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State of the Union

Interview with Democratic Senators Amy Klobachur and Ben Nelson; Interview with Governor Tim Pawlenty; Interview with CDC Director Dr. Thomas Frieden; Congressman Keith Ellison Gets "The Last Word"; The Health Care Co-Op

Aired September 06, 2009 - 20:00   ET



JOHN KING, HOST: A dairy farmer who relies on cooperatives for feed, seed and now his health care, says reform doesn't have to mean more government spending.

And the congressman leading the fight for a public health care option. Minnesota Democrat Keith Ellison gets "The Last Word."

This is the STATE OF THE UNION for Sunday, September 6th.


KING: Labor Day weekend means more than the final days of the Minnesota State Fair and summer vacation. Congress is coming back from an August break, defined by feisty health care town halls, and President Obama faces a decisive test.

Support for his reform ideas is slipping, and the president is betting on a speech Wednesday to a joint session of Congress to reframe the health care fight more to his liking.

Mr. Obama's biggest challenge is bridging differences in his own Democratic Party over how much the government can afford, how best to reduce the costs, and whether there must be a so-called public or government-run insurance option. As the president is fond of saying, if it were easy, someone would have already done it.

But what must he do now? We begin with two Democratic senators who want big changes, but don't always see eye to eye. Minnesota's Amy Klobuchar is here with me at the state fair, and Ben Nelson of Nebraska joins us from Omaha.

Senator Klobuchar, let me start with you. A big speech from the president. What is the one thing you need to hear from him to convince you he has the momentum and the initiative back?

SEN. AMY KLOBUCHAR (D), MINNESOTA: I believe, after spending many days here at the state fair, the Minnesota State Fair, the mother of all town hall meetings, people everywhere wanting to talk to you. People really want to see a focus on affordability and cost.

That seems to me what brings people together across party lines and emphasis on how can we make this more affordable. They realized, and I think times have changed over August, things have calmed a tinny bit, and people have started to step back and say, you know what? I know that my premiums have doubled in the last 10 years, and I have every reason to believe they're going to double again and that's what the numbers show.

If you're a senior, going to be a senior by 2017, Medicare is going in the red. So this focus on costs, accountability, on doing something, getting something done, that's what I'd like him to talk about.

KING: And Senator Nelson, the White House says the president will be more specific. You know the big flashpoints in this debate. What is the one specific where you think the president needs to say, this is the way I need it to be? I'm the president of the United States. This is what we're going to do?

SEN. BEN NELSON (D), NEBRASKA: Well, I think he has to say if there's going to be a public option, it has to be subject to a trigger. In other words, if somehow the private market doesn't respond the way that it's supposed to, then it would trigger a public option or a government-run option, but only as a fail/safe backstop to the process.

And when I say trigger, you know, out here in Nebraska, in the Midwest, I don't mean a hair trigger. I mean a true trigger, one that would only apply if there isn't the kind of competition in the business that we believe there would be.

KING: Are you ready to accept that, Senator Klobuchar, a three, maybe a five-year period where you see if the private market responds, and then a public option would kick in only if you don't get more access, more affordability, more competition?

KLOBUCHAR: You know, I'd want to see what those triggers are, what the benchmarks are. Because when I get around our state, talk to, like, a small business, a backpack company up in Two Harbors, a guy there owns a company, $24,000 a year he's paying for his family of four, and he says he wouldn't even started the company 15 years ago if he knew that.

So what I want to see is something where small businesses, self- employed, small businesses are paying 20 percent more than people who work at big corporations, that they have a chance to buy into something. And certainly it's worth looking at, but we have to push competition. We have to do a better job of putting some rules on the insurance companies.

I got involved in this when I got kicked out of the hospital when my daughter was born. She was incredibly sick, couldn't swallow, and I got kicked out in 24 hours. And I went to the legislature with other moms and got one of the first state laws passed guaranteeing new moms and their babies a 48-hour hospital stay.

KING: In the Senate, Senator Nelson, Max Baucus, the chairman of the Finance Committee, has been trying for months to come up with a bipartisan approach. He has been calling moderate and conservative Democrats. I understand you're one of the Democrats he has called recently.

Has he convinced you that he has a plan that not only can pass the Senate but pass the Senate with bipartisan support?

NELSON: Well, I -- no, he doesn't have a consensus at this point in time. I think he still remains optimistic, and is going to wait and see what the president has to say Wednesday night. That might break the logjam and bring some Republicans on.

I know that Senator Grassley seems to be concerned that only three Republicans is not bipartisan enough for him. So perhaps with the right combination of ideas and a trigger and things like that, others might join in the process.

KING: Is that enough for you? The question is, do you do this with 55 or 60, and maybe should the president slow down, or do you do this with 50 and the Democrats use their muscle, 50, 51 votes and go through?

KLOBUCHAR: You know, I would like to see us at 60. I would like to see some bipartisan support for this bill.

KING: Is there any possibility of that?

KLOBUCHAR: I do. Olympia Snowe is still hanging in there. She understands how important this issue is for the people of Maine. You see some of the Republican senators coming back, like Senator Corker, saying we hope we can find some common ground. So I do think that it is a possibility.

The problem with going down to 50 is we just have more limited tools in terms of getting the kind of work that needs to get done to help people.

NELSON: I was going to say...

KING: Please, jump in, sir.

NELSON: If I might add one thing about that 50 votes, that reconciliation process, people in Nebraska are already concerned that we've been rushing things through, and if we went to some sort of a parliamentary shortcut, I think they would be even more alarmed than they are right now. That's what I heard during the town hall meetings.

KING: I want to show you both some things I picked up here at the state fair. These are from the Republican Party here. You have a button here that says, "Change? I'd like mine back." This one, "Hands off my health care."

To oppose something is pretty easy. To sell something hard is much more difficult. As the president goes before the Congress Wednesday night, Senator Klobuchar, to you first, does he have a policy problem or a marketing problem?

KLOBUCHAR: First of all, I think it's a great opportunity as I look at the pot roast booths behind you for him to put the meat on the bones, to really give the American people some details.

Because when I look back at this debate, I think one of the issues was when it first came up, it came out as, oh, here's the big plan, you could get this, you could get this, you could get that.

And Americans, still struggling with the economy, understandably, looking at some of the debt and deficits that we're facing said, wait a minute. So I think it's very important that the president steps back and says, we have a problem here.

KING: You were a governor before you came to the Senate. President Obama was a senator before he became the chief executive. Do you have any advice for him, anything he has done in this health care debate so far that you think, Mr. President, you got that one wrong, here's a bit of advice for you?

NELSON: Well, I don't know if it was gotten wrong, but I think they have an opportunity to grab the message now and perfect the message. I think if there's anything that has misinformed the American people, it's the message that didn't outline what the insured public will gain from this.

In other words, it was inadequate in explaining to them that the costs are out of control, and that if the costs continue, as Amy has said, to go at the rate they have, then it becomes unsustainable for all of us to be able to cover ourselves with the rising health care costs.

So I think that's the message, to tell people who currently have coverage what's in it for them. What I found during the town halls is people wanted us to do nothing because they're afraid whatever we did, they'd be worse off.

They couldn't understand how they'd be better off. They were worried that something would be taken from them to be given to someone else. And you can't really straighten that out unless the message improves on how cost containment, wellness programs, prevention, all the things that can be done, will benefit them in the short term, but particularly in the long term.

KING: All right. We'll have more with Senators Nelson and Klobuchar in just a moment. We'll ask them whether more U.S. troops in Afghanistan is the answer and whether the government is ready for a potential H1N1 flu pandemic. Stay with us.


KING: The AARP booth here at the Minnesota State Fair, taking a kernel poll. There is the Republican booth there, "Waiting in Line for Obamacare." Health care a big issue here at the Minnesota State Fair, and we're back with Senator Amy Klobuchar and with us from Nebraska is Senator Ben Nelson, two Democrats.

I want to move to another issue, because also an issue here at the fair is the H1N1 flu virus. There have been some 4-H students who were sent home from here because they had confirmed cases, others suspected. To you, Senator Klobuchar, first. Are you confident that the administration has a plan in place to deal with this as America goes back to school?

KLOBUCHAR: They do have a plan, but everyone knows that there is going to be challenges. And I think they've been very good about getting out front on those challenges. The fact that the regular flu vaccine is more targeted to seniors and others. The fact that the new H1N1 vaccine really has to go first to kids and to pregnant women.

So those -- I talked to some of our health officials in smaller counties, with their education challenges ahead, but I think the administration has made that very clear and has been clear in their message so that the minute that vaccine comes out, people are starting to understand who gets it first. And they're really pushing the regular flu vaccine right now, which I think is also smart.

KING: And, Governor Nelson, from your perspective in a rural state -- and we should note to our viewers you're holding a telephone up because we're having some issues with your audio, if they haven't figured that out already.

Does it concern you that this vaccine won't be ready until mid-October at the earliest, and we're already seeing an uptick in cases across the country?

NELSON: Well, obviously, you'd like to have it in advance, but it's a major challenge to get the plan put in place because we're not really certain what's going to happen. These flu viruses change as they go along. What was happening in the spring, not happening the same in the fall.

But I think the administration is taking the right steps. I think we'll be in a position to do everything that we can do. But obviously everyone would have liked to have seen it just a little bit earlier.

KING: And, Senator Nelson, let me stick with you on this point. Another difficult issue facing the president is the question, after already having sent more troops into Afghanistan, his commanding general there believes he needs still more.

Do you believe that more troops should go to Afghanistan and do you believe that the president has a clear mission and an exit strategy?

NELSON: Well, I don't know about the mission and the exit strategy, but we are going to have the benchmarks that I've been pushing for some time as part of the Armed Services Committee. We're going to have those available rather shortly, because we do have to know what the mission is.

We have to be able to measure our progress, or lack of progress towards that mission, and we have to determine what it is that we're trying to do with the Taliban, and make the country not another platform for the al Qaeda staging platform for their goals, which are detrimental to the rest of the world.

So these benchmarks I think will be very helpful in understanding what we need to do and how we're doing, trying to get that.

Now, Admiral Mullen is coming in to see me this week and you can only imagine what my first question is, why do we need more troops, and how do those troops fit in with the benchmarks that are about to come out.

KING: And so, Senator Klobuchar, here at the state fair and in your travels, do the American people want more troops sent to Afghanistan? Do they think it's worth it?

KLOBUCHAR: Well, our focus right here in this state is of so many National Guard and Reserve, Minnesotans serving over there. We've lost a number of brave soldiers just in the last month, so they understand the challenges.

At the same time they know that it has been a mess there for a long time. The previous administration was so singularly focused on Iraq that I think things were left to decay in Afghanistan.

So the president is really changing that policy with a new general, General McChrystal. And I think we need to give him a chance to do his work.

You've got a country where people are throwing acid in faces of little girls when they go to school, where they're trying to hold on to having a democratic election clearly with some problems.

And I think it's very important that we give General McChrystal a chance to change strategy there.

KING: Let's step back in closing. We have a minute -- a little more than a minute left. I want you to both assess the political moment more broadly. And I want to start by looking at the president's handling of big issues, because his poll numbers have dropped dramatically.

If you ask the American people, do you approve of how the president is handling the economy, only 49 percent say yes. Health care down to 44 percent. The budget deficit, 36 percent.

And having -- looking at these numbers, you have Charlie Cook, who is a noted public pollster and campaign watcher, writes this: "Wave elections, more often than not, start just like this. The president's ratings plummet, his party loses its advantage on the generic congressional ballot test, the intensity of opposition party vote skyrockets, his own party's voters become complacent or even depressed, and independent voters move lopsidedly away. These were the early warning signs of past wave elections. Seeing them now should terrify Democrats."

Senator Klobuchar, heading into 2010, are you terrified?

KLOBUCHAR: No, because, first of all, there is quite a bit of time before 2010. And what this president has said is, he's not going to put his head in the sand. These are major issues that have been left dormant, where no one has done one thing. These health premiums going up, doubling in just 10 years, and he's taking on major issues. KING: Quickly on that point, should the Democrats be worried about what's going to happen next year?

NELSON: Well, with leadership goes responsibility. And the president is stepping up to the -- this effort. I think there's no question about it.

The economy is changing. I think it's improving. We're not talking about the "D" word, "depression," any longer. We're talking about and debating whether we're coming out of the recession.

Everyone is still concerned about unemployment numbers, but we understand they tend to lag. When you look at health care, I think he's taking on a very difficult issue, trying to work with Congress, both houses, both parties, to find a solution.

And when it comes to the war, that's a -- that's a carryover from the last administration. I think he's trying to do everything he can there.

KING: All right, Senator Nelson in Omaha, we thank you, sir, especially for dealing with the difficulties.

And, Senator Klobuchar, before we let you go, our next guest is your governor, Tim Pawlenty, here at the state fair. Here's one thing the Republicans are giving out.

KLOBUCHAR: Very nice.

KING: Thank you, Governor Pawlenty...

KLOBUCHAR: Oh, I'm sure he'll want me to wear that.

KING: I'm sure he would like you to wear that.

KLOBUCHAR: Let me tell you this. I have for you chocolate covered bacon, one of our fair delicacies. I'd like you to eat it on the air.

KING: I'm not going to eat it on the air.


I can assure you I'm not going to eat it on the air.


But this is one of the many things we have here -- at least this is not on a stick -- chocolate covered bacon, at the Minnesota State Fair, an argument for health care reform in its own right, right there.

Senator Amy Klobuchar...

KLOBUCHAR: Thank you for visiting. We really appreciate it.

KING: ... thank you so much for being here. And up next, the Republican view on health care and other big issues from a governor many see as angling for the chance to evict Mr. Obama from the White House, Minnesota Governor Tim Pawlenty, right here when STATE OF THE UNION returns.



GOV. TIM PAWLENTY (R), MINNESOTA: We don't need a president who can just read a poll or momentarily thrill a crowd. We don't need rhetoric or empty promises. We need a president who has the integrity and the courage to make the tough choices so America will be stronger and safer.


KING: That's Minnesota's governor, Tim Pawlenty, addressing the Republican National Convention, right here in Minneapolis, St. Paul, exactly one year ago.

Democrat Obama won the election, of course, including a comfortable win right here in Minnesota. But that hasn't stopped the governor from taking issue. And Mr. Pawlenty joins us now at the Minnesota State Fair.

It's good to see you.

PAWLENTY: Good to see you, John.

KING: Big speech from the president Wednesday night. You have been harshly critical of him and his approach throughout the health care debate. Give me one thing that the president could say where you would say, "OK, he's serious about reaching out. Let's turn off the rhetoric machine and try to do business"?

PAWLENTY: Well, one thing he could do -- Harvard University recently came out with a study that said that 30 percent of all the health care in the United States of America is medically unnecessary. And one of the driving reasons why that's being the case is a fear of medical malpractice lawsuits.

Everyone in this debate realizes we've got overbaking of the costs because of medical malpractice concerns. So he could take on one of his constituencies, which is the trial lawyers, and say, "You know what? We need to come together on this issue." Republicans would embrace that as one example.

KING: If he were to do something like that, would you embrace a backup public option, if they went to the trigger approach, that we create a public option but it only kicks in if three years or five years, they'd set a deadline, if the insurance market isn't for competitive, if there isn't more access, there isn't more affordability?

PAWLENTY: There's lots of things we could agree to on a bipartisan basis, John. The public option isn't one of them. The trigger option simply kicks the can down the road. All it does is delays the inevitable, and for a lot of reasons, it's a bad idea.

I think, if the Democrats embrace the public option, even in the form of the trigger, they're going to shoot themselves in the foot.

KING: What about a thing you see quite frequently out here, including in your state and throughout farm country, is a co-op. If they came up with a co-op approach instead of a public option, could you help them there and support them?

PAWLENTY: Well, Minnesota is actually a state that has elements of a co-op approach. And many, many years ago, people decided, in this state, we're going to have only nonprofit health care providers.

And while it has helped, a little bit, at the margins, it hasn't solved the problem. It's helped, a little bit, at the margins only in some cases.

So to say that that is the solution, I think, defies what we know about most of the experience with co-ops already. It hasn't substantially altered the trajectory of health care costs.

KING: Let me move on to another issue, another big issue on the president's plate, where, in Congress, he's largely getting more Republican support than Democratic support, and that's Afghanistan.

George Will, a very influential conservative columnist, wrote this earlier in the week, "Forces should be substantially reduced to serve a comprehensively revised policy. America should do only what can be done from offshore, using intelligence, drones, cruise missiles, air strikes, and small potent special forces units concentrating on the porous 1,500-mile border with Pakistan, a nation that actually matters."

Is it time for the United States to pull almost all of its troops from Afghanistan?

PAWLENTY: No. And I recently returned from my fourth trip to Iraq and my second trip to Afghanistan. The administration has defined the mission in Afghanistan as to disrupt and destroy the Taliban and al Qaeda and other terrorist forces that represent a threat to the national security interests of the United States.

We need to make sure that mission is successful. And the rule needs to be, when the United States goes to war, the United States wins, and so we need to make sure we do those things to complete that mission successfully, and that includes putting more troops into Afghanistan if needed.

KING: Let me ask you a broader question, your convention was here a year ago. We just showed a snippet of your speech. Barack Obama won 53 percent of the vote nationally. He turned nine red states blue. Nine states George W. Bush had won four years previously, Barack Obama changed. As we have this conversation a year after the convention and eight months almost since Barack Obama took office, has the Republican Party taken the right steps, in your view, to repair its relationship with the American people or at the moment are you just benefiting from doubts about him?

PAWLENTY: Some of both. I mean, our strategy can't be, we hope the other side kicks it in the dugout. Now he has inherited a tough situation, but he's, I think, taken the country in a direction that is a kind of movement liberal. And the country is a center, center-right country.

But the Republicans have to articulate a vision beyond just being critics-in-chief. We also have to have our own ideas and solutions and I'm trying offer that as well.

KING: He is supposed to speak to schoolchildren on Tuesday, I believe, and it has caused quite a stir on conservative talk radio, saying the president is trying to indoctrinate our school children. Should the president speak to schoolchildren?

PAWLENTY: Well, this isn't the most important issue facing our nation, but I agree with the Minnesota Association of School Administrators, which is a nonpartisan organization. They say, look, it's the first day of school, people are trying to find their classes. There is lots of issues on the first day of school.

It's disruptive. And so they're encouraging Minnesota school districts not to participate.

KING: Just the day is disruptive or the president under any circumstances speaking to the school?

PAWLENTY: Well, I think there's concerns about the disruption. There is also concerns about, is this going to be done in an appropriate manner? I trust and hope that the White House will have a content that is not political and they're not using the public school infrastructure for that purpose.

But I think the main concern in Minnesota has been that it's disruptive to the school day. And in the era of YouTube, if somebody wants to hear a message from the president, they can go get it, it doesn't have to be visited upon them, you know, one moment on the first day of school.

KING: If we look at your schedule, you decided not to run for re- election. You're still the governor of Minnesota. But if we look at your schedule in recent months, you've been a very busy man.

I'm going to rattle off some of the states just since June: Washington, D.C., not quite a state, but a travel there; Chapel Hill, North Carolina; Little Rock, Arkansas; Aspen, Colorado; San Diego, California; Chicago, Illinois; I'm not sure I'm pronouncing this right, but Guaynabo, Puerto Rico; Orlando, Florida; Bergen County, New Jersey. I could look at that, especially North Carolina, California, Illinois, Florida, New Jersey, I would say, Tim Pawlenty is running for president.

PAWLENTY: Well, Tim Pawlenty became a leader, along with Haley Barbour, of the Republican Governors Association, so part of my responsibility as vice chair -- Haley is the chair -- is to travel the country, when appropriate, as time allows, to help Republican candidates for governor get elected or reelected.

So that's part of it. And then as time allows, I'm going to speak to issues that I think my party needs to improve on both here in Minnesota and nationally.

KING: That was a careful answer. But let me ask you something else. I want to go back in time, again, to that convention a year ago. We spent some time before we knew who Senator McCain's choice would be for a running mate. And Dan Balz and Haynes Johnson of "The Washington Post" have written a great book looking back at the 2008 campaign.

And they write this: "At that point there seemed to be only two realistic finalists, Pawlenty and Palin. Though not particularly flashy, Pawlenty was seen as a more than credible choice, a running mate who might keep the Upper Midwest competitive. He was the safe choice if Palin faltered."

In hindsight, Senator McCain make the wrong choice?

PAWLENTY: Well, I'm a huge fan of Senator McCain. I think he made the choice he felt was right for not only his ticket but for the country in the circumstances of the time. Governor Palin, I think, was a remarkable leader for Alaska. She's a friend. I don't view her as somebody who is, you know, a competitor for anything. I view her as a teammate.

KING: You don't view her as a competitor for anything?

PAWLENTY: I view her as a friend. And I think she is somebody who, you know, has been a remarkable leader under difficult circumstances in Alaska. I don't know what the future holds for her, but I think Senator McCain made a choice that was out of the box, and he's sometimes an out-of-the-box leader. Sometimes you need that.

KING: Do you think he made a mistake?

PAWLENTY: No, I don't think he made a mistake.

KING: Governor Tim Pawlenty, we thank you for joining us here. We should note Republicans know that the governor is not seeking reelection. They're handing out these buttons. "Thank you, Governor Pawlenty." Pretty interesting (INAUDIBLE) right there.

PAWLENTY: And before you go, John, I want to show you this bacon- flavored lip balm...

KING: Bacon-flavored lip balm.

PAWLENTY: ... and even after the bacon is eaten, the flavor endures. So maybe you can bring that back to Washington, D.C., and as you talk about pork, you can get a little lasting flavor there on your lips.

KING: There we go. Anyone who puts pork barrel spending in, gets some bacon balm? Is that how it works?

PAWLENTY: Available here at the Minnesota State Fair, that's right.


KING: Governor Tim Pawlenty, thank you very much.

PAWLENTY: All right.

KING: Now much of the nation, as we noted, is already back to school with the rest to follow in the week ahead. And parents coast- to- coast are asking the same question, are my children safe from the H1N1 flu virus?

Up next, the director of the Centers for Disease Control tells us why it's taking so long to get a vaccine and what you can do in the meantime.


KING: The 4-H Musical is a big tradition here at the Minnesota State Fair, but is suddenly off the schedule because of this year's biggest public health concern. More than 100 4-H students were sent home from the fair this past week because four were diagnosed with the H1N1 flu virus, and a dozen others complained of flu-like symptoms.

It is a challenge facing school districts and employers across the country and the world. And the early flu numbers have some worrying about a major pandemic.

So is the Obama administration ready?

Before we headed out here to the state fair, we spoke with the director of the Centers for Disease Control and Prevention, Dr. Thomas Frieden.


KING: Dr. Frieden, thank you for joining us. Let me just start with your threshold. Much of the nation is back to school. The rest will be heading back to school in the week ahead.

Based on what you've seen so far, what is your expectation for the number of cases in the United States and the number of deaths we are looking for as we address the H1N1?

DR. THOMAS FRIEDEN, DIR., CENTER FOR DISEASE CONTROL & PREVENTION: Only the future will tell what the future brings. What we do know is that with schools back in session, particularly in the southeast of the U.S. but also in many parts of the country, we're seeing a fair amount of influenza and that's very unusual for this time of the year.

KING: If it's a fair amount, I'm going to get up and go over to our wall. As you say, if it's a fair amount already, sir, now we have a heat map here that shows some of the cases here. The brighter the state, the higher number of cases.

If it's a fair amount already in September and generally it's mid- October or a bit later in the season, what does that tell you? Does that make you more worried?

FRIEDEN: We generally expect that flu will continue to go up after it starts, but this is really something we haven't seen before. It's very unusual to see flu continue to occur over the summer. It's very unusual to see it start to increase this rapidly in August and September.

So only time will tell what the future holds. We do know that two things are essential. One is to intensively monitor so we understand what's happening, where flu is occurring and whether it becomes more deadly and so far, it hasn't.

And second, to be ready to adapt, to be ready to change when things develop. But the fact that flu is here now means that we need to do things now, to address it. That means, on the one hand, simple things, like not going to school or work if you have a fever, covering your cough and sneeze, and washing your hands frequently, and for people who are sick, there are special measures as well which we can get into.

KING: We will get into those. I want to first pop in, Wisconsin is one of the states with the highest incidence of cases so far. And I wanted to pull up this from the President's Council of Advisers on Science and Technology.

Now this has many Americans alarmed, that report to the president said 30 to 50 percent of the U.S. population this fall and winter could become infected, 30,000 to 90,000 deaths possible in the United States, concentrated among children and young adults. And perhaps as many as 1.8 million hospital admissions because of H1N1.

Are you in sync with these numbers, sir, or do you think that is too alarming a presentation?

FRIEDEN: What the President's Council reported and what we completely agree with is that there are a range of scenarios and it's really important that we prepare for scenarios that are severe, and they outline one such scenario and we are in fact preparing for that.

KING: Let me ask you a bit more then. Let me just show the high risk chart then. People 65 and older, children under 5, pregnant women, people with chronic medical conditions and people taking immune- suppressing medications.

For people on this list, should they be doing something different than the everyday population? FRIEDEN: Yes. If you're at higher risk of having influenza or more importantly of getting severely ill, if you get it, then you need to do a couple of things. First is, if flu is in your community, and you develop a fever, see your doctor right away. Treatment within the first 48 hours makes a big difference. And when vaccine becomes available, get vaccinated.

KING: Well, you mentioned when vaccine becomes available. That's one of the questions people have in the sense that this first surfaced in the spring. They're being told now by the government the vaccine should be ready, should be ready sometime mid-October. Why does it take so long?

FRIEDEN: We wish we had more modern methods of making vaccine, quicker methods of making vaccine. We wish we could turn on a dime and make vaccine to a new strain. The fact is that growing vaccine currently, growing the virus up, growing it then in eggs, a time- honored way of making flu vaccine, which we're confident in the safety and efficacy of, that takes nearly six months.

KING: And as you know, many people get very suspicious and anxious when it comes to this. A new vaccine, rushed into production, what do we know about possible site effects and what do you say to a parent out there who says wait a minute, if this is not such a deadly strain, I'm not going to do this, I'm not going to take this risk with my child.

FRIEDEN: Well it's not a new vaccine. This is a flu vaccine that's made in the same way the flu vaccine is made every year, it's a new strain. Every year we add new strains into the flu vaccine. So the way it's being made, the content of it is similar to the flu vaccine that literally hundreds of millions of doses have been given of.

My kids are going to get this vaccine when it becomes available. We have a very high confidence in the safety of influenza vaccination.

KING: Is there anything you need, when you -- now you're in your new job in Atlanta, is there anything when you get on the phone to Washington, saying you know what, I need this now?

FRIEDEN: Well, I think the challenges are really significant. On the one hand, we have a public health infrastructure, health departments at states and localities that have had literally decades of underinvestment.

And on top of that now, fiscal crisis, so we've had layoffs and hiring freezes and furloughs, and these are the individuals, these are the programs which are really essential to our response, and essential to public safety that are going to have to step up and do the vaccination and coordination and treatment, the communication in the coming weeks and months.

And the health care system, which is going to have to deal with an influx of people who are mostly not severely ill but large numbers, but may have to deal with people who are severely ill, in some parts, may have to deal with vaccinating people in large numbers, and our health care system is not well set up to coordinate.

It's not well set up to have an information system that allows us to manage the population's health, wealth and frankly, it's not set up to prioritize prevention, and those are things that make addressing H1N1 more difficult.

KING: And when this vaccine is ready in mid-October, sir, how many doses do you expect to have at your disposal?

FRIEDEN: Each year, we vaccinate about 100 million people for influenza and the current projections are that we'll have 40 to 50 million doses in mid-October or by mid-October. I think although we might wish we had more, it's actually not going to be so easy to get out large numbers and what we're going to try to ensure is that everyone who wants to get vaccinated can be vaccinated but to prioritize those of highest risk.

KING: Dr. Frieden, thank you very much for your time.

FRIEDEN: Thank you.


KING: He says any health care plan must have a public option. And he's not afraid to let the president know it. Democratic congressman Keith Ellison gets "The Last Word" next.


KING: Nineteen newsmakers, analysts and reporters were out on the Sunday morning talk shows, but only one gets "The Last Word." And that honor this Sunday goes to the Democratic Congressman Keith Ellison of Minnesota, here with us at the state fair.

Big speech from the president Wednesday night, a divide in the Democratic Party about whether you have the votes for the public option, whether it's time for the president to say, sorry, we don't have the votes, let's move on. What do you want the president to say?

REP. KEITH ELLISON (D), MINNESOTA: Well, or the opposite, John, he could say, you know what, the public option is essential to reform. He could say that a public option is the only thing that's going to hold insurance premiums down as we've seen them double over the last 10 years.

He could say that a public option with a large provider network is going to help promote better medical practices based on evidence. So I'm hoping that he understands the essentiality of the public option.

A number of us were with on a conference call with him earlier in the week telling him we really do need that public option. And he said he preferred a public option. So we're trying to give him the political backing he needs to get what he prefers, which I think is the right thing.

KING: He prefers it. The question is can he get the votes out of the Senate?

Now I want you to listen to Ben Nelson of Nebraska, a more moderate conservative Democrat who says he could support a public option if it were a backup plan, if it were part of a trigger. Let's listen.


NELSON: Well, I think he has to say that if there's going to be a public option, it has to be subject to a trigger. In other words, if somehow the private market doesn't respond the way that it's supposed to, then it would trigger a public option or a govern-run option but only as a failsafe backstop to the process.


KING: Could you support that, give the insurance companies a chance but have hanging over them the prospect of two, three, four years down the road the public option would then kick in with a trigger? Or is that a copout?

ELLISON: They had 60 years of a chance and we've seen doubling premiums for the 85 percent of Americans who already have employer- based health care. Now it's time for a public option that can really help.

Here's the thing. You know, we have monopolized and oligopolies markets in nearly every major metropolitan area with regard to insurance. How are we going to drive them down? Why do they cost -- charge us more? Because they can.

How are we going to get them down? By introducing three things -- competition, choice, and a competitive price. I don't know how any conservative can be against those three things.

KING: What about the co-op approach? You have them here in Minnesota. We visited one in Wisconsin. Some people say that deals with access and affordability, put some competition in the marketplace, but with less government. Is that a public option?

ELLISON: Well, government is a good thing. I mean, government got me on -- got me to the fair today. I drove on a government road. I went to University of Minnesota, which is a public school.

I mean, you know, come on, government does good for us. Let's stop this ideological commitment to bashing government. The fact is look, a co-op will not give us the strength of a large provider network that we need from the very beginning. If we have a weak little provider network, it is not going to work out.

Minnesota has been building on its co-op for literally decades and so if we're going to have something that is going to be competitive from the beginning, we need a public option and I'd like to see the president fight for it.

We can get it through the House and remember, budget reconciliation requires that we can only -- the Senate only needs 51 percent. So I'm hoping that the president will look at that as a viable option, too.

KING: And what happens if it's not there? If you can't get the votes for a public option in the Senate and the compromise before you in the fall does not have a public option, should progressives say, all right, we tried and vote for that or should progressives say, no, that's not real reform, and walk way?

ELLISON: Progressives should say it's not real reform.

KING: And walk away?

ELLISON: Well, it wouldn't be...

KING: You'd rather not pass half a loaf?

ELLISON: Well, it wouldn't be the progressives not doing the right thing. I mean it would be the insurance industry and people in Congress who are beholden to them stopping reform because at the end of the day, how are we going to give the insurance industry 49 brand new customers, give them this enormous pool, and yet no ability to control costs and to promote good evidence-based medicine?

I think that folks -- we've said that we...

KING: What if the president said, I need this? I know you don't like it. I know it's not enough but I need this. Politically I cannot afford to pass a health care bill, don't walk away?

ELLISON: I'd say he needs to go talk to those people who won't compromise with him and insist there be no public option. He can talk to them as well as he can talk to us. I think that -- you know why should the progressives, why should the liberals always cave?

The fact is those folks who are getting all kinds of campaign donations, and getting lobbied to the tune of $1.4 million a day by the insurance industry, why don't they compromise a little bit?

KING: Let me ask you lastly about Afghanistan. The president will face a recommendation to his commanding general to send even more troops to Afghanistan. Can the progressive wing of the Democratic Party support that more troops in Afghanistan? Or does the president have to do something to win you over?

ELLISON: The president has to win me over with a civilian surge which he promised. Look, we're only about a quarter of the way toward that civilian surge that we talked about last spring.

We need to have a civilian surge because we need to help Afghanistan build institutions that Afghanis are willing to defend. Right now we've got to cut the civilian casualties, we've got to put a premium on protecting civilians, and that way we can start really to get some local community.

KING: You're not sold on the military mission. You agree with George Will? Troops should come out, use drones, use other... ELLISON: I don't like the drones. They're not very smart, because, you know, they shoot at large numbers of people without distinguishing. And then you get these civilian casualties. But I think that we need a civilian surge just like was promised.

We haven't seen that yet. We're already talking about more guns and bombs but where are the people that are going to get some wells and some schools and some roads and some farmers to get their product to market over than poppy?

The fact is this is where we're at. The people need some institution building and we haven't done enough of that yet.

KING: Congressman Keith Ellison, he has "The Last Word" on this Sunday. Sir, we thank you for joining us at the state fair.

And up next, we go east to a dairy farm in neighboring Wisconsin for an up-close look at a subject we were just talking about. It's an old practice when it comes to buying and selling crops: co-ops. Now some say co-ops would be just a new wrinkle for the stalled health care debate. Stay with us.


KING: You see the Minnesota State Fair there. It's a beautiful place. And visit the Republican Party booth here, and there are warnings that a so-called public option on health care reform would lead to a government takeover.

And some Democrats oppose the idea, too, saying there are ways to make the insurance market more competitive without such dramatic government intervention.

Try co-ops instead, many say, citing examples around the country of, over the years, of how those without electricity or telephones or other services banded together to get what they needed at a fair price.

So would the co-op system work for health care?

Critics say the needs are too big, or that what works in rural America can't be copied in the big city. Supporters know here in Minnesota and other farm states think co-ops could solve at least a big chunk of the health care access and affordability problem.

So in our "American Dispatch" this week we wanted to take a closer look. We headed to Minnesota's neighbor, Wisconsin -- Waterloo, Wisconsin, to be exact -- and a dairy farm where co-ops are a big part of the family business.


KING (voice over): Two hundred and eighty cows here; each eats about 100 pounds of feed a day. Three milking cycles, not to mention tending to the corn and other crops. A family farm is a long, hard day's work. With milk prices down, a profit is hard to come by, which makes Bob Topel all the more grateful for his invisible partner.

BOB TOPEL, WISCONSIN DAIRY FARMER: Seed, fuel, fertilizer, feed -- everything we buy is pretty much through a cooperative. We market our milk through a cooperative. If there is any profit made, the profit returns to the owners. And so, the more you use the cooperatives, the more earnings you get back.

Co-ops have been around for over 100 years in agriculture.

KING: And for the past 10 months, Topel has turned to the co-op approach for something far more personal, his health care, joining a 2 1/2-year-old farmers' cooperative he says should be a model as Washington looks for a way to force private insurance companies to compete more for their business.

TOPEL: A lot of farmers who had individual health insurance elsewhere came us to and saw their premiums go down. And -- and the other benefit we saw was there was farmers who didn't come to farmers' health, but by putting an extra layer of competition in the marketplace, their premiums went down just to meet what the farmers' health was putting on.

KING: Competition and choice are the main goals, and co-op fans say their way makes more sense than a new government-run health insurance option.

BILL OEMICHEN, PRESIDENT, THE COOPERATIVE NETWORK: Eighty-five percent of the members of the Farmers' Health Cooperative, for example, reported to us either their premiums fell or they stayed somewhat similar to what they had before.

But as importantly, 65 percent of them said their health benefits actually increased substantially over what they had before. So, where co-ops are, they tend to be very, very high quality because it is the consumer who owns them, that is making sure that their health care provider is a quality health care provider.

KING: In addition to expanding choice and competition, Bill Oemichen of the Cooperative Network says the plans are helping with another big problem.

OEMICHEN: About 12 percent of our members are previously uninsured. So we think we've had a real impact on bringing in producers who previously couldn't get access to health insurance.

KING: Wisconsin has a dozen health care co-ops in all. Some hire doctors directly. Others use their pooled purchasing power to negotiate better rates with private insurers. The plans are widely accepted across the state, including this clinic in Monroe.

UNIDENTIFIED MALE: No numbness or tingling?

KING: Bob Topel knows critics suggest what works in rural areas or small cities might not fit in more diverse suburbs or in urban America, but he's just as skeptical that government has the answer.

TOPEL: To me, just looking at the way the government managed the Clunkers program and managed the -- FEMA and Katrina and all those things, I just -- I don't want to turn my health care over to a government agency and try to get my round peg in a square hole, and if it doesn't fit, I'm caught in some bureaucratic red tape.

With the co-op system, I know the people that I can call and they're going to take care of me because I'm an owner versus just a number.


KING: Our thanks to Bob Topel and his family in Wisconsin and to everybody here at the Minnesota State Fair.

We'll be here again next Sunday and every Sunday at 9:00 a.m. Eastern for the first and last words in Sunday talk. Until then, I'm John King reporting from St. Paul, Minnesota. Take care.