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State of the Union

Last Word: Interview With Mike Ross

Aired August 16, 2009 - 12:00   ET


KING: We begin this Sunday with someone who has firsthand experience of the contentious turn in the national debate over health care reform. Secretary of Health and Human Services Kathleen Sebelius has heard the heckling and the boos, and more importantly the detailed questions Americans are asking at town halls organized by members of Congress home for their August break.

Secretary Sebelius joins us from Michigan this morning to answer the administration's critics and the questions you might be asking around the kitchen table.

Thank you for joining with us, Madam Secretary. I would like to begin with something the president said at a town hall out in Colorado yesterday. Among the most contentious points of the debate and something the president once described as critical, is the so-called government or public option, to compete with private insurance companies. But if you listened to the president yesterday, he seemed to think, maybe it's not so important.


OBAMA: The public option, whether we have it or we don't have it, is not the entirety of health care reform. This is just one sliver of it. One aspect of it. And by the way, it's both the right and the left that have become so fixated on this that they forget everything else.


KING: Now, some, Madam Secretary, take that as a simple statement of fact, because you don't have the votes right now in the Senate for the public option. But some in this town in Washington, especially House Democrats, more liberal Democrats who have said that is critical. That they will not support health care without a public option. They take that as a message from the president that the votes aren't there, it's time to come up with a plan B.

SEBELIUS: Well, I think, John, that the president is absolutely right. This piece of the puzzle has had enormous focus and the president continues to believe that it's good to have consumer choice, let people choose an option in the new marketplace. And it's good to have competition for the private insurers who will inherit a lot of new customers and without competition, costs could skyrocket.

In a monopoly system, it's not a great way to hold down costs. So he continues to be very supportive of some options for consumers. What we don't know is exactly what the Senate Finance Committee is likely to come up. They've been more focused on a co-op, not-for- profit co- op as a competitor as opposed to a straight government-run program.

And I think what's important is choice and competition. And I'm convinced at the end of the day, the plan will have both of those. But that is not the essential element.

KING: So is the president trying to say to -- you know that the votes in the House and you know the support among liberals and they're angry. They think they're being sold out in the Senate. Is the president trying to say, I'm sorry, the votes aren't there, be prepared to embrace a co-op instead of a more robust public option?

SEBELIUS: Well, the way that the process works, the Senate will have a version, the HELP Committee has already come out in the Senate with a version that has a very robust public option. It's the same version that's in the House-passed bills. What we don't know is the final committee structure.

And I think the president is just continuing to say, let's not have this be the only focus of the conversation. Coverage for all Americans, lowering the crushing cost for everyone, making sure that we have new rules for insurance companies, that they can't dump people out of the marketplace if you get sick, that they can't drop your coverage based on a pre-existing condition, that you can't be priced out because you're a woman instead of a man, and gender discrimination won't be allowed to continue anymore.

Those are really essential parts of the program, along with choice and competition, which I think we'll have at the end of the day.

KING: So I want to get some of the president's travels this week, so I've moved over to our magic wall here in Washington. But let me just quite simply -- so the public option is not a deal-breaker from the president's standpoint?

SEBELIUS: Well, I think there will be a competitor to private insurers. That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing. We need some choices, we need some competition.

KING: You have been at some of these town halls, you know the volume has gone up. I want to walk through where the president has traveled in this past week as he makes his case. One town hall the president was at was up in Portsmouth, New Hampshire.

What makes New Hampshire so interesting is that 44 percent of its voters are registered as independents. And as you know, independent support for the president, specifically on health care, has dropped a bit in recent weeks. That was one stop up in New Hampshire.

He also then went from the East way out here up into Montana in the West. The president having another town hall out here. More casual, shirt sleeves out in the West. Interesting, in Montana, the president lost to John McCain, but just narrowly there.

And as you know, Madam Secretary, when you get further West, you have increased skepticism about Washington and about government spending and the role of government in health care.

And the president wrapped up his week with a town hall in Colorado out here in the conservative part of the state. This was a red state he turned blue in the election, but out in conservative Grand Junction, interesting in Colorado, 17 percent of the state's residents lack health insurance, 9 percent are on Medicare, and 8.5 percent on Medicaid.

As we watch the president travel, politically, many of his own allies, even some of his allies say, they are more and more skeptical he can get this bill this year. Do you share that skepticism?

SEBELIUS: I don't. I think that the debate across the country is -- reflects the fact that Americans care deeply about health care. It's the most personal issue to most folks. Everyone has a loved one, a family member, a child, a parent. They've gone through the system.

And I think there's a general recognition that the system we have in America is fundamentally broken. We spend more than any country on Earth. Our health results look like we're a developing nation. So we have to reform the system.

And I think what's going on right now is complicated, because we need to put the specific language together. But by and large, I find it encouraging that Congress is at the table working, that Congress is now traveling out to hear from their constituents.

We knew we were in trouble in Pennsylvania, John, when the woman who runs the Constitutional Law Center got up to welcome the crowd and she was booed. So, clearly, some of this anger is not directed to health reform.

It's people who are, I think, uncertain and afraid about the future and, unfortunately, there has been a lot of misinformation intentionally circulated, trying to scare people, trying to scare...

KING: I want to get...

SEBELIUS: ... seniors and veterans.

KING: I'm sorry to interrupt. I want to get to some of those specific points and some of what you call misinformation coming up at the town hall.

But I want to ask you a question first as Governor Sebelius. You are Secretary Sebelius now, but not long ago you were the governor of this state right out here of Kansas. As you know, Democrats were saying, let's wait another month, let's see if they can come up with a bipartisan bill in the Senate, and if they can't by September 15th, then the Democrats are going to have to use their party line muscle and put a bill through the House and put a bill through the Senate. Could Governor Sebelius sell that back home here in the red state of Kansas? Should we do something so big, so personal, and so expensive along a party line vote?

SEBELIUS: Well, I think the president is still hopeful and I am too, that we will have a bipartisan bill. I thought it was interesting that we had a Republican congressman from Louisiana yesterday come out and endorse the bill, saying that he intends to vote for health reform.

I think we'll have senators who still are working with the Finance Committee structure and they're likely to be part of the final solution. And there's no question, we have lots of Republican ideas, even in the House version, which at the committee level, did not have Republican votes. We have lots of Republican ideas.

KING: Let's go through some of the specifics, some of the things that have come up at these town halls. And this e-mail I'm holding up here has been distributed by conservative critics of the president's plan to millions, millions of Americans across the country and we are finding people using it and reading off it at town halls.

And I want to go through some of the line-by-line criticisms. One of the criticisms is this, they say, in the House legislation, on page 30 section 123 of the House bill, it says, there will be a government committee that decides what treatments and benefits you get. That true?

SEBELIUS: Well, I think that what Congress has done is to say that the bills themselves will not try to enumerate what the benefit package looks like. That will be left as it is in state employee health plans and in veterans' health plans and others to a group to say, here is the kind of basic benefit package.

And then ask for the companies to essentially put together the best possible package for Americans, knowing that that's a dynamic that changes from year to year. Some drugs are available now that weren't available five years ago.

We want to make sure that it's the best plan, the best options, and that the plans actually look different based on what companies decide to include as benefit packages.

KING: But how much -- let me jump in...

SEBELIUS: Congress won't...

KING: How much power would the government have in this dramatically changed marketplace? Because here specifically on that point, I read you the one-line bullet point from the e-mail. Here's specifically what that page of the bill says.

"There is established a private-public entity advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential enhanced and premium plans." So the government would have a voice in what it says should be in those plans.

SEBELIUS: Absolutely, John. And that goes on every day. It's how the Medicare benefits get decided. It's how the Medicaid benefits get decided. It's really what happens in any private insurance company when they put together a benefit package along with an employer.

So it's exactly -- I was an insurance commissioner for eight years.

SEBELIUS: It's exactly how health benefit plans are decided and defined around a broad set of parameters, saying, we want preventative care, we want to make sure we have primary care, we want to cover catastrophic care, we want the basic prescription benefits to be available to all Americans. And then the specifics are decided on an ongoing dynamic.

You don't want legislators trying to write specific statutes saying, this is in, this is out, knowing that it changes from year to year, day to day. We want a dynamic benefit system that benefits the American public.

KING: More of our conversation with Secretary Sebelius just ahead. More on the health care debate, also her thoughts on whether as parents get ready to send their children back to school, the country is ready for the return of the H1N1 virus. Stay with us.


KING: We're back talking with the secretary of health and human services, Kathleen Sebelius. Madam Secretary, before the break, you talked about the scare tactics. You don't like some of these issues being raised or criticisms being raised that you think are misleading or out of bounds. The president himself used the term, and I'm holding up "The Bozeman Daily Record" here -- the "Roswell Daily Record" I'm sorry -- he said on the death panel debate, simply dishonest things have been said in that debate, simply dishonest. I want to ask you, if we're going to have that standard and try to hold everybody to it in the health care debate, that what you say must be factual, how about this statement the president said earlier this week at Portsmouth, New Hampshire.


OBAMA: Under the reform we're proposing, if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan.


KING: Now, the president uses those exact same words in this essay published today in the New York Times. He can't say that, though, with great certainty, can he, that in a changed marketplace, my employer or any employer that provides me benefits might say it's cost-effective in this new marketplace to change things, maybe take the public option, maybe go look for another plan. And if there are changes, I might not get to keep my doctor, I might not get to keep my plan. Isn't that factually correct?

SEBELIUS: Well, what I think, John, what the president is saying that he wants to start with the employer-based insurance coverage that we've had in this country since the 1930s...


KING: Forgive me, forgive me, I'm sorry to interrupt you, but that's not what he's saying. He says if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care. That's very specific, what he's saying, and many have said that that's not exactly true.

SEBELIUS: (inaudible). Well, clearly, he can't prevent employers from dropping coverage, and it happens all the time, although health reform will stabilize that marketplace. That's what I was trying to get at. It provides tax incentives for small employers who now are dropping coverage year in and year out to get into the market. It provides help for lower-income employees to take their employer-based health coverage.

So I think at the end of the day, what he's saying is, you're going to have a stronger employer-based system, encourage more employers to stay where they are and encourage more doctors to actually participate in the system.

Clearly, he can't mandate that a doctor not retire or that an employer not switch a plan that might have a different network of doctors. But strengthening the existing platform that serves 180 million Americans well, making sure that employers have incentives to stay in and really putting up some firewalls so that we don't have employers dumping coverage, which we have day in and day out today. 12,000 Americans a day are losing their health coverage. And what the president is talking about doing with health reform is actually stabilizing that marketplace, not dismantling the marketplace.

KING: We're almost out of time, but I want to read you a line from the current issue of Time magazine as parents get ready to send their children back to school, and I want you to help us understand government preparations levels and when a vaccine will be ready and the effectiveness. Here's the line about the H1N1 virus. "One pessimistic model from the Centers for Disease Control and Prevention predicts that 40 percent of the nation could be struck, roughly 140 million people, with perhaps a six-figure death toll if a vaccination campaign is not successfully implemented."

Is that right?

SEBELIUS: Well, John, we're playing out a whole variety of scenarios. We're preparing for the worst and hoping for the best. We're still optimistic that we'll have a vaccine available about the 15th of October, but the regimen will take about five weeks. First shot, three weeks delay, second shot, and then about two weeks for full immunity. So we really need to work between now and Thanksgiving with lots of social mitigation, keeping kids home from school if they're sick. I would urge every family to have a backup child care plan. If your child comes down with the flu, you need to keep him or her home. Who's going to take care of that child? Who's going to be at home? If a parent gets sick, what is the plan? Because we know the disease spreads quickly, and we will not have fully immunized even priority populations until about Thanksgiving.

KING: Many challenges facing the secretary of health and human services, Kathleen Sebelius. Madam Secretary, thanks for your time today.

SEBELIUS: Thanks, John.

KING: Thank you.

And next, more of your questions about health care. We'll separate fact from fiction with three members of Congress who also happen to be medical professionals. Stay with us.


KING: The crackling, often contentious health care debate at town halls this past week was proof to us that we needed to do a better job honing in on the specifics and working carefully to separate myth from reality.

Our next guests are uniquely qualified to help us understand the fine print. Republican Senator John Barrasso of Wyoming, Republican Congressman Tom Price of Georgia, and Democratic Congresswoman Eddie Bernice Johnson of Texas. Senator Barrasso and Congressmen Price are also medical doctors, while Congresswoman Bernice Johnson is a registered nurse.

Thank you all for being with us today. Congresswoman, I want to start with you, because Secretary Sebelius at the top of the program made crystal clear that the public option that the president early on had said was a critical element and that your colleagues, especially, in the House Democratic Caucus have said is a central, critical component of health care reform, the White House now says too much attention on the public option, clearly signaling it is ready to sign a health care bill without one. Could you support one? Could other House Democrats support a health care reform measure that does not have a robust public option?

JOHNSON: It would be very, very difficult, because without the public option, we'll have the same number of people uninsured. If the insurance companies wanted to insure these people now, they'd be insured. The only way that we can be sure that very low-income people and persons who work for companies that don't offer insurance can have access to it is through an option that would give the private insurance companies a little competition. The private insurance companies have been in charge so long that I think they feel that nobody else ought to be able to do it.

KING: You say, very difficult. I want to bring in our Republican -- your Republican colleagues here. When you say very difficult, would House Democrats -- would you go to your speaker and say, Madam Speaker, go down to the White House and say, no? JOHNSON: We've already done that. We've already expressed that to the speaker.

KING: Congressman Price, you jump in on this point before I want to get up and go to the wall, because I want to mostly have a town hall discussion here today and raise some of the questions that are coming up around the country.

But if the president is signaling a public option is not essential, then would House Republicans maybe say it's time -- maybe you'll go down to the White House and say, Mr. President, here is what we can do.

PRICE: Well, we would love to go down to the White House and work with the president. And the fact of the matter is that this notion that there's just two options, the government option or a private insurance option, is just simply false. There's the third way, which is the right way, we believe, which is a patient way, a patient-centered way, to put patients in charge. And there is a way to get folks insured without having the government option. If you have the government option, then what that does is crowd out all sorts of folks from private personal insurance to the government-run program.

There are all sorts of studies that demonstrate that. The Congressional Budget Office demonstrates that, the Heritage Foundation. Tens of millions of individuals would be moved from their personal, private insurance to the government-run program. We simply don't think that's acceptable.

KING: I want to have a town hall here at "State of the Union," much like you're having at home. And Senator Barrasso, Dr. Barrasso, I want to go to you first and I want to go out to the state of Iowa. And I want to play for you a question that came up at a town hall for your Republican colleague, Chuck Grassley and I want your thoughts here. Let's listen.


(UNKNOWN): I'm a second-year medical student. If plans like these are going to drastically increase the number of people on plans who result in paying the low Medicare reimbursement that we get here in Iowa, how are you going to keep future doctors like me and thousands of doctors across the state in Iowa?


KING: Senator Barrasso, the question essentially being in the context of, if you have a public option, will the reimbursement rates be low, like in Medicare and Medicaid, in that student's opinion, so the doctors, as we've seen in many states, simply opt out?

BARRASSO: I had that same question at a town hall meeting in Wirling (ph), Wyoming in Washakie County just this past Friday. Physicians are very concerned, because in the past, Medicare and government payers -- government is the biggest deadbeat. They don't pay enough, the fair price. They don't even pay the ambulances enough to get the patient to the hospital, so then there's this dramatic cost shifting, John, that happens in America. But at a town hall, what I heard from people in Wyoming is, they are afraid that with this new plan that the president is proposing, is they're going to end up paying more and ending up with worse care overall. They're very concerned about all of this Washington spending, the major debt that we're facing, and they're really focused on the economy right now and saying that really ought to take priority over health care.

KING: Let's go to another question. And, Congressman Price, I want you to take this one. I'm going to zoom into the state of Maryland. Senator Ben Cardin had a town hall up here in the Hagerstown area, and you notice he's a Democrat, but this is a conservative part of the state up here. Here was the question put to Senator Cardin.


(UNKNOWN): Say my dad and my grandfather both came down with cancer. Would my dad get priority care because he's younger and can contribute longer to society?


KING: Interesting question from the young man there. Would the government, Congressman Price, be involved in those decisions?

PRICE: Oh, it's very concerning, John. I'm up here in northern Michigan visiting my mom, who had a recent bout of cancer. And I believe that the surgery that she was allowed to have and the chemotherapy that she was allowed to have in the House bill would not be available to her.

And that's why you see seniors across this land so very concerned, because the proposal in the House is to decrease, is to cut $500 billion from Medicare. They know that that means a decrease in the quality of care and the level of care that they're able to receive, and it's not acceptable to them, and it's not acceptable to us, especially when there are positive ways to solve this problem without throwing everything out and making it so that the government's running the show.

KING: I want to let the Democrat in on that conversation. Congresswoman, you heard your Republican colleague there. And this does come up when you travel the country.

I was in your state recently, and it came up there, that if you're trying to squeeze all these savings from Medicaid and Medicare, no one disputes that there's not a lot of money to be saved in getting rid of waste, fraud and abuse in a bureaucracy, but doctors and patients do have a concern that if you squeeze too much, you ultimately do affect care. How do you guarantee, Congresswoman, that doesn't happen?

JOHNSON: First of all, we'll have another part of it -- part of the health care getting attention, primary care. With primary care, much of the hospital and the emergency room-type of care will be eliminated, because we really won't need it.

When people learn how to be self-sufficient and take care of themselves through our community health centers, there won't be as many emergency room patients, there won't be as many people going to the hospital, because they won't need it.

And it's not that care would be rationed. It's just that when they learn how to take care of themselves -- there's a big difference between a diabetic ending up in the emergency room in a diabetic coma versus one who has gone to a community health center and gotten instructions as to how to keep from having that blood sugar go up. There's a vast difference in what that would cost.

KING: Gentlemen, I know you want to jump in. Let me work in a quick break here. We'll be right back, and we'll get the Republican colleagues involved. A lot more to dissect with Senator Barrasso, Congressman Price, and Congresswoman Bernice Johnson. Please stay with us.


KING: We're back with three medical professionals who now serve in the Congress, Republican Senator John Barrasso of Wyoming, Republican Congressman Tom Price of Georgia, and Democratic Congresswoman Eddie Bernice Johnson of Texas.

Let's continue in our town hall format here. I want to go into the state of Maryland. Congresswoman Donna Edwards had a town hall recently, and I'll show her picture up here. She's conducting the town hall meeting.

One of the things CNN obtained at this meeting was an e-mail that conservatives are using across the country. It's gone out to millions of people, criticizing the Obama health care plan and the details. And you see it here.

And it goes line by line through many specific criticisms of the plan. I want to read you one of them. This e-mail says that, on page 427, lines 15 through 24 of the House bill, quote, "the government mandates program for orders for end of life. The government has a say in how your life ends."

If you go to the actual legislation on that page, what it is, is advanced care planning consultations. The bill would cover the costs of sitting down with someone to discuss a living will, to discuss a DNR.

Congressman Price, I want to go to you first. Many conservatives have said, "You know what? To say there are death panels, that the government can pull the plug on grandma, is simply wrong." Does it hurt your cause when conservative critics are misleading people and are twisting the facts?

PRICE: Well, I think this is symptomatic of the process that we've been through, and that is that it's been mostly in secret, that it hasn't been a bipartisan way, certainly in the House. The concern that people have across this land is, what role is the government going to play? Who's going to make these crucial decisions? And when they go to that area of the bill and they see that the government will mandate, will dictate that the physician and the patient, who is eligible for Social Security, have that conversation at least once every five years, and then they see earlier this year that the Comparative Effectiveness Research Council was put in place, and the Congress refused to say that it would only deal with clinical situations, it would also deal with costs, and you put those things together, and people have a reasonable concern that the government is going to be making decisions that ought to be left to families and patients and doctors.

That's where these decisions ought to stay. The problem is, that's not what the bill says.

KING: Well, you say it mandates. Others who read the bill, including our organizations, fact-checkers and other organizations' fact-checkers, says that it covers and recommends you have these conversations.

Dr. Barrasso, the president says any talk of a death panel -- I'm holding up a newspaper here -- is simply dishonest. Do you view that as dishonest? And is someone who has legitimate questions about the cost of this bill, the scope of government involvement in this bill, Senator Barrasso, does it hurt your cause if things are being said and distributed that are misleading or take things out of context?

BARRASSO: You don't want anything to be misleading, but you want people to have the facts. In the Senate bill, the HELP Committee bill, John, this -- this is it, and it's not been bound together. This is what they came out with at committee four weeks ago. And the reason they haven't bound it together is because they don't want to put a price tag on it yet.

People want to read this all across America. We have the House bill, which is this 1,000-page bill. People want to read what's in the Senate HELP bill. It hasn't been bound together, so they don't have a score on it, because there's going to be sticker shock again.

So I think when people can't get a copy of the bill to read, they may come up with ideas that say, "Gee, what does this really mean?" But I think some of this is so poorly put together and written that it can lead to different conclusions.

But you talk about misleading. I mean, yesterday -- and you played the tape of the president continuing to talk about, you know, you can keep the policy you want, you can keep what you have. Then, why in his town hall meeting yesterday did he immediately after saying that go and say, "But we're going to get rid of Medicare Advantage," a program that 11 million seniors in this country have, 3,000 in Wyoming, many in every congressional district, a program that actually does some things with prevention, does some things with coordinated care that Medicare doesn't do?

These are programs that people like. Eleven million seniors have this Medicare Advantage. The president wants to eliminate it, in terms of saving money, cutting costs to Medicare.

So I think he has to be cautious in terms of the things that he's saying, as well, because in the same -- in the same town hall meeting, he says one thing and then -- and then actually flips and says something very different about allowing people to keep what care they have. KING: Help me out on this in the short time we have left. I'll go to each of you. Please take about a minute. Help me out, then. The three of you have worked as medical professionals, two doctors and a nurse. You understand how this works in the real world. You can read the bill and understand how it would work in real life after it leaves this town we call Washington.

Is there any way to reset this process and have a truly bipartisan conversation and meet the president's goal -- he was elected in a campaign in which he said he would do this out of the box -- and meet the president's goal of getting it done this year? Or as we have watched this miss the deadline to vote by August, go out into the country in August, have the prospects of a bipartisan bill this year simply evaporated?

Congresswoman, I'll go to you first. Ladies first.

JOHNSON: It's really difficult to tell, but it appears to be that the Republicans are just not going to cooperate, no matter what. They'd rather have a problem so they can talk about it.

KING: Is that right, Congressman Price?

PRICE: Not at all. In fact, the status quo is unacceptable. Everybody appreciates that. We believe strongly that there ought to be appropriate reforms. We need to keep what's good in the current system and fix what's flawed.

And the way to do that is to make certain that everybody is able to have health insurance, that that insurance is portable, they can take it with them if they change their job or they lose their job, and that medical decisions stay with doctors and patients. There's a way to do that in a responsible way, doesn't require increasing taxes one bit at all. I'm chair of the Republican...


JOHNSON: I'd like to know that way.

KING: Let me move on. Senator Barrasso -- let me let Senator Barrasso have the last word. You are from what they call in Washington the world's most deliberative body. Your colleague from Wyoming, Mike Enzi, is in those conversations. And those Republicans in the room are increasingly pessimistic there can be a bipartisan deal. Do you share that pessimism?

BARRASSO: I want to work together with all people. My wife is a breast cancer survivor. Mike Enzi's wife is a colon cancer survivor. We know about pre-existing conditions; we know about the need to reform. I know it from the standpoint of being a doctor, as well as, you know, from -- from at home with my wife. We've seen all the different sides of this. We need health care reform. It affects one-sixth of our economy. It matters to everybody in this country. We can do a much better job. We don't need a government takeover of health care, and we can do it without spending this incredible amount of money that we right now as a nation cannot afford.

KING: We will have all of you back, because we appreciate your unique insights. We're out of time at the moment. But, Congresswoman Bernice Johnson, Congressman Price, Senator Barrasso, thank you so much for coming in today, and we will welcome you back on another day.

PRICE: Thank you, John.

KING: And don't forget, coming up right here at 1:00 p.m. Eastern, "Fareed Zakaria: GPS." This week, Fareed speaks with the Israeli ambassador to the United States, Michael Oren.


FAREED ZAKARIA, CNN: John Bolton has recently said that he believes that Israel is likely to attack Iran by the end of this year. Is that true?

MICHAEL OREN, ISRAEL'S AMBASSADOR TO U.S.: I don't think it's true. I think that we are far from even contemplating such things right now. The government of Israel has supported President Obama in his approach to Iran.


KING: Stay tuned for "Fareed Zakaria: GPS" coming up at the top of the hour only here on CNN.

He's a key player in the health care reform battle. Conservative Blue Dog Democratic Congressman Mike Ross of Arkansas gets "The Last Word," next.


KING: 33 newsmakers, analysts and reporters were out on the Sunday shows this morning, but only one gets "The Last Word," and that honor this day goes to Congressman Mike Ross of Arkansas. He joins us from Little Rock.

Congressman, thank you for joining us.

You are among the conservative Blue Dog Democrats. Among the things you have raised questions about is this so-called public option to compete with private insurance plans. The secretary of health and human services, Kathleen Sebelius, was here earlier today. She said she -- the president will insist on competition and choice in any final health care bill, but not necessarily a robust public option. Let's listen.

(BEGIN VIDEO CLIP) SEBELIUS: I'm convinced at the end of the day the plan will have both of those, but that is not the essential element.


KING: Not the essential element, a robust public option. I assume that is good news from a conservative Democratic standpoint, but when you come back from Washington, do you think you and the president can sell that to Speaker Pelosi and more liberal Democrats?

ROSS: Well, John, I think at the end of the day, there is going to be some common ground here. The reality is that it takes 60 percent to get this done in the Senate. It's probably going to have to be bipartisan in the Senate, which I think it should be, and -- so I know a lot of members in my party in the House don't want to hear this, but the reality is that what comes out of that conference report, which is what really matters, my guess is about 90 percent of it will be reflected from what's in the Senate Finance Committee bill.

KING: I've moved over to our magic wall, because I want to highlight -- I want to boom in on your state down here, Little Rock, Arkansas, a state I got to know very well during the Clinton presidency. You're out here in the Fourth District, and you're a member, as we said, of the Blue Dog coalition. 52 members in your coalition from 29 states, and the significant part is, 32 of those members represent a district that John McCain won in 2008. So you're dealing with more conservative voters where you are from, and at one of your recent town halls, there was actually a young man -- not quite ready to vote, I don't believe -- who got up and raised one of the big concerns about this bill, and that is spending.


(UNKNOWN): Mr. Ross, I want the same opportunity that you had. Please do not -- don't load me up with debt that I can't pay.



KING: Now, you voted in committee to keep the process moving, to get the House bill moving along, to keep it moving after you got some concessions. If that bill were on the full House floor tomorrow, based on everything you have heard back home, including the concern there about deficit spending, would you vote yes or do you need additional changes?

ROSS: Well, I think -- I think we'd probably need to see a few more changes, too.

Let me say this, that I'm glad to see all people, young and old, starting to talk about the debt. I've been talking about the debt for nine years. Let's not forget here, it took George Washington to Bill Clinton to put this country $5 trillion in debt. It took the last president to double it. And so, I'm one of those that have said, one of my key principles is I will not support a health care reform bill that is not deficit-neutral, period.

KING: Not deficit-neutral, period. As you know, the president is not on the ballot next year, but all of you Blue Dog Democrats in the House are on the ballot, and the Republican National Committee is already after you on the radio, sir. I want you to listen to a snippet from this radio ad attacking you for voting to keep the process moving.


COMIC VOICE: He folded like a lawn chair.


COMIC VOICE: He threw in the towel.

ANNOUNCER: Mike Ross did exactly what Nancy Pelosi wanted him to do.

COMIC VOICE: He caved in, he buckled.

ANNOUNCER: Mike Ross was one of just four congressmen who cast the deciding votes to advance Nancy Pelosi's radical big government health care plan. Ross backed a plan that will cost taxpayers billions, just days after talking like he wouldn't.

(END VIDEO CLIP) KING: Such an important policy question facing the country right now, Congressman, but also a very dicey political environment. Can you vote for anything along the lines of what is right now before the House of Representatives and survive next year?

ROSS: John, first, I've got a response ad that I'm running to that ad, and I hope at some point you all will play just as many seconds of it.

I read the newspaper this morning. $57 million has been spent in the last six months, most of it in the last 45 days, trying to scare folks. I saw an ad the other night on TV. It scared the living daylights out of me. But I went back and watched it again. It used the word "could" six times in 60 seconds.

I've laid out -- I've now done 37 town hall meetings on health care reform since April. I'm doing telephone town hall meetings. I'm doing roundtable discussions at hospitals, where we bring in small- business owners, the self-employed, the uninsured, doctors, hospital administrators, and we're listening to them.

I can tell you, I've laid down my set of principles, so I will not force government-run health care on anyone. If there ever is government-run health care, the first ones to sign up should be the president and every member of Congress, including myself. You should be able to keep the insurance you've got today, if you like it, and always choose your own doctor. No federal funding for illegal immigrants or for abortion, and no rationing of health care. I will never vote for a bill to kill old people, period. KING: Congressman Ross, we appreciate your time today. I want you back here in the studio when you have more time, and I'll make you this promise right now -- we ran the ad against you; we'll run the ad, your response ad to it. We'll also put a link up to it on our Web site. We believe right here -- we've tried to have a town hall environment today. We'll let the people decide.

We appreciate your time. Again, I love your city there of Little Rock, and we'll see you soon right back here.

ROSS: John, it's good to be with you. Thanks for having me on.

KING: Thank you, sir.

Next our "American Dispatch" from South Dakota, Cheyenne River Indian reservation, where staggering poverty exists in stark contrast to a breathtaking and beautiful landscape. Stay with us.


KING: As you know, we're making our mission to get out of Washington every week, to look up close at how the decisions made here impact the communities where you live. "American Dispatch" is what we call it, perhaps this week's should be called "First Americans Dispatch." We traveled out here to the western South Dakota prairie where people whose ties to the land predate the colonies or any talk of the United States of America.

We met a proud people out here who struggle to live in the Cheyenne Indian reservation. The unemployment rate in South Dakota, 5.1 percent. On the Cheyenne River Reservation, a staggering 87 percent. Statewide, 13 percent live below the poverty line, on the reservation, 93 percent. And about 8.3 percent of South Dakota's population are Native American.

We want you to listen closely now as we visit the reservation and meet a man and a people who say they don't need much but often feel forgotten.


KING (voice-over): The August sun is scorching, but Herbert Hale is busy pulling weeds, carefully.

HERBERT HALE, LAKOTA TRIBE: I have to be careful, sometimes there are some snakes around here, rattlesnakes. Nothing to mess around with.

Yes, put them on a pile for them to dry. Put them in a box, crumble them up, start a fire.

KING: Start a fire in here, his one-room cabin on a western South Dakota hillside.

(on camera): Tell me about your home. HALE: It's slowly falling apart. That place is rotting right there and I've got to place a new one in it. It leaks to the floor, I've got to fix.

KING: No running water and no electricity. A rickety steel cot and a rusting wood-burning stove, all the comforts Herbert Hale says he needs. HALE: All I need is logs, glue, dirt and water, put it together, then cement, chicken string. And as long as the windows don't break, it will be nice and warm.

KING: Herbert is 54 years old, an Army Vietnam combat veteran and part of two stunning statistics here on the Cheyenne River Reservation. Unemployment runs above 80 percent. And in Ziebach County, the nation's poorest, nearly six in 10 live in poverty, among children the poverty rate eclipses 70 percent.

Herbert last held a steady job as a firefighter back in the early 1980s. His back gave out. And then worse...

HALE: Cancer caught up to me. I have a brain tumor.

KING: There are no jobs here in tiny Cherry Creek, not even a gas station or general store. So nearly every day he heads to Eagle Butte looking for odd jobs.

HALE: Take the trash out, they put it in back. I sleep in the front.

KING (on camera): And how much can you make in a day doing that?

HALE: Oh, I don't know, probably tops is 20.

KING (voice-over): Twenty dollars tops. A man who doesn't own a car looking for work in a town 40 miles from home. Fellow tribal members call him "Walking Herbert Hale."

HALE: Somebody on wheels will pick me up.

KING: Often that somebody is Bryce in the Woods, a Lakota Indian and tribal council member whose district includes Cherry Creek and who thinks most of the politicians in far-away Washington don't understand places and people like this.

BRYCE IN THE WOODS, LAKOTA TRIBAL COUNCIL: I think there's a stereotype out there that all tribes have casinos. And that's not true.

KING: This is one source of hope, a tutoring center where Lakota can study and then take their high school equivalency exam.

BRYCE IN THE WOODS: You know, we have all of the negativity, but there's still a way that we can bring that respect back into the family and stop being punished, stop being stereotyped.

KING: In the fight against systemic poverty, Bryce in the Woods says the tribe must first help itself. He backs land reforms he said would better spread grazing proceeds among all Lakota. As he and others suggest, tribal factions and rivalries, easy to see at council meetings, often slow progress.

This medical center is being built with stimulus funds, and nearly 70 Lakota are benefiting from construction-related jobs. This was the first tribe to endorse candidate Obama, and now that there's a President Obama, elected Tribal Chairman Joseph Brings Plenty is among those who believes the Lakota have yet to receive their fair share.

CHAIRMAN JOSEPH BRINGS PLENTY, LAKOTA TRIBE COUNCIL: At this point very appreciative to what we have received. But as far as expectation, I can say, no, I feel that we are forgotten because we don't have that voice out there.

KING: To visit is to hear both of historical grievances and immediate needs: more jobs, better schools, help with the severe water shortage. No one answer, but a striking, startling contrast of chronic poverty surrounded by land that is so rich and so breathtaking.


KING: Truly a beautiful place. but struggling at the moment. This quick footnote. Every week we write about our travels on Often our dispatches strike a chord. This week, Citizens for Financial Justice, a non-profit organization that helps military veterans, wanted to help Herbert Hale. And through Harr Motors in Aberdeen, South Dakota, is working now to donate a car to help Herbert get around. A reason to smile this Sunday.

We've traveled from South Dakota to Florida and many states in between. Where should we go next? You can e-mail us to, tell us why we should come to your community.

I want to say good bye now to our international audience for this hour. But we'll be here again next Sunday and every Sunday at 9:00 a.m. Eastern for the first and last word in Sunday talk, until then, I'm John King in Washington, please take care.

For our international viewers, "AFRICAN VOICES" is next. For everyone else, "FAREED ZAKARIA: GPS" starts right now.