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State of the Union
Update on Situation in Iran; 'The Last Word'
Aired June 21, 2009 - 12:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
JOHN KING, HOST: And now we'd like to welcome back our international viewers to our STATE OF THE UNION report for this Sunday, June 21st.
Once again today, protesters are out on the streets of Tehran after a day marked by violent clashes between demonstrators, police and pro-government militia men. Throughout this hour, we'll bring you the latest and breaking news on this developing story.
Health care reform off to a rocky start in Congress with predictions of sky high costs and limited results. Can we afford to insure all Americans? Four leading senators, players for both parties, are with us throughout the hour to tell us what comes next in the Iran and the health care debates and to answer your questions and concerns.
And this week, we give the last word to the people of Iran. The protesters who stormed the streets of Tehran as the whole world watches. That's all ahead this hour on STATE OF THE UNION.
Protesters there, I believe these shots are here in Washington. Protesters protesting the handling of the election in Iran today. And on the streets of Tehran, additional protests, thousands in the street in defiance of their supreme leader who have urged the protesters to stop.
Our Christiane Amanpour has been following these developments. She was in Iran. She is just out of that country. She joins us now with the latest. Christiane, the demonstrators are back in the streets today, help us understand the significance.
CHRISTIANE AMANPOUR, CNN CHIEF INTERNATIONAL CORRESPONDENT: Well, we're being told, John, and of course it's always difficult to confirm that it's much less than yesterday and so far not violent.
I'm told by calls that I've made and people that I talked to that there are scores and scores, if not hundreds, many, many hundreds, of police and riot police out on many, many parts of the city, whether it be an intersection, a square, in various neighborhoods and are not just preventing people from coming and gathering but also going in and basically using their batons to disburse anybody who is just standing around. In addition, going house to house in some areas and cracking down there. So an attempt to put this down. What we're also seeing amongst officials is a widening rift as well as accusations against, quote, foreign interference. For the first time in a few days, President Ahmadinejad has been quoted speaking to clerics in which he has accused specifically the United States and Britain of interfering and of having premature statements on these international Iranian matters.
He says that specifically addressing both Prime Minister Gordon Brown and U.S. President Barack Obama that you will not be considered, quote, "in the circle of friends and you must reconsider your statement."
This after the foreign minister, Manouchehr Mottaki addressed diplomats in Iran and specifically blamed Britain for pre-involvement in this and alleging that they were involved in the protest. Britain has categorically rejected that in a statement by the foreign secretary today.
Now, Facebook, we're told, the Facebook page of Mir-Hossein Mousavi are not what we should be looking to for his messages. Instead, they are being carried on a particular Iranian Web site, the Ghalam News and he has issued a long message to the Iranians today in which he describes all that's happened. It's much more measured than some of the more hysterical comments that are being attributed to him. But he does call for an annulment of the election. He says that a nationwide neutral commission should be formed to investigate, and that is echoed by former reformist president and supporter Mohammad Khatami who also calls for a neutral commission to investigate, and also says that it's insulting to accuse Iranians of being stirred up by foreign interference, that the protesters are and should have the right to peaceful protests and peaceful civil response to their elections.
The speaker on the Iranian parliament, conservative Ali Larijani came out and accused the guardian council of unfairly and improperly siding with one candidate on this. So rifts opening up amongst very elite leaders both conservative and reform in Iran at this time.
KING: Christiane Amanpour joining us from London just out of Iran. Christiane, thank you, we'll continue to check in as this dramatic day unfolds.
A conversation this Sunday with four senators with unique insights in critical roles in the pressing debates over Iran, North Korea, health care and the nation's struggling economy.
Senator Chuck Grassley is the top Republican on the Finance Committee, where the Democrats leading health care reform proposals stalled this past week. He joins us from Cedar Falls, Iowa.
Coming to us from Scranton, Pennsylvania, Democratic Senator Bob Casey, who serves on the Foreign Relations Committee, and one of the key panels in the health care debate. With me here in Washington, California Senator Dianne Feinstein, she leads the Intelligence Committee, and her state has perhaps the biggest stake in the health care financing fight.
And Senator Richard Lugar of Indiana, who is a ranking Republican on the Foreign Relations Committee, and a leading voice in international policy for a quarter century. We begin with the election fallout in Iran, and I begin at the magic wall because I want to take us through some of these dramatic images we have seen. First a reminder, as we watch the fallout in Iran, it is, of course, in one of the most unpredictable and volatile neighborhoods of the world. Iraq here, Afghanistan and Pakistan here.
And the images we have seen, and we've said, we've just confirmed more protests today, here are some images throughout the weekend. Rock-throwing on the streets here. Those who support the candidate who lost the election, Mr. Mousavi. Flames and fire in the street.
And I want to begin with you, Senator Lugar, you're one of the leading voices in this town on foreign policy. When you these pictures and more protests today even after the supreme leader said, stay out of the streets, are we seeing frustration at the election or are we seeing the seeds of another Iranian revolution?
LUGAR: I think we're seeing a challenge of the regime. The leader, Khamenei, perhaps made a grievous error by making that the issue. In other words, he could have called for another election or for reforms or various other things. But in his speech on Friday, comprehensibly, he said now out in the streets you're indicating opposition to the state, to the regime itself. It's not a question of Mousavi or Ahmadinejad, it's me and the supreme council.
So the protests have continued. The challenge continues, which is -- is going to come to a conclusion one way or another in which either the protesters bring about change or they're suppressed. And it's a potentially very brutal outcome at the end of the day.
KING: And, Senator Feinstein, you are the chairwoman of the Intelligence Committee. As we watch this very volatile situation unfold, do you believe, based on what you're being told by U.S. intelligence, is this regime's survival at stake? Is that at issue in the streets of Tehran?
FEINSTEIN: Well, I think Senator Lugar said it correctly. I think what became as -- what began as a challenge to the election has become a challenge to the leadership now. And I think the way the leadership has behaved is really terrible for leadership that derives its authority from religion.
And a president newly elected who calls hundreds of thousands of people who protest an election just "dust," I mean, these were -- they threw the gauntlet to the people, essentially.
When there was a way out for the supreme leader, simply to say, so many people object to this election, we will do it over and we will show that we can do an election correctly, and with the people's confidence in our country.
Instead what you have is a total putdown by the leadership of what began as a legitimate protest, which has now turned into much more than that because of the brutality that the regime has shown to its people. KING: And one of the questions, of course, any time you have a dramatic world event like this is, what is the role of the United States? And what is the role of the U.S. president?
Senator Grassley, I want to go to you, because some Republicans and conservatives have said that President Obama has not been bold enough.
That he should stand at the White House and tell those people in the streets risking their lives that he stands with them and that the people of the United States stand with them.
I want you to listen to Senator John McCain and Congressman Mike Pence, two Republicans who say the president has this wrong.
(BEGIN VIDEO CLIP)
SEN. JOHN MCCAIN, R-ARIZ.: On this issue, I do not believe that the president is taking the leadership that is incumbent upon an American president.
REP. MIKE PENCE, R-IND.: When Ronald Reagan went before the Brandenburg Gate, he did not say, Mr. Gorbachev, that wall is none of our business.
(END VIDEO CLIP)
KING: Senator Grassley, the president says to be more direct than he has been. And he has said, the world is watching, and he has said he sees things that he believes are unjust by the Iranian regime. He says to go further would be to give a foil to Ahmadinejad and the supreme leader. How do you rate the president's performance on this one?
GRASSLEY: Well, I believe that we could be more forceful than we have, and I believe that the United States being a democracy for 200 years, we've bragged about what we want to do, extending democracy around the world.
We've been involved in the Philippines, in Bosnia, several other countries over the last several years and actually being very forceful in promoting democracy. If America stands for democracy and all of these demonstrations are going on in Tehran and other cities over there, and people don't think that we really care, then obviously they're going to question, do we really believe in our principles?
GRASSLEY: So wherever there's opportunity to promote democracy, it seems to me we ought to be in the forefront of that promotion, particularly when it comes from the grassroots demonstration that the people really want the ballot box to work and people to be elected honestly as opposed to what looks like a charade that went on last weekend in Iran.
KING: Senator Casey, you're on the Foreign Relations Committee, has your friend, the president, been too timid here, as Senator Grassley suggests?
CASEY: No, John. I think he has gotten it just right. The president, I think, has struck the right balance between making sure that we affirm and speak out in favor of the universal values of the freedom to assembly, the freedom of speech, all of those important values that our history has taught us.
But at this moment in the history of Iran, we should not politicize this issue here in the United States. The key thing here is striking the right balance, telling those who are protesting that we share their values, but also making sure that we keep our eye on the ball here.
The biggest threat down the road in terms of our security and the security of the region is Iran's nuclear program. And the best way to approach that is to leave every option on the table, including the strong and tough diplomacy, but also, and the Congress plays a role in this especially, and I've been a leader on introducing legislation on sanctioning Iran, or at least giving the president the authority to provide -- or to impose, I should say, sanctions on the Iranian regime if they continue to pursue a nuclear weapon strategy. So I think he has gotten the balance just right.
KING: On that point, I want to get up and walk over to the wall, because I want to remind our viewers about the government structure in Iran. Senator Casey, you just say you believe diplomacy should stay an option. I want to show this float chart just so the American people understand.
President Ahmadinejad is down here in this structure. And President Obama has said he would like high-level diplomacy, even leaving the door open to a meeting with President Ahmadinejad early on in the administration.
It is the supreme leader, of course, who calls the shots, the armed forces report to him, the state media reports to him. Senator Lugar, I want to come back to you on Senator Casey's point. The president said diplomacy should be on the table. He has been waiting for the Iranians to come back to him.
If President Ahmadinejad or the supreme leader, Mr. Khamenei, came back now and said, we want to sit down with the United States at a high level, Secretary Clinton perhaps to the foreign minister, or president to president, should the United States say yes or would you be rewarding the unjust, to use the president's word, behavior he sees on the streets of Iran right now?
LUGAR: We would sit down because our objective is to eliminate the nuclear program that is in Iran. This is...
(CROSSTALK)
KING: Even though -- even though they are shooting people in the streets and beating people in the streets and arresting political opponents, if they called tomorrow, you would sit down with them?
LUGAR: Yes, it's totally improbable. And the reason is that this regime now is under fire. This is not a stable regime in which two people suddenly sit down with the United States. They may not be able to impose their will. This is what -- this is all about in the streets.
But in direct answer to your question, of course, we really have to get into the nuclear weapons. We have to get in the terrorism of Iran in other areas in the Middle East. Now we have a new opportunity in which we might very well say we want communication with Iran.
We want openness of the press. We don't want to have use Twitter. We want to have to press on the ground. But in order to have any kind of relationship, we need to be able to talk to people, hear from people, argue with people.
KING: Up next, more on Iran, as well as health care in the economy with our four senators. STATE OF THE UNION will be right back.
(COMMERCIAL BREAK)
KING: We're back with four key U.S. senators. With me here in Washington, Republican Richard Lugar and Democrat Dianne Feinstein. In Iowa, Republican Chuck Grassley and from Pennsylvania, Democrat Bob Casey. Let's get straight back to our conversation about Iran and first, a bit of history. It was Persia until 1935, then in 1953, a coup engineered in part by the United States and Britain knocked out the prime minister of Iran and the shah returned to power. Then in 1979, the Islamic revolution, the shah and his family were forced into exile, the Islamic Republic of Iran is proclaimed, and Ayatollah Khomeini returns from exile. And we all know tragically 52 Americans were taken hostage inside the U.S. Embassy.
Today, we see violence in the streets over Ahmadinejad's disputed reelected victory. Human rights organizations say prominent activism politicians are being arrested. Senator Feinstein, I want to come to you out of the context, especially, given the role in the past. The United States and the British government did interfere in Iranian politics. It may have been 50 something years ago. You're the chairwoman of the Intelligence Committee again. You are briefed when the United States does things covertly. You saw the Iranian foreign minister saying Britain, Germany, France, the United States are meddling in their affairs. Can you look the American people in the eye this morning and say absolutely not, no U.S. taxpayer dollars are being spent to undermine the regime?
FEINSTEIN: I can say this, to the best of my knowledge, there has been no interference with the election, there has been no manipulation of people following the election. These questions have been asked as late as this past week of people in the clandestine operations who would know this and in a formal setting, and that's the answers we were given.
So I think, you know, by blaming the United States and Great Britain, the regime is trying to take the responsibility from its own shoulders and clearly I think most people see that the responsibility belongs on those shoulders, not ours.
KING: Do you trust -- I'm going to stay with you for one second because of your role. Do you trust the intelligence? The legacy of Iraq was we put too much reliance on dissidents who may have an axe to grind or electronic eavesdropping and not enough intelligence on the ground, eyes and ears that we know and trust. Do you trust the intelligence you get from Iran?
FEINSTEIN: Well, I don't think our intelligence candidly is that good. I think it's a very difficult country in which to collect intelligence right now. So I think our ability to get in there and change the course of human events is very low, to be very candid with you.
KING: So Senator Lugar, what should we do? Senator Casey said before the first break that he has sponsored some legislation that would essentially -- like South Africa, disinvestment. If you're a pension fund doing business with an oil company or petrol chemical company doing business in Iran, no, we want to outlaw that. What next?
Should the president go to the United Nations and say we need even tougher sanctions? Because economically we know unemployment is quite high in Iran, they don't have a great economy right now. If we could put more diplomatic sanctions pressure on them, would that be a way of effecting change?
LUGAR: Initially it's more complex because we don't know what the outcome of the challenge of the regime is going to be. That is, who is going to be governing Iran? That's the question, how many people will come out? Will the police finally decide not to suppress them? And if so, what kind of hybrid situation exists?
Secondly, the fact that they've condemned Great Britain and France and Germany is a plus factor because these countries have sometimes been reticent to impose sanctions that would be very, very tough on Iran. If those four countries as well as others decided simply that the nuclear policy has to change and we really went after it, then that's going to be, I think, very decisive. And the Iranian leadership, at least -- and this is a mistake again on their part, by blaming all of these countries has added allies to the United States in our diplomatic effort.
KING: Senator Grassley, you are known every time you go home to Iowa, you're a guy who travels, your state has a number of town halls. This is a connection to the American people question. Does this matter at home? Do people come up to you and raise this issue what are we doing in Iran? What do you know about what's happening in Iran? Or is this more of a Washington debate?
GRASSLEY: Well, it's more of a Washington debate right now as far as the demonstrations are going on. But over a period of time, usually Iran in my town meetings will get thrown in with North Korea and the questions raised about the prospects of nuclear, what are we going to do? And the questions come from the standpoint of my people wanting answers. And my usual answer is that, you know, we have encouraged the Iranians to ignore us for the most part.
I'm talking about their government because the last seven or eight years, you know, we have relied a great deal, particularly while we were bogged down in Iraq on Germany and Great Britain leading this. And they would feel we made some progress. And then in the final analysis, you know, we didn't follow through when Iran didn't keep their word to us.
So we encouraged this sort of abuse and disregard for the negotiations that the West was carrying on with them. And so now when we have a chance to stand tall and let the people know we're behind them, I think there's all the more reason to let them know that they have a friend in the West.
KING: And Senator Casey, if diplomacy is the carrot and sanctions is the stick, you said -- you said you mentioned your legislation earlier, what should the president do now? It seems everyone wants -- at least Senator Lugar and Feinstein and Senator Casey want him to hold the carrot of diplomacy out there, does he need to have a tougher stick?
CASEY: Well, John, I think he's gotten it right, at the right balance. I was just looking at the statement he issued yesterday. He said and I quote "We call on the Iranian government to stop all violent and unjust action against its own people." He says, "The world is watching and they must respect the dignity of their own people."
So I think he's given a very tough and consistent line to the regime in supporting the values that we spoke of earlier of those who are protesting in the streets. But the president doesn't have the luxury of just thinking about the next couple of days. He's got to be able to think about the short-term, the long-term, tactical moves as well as long-term strategy. I think he's gotten it right.
But the Congress should reaffirm, I think, what I believe is a bipartisan consensus to give him the authority to use sanctions if necessary. But part of this is not just the sanctioning those companies around the world that do business with Iran in terms of the refined gasoline products, for example, the divestment legislation of mine that I spoke of earlier, but also, to make sure that we're working in concert with others on the U.N. Security Council to continue to provide that pressure.
I think there's a consensus about this. But I think there's been a lot of early and unfortunate criticism of the president's policy. I think he's gotten it right. But this thing is unfolding and it's never going to be the same in Iran. Something is stirring in the hearts of Iranians that we've never seen before. And we shouldn't just measure it by the number of people on the streets. There's a lot of people in their homes that are feeling this. This is a movement of the likes of which we've never seen. I think it's going to continue. We have to monitor it closely.
KING: Senator Feinstein, you were nodding when Senator Casey said something is stirring.
FEINSTEIN: Well, that's right. And I think Senator Casey has it correct and I think the president has it correct. And I think, you know, there is an urge for the United States from some to get out there and really say, you know, we're going to be behind you, we're going to do this, we're going to do that. And we've done that before and then haven't delivered. And that too can be a problem.
It is very crucial as I see that we not have our fingerprints on this. That this really be a truly inspired by the Iranian people. We don't know where this goes. And I sure wouldn't want to be responsible for thousands of people being killed, which is a distinct possibility.
So this is really within the hands of Mr. Mousavi, with his supporters, with the bulk of the Iranian people, and I think the important thing is that this may well reveal the enormous fallacy behind this Iranian religious inspired regime.
You know, people don't look to religion to go out and shoot a young woman in the heart. So I think, you know, my heart and thoughts are with the people. I think the people in Iran know instinctively that the United States of America is supportive of a true democracy, not a fixed ballot, but a true democracy.
KING: I want to ask one more foreign policy question before we go to health care and the economy. And I want to ask it of you, Senator Lugar, because it was two years ago this week, you gave a very important speech on the floor of the Unites States Senate in which you questioned severely, some say broke with the Bush administration on its policy in Iraq. And you gave a very detailed speech as to why you thought the policy had gone off the tracks. I want you to listen to one portion of what you said then and I want to ask you how it applies now. Let's listen.
(BEGIN VIDEO CLIP)
LUGAR: American manpower cannot keep the lid on indefinitely. The anticipation that our training operations could produce an effective Iraqi army loyal to a cohesive central government is still just a hopeful plan for the future.
(END VIDEO CLIP)
KING: Fast forward two years to right now, a critical moment. As this president of the United States starts to draw down U.S. troops in Iraq, is it still a hopeful plan for the future? Or are the Iraqi security forces up to par in your view?
LUGAR: Well, they're not up to par and therefore it is hopeful for the future. Now the hopes are based upon the fact that more people are under training, more governance is occurring. We'll see pretty rapidly come June 30, and the withdrawal of the cities, the first part of our agreement, and the Iraqis are insisting on that.
So this is no longer an option on our part, and we have to hope...
KING: Are you nervous?
LUGAR: Of course, because there clearly are gaps in terms of the training, the security, the governance of various cities as well as other provinces.
KING: We'll be back shortly with our senators. Up next, we'll turn to the problems facing Congress back here in the United States, including how to pay for health care reform. Much more with our four senators when "State of the Union" returns.
(COMMERCIAL BREAK)
KING: You're looking, there, at the Golden Gate Bridge in San Francisco. That's Senator Feinstein's hometown; 18.5 percent of California does not have health insurance, which brings us to our next topic, as we welcome you back to "State of the Union."
I'm joined, once again, by four leading voices in the U.S. Senate, Republican Richard Lugar and Democratic Dianne Feinstein, Republican Chuck Grassley and Democrat Bob Casey.
As we move on to the health care debate, let's take a look at one of the reasons the debate in the Congress went off the tracks a bit this past week.
The Congressional Budget Office took a look at the leading Democratic plan, said it would cost $1 trillion or more over 10 years, and it was estimated to reduce the number of uninsured by just 16 million by 2015.
KING: Why is that important? Let's go to the next number here. You will see without the $1 trillion plan, the Congressional Budget Office says there will be 51 million Americans without insurance in 2015. After spending $1 trillion, the Congressional Budget Office says that number would still be 35 million. That has led many to say too much money for too little gain.
Senator Grassley, you are the ranking Republican on the Finance Committee, the key committee when it comes to paying for this. You spent much of the past week shuttling with a few other Republicans in and out of the Democratic chairman's office. Can you tell us today that progress toward a bipartisan plan has been reached? Or is health care reform this year in peril?
GRASSLEY: Well, it has not been reached, obviously yet, or we'd have a bill for Tuesday for committee action. But we're still working. Our goal is affordability for people to have insurance and accessibility to do away with the discrimination that comes from people not getting insurance because of preexisting conditions. Our goal is to insure 45 million Americans that don't have health insurance, and to make it affordable. Our goal is to do that.
Our committee has a responsibility for finance, but also don't forget our committee has the responsibility for a lot of health care policies, as well, because we have jurisdiction over Medicare and Medicaid. And we feel that we will be able to put together a bipartisan plan that will do what everybody wants to do, accessibility and affordability. And we'll be able to pay for that, and we will not have the problems that you described of $1 trillion and only covering 16 million people. Now, we have a separate piece of legislation than the one you were referring to because that was the other committee, the health committee, and, of course, that's a major problem. But we also had a score from Congressional Budget Office on ours that brought it in higher than we anticipated.
So we're in the position of dialing down some of our expectations to get the costs down so that it's affordable and most importantly, so that it's paid for because we can't go to the point where we are now of not paying for something when we have trillions of dollars of debt. And we anticipate paying for it through some savings and Medicare, and from some increases in revenue.
KING: Senator Lugar, before I get to the Democrats, Senator Grassley's under pressure from a lot of Republicans because he's negotiating with the Democrats saying don't go too far, don't give away the store. What is your message in this debate? Can we do all he just said, reform Medicare and Medicaid, insure those 45 to 50 million uninsured Americans in one full sweep? Or should there be some incremental steps first?
LUGAR: Well I think it should be incremental steps. As a matter of fact, I don't have the slightest idea what is in either of the two bills in the committees. None of us do because much of it hasn't been written, still being drafted. People are scoring something that doesn't exist. What I would suggest is we hang on now for a period of study so that we find literally what the alternatives are.
KING: So not this year like the president insists.
LUGAR: Not this year because the president is trying to solve the economic crisis in our country and the world. We already have $1.8 trillion deficit projected apart from all of this. And we're going to have to be thoughtful about the dollar. Will the Chinese continue to buy our bonds? Will the Japanese pay our deficits? We can't pay them right now with the resources of this country. This is alarming and therefore health care is very important. And reforms might occur incrementally even this year. But this is such an audacious move that it threatens more than just the health care problem, it threatens our basic structure of our economy.
KING: Senator Feinstein, I see you nodding. I want you to come into the conversation to see if you agree with Senator Lugar, that it should be incremental.
But first, I went out to the Cleveland Clinic this week. The CEO is very impressive, Toby Cosgrove. It's a place where they give some of the best care in the world and they do it at a much lower cost than many places around the world. And he's a big champion of reform, the CEO is, but he also worries about the cost. I'm going to liken it to the ketchup or mustard pack you get at that ball game. If you squeeze it too hard, it sprays out somewhere and you get unexpected results. He said he is worried. The president has said, as you know, and your state would be hard-hit by this, that the immediate savings should come from Medicare and Medicaid. That's one of the ways to pay for it. Dr. Cosgrove says that might be fine, but if you do it too fast and you take too much out of the program, there will be huge negative results among them, he says could be this.
(BEGIN VIDEO CLIP)
DR. TOBY COSGROVE, PRESIDENT AND CEO, CLEVELAND CLINIC: The first thing you still see happening is a deferment of all of the reinvestment in the infrastructure. Classic example of that what's happened to the national health in England. They didn't invest in any of their infrastructure for 50 years, and now a lot of the hospitals in England are 100 years older and way behind. So, you know, if you begin to take money out, it will make a difference. And it will hurt the system in some way.
(END VIDEO CLIP) KING: As a leading Democrat in the Congress, is your president trying to seize this political moment because he has the votes right now and the political capital in the first year in office? And might he as a result potentially do more harm than good if you try to do this all at once?
FEINSTEIN: Well to be candid with you, I don't know that he has the votes right now. I think there's a lot of concern in the Democratic caucus. Senator Lugar's point about the economy, the trillions of dollars that have gone into buttressing the economy, now we're going to be dealing with regulation of the financial sector. What all of the impact of this is not yet known.
Ergo, you have enormous problems in my state. California's bigger than the populations of 21 states and the District of Columbia put together. We have an enormous health care industry, 350 hospitals. University of California alone has 34,000 health care workers, has health care worth $4 billion a year.
So it's complicated. Additionally, the state is in a state of financial catastrophe. I think that's clear. So, if you change the Medicaid rate, for example, it has an impact on California between $1 billion and $5 billion a year.
Now, how could I support that?
Because it would take down the state.
You also have enormous profit centers in the health care industry, in pharmaceuticals, in medical insurance. And I wonder about these profit centers. Because, unless you have some method to control these profits, premiums continue to rise in the private sector, as they have over the past eight years, substantially.
Therefore, controlling costs is a very major and difficult subject, as long as you have a large private-sector involvement. So this needs to be worked out.
The issue of coverage, I think, you raised -- over $1 trillion to cover 16 million people. We have 6.6 million people without coverage and below the poverty line. So just to cover them becomes a huge, huge problem.
KING: So, Senator Casey, come into the conversation with your views. And as you do so, Senator Feinstein, a Democrat, just raised some significant questions. She'd like to get this done but she has big questions.
Senator Mary Landrieu of Louisiana is another Democrat who lives in a more conservative state. She has raised some questions. The reward for her raising questions has been a liberal group, moveon.org, is now attacking her on the radio. Let's listen.
(BEGIN AUDIO CLIP) ANNOUNCER: Why is Mary Landrieu opposing the president's plan to provide health care choices for all Americans, including the option to join a high-quality public health insurance plan? She did receive $1.6 million in campaign contributions from the health care industry, the same industry that's now spending millions to stop the president's plan. Call Mary Landrieu.
(END VIDEO CLIP)
KING: Senator Casey, is that helpful? That's an ally of your party, moveon.org. They have helped the Democrats in elections. They helped President Obama in the election. There's not a bill to vote on yet. There are people like Senator Feinstein, like Senator Lugar, like Senator Grassley. I bet Senator Casey has some questions about this legislation.
And before there's even a bill to vote on, she's being attacked on the radio. Should the president of the United States, the leaders of the Democratic Party tell moveon.org to save its money and get off the radio?
CASEY: Well, John, I'm not sure we can be in the business of telling groups how they spend their money. But, look, this is very early. I don't think either side on this should overreact, people in the Democratic party, groups that support us, nor people in the Republican party. There's still an awful long way to go here.
But the reality, for a lot of families, in Pennsylvania and across the country -- I'll just give you one example. In Pennsylvania, if you look at 2007 and 2008, at some period of time within those two years, more than a quarter of our population had no health insurance at all.
It's a huge number, and the same is true across the country. The worst thing we could do is to sit back and continue to wait and debate for too long.
KING: I will continue to cover this issue and all the other issues, as we go forward. I want to thank all of you senators for joining us for a long, extended conversation today. And yet, believe it, despite all this time, I have more I wish I had time to ask. But we'll invite you all back.
Senator Casey, Senator Grassley, Senator Lugar, Senator Feinstein, thank you so much.
And coming up, our weekly "Last Word" segment. You're going to want to stick around. This won't be like any "Last Word" segment we've ever done. Straight ahead, the latest from Iran.
(COMMERCIAL BREAK)
KING: I'm John King, and this is "State of the Union." Here are our stories breaking this Sunday.
Two demonstrations today in Iran. This is amateur video showing a large crowd marching through Tehran. We're being told thousands of riot police and militia are lining the street. So far, no word of any clashes between demonstrators and security forces.
Hospital sources say at least 19 people were killed yesterday in violence between protesters and armed security forces.
Protesters denouncing the Iran government are hitting the streets here in the United States, a rally under way this hour in the nation's capitol. Protests are also scheduled today in New York and Los Angeles.
Yesterday hundreds of demonstrators in several U.S. cities criticized Iranian President Mahmoud Ahmadinejad and called for a new election.
Rescue crews in Iraq are searching for survivors of a massive bombing near Kirkuk. Officials say yesterday's blast killed at least 80 people, making it the deadliest attack in Iraq this year. More than 200 were wounded. No one has claimed responsibility, but police say Al Qaida militants are suspected. That and more, ahead on "State of the Union."
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KING: Thirty-one newsmakers, analysts and reporters were out on the Sunday talk shows, the vast majority Washington insiders and politicians. Normally, we bring one of them in here to give them the last word.
This week, we give the last word to people outside of Washington who have been fighting, and in some cases, dying to be heard.
We want to zoom in on Tehran this week because, on this day, we want to give the last word to the people of Iran who are marching in the street, urging that their voices be heard. We can't hear from them, but that doesn't mean we can't give them the last word.
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(CHANTING)
(UNKNOWN) (THROUGH TRANSLATOR): We started marching toward Alzadi (ph) Square, or Freedom Square, at around 3:30, and it was a very peaceful protest. We just raised our hands. We raised our hands with the peace sign, and it was relatively quiet.
When everybody had circled the square and they were heading home and the crowd was dispersing, people started to hear gunshots. I could hear gunshots coming from the right hand of the square. And people were terrified because the gunshots would not stop.
The people said that it was from Basijis or plainclothes security officers.
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KING: We show you those dramatic pictures, and here more pictures of what's happening in Iran today. We have to be honest; we don't know exactly what happened in the election, and it's very hard to keep track of exactly what is happening in this country because of the nature of the regime and the restrictions placed on us.
KING: But we can promise you here at CNN, we will continue to do our best to follow this unfolding and dramatic story.
Coming up, it's the next generation of health care here in the United States. We'll take you inside the prestigious Cleveland Clinic, where doctors are revolutionizing the way patients are treated, all the while keeping costs under control. Stay with us.
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KING: We close today with a debate over health care reform as Congress tries to get insurance for the 45 to 50 million Americans who don't have it, one of the big questions is how do you pay for it? And as the Congress looks at how to pay for it, one of the big discrepancies is does the health care cost differ all across the country?
Let's take a closer look. For example, if you head down here to McAllen, Texas, you'll see Medicare spends almost $15,000 per enrollee. That's almost twice the national average. And yet, if you pull out the map and come over right here, that's not all that far away. Grand Junction, Colorado, look at the difference, Medicare spending here just $5,800 per enrollee -- $5,800 in Grand Junction, Colorado, more than $15,000 for the same patient in McAllen, Texas.
So we tried to figure out why this is happening this week, and one of the places we went to is the Cleveland Clinic in Ohio. It is pioneering for high-quality care and for lowering costs. It's ranked No. 1 in the nation for heart care, 14 years in a row. There are 1,800 salaried physicians, and that's significant. Remember that word, salaried. More than 3.3 million total visits to this hospital, 50,000 admissions in 2008.
They have high-quality care, they have lowered their costs. S as the Congress debates what to do and how to pay for it, the Cleveland Clinic is a leading example.
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KING (voice-over): Cardiac intensive care unit at the Cleveland Clinic. World renowned for both its high-quality care and its comparatively low costs. Those who work here, like Dr. Steven Nissen, an important example as Washington debates a radical restructuring of American health care. DR. STEVEN NISSEN, CLEVELAND CLINIC: Everything that we do is done with the patient at the center of the picture, not the doctor.
KING: In many hospitals, cardiologists and cardiac surgeons work in different departments. Here, all under one roof. The business model that translates into more collaboration and less competition for patients and for health care dollars.
NISSEN: The Cleveland clinic is not a fee for service model. I get paid a salary. We all get the same check. It doesn't matter whether we do an operation or do an angioplasty. And so we have taken that issue of income out of the equation.
Now, unfortunately, that's not the case across the country. And that does lead to excess costs. Everybody wants to do their procedure.
COSGROVE: What are we talking about?
KING: CEO Dr. Toby Cosgrove is an outspoken advocate of reform, but also sounds several cautionary notes as Washington debates just what to do and how to pay for it.
COSGROVE: Yes, I think if you begin to take money out of the system, my concern is that you begin to drive quality down.
KING: Most hospitals get about half their income from Medicare and Medicaid, and it is those programs the president says must be squeezed for major cost savings.
COSGROVE: Fifty percent of the hospitals in the United States are running in the red. So if you begin to look at reducing the amount of money that's coming to hospitals to look after patients, I think you're beginning to look at failure of a group of hospitals.
NISSEN: The platelet count has fallen from 200 to 130.
KING: The American Medical Association is wary.
NISSEN: Heart rate 77, common normal sinus rhythm.
KING: But many doctors at the Cleveland Clinic are open to a government-run insurance plan as part of a major reform insurance package.
NISSEN: Having 46 million people ho have no health insurance is an embarrassment. It's the wrong thing to do. And a public plan that gives everybody access to some kind of a health care, subsidized, if necessary, I think it's an extraordinary step in the right direction.
KING: But again, CEO Cosgrove sounds a cautionary note. Hospitals worry private insurers will see lower payments in a government program and look to trim their reimbursements as well.
COSGROVE: If you begin to drive down the payment from the private patients with insurance to a level close to Medicare or Medicaid, then it's going to be very difficult for physicians and providers to remain solvent. If you begin to take money out, it will make a difference, and it will hurt the system in some way.
KING: Cleveland Clinic holds itself out as an example of how to lower costs, yet also improve results.
UNIDENTIFIED FEMALE: It is time for you to go home.
KING: The emphasis on preventative care is designed to reduce the need for expensive surgeries and procedures. The leaders here say a major reform goal must be to reverse the system's financial model.
COSGROVE: Begin to reimburse for wellness. Right now if I do a heart operation, I get paid for doing the heart operation. If I prevent somebody from needing a heart operation by helping them understand their diet and their exercise, I don't get paid anything.
KING: Wellness is a Cleveland Clinic obsession. It won't hire smokers. Healthier foods dominate cafeteria options. A farmer's market on campus, yoga classes for employees and patients.
COSGROVE: We've lost over 75,000 pounds in six months as an organization, 70 percent of the cost of health care is from chronic diseases, and chronic diseases come from really three big things, from obesity, from lack of exercise and from smoking. So we have got to go after the prevention in wellness aspect. That all brings down the level of disease across our entire country. We live longer, we live healthier, and we live cheaper.
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KING: We thank our friends at the Cleveland Clinic for that unique access. We also urge you to continue watching CNN for all the drama unfolding in Iran. This is the place to be as we watch that unfold. And we'll be right here again next Sunday and every Sunday at 9 a.m. for the first and last word in Sunday talk. Until then, I'm John King in Washington. Have a great Sunday and happy Father's Day. "Fareed Zakaria: GPS" starts right now.
