Right now, they have the most motivation of all time to make certain those people are not losing their coverage and yet they will not provide...


EDWARDS: ... they will not provide a cost efficient program. And we can't do it -- I think it's -- it sounds like a great idea, let's do a tax rebate -- I mean, a refundable tax credit to people so that they can get health insurance. Are we really going to give families $18,000 a year to pay for their health insurance next year?

Because that's what...

THOMPSON: No, we don't have to.

EDWARDS: Of course we have to. That's what -- that's what the average cost...

THOMPSON: No, we don't.

EDWARDS: That's the average cost of insurance next year...

THOMPSON: You put out...

EDWARDS: ... it's $18,000.

THOMPSON: You put out private -- you put private insurance out on a competitive basis, it would be down around $4,000 or $5,000; a refundable tax credit will cover that. You'll be able to solve a lot of the problems. You'll get a lot of the uninsured. The problem is, is that, you know, you...

EDWARDS: That's not just realistic, Tommy.

THOMPSON: It is -- it is, Elizabeth. It's very realistic. EDWARDS: But that -- where can they get an insurance today?

THOMPSON: Put it out in a competitive way, like we did on Part D -- like we did on Part D. We put drugs out for competitive bids and they've stabilized the drug prices.


THOMPSON: You put out the bids...


THOMPSON: ... for all the uninsured in every state and have the states hold and allow insurance companies to come in and bid on that, you will drive down the cost, put a refundable credit in for those individuals under 125 percent of poverty and we can cover everybody in America. And that's what you want, that's what I want.

EDWARDS: Well, there...

THOMPSON: And we can do it without the government running the health insurance.

EDWARDS: When the Republicans were in charge of doing something about health care, what they did was just what you said, prescription -- the prescription drug benefit for seniors. And what they decided was that the federal government could not negotiate the lowest possible price.

We've protected -- we've protected the companies to the disadvantage of the American consumers. Again, we're seeing the Republicans protecting the companies -- the insurance companies, to the disadvantage of the American consumer.

THOMPSON: No. Republicans want to protect health care in America. Democrats want to destroy it. If you want to -- if you want to call radical rhetoric...

EDWARDS: Of course we do not.

THOMPSON: ... Elizabeth. Well, then let's -- let's fix the system. Let's not -- let's not destroy it. Let's not have the government control health care...


KING: OK, I'll tell you what. I'm going to...

THOMPSON: People don't want it. People don't want it.

KING: Let's have both of you come back as this goes along, because you're both terrific.

Elizabeth, how is your health?

EDWARDS: It's pretty good. I'm still -- I'm still out here fighting.

KING: Yes. You're stage four, though, right?

EDWARDS: Yes. Yes. No, it's a -- you know, the numbers don't look that optimistic. But I feel good and my recent -- I've had recent tests that show me in -- to be in pretty good health, all things considered.

KING: And, Tommy...

THOMPSON: Keep fighting, Elizabeth. We're...

KING: ...your family, how are they?

THOMPSON: First off, I'd just like to say, Elizabeth, we're pulling for and we're praying for you and keep fighting. We...

EDWARDS: Thanks.

THOMPSON: We think you're a great model. You're wrong on public insurance, but you're right on fighting for breast cancer. My wife and daughter, thank the good lord, are -- are doing well.

EDWARDS: That's great.

THOMPSON: And they're both working and doing great.

KING: Thanks, both, very much, Elizabeth Edwards and Tommy Thompson.

EDWARDS: Thank you.


KING: Everyone talks about the weather, and no one does anything about it. That's an old Mark Twain statement. Right now that weather is affecting our signal in Vermont because of those weather storms up along the East Coast so we'll check in with Howard Dean in a moment.

Joining us right away from Nashville is former Senator Bill Frist, professor of medicine and business at Vanderbilt, former Senate majority leader, a heart transplant surgeon. And a new book of his coming out in October, "A Heart To Serve: A Passion To Bring Health, Hope and Healing," due in October.

A key area, Senator, in the health care debate is the so-called public option. Sunday on CNN, HHS Secretary Kathleen Sebelius said it was not essential. Today, she's totally behind it.

Now let's watch.


KATHLEEN SEBELIUS, HHS SECRETARY: Here's the bottom line: absolutely nothing has changed. We continue to support the public option that will help lower costs, give American consumers more choice and keep private insurers honest. If people have other ideas about how to accomplish these goals, we'll look at those, too. But the public option is a very good way to do this.


KING: Senator Frist, do you like the public option or not?

BILL FRIST, FORMER SENATE MAJORITY LEADER, PROFESSOR OF MEDICINE & BUSINESS, VANDERBILT UNIVERSITY: Larry, I don't think it's necessary. The public option, if you look at it very simply, is a single-payer system that is nationalized.

And I think that what it does, it crowds out a lot of the innovation, a lot of the creativity, a lot of the change that we know is necessary to keep up with the biological systems that we have to treat, through health care, through prevention, through wellness.

KING: But doesn't it force the other insurance companies, though, to reduce costs when the government is one of their competitors?

FRIST: Well, you know, that's what the line is. And if you pay -- the public plan over the national plan, a single-payer plan, would pay physicians less, would pay hospitals less, by definition.

And the real fear -- and I think it would happen because we saw it happen, actually, through a very similar plan here in Tennessee, is that it causes the employer-sponsored insurance industry to diminish because all of those people on those more expensive plans get dumped onto the private plan.

Over a period of time, that -- or the public plan. That public plan, over a period of time, continues to grow and grow and grow. The private insurance diminishes. And it's in the private insurance market that we see all the innovation and the choice.

And then you end up with a single-payer national plan that people simply don't have the choice that they would otherwise.

KING: But we -- also, Senator, obviously, there's something wrong if 48 million people aren't insured, if -- if all other major civilized countries have some sort of national health insurance and we don't.

Do you think, philosophically, that we're entitled to health?

FRIST: I do. I think that the time has come, in a nation that is as rich as ours, that everybody is entitled to affordable access of some kind of health insurance policy.

You said we have 48 million people uninsured. We have about 20 million people who are hard core uninsured today. And I think, in the 21st Century, in the United States of America, now is the time to bring them into the insurance market and then focus on having to -- how to make those insurance markets work, have more competition, more transparency, more choice, because you're right, we have huge health care problems today.

But the real answer, to me, is not more public health, not more single-payer, not more national health, but more transparency, where you can empower consumers to make choices for what is best for them and then address the uninsured issue, the 20 million hard core.

But you don't have to do what President Obama has promised people in the past, and that is to give all 46 million people...

KING: All right...

FRIST: ... a very expensive health care plan, like the president has or a United States senator has.

KING: But you are not, as some are -- on the left are charging, saying that the Republicans just don't want health care reform?

FRIST: No. Listen, I was majority leader of the United States Senate. And under our leadership, under Republican leadership and working with President Bush, we passed about a $600 billion health care plan that gave affordable access to prescription drugs to 40 million seniors under Medicare who didn't have it.

So, no, I am hard-charging for reform, but I want to do it in a smarter way, with smarter purchasing, more choice, instead of having centralized bureaucratic control coming from the top. Come back to the doctor.

KING: Moments...

FRIST: Come back to the patient.


KING: Moments ago, Senator, Congressman Barney Frank of Massachusetts wrapped up a town hall meeting on health care in Dartmouth, Massachusetts.

Watch this exchange.


UNIDENTIFIED FEMALE: Why do you continue to support a Nazi policy, as Obama has expressly supported this policy?


UNIDENTIFIED FEMALE: Why are you supporting it?



FRANK: Wait, I will...

(CROSSTALK) FRANK: When you asked me that question, I am going to revert to my ethnic heritage and answer your question with a question: On what planet do you spend most of your time?



FRANK: Do you want me to answer the question?


FRANK: Yes. As you stand there with a picture of the president defaced to look like Hitler and compare the effort to increase health care to the Nazis, my answer to you is, as I said, before, it is a tribute to the First Amendment that this kind of vile, contemptible nonsense is so freely propagated.


FRANK: Ma'am, trying to have a conversation with you would be like trying to argue with a dining room table. I have no interest in doing it.


KING: We are now connected with Governor Dean.

You can see a lot of this occurring across the country and comparing the president to Hitler and conceptions like that.

How did it get to this, Howard?

HOWARD DEAN, FORMER DNC CHAIRMAN: Look, I think this is very complicated. And do you really want to talk about this or do you want to talk about health care? I'm happy to talk about this...


KING: No, I do. But I did...


KING: But health care has come under this kind of concept that...


DEAN: Well, this has nothing to do with health care, Larry. This has nothing to do with health care. This is a group of very angry, frustrated people, well-organized. This has been -- this kind of anger politics has been going on for 30 years.

Look, we've had a huge shift in this country as a result of this past election and for the first time, more than -- more people who are under the age of 35 voted than over the age of 65. And there are a lot of people who are kind of feeling adrift of that. They're in a big recession, which they didn't cause, and they're very angry about that.

So this is a much bigger deal than health care, all this kind of mass anger...

KING: All right...

DEAN: And it really doesn't have a lot to do with health care.

KING: All right. Have you -- have you been listening -- I know we had a bad connection, but -- we couldn't make a connection because of the weather.

DEAN: I -- I could hear everything. I could just...

KING: Have you heard? All right.

DEAN: I have heard everything that Bill said.

KING: What are your comments on what...

DEAN: Well, I...


KING: What are your comments on what he said?

DEAN: Well, first of all, I always enjoy Bill, because he doesn't exaggerate. He doesn't give the party line so much as some of the other folks I get on the show with. And so, Bill, it's great to be on with you again.

I think that's true, the public option is a form of nationalized, government-run health care. That's what Medicare is. We already have 50 million people in the Medicare system. We have a Veterans Affairs system which is very, very good. And so that we already have nationalized care.

There's already another group of people, of which Senator Frist was one, Congress has a socialized health care. If you get sick, you can go downstairs to the doctor. You can go to Walter Reid Hospital. That's all government-run.

The question is here, who's going to choose? My question is, why can't we, given the successes of this national health care system, why can't we let more Americans make their own choices?

The truth is not very many people will actually choose the public option. Now, Senator Frist talked about the Medicare Part D, which has been very successful. Only 6 percent choose the public option there.

But to have the public option, if you can't get into an insurance company; if they cut you off, as, unfortunately, so many of them do, if you get sick; if you move; if you lose your job; the public option is always there.

Another wonderful thing about Medicare is they don't charge you any differently whether you're healthy or sick. Those are the things...

KING: All right. Hold on.

DEAN: That's the way -- that's the way a health insurance system should be.

KING: Hold on, Howard. We're going to let...

DEAN: Yes?

KING: Let me let Senator Frist respond. We'll be back right away.



KING: All right. Senator Frist, is Governor Dean right? Haven't a lot of these federal programs worked?

FRIST: Well, Larry, he said Medicare. Medicare, I think, overall, has worked pretty well. It's a -- I think it's a great program. And as a physician, obviously, I've had thousands of patients who are in it.

He didn't mention the Indian Health Services, though, which is probably the most miserable -- one of the most miserable, under- supported, inadequately managed programs and it's a federal health program.

Or Medicaid, which has about 35 million people and it's a federal government -- it is a federal government program that is a federal state program. And he didn't mention that, where physicians are getting paid 20 percent less what they are in the private sector.

In a state like Tennessee, people flee from Medicaid. Only about 40 percent of the physicians in Tennessee have stayed in the program because they are underpaid. And the ones that do stay...

DEAN: But, Bill, I don't -- I don't mean to interrupt, but, in fairness, every child in -- essentially, every child in Vermont has health insurance because of -- because of Medicaid. So it's...

FRIST: I'm just -- yes.

DEAN: That changes from state to state.

FRIST: No, it's very good. But we -- and I don't think you would want Medicaid to be the program throughout the country today.

DEAN: Well, we raised...


DEAN: What we did was we raised reimbursement rates, you're right about that.

FRIST: And that's...

DEAN: In order to make it work for us...

FRIST: And that's what happened...

DEAN: ... we raised reimbursement rates.

FRIST: And that's what happened in Tennessee in 1994. We put a universal coverage program in called TennCare. And, Howard, you're familiar with it. And...

DEAN: Yes.

FRIST: And we extended coverage. It worked great for about three years. But after about four or five years, the cost went exactly what you said -- you had to start escalating it. And it ended up, eight years later, costing three times -- both per capita and at the state level and just about drove the state bankrupt, an experiment that didn't work in Tennessee, 140,000 people were taken off the rolls a year ago by a Democratic governor because it failed.

And America doesn't want to have an experiment that failed in Tennessee to be taken nationally. And that's what...

DEAN: But we're not talking about that.


DEAN: Bill, we're not talking about that.

FRIST: This is a government program...

DEAN: We're talking about using...

FRIST: This is a government program -- no, you're -- you're choosing...

DEAN: ... a program we already have that 50 million people...

KING: Governor, let him -- let him speak.

DEAN: We've had it for 45 years

KING: I mean, Senator, let him talk.


FRIST: You clearly believe that the federal government is the answer and you used Medicare, which it is a good program...


FRIST: But I'm saying you don't mention the Indian Health Services.

DEAN: I don't think...

FRIST: You don't mention Medicaid and you don't mention a lot of other...

KING: All right. Let him respond.


DEAN: I don't...

KING: Senator, let him respond.

DEAN: I don't think the federal government is necessarily the answer. I think the American people are the answer. I think if you put two choices out there, the private sector and the public sector, and let the American people choose, they'll reform health care as they see fit.

If the public sector program is no good, they won't use it, just as they haven't used it very much in Part D in Medicare.

If it's great, the insurance companies are going to have to start behaving themselves and not cutting people off and doing all these terrible things they do to people.


DEAN: Let the American people choose. I think the American people deserve to have this choice.

FRIST: But if you let the fear...


KING: All right, gentlemen -- gentlemen, I'm sorry. We have limited time. We're going to do a lot more with both of you.

A quick question for each. Are we going to get a program passed, Howard?

DEAN: Yes. A public option will be included in the final program. It will be up to the American people to choose whether they want it or not and the president will sign it in December.

FRIST: And I agree...


KING: Senator, are we going to get a plan? FRIST: We will have a plan passed in November. It will be about $800 billion. It will insure about 20 million more people. It won't cover everybody. It will have a public plan, not Howard's type, as a backup plan, as a fall-back option...



FRIST: ... a cooperative-type plan.

KING: Off the topic, one quick question, Senator, before we leave. We understand from our crack staff that you took advantage of the Cash for Clunkers program. We understand you traded a 1991 Chevy Suburban for a 2009 Prius.

FRIST: And in Tenn...

KING: True or false?

FRIST: And in Tennessee, the Prius is, for a Republican -- you don't see a lot of Republicans driving a Prius. But I'm going to get 50 miles to the gallon. My -- my 18-year-old Suburban is going to have that -- that junk put in it which is going to kill it. So I'm very sad. But the taxpayer gave me $6,000 to do it and so I'm out there driving my Prius.

DEAN: And as a good Democrat, I'm about to do the...

KING: Thank you both.

DEAN: I'm about to do the same, but I'm going to get a Ford Escape because I like to buy American.

KING: Whoa.

FRIST: You got me there.


KING: Howard Dean and Bill First going at it. Thank you both very much.

Three more doctors coming. Congressman Ron Paul, he's a doctor. Dr. Paul Song (ph) and Dr. Sanjay Gupta write their prescriptions for health care next.


KING: Three more doctors join us. In Clute, Texas, Congressman Ron Paul, Republican of Texas, medical doctor. By the way, he was a flight surgeon in the U.S. Air Force and an OB-GYN in private practice.

Here in L.A., Dr. Paul Song, radiation oncologist. He supports the president's health care initiative and believes there must be a public option.

And in Atlanta, our own Dr. Sanjay Gupta, CNN chief medical correspondent and a practicing neurosurgeon.

How will this debate about public access and the like affect you? Your public -- will a public option affect you, Sanjay?

DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Well, probably not. And, in fact, the president has come out and said that people who have private insurance right now, who have access to private insurance and who -- whose premiums are not above a certain percentage, overall, of their income, aren't going to be eligible for the public option.

So there's a lot of people who it won't affect. And I think that's really important, Larry, because there was all of these -- this sort of talk about people sort of flooding the public option. Not everyone is going to qualify, myself included; you, as well, Larry.

KING: Yes.

Dr. Song, you favor it, do you not?

DR. PAUL SONG, RADIATION ONCOLOGIST, SUPPORTS HEALTH CARE REFORM BUT WANTS PUBLIC OPTION IN FINAL PLAN: Yes. And I think the big reason is that Milton Friedman, who is an economist that a lot of the conservatives like to quote, in 2001, had an essay that basically said that the third-payer system that we have right now was the most cost- ineffective system that was available.

But since that time, the insurance companies continue to grow. Their -- their overall profits have increased by over 400 percent. And the premiums have raised by greater than 87 percent during that time.

And I think the big concern is that if we don't have a public option, all you're doing is putting more money into this system that will basically go to the insurance companies without any regulation for patients.

KING: Congressman Paul, if you agree something is wrong and you don't like public option, what do you like?

REP. RON PAUL (R-TX), MEDICAL DOCTOR, WAS FLIGHT SURGEON IN THE U.S. AIR FORCE, RAN FOR PRESIDENT: Well, I'd like to see a little bit more freedom. Most of the time people do say there's problems and nobody's denying that. But, you know, the problem is that we've had managed care -- we've had government manipulation of medical care for 40 years now. And so we can hardly say it's the private sector that has caused the trouble.

So I would like to see a renewal of the spirit of freedom in this country, where we can trust the market, but not trust the government, because the government doesn't deliver. They've had Medicare. It's broke. They have veterans care. It's a lousy system. Nobody likes that. People aren't taken care of. But what do we do?

KING: Do you...

PAUL: We have rejected the notion of, say, the church hospital. We've wiped them out of the business. We have Shriner Hospitals, 22 of them, that gives free care to all children. And they are having a trouble because of the inflation, because of the cost.

KING: Do you...

PAUL: So I think our biggest failure in this debate is we have not analyzed where the problems came from, rather than just saying, let's go on with more government.

KING: Before I get back to Dr. Gupta, do you want to respond, Doctor?

SONG: Yes, I have a lot of respect for Dr. Paul. But one of the things that I think he's saying is incorrect. The idea that the V.A. system and, also, Medicare being failures or not being popular are absolutely false.

The Rand Corporation, which is actually a conservative think- tank, recently published a study that showed excellent satisfaction with the V.A. system, and the Kaiser Family Foundation actually showed that Medicare is actually run more efficiently with much more dollars going for actual patient care than the private sector.

So -- and the other thing I want to touch on is this idea of freedom. We have less freedom when you are told by an insurance company where to go, where to get your pay -- treatment, where -- what hospital you need to get seen at.

Some patients need to drive extra distances because their insurance companies won't let them go to the hospital that's in their own neighborhood. If you had some sort -- type of single-payer system, patients would be free to go wherever they wanted.

And I would also add, if you're really concerned about freedom, that if you're an employee who is stuck in a job that you don't like but you're there strictly because of the health benefits, if you had some sort of universal system, you could go to take a job anywhere you wanted.

KING: Dr. Paul, before we get to Sanjay, what do you think of the co-op idea?

PAUL: Well, if it's private, it's OK. But a government-mandated co-op won't work.

But the doctor mis -- misinterpreted what I said, because he didn't accept the fact that we've had managed government care.

So if he says it's -- it's not doing well, then you have to blame managed care, the tax code, tort law, how -- how well people can sell insurance across the borders and the inflationary problem...

KING: And you...

PAUL: And I did not say that Medicare didn't work, I said it was broke. And you've got to admit that. And here we're putting another program on the government system, the government is broke.

KING: All right...

PAUL: We have $2 trillion worth of debt this year...

KING: Sanjay...

PAUL: ... and you think we're going to add this new program and the government, and the country's bankrupt.

KING: Sanjay...

PAUL: We're not being practical at all...

KING: Sanjay where...

PAUL: ... by talking about this.

KING: Sanjay -- Sanjay, where are you in this?

GUPTA: Well, you know, no one is good at controlling costs here. I mean, that's one thing that's an irrefutable fact. Whether it's the private sector or the public sector, you can't hold up any of these sectors and say, look, this is a good example of how to do this right.

And, by the way, it's not just the United States. It's around the world, where health care costs have outstripped -- outpaced, rather, inflation in just about every country in the world.

So this is -- this is something that we're dealing with as a global society, Larry. Whether it's people are using technology more, using more prescription drugs, whether it's chronic disease. You know, we spent over -- almost $150 billion on obesity-related diseases in this country alone.

So, you know, health care is expensive. And I think that that's really at the heart of a lot of this -- how exactly you pay for it, who's going to pay for it, exactly. I think that's where this debate is really centered.


KING: Sanjay, can you briefly explain the co-op idea?

GUPTA: A co-op is not government-run, although it may have some government seed money. It is a non-profit organization that, you know, typically is made up of people who are often members insured, meaning that people -- they want to get health care insurance from a co-op, but they're also members of the board of the co-op. So they can help determine premiums. They can help determine what sort of services are covered.

The way that a co-op is successful, typically, is that it's based on scale. If you have hundreds of thousands of people involved in a co-op, actually buying into it, you can negotiate prices well and be competitive with the private insurance industry.

So, you know, for example, a house mom in Tennessee watching right now, and she's uninsured, she's trying to get herself and her kids in church, she might join a co-op and it could be cheaper than private insurance, if they have a lot of people involved. But if they don't, it's hard to compete.

KING: Dr. Song, does that appeal to you?

SONG: I think the problem with that, in my study of this, is that unless you have at least 500,000 people that will form a network, that it's going to be hard to do, particularly in rural areas.

And what you're seeing more and more in the past seven years is monopolies that have been formed by insurance companies that make it real hard for any type of negotiating power. And premiums have gone up.

So if you can't get 500,000 people together to really put together a good economy of scale, I'm not sure how this will work in large parts of our society.

KING: All right. Congressman Paul, you're there in the House. Where do you think it's going? What are we going to get?

PAUL: A little incrementalism. I don't think Obama is going to get what he wants. But we'll have more government and the cost will continue to go up and the quality of medical care will go down. They put $50 billion in the bill just for surveillance of every single medical transaction. And they have the legislation to control that in Washington.

So there will be no medical transaction that isn't controlled electronically and known by the government for so-called monitoring. So it's going to cost $50 billion to try to find out where the waste and the fraud is, but the system is wasteful and fraudulent.

KING: Sanjay, you look puzzled.

GUPTA: Yes, I was -- I'm not -- I guess I was a little confused as to what specifically Congressman Paul was talking about there. I'm not sure if he's talking about the health IT or what, or if he's saying that's a bad idea. My understanding was that was to try and streamline a lot of the unbelievable paperwork.

You have primary care doctors who are seeing over 5,000 patients in their clinic. Each one of those patients comes with insurance forms and all sorts of other forms. To try to streamline that in some way has been one sort of tactic to try to increase the number of primary care doctors. I was just a little confused by what you were talking about. PAUL: OK, let me tell you. The stimulus package gave the authority to the executive branch to set up the computer system to record every medical transaction in the country. Now they put $50 billion of seed money in there for somebody to monitor everything a hospital does, everything the lab does, everything a doctor does, everything a pharmacy does.

Now that is not going to be efficient. That's going to cost a lot of money, very confusing, and it's going to distort the whole concept. But when the government is in charge, and they want this one- payer system, this is socialized medicine.

It doesn't work. It fails all the time. Some people may get care for a while, but eventually everybody is going to get equal care. But quality is going to go down. That's what it's all about. We don't want to see equality of...


KING: But you're not -- we don't have the best care now, do we, Dr. Song?

SONG: No, I would argue that no one agrees -- I mean, we can all agree that the current system is absolutely broken. And as far as the track record of how government programs work, I think Medicare has been in business for 45 years. My own father who was...

PAUL: But they're broke.

SONG: ... diagnosed with cancer is able to get access to care on a much more timely fashion than my own patients who are coming to me, who have private insurance.

KING: All right, tell you what, guys, we're going to have you all back, maybe tomorrow, because this needs a lot more attention than it's getting. And it's getting a lot.