Topics: Politics, Health Reform, Medicaid, States
KHN has convened two discussions to review the politics and policy of health care as the 2012 election nears.
A transcript follows.
MARY AGNES CAREY: Good day and welcome to Health Care Policy & the 2012 Election. While the economy remains the dominant issue this campaign season, health care is another top concern among voters. Today we’ll take a closer look at the presidential candidates’ health care proposals and how those ideas are influencing the race to control the White House and Congress. First, a conversation with well-known policy analysts and then a journalists’ roundtable.
Former Senate Majority Leader Tom Daschle was a key behind-the-scenes player in passage of the health care overhaul law and remains one of its most vocal defenders. Sen. Daschle is now a senior policy advisor at DLA Piper. Avik Roy is a senior fellow at The Manhattan Institute, a conservative think tank, and he writes a health care policy blog for Forbes. He is an outside health care adviser to the Romney campaign. Joining me in the questioning is Karen Tumulty, national political correspondent for the Washington Post. Thank you all so much for being here. As we were just discussing, there wasn’t a lot of health care in last night’s debate, but did you hear anything you think moved the needle? Sen. Daschle?
TOM DASCHLE: Well, I think the whole debate about contraception and just what impact the current law has on women and the difference between the two candidates became really one of the focal points, probably in the second-tier of importance overall as the debate went back and forth. But clearly, that is a distinction that the president wanted to talk a good deal about, and I think Mr. Romney attempted to explain his position. Except for that, I was a little disappointed that we weren’t able to get into the health issues with greater consequence than we did.
MARY AGNES CAREY: Avik?
AVIK ROY: That’s one of the things that Romney brought up in one of his discussions was the point about: Does Sen. Obama’s promise that premiums would go down, or health costs would go down, for every family – or average family – in the United States by $2,500 per year? When in fact, premiums have gone up by that amount since the Affordable Care Act was passed. I think the issue of the rising cost of health premiums is a big part of the challenge that we all face and we all talk about in health policy – and is certainly something that we should continue to talk about when comparing what the Affordable Care Act would do and what Gov. Romney’s plan would try to achieve as well.
KAREN TUMULTY: Although the law has not been implemented, actually, so forces that they argue would drive costs down haven’t really taken effect yet.
AVIK ROY: True, but the insurers are anticipating a lot of the mandates and regulations coming into force, and that’s one of the reasons why premiums continue to increase as people try to lock in certain cost increases – both providers and payers – before those provisions come into place.
MARY AGNES CAREY: Let’s talk a little about pre-existing medical conditions. As we know, the Affordable Care Act, as of 2014, you cannot deny coverage based on a pre-existing medical condition. And Gov. Romney has a plan on pre-existing medical conditions, he says he has a plan, could you please explain what that is, and is it as comprehensive as what is in the Affordable Care Act?
AVIK ROY: So first we need to step back and understand who are the uninsured in America? If you look at the uninsured in America, the vast majority of people who don’t have insurance in America, it’s because insurance is too expensive, it’s not because they can’t get insurance. There is a small percentage – an important population of people – but it’s a small percentage of people who today don’t have protections in terms of being able to get insurance regardless of pre-existing conditions. Because there are a lot of people who can, right? So, if you’re in the small group market, you can get, you have guaranteed issue in the small group market. Where we don’t have guaranteed issue is in the non-group market, which a small fraction of Americans participate in.
And why is it? Why is it that there are people out there who can’t get insurance because of a pre-existing condition? It goes back to a quirk in the tax code from World War II, whereby employers sponsor insurance and get a huge tax subsidy for doing so. And as a result, there are a lot of inefficiencies that come out of that, one is that health insurance is more expensive and the other is that because employment is tied to insurance – when people lose their job or switch their job, they have gaps in coverage. So that’s what creates the pre-existing condition problems. We have to understand first what’s causing the pre-existing conditions problem in the first place. So there are two ways to address it: One is to do what the Affordable Care Act does, which is create another sort of policy patch on top of that, which then requires the individual mandate, subsidies for lower-income individuals and all the other mechanisms to ensure that if you’re going to have guaranteed issue for everybody, you’re going to do all the other things.
That’s what creates the Affordable Care Act to a large degree. The Romney approach is to say: Let’s address the original problem. The original problem is that people don’t own their own insurance and can’t take it from job to job. They can to a degree [with] HIPAA, which the senator was involved in shepherding through Congress – it was an important advance in that regard. But there are still other things you can do to expand HIPAA protections to people who have credible coverage. And then for people who still have those gaps, do more with high-risk pools and do other things to make sure that the people who can’t get insurance today have the ability to get it through subsidized high-risk pools at the state level.
MARY AGNES CAREY: Is that enough, Sen. Daschle?
TOM DASCHLE: Unfortunately, no. It’s all about actuarial calculation and actuarial viability and you can’t get to actuarial viability to cover all of those. And I would differ slightly. It’s not a small percentage. We’re talking about 50 million people that don’t have insurance and another 40 million people who are very under-insured in this country. Nearly 100 million people, and they’re all under the age of 65, so it’s a very significant portion of the population. And the problem we have today is that, because of the actuarial calculations that all insurance companies with the business models that they are forced to use consider as they try to determine the degree to which they can make insurance affordable to those who have pre-existing conditions, it simply doesn’t calculate without everybody participating. Now, everybody does participate today but in the most inefficient way. We already have a mandate and the mandate is the one that requires uncompensated care to be provided, and we all pay for the cost of uncompensated care – added to our bill, mandated to our bill, if you will – at the time when we pay our bills to the doctor in the hospital. So what the Affordable Care Act tries to do is to put in place an opportunity to create a new actuarial model that relies on universal participation. That allows then the actuarial balance to come back to what it needs to be to allow the insurance companies to comfortably cover all of those with pre-existing conditions today. That’s what it does, and as Karen so correctly points out, we don’t really have that model in place yet. It doesn’t really kick in until 2014. The states are going to have a year to put in place exchanges that will allow us the opportunity to create these insurance levels at different actuarial values, but that won’t begin for another year and a half.
AVIK ROY: The Congressional Budget Office did a study that analyzed this question of why are people uninsured. And 71 percent of the people who were uninsured over a long period of time were uninsured because of the cost of insurance. Only three percent were uninsured because of their health status --they couldn’t get insurance because they were ill. So it’s an important population. In a big country like ours, if under one percent of people have this problem, that’s still one to three million people. So it’s still an important problem for us to understand. But we have to make sure that whatever the solution is doesn’t drive up the cost of insurance for the other 99 percent of the population. And that’s part of the challenge with the Affordable Care Act is that it doesn’t do enough. In fact it goes in the other direction, in terms of driving up the cost of health insurance for the vast majority of people who have it already.
TOM DASCHLE: I’m not familiar with that study, but it just defies credibility. It would seem to me – you look at the obesity problem in this country, you look at the Type II diabetes problem we have in this country, you look at the coronary and other chronic illness problems we have in this country – and I know statistically and demographically, it’s more than three percent of the population. So I want to go back and look at that study. So regardless of what the percentage, the problem is still there. It’s one of actuarial accountability and actuarial balance and the only way you get there is with a mandate.
KAREN TUMULTY: Could I get a couple of scenarios out here and if you could play it out for us what the next couple of years would look like. Suppose Mitt Romney wins the presidency, but – as is almost certain – the Republicans are somewhere short of 60 votes in the Senate, whether they’re in a small minority or a small majority. A President Romney says he would repeal Obamacare. How far could he get in this sort of situation? He could use the reconciliation process to some degree, but how much of this bill would be dismantled?
TOM DASCHLE: I would say that the bulk of it can be dismantled. If a president is determined to do it, he can do three things. First of all, he can pass legislation. As you say, he can use reconciliation for certain amounts affecting the budget of the federal government. And that’s calculated to be somewhere in the 40 to 60 percent range, depending on how parliamentarians ultimately rule on some of these budgetary questions. So that’s number one. Number two: through rule making. He can really do a lot to change the course of the legislation because – especially with the Affordable Care Act – the secretary and the president were given wide latitude. And third, he can defund it. He can just simply not dedicate resources within the budget. That will be his prerogative as he sets his own budget. So he could have a profound effect on the outcome of the ACA in a very short period of time.
MARY AGNES CAREY: What do think would be the reaction to that? Let’s say, to Karen’s point, the thought is perhaps Republicans keep the House, Democrats keep the Senate – how does Congress respond under that scenario?
TOM DASCHLE: I think if you make the assumption that it will be a status quo election and the Houses remain the same, where the Senate is still governed by a Democratic majority, in the House the Republicans, there really isn’t a lot they can do. They wouldn’t have the consensus that it would take to override a veto or to press legislation that the president could sign. So it is most likely that you would see a significant stalemate. That said, I think there is an inexorable momentum that is going on. And as I look at the health sector all over the country, there are things that are happening out there – on payment reform, on delivery reform, on insurance reform – that are not reliant necessarily on the ACA. So I think you’ll still see movement. We’re at a very transformational time, but nothing like the definition that the ACA provides this movement today.
MARY AGNES CAREY: Avik, how do you see this playing out – this scenario concept?
AVIK ROY: Well, I’ll certainly defer to the Senator’s expertise about reconciliation. I would agree that, in general, the point of reconciliation is that you can use reconciliation to pass legislation that is germane to the budget. And clearly the ACA is germane to the budget. And a piece of repeal legislation would theoretically be simpler. It’s not like you have to pass every provision, every section of the ACA or repeal each section one by one. You can repeal them in chunks, which makes it more germane to the deficit. So in that sense reconciliation is easier to use with repeal than it is with passing the original bill.
In terms of what would happen if the Democrats control the Senate, I think it’s pretty unpredictable. I can say certainly I don’t know if grassroots conservative or congressional Republicans have articulated what they would want to do in that setting. I think that what Gov. Romney has stated is that if he doesn’t have a Senate majority, what he would certainly do is he would try to assign waivers to the states to liberate states from implementing as much of the law that he would have the legal authority to do. So he would use executive orders to limit the implementation of the law. But aside from that I think a lot of people would have to do some hard thinking about where they could work with the other side.
KAREN TUMULTY: Let’s look at the other alternative. Say President Obama is reelected. We’re coming up on 2014, he’s got of sort of put the key in the ignition and turn it and see if the car engine turns over here. If you were secretary of HHS and you look out across the map and you have all these states in various degrees of preparedness, in various degrees of eagerness to do this, what would be keeping you awake at night?
SEN. TOM DASCHLE: I think the degree to which there are deadlines in the legislation that I think could be a challenge to meet in some cases with the states currently in the position they are, so I think what would keep me up in part would be, number one, could we meet those deadlines?
I think the president would probably use the authority that he has to intervene and to set up in many cases a federal exchange, or a federal system, to accommodate those states that are simply farther behind. But I think more than that, what keeps me up mostly would be the larger budget about health as we go into the fiscal cliff decisions, and all of the other huge legislative challenges the president and the Congress will be facing. What will happen to Medicare, what will happen to Medicaid, what will happen to the funding of the implementation of the ACA with the backdrop that we’re going to be facing beginning almost immediately around the budget and the fiscal cliff?
KAREN TUMULTY: What do you think?
AVIK ROY: I think that’s absolutely right. I think the broader fiscal picture, particularly with the lame duck session coming up but even afterwards, health spending continues to be the dominant growth driver of federal spending in general, and regardless of what happens with the Affordable Care Act, regardless of what happens with Gov. Romney’s approach to Medicare reform, these problems are not going to go away so it’s going to be a challenge and it’s going to have to be something both sides are going to have to come together on. I think that’s one of the things that is really important here, that there’s not going to be an ideological victory on this stuff. You’ve got to find people on both sides of this equation who are willing to work together to find solutions.
KAREN TUMULTY: Plus you have a lot of governors, even Democratic governors, who are pretty skeptical that even with the federal match on the Medicaid that they can make these numbers work. Is that a valid concern?
SEN. TOM DASCHLE: This is as good a deal that governors are ever going to get in terms of the expansion, but I think that every executive, every chief executive, whether it’s state or federal, is going to be facing a lot of these budgetary challenges with a degree of anxiety, with a degree of frustration, because they know the clock is ticking and the calendar pages are turning, and they just don’t have a lot of time.
Time and budget and overall yearning for some degree of consensus on some of these things is going to be very high.
MARY AGNES CAREY: While Medicare will be a part of the discussion next year on the budget, it’s also a big part of the campaigns, lots of discussion about premium support, about Gov. Romney and Congressman Ryan’s proposal on premium support.
How do they assure the American public that the amount of money they will provide in premium support to allow a senior to buy traditional Medicare or a private health insurance plan, that that will be enough and it will rise enough with the increase in health care costs that seniors don’t have to go digging into their pockets to get the coverage that they choose.
AVIK ROY: This is the whole reason why the plan was designed the way it was. You may remember about a year ago in the Republican primaries all the candidates kept getting asked: Do you support the Ryan plan? Do you support the Ryan plan? and what Gov. Romney said was: I support the broad principle of entitlement reform but I’m going to come up with my own plan. And everyone said: What does that mean? But eventually he rolled out his plan.
What was his plan? His plan responded to just that criticism. It said that we are going to bring up the level of premium support in every market so that it matches what will be necessary to cover all the traditional benefits that are covered today. And what you do is you have a bunch of insurers, including the traditional government-run Medicare fee-for-service option, compete and whoever has the second-lowest bid of the group, that would be the level of the subsidy. But that level of the subsidy would mean that every senior would be guaranteed coverage for the exact same benefits they have today. The whole reason he went to that system, and there’s no cap in Gov. Romney’s approach. For example with both the old Ryan approach, with President Obama’s budget, there’s this cap of Medicare can only grow at a certain amount, the ACA also has a growth rate.
MARY AGNES CAREY: Is this the GDP plus a half a percentage point that you’re talking about?
AVIK ROY: Exactly. Gov. Romney’s plan doesn’t have that kind of a growth cap. The approach of Gov. Romney is let’s let competition do the work and not arbitrarily put a global budget cap on the way we adjust these payments. So there’s a 100 percent iron-clad guarantee that the payments will cover the benefits. It may be that in certain markets, like in the study the Kaiser Family Foundation recently published, that the Medicare [fee-for-service] traditional government-run option is cheaper. In other markets, it may be that private insurers are cheaper. But seniors would have the choice to choose whatever plan they want. And they would have the ability to select the plan that was best for them. And if they wanted to pay more for a more generous plan, they could do that.
MARY AGNES CAREY: Sen. Daschle?
TOM DASCHLE: Well I think it’ll work about as well as the SGR has worked over the last 13 years.
MARY AGNES CAREY: The sustainable growth rate, that pays doctors in Medicare.
TOM DASCHLE: Yes, we pay doctors, and they were given all the assurances -- and I must say I was part of that in the early years and feel very badly that we didn’t do a better job of addressing many of the concerns raised at the time.
But I think there are two choices legislators have: They can either cut and shift or they can redesign and improve these programs. Cutting and shifting doesn’t solve the problems, it simply exacerbates them by passing on the responsibilities to others including the beneficiaries. I’d much rather address the core issues that we face, in addressing costs effectiveness in a lot more comprehensive way, than by cutting and shifting. But that’s really what we’re doing: We’re putting older people into the individual market —which the CBO has said is a lot more of an expensive approach to use. First, because administrative costs are so much higher, secondly because you’ve got a lot more involvement in the part of a lot more organizations where the coordination of that coverage becomes a lot more complicated.
You know we already give seniors the choice as they have an opportunity to sign up for Medicare Advantage, so to take it beyond that with a new voucher program in the individual market—the most expensive marketplace in health care in the country today—is not an example of cut and shift that I think the majority of members of Congress can support, or will support.
AVIK ROY: So I completely agree with that dichotomy between cutting and shifting versus structural reforms that improve the efficiency of the program, but I would contend that it’s the Affordable Care Act that does the cutting and shifting. It cuts provider payments by $450 billon which will drive a lot of providers out of business. And what you’d rather do instead is let seniors have control over their own health dollars and buy plans that are more efficient. There’s a lot of literature that’s come out the last couple of months that’s shown that Medicare Advantage plans with the same level of benefits is more cost-efficient than traditional fee-for-service. So why not give seniors the option to buy the same benefits at a lower cost?
KAREN TUMULTY: But you don’t buy the argument that healthier seniors will in fact go out and do that, but that will leave sicker seniors back in traditional Medicare and make it more expensive for the government?
AVIK ROY: So what you do is you have a risk adjustment program to ensure that insurers aren’t engaging in risk selection. This is what we do with the Medicare Advantage program, this is what we do with Medicare Part D, this is what we do in the Federal Employee Health Benefits program that all members of Congress belong to. It’s a relatively routine process, and their critique of how you can tweak or improve risk adjustment. But we know a lot about risk adjustment and we can use it to work in this situation.
TOM DASCHLE: Well, you can’t do it actuarially. First of all you can’t tell somebody they can’t leave the system, but you’re going to see this natural evolution away and the healthy people are. You know the other thing I think about is my mother: 89 years old and not a clue, not a clue, about how all this works.
To pit my mother against the marketplace -- and I might say even I think I know a little bit about this, but the lack of transparency, the fact that we really don’t have a market -- the health sector is the only place in the country the only sector of the economy that at the time of purchase we don’t know what it’s going to cost or who is going to pay. And we have a lot more statistics on every sports figures than we do on any provider or any institution today.
So the lack of transparency does not allow for the market forces that would work in other settings to work here. They just don’t work. And so I think we really got to be sensitive to the needs of my mother, to the needs of those who understand that in an individual market to put an 89-year-old woman in that setting and expect her to make the best decision is just not do-able.
MARY AGNES CAREY: We’re getting near the end of this campaign, we have another debate coming, and the election will be here soon. How critical is health care in this campaign? And what do the candidates need to say to lock down the voters’ vote — for voters on health care — what is the critical message they need to get out there in the next few weeks?
AVIK ROY: I would certainly say Gov. Romney’s first and foremost focus is on the economy. He’s concerned about the state of the economy today and he wants to improve it. The focus of the health care message is primarily around what the ACA does to retard economic growth, what it does to retard our hiring. What it does to our fiscal situation. So it’s really about the economy at the end of the day and how the ACA feeds into that.
TOM DASCHLE: Winston Churchill said it best. He said once: A lie gets half way around the world before the truth gets its shoes on. And that was never more clear than in the debate about health care. There have been so many mistruths and misinformation that I think the best thing the president can do is to contribute to helping to clarify just what it does and what it doesn’t do. What I take a great solace in is the knowledge that the more people know, the more they like. They like the protections that they have already been given. They’re going to like when they find out that they’re covered on all 10 categories of essential care in new insurance plans that they are not eligible for today. They are going to like the subsidies they get to help pay down the premiums. They are going to like the new paradigm once it’s filled with greater transparency. But today there is just so much confusion in large measure because they have been so many lies.
MARY AGNES CAREY: Karen, you’re so closely following the campaign, reporting on it. How did you see health care shaping the campaign as it continues?
KAREN TUMULTY: One thing I’ve been struck with, and tell me Sen. Daschle if this is your sense too, I think President Obama has become much more aggressive about framing health care as an economic issue and I do think we heard a little bit more of that in the debate last night, too. Is your sense that they missed the boat on this at the beginning? Are they trying to make up for some lost ground?
TOM DASCHLE: Well, you know the president had a lot on his plate, and I give him that. One of the mistakes that I think we made, when we passed [Medicare] Part D, the drug bill, we passed an education and promotion account that allowed us to actually hire people like [former Sen. ] Bob Dole, a very dear friend of mine, to go out and articulate to the senior population just what it did and how good it was. As one of the last minute decisions we made to bring down the costs, we took all that money out of the budget for the Affordable Care Act. So we really had no way by which to do what we did with Part D, to educate to promote. And I think there was health fatigue after all of the tremendous work to get the job done. People just said, “Look, enough already. Let’s move on to other things. I’m tired of talking about it.” But it was a mistake. I think we did well with implementation so far.
I think we’ve done well in putting the new paradigm in place. But I think we did poorly at messaging.
MARY AGNES CAREY: How do much of this is getting through to voters? We’re in Washington. We live and breathe the debate over premium support or Medicaid block grants or pre-existing conditions. Karen, what are voters getting and what are they not getting?
KAREN TUMULTY: I was really struck I was in Nebraska about a month and a half ago with Bob Kerrey, who is running for not quite reelection but to get his old Senate seat back. And we walked in to a charity that goes around the country giving people dental care. And there had been people in the parking lot of this shopping center where were doing it who had shown up at midnight the day before just to get in and get their teeth worked on. And we walked in and one of the volunteers the first thing she asked former Sen. Kerrey, “Are you for this Obamacare?” And he said, “Yes, I am.” And she says, “I hate that.” So here you are surrounded by hundreds and hundreds of people who obviously don’t have access to basic dental care, and yet the resistance out there is real. I mean people are afraid of what this is and what it means. I don’t think the feelings of insecurity about it have been addressed.
MARY AGNES CAREY: Avik, what’s getting through?
AVIK ROY: I would say there has been a lot of misinformation about health care. There always is. And that’s true on both sides. So a lot of the talk about throwing grannies off the cliff is misinformation as well, right?
The irony is that premium support is not just something that is used in the Romney-Ryan plan for Medicare reform. It’s used in the ACA exchanges. The ACA exchanges have premium subsidies that are tax credits that grow at a certain rate that may not keep up with the cost of health care inflation. So these are ideas that a lot of people try to adapt to their health care formulas and maybe that’s where some sort of bipartisan approach can come through. But I think that at the end of the day one of the things that people are really concerned about is the cost of health insurance premiums. And unfortunately the ACA doesn’t do enough. In fact, it goes in the other direction.
Jonathan Gruber, one of President Obama’s advisers, has issued reports to states saying that in Wisconsin premiums in the non-group market will go up by 30 percent, in Colorado by 19 percent because of the regulations and mandates the law is imposing on insurers. So that’s something that a lot of people are rightly concerned about: health premiums keep going up, they eat up a larger and larger percentage of wages and that has economic effects -- and I think that’s something we don’t talk about enough when we talk about health reform.
MARY AGNES CAREY: Would you like to weigh in quickly?
TOM DASCHLE: Well, I agree with much of what was said. We know we are going to spend $35 trillion on health in the country in the next 10 years and that we can’t sustain that permanently. But what we have to do is bend the cost curve to bring in play the these mechanisms and we know where we have to look. We have to look at transparency, we have a coordinating chronic illness, we have to look at getting rid of fee for service or finding alternatives in large setting that would allow us to deal with the volume driven approach we have today. We have to deal fraud and abuse. We have to deal with administrative costs. The ACA puts on the field an opportunity for us to do that for the first time. Does it solve it all? No. Could it have gone farther? Absolutely.
I strongly support IPAB [the Medicare Independent Payment Advisory Board set up in the health law] and I know we could have a big debate about that but we won’t today. But it puts in place mechanism to address the causes. It redesigns and improves , which is what I said at the beginning. What we need to do make a difference in health costs in the future.
MARY AGNES CAREY: All right. I’m going to leave it there. Thank you so much, Tom Daschle and Avik Roy. And Karen and I will be back in a moment for our journalist roundtable.
MARY AGNES CAREY: Welcome back. We now continue the conversation about health care policy and how it’s playing in the 2012 campaigns. Joining me once again is Karen Tumulty of the Washington Post, Jonathan Allen, senior Washington correspondent for Politico, and Sarah Varney, a senior correspondent for Kaiser Health News. Thank you all, for being here. Thanks Karen, for staying around.
First of all, what did you two think? And Karen, weigh in as well about what you just heard. Sarah?
SARAH VARNEY: I thought it was interesting how Sen. Daschle talked about how just widespread the ACA is. How overarching it really is. And I think that’s something that gets lost a lot in discussion over Medicare, Medicaid, all of the ways in which it has set into place: momentum that really won’t be stopped regardless of whether or not the A-C-A gets repealed.
So you’re seeing a lot of formations of these affordable care organizations in California, where I report. The business market place is really sort of reorienting itself a couple years ahead of 2014. And many people that I’ve talked to over the years -- whether they’re at hospital chains, or they work for the county health department, or individual doctors’ practices -- all say these are things that we need to do anyway and so we’re going to continue to do them sort of regardless of what happens in Washington.
MARY AGNES CAREY: Sure. Jon?
JONATHAN ALLEN: I thought it was interesting to see how much agreement there seemed to be on the states in particular. And all these deadlines coming up and I think you can throw in the Supreme Court decision and what that did. You know with regard to Medicaid and how states are going to deal with whether or not they’re want to take Medicaid money. I think all that agreement that this is like sort of a critical juncture upcoming or set of junctures for the success of this law was interesting. There wasn’t really any disagreement that states are going to have a hard time figuring that out. Sen. Daschle, for instance, talking about the time elapsing quickly, the calendar pages turning, and the budget constraints still being there for all these governors.
MARY AGNES CAREY: Karen?
KAREN TUMULTY: Well, I was a little bit surprised when Sen. Daschle was talking about the powers of the president. It would have to essentially slow walk the implementation of the Affordable Care Act whether or not Congress goes along.
MARY AGNES CAREY: Right. I thought that was very interesting as well. And John, to your point, and Sarah, to yours, I think that there was some commonality there of purpose of looking at the Medicare program, looking at entitlement spending, and how that’s going to figure into all this discussion about the fiscal cliff, entitlement reform, and tax reform if it happens next year. But before we get to next year we do have an election. Health care is very big in that election. And Sarah, I know that you’ve been following a California house race that kind of mirrors this larger debate over Medicare and over the Affordable Care Act.
Tell us about that.
SARAH VARNEY: Sure. This is in eastern Sacramento. So this is really where the sort of liberal coast meets the conservative farmlands and sort of exurbs of Sacramento County. This is a redistricted area. It was redistricted in 2010 after the 2010 Census. And it went from being a Republican majority to now being evenly split between Republicans and Democrats.
So you have Rep. Dan Lungren. He’s a nine-term congressman, a Republican, defending his seat against a challenger, Dr. Ami Bera, who challenged him in 2010 and lost. So, Dr. Bera is really playing up in this election compared to how he ran in 2010. He’s really playing up his background as a physician. He was a chief medical officer for a big a big hospital chain in Sacramento and then also the chief medical officer in Sacramento County.
He’s really talking about: I’m the guy to go to Washington. I know how to control health care cost. I did it in this hospital chain. I did it in Sacramento.
I went to a town hall meeting one night of Rep. Lungren’s. This was not a campaign event. This was just a town hall meeting that he was just holding for all of his constituents. And for hours, it was just dominated by one question after another about Medicare. And Rep. Lungren very much supports the Romney-Ryan plan and basically said at the end of it: If you don’t like it, I’m sorry, but this is what I support. And so it was interesting.
There was a group there called the Seniors Against Lungren who were obviously upset with him. There were a lot of tea party folks who had come not just from his district, but really from all over northern California, to come down to tell him they supported him. But I think it’s interesting how Rep. Lungren essentially was just saying, in a sense: Take it or leave it.
MARY AGNES CAREY: Does this mirror other campaigns that you’ve read about or covered as reporters?
KAREN TUMULTY: I’m struck by the potency of the Medicare issue and the aggressiveness with which the two sides are framing who really gutted it by $716 billion. Basically Paul Ryan’s budget and Barack Obama’s health care law would take the same amount of money from the program, and yet each one is attacking the other as gutting it, and doing it over and over again, no matter how many times they get called on it by the fact checkers.
JONATHAN ALLEN: For several cycles now, we’ve seen Republicans basically make the argument that they’re not necessarily going to win the Medicare debate, but what they want to do is at least draw even. The goal is, if they can blunt this edge the Democrats have had for so many years on Medicare by proposing their own plan, by rallying people behind it and getting anywhere close to even, they’ll feel like they’ve got something of a victory.
You’ll notice the debate has tended to be in the past that Democrats are for Medicare, for Medicaid, but particularly Medicare, which affects a lot of voters. And then what they do is hammer Republicans for being against it if Republicans want to cut back on it at all. They say: Well , you’re against it. You didn’t vote for it in 1965, You’ll never be for it.
Republicans now under Ryan, first through his budget and now under Romney-Ryan, which is a somewhat watered-down version of the Ryan approach, have an alternative they’re putting forward. And they’re able to argue, some would say convincingly, some would say not, but they’re able to argue we are trying to save this program. We believe in this program. Paul Ryan will talk about his mother and his grandmother, and how Medicare was helpful to her. And I think that Republicans feel they’re in a much better place in terms of having an argument to put up against Democrats, having a plan to save Medicare, than they were before.
MARY AGNES CAREY: So it didn’t hurt Republicans for Romney to pick Congressman Ryan, who, Karen, you talk about as so identified with a sweeping reform to the Medicare program?
KAREN TUMULTY: And yet the overhaul of the program that Congressman Ryan has proposed remains unpopular. They try to keep pointing out that it won’t affect current seniors, that it won’t affect even people entering the program in the next few years. But it remains a pretty unpopular concept.
MARY AGNES CAREY: So John, are Republicans pulling even?
JONATHAN ALLEN: I don’t know that I’ve seen any polling that suggests they’re even yet on this issue, other than in a presidential year, everything gets thrown together, so when the two candidates get even, they suddenly are even on every topic. But if you take it a little bit outside of that down-to-the-wire presidential environment, I think Democrats still have an advantage on this issue.
The question is, is it what it once was? And are the Republicans laying the groundwork to be able to make significant changes to Medicare in the future if they win power, and be able to say: Look, well we have a mandate for this because we’ve been talking about this for a while. It’s obviously tricky politics. Democrats who are willing to talk about changes to the program to save money in private conference rooms in the Capitol are suddenly very unwilling and uninterested in doing that come election time, because they know they can go back to beating Republicans up on the idea that Republicans want to underfund it or disestablish it.
MARY AGNES CAREY: Now health care, whether it is the Affordable Care Act or Medicare -- and we can talk about Medicaid in a second -- but it’s playing in so many races. Sarah, I know you’ve also taken a look at the Wisconsin Senate race. Tommy Thompson, the Republican challenger and former governor of the state, and Tammy Baldwin, who’s a Democratic House member, running for an open Senate seat of Herb Kohl. Could you talk a little bit about the Wisconsin race?
SARAH VARNEY: Sure. If the Lungren-Bera race sort of mirrors Romney-Obama, in a way, the Baldwin-Thompson race is even more extreme because you have Ms. Baldwin, who’s a supporter of single payer which is the system they have in Canada, where you have private doctors, private hospitals, but the government is the sole insurer.
It’s interesting looking through some of her literature, and some of her ads which she’s putting forward this personal story that she has, that when she was 9 years old, she was being raised by her grandparents, and she had to go into the hospital for three months. And she was not covered as a dependent on her grandparents health plan. So it didn’t cover the hospitalization. When she came out and recovered, her grandparents were unable to get any insurance for her because of a preexisting condition.
So she talks a lot from a very personal place about how she arrived at her viewpoint of the role around the role health care in the United States. That’s obviously a direct contrast to Mr. Thompson, who does not support the Affordable Care Act and would really like to repeal the ACA, although he says he would like to preserve the wellness and prevention programs and he essentially wants to move to a market based plan.
KAREN TUMULTY: And he is a little bit compromised on this, because at least while the act was being hammered out he was saying positive things about it, and he also in his time as HHS secretary actually signed the waiver with which Mitt Romney was able to implement a very ACA-like law in Massachusetts.
JONATHAN ALLEN: It’s a really interesting race here in Wisconsin, and it’s fascinating that Tammy Baldwin’s in shouting distance of a guy who was a very popular governor in part because of his willingness to experiment with public policy, which has now, as you point out, kind of boxed him in a little bit. Not only did he sign that waiver, but he was doing the [Medicare] prescription drug plan in 2003. He was literally on the floor of the House of Representatives -- Mac and I remember that very harrowing three hour vote from 3 a.m. to 6 a.m. -- he was down there twisting arms on the floor.
KAREN TUMULTY: And unpaid for we ought to point out, too. There were no offsets in the budget. This was on the credit card.
JONATHAN ALLEN: Right, it was a big deficit increaser. But also I think a law that starts to foreshadow what was going to happen in health care. When you actually deal with the public policy as opposed to just the elections, a lot of these guys are in similar places on the ideas. And that becomes trickier for him to get out of and just be against what is in Obamacare.
MARY AGNES CAREY: How is health care playing in the swing states? I’m thinking about Florida, the Connie Mack, Bill Nelson race. Closer to where we are in Virginia, the race for Senate there. Is Medicare a big issue in the swing states? Is the health care law a bigger issue in the swing states? Are they both predominant issues?
KAREN TUMULTY: When you go to different places, you hear different things. In the places that are particularly depressed or particularly hard hit by this economy, you hear a lot of people who have lost their jobs and who are worried about their own health care. In Florida, who is it who is really raiding Medicare has become a major, major part of the conversation.
JONATHAN ALLEN: I think there’s a real fear among seniors that Medicare won’t continue to be there, because it is on an unsustainable path unless there are some significant changes. And I think everyone who is serious recognizes that, whether or not they will say that outside of private conference rooms.
Marco Rubio, the Republican Senator from Florida, last time around ran on a platform that included reforming entitlements, included reforming Medicare in a way similar to what you’re seeing from Romney and Ryan now. I think a lot of people thought that was going to be very dangerous for him. I think it probably didn’t help him win, but he also did win. It didn’t prevent him from winning. And I think that Florida voters in particular are open to listening to the various ideas.
Now how they end up voting is another question, but they are at least open. I imagine older voters in other swing states are also somewhat open to hearing solutions. Because they don’t see how Medicare is sustainable without other changes.
KAREN TUMULTY: And people know their own circumstances. A lot of the pushback on the Affordable Care Act is from small businesses, too. Which has been certainly a part of Mitt Romney’s argument which is that these are the job creators.
SARAH VARNEY: One of the stories that I’ve been working on recently is following Democrats who voted for Reagan in 1980 and 1984. I was talking to voters in West Virginia, and the suburbs of Chicago, and in rural California, an area called Gilroy, which is the garlic capital of the world.
JONATHAN ALLEN: We’ll move a little bit farther away from you.
SARAH VARNEY: And it was interesting because the three voters that I ended up recording for the story, although I talked to many more than that, really ended up reflecting the three different places that you can end up on this issue.
One of the women, who lives in the suburbs of Chicago, is a Romney supporter. It’s her view that what Ryan and Romney are proposing is really no different than the Medicare Advantage plan that’s available today. And so she doesn’t see a problem with it. She thinks the ACA can be repealed and there would be really no impact on her or her family’s life.
Another voter I spoke to in rural West Virginia. These are all folks who were in their 30s and 40s in the 80s and are now on Medicare. So they’re older now – 60, 70 years old. And this one man is independent. He’s an undecided voter. He has said I just don’t really know who to believe. I don’t think if Obama stays in office he’s really going to be able to get much done with the Senate. And if Romney gets elected I don’t think he’s really going to have a lot of pull to really get anything done either.
But he’s very distrustful of this idea that the free market is really the place to turn to for an answer. He thinks there will be this cherry-picking by the insurance companies if they move forward with this Medicare plan.
And then this women in Gilroy, the garlic capital — she’s sort of bewildered. She’s going to vote for Obama. She just simply said it doesn’t make sense to me that if you have for-profit companies coming into the Medicare space that they’re going to be able to do this less expensively than Medicare —that if there’s a profit margin involved when there isn’t’ one now for the Medicare program, how on earth does that add up?
JONATHAN ALLEN: I think it’s fascinating that you were talking to a voter who said I don’t think Obama’s going to be able to do that much, I don’t think that Romney’s going to be able to do that much. But Sen. Daschle was in here earlier saying just how much power the administration has — not just in the health care law, the ACA, but also just sort of more broadly.
An administration we’ve found out over the years has a lot of power until Congress steps in and says, no, you can’t do that — through repealing regulations, through reactions to what administrations do. In particular in the ACA, the secretary of Health and Human Services was given a ton of power to implement. But even more broadly like you see with regulatory power, who is president makes a huge difference in the way that policies are implemented, in the way long-standing laws are interpreted. Then the courts and the Congress can sometimes jump in but are generally reluctant or unable to do so. So it’s interesting that they feel like maybe it doesn’t matter who’s president, that they weren’t going to be able to get something done. Sen. Daschle’s view was that the executive is extremely powerful.
MARY AGNES CARY: Let’s talk about Medicaid. Very different views from the candidates on Medicaid. Mitt Romney would turn it into a block grant. The president would expand it to as many as 17 million people. But then we know the Supreme Court gave states the right to either expand or not expand to this additional population.
Karen, how is Medicaid playing in the elections from your perspective? What have you seen and heard?
KAREN TUMULTY: It is pretty much the dog that isn’t barking, at least from what I’ve been hearing. There was a flurry of activity right after the Supreme Court decision in which states did get this option to drop out. But you talk to health care economists and they say this is the big wild card in the bill when the rubber hits the road and it has to become reality. There is no health care economist who doesn’t believe who doesn’t believe that you’re going to have to up those reimbursements of providers through the roof.
MARY AGNES CARY: You’re talking about payments to hospitals, to physicians, to those who provide the care to the Medicaid beneficiaries.
KAREN TUMULTY: That you are simply not going to be able to find providers for all of the additional people if states continue to reimburse doctors and hospitals at the very low rates that they do for Medicaid. So that does have potential to be the real element of this bill that could explode the cost.
MARY AGNES CARY: One thing that intrigued me: The president did a campaign ad on Medicaid. And he focused on the fact that Medicaid pays such a large percentage of long term care in this country, which a lot of people don’t understand until they experience it themselves. Is that resonating with voters, the Medicaid angle and the fact that perhaps if you don’t need it today you might need it tomorrow? Have you seen that Jon?
JONATHAN ALLEN: It’s an interesting choice for the president. We’re so accustomed to politicians ignoring the Medicaid population. Medicare is seen is sort of as this big group of people who are out there as potential swing voters, as people who are going to be animated as people who actually go to the polls. And with the Medicaid population, not as much. I don’t know whether it ends up resonating with voters. I do know this. It is the area where the two parties seem to fight the most without making any noise.
So President Obama wanted to expand Medicaid and SCHIP, the children’s health insurance program — huge amounts of money in the ACA went into that. When Paul Ryan came out with his first budget, what did do? He decided that he wanted to turn that into a block grant program, he wanted to take a lot of that money back out of the system. To save money, would be another way of looking at it. But these were not things that people talked about. They talked about what was the effect on Medicare. They talked about the health exchange. They talked about everything other than Medicaid, which largely serves the poor and disabled but also does long-term care as you point out. It will be interesting to see if Obama gets traction on that.
SARAH VARNEY: I can tell you in California at least, California has been very aggressive in implementing the Medicaid expansion, even several years earlier. So almost every county in California is involved in this initiative to expand Medicaid to uninsured adults. So those people are now being and have been for the last year being enrolled in this sort of Medicaid lite program, which starting on Jan. 1 2014, if all this goes forward, a switch gets flipped, and they are automatically enrolled into Medicaid. And I do wonder. These are people I’ve spent a lot of time with.
I did a story that looked at how people who are coming out of prison are disproportionately benefitting from this, because a lot of men, particularly, who come out of prison are uninsured. They’re adults with no children in the home, so this is – trying to get them enrolled with local providers, those sorts of things. These are not people that politicians necessarily care about – I’m sure they care about them, but they’re not trying to get their vote.
I do wonder though, at least in a state like California – obviously California will most likely vote for Obama – but nonetheless, I wonder if, in a way, it has sort of brought people into the fold a little bit more. Because before this they had just sort of been out in the wilderness on their own, completely uninsured, not connected to any kind of services at all. And there has been a lot of work done in the counties – even conservative counties – like Kern County, where Rep. McCarthy is from, to really educate people about why this expansion is happening and that it is in fact linked to the Affordable Care Act.
MARY AGNES CAREY: Jon, you were talking a moment ago, if I understood you correctly, about how Democrats may privately admit that they may need to make some changes in the way Medicare is done and how the program is delivered, but no one is going to do that now on the heat of the political season. And we talked a little bit about how some things that can happen in a divided government setting – the administration’s power. But let’s talk a bit more about divided government, which we may have next year.
One, who knows who’s going to get the White House? Republicans look like they’re going to get the House. The Democrats may or may not control the Senate – or do so by less of a margin.
Is there any room for Democrats to embrace the premium support idea, not as currently structured, perhaps, by Gov. Romney, but this idea of limiting the amount of money the government contributes for Medicare coverage? Or is that simply so hot of an issue that they would never go there?
JONATHAN ALLEN: Like most issues, if everybody in Congress joins hands and jumps off the cliff together, the public won’t notice until they get the bill, and then they may be angry.
I do think that there’s probably room for a lot of different policy solutions if they can agree to take a risk together. I’m not sure that the environment is there for that. We’ll have to see what happens after the election. I don’t foresee if you have a status quo, with President Obama staying in power, Democrats in the Senate, Republicans in the House – I don’t see John Boehner’s House Republicans suddenly saying: Boy, we ought to start compromising with Barack Obama now; he’s sure got a mandate.
So I think that if those changes are going to be made, they’ll probably be made sometime next year. It’s not likely to happen in a Lame Duck. I think that they would likely be slowly implemented, because no politicians wants to face the voters right away, much like ACA was kind of slowly implemented.
MARY AGNES CAREY: Nowhere near the midterms, right?
JONATHAN ALLEN: Right. With all these caveats, I guess at some point they’re going to have to make some changes. You just look at the numbers. Medicare eats a larger and larger percentage of the budget.
KAREN TUMULTY: That’s what I think that we all think: Someday, this mythical day far into the future will arrive, when there will have to be some grand bargain on entitlements. I don’t know that the system of deeply divided government that we have now is capable of that anymore.
It’s not 1983 anymore, where everybody could come together on a Social Security fix.
JONATHAN ALLEN: Can I toss out a counter view to that? I’m not suggesting this will actually happen, but Bill Clinton got his welfare reform law in his second term – I’m sorry he got the welfare law right at the end of the first term, but got the big budget deals early in the second term.
This was a situation where he wanted a legacy, where he felt like he had an opportunity to work with Republicans, or I think he moved toward them to get something done. If President Obama sees an opportunity to do some of those things, it is possible for him to focus on both sides. But I don’t think he’s going to get that unless he come for the Republicans pretty far.
KAREN TUMULTY: That was also after the Republicans themselves had an incentive to move, because they’d been through the government shutdown, and their own brand was looking pretty ragged , as well.
MARY AGNES CAREY: And I can’t imagine either party would want to go through that one other time.
Reflecting just for a moment again, last night – I know there have been some recent polls that show that Gov. Romney’s support among some women had increased. And there was a small back and forth on contraception, access to contraceptives, where the president was very pointed in his remarks.
Does that do anything to erode that measure Gov. Romney had over the president? Did the president sort of reclaim that issue last night? Sarah, what do you think how that will move forward?
SARAH VARNEY: It’s hard to know. I was actually watching the debate at the hotel bar.
MARY AGNES CAREY: Very focused on the debate, I’m sure.
SARAH VARNEY: Very focused on the debate over my glass of wine. So there were people from all over the country who were at the bar. And people sort of seemed to tune out when that issue actually was raised.
I don’t know if that’s just simply the setting, of course. But even found it difficult to sort through what they were both saying. They were both kind of talking over one another. It seemed implausible that Mr. Romney would say something that was flatly untrue, as President Obama countered.
So I’m not really sure. I think it was very hard – just even as a viewer -- to sort of follow that. And if you didn’t know the issue particularly well, I don’t know how you end up making a judgment on who won that point.
MARY AGNES CAREY: What do you think, Jon?
JONATHAN ALLEN: I think the question is: Why was Mitt Romney making such progress among women.
MARY AGNES CAREY: That’s a great question.
JONATHAN ALLEN: Older women, just like older men, have always been more inclined to be with Romney. As you go down the age range, they go closer and closer toward Obama, to the point where at the youngest age range, I think, Obama had an 18 point lead.
Why were women going over to Romney? Was it because he finally made the economic point to them? Or a national security point to them that made them think: I want this guy to be my president? Or is it because the contraception issue, the war on women idea backfired? If that’s the case, then maybe some of that will erode. But I don’t think Mitt Romney loses points with women from last night, if they were moving toward him because of issues other than the social issue, the health care issue.
KAREN TUMULTY: My understanding is the broad cohort of women, the women who were moving toward Gov. Romney were primarily white, upper-income women. And so I did notice, I thought President Obama last night was much more explicit, much more aggressive about arguing that contraception is part of a whole package of issues that are, in fact, economic issues for women.
JONATHAN ALLEN: We’ll have to see how that plays. If there are white women with money that you are talking about, is it that they are compassionate toward women who have less money, women who may need their employer to provide contraceptive coverage, or perhaps government funding of Planned Parenthood? Or do they look at it and say: Well, I’m taken care of, I don’t have to worry about whether a round of birth control costs $10 or $50? I think we’ll just have to wait and see.
MARY AGNES CAREY: As we all know, the election is just a few weeks away. I’d like to close with your thoughts on what you think the candidates have to say to voters to lock down those votes, as far as health care goes. Karen, I’d like you to start.
KAREN TUMULTY: Well, I do think that President Obama’s embrace of the term Obamacare was a watershed. I think they finally realized that he had dealt himself this hand and they he had better go with it.
JONATHAN ALLEN: I think that the sale for Obama is that the health care system is better than it was when he took office and it’s going to continue to get better in the next four years and that he ought to be able to be in place to implement it. I think that’s case he needs to make.
On the other hand, I think Romney needs to make that his alternative view of the world will not, as people have criticized him for, through granny off the cliff. He needs to make people comfortable with the idea that you can make changes to Medicare and other health care programs that are compassionate and that serve the least among us without making cold, Machiavellian decisions.
MARY AGNES CAREY: All right, Sarah, you have the last word.
SARAH VARNEY: I think, to some extent, some of these arguments just seem to be circling around one another and you don’t necessarily get anywhere, around Medicare and the Affordable Care Act. I almost wonder if, as we talked about with Medicaid, if there is an opportunity for that issue to really come to the fore.
I think about my own father, when his mother was needing to go into a nursing home, she’s somebody who had to spend down all of her savings. She was a very proud women, who had saved up money. But in order to go into a nursing home, this is what she had to do. And I think there are enough people who are faced with that situation, for Democrats at least, if they really want to hit home on that issue, I think it’s an issue that hasn’t really been used as much as it probably could be, to at least get people to start listening again, when they may have already tuned out what feels to them just like a lot of noise.
MARY AGNES CAREY: Okay, well you’ve given us all so much to think about. I want to thank Sarah Varney, Jonathan Allen and Karen Tumulty. Thank you very much for being here. And I’d like to thank all of you for watching. I’m Mary Agnes Carey with Kaiser Health News.
Topics: Politics, Health Reform, Women's Health, Medicare, Insurance
Even when the questions aren't about health care, many of the responses are. Here's what President Barack Obama and his Republican opponent, former Mass. Gov. Mitt Romney had to say Tuesday night about contraception, Medicare and the health law.
The town hall debate between the two candidates took place in Hempstead, N.Y.
BARACK OBAMA: Katherine, I just want to point out that when Gov. Romney's campaign was asked about the Lilly Ledbetter bill, whether he supported it, he said: I'll get back to you. And that's not the kind of advocacy that women need in any economy.
Now, there are some other issues that have a bearing on how women succeed in the workplace: for example, their health care. A major difference in this campaign is that Gov. Romney feels comfortable having politicians in Washington decide the health care choices that women are making. I think that's a mistake. In my health care bill, I said insurance companies need to provide contraceptive coverage to everybody who is insured, because this is not just a health issue. It's an economic issue for women. It makes a difference. This is money out of that family's pocket.
Gov. Romney not only opposed it -- he suggested that, in fact, employers should be able to make the decision as to whether or not a woman gets contraception through her insurance coverage. That's not the kind of advocacy that women need. When Gov. Romney says that we should eliminate funding for Planned Parenthood, there are millions of women all across the country who rely on Planned Parenthood for not just contraceptive care. They rely on it for mammograms, for cervical cancer screenings. That's a pocketbook issue for women and families all across the country.
MITT ROMNEY: I'd just note that I don't believe that bureaucrats in Washington should tell someone whether they can use contraceptives or not, and I don't believe employers should tell someone whether they could have contraceptive care or not. Every woman in America should have access to contraceptives. And the president's statement of my policy is completely and totally wrong.
And then let's take the last one, championing small business. Our party has been focused on big business too long. I came through small business. I understand how hard it is to start a small business. That's why everything I'll do is designed to help small businesses grow and add jobs. I want to keep their taxes down on small business. I want regulators to see their job as encouraging small enterprise, not crushing it.
And the thing I find most troubling about Obamacare -- well, it's a long list -- but one of the things I find most troubling is that when you go out and talk to small businesses and ask them what they think about it, they tell you it keeps them from hiring more people.
BARACK OBAMA: You know, there are some things where Gov. Romney is different from George Bush. George Bush didn't propose turning Medicare into a voucher. George Bush embraced comprehensive immigration reform. He didn't call for self-deportation. George Bush never suggested that we eliminate funding for Planned Parenthood.
But you should pay attention to this campaign, because Gov. Romney's made some commitments as well, and I suspect he'll keep those, too. You know, when members of the Republican Congress say, we're going to sign a no tax pledge so that we don't ask a dime from millionaires and billionaires to reduce our deficit so we can still invest in education and helping kids go to college, he said: me, too. When they said, we're going to cut Planned Parenthood funding, he said: me, too. When he said, we're going to repeal Obamacare, first thing I'm going to do -- despite the fact that it's the same health care plan that he passed in Massachusetts and is working well -- he said: me, too. That is not the kind of leadership that you need, but you should expect that those are promises he's going to keep.
And the choice in this election is going to be whose promises are going to be more likely to help you in your life, make sure your kids can go to college, make sure that you are getting a good-paying job, making sure that Medicare and Social Security will be there for you.
MITT ROMNEY: I want to make sure that regulators see their job as encouraging small business , not crushing it. And there's no question but that Obamacare has been an extraordinary deterrent to enterprises of all kinds hiring people. My priority is making sure that we get more people hired. If we have more people hired, if we get back manufacturing jobs, if we get back all kinds of jobs into this country, then you're going to see rising incomes again.
Topics: Politics, Women's Health
Vice President Joe Biden and Rep. Paul Ryan talked about how their Catholic faith informs their stances on abortion at the vice presidential debate in Danville, Ky., on Thursday.
MARTHA RADDATZ: I want to move on, and I want to return home for these last few questions. This debate is indeed historic. We have two Catholic candidates, first time on a stage such as this, and I would like to ask you both to tell me what role your religion has played in your own personal views on abortion. Please talk about how you came to that decision. Talk about how your religion played a part in that. And please, this is such an emotional issue for so many people in this country. Please talk personally about this if you could. Congressman Ryan.
PAUL RYAN: I don't see how a person can separate their public life from their private life or from their faith. Our faith informs us in everything we do. My faith informs me about how to take care of the vulnerable, about how to make sure that people have a chance in life.
Now, you want to ask basically why I'm pro-life? It's not simply because of my Catholic faith. That's a factor, of course, but it's also because of reason and science. You know, I think about ten and a half years ago, my wife Janna and I went to Mercy Hospital in Janesville where I was born for our seven-week ultrasound for our firstborn child, and we saw that heartbeat. Our little baby was in the shape of a bean, and to this day, we have nicknamed our firstborn child, Liza, "Bean."
Now, I believe that life begins at conception. That's why -- those are the reasons why I'm pro-life.
Now, I understand this is a difficult issue. And I respect people who don't agree with me on this. But the policy of a Romney administration will be to oppose abortion with the exceptions for rape, incest and life of the mother.
What troubles me more is how this administration has handled all of these issues. Look at what they're doing through Obamacare with respect to assaulting the religious liberties of this country. They're infringing upon our first freedom, the freedom of religion, by infringing on Catholic charities, Catholic churches, Catholic hospitals. Our church should not have to sue our federal government to maintain their religious liberties.
And with respect to abortion, the Democratic Party used to say they want it to be safe, legal and rare. Now they support it without restriction and with taxpayer funding, taxpayer funding in Obamacare, taxpayer funding with foreign aid. The vice president himself went to China and said that he sympathized or wouldn't second-guess their one-child policy of forced abortions and sterilizations. That, to me, is pretty extreme.
RADDATZ: Vice President Biden.
JOE BIDEN: My religion defines who I am. And I've been a practicing Catholic my whole life. And it has particularly informed my social doctrine. Catholic social doctrine talks about taking care of those who -- who can't take care of themselves, people who need help.
With regard to -- with regard to abortion, I accept my church's position on abortion as a -- what we call de fide doctrine. Life begins at conception. That's the church's judgment. I accept it in my personal life.
But I refuse to impose it on equally devout Christians and Muslims and Jews and -- I just refuse to impose that on others, unlike my friend here, the congressman.
I do not believe that we have a right to tell other people that women, they can't control their body. It's a decision between them and their doctor, in my view. And the Supreme Court -- I'm not going to interfere with that.
With regard to the assault on the Catholic Church, let me make it absolutely clear. No religious institution, Catholic or otherwise, including Catholic Social Services, Georgetown Hospital, Mercy -- any hospital -- none has to either offer contraception. None has to pay for contraception. None has to be a vehicle to get contraception in any insurance policy they provide. That is a fact. That is a fact.
Now, with regard to the way in which we differ, my friend says that he -- well, I guess he accepts Gov. Romney's position now, because in the past he has argued that there was -- there's rape and forcible rape. He's argued that, in the case of rape or incest, it was still -- it would be a crime to engage in having an abortion. I just fundamentally disagree with my friend.
RADDATZ: Congressman Ryan.
RYAN: All I'm saying is if you believe that life begins at conception, that therefore doesn't change the definition of life. That's a principle. The policy of a Romney administration is to oppose abortion with exceptions for rape, incest and life of the mother. Now, I've got to take issue with the Catholic Church and religious liberty.
BIDEN: You have, on the issue of Catholic social doctrine, taken issue.
RYAN: If they agree with you, then why would they keep suing you? It's a distinction without a difference.
RADDATZ: I want to go back to the abortion question here. If the Romney-Ryan ticket is elected, should those who believe that abortion should remain legal be worried?
RYAN: We don't think that unelected judges should make this decision, that people, through their elected representatives and reaching a consensus in society through the democratic process, should make this determination.
BIDEN: The court -- the next president will get one or two Supreme Court nominees. That's how close Roe v. Wade is.
Just ask yourself: With Robert Bork being the chief adviser on the court for Mr. Romney, who do you think he's likely to appoint? Do you think he's likely to appoint someone like Scalia or someone else on the court, far right, that would outlaw Planned -- excuse me -- outlaw abortion? I suspect that would happen.
I guarantee you that will not happen. We picked two people. We picked people who are open-minded. They've been good justices. So keep an eye on the Supreme Court.
RYAN: Was there a litmus test on them?
BIDEN: There was no litmus test. We picked people who had an open mind, did not come with an agenda.
Topics: Aging, Medicare, Politics
Vice President Joe Biden and Rep. Paul Ryan laid out their parties' competing visions for Medicare at the vice presidential debate in Danville, Ky., on Thursday.
MARTHA RADDATZ: Let's talk about Medicare and entitlements.
Both Medicare and Social Security are going broke and taking a larger share of the budget in the process. Will benefits for Americans under these programs have to change for the programs to survive, Mr. Ryan?
PAUL RYAN: Absolutely. Medicare and Social Security are going bankrupt. These are indisputable facts.
Look, when I look at these programs, we've all had tragedies in our lives. I think about what they've done for my own family. My mom and I had my grandmother move in with us who was facing Alzheimer's. Medicare was there for her, just like it's there for my mom right now who's a Florida senior. After my dad died, my mom and I got Social Security survivors benefits. Helped me pay for college. It helped her go back to college in her 50s, where she started a small business because of the new skills she got. She paid all of her taxes on the promise that these programs would be there for her. We will honor this promise.
And the best way to do it is reform it for my generation. You see, if you reform these programs for my generation, people 54 and below, you can guarantee they don't change for people in or near retirement, which is precisely what Mitt Romney and I are proposing.
Look at Obamacare does. Obamacare takes $716 billion from Medicare to spend on Obamacare. Even their own chief actuary at Medicare backs this up. He says you can't spend the same dollar twice. You can't claim that this money goes to Medicare and Obamacare.
And then they put this new Obamacare board in charge of cutting Medicare each and every year in ways that will lead to denied care for current seniors. This board, by the way, it's 15 people. The president's supposed to appoint them next year. And not one of them even has to have medical training.
And Social Security, if we don't shore up Social Security, when we run out of the IOUs, when the program goes bankrupt, a 25 percent across-the-board benefit cut kicks in on current seniors in the middle of their retirement. We're going to stop that from happening.
They haven't put a credible solution on the table. He'll tell you about vouchers. He'll say all these things to try and scare people.
Here's what we're saying: Give younger people, when they become Medicare-eligible, guaranteed coverage options that you can't be denied, including traditional Medicare.
Choose your plan, and then Medicare subsidizes your premiums, not as much for the wealthy people, more coverage for middle-income people and total out-of-pocket coverage for the poor and the sick. Choice and competition -- we would rather have 50 million future seniors determine how their Medicare is delivered to them instead of 15 bureaucrats deciding what -- if, where, when they get it.
RADDATZ: Vice President Biden, two minutes.
JOE BIDEN: You know, I heard that death panel argument from Sarah Palin. It seems that every vice presidential debate, I hear this kind of stuff about panels. But let's talk about Medicare.
What we did is we saved $716 billion and put it back -- applied it to Medicare. We cut the cost of Medicare. We stopped overpaying insurance companies when doctors and hospitals -- the AMA supported what we did. AARP endorsed what we did. And it extends the life of Medicare to 2024. They want to wipe this all out. It also gave more benefits. Any senior out there, ask yourself: Do you have more benefits today? You do. If you're near the doughnut hole, you have $600 more to help your prescription drug costs. You get wellness visits without copays. They wipe all of this out, and Medicare goes -- becomes insolvent in 2016, number one.
Number two, guaranteed benefit -- it's a voucher. When they first proposed -- when the congressman had his first voucher program, the CBO said it would cost $6,400 a year, Martha, more for every senior 55 and below when they got there. He knew that, yet he got it -- all the guys in Congress, and women in the Republican party to vote for it. Gov. Romney, knowing that, said, I would sign it were I there. Who you believe, the AMA? Me? A guy who's fought his whole life for this? Or somebody who had actually put in motion a plan that knowingly cut -- added $6,400 a year more to the cost of Medicare?
Now they got a new plan. Trust me, it's not going to cost you any more. Folks, follow your instincts on this one.
And with regard to Social Security, we will not privatize it. If we had listened to Gov. Romney and the congressman during the Bush years, imagine where all those seniors would be now if their money had been in the market. Their ideas are old, and their ideas are bad, and they eliminate the guarantee of Medicare.
RYAN: Here's the problem. They got caught with their hands in the cookie jar turning Medicare into a piggy bank for Obamacare. Their own actuary from the administration came to Congress and said one out of six hospitals and nursing homes are going to go out of business as a result of this.
BIDEN: That's not what they said.
RYAN: Seven point four million seniors are projected to lose the current Medicare Advantage coverage they have. That's a $3,200 benefit cut.
BIDEN: That didn't happen.
RYAN: What we're saying --
BIDEN: More people signed up.
RYAN: These are from your own actuaries.
BIDEN: More people signed up for Medicare Advantage after the change.
RYAN: What they're --
BIDEN: No, nobody is getting shut down.
RYAN: Mr. Vice President, I know --
BIDEN: No -- no --
RYAN: Mr. Vice President, I know you're under a lot of duress to make up for lost ground, but I think people would be better served if we don't keep interrupting each other.
BIDEN: Well, don't take all the four minutes, then.
RYAN: Now let me say this. We are saying, don't change benefits for people 55 and above. They already organized their retirement around these promises.
BIDEN: They already are --
RYAN: But you want to -- these programs for those of us --
RADDATZ: Let me ask you this: what is your specific plan for seniors who really can't afford to make up the difference in the value of what you call a premium support plan and others call a voucher?
RYAN: A hundred percent coverage for them.
RADDATZ: And what --
RYAN: That's what we're saying.
RADDATZ: How do you make that up?
RYAN: So we're saying income-adjust these premium support payments by taking down the subsidies for wealthy people. Look, this is a plan -- by the way, that $6,400 number, it was misleading then. It's totally inaccurate now. This is a plan that's bipartisan. It's a plan I put together with a prominent Democrat senator from Oregon.
BIDEN: There's not one Democrat who endorsed this --
RYAN: It's a plan --
BIDEN: -- not one Democrat who signed his plan.
RYAN: Our partner is a Democrat from Oregon.
BIDEN: And he said he does no longer supports --
RYAN: We put it together with the former Clinton budget director.
BIDEN: Who disavows it.
RYAN: This idea -- this idea came from the Clinton commission to save Medicare, chaired by Sen. John Breaux. Here's the point, Martha.
BIDEN: Which was rejected.
RYAN: If we don't fix this problem pretty soon, then current seniors get cut.
Here's the problem. Ten thousand people are retiring every single day in America today, and they will for 20 years. That's not a political thing. That's a math thing.
BIDEN: Martha, if we just did one thing, if they allow Medicare to bargain for the cost of drugs like Medicaid can, that would save $156 billion right off the bat.
RYAN: And it would deny seniors choices.
BIDEN: Seniors are not denied.
BIDEN: Sorry, they are not denied.
Look, folks, and all you seniors out there, have you been denied choices? Have you lost Medicare Advantage or, if you have signed up --
RYAN: Because it's working well right now.
BIDEN: Because we changed the law.
RADDATZ: Vice President Biden, let me ask you, if it could help solve the problem, why not very slowly raise the Medicare eligibility age by two years, as Congressman Ryan suggests?
BIDEN: Look, I was there when we did that with Social Security, in 1983. I was one of eight people sitting in the room that included Tip O'Neill negotiating with President Reagan. We all got together, and everybody said, as long as everybody's in the deal, everybody's in the deal, and everybody is making some sacrifice, we can find a way. We made the system solvent to 2033.
We will not, though, be part of any voucher plan eliminating -- the voucher says, Mom, when you're 65, go out there, shop for the best insurance you can get, you're out of Medicare. You can buy back in, if you want, with this voucher, which will not keep pace with health care costs, because if it did keep pace with health care costs, there would be no savings. That's why they go the voucher. We will be no part of a voucher program or the privatization of Social Security.
RYAN: A voucher is you go to your mailbox, get a check and buy something. Nobody's proposing that. Barack Obama, four years ago, running for president, said if you don't have any fresh ideas, use scare tactics to scare voters. If you don't have a good record to run on, paint your opponent as someone people should run from. Make a big election about small ideas.
RADDATZ: You were one of the few lawmakers to stand with President Bush when he was seeking to partially privatize Social Security.
RYAN: For younger people. What we said then and what I've always agreed is let younger Americans have a voluntary choice of making their money work faster for them within the Social Security system.
BIDEN: You saw how well that worked.
RYAN: That's not what Mitt Romney's proposing. What we're saying is no changes for anybody 55 and above.
BIDEN: What Mitt Romney is proposing --
RYAN: And then the kinds of the changes we're talking about for younger people like myself is don't increase the benefits for wealthy people as fast as everybody else --
BIDEN: Martha --
RYAN: -- slowly raise the retirement age over time.
RYAN: It wouldn't get to the age of 70 until the year 2103, according to the actuaries.
Now, here's the issue.
RADDATZ: Quickly, Vice President.
BIDEN: Quickly, the bottom line here is that all the studies show that if we went with Social Security proposal made by Mitt Romney, if you're 40 -- in your 40s now, you will pay $2,600 a year -- you get $2,600 a year less in Social Security.
If you're in your 20s now, you get $4,700 a year less. The idea of changing -- and change being, in this case, to cut the benefits for people without taking other action you could do to make it work -- is absolutely the wrong way.
These guys haven't been big on Medicare from the beginning. Their party's not been big on Medicare from the beginning. And they've always been about Social Security as little as you can do. Look, folks, use your common sense. Who do you trust on this? A man who introduced a bill that would raise it $6,400 a year, knowing it and passing it, and Romney saying he'd sign it? Or me and the president?
RYAN: That statistic was completely misleading. But more importantly --
BIDEN: That's -- there are the facts, right?
RYAN: -- this is -- this is what politicians do when they don't have a record to run on: try to scare people from voting for you. If you don't get ahead of this problem, it's going to --
BIDEN: Medicare beneficiaries have more benefits now --
RYAN: We are not going to run away -- we are not going to run away --
RADDATZ: OK. We're going to -- we're going to move on to a very simple question to you both.
RYAN: Medicare and Social Security did so much for my own family. We are not going to jeopardize this program, but we have to save it for the next generation so it doesn't go bankrupt.
BIDEN: You are jeopardizing the program. You're changing the program from a guaranteed benefit to a premium support. Whatever you call it, the bottom line is people are going to have to pay more money out of their pocket.
RYAN: The wealthy would.
BIDEN: And the families I know and the families I come from -- they don't have the money to pay more out of --
RADDATZ: Gentlemen, gentlemen --
RYAN: That's why we're saying more for lower-income people and less for higher-income people.
RADDATZ: I would like to move on to a very simple question for both of you. And something tells me --
RADDATZ: -- I won't get a very simple answer. But let me ask you this.
BIDEN: I gave you a simple answer: He's raising the cost of Medicare.
Topics: Medicare, Politics, Aging, Health Costs, Insurance
Medicare and how to rein in its rapidly growning costs was a major focus of Wednesday night's presidential debate in Denver between President Barack Obama and former Mass. Gov. Mitt Romney.
>> More Debate Video: On 'Obamacare' | On Medicaid
A transcript follows.
JIM LERHER: First, Governor Romney, you have two minutes on Social Security and entitlements.
MITT ROMNEY: Well, Jim, our seniors depend on these programs, and I know anytime we talk about entitlements, people become concerned that something's going to happen that's going to change their life for the worse.
And the answer is neither the president nor I are proposing any changes for any current retirees or near retirees, either to Social Security or Medicare. So if you're 60 or around 60 or older, you don't need to listen any further.
But for younger people, we need to talk about what changes are going to be occurring. Oh, I just thought about one. And that is, in fact, I was wrong when I said the president isn't proposing any changes for current retirees. In fact he is on Medicare. On Social Security he's not.
But on Medicare, for current retirees, he's cutting $716 billion from the program. Now, he says by not overpaying hospitals and providers. Actually just going to them and saying, we're going to reduce the rates you get paid across the board, everybody's going to get a lower rate. That's not just going after places where there's abuse. That's saying we're cutting the rates.
Some 15 percent of hospitals and nursing homes say they won't take anymore Medicare patients under that scenario.
We also have 50 percent of doctors who say they won't take more Medicare patients.
We have 4 million people on Medicare Advantage that will lose Medicare Advantage because of those $716 billion in cuts. I can't understand how you can cut Medicare $716 billion for current recipients of Medicare.
Now, you point out, well, we're putting some back. We're going to give a better prescription program. That's $1 for every $15 you've cut. They're smart enough to know that's not a good trade.
I want to take that $716 billion you've cut and put it back into Medicare. By the way, we can include a prescription program if we need to improve it.
But the idea of cutting $716 billion from Medicare to be able to balance the additional cost of Obamacare is, in my opinion, a mistake.
And with regards to young people coming along, I've got proposals to make sure Medicare and Social Security are there for them without any question.
LEHRER: Mr. President?
BARACK OBAMA: First of all, I think it's important for Gov. Romney to present this plan that he says will only affect folks in the future.
And the essence of the plan is that you would turn Medicare into a voucher program. It's called premium support, but it's understood to be a voucher program. His running mate …
LEHRER: And you don't support that?
OBAMA: I don't. And let me explain why.
ROMNEY: Again, that's for future people, right, not for current retirees.
OBAMA: I understand.
If you're 54 or 55, you might want to listen, because this will affect you.
The idea, which was originally presented by Congressman Ryan, your running mate, is that we would give a voucher to seniors and they could go out in the private marketplace and buy their own health insurance.
The problem is that because the voucher wouldn't necessarily keep up with health care inflation, it was estimated that this would cost the average senior about $6,000 a year.
Now, in fairness, what Gov. Romney has now said is he'll maintain traditional Medicare alongside it. But there's still a problem, because what happens is, those insurance companies are pretty clever at figuring out who are the younger and healthier seniors. They recruit them, leaving the older, sicker seniors in Medicare. And every health care economist that looks at it says, over time, what'll happen is the traditional Medicare system will collapse.
And then what you've got is folks like my grandmother at the mercy of the private insurance system precisely at the time when they are most in need of decent health care.
So, I don't think vouchers are the right way to go. And this is not only my opinion. AARP thinks that the savings that we obtained from Medicare bolster the system, lengthen the Medicare trust fund by eight years. Benefits were not affected at all. And ironically, if you repeal Obamacare, and I have become fond of this term, "Obamacare," if you repeal it, what happens is those seniors right away are going to be paying $600 more in prescription care. They're now going to have to be paying copays for basic checkups that can keep them healthier.
And the primary beneficiary of that repeal are insurance companies that are estimated to gain billions of dollars back when they aren't making seniors any healthier. And I don't think that's the right approach when it comes to making sure that Medicare is stronger over the long term.
LEHRER: We'll talk specifically about health care in a moment. But do you support the voucher system, Governor?
ROMNEY: What I support is no change for current retirees and near-retirees to Medicare. And the president supports taking $716 billion out of that program.
LEHRER: And what about the vouchers?
ROMNEY: So that's number one.
Number two is for people coming along that are young, what I do to make sure that we can keep Medicare in place for them is to allow them either to choose the current Medicare program or a private plan. Their choice.
They get to choose, and they'll have at least two plans that will be entirely at no cost to them. So they don't have to pay additional money, no additional $6,000. That's not going to happen. They'll have at least two plans.
And by the way, if the government can be as efficient as the private sector and offer premiums that are as low as the private sector, people will be happy to get traditional Medicare or they'll be able to get a private plan.
I know my own view is I'd rather have a private plan. I'd just assume not have the government telling me what kind of health care I get. I'd rather be able to have an insurance company. If I don't like them, I can get rid of them and find a different insurance company. But people make their own choice.
The other thing we have to do to save Medicare? We have to have the benefits high for those that are low income, but for higher income people, we're going to have to lower some of the benefits. We have to make sure this program is there for the long term. That's the plan that I've put forward.
And, by the way the idea came not even from Paul Ryan or Sen. Wyden, who's the co-author of the bill with Paul Ryan in the Senate, but also it came from Bill Clinton's chief of staff. This is an idea that's been around a long time, which is saying, hey, let's see if we can't get competition into the Medicare world so that people can get the choice of different plans at lower cost, better quality. I believe in competition.
OBAMA: Jim, if I can just respond very quickly, first of all, every study has shown that Medicare has lower administrative costs than private insurance does, which is why seniors are generally pretty happy with it.
And private insurers have to make a profit. Nothing wrong with that. That's what they do. And so you've got higher administrative costs, plus profit on top of that. And if you are going to save any money through what Gov. Romney's proposing, what has to happen is, is that the money has to come from somewhere.
And when you move to a voucher system, you are putting seniors at the mercy of those insurance companies. And over time, if traditional Medicare has decayed or fallen apart, then they're stuck.
And this is the reason why AARP has said that your plan would weaken Medicare substantially. And that's why they were supportive of the approach that we took.
One last point I want to make. We do have to lower the cost of health care, not just in Medicare and Medicaid ...
LEHRER: Talk about that in a minute.
OBAMA: ... but overall.
OBAMA: And so ...
ROMNEY: That's a big topic. Can we stay on Medicare?
OBAMA: Is that a separate topic?
LEHRER: Yeah, we're going to, yeah, I want to get to it.
OBAMA: I'm sorry.
LEHRER: But all I want to do is go very quickly before we leave the economy ...
ROMNEY: Let's get back to Medicare.
The president said that the government can provide the service at lower cost and without a profit.
LEHRER: All right.
ROMNEY: If that's the case, then it will always be the best product that people can purchase.
LEHRER: Wait a minute, Governor.
ROMNEY: But my experience the private sector typically is able to provide a better product at a lower cost.
LEHRER: All right. Can the two of you agree that the voters have a choice, a clear choice between the two of you on Medicare?
Topics: Medicaid, Politics, States
The Medicaid program was not a major focus of Wednesday night's debate between President Barack Obama and former Mass. Gov. Mitt Romney, but it was a topic of discussion as the two candidates laid out their domestic policy priorities.
>> More Debate Video: On Medicare | On 'Obamacare'
BARACK OBAMA: You know, when Gov. Romney stood on a stage with other Republican candidates for the nomination and he was asked, would you take $10 of spending cuts for just $1 of revenue? And he said no.
Now, if you take such an unbalanced approach, then that means you are going to be gutting our investments in schools and education. It means that Gov. Romney talked about Medicaid and how we could send it back to the states, but effectively this means a 30 percent cut in the primary program we help for seniors who are in nursing homes, for kids who are with disabilities.
JIM LEHRER: Mr. President, I'm sorry.
OBAMA: And that is not a right strategy for us to move forward.
OBAMA: As I indicated before, when you talk about shifting Medicaid to states, we're talking about potentially a 30 percent cut in Medicaid over time.
Now that may not seem like a big deal when it just is numbers on a sheet of paper, but if we're talking about a family who's got an autistic kid and is depending on that Medicaid, that's a big problem.
And governors are creative. There's no doubt about it. But they're not creative enough to make up for 30 percent of revenue on something like Medicaid. What ends up happening is some people end up not getting help.
MITT ROMNEY: Jim, we've gone on a lot of topics there, and so it's going to take a minute to go from Medicaid to schools. Come back to to oil, to tax breaks, then companies going overseas. So let's go through them one by one.
ROMNEY: And, finally, Medicaid to states? I'm not quite sure where that came in, except this, which is, I would like to take the Medicaid dollars that go to states and say to a state, you're going to get what you got last year, plus inflation, plus 1 percent, and then you're going to manage your care for your poor in the way you think best.
And I remember, as a governor, when this idea was floated by Tommy Thompson, the governors -- Republican and Democrats -- said, please let us do that. We can care for our own poor in so much better and more effective a way than having the federal government tell us how to care for our poor.
So let's state, one of the magnificent things about this country is the whole idea that states are the laboratories of democracy. Don't have the federal government tell everybody what kind of training programs they have to have and what kind of Medicaid they have to have. Let states do this.
And, by the way, if a state gets in trouble, well, we can step in and see if we can find a way to help them.
Topics: Health Reform, Politics, Medicare, Quality, Health Costs, Insurance, Hospitals
The bulk of Wednesday night's presidential debate in Denver focused on the topic of health care. In this segment, President Barack Obama and former Mass. Gov. Mitt Romney discuss the 2010 health law.
>> More Debate Video: On Medicare | On Medicaid
JIM LEHRER: You want the Affordable Care Act repealed. Why?
MITT ROMNEY: I sure do. Well, in part, it comes, again, from my experience. You know, I was in New Hampshire. A woman came to me and she said, look, I can't afford insurance for myself or my son. I met a couple in Appleton, Wis., and they said, we're thinking of dropping our insurance, we can't afford it.
And the number of small businesses I've gone to that are saying they're dropping insurance because they can't afford it, the cost of health care is just prohibitive. And we've got to deal with cost.
And, unfortunately, when you look at Obamacare, the Congressional Budget Office has said it will cost $2,500 a year more than traditional insurance. So it's adding to cost. And as a matter of fact, when the president ran for office, he said that by this year he would have brought down the cost of insurance for each family by $2,500 a family. Instead, it's gone up by that amount. So it's expensive. Expensive things hurt families. So that's one reason I don't want it.
Second reason: It cuts $716 billion from Medicare to pay for it. I want to put that money back in Medicare for our seniors.
Number three, it puts in place an unelected board that's going to tell people ultimately what kind of treatments they can have. I don't like that idea.
Fourth, there was a survey done of small businesses across the country, said, what's been the effect of Obamacare on your hiring plans? And three-quarters of them said it makes us less likely to hire people. I just don't know how the president could have come into office, facing 23 million people out of work, rising unemployment, an economic crisis at the kitchen table, and spend his energy and passion for two years fighting for Obamacare instead of fighting for jobs for the American people. It has killed jobs.
And the best course for health care is to do what we did in my state: craft a plan at the state level that fits the needs of the state. And then let's focus on getting the costs down for people, rather than raising it with the $2,500 additional premium.
LEHRER: Mr. President, the argument against repeal?
BARACK OBAMA: Well, four years ago, when I was running for office, I was traveling around and having those same conversations that Gov. Romney talks about. And it wasn't just that small businesses were seeing costs skyrocket and they couldn't get affordable coverage even if they wanted to provide it to their employees. It wasn't just that this was the biggest driver of our federal deficit, our overall health care costs, but it was families who were worried about going bankrupt if they got sick, millions of families, all across the country.
If they had a pre-existing condition, they might not be able to get coverage at all. If they did have coverage, insurance companies might impose an arbitrary limit. And so as a consequence, they're paying their premiums, somebody gets really sick, lo and behold, they don't have enough money to pay the bills, because the insurance companies say that they've hit the limit.
So we did work on this, alongside working on jobs, because this is part of making sure that middle-class families are secure in this country.
And let me tell you exactly what Obamacare did. Number one, if you've got health insurance, it doesn't mean a government takeover. You keep your own insurance. You keep your own doctor. But it does say insurance companies can't jerk you around. They can't impose arbitrary lifetime limits. They have to let you keep your kid on your insurance plan until you're 26 years old. And it also says that you're going to have to get rebates if insurance companies are spending more on administrative costs and profits than they are on actual care.
Number two, if you don't have health insurance, we're essentially setting up a group plan that allows you to benefit from group rates that are typically 18 percent lower than if you're out there trying to get insurance on the individual market.
Now, the last point I'd make before ...
LEHRER: Two minutes -- two minutes is up, sir.
OBAMA: No, I think -- I had five seconds before you interrupted me, was the irony is that we've seen this model work really well in Massachusetts, because Gov. Romney did a good thing, working with Democrats in the state to set up what is essentially the identical model, and as a consequence people are covered there. It hasn't destroyed jobs. And as a consequence, we now have a system in which we have the opportunity to start bringing down costs, as opposed to just leaving millions of people out in the cold.
LEHRER: Your five seconds went away a long time ago.
All right, Governor. Governor, tell the president directly why you think what he just said is wrong about Obamacare?
ROMNEY: Well, I did with my first statement.
First of all, I like the way we did it in Massachusetts. I like the fact that in my state, we had Republicans and Democrats come together and work together. What you did instead was to push through a plan without a single Republican vote. As a matter of fact, when Massachusetts did something quite extraordinary -- elected a Republican senator to stop Obamacare, you pushed it through anyway.
So entirely on a partisan basis, instead of bringing America together and having a discussion on this important topic, you pushed through something that you and Nancy Pelosi and Harry Reid thought was the best answer and drove it through.
What we did in a legislature 87 percent Democrat, we worked together: 200 legislators in my legislature, only two voted against the plan by the time we were finished. What were some differences? We didn't raise taxes. You've raised them by $1 trillion under Obamacare. We didn't cut Medicare. Of course, we don't have Medicare, but we didn't cut Medicare by $716 billion.
We didn't put in place a board that can tell people ultimately what treatments they're going to receive. We didn't also do something that I think a number of people across this country recognize, which is put people in a position where they're going to lose the insurance they had and they wanted.
Right now, the CBO says up to 20 million people will lose their insurance as Obamacare goes into effect next year. And likewise, a study by McKinsey and Company of American businesses said 30 percent of them are anticipating dropping people from coverage.
So for those reasons, for the tax, for Medicare, for this board, and for people losing their insurance, this is why the American people don't want Obamacare. It's why Republicans said, do not do this, and the Republicans had the plan. They put a plan out. They put out a plan, a bipartisan plan. It was swept aside.
I think something this big, this important has to be done on a bipartisan basis. And we have to have a president who can reach across the aisle and fashion important legislation with the input from both parties.
OBAMA: Gov. Romney said this has to be done on a bipartisan basis. This was a bipartisan idea. In fact, it was a Republican idea. And Gov. Romney at the beginning of this debate wrote and said what we did in Massachusetts could be a model for the nation.
And I agree that the Democratic legislators in Massachusetts might have given some advice to Republicans in Congress about how to cooperate, but the fact of the matter is, we used the same advisers, and they say it's the same plan.
When Governor Romney talks about this board, for example, unelected board that we've created, what this is, is a group of health care experts, doctors, etc., to figure out, how can we reduce the cost of care in the system overall.
Because there are two ways of dealing with our health care crisis. One is to simply leave a whole bunch of people uninsured and let them fend for themselves, to let businesses figure out how long they can continue to pay premiums until finally they just give up, and their workers are no longer getting insured, and that's been the trend line.
Or, alternatively, we can figure out, how do we make the cost of care more effective? And there are ways of doing it.
So at Cleveland Clinic, one of the best health care systems in the world, they actually provide great care cheaper than average. And the reason they do is because they do some smart things. They say, if a patient's coming in, let's get all the doctors together at once, do one test instead of having the patient run around with 10 tests. Let's make sure that we're providing preventive care so we're catching the onset of something like diabetes. Let's pay providers on the basis of performance as opposed to on the basis of how many procedures they've engaged in.
Now, so what this board does is basically identifies best practices and says, let's use the purchasing power of Medicare and Medicaid to help to institutionalize all these good things that we do.
And the fact of the matter is that, when Obamacare is fully implemented, we're going to be in a position to show that costs are going down. And over the last two years, health care premiums have gone up -- it's true -- but they've gone up slower than any time in the last 50 years. So we're already beginning to see progress. In the meantime, folks out there with insurance, you're already getting a rebate.
Let me make one last point. Gov. Romney says, we should replace it, I'm just going to repeal it, but we can replace it with something. But the problem is, he hasn't described what exactly we'd replace it with, other than saying we're going to leave it to the states.
But the fact of the matter is that some of the prescriptions that he's offered, like letting you buy insurance across state lines, there's no indication that that somehow is going to help somebody who's got a pre-existing condition be able to finally buy insurance. In fact, it's estimated that by repealing Obamacare, you're looking at 50 million people losing health insurance at a time when it's vitally important.
LEHRER: Let's let the governor explain what you would do if Obamacare is repealed. How would you replace it?
ROMNEY: Well, actually it's lengthy description. But, number one, preexisting conditions are covered under my plan. Number two, young people are able to stay on their family plan. That's already offered in the private marketplace. You don't have to have the government mandate that for that to occur.
But let's come back to something the president and I agree on, which is the key task we have in health care is to get the cost down so it's more affordable for families. And then he has as a model for doing that a board of people at the government, an unelected board, appointed board, who are going to decide what kind of treatment you ought to have.
In my opinion, the government is not effective in bringing down the cost of almost anything. As a matter of fact, free people and free enterprises trying to find ways to do things better are able to be more effective in bringing down the cost than the government will ever be.
Your example of the Cleveland Clinic is my case in point, along with several others I could describe.
This is the private market. These are enterprises competing with each other, learning how to do better and better jobs.
I used to consult to hospitals and to health care providers. I was astonished at the creativity and innovation that exists in the American people.
In order to bring the cost of health care down, we don't need to have a board of 15 people telling us what kinds of treatments we should have. We instead need to put insurance plans, providers, hospitals, doctors on target such that they have an incentive, as you say, performance pay, for doing an excellent job, for keeping costs down, and that's happening. Intermountain Healthcare does it superbly well, Mayo Clinic is doing it superbly well, Cleveland Clinic, others.
But the right answer is not to have the federal government take over health care and start mandating to the providers across America, telling a patient and a doctor what kind of treatment they can have.
That's the wrong way to go. The private market and individual responsibility always work best.
OBAMA: Let me just point out first of all this board that we're talking about can't make decisions about what treatments are given. That's explicitly prohibited in the law. But let's go back to what Gov. Romney indicated, that under his plan, he would be able to cover people with preexisting conditions.
Well, actually Governor, that isn't what your plan does. What your plan does is to duplicate what's already the law, which says if you are out of health insurance for three months, then you can end up getting continuous coverage and an insurance company can't deny you if it's been under 90 days.
But that's already the law, and that doesn't help the millions of people out there with preexisting conditions. There's a reason why Gov.Romney set up the plan that he did in Massachusetts. It wasn't a government takeover of health care. It was the largest expansion of private insurance. But what it does say is that "insurers, you've got to take everybody."
Now, that also means that you've got more customers. But when Gov. Romney says that he'll replace it with something, but can't detail how it will be in fact replaced and the reason he set up the system he did in Massachusetts was because there isn't a better way of dealing with the preexisting conditions problem.
It just reminds me of, you know, he says that he's going to close deductions and loopholes for his tax plan. That's how it's going to be paid for, but we don't know the details. He says that he's going to replace Dodd-Frank, Wall Street reform, but we don't know exactly which ones. He won't tell us. He now says he's going to replace Obamacare and ensure that all the good things that are in it are going to be in there, and you don't have to worry.
And at some point, I think the American people have to ask themselves, is the reason that Gov. Romney is keeping all these plans to replace secret because they're too good? Is it because that somehow middle-class families are going to benefit too much from them?
No. The reason is, is because, when we reform Wall Street, when we tackle the problem of pre-existing conditions, then, you know, these are tough problems and we've got to make choices. And the choices we've made have been ones that ultimately are benefiting middle-class families all across the country.
LEHRER: We're going to move to ...
ROMNEY: No, I have to respond to that.
LEHRER: No, but ...
ROMNEY: Which is my experience as a governor is if I come in and lay down a piece of legislation and say, it's my way or the highway, I don't get a lot done. What I do is the same way that Tip O'Neill and Ronald Reagan worked together some years ago. When Ronald Reagan ran for office, he laid out the principles that he was going to foster. He said he was going to lower tax rates. He said he was going to broaden the base. You've said the same thing, you're going to simplify the tax code, broaden the base.
Those are my principles. I want to bring down the tax burden on middle-income families. And I'm going to work together with Congress to say, OK, what are the various ways we could bring down deductions, for instance? One way, for instance, would be to have a single number. Make up a number, $25,000, $50,000. Anybody can have deductions up to that amount. And then that number disappears for high-income people. That's one way one could do it. One could follow Bowles-Simpson as a model and take deduction by deduction and make differences that way. There are alternatives to accomplish the objective I have, which is to bring down rates, broaden the base, simplify the code, and create incentives for growth.
And with regards to health care, you had remarkable details with regards to my pre-existing condition plan. You obviously studied up on my plan. In fact, I do have a plan that deals with people with pre-existing conditions. That's part of my health care plan. And what we did in Massachusetts is a model for the nation state by state. And I said that at that time.
The federal government taking over health care for the entire nation and whisking aside the 10th Amendment, which gives states the rights for these kinds of things, is not the course for America to have a stronger, more vibrant economy.
KHN's Marilyn Werber Serafini talks about how the Medicare issue is playing in the race for Pennsylvania's 6th Congressional District between Democrat Dr. Manan Trivedi and GOP incumbent Jim Gerlach.
>>Related: Medicare Battle Heats Up California House Race
Topics: Politics, Medicare
In their acceptance speeches at the Democratic National Convention in Charlotte, N.C., Thursday night, President Barack Obama and Vice President Joe Biden both denounced Rep. Paul Ryan's plan for Medicare as a "voucher."
A transcript follows:
JOE BIDEN: Speaking of tough calls: Last week we heard at the Republican convention, we heard our opponents, we heard them pledge that they, too, had the courage to make the tough calls. That's what they said.
But, folks, in case you didn't notice -- and I say to my fellow Americans -- in case you didn't notice, they didn't have the courage to tell you what calls they would make. They never mentioned any of that.
Mrs. Robinson, you watched from home, I guess, from the White House -- you heard them talk so much about they cared so much about Medicare. How much they wanted to preserve it. That's what they told you.
But let's look at what they didn't tell you. What they didn't tell you is that the plan they have already put down on paper would immediately cut benefits to more than 30 million seniors already on Medicare. What they didn't tell you is that the plan they are proposing would cause Medicare to go bankrupt by 2016. And what they really didn't tell you is, they -- if you want to know -- they're not for preserving Medicare -- at all. They're for a whole new plan. It's called "vouchercare." Look, folks, that's not courage. That's not even truthful.
BARACK OBAMA: I refuse to ask students to pay more for college or kick children out of Head Start programs, to eliminate health insurance for millions of Americans who are poor and elderly or disabled -- all so those with the most can pay less. I'm not going along with that.
And I will never turn Medicare into a voucher. No American should ever have to spend their golden years at the mercy of insurance companies. They should retire with the care and dignity that they have earned. Yes, we will reform and strengthen Medicare for the long haul, but we'll do it by reducing the cost of health care, not by asking seniors to pay thousands of dollars more. And we will keep the promise of Social Security by taking the responsible steps to strengthen it, not by turning it over to Wall Street.
Topics: Politics, Health Reform, Medicare, Medicaid, Insurance, Health Costs
Former President Bill Clinton, reminding voters that "I've been there," gave a 50-minute defense of the Obama administration's record Wednesday night at the Democratic National Convention in Charlotte, N.C., In the video excerpt above, Clinton praised Obama's health policies and drew contrasts to Republican proposals.
PRESIDENT BILL CLINTON: That brings me to health care.
The Republicans call it, derisively, "Obamacare." They say it's a government takeover, a disaster, and that if we'll just elect them, they'll repeal it. Well, are they right?
Let's take a look at what's actually happened so far.
First, individuals and businesses have already gotten more than $1 billion in refunds from insurance companies, because the new law requires 80 percent to 85 percent of your premium to go to your health care, not profits or promotion.
And the gains are even greater than that, because a bunch of insurance companies have applied to lower their rates to comply with the requirement.
Second, more than 3 million young people between 19 and 25 are insured for the first time, because their parents' policies can cover them.
Third, millions of seniors are receiving preventive care, all the way from breast cancer screenings to tests for heart problems and scores of other things, and younger people are getting them, too.
Fourth, soon the insurance companies -- not the government, the insurance companies -- will have millions of new customers, many of them middle-class people with pre-existing conditions who never could get insurance before.
Now, finally, listen to this. For the last two years -- after going up at three times the rate of inflation for a decade -- for the last two years, health care costs have been under 4 percent in both years for the first time in 50 years.
So let me ask you something. Are we better off because President Obama fought for health care reform? You bet we are.
Now, there were two other attacks on the president in Tampa I think deserve an answer. First, both Gov. Romney and Congressman Ryan attacked the president for allegedly "robbing Medicare" of $716 billion. That's the same attack they leveled against the Congress in 2010, and they got a lot of votes on it. But it's not true.
Look, here's what really happened. You be the judge. Here's what really happened. There were no cuts to benefits at all, none.
What the president did was to save money by taking the recommendations of a commission of professionals to cut unwarranted subsidies to providers and insurance companies that were not making people healthier and were not necessary to get the providers to provide the service.
And instead of raiding Medicare, he used the savings to close the doughnut hole in the Medicare drug program.
And -- you all got to listen carefully to this; this is really important -- and to add eight years to the life of the Medicare trust fund so it is solvent until 2024.
So, President Obama and the Democrats didn't weaken Medicare. They strengthened Medicare.
Now, when Congressman Ryan looked into that TV camera and attacked President Obama's Medicare savings as, quote, "the biggest, coldest power play," I didn't know whether to laugh or cry, because that $716 billion is exactly, to the dollar, the same amount of Medicare savings that he has in his own budget.
You've got to give one thing: It takes some brass to attack a guy for doing what you did.
Now you're having a good time, but this is getting serious. I want you to listen. It's important, because a lot of people believe this stuff.
Now, at least on this issue, on this one issue, Gov. Romney has been consistent. He attacked President Obama, too, but he actually wants to repeal those savings and give the money back to the insurance companies.
He wants to go back to the old system, which means we'll reopen the donut hole and force seniors to pay more for drugs, and we'll reduce the life of the Medicare trust fund by eight full years.
So if he's elected, and if he does what he promised to do, Medicare will now go broke in 2016. Think about that. That means after all we won't have to wait until their voucher program kicks in, in 2023, to see the end of Medicare as we know it. They're going to do it to us sooner than we thought.
Now, folks, this is serious, because it gets worse. And you won't be laughing when I finish telling you this. They also want to block grant Medicaid and cut it by a third over the coming 10 years. Of course, that's going to really hurt a lot of poor kids.
But that's not all. A lot of folks don't know it, but nearly two-thirds of Medicaid is spent on nursing home care for Medicare seniors who are eligible for Medicaid.
It's going to end Medicare as we know it. And a lot of that money is also spent to help people with disabilities, including a lot of middle-class families whose kids have Down syndrome or autism or other severe conditions.
And, honestly, just think about it. If that happens, I don't know what those families are going to do. So I know what I'm going to do: I'm going to do everything I can to see that it doesn't happen.
We can't let it happen. We can't.
Topics: Politics, Health Reform, Health Costs, Insurance
Several speakers cited the 2010 health law as a signature achievement of the Obama administration Tuesday night at the Democratic National Convention in Charlotte, N.C. This video sample includes Stacey Lihn, the mother of a child with congenital heart disease, HHS Secretary Kathleen Sebelius, San Antonio Mayor Julián Castro and first lady Michelle Obama.
See Also: Video Excerpts: Kennedy-Romney Debate 1994
STACEY LIHN: Knowing we have that net below us, to catch us if we fall -- or if, God forbid, Zoey needs a heart transplant, Obamacare provides my family security and relief.
But we're also scared. Gov. Romney repealing health care reform is something we worry about literally every single day.
Zoey's third open-heart surgery will happen either next year or the year after. If Mitt Romney becomes president and Obamacare is repealed, there is a good chance she will hit her lifetime cap. There's no way we could afford to pay for all the care she needs to survive.
KATHLEEN SEBELIUS: If you're under 26, you can stay on your parents plan. You can go back to school or get extra training without fear of a health catastrophe bankrupting your entire family. Over three million previously uninsured young adults are now on their parents' plans. That's what change looks like.
Under Obamacare, insurance companies can no longer discriminate against women.
Now, before some wouldn't even cover woman's most basic health needs, like contraception and maternity care -- but still charged us up to 50 percent more than men for a worse plan. They said women who had C-sections or survived breast cancer or even domestic violence had a preexisting condition and would deny them coverage. But this president made it illegal to discriminate against women and ended the practice of insurance companies charging women higher premiums than men for the same coverage.
The president ensured women's access to preventive services like breast cancer screenings. So the good news is: Being a mother is no longer a liability. And being a woman is no longer a preexisting condition.
Now that's what change looks like.
JULIAN CASTRO: When it comes to expanding access to good health care, Mitt Romney says "no."
Actually -- actually, Mitt Romney said "yes," and now he says "no."
Gov. Romney has undergone an extreme makeover.
And it ain't pretty. So here's what we are going to say to Mitt Romney in November: We're going to say, "no."
MICHELLE OBAMA: When it comes to the health of our families, Barack refused to listen to those folks who told him to leave health reform for another day, another president. He didn't care whether it was the easy thing to do politically. No, that is not how he was raised. He cared that it was the right thing to do.
He did it, because he believed that here in America, our grandparents should be able to afford their medicine. Our kids should be able to see a doctor when they're sick. And no one in this country should ever go broke because of an accident or an illness.
And he believes that women are more than capable of making our own choices about our bodies and our health care.
That is what my husband stands for.
Topics: Politics, Health Reform, Women's Health
As part of a video tribute to the late Sen. Edward Kennedy, D-Mass., Democrats showed this 18-year-old debate excerpt at their convention in Charlotte, N.C. on Tuesday. In 1994, Mitt Romney was the Republican nominee for U.S. Senate from Massachusetts, challenging Kennedy, the incumbent at that time.
See Also: 'Obamacare' Plays Starring Role In First Night Of Convention
MITT ROMNEY: I believe that abortion should be safe and legal in this country. I believe that since Roe v. Wade has been the law for 20 years, that we should sustain and support it. And I sustain and support that law and the right of a woman to make that choice.
EDWARD KENNEDY: On the question of the choice issue: I have supported the Roe v. Wade. I am pro-choice. My opponent is multiple choice.
EDWARD KENNEDY: When, Mr. Romney, are you going to tell the people of Massachusetts which health care program you favor?
MITT ROMNEY: I have a plan. I have a position paper on health care. I am happy to show it to you, Senator, any time you'd like.
EDWARD KENNEDY: Mr. Romney, it isn't a question of showing me your paper. It's a question of showing all the people in here that are watching this program the paper.
MITT ROMNEY: ... well they can get ...
EDWARD KENNEDY: They ought to have an opportunity to know.
MITT ROMNEY: I think it's a wonderful idea to take it through piece by piece and ...
EDWARD KENNEDY: That's what you have to do as a legislator.
MITT ROMNEY: I understand ...
EDWARD KENNEDY: That's exactly what you have to do as a legislator.
Topics: Politics, Health Reform, Medicare, Women's Health
Health care was not featured in the Republican presidential nominee's acceptance speech, but former Massachusetts Gov. Mitt Romney repeated his pledge to repeal or replace the incumbent's signature legislative achievement.
MITT ROMNEY: His $716 billion cut to Medicare to finance Obamacare will both hurt today's seniors and depress innovation and jobs in medicine.
And it means that we must rein in the skyrocketing costs of health care by repealing and replacing Obamacare.
As president, I'll protect the sanctity of life. I'll honor the institution of marriage. And I will guarantee America's first liberty: the freedom of religion.
Rep. Paul Ryan, the GOP vice presidential nominee, was not the only speaker who denounced the health law at the Republican National Convention Wednesday night. State Attorneys General Sam Olens of Georgia and Pam Bondi of Florida spoke about the federal lawsuit against the law, and former Ark. Gov. Mike Huckabee called the law's provisions an "attack on my Catholic brothers and sisters."
SAM OLENS: As attorneys general, we have been on the front line defending the Constitution and the American people from a president driven to exercise government power over our freedoms, our rights and our lives. We know that the Constitution limits federal power. But President Obama clearly believes those limits just get in his way. So he ignores them time and again.
PAM BONDI: He talks about giving us more control over health care decisions but instead grants that power to government bureaucrats. He claims that government is responsible for private sector success, but he only thing he is building is bigger government.
MIKE HUCKABEE: I want to clear the air about something that has been said. People wonder whether guys like me, an evangelical, would only support a fellow evangelical? Well my friends I want to tell you something, of the four people on the two tickets, the only self-professed evangelical is Barack Obama. And he supports changing the definition of marriage. Believes that human life is disposable and expendable at any time in the wound, even beyond the womb. And he tells people of faith that they have to bow their knees to the God of government and violate their faith and conscience in order to comply with what he calls, health care. Friends I know we can do better.
Let me say it as clearly as possible, that the attack on my Catholic brothers and sisters is an attack on me.
The Democrats have brought back that old dance, the limbo. To see how low they can go in attempting to limit our ability to practice our faith. But this isn't a battle about contraceptives and Catholics, but about conscience and the Creator. Let me say to you tonight, I care far less as to where Mitt Romney takes his family to church, than I do about where he takes this country.
PAUL RYAN: Maybe the greatest waste of all was time. Here we were, faced with a massive job crisis — so deep that if everyone out of work stood in single file, that unemployment line would stretch the length of the entire American continent. You would think that any president, whatever his party, would make job creation, and nothing else, his first order of economic business.
But this president didn’t do that. Instead, we got a long, divisive, all-or-nothing attempt to put the federal government in charge of health care.
Obamacare comes to more than two thousand pages of rules, mandates, taxes, fees, and fines that have no place in a free country.
The president has declared that the debate over government-controlled health care is over. That will come as news to the millions of Americans who will elect Mitt Romney so we can repeal Obamacare.
And the biggest, coldest power play of all in Obamacare came at the expense of the elderly.
You see, even with all the hidden taxes to pay for the health care takeover, even with new taxes on nearly a million small businesses, the planners in Washington still didn’t have enough money. They needed more. They needed hundreds of billions more. So, they just took it all away from Medicare. Seven hundred and sixteen billion dollars, funneled out of Medicare by President Obama. An obligation we have to our parents and grandparents is being sacrificed, all to pay for a new entitlement we didn’t even ask for. The greatest threat to Medicare is Obamacare, and we’re going to stop it.
In Congress, when they take out the heavy books and wall charts about Medicare, my thoughts go back to a house on Garfield Street in Janesville. My wonderful grandma, Janet, had Alzheimer’s and moved in with Mom and me. Though she felt lost at times, we did all the little things that made her feel loved.
We had help from Medicare, and it was there, just like it’s there for my Mom today. Medicare is a promise, and we will honor it. A Romney-Ryan administration will protect and strengthen Medicare, for my Mom’s generation, for my generation, and for my kids and yours.
So our opponents can consider themselves on notice. In this election, on this issue, the usual posturing on the Left isn’t going to work. Mitt Romney and I know the difference between protecting a program, and raiding it. Ladies and gentlemen, our nation needs this debate. We want this debate. We will win this debate.
Obamacare, as much as anything else, explains why a presidency that began with such anticipation now comes to such a disappointing close.
Excerpts on health issues from Gov. Chris Christie's keynote speech, plus speeches by former Republican Sen. Rick Santorum and former Democratic Rep. Artur Davis.
RICK SANTORUM: Four and a half years ago I stood over a hospital isolette, staring at the tiny hands of our newborn daughter who we hoped was perfectly healthy. But Bella's hands were just a little different. And I knew different wasn't good news. The doctors later told us that Bella -- that Bella was incompatible with life and to prepare to let go. They said even if she did survive, her disabilities would be so severe that Bella would not have a life worth living. We didn't let go.
Today Bella is full of life. And she has made our lives and countless others, much more worth living.
I thank God that America still has one party that reaches out their hands in love to lift up all of God's children, born and unborn.
ARTUR DAVIS: And in terms of their crown-jewel legislative achievement, who knew that when asked, could government conceivably impose a federal mandate requiring middle-class Americans to buy health insurance, whether they could afford it or not, that the Obama answer would be: Yes we can.
CHRIS CHRISTIE: We believe in telling hardworking families the truth about our country's fiscal realities, telling them what they already know: The math of federal spending does not add up.
With $5 trillion in debt added over the last four years, we have no other option but to make the hard choices, cut federal spending and fundamentally reduce the size of this government.
Want to know what they believe? They believe that the American people want to hear the truth about the extent of our fiscal difficulties. They believe the American people need to be coddled by big government. They believe the American people are content to live the lie with them. They are wrong.
We believe in telling our seniors the truth about our overburdened entitlements. We know seniors not only want these programs to survive, but they just as badly want them secured for their grandchildren.
Mitt Romney will tell us the hard truths we need to hear to end the torrent of debt that is compromising our future and burying our economy.
Mitt Romney will tell us the hard truths we need to hear to end the debacle of putting the world's greatest care system in the hands of federal bureaucrats and putting those bureaucrats between an American citizen and her doctor.
Topics: Politics, Health Reform
Mitt Romney, who is expected to be the Republican nominee for president, doesn’t usually talk about health care in his campaign stump speeches. Tuesday, at Con-Air Industries in Orlando, Florida, he blasted the 2010 federal health law and outlined what he would do if elected president.
Here is a transcript of the health care portion of the speech:
MITT ROMNEY: Now just yesterday, the president said something else that shows just how much out of touch he is. He said he didn't understand that Obamacare was hurting small business. He doesn't understand that Obamacare impacts small business and you have to scratch your head about that because about a year ago, the Chamber of Commerce did a survey of some 1,500 small businesses, and of those small businesses, three-quarters—75 percent—said Obamacare made it less likely for them to hire people.
It is having an impact on middle-income families that want to have good jobs. We also found out that 30 percent of employers in this country plan on dropping people once Obamacare is put in place—dropping them from their health care plan.
And then there were some other revelations about Obamacare. Instead of costing a trillion dollars, it's going to cost $2 trillion. It's not only bad policy, and bad for middle-income families, and bad for small business, it's simply unaffordable and so the right course for us is to make sure that the next president of the United States repeals Obamacare and replaces Obamacare.
The president needs to get in touch with what's happening in the private sector; what's happening with middle-income families and the damage that's being done by the specter of Obamacare, and the taxes that it already charges to businesses in the health care sector.
Now I know the Supreme Court is about to make a decision with regards to Obamacare, and I have right here in my pocket what they're going to say. Actually, I don't know what they're going to do. But you know, regardless of what they do, it's going to be up to the next president to either repeal and replace Obamacare or to replace Obamacare.
And I intend to do both, if I'm the president at a time when the Supreme Court has left Obamacare in place, I will repeal it on day one by sending out a waiver to all 50 states to keep them from having to pursue Obamacare.
Now if I'm able to repeal it—or if the Supreme Court is able to get that job done for us—we want to replace it. And I want to mention to you a number of things I would put in place with which to replace Obamacare.
Number one: The uninsured. Right now the uninsured are cared for at the state level. Each state has its own program for dealing with those that are uninsured. Some send uninsured people to clinics for care, others send them to emergency rooms.
What I would do is keep—as we have today—state responsibility for those that are uninsured. You see I believe in the 10th Amendment. I believe the states have responsibility to care for their people in the way they feel best. But to help states care for their own uninsured, I would take the Medicaid dollars that comes with all sorts of strings attached today, send them back to the states along with something known as the DSH money, and let states care for their own people in the way they think best. That—in my view—is the best way to care for the uninsured.
And states will learn from each other, and some will have good experiences and others will not. That's happening even today and states are learning and trying new ways to care for the uninsured. It's important for us in my view to make sure that every American has access to good health care.
There are other things I'd do. I want to get health care to act more like a consumer market, meaning like the things we deal with every day in our lives: The purchases of tires, of automobiles, of air filters, of all sorts of products. Consumer markets tend to work very well—keep the costs down and the quality up.
So how would I do that on health care? Well right now, most people get their insurance through their employer and the reason they do that is because their employer gets a tax deduction when they buy insurance for you. But if you're a very small-business person—let’s say a one-person business—you don't get a tax deduction for buying insurance. And if you're an individual that's not employed, you don't get a tax deduction for buying your own insurance.
What I would do is level the playing field and say individuals can buy insurance on the same tax advantage basis that businesses can buy insurance.
I also want to make sure that people can't get dropped if they have a preexisting condition. What I mean by that—so let's say someone has been continuously insured and they develop a serious condition, and let's say they lose their job or they change jobs, they move and they go to a new place. I don't want them to be denied insurance because they've got some preexisting condition. So, we're going to have to make sure that the law we replace Obamacare with assures that people who have a preexisting condition—who've been insured in the past are able to get insurance in the future—don't have to worry about that condition keeping them from getting the kind of health care they deserve.
And I want these individuals and businesses to be able to buy insurance across state lines to get the best deal they can get anywhere in the country. And I wanted to be able to join associations of like types of organizations so they can get bargaining power, purchasing power, and get insurance at a reasonable rate.
We can get health care to act more like a consumer market, and if we do that and we stop making it like big government managed utility, we're going to see better prices, lower costs and better care. It's happened everywhere we've applied consumer market principles. Free enterprise is the way America works—we need to apply that to health care.
Let me mention something else about health care, and that's Medicare. Medicare is the health care program for our seniors, and the president did something—I think—that that surprised a lot of seniors. When they saw the president campaign four years ago, he didn't mention to them that he was planning on cutting Medicare by $500 billion to pay for his health care plan, but that's what he did.
And so if you have seniors that say I need someone to protect Medicare, you remind them this president was the one that cut $500 billion out of Medicare. My plan is to protect and save Medicare, to make sure it's there not just for current seniors, but for future seniors. And my plan is this: I want people to have more choice. I want them to be able to have traditional government sponsored Medicare or private-sector Medicare provided by various companies, and let them make their choices to which one they want.
And by the way, higher-income people—I think—should get less help getting Medicare than lower-income people. I think we should care for those that need the help most and let them choose the private or public system they prefer. I think choice is the right course in Medicare.
Matthew Fleming contributed.
In a pair of speeches on Saturday, President Obama fired up Democratic party faithful in Ohio and Virginia. He spoke about his plans for -- and record on -- Medicare, health insurance and birth control. And he vowed that the country "will not go back to the days when insurance companies had unchecked power to cancel your policy."
Here is a transcript of the excerpts of the health care parts of his speech in Columbus, Ohio:
Now we face a choice. For the last few years, the Republicans who run this Congress have insisted that we go right back to the policies that created this mess. But to borrow a line from my friend Bill Clinton, now their agenda is on steroids. This time, they want even bigger tax cuts for the wealthiest Americans. This time, they want even deeper cuts to things like education and Medicare, and research and technology.
We know that our economy grows when we support research into medical breakthroughs and new technologies that lead to the next Internet app or life-saving drug.
We know that our country is stronger when we can count on affordable health insurance and Medicare and Social Security. When we protect our kids from toxic dumping and mercury pollution. When there are rules to make sure we aren’t taken advantage of by credit card companies and mortgage lenders and financial institutions. And we know these rules aren’t just good for seniors, or kids, or consumers -- they're good for business, too. They're part of what makes the market work.
Look, we don’t expect government to solve all our problems, and it shouldn’t try. I learned from my mom that no education policy can take the place of a parent’s love and affection. As a young man, I worked with a group of Catholic churches who taught me that no poverty program can make as much of a difference as the kindness and commitment of a caring soul. Not every regulation is smart. Not every tax dollar is spent wisely. Not every person can be helped who refuses to help themselves.
But that’s not an excuse to tell the vast majority of responsible, hardworking Americans, 'You’re on your own.' That unless you’re lucky enough to have parents who can lend you money, you may not be able to go to college. That even if you pay your premiums every month, you’re out of luck if an insurance company decides to drop your coverage when you need it most.
I refuse to pay for another millionaire’s tax cut by eliminating medical research projects into things like cancer and Alzheimer’s disease. I refuse to pay for another tax cut by kicking children off of Head Start programs; or asking students to pay more for college; or eliminating health insurance for millions of poor and elderly and disabled Americans on Medicaid.
And as long as I’m President of the United States, I will never allow Medicare to be turned into a voucher that would end the program as we know it. We will not go back to the days when our citizens spent their golden years at the mercy of private insurance companies. We will reform Medicare -- not by shifting the cost of care to seniors, but by reducing the spending that isn’t making people healthier. That’s what’s at stake in this election. That’s what’s at stake, Ohio.
On issue after issue, we can’t afford to spend the next four years going backward. America doesn’t need to refight the battles we just had over Wall Street reform and health care reform. On health care reform, here is what I know: Allowing 2.5 million young people to stay on their parents’ health insurance plan -- that was the right thing to do. Cutting prescription drug costs for seniors -- that was the right thing to do. I will not go back to the days when insurance companies had unchecked power to cancel your policy, or deny you coverage, or charge women differently from men. We’re not going back there. We’re going forward.
"We don’t need another political fight about ending a woman’s right to choose, or getting rid of Planned Parenthood -- or taking away access to affordable birth control. I want women to control their own health choices, just like I want my daughters to have the same opportunities as your sons. We are not turning back the clock. We are moving forward.
As Mitt Romney celebrated his primary night wins in Connecticut, Delaware, Rhode Island, Pennsylvania and New York, he attacked the Affordable Care Act and the president.
Here is a transcript of the portion of his speech which affects health care:
We know that this election is about the kind of America we will live in and the kind of America we will leave to future generations. When it comes to the character of America, President Obama and I have very different visions.
Government is at the center of his vision. It dispenses the benefits, borrows what it cannot take, and consumes a greater and greater share of the economy. With Obamacare fully installed, government will come to control half the economy, and we will have effectively ceased to be a free enterprise society.
This President is putting us on a path where our lives will be ruled by bureaucrats and boards, commissions and czars. He's asking us to accept that Washington knows best - and can provide all.
We've already seen where this path leads. It erodes freedom. It deadens the entrepreneurial spirit. And it hurts the very people it's supposed to help. Those who promise to spread the wealth around only ever succeed in spreading poverty. Other nations have chosen that path. It leads to chronic high unemployment, crushing debt, and stagnant wages. … We will stop the unfairness of urban children being denied access to the good schools of their choice; we will stop the unfairness of politicians giving taxpayer money to their friends' businesses; we will stop the unfairness of requiring union workers to contribute to politicians not of their choosing; we will stop the unfairness of government workers getting better pay and benefits than the taxpayers they serve; and we will stop the unfairness of one generation passing larger and larger debts on to the next.
We know that this election is about the kind of America we will live in and the kind of America we will leave to future generations. When it comes to the character of America, President Obama and I have very different visions.
Government is at the center of his vision. It dispenses the benefits, borrows what it cannot take, and consumes a greater and greater share of the economy. With Obamacare fully installed, government will come to control half the economy, and we will have effectively ceased to be a free enterprise society.
This President is putting us on a path where our lives will be ruled by bureaucrats and boards, commissions and czars. He's asking us to accept that Washington knows best - and can provide all.
We've already seen where this path leads. It erodes freedom. It deadens the entrepreneurial spirit. And it hurts the very people it's supposed to help. Those who promise to spread the wealth around only ever succeed in spreading poverty. Other nations have chosen that path. It leads to chronic high unemployment, crushing debt, and stagnant wages. … We will stop the unfairness of urban children being denied access to the good schools of their choice; we will stop the unfairness of politicians giving taxpayer money to their friends' businesses; we will stop the unfairness of requiring union workers to contribute to politicians not of their choosing; we will stop the unfairness of government workers getting better pay and benefits than the taxpayers they serve; and we will stop the unfairness of one generation passing larger and larger debts on to the next.
After his primary victories in Wisconsin, Maryland and the District of Columbia, Mitt Romney attacked President Obama on a variety of social and economic issues, briefly mentioning health care. Meanwhile, challenger Rick Santorum went after Romney by reprising his theme that the former Massachusetts governor would be a weak candidate against Obama on health care.
Here's a transcript of what was said:
ROMNEY: In Barack Obama's government-centered society, government spending always increases because, well, why not? There's always someone who's entitled to something more and who's willing to vote for anyone who will give them something more.
If we become one of those societies that attack success, why not come as certain there will be a lot less success? And that's not who we are. The promise of America has always been that if you worked hard, had the right values, took some risks, that there was an opportunity to build a better life for your family and for your next generation.
This means that government has to be smaller and have strict limits placed on its power. ObamaCare violates both those principles, and I will get rid of it.
SANTORUM: We need someone in this race who can go out and make the clarion call for liberty. Someone who has stood tall and opposed government run health care at any level, state or federal. Who can go out and make the case of what Barack Obama is doing, which even Justice Stevens, which is what Obamacare does and what his agenda of government control of health care and his attempt to do Cap and Trade, where he's going dictate how you -- energy -- how much energy, not just health care, but how much energy you're going to use.
That this is a fundamental change in the relationship between the people and their government. Ladies and gentleman if we're going to win this race, we can't have little differences between our nominee and President Obama. We have to have clear contrasting colors.
On a day with 10 GOP primaries and caucuses, former Pa. Sen. Rick Santorum calls health care "the most important issue of the day." Former Mass. Gov. Mitt Romney repeats pledge to "repeal Obamacare."
Topics: Politics, Women's Health, Insurance
During a Tuesday news conference, the president responded to questions about Rush Limbaugh and the heated debate over contraception coverage, and about whether Republican positions on these issues constitute a "war on women."
During a Fox News debate in the battleground state of Ohio, Mitt Romney contrasts proposed cuts to Tricare to health benefits for other government employees, while Rick Santorum said of health savings accounts, "We need to expand them greatly."
Here's a transcript of the health care portions:
DAVID MCARTHUR, SMALL BUSINESS OWNER: You know, sir, and I thank you so much for that. But it's his brothers. That's his concern. You know, the [Department of Veterans Affairs] today is a nightmare. Just a nightmare to deal through to try and get any service out of them.
You know, [traumatic brain injury] victims wait. When they come home they wait six months for their first check. Again, please, sir.
MITT ROMNEY: Yes.
ROMNEY: Yes. I understand that the -- the benefit recovery period, the time it takes to get benefits paid has been lengthened dramatically under this administration. And -- and I've got a son who works in health care. He's a doctor. He's in residency.
And -- and he works at the V.A. Hospital sometimes as part of his training. Then he works in regular hospitals. And he says, "You know, dad, the V.A. Hospital isn't getting, you know, the same level of care and attention that sometimes exists in the private hospitals in the public hospitals."
We need to recognize that those who served this country in our uniform have a special place in our hearts. And we have to care for them. And -- and the American people feel that. No question in my mind but that they recognize that we have a huge obligation to those who served our country. And I certainly feel that way.
One of the things I can't understand. Right now the president is cutting back on spending. And that's something that has to happen. But he's only cutting back in the military. He's going after Tricare. Saying "OK, we're going to -- we're going to raise the co-pays. We're going to cut the benefits." Why is it we go after military families?
Why isn't he going after government workers that are represented by the big government unions? I think I know the answer. My view is we care for our soldiers. We care for our soldiers and -- and their families first. That's our responsibility as a nation.
MCARTHUR: Regulations, regulations, regulations. Right now, one of -- the major one that's killing us, sir, is health care. On Wednesday, our employees saw their new health care plan, 2012. The deductible went from $2,250 to $6,000.
People were mad. Tears were visible. Medical savings plans that mothers depend on were gutted. You say you're going to eliminate "Obamacare," but replace it with what?
RICK SANTORUM: Well, you mentioned -- you're talking about medical savings -- you meant flexible spending accounts?
MCARTHUR: That's exactly right.
SANTORUM: FSAs. FSAs are a great program, and you're right, they were gutted. The Obama administration put a cap put on them. So here -- it's all the way President Obama focuses on things. It's always about him micromanaging everything, dictating to people what they can -- he doesn't want people to have flexible spending accounts for them to meet their own health care needs! He wants to limit that and then shift the responsibility to government to tell you what health care plan everybody has to have!
That's the fundamental shift that we're seeing already starting to take place as "Obamacare" slowly is implemented, and eventually, we'll have not only no flexible spending accounts, or very limited ones, but mandated benefits on everybody! And of course, your $6,000 plan ...
MCARTHUR: (INAUDIBLE) can't afford it.
SANTORUM: Yes, well, it's right, unless you have something that I've worked on, and actually, you know, we're here in Ohio and Governor Kasich and I were the authors of health savings accounts. And health savings accounts is an idea of high deductible but having the premium savings of the higher deductible go the employee in these accounts to help them meet the ordinary and necessary expenses.
Health savings accounts are growing in this country. They're growing in popularity. We need to expand them greatly. We need to have transparency in pricing. We have to have transparency in the idea on -- with respect to the quality of the provider that's providing this care.
In other words, we need to do what you do, which is to go out and compete, go out and have 30 million -- excuse me -- 300 million consumers in America. That will drag down health care costs, not government regulation!
GOP presidential candidates Mitt Romney and Rick Santorum struck out at the Democrats' health law in speeches Tuesday night after Romney won both the Arizona and Michigan GOP primaries.
> > Read more: Where the GOP candidates stand on health care.
Here's a transcript of the health care mentions in their speeches after the polls closed:
ROMNEY: President Obama is making the federal government bigger, burdensome, and bloated. I’ll make it simpler, smaller, and smarter, and it’s about time for that to happen. He raised the national debt. I will cut, cap, and balance the budget. He passed Obamacare. I’ll repeal Obamacare.
You realize that after saying that Medicare and Social Security are in trouble, he has has yet to offer a single serious proposal for saving Medicare and Social Security. I have a plan to save them both — and, unlike him, I have the courage to put my plan on the table for people to see. What this campaign is about, what my plans are about, are creating jobs and raising wages for the American people. They’re gonna strengthen our entitlement programs for the next generations. And they will not add to our deficit — we will finally balance America’s budget.
This election comes down to two very different visions of America. It’s a choice between becoming a nation of and by Washington or remaining a nation of and by a free people. A choice between an entitlement society … and a land of opportunity.
SANTORUM: We will repeal every single one of Barack Obama’s big government regulations on day one. And, of course, part of those regulations -- the one of the things we’re going to repeal right out is Obamacare. That is the biggest issue in this race. It’s an issue about fundamental freedom. It’s an issue about whether you want the government to take your money, in exchange, give you a right. Give you a right. They’re going to give you the right to health care; that’s what President Obama promised.
But, of course, when the government gives you a right, they can take that right away. And when the government gives you that right, they can tell you how to exercise that right. And they do, not just what doctors you can see and what insurance policies or how much you’re going to get fined if you don’t do what the government tells you to do, but even go so far as to tell you how to exercise your faith as part of your health care bill. If the government can go that far with Obamacare, just think what’s next.
Ladies and gentlemen, we need a candidate who can go out and take on Barack Obama, who was -- who was an author from 20 years ago, the author of free-market health care economics, health savings accounts, has been a fighter for replacing all of these programs across this country at the federal level with their government-run health care, with not Romneycare or Obamacare, but a program that’s based upon you called “You Care”, because that’s what we believe in, in America.
Topics: Politics, Health Reform, States
In the last scheduled Republican debate, candidates Rick Santorum, Mitt Romney, Newt Gingrich and Ron Paul attacked the Obama administration on its birth control stance. Santorum dovetailed the issue into an attack of the 2006 Massachusetts health reform law, which Romney, as governor, endorsed.
Here is a transcript of the health care portions of the debate:
KING: Welcome back to the Mesa Arts Center and the Arizona Republican Presidential debate. Let's get right back to questioning the four contenders for the Republican nomination. We take a question now from cnnpolitics.com. You can see it up on the screen here.
Since birth control is the latest hot topic, which candidate believes in birth control, and if not, why? As you can see -- it's a -- it's a very popular question in the audience, as we can see. Look, we're not going to spend a ton of time on this but it is -- please.
GINGRICH: Can I just make a point?
UNIDENTIFIED MALE: These guys are giving you some feedback here, John.
KING: I see that. I see that.
UNIDENTIFIED MALE: I think they're making it very clear.
GINGRICH: No, I think -- look, I think there's -- I want to make two -- I want to make two quick point, John.
The first is there is a legitimate question about the power of the government to impose on religion activities which any religion opposes. That's legitimate.
KING: Sure is.
GINGRICH: But I just want to point out, you did not once in the 2008 campaign, not once did anybody in the elite media ask why Barack Obama voted in favor of legalizing infanticide. OK? So let's be clear here.
GINGRICH: If we're going to have a debate about who the extremist is on these issues, it is President Obama who, as a state senator, voted to protect doctors who killed babies who survived the abortion. It is not the Republicans.
ROMNEY: John, what's happened -- and you recall back in the debate that we had George Stephanopoulos talking out about birth control, we wondered why in the world did contraception -- and it's like, why is he going there? Well, we found out when Barack Obama continued his attack on religious conscience.
I don't think we've seen in the history of this country the kind of attack on religious conscience, religious freedom, religious tolerance that we've seen under Barack Obama. Most recently, of course --
ROMNEY: -- most recently requiring the Catholic Church to provide for its employees and its various enterprises health care insurance that would include birth control, sterilization and the morning-after pill. Unbelievable.
And he retried to retreat from that but he retreated in a way that was not appropriate, because these insurance companies now have to provide these same things and obviously the Catholic Church will end up paying for them.
But don't forget the decision just before this, where he said the government -- not a church, but the government should have the right to determine who a church's ministers are for the purposes of determining whether they're exempt from EEOC or from workforce laws or labor laws.
He said the government should make that choice. That went all the way to the Supreme Court. There are a few liberals on the Supreme Court. They voted 9-0 against President Obama. His position --
ROMNEY: -- his position -- his position on religious tolerance, on religious conscience is clear, and it's one of the reasons the people in this country are saying we want to have a president who will stand up and fight for the rights under our Constitution, our first right, which is for freedom of religion.
KING: So let's focus the time -- let's focus the time we spend on this on the role of the president and your personal views and question the role of government.
And Senator Santorum, this has come up -- yes, it has come up because of the president's decision in the campaign. It's also come up because of some of the things you have said on the campaign trail. When you were campaigning in Iowa, you told an evangelical blog, if elected, you will talk about what, quote, "no president has talked about before -- the dangers of contraception." Why?
SANTORUM: What I was talking about is we have a society -- Charles Murray just wrote a book about this and it's on the front page of "The New York Times" two days ago, which is the increasing number of children being born out of wedlock in America, teens who are sexually active.
What we're seeing is a problem in our culture with respect to children being raised by children, children being raised out of wedlock, and the impact on society economically, the impact on society with respect to drug use and all -- a host of other things when children have children.
And so, yes, I was talking about these very serious issues. And, in fact, as I mentioned before, two days ago on the front page of "The New York Times", they're talking about the same thing. The bottom line is we have a problem in this country, and the family is fracturing.
Over 40 percent of children born in America are born out of wedlock. How can a country survive if children are being raised in homes where it's so much harder to succeed economically? It's five times the rate of poverty in single-parent households than it is in two-parent homes. We can have limited government, lower tax -- we hear this all the time, cut spending, limit the government, everything will be fine. No, everything's not going to be fine.
There are bigger problems at stake in America. And someone has got to go out there -- I will -- and talk about the things.
And you know what? Here's the difference.
The left gets all upset. "Oh, look at him talking about these things." You know, here's the difference between me and the left, and they don't get this. Just because I'm talking about it doesn't mean I want a government program to fix it.
That's what they do. That's not what we do.
KING: Congressman Paul?
PAUL: As an OB doctor, I've dealt with birth control pills and contraception for a long time. This is a consequences of the fact the government has control of medical care and medical insurance, and then we fight over how we dictate how this should be distributed, sort of like in schools. Once the government takes over the schools, especially at the federal level, then there's no right position, and you have to argue which prayer, are you allowed to pray, and you get into all the details.
The problem is the government is getting involved in things they shouldn't be involved in, especially at the federal level.
But sort of along the line of the pills creating immorality, I don't see it that way. I think the immorality creates the problem of wanting to use the pills. So you don't blame the pills.
I think it's sort of like the argument -- conservatives use the argument all the time about guns. Guns don't kill, criminals kill.
So, in a way, it's the morality of society that we have to deal with. The pill is there and, you know, it contributes, maybe, but the pills can't be blamed for the immorality of our society.
KING: Governor, please.
ROMNEY: John, you know, I think as Rick has just said, this isn't an argument about contraceptives, this is a discussion about, are we going to have a nation which preserves the foundation of the nation, which is the family, or are we not? And Rick is absolutely right.
When you have 40 percent of kids being born out of wedlock, and among certain ethnic groups the vast majority being born out of wedlock, you ask yourself, how are we going to have a society in the future? Because these kids are raised in poverty in many cases, they're in abusive settings. The likelihood of them being able to finish high school or college drops dramatically in single-family homes. And we haven't been willing to talk about this.
And when we have programs that say we're going to teach abstinence in schools, the liberals go crazy and try and stop us from doing that. We have to have a president who's willing to say that the best opportunity an individual can give to their unborn child is an opportunity to be born in a home with a mother and a father. And I think --
KING: It's an issue on which all of you have criticism on the Obama administration, it's an issue on which some of you have also criticized each other.
Governor Romney, both Senator Santorum and Speaker Gingrich have said during your tenure as governor, you required Catholic hospitals to provide emergency contraception to rape victims.
And Mr. Speaker, you compared the president to President Obama, saying he infringed on Catholics' rights.
Governor, did you do that?
ROMNEY: No, absolutely not. Of course not.
There was no requirement in Massachusetts for the Catholic Church to provide morning-after pills to rape victims. That was entirely voluntary on their report. There was no such requirement.
Likewise, in Massachusetts health care bill, there's a provision in Massachusetts general laws that says people don't have to have coverage for contraceptives or other type of medical devices which are contrary to their religious teachings. Churches also don't have to provide that to entities which are either the church themselves or entities they control. So we have provisions that make sure that something of that nature does not occur.
That's why when I worked closely with the leaders of the Catholic Church, I met with the cardinal a number of times, and with his emissaries. We talked about the issues we were concerned about.
We battled, for instance, to help the Catholic Church stay in the adoption business. The amazing thing was that while the Catholic Church was responsible for half the adoptions in my state -- half the adoptions -- they had to get out of that business because the legislature wouldn't support me and give them an exemption from having to place children in homes where there was a mom and a dad on a preferential basis.
Absolutely extraordinary. We have to have individuals that will stand up for religious conscience, and I did and I will again as president.
KING: Mr. Speaker?
GINGRICH: Well, the reports we got were quite clear that the public health department was prepared to give a waiver to Catholic hospitals about a morning-after abortion pill, and that the governor's office issued explicit instructions saying that they believed it wasn't possible under Massachusetts law to give them that waiver. Now, that was the newspaper reports that came out. That's something that both Senator Santorum and I have raised before. But I want to go a step further, because this makes a point that Ron Paul has been making for a generation and that people need to take very seriously.
When you have government as the central provider of services, you inevitably move towards tyranny, because the government has the power of force.
You inevitably -- and I think this is true whether it's Romneycare or Obamacare or any other government centralized system -- you inevitably move towards the coercion of the state and the state saying, "If you don't do what we, the politicians, have defined, you will be punished either financially or you will be punished in some other way like going to jail."
And that's why we are, I think, at an enormous crossroads in this country. And I think the fact is, for almost all of us who have been at this for any length of time, we're now looking at an abyss that forces you to change what you may once have thought -- and I suspect all four of us are much more worried today about the power of the state than we would have been -- with the possible exception of Congressman Paul -- than we would have been at any point in the last 25 years.
KING: Congressman, please.
PAUL: ... have a quick follow-up?
(APPLAUSE) You know, we talk about the morning-after pill. Actually, the morning-after pill is nothing more than a birth control pill, so if birth control pills are on the market, the morning-after pill -- so if you're going to legalize birth control pills, you really -- you can't separate the two. They're all basically the same, hormonally.
But once again, the question is, if you voted for Planned Parenthood like the senator has, you voted for birth control pills. And you literally, because funds are fungible, you literally vote for abortions because Planned Parenthood gets the money -- "Oh, I'll buy birth control pills," but then they have the money left over to do the abortion.
So that's why you have to have a pretty strong resistance of voting for these bunches of bills put together. Planned Parenthood should get nothing, let alone designate how they spend.
KING: Senator Santorum?
SANTORUM: As Congressman Paul knows, I opposed Title X funding. I've always opposed Title X funding, but it's included in a large appropriation bill that includes a whole host of other things, including...
... the funding for the National Institutes of Health, the funding for Health and Human Services and a whole bunch of other departments. It's a multi-billion-dollar bill.
What I did, because Title X was always pushed through, I did something that no one else did. Congressman Paul didn't. I said, well, if you're going to have Title X funding, then we're going to create something called Title XX, which is going to provide funding for abstinence-based programs, so at least we'll have an opportunity to provide programs that actually work in -- in keeping children from being sexually active instead of facilitating children from being sexually active. And I pushed Title XX to -- to accomplish that goal.
So while, yes, I -- I admit I voted for large appropriation bills and there were things in there I didn't like, things in there I did, but when it came to this issue, I proactively stepped forward and said that we need to do something at least to counterbalance it, A; B, I would say that I've always been very public that, as president of the United States, I will defund Planned Parenthood; I will not sign any appropriation bill that funds Planned Parenthood.
KING: Senator (sic), go ahead.
PAUL: John, this demonstrates the problem that I'm talking about. There's always an excuse to do this. Now...
... Title XX -- I don't know whether you inferred that I would support Title XX for abstinence. No, it would cost money as a program. It's not a program of the federal government to get involved in our lives this way. If you want laws like that, maybe the state, but...
... the federal government shouldn't even be having -- spending money on abstinence. That's way too much more. I don't see that in the Constitution any...
ROMNEY: Just a -- just a brief comment. Senator, I just saw a YouTube clip of you being interviewed where you said that you personally opposed contraceptives but that you -- you said that you voted for Title X. You...
ROMNEY: But you used that as an argument, saying this is something I did proactively. You didn't say this is something I was opposed to; it wasn't something I would have done. You said this -- you said this in a positive light, "I voted for Title X."
SANTORUM: I think it's -- I think I was making it clear that, while I have a personal more objection to it; even though I don't support it, that I voted for bills that included it. And I made it very clear in subsequent interviews that I don't -- I don't support that...
... I've never supported it, and -- and have -- and on an individual basis have voted against it. That's why I proposed Title XX to counterbalance it.
So I -- you know, Governor Romney, I can just say that -- that, you know, we were talking about this issue before of, you know, religious conscience and protections. But this is -- the whole reason this issue is alive is because of the bill that you drafted in Massachusetts, Romneycare, which was the model for Obamacare and the government takeover of health care.
ROMNEY: Wait a second. Wait a second. Wait a second.
SANTORUM: And there was a study...
ROMNEY: Wait a second.
SANTORUM: There was a study that just came out about 10 days ago, two weeks ago, that listed 15 ways in which Romneycare was the model for Obamacare, everything from individual mandates, everything from -- from fines. Yours is different. You required businesses over 10 employees; Barack -- President Obama's is over 50 employees.
But there -- there's a -- and even the drafter of your bill, when they were working on Obama's bill, said in fact it was the model. So here we have, as Newt said, the real fundamental issue here is government coercion and government coercion when you give governments the right to be able to take your responsibility to provide for your own health and -- and -- and care, and give it to the government.
That's what Governor Romney did in Massachusetts. It would be a very -- very, let say it would be a difficult task for someone who had the model for Obama Care, which is the biggest issue in this race of government in control of your lives, to be the nominee of our party. It would take that issue completely off...
KING: Governor -- Governor, take 30 seconds to respond and then I want to move the conversation on.
ROMNEY: Much longer than 30 seconds.
KING: I hope not.
ROMNEY: That's a -- that's a long -- that's a long -- that's a long answer. First of all, let's not forget that four years ago, well after Romney Care was put in place, four years ago, you not only endorsed me, you and Laura Ingram, and said and this is the guy who is really conservative and we can trust him. Let's not forget you said, that number one.
ROMNEY: Number two...
ROMNEY: ...number two, under the tenth amendment, states have the right to do things that they think are in their best interest. I know you -- you agree with that. But let's -- let's point this out, our bill was 70 pages. His bill is 2700 pages. There's a lot in that 2,700 pages I don't agree with and let me tell you, if I'm president of the United States, I will repeal Obama Care for a lot of reasons. One, I don't want to spend another trillion dollars. We don't have that kind of money, it's the wrong way to go. Number two, I don't believe the federal government should cut Medicare by some $500 billion.
Number three, I don't think the federal government should raise taxes by $500 billion and, therefore, I will repeat Obama Care. And let me -- let me -- let me mention one more -- the reason we have Obama Care -- the reason we have Obama Care is because the Senator you supported over Pat Toomey in Pennsylvania, Arlen Specter, the pro- choice Senator of Pennsylvania that you supported and endorsed in a race over Pat Toomey, he voted for Obama Care. If you had not supported him, if we had said, no to Arlen Specter, we would not have Obama Care. So don't look at me. Take a look in the mirror.
KING: Senator please, quickly?
SANTORUM: So, okay Governor, let's -- let's get this straight. First off number one, you funded Romney Care through federal tax dollars through Medicaid. I know it well, it's called disproportionate share provider tax. About $400 million that you got from the federal taxpayers to underwrite Romney Care to make sure you didn't have to raise taxes right away. But of course you had to. Ask your governor, of the $8 billion of tax increases he had to put in place.
Yes governor, you balanced the budget for four years. You have a constitutional requirement to balance the budget for four years. No great shakes. I'm all for -- I'd like to see it federally. But don't go around bragging about something you have to do. Michael Dukakis balanced the budget for 10 years, does that make him qualified to be president of the United States? I don't think so.
SANTORUM: The bottom line is, what you did was you used federal dollars to fund the government takeover of health care in Massachusetts, used it as -- and -- and Barack Obama...
ROMNEY: ...Arlen Specter.
SANTORUM: Well, I'll get to that in a minute.
SANTORUM: But -- and then Barack Obama used it as a model for taking over this health care system in America. Why I supported Arlen Specter, number one because -- because Arlen Specter was a -- a Senator who was going to be the chairman of the Judiciary Committee at a time when the most important issue that was coming up in the next session of Congress was two to three Supreme Court nominees that were going to be available. And one, and maybe two of them, or maybe all three were going to be out of the conservative block. And Arlen Specter as chairman of the Judiciary Committee, we had a conversation.
He asked me to support him. I said will you support the president's nominees? We had a 51/49 majority in the Senate. He said I'll support the president's nominees as chairman. Every nominee Arlen Specter supported from the time he -- he took on Judge Forks and saved Justice Thomas. Every nominee he supported, passed. Why? Because it gave Democrats cover to vote for it and it gave Republican moderates cover to vote for it.
After he won Republican presidential nominating contests in Missouri, Minnesota and Colorado, former Sen. Rick Santorum criticized the health law, the Obama administration’s birth control coverage policies and Mitt Romney’s record. He again asserted he was the only candidate to challenge the president on health care issues.
Health care, especially the individual mandate, was the focus of a tense and angry exchange in Thursday night's last debate before the crucial GOP Florida primary. In answering a question from the audience, all four candidates – Newt Gingrich, Mitt Romney, Rep. Ron Paul and Rick Santorum – had sharp words as they tried to claim they were the right candidate on this crucial election issue. Moderator Wolf Blitzer tried to contain the discussion, but Santorum pursued Romney doggedly.
Here is a complete transcript of the health care portion of the debate, courtesy CNN:
QUESTION: My name is Lynn Frazier and I live here in Jacksonville. And for the Republican presidential candidates, my question is, I'm currently unemployed and I found myself unemployed for the first time in 10 years and unable to afford health care benefits.
What type of hope can you promise me and others in my position?
WOLF BLITZER: Let's ask Congressman Paul.
RON PAUL: Well, it's a tragedy because this is a consequence of the government being involved in medicine since 1965.
When I was growing up, we didn't have a whole lot, but my dad had a small insurance, but medical care costs weren't that much. And you should have an opportunity -- medical care insurance should be given to you as an individual, so if you're employed or not employed, you have -- you just take care of that and you keep it up. When you lose a job, sometimes you lose your insurance.
But the cost is so high. When you pump money into something, like housing, cost -- prices go up. If you pump money into education, the cost of education goes up. When the government gets involved in medicine, you don't get better care; you get -- cost goes up and it distorts the economy and leads to a crisis.
But your medical care should go with you. You should get total deduction on it. It would be so much less expensive. It doesn't solve every single problem, but you're -- you're suffering from the consequence of way too much government and the cost going up because government has inflated the cost and we have a government-created recession, and that is a consequence of the business cycle.
BLITZER: Speaker -- Speaker Gingrich, what should Lynn do?
NEWT GINGRICH: Well, look, the first -- she actually put her finger on two different problems. The largest challenge of this country is to get the economy growing so she can have a job so it's easy for her to have insurance.
We -- we need -- and the president did nothing about this the other night. In fact, his proposal on taxes would make the economy worse.
We need to have a program which would start with, frankly, repealing Obamacare, repealing Dodd-Frank, repealing Sarbanes-Oxley.
And we need to give her a chance at a job.
Second, we need real health reform, not the Obama style, but we need health reform that allows her to buy in. And Dr. Paul is right. She ought to get the same tax break whether she buys personally or whether she buys through a economy.
She should also be able to buy into an association so that she's buying with lots of other people so it's not single insurance, which is the most expensive kind.
But you combine those two, reforming the insurance system and getting the economy growing again so people are back at work, you cure an awful lot of America's problems with those two steps, and you put her back in a position where she's in charge of her life; she's not dependent on Barack Obama to take care of her.
BLITZER: That plan work for you, Governor?
FORMER GOV. MITT ROMNEY: Actually, what both these gentlemen said is pretty much spot-on. And I'd -- and I'll add a couple of things.
One, I want to underscore something both of them said, and that is, right now in America, if you have insurance, you most likely got it through your employer. And the reason is, your employer gets a deduction for you when they buy the insurance for you.
That means that, if you change jobs, you've got to get a new insurance company, most likely. And if you become unemployed, you lose your insurance.
That doesn't make sense. And if an individual wants to own their own insurance, they're not part of a big group, and so as a result they get a very high rate. What we should do is allow individuals to own their own insurance and have the same tax treatment as companies get. You do that and people like this young woman would be able to own her insurance. The rates would be substantial lower for her buying it individually than if she had to buy it individually today.
Secondly, getting people to work. This president has failed the American people.
He got up there and gave a speech last night. It was like Groundhog Day all over again. He said the same things and the same results we're seeing today. People are not working.
ROMNEY: And we know what it takes to put people back to work. He said some of those things last night -- lowering corporate taxes, lowering regulations, opening up all of the above in energy, cracking down on China. He just doesn't do any of those things, and if I'm president, I will do those things and I'll get you back to work.
SANTORUM: All three of these folks sound great and I agree with them. I would just add that health savings account, which I introduced 20 years ago with John Kasich, is really the fundamental reform of getting consumers back involved in the health care system.
The problem with the answers from Congressman Gingrich and Governor Romney is that, well, they didn't always say what they're saying. Governor Romney was the author of Romneycare, which is a top- down government-run health care system which, read an article today, has 15 different items directly in common with Obamacare, everything from the increase in the Medicaid program, not just that government is going to mandate you buy something that's a condition of breathing, mandate that you buy an insurance policy, something that Governor Romney agreed to at the state level, something Congressman Gingrich for 20 years advocated, that the federal government can force each and every person to enter into a private contract. Something that everyone now, at least up on this stage, says is radically unconstitutional, Congressman Gingrich supported for 20 years.
Governor Romney supported it in the state, a state that is a -- pretty much a model for what Obamacare is going to look like -- the highest health care costs in the country, 27 percent above the average, average waiting time -- 94 percent of the people in Massachusetts are now insured, but there was just a survey that came out and said one in four don't get the care they need because of the high cost. So, you have a card, you're covered, but you can't get care.
This is the top-down model that both of these gentlemen say they're now against, but they've been for, and it does not provide the contrast we need with Barack Obama if we're going to take on that most important issue. We cannot give the issue of health care away in this election. It is too foundational for us to win this election.
BLITZER: A quick rebuttal from Speaker Gingrich and then Governor Romney.
GINGRICH: Well, in my case, I think Rick is lumping us together rather more than is accurate.
If you go to healthtransformation.net, I founded the Center for Health Transformation. I wrote a book in 2002 called "Saving Lives and Saving Money." It calls for you and your doctor and your pharmacist and your hospital have a relationship. I believe in something like patient power.
I didn't advocate federal mandates. I talked about it at a state level, finding a way -- which included an escape clause that people didn't have to buy it -- finding a way to try to have people have insurance, particularly for wealthy people who are simply free-riding on local hospitals. But the fact is, it was a personal system, dramatically different than either Romneycare or the version Rick just discussed.
BLITZER: Governor Romney?
ROMNEY: The system that we put in place in our state was something we worked out with the labor community, the health care community, business, and the citizens of the nation. We came together, it was voted by a 200-person legislature. Only two voted no.
Our system has a lot of flaws, a lot of things I'd do differently. It has a lot of benefits. The people of the state like it by about three to one.
We consider it very different than Obamacare. If I were president, day one I will take action to repeal Obamacare. It's bad medicine. It's bad economy. I'll repeal it.
ROMNEY: And I believe the people -- I believe the people of each state should be able to craft programs that they feel are best for their people. I think ours is working pretty well. If I were governor, it would work a heck of a lot better.
BLITZER: All right.
And very quickly, go ahead.
SANTORUM: What Governor Romney just said is that government-run top-down medicine is working pretty well in Massachusetts and he supports it. Now, think about what that means --
ROMNEY: That's not what I said.
SANTORUM: -- going up against Barack Obama, who you are going to claim, well, top-down government-run medicine on the federal level doesn't work and we should repeal it. And he's going to say, wait a minute, Governor. You just said that top-down government-run medicine in Massachusetts works well.
Folks, we can't give this issue away in this election. It is about fundamental freedom. Whether the United States government or even a state government -- you have Amendment 1 (ph) here offered by Scott Pleitgen (ph), who, by the way, endorsed me today, and it's going to be on your ballot as to whether there should be a government mandate here in Florida.
According to Governor Romney, that's OK. If the state does it, that's OK. If the state wants to enforce it, that's OK. Those are not the clear contrasts we need if we're going to defeat Barack Obama and a --
BLITZER: Let's go to Miami.
BLITZER: Very quickly.
ROMNEY: Rick, I make enough mistakes in what I say, not for you to add more mistakes to what I say. I didn't say I'm in favor of top-down government-run health care, 92 percent of the people in my state had insurance before our plan went in place. And nothing changes for them. They own the same private insurance they had before.
And for the 8 percent of people who didn't have insurance, we said to them, if you can afford insurance, buy it yourself, any one of the plans out there, you can choose any plan. There's no government plan.
And if you don't want to buy insurance, then you have to help pay for the cost of the state picking up your bill, because under federal law if someone doesn't have insurance, then we have to care for them in the hospitals, give them free care. So we said, no more, no more free riders. We are insisting on personal responsibility.
Either get the insurance or help pay for your care. And that was the conclusion that we reached.
SANTORUM: Does everybody in Massachusetts have a requirement to buy health care?
ROMNEY: Everyone has a requirement to either buy it or pay the state for the cost of providing them free care. Because the idea of people getting something for free when they could afford to care for themselves is something that we decided in our state was not a good idea.
SANTORUM: So, in Massachusetts...
SANTORUM: Just so I understand this, in Massachusetts, everybody is mandated as a condition of breathing in Massachusetts, to buy health insurance, and if you don't, and if you don't, you have to pay a fine.
What has happened in Massachusetts is that people are now paying the fine because health insurance is so expensive. And you have a pre-existing condition clause in yours, just like Barack Obama.
So what is happening in Massachusetts, the people that Governor Romney said he wanted to go after, the people that were free-riding, free ridership has gone up five-fold in Massachusetts. Five times the rate it was before. Why? Because...
ROMNEY: That's total, complete...
SANTORUM: I'll be happy to give you the study. Five times the rate it has gone up. Why? Because people are ready to pay a cheaper fine and then be able to sign up to insurance, which are now guaranteed under "Romney-care," than pay high cost insurance, which is what has happened as a result of "Romney-care."
ROMNEY: First of all, it's not worth getting angry about. Secondly, the...
ROMNEY: Secondly, 98 percent of the people have insurance. And so the idea that more people are free-riding the system is simply impossible. Half of those people got insurance on their own. Others got help in buying the insurance.
Look, I know you don't like the plan that we had. I don't like the Obama plan. His plan cuts Medicare by $500 billion. We didn't, of course, touch anything like that. He raises taxes by $500 billion. We didn't do that.
He wasn't interested in the 8 percent of the people that were uninsured. He was concerned about the 100 percent of the people of the country. "Obama-care" takes over health care for the American people.
If I'm president of the United States, I will stop it. And in debating Barack Obama, I will be able to show that I have passion and concern for the people in this country that need health care, like this young woman who asked the question.
But I will be able to point out that what he did was wrong. It was bad medicine, it's bad for the economy, and I will repeal it.
BLITZER: Let's move on, let's move on.
SANTORUM: Wolf, what Governor Romney said is just factually incorrect. Your mandate is no different than Barack Obama's mandate. It is the same mandate. He takes over...
BLITZER: All right. All right.
SANTORUM: You take over 100 percent, just like he takes over 100 percent, requires the mandate. The same fines that you put in place in Massachusetts are fines that he puts in place in the federal level. Same programs.
BLITZER: Congressman Paul, who is right?
PAUL: I think they're all wrong.
PAUL: I think this -- this is a typical result of when you get government involved, because all you are arguing about is which form of government you want. They have way too much confidence in government sorting this out.
So, I would say there's a much better way. And that is allow the people to make their decisions and not get the government involved. You know, it has only been...
PAUL: When I started medicine, there was no Medicare or Medicaid. And nobody was out in the streets without it. Now, now people are suffering, all the complaints going on. So the government isn't our solution.
So, I'm not too happy with this type of debate, trying to blame one versus the other, so, but -- most likely we're going to continue to have this problem unless we straighten out the economy. And that means...
BLITZER: I'll give you 30 seconds, Mr. Speaker.
PAUL: ... cut the spending. And they talk about these new programs and all, but how many of the other candidates are willing to cut anything? I'm willing to cut $1 trillion out of the first year.
GINGRICH: Well, I just want to say that I actually think if you look at what Ron Paul's background is as a doctor, and you look at medicine in the early '60s, and you look at how communities solved problems, it was a fundamentally more flexible and less expensive system.
And there's a lot to be said for rethinking from the ground up, the entire approach to health care.
Topics: Politics, Medicare, Health Reform
Health care came up in a variety of ways in Monday's debate in Tampa, sponsored by NBC, National Journal and the Tampa Bay Times. Mitt Romney accused Newt Gingrich of influence-peddling on Medicare and also defended the Massachusetts health care reform. Rick Santorum tried to distinguish himself from both men, claiming their support of the individual mandate in the past undermines their conservative credentials. And he defended his behavior during the 1995 controversy about Terri Schiavo, who was in the center of a right-to-die dispute.
Here's a transcript, courtesy The Washington Post:
MITT ROMNEY: We have congressmen who also say that you came and lobbied them in favor...
NEWT GINGRICH: I didn't lobby them.
MITT ROMNEY: You have congressmen who say...
MITT ROMNEY: ... that you came and lobbied them with regards to Medicare Part D, at the same time...
NEWT GINGRICH: Now, wait. Whoa, whoa.
MITT ROMNEY: ... your center was taking in contributions...
NEWT GINGRICH: You just jumped a long way over here, friend.
MITT ROMNEY: Well, another -- another area of influence-peddling.
NEWT GINGRICH: No, not -- now, let me be very clear, because I understand your technique, which you used on McCain, you used on Huckabee, you've used consistently, OK? It's unfortunate, and it's not going to work very well, because the American people see through it.
I have always publicly favored a stronger Medicare program. I wrote a book in 2002 called "Saving Lives and Saving Money." I publicly favored Medicare Part D for a practical reason, and that reason is simple. The U.S. government was not prepared to give people anything -- insulin, for example -- but they would pay for kidney dialysis. They weren't prepared to give people Lipitor, but they'd pay for open-heart surgery. That is a terrible way to run Medicare.
I am proud of the fact -- and I'll say this in Florida -- I'm proud of the fact that I publicly, openly advocated Medicare Part D. It has saved lives. It's run on a free enterprise model. It also included health savings accounts and it include Medicare alternatives, which gave people choices.
And I did it publicly, and it is not correct, Mitt -- I'm just saying this flatly, because you've been walking around this state saying things that are untrue -- it is not correct to describe public citizenship, having public advocacy as lobbying. Every citizen has the right to do that.
MITT ROMNEY: They sure do.
NEWT GINGRICH: And what I did on behalf of Medicare...
NEWT GINGRICH: ... I did out in the open, publicly, and that is my right as a citizen.
NBC NEWS MODERATOR BRIAN WILLIAMS: Gentlemen...
MITT ROMNEY: Here's why it's a problem, Mr. Speaker. Here's why it's a problem. And that is, if you're getting paid by health companies, if your entities are getting paid by health companies that could benefit from a piece of legislation, and you then meet with Republican congressmen and encourage them to support that legislation, you can call it whatever you'd like. I call it influence-peddling.
It is not right. It is not right. You have a conflict. You are -- you are being paid by companies at the same time you're encouraging people to pass legislation which is in their favor.
MITT ROMNEY: This is -- you spent now 15 years in Washington on K Street. And -- and this is a real problem, if we're going to nominate someone who not only had a record of -- of great distress as the speaker, but that has worked for 15 years lobbying.
TAMPA BAY TIMES MODERATOR ADAM SMITH: Senator Santorum, in 2005, Florida was in the middle of a huge national debate over Terri Schiavo, whether her feeding tube should be removed after the courts had ruled that she had been in a vegetative state for years. You were at the center, at the front of advocating congressional intervention to keep her alive. You even came down here, came to her bedside after a fund-raiser. Why should the government have more say in medical decisions like that than a spouse?
RICK SANTORUM: Well, number one, I didn't come to her bedside, but I did come down to Tampa. I was scheduled to come down anyway for that event, and it so happened that this situation was going on.
I did not call for congressional intervention. I called for a judicial hearing by an impartial judge at the federal level to review a case in which you had parents and a spouse on different sides of the issue.
And these were constituents of mine. The parents happen to live in Pennsylvania, and they came to me and made a very strong case that they would like to see some other pair of eyes, judicial eyes, look at it. And I agreed to advocate for those constituents because I believe that we should give respect and dignity for all human life, irrespective of their condition.
And if there was someone there that wanted to provide and take care of them, and they were willing to do so, I wanted to make sure that the judicial proceedings worked properly. And that's what I did, and I would do it again.
SMITH: Do not resuscitate directives; do you think they're immoral?
RICK SANTORUM: No, I don't believe they're immoral. I mean, I think that's a decision that people should be able to make, and I have supported legislation in the past for them to make it.
SMITH: Speaker Gingrich, in that case the courts had ruled repeatedly. How does that square, the Terri Schiavo, action with your understanding of the Constitution and separation of powers?
GINGRICH: Well, look, I think that we go to extraordinary lengths, for example, for people who are on murderers row. They have extraordinary rights of appeal.
And you have here somebody who was in a coma, who had, on the one hand, her husband saying let her die and her parents saying let her live. Now, it strikes me that having a bias in favor of life, and at least going to a federal hearing, which would be automatic if it was a criminal on death row, that it's not too much to say in some circumstances your rights as an American citizen ought to be respected. And there ought to be at least a judicial review of whether or not in that circumstance you should be allowed to die, which has nothing to do with whether or not you as a citizen have a right to have your own end-of-life prescription which is totally appropriate for you to do as a matter of your values in consultation with your doctor.
SMITH: Congressman Paul, you're a doctor. What was your view of the Terri Schiavo case?
RON PAUL: I find it so unfortunate, so unusual, too. That situation doesn't come up very often. It should teach us all a lesson to have living wills or a good conversation with a spouse. I would want my spouse to make the decision. And -- but it's better to have a living will.
But I don't like going up the ladder. You know, we go to the federal courts, and the Congress, and on up. Yes, difficult decisions. Will it be perfect for everybody? No. But I would have preferred to see the decision made at the state level.
But I've been involved in medicine with things similar, but not quite as difficult as this. But usually, we deferred to the family. And it wasn't made a big issue like this was. This was way out of proportion to what happens more routinely.
But I think it should urge us all to try to plan for this and make sure either that one individual that's closest to you makes the decision or you sign a living will. And this would have solved the whole problem.
WILLIAMS: Which, Senator Santorum, gets us back to electability, the gap between the Republican Party and the president. Some of the newspaper headlines about this gathering we were going to have tonight, in Florida, Romney seeks to link Gingrich to foreclosure crisis. And here's a second one: The verdict is in, Mitt Romney's Bain Capital problem is real. What's the net effect of all this, of the tax release tomorrow, of Freddie -- the Freddie Mac release tonight on your party, say your candidacy, as you try to go forward?
RICK SANTORUM: Well, I would say that there are more fundamental issues than that, where there's a gap and a problem with two of the gentlemen who are up here with me. And one is on the biggest issue that they -- we have to deal with in this election, that's -- that's crushing the economy, will crush it even further and crush freedom, and that's Obamacare.
Governor Romney's plan in Massachusetts was the basis for Obamacare. Speaker Gingrich for 20 years supported a federal individual mandate, something that Pam Bondi is now going to the Supreme Court saying is unconstitutional. Speaker Gingrich, for 20 years, up until last year supported an individual mandate, which is at the core of Obamacare.
If you look at cap-and-trade, Governor Romney was very proud to say that he was the first state in the country as governor to sign a cap on CO-2 emissions, the first state in the country to put a cap believing in -- in global warming and criticized Republicans for not believing in it, as did, by the way, Speaker Gingrich, who was for a cap-and-trade program with incentives, business incentives, but was for the rubric of cap-and-trade, not specifically the cap-and-trade bill that was out there.
Again, huge, huge differences between my position and where President Obama is, but not so on two major issues. You go down and you look at the Wall Street bailouts, I said before, here's one where you had folks who preach conservativism, private sector, and when push came to shove, they got pushed. They didn't stand tall for the conservative principles that they argued that they were for. And as a result, we ended up with this bailout that has injected government into business like it had never been done before.
They rejected conservativism when it was hard to stand. It's going to be hard to stand whoever this president is going to be elected. It's going to be tough. There is going to be a mountain of problems. It's going to be easy to be able to bail out and compromise your principles.
We have gentlemen here on the three issues that got the Tea Party started, that are the base of the conservative movement now in the Republican Party. And there is no difference between President Obama and these two gentlemen. And that's why this election in Florida is so critical, that we have someone that actually can create a contrast between the president and the conservative point of view.
WILLIAMS: Congressmen Paul, are the two men in the middle insufficiently conservative for you?
RON PAUL: Well, I think the problem is, is nobody has defined what being conservative means.
WILLIAMS: Go ahead.
RON PAUL: And I think that is our problem. Conservative means we have a smaller government and more liberty. And yet, if you ask, what have we done? I think we have lost our way.
Our rhetoric is still pretty good, but when we get in charge, we expand the government. You talk about Dodd-Frank, but we gave Sarbanes-Oxley. We gave debts as well, you know, when we're in charge.
So, if it means limited government, you have to ask the basic question, what should the role of government be? The founders asked that question, had a revolution and wrote a Constitution. And they said the role of government ought to be to protect liberty.
It's not to run a welfare state and not to be the policemen of the world. And so if you're a conservative, how can you be conservative and cut food stamps, but you won't cut spending overseas? There is not a nickel or a penny that anybody will cut on the conservative side, overseas spending. And we don't have the money.
They are willing to start more wars. So, I say, if you're conservative, you want small government across the board, especially in personal liberty. What's wrong with having the government out of our personal lives? So, this is what -- we have to decide what conservative means, what limited government means.
And I have a simple suggestion. We have a pretty good guide, and if we follow the Constitution, government would be very small and we would all be devoted conservatives.
WILLIAMS: Governor Romney, again tonight, so called Romneycare and so-called Obamacare have been positioned very closely side by side by your opponent, the senator. And again, you have been called insufficiently conservative.
MITT ROMNEY: You know, I have a record. You can look at my record. I just described what I had accomplished in Massachusetts. It's a conservative record.
Also, the fun of running against Ted Kennedy. What a great thrill that was. I didn't beat him, but he had to take a mortgage out on his house to make sure that he could defeat me. I believe that the policies he put in place had hurt America and helped create a permanent underclass in this country.
My health care plan, by the way, is one that under our Constitution we're allowed to have. The people in our state chose a plan which I think is working for our state.
At the time we crafted it, I was asked time and again, "Is this something that you would have the federal government do?" I said absolutely not.
I do not support a federal mandate. I do not support a federal one-size-fits-all plan. I believe in the Constitution. That's why the attorney general here is saying absolutely not.
You can't impose Obamacare on the states. What I will do if I'm president, I will repeal Obamacare and return to the states the authority and the rights the states have to craft their own programs to care for their own poor.
Jan. 20, 2012 -- On CNN last night, Republican presidential candidates Mitt Romney, Newt Gingrich, Rick Santorum and Rep. Ron Paul disputed each other's positions on the health law and on abortion. The moderator was John King.
Here is a full transcript of the health care sections of the debate:
JOHN KING, DEBATE MODERATOR AND CNN CHIEF NATIONAL CORRESPONDENT: Let's turn to our audience now.
Let's turn now and take a question from down in our audience tonight. Go ahead, sir.
QUESTION: My name is Sonny Cohen. I'm from Sevier County, Tennessee. My question to any of the candidates is: Do any of you sincerely believe that Obamacare can either be repealed or reversed in its entirety?
KING: Let me go first to Governor Romney on that one.
Governor, you had said you would do it on day one with an executive order that would free the states up to opt out, waivers essentially to get out of that program. I know your friend, the South Carolina governor might like to have that option.
Help me understand as you do that how would it play out? And what happens to those, someone with a preexisting condition for example, who now has coverage under the president's health care plan, or a young American, 22, 23, 24, who because of the changes in the law, can now stay a few extra years on their parents' health care? What happens to them when you sign that executive order?
FORMER GOV. MITT ROMNEY (R-MA.), PRESIDENTIAL CANDIDATE: Well, first of all, the executive order is a beginning process. It's one thing, but it doesn't completely eliminate Obamacare. It's one thing I want to get done to make sure that states could take action to pull out of Obamacare.
But number two, we have to go after a complete repeal and that's going to have to happen...
... that -- that's going to have to happen with a House and a Senate, hopefully that are Republican. If we don't have a Republican majority, I think we're going to be able to convince some Democrats that when the American people stand up loud and clear and say, "We do not want Obamacare; we do not want the higher taxes; we do not want a $500 billion cut in Medicare to pay for Obamacare," I think you're going to see the American people stand with our president and say, "Let's get rid of Obamacare."
But we'll replace it, and I've laid out what I'll replace it with. First, it's a bill that does care for people that have preexisting conditions. If they've got a preexisting condition and they've been previously insured, they won't be denied insurance going forward.
Secondly, I'd allow people to own their own insurance, rather than just be able to get it from their employer. I want people to be able to take their insurance with them if they go from job to job.
So -- so we'll make it work in the way that's designed to have health care act like a market, a consumer market, as opposed to have it run like Amtrak and the post office. That's what's at risk...
... at stake here. Do we -- we -- we go back to this. Ours is the party of free enterprise, freedom, markets, consumer choice. Theirs is the party of government knowledge, government -- government domination, where Barack Obama believes that he knows better for the American people what's best for them. He's wrong. We're right. That's why we're going to win.
KING: Mr. Speaker, you heard the skepticism. This is a southern Republican voter, but he's skeptical. He knows how Washington works. He's watched Washington work. He's asking it be reversed in its entirety.
You -- you were the speaker of the House. You understand how this works. How -- how can it be repealed in this current political environment?
GINGRICH: Well, let me say first of all, if you've watched Washington and you're not skeptical, you haven't learned anything.
I mean, this -- this system is a total mess right now. Second, can you get it repealed in total? Sure. You have to elect a House, a Senate and a president committed to that. It has to be major part of the fall campaign. And I think that, frankly, on our side with any of us, it's going to be a major part of the fall campaign.
The American people are frightened of bureaucratic centralized medicine. They deeply distrust Washington and the pressure will be to repeal it. And a lot of what Governor Romney has said I think is actually a pretty good, sound step for part of the replacement.
I would always repeal all of it because I so deeply distrust the congressional staffs that I would not want them to be able to pick and choose which things they cut.
But let me make one observation. He raised a good example. Why is President Obama for young people being allowed to stay on their parents' insurance until 26? Because he can't get any jobs for them to go out and buy their own insurance.
I mean I have -- I have an offer -- I have an offer to the parents of America: Elect us and your kids will be able to move out because they'll have work.
KING: Senator Santorum, you heard Governor Romney and you heard Speaker Gingrich. Do you trust them if one of them is the Republican party's nominee and potentially the next president of the United States to repeal this?
FORMER SEN. RICK SANTORUM (R-PA.), PRESIDENTIAL CANDIDATE: The biggest -- the biggest thing we have to do is elect a president. I think Newt's right. The problem is that two of the people up here would be very difficult to elect on, I think, the most important issue that this country is dealing with right now, which is the robbing of our freedom because of Obamacare.
Governor Romney tells a very nice story about what his plan is now. It wasn't his plan when he was in a position to do a plan. When he was governor of Massachusetts, he put forth Romneycare, which was not a bottom-up free market system. It was a government-run health care system that was the basis of Obamacare, and it has been an abject failure. And he has stood by it. He's stood by the fact that it's $8 billion more expensive...
... than under the current law. He stood by the fact that Massachusetts has the highest health insurance premiums of any state in the country. It is 27 percent more expensive than the average state in the country.
Doctors -- if you're in the Massachusetts health care system, over 50 percent of the doctors now are not seeing new patients -- primary care doctors are not seeing new patients. Those who do get to see a patient are waiting 44 days on average for the care. It is an abject disaster. He's standing by it. And he's going to have to run against a president -- he's going to have to run against a president who's going to say, well, look, look at what you did for Massachusetts, and you're the one criticizing me for what I've done? I used your model for it. And then...
... then we have Speaker Gingrich, who has been -- who has been for an individual mandate, not back when the time that just was -- Heritage was floating around in the '90s, but as late as comments since 2008, just a few years ago.
He stood up and said that you should have an individual mandate or post $150,000 bond. How many $150,000 bond holders do we have here who can post a bond for their health insurance?
These are two folks who don't present the clear contrast that I do, who was the author of health savings accounts, which is the primary basis of every single conservative reform of health care.
I was the author of it back in 1991 and '92, 20 years ago. I've been fighting for health reform, private sector, bottom up, the way America works best, for 20 years, while these two guys were playing (inaudible) with the left.
KING: I want to bring Congressman Paul -- bring you into the discussion in just a moment. But Senator Santorum directly challenged the governor and then the speaker. Governor, you first.
ROMNEY: Well, so much of what the senator said was wrong. Let me mention a few of the things. First of all, the system and my state is not a government-run system. Ninety-two percent of the people had their own insurance before the system was put in place and nothing changed for them. They still had the same private insurance. And the 8 percent of the uninsured, they brought private insurance, not government insurance.
And the people in the state still favor the plan 3-1. And it certainly doesn't work perfectly. Massachusetts, by the way, had the highest insurance costs before the plan was put in place and after. But fortunately, the rate of growth has slowed down a little less than the overall nation.
And one of the things I was proud of is that individuals who wanted to buy their own insurance saw their rates -- when they were not part of a big group -- saw their rates drop by some 40 percent with our plan.
Is it perfect? Absolutely not. But I do believe that having been there, having been in the front lines, showing that I have compassion for people that don't have insurance but that the Obama plan is a 2,700-page massive tax increase, Medicare-cutting monster. I know how to cut it. I'll eliminate it. I will repeal it. And I'll return to the -- I'll return the power to the states, where the power for caring for the uninsured ought to reside constitutionally. Thank you.
KING: Senator Santorum, he says your facts are wrong.
SANTORUM: Well, they're simply not wrong. The fact is that, yes, you're right, Governor Romney. Ninety-two percent of people did have health insurance in -- in Massachusetts. But that wasn't private- sector health insurance. A lot of those people were, as you know, on Medicare and Medicaid. So they're already on government insurance, and you just expanded.
In fact, over half the people that came on the rolls since you put Romneycare into effect are fully subsidized by the state of Massachusetts. And a lot of those are on the Medicaid program.
So the idea that you have created this marketplace in -- with this government-run health care system, where you have very prescriptive programs about reimbursements rates. You have very prescriptive programs just like what President Obama is trying to put in place here.
You're arguing for a plan; you're defending a plan that is top-down. It is not a free-market health care system. It is not bottom-up. It is prescriptive and government. It was the basis for Obamacare.
And you do not draw a distinction that's going to be effective for us just because it was the state level, not the federal level.
KING: If you want, Governor, quickly?
ROMNEY: Sure, absolutely. First of all, as you probably know, Medicaid is not a state program.
SANTORUM: Of course it is. It's a state and federal program.
ROMNEY: Medicaid is as demanded by the federal government and it is -- it's a mandate by the federal government and it's shared 50/50, state and federal.
The people of Massachusetts who are on Medicaid -- I would like to end that program at the federal level, take the Medicaid dollars and return them to the states and allow states to craft their own plans. That would make the plan we had in Massachusetts a heck of a lot better.
My view is get the federal government out of Medicaid, get it out of health care. Return it to the states. And if you want to go be governor of Massachusetts, fine. But I want to be president and let states take responsibility for their own plans.
KING: Mr. Speaker -- it may seem like a while ago, Mr. Speaker, but Senator Santorum made the point, in his view, you don't have credibility on this issue.
GINGRICH: No, what he said, which I found mildly amazing, was that he thought I would have a hard time debating Barack Obama over health care. Now, in fact, I -- as Republican whip, I led the charge against Hillarycare in the House. As Speaker of the House, I helped preside over the conference which wrote into law his idea on health savings accounts. So I was delighted to help him get it to be a law.
And the fact is, I helped found the Center for Health Transformation. I wrote a book called "Saving Lives and Saving Money" in 2002. You can go to healthtransformation.net and you'll see hundreds of ideas, none of which resemble Barack Obama's programs.
So I'd be quite happy to have a three-hour Lincoln/Douglas style debate with Barack Obama. I'd let him use a teleprompter. I'll just rely on knowledge. We'll do fine.
KING: Senator, I want to bring Congressman Paul in. You're shaking your head. Quickly.
SANTORUM: The core of Obamacare is an individual mandate. It is what is being litigated in the Supreme Court right now. It is government, top-down, telling every business, every American what kind of health care you will have. That is the problem with Obamacare at the core of it, and the Speaker supported it repeatedly for a 10-year period.
So when he goes and says, I can, you know, run rings around President Obama in a Lincoln/Douglas debate, you can't run rings around the fact, Newt, that you supported the primary, core basis of what President Obama's put in place.
GINGRICH: Look, just one --
KING: Quickly, Mr. Speaker. The congressman's getting lonely down here. Let's go.
GINGRICH: Just one brief comment. Of course you can. I can say, you know, I was wrong and I figured it out. You were wrong and you didn't.
SANTORUM: Newt, you held that position for over 10 years. And, you know, it's not going to be the most attractive thing to go out there and say it took me 10 or 12 years to figure out I was wrong when guys like Rick Santorum knew it was wrong from the beginning.
KING: Congressman Paul, you have the floor. Do you trust these men to repeal Obamacare?
REP. RON PAUL (R-TX.), PRESIDENTIAL CANDIDATE: Thank you.
PAUL: I thought you were -- I thought maybe you were prejudiced against doctors and a doctor that practiced medicine in the military or something.
No, I want to address the question. The gentleman asked whether he thinks we can repeal Obamacare.
Theoretically, we can. The likelihood isn't all that good.
We can diminish some of the effect, but I'm more concerned about a bigger picture of what's happening. And that is, government involvement in medicine.
I had the privilege of practicing medicine in the early '60s before we had any government. It worked rather well and there was nobody out in the street suffering with no medical care.
But Medicare and Medicaid came in and it just expanded. But even when we had the chance to cut back on it, when we had a Republican Congress and a Republican president, we gave them prescription drug programs. Senator Santorum supported it. You know, that's expanding the government.
PAUL: So -- and most of them are bankrupt. Prescription drugs, they're not going to be financed. Medicare's not financed. Medicaid's in trouble. But nobody talks about where the money's going to come from.
Now, even in my budget proposal, which is very, very tough, because I'm going to cut $1 trillion the first year, but I try to really --
PAUL: Even though these programs should have never started but a lot of people depend on it, I want to try to protect the people who are dependent on medical care.
Now, where does the money come? My suggestion is, look at some of the overseas spending that we don't need to be doing.
PAUL: We have troops in Korea since the Korean War, in Japan since World War II, in Germany since -- those are subsidies to these countries. And we keep fighting these wars that don't need to be fought. They're undeclared. They never end. Newt pointed out that World War II was won in less than four years. Afghanistan, we're there for 10 years. Nobody says where's the money coming from?
We could work our way out of here and take care of these people with these medical needs. But we can't do it with the current philosophy of the government taking care of everybody forever on medical care, cradle to grave, and being the policeman of the world.
We will get rid of all this government program, unfortunately because we're going bankrupt and you're going to have runaway inflation, and our checks are going to bounce. And that's going to be a lot worse problem than we're facing tonight.
And here's what the candidates had to say on abortion:
KING: I think we have nodding heads. I assume we have agreement on that. But let's move on to another issue that came up in the campaign right here in South Carolina this week, and that's the life issue.
Mr. Speaker, your campaign sent out a mailing to South Carolina Republicans across this state essentially questioning Governor Romney's commitment on this issue, saying that he has changed his position on the abortion issue.
If you'll recall, I moderated a debate back in New Hampshire in June. There were seven candidates then. We have four tonight. But when this came up, we talked about it briefly, and then I asked, is this fair game, an issue in this campaign, or is it case closed?
Mr. Cain, who was with us at the time, said case closed, and I paused. No one else took the opportunity to speak up.
If it was case closed then, why is a legitimate issue now?
GINGRICH: You just said nobody else spoke. So nobody else said, yes, it's case closed. I mean, Herman Cain said it was case closed, the rest of us, it wasn't a particular issue we wanted to fight that night.
I mean, we are allowed to run our own campaigns, John. It's not an automatic requirement that we fit in your debate schedule.
This is -- look, this is a very straightforward question. Governor Romney -- and I -- and I accept this -- I mean, Governor Romney has said that he had a experience in a lab and became pro-life, and I accept that.
After he became pro-life, Romneycare does pay for tax-paid abortions. Romneycare has written into it Planned Parenthood, the largest abortion provider in the country, by name. Does not have any right to life group written into it.
He did appoint pro-abortion judges. And a branch of the government which included his appointees did agree to fund an abortion clinic for Planned Parenthood. All that occurred after he had become pro-life.
Now, those are all facts which we validated, and it seems to me that's a legitimate part of the campaign, is to say, "OK, if you're genuinely pro-life, how come these things are occurring?"
KING: Governor Romney, he questions whether you're genuinely pro- life.
ROMNEY: I'm not questioned on character or integrity very often. And I don't feel like standing here for that. But let me clarify the things which are wrong in what the speaker just said. And -- and he can get a scintilla of truth in there to make it seem like this is a significant issue. But let's go through one by one.
First, in Romneycare there's no mention of abortion whatsoever. The courts in Massachusetts, the supreme court was the body that decided that all times if there was any subsidy of health care in Massachusetts that one received abortion care. That was not done by the legislature. Would not be done by me either. I would have vetoed such a thing. That was done by the courts, not by the legislature or by me.
Number two, it's true, somewhere in that bill of ours, 70 pages, there's the mention of the word Planned Parenthood, but it describes a person at a technical advisory board about payment structures. There's no requirement or no participation of Planned Parenthood in our health care plan.
With regards to judges, I appointed probably 50 or 60 judges, at the trial court level mostly, the great majority. These were former prosecutors, 80 percent of them former prosecutors. We don't have a litmus test for appointing judges, asking them if they're pro-life or not pro-life. These are people going after crimes and -- and -- and the like. I didn't get to appoint any supreme court justices.
I am pro-life. And the Massachusetts Citizens for Life and several other family-oriented groups wrote a letter two weeks ago and said they'd watched my record, that I was an avidly pro-life governor. I'm a pro-life governor. I am a pro-life individual.
And -- and I -- I have to be honest here. It is -- this is not the time to be doubting people's words or questioning their integrity. I'm pro-life.
By the way, is there any possibility that I've ever made a mistake in that regard, I didn't see something that I should have seen? Possibly. But you can count on me as president of the United States to pursue a policy that protects the life of the unborn, whether here in this country or overseas. And I'll reverse the policies of this president.
KING: Mr. Speaker, he says you're questioning his integrity.
GINGRICH: I'll yield to Senator Santorum.
SANTORUM: I just want to make one point. And a lot of legislatures here -- legislators here in the room and they -- and they know this to be the truth, that if you write a piece of legislation and you -- and you say medical care and you do not specifically mention that abortion is not covered, we know from every court decision at the state and federal levels that the federal courts and state courts will require it.
That is someone (sic) every governor knows, every state legislator knows. And so when Governor Romney did not put that in the bill, you can't say, "Oh, gee, surprise, the court made us cover abortions." He knew very well that the court would make them cover abortions. That's number one.
Number -- number two, what we're talking about here is someone who's not going to just check the boxes and say, "Yes, I'm pro-life."
We've got a lot of folks who just whisper into the microphone that they're pro-life, and then you have other people who go out and fight the battle and defend life and come out of the trenches and actually work to make sure that the dignity of every human life, innocent human life in this country is protected.
And I've done that.
And I -- and I would say to you in -- in contrast with Speaker Gingrich, who on the social issues, in particular when he was speaker and even afterwards, they were pushed on the back bench. There was a pledge to America that the Congress tried to put together in 2010. I got phone calls ringing off the hook that Speaker Gingrich went in and told them, "Keep social issues out of the pledge to America for the 2010 elections, and we need you to come in and help to try to convince these folks to put that back into the pledge."
We don't need someone who in the back rooms is going to say social issues in the front -- are in the back of the bus, and then come out here and try to prevent they're pro-life.
KING: Governor Romney and then Speaker Gingrich, he mentioned (inaudible). Very quickly.
ROMNEY: Senator, I -- I admire the fact that you've been a stalwart defender of -- of pro-life and in a state where that's not easy. I was also a governor in a state where being pro-life was not easy. And I -- and I battled hard. What came to my desk was a piece of legislation that said "We're going to redefine when life begins." In our state, we said life began at conception. The legislature wanted to change that to say, "No, we're going to do it an implantation." I vetoed that.
The legislature also said, "We want to allow cloning for purposes of -- of creating new embryos for testing." I vetoed that. The legislature did not want to abstinence education. I pushed and pursued abstinence education. There was an effort to also have a morning-after pill provided to, as I recall, young women in their teens. I can't remember the exact age. I vetoed that.
I stood as a pro-life governor and that's why the Massachusetts Pro- Life Family Association supported my record as governor, endorsed my record as governor. I -- I did my very best to be a pro-life governor. I will be a pro-life president. I'm proud of that. I wrote about it in my book. My record is -- is solid.
I appreciate your record. I hope you'll appreciate mine.
KING: Mr. Speaker, he -- he mentioned you specifically, and then we want to move on, but please respond.
GINGRICH: Well, the fact is that I voted with Henry Hyde, who was the leading pro-life advocate in the House for a generation. I had a 98.6 percent pro-life voting record. The only one we disagreed on was welfare reform, which they scored for reasons we never understood. Otherwise, it was a perfect record on -- on pro-life.
When I was speaker, we twice passed a bill that actually Rick was -- was very active in, to end partial-birth abortion. Twice, it was vetoed by Clinton, but twice we passed it.
In the 2010 election, the freshman class has the highest percentage of pro-life members ever in history, and my job was to maximize their winning. And the fact is, we won a huge victory in 2010 with the largest number of pro-life members ever elected in a freshman class.
KING: All right, let's move on. Let's take another question.
Congressman, I'll (inaudible) on this one. Let's -- let's take a question now from social media. Question -- (inaudible), before we move on, do you want in on this issue? They want you in on this issue. Would you like in on this issue?
PAUL: John, once again, it's a medical subject and I'm a doctor.
No, I do want to make a couple of comments because I can remember the very early years studying obstetrics and I was told -- and it was before the age of abortion. And I was told taking care of a woman that's pregnant, you have two patients. And I think that's -- that solves a lot of the problems of life -- you know, when life begins and all.
And I also experienced a time later on in my training, in the 1960s when the culture was changing. The Vietnam War was going on. The drugs were there and pornography and everything came in. And abortion became prevalent, even though it was illegal. So the morality of the country changed, but then the law followed up. When the morality changed, it will -- reflects on the laws.
The law is very important. We shouldn't have these laws, but law will not correct the basic problem, and that's the morality of the people that we must do.
Now, just very, very briefly, I want to talk a little bit about that funding because the flaw there is if you -- if you send funding out and you say, "Well, you can have it for birth control, but not for abortion," all funds are fungible. Even funds that go to any hospital if you say, "Well, it's not for birth control and it's not for Planned Parenthood and it's not for abortion," if you send it to the hospital, they can still use that money.
This is an indictment of government-run medicine because you never can sort that all out. You need the government out of that business or you will always argue over who's paying what bills.
KING: Very quickly, Senator.
SANTORUM: I think that was directed at me, and so I would just say this. Congressman Paul has a national right-to-life voting record of 50 percent, which is pretty much what Harry Reid's national right to life voting record is.
So for -- to go out and say that you're someone who stands up for the right to life, you repeatedly vote against bills on a federal level to promote the right to life. And you say that this is an individual, a personal decision, or state decision. Life should be protected, and you should have the willingness to stand up on a federal law and every level of government and protect what our Declaration protects, which is the right of our creator to life, and that is a federal issue, not a state issue.
KING: Quickly, sir.
PAUL: Just for the record, I wasn't even thinking about you when I was giving my statement, so you are overly sensitive.
PAUL: But it is true that we have a disagreement on how we approach it. I follow what my understanding is of the Constitution. And it does allow for the states to deal with difficult problems.
A matter of fact, it allows the states to deal with almost all the problems if you look at it. It is not given -- these powers aren't given to the Congress.
I see abortion as a violent act. All other violence is handled by the states -- murder, burglary, violence. That's a state issue.
So don't try to say that I'm less pro-life because I want to be particular about the way we do it and allow the states the prerogative. This is the solution. This is the solution. Because if we would allow the states to write their laws, take away the jurisdiction by a majority vote in the Congress, you repeal Roe versus Wade overnight, instead of waiting year after year to change the court system.
In Monday night's GOP presidential candidate debate in Myrtle Beach, South Carolina, front-runner Mitt Romney described his approach to Medicare, which includes charging wealthier recipients more and including 'premium supports.' He also attacked the health law, the only candidate on the stage to discuss the law. Former Sen. Rick Santorum and former House Speaker Newt Gingrich both challenged Romney. The S.C. primary is on Saturday.
Here is a transcript of the health care parts of the debate, which was sponsored by Fox News, The Wall Street Journal and the South Carolina Republican Party:
BRET BAIER, Fox News: Welcome back to Myrtle Beach, South Carolina and the Republican presidential debate.
We are getting questions from Twitter. Governor Romney — Governor Huntsman endorsed you today. But in New Hampshire he called you a, quote, "perfectly lubricated weather vane on the important issues of the day." And just last week, Governor Huntsman charged that it’s hard to find your core. Which leads to our first Twitter question.
From MissinDixie, quote, "I want to support Mitt Romney, but considering his changing views, convince me you won’t change again."
MITT ROMNEY: You know, the issue where I change my mind, which obviously draws a lot of attention was that when I was running for governor, I said I would leave the law in place as it related to abortion. And I thought I could go in that narrow path between my personal belief and letting government stay out of the issue.
Then a piece of legislation came to my desk and it said we would begin to create embryos for the purpose of destroying those embryos, and I said I simply couldn’t sign something like that. And I penned an op-ed in the Boston Globe and said I’m pro-life, described my view and served as a pro-life governor.
The Massachusetts Citizens for Life have just written a letter last week describing my record and saying this is a solid record of a very pro-life governor. I’m proud of that record.
GERALD SEIB, The Wall Street Journal: Governor Romney, in the book you wrote just before this campaign began, you said you were surprised that the press in the last campaign didn't press for more specifics on how to fix Social Security and Medicare, so let’s fix that tonight. Let me ask you specifically: Would you reduce the cost of these programs by raising the retirement age for Social Security, by raising the eligibility age for Medicare, or by reducing benefits for seniors with higher incomes?
ROMNEY: Let me lay it out. First of all, for the people who are already retired or 55 years of age and older, nothing changes. It’s very important, because I know the Democrats are going to be showing videos of, you know, old people being thrown off cliffs and so forth. But don’t forget…
Don’t forget who it was that cut Medicare by $500 billion, and that was President Obama to pay for Obamacare. So let’s not forget that.
What — what I would do with Social Security is that I would lower — if you will, the 2.0, the version for the next generations coming up, I’d lower the rate of inflation growth in the benefits received by higher-income recipients and keep the rate as it is now pretty high for lower income recipients. And I’d also add a year or two to the retirement age under Social Security. That balances Social Security.
ROMNEY: With regards to Medicare, I would lay out the plan that — well, I actually did a couple of months ago that said, again, for higher-income recipients, lower benefit, a premium support program which allows people to buy either current standard Medicare or a private plan.
And this is the proposal which Congressman Paul Ryan has adopted. It’s a proposal which I believe is absolutely right on. We have a premium support program. Give people choice. Let competition exist in our Medicare program by virtue of the two things that I’ve described: higher benefits for lower-income people, lower benefits for higher-income people and making a premium support program in Medicare and in — and Social Security a slightly higher retirement age. You balance those two programs.
By the way, the third major entitlement, Medicaid, you send back to the states. And the fourth new entitlement, ObamaCare, you repeal that one and finally get our balance sheet right.
BAIER: Speaker Gingrich. Speaker Gingrich, the plan that you have endorsed for addressing Social Security, you suggest also that younger workers should be allowed to put their tax money into private accounts rather than into the government program.
But that plan also says that if those private accounts don’t pay out as much as the government program would, Washington should cut a check to make up the difference. Is that really a free market outcome if the government guarantees the outcome?
NEWT GINGRICH: Well, it is, as a historian, a fact-based model that has Galveston, Texas, and the entire country of Chile as testing grounds. Chile has done this. Jose Pinera’s (ph) glad to talk about it, the guy who created it, they have done it for over 30 years.
First of all, it’s totally voluntary. If you want to stay in the current system, stay in it. If you are younger and you want to go and take a personal savings account, which would be a Social Security savings account, you can take it.
Your share of the tax goes into that. The employer's share goes into the regular fund to pay for the regular fund. The historic record in Chile is the average young person gets two to three times the retirement income. In 30 years they have never written a single check, because nobody has fallen below the minimum payment of Social Security, and these are historic facts.
They now have 74 percent of the GDP in their savings fund, so much that they now allow people to actually invest outside the country. The principal group in Des Moines, Iowa, actually runs part of this program, and I actually interviewed the person who is in charge of it for the principal group.
So the Social Security actuary estimate if you make it a voluntary program, 95 to 97 percent of young people will take the program, because it is such a big return on your investment, you’d be relatively stupid not to do it. OK.
GINGRICH: Now, what does it do? It gets the government out of telling you when to retire. It gets the government out of picking winners and losers. You save — it makes every American an investor when they first go to work. They all have a buildup of an estate, which you do not get in the current system.
And the estimate by Martin Prostein (ph) at Harvard is, who was Reagan’s chief counsel and economic advisors, was you actually reduce wealth inequality in America by 50 percent over the next generation because everybody becomes a saver and an investor and you have a universal investing nation.
BAIER: Senator Santorum, Senator Santorum, in your jobs program you propose to eliminate the corporate income tax for manufacturers, but not for other businesses. Isn’t that picking winners and losers in the same way the Obama administration did when it gave grants to one solar energy company, Solyndra, and it went bankrupt?
RICK SANTORUM: No, it's not. What we do is cut corporate taxes for everybody. We cut it from 35 percent to 17.5 percent, make it a — basically a net profits tax. And then we take the area of the economy that’s under competition from overseas for our jobs. The rest of the economy is not being shipped off like the mills here in South Carolina were to other countries around the world because of foreign competition.
Why? The foreign competition that we are dealing with right now is much cheaper to do business, excluding labor costs than we are, about 20 percent more, and that 20 percent differential is government. It’s government regulation and it’s also government taxation.
So part of what we are trying to do is to have a government system that can compete with who our competitor is. The competitor at the local drugstore is not China. The competitor is other people.
And as long as that is level and everybody’s paying, the big corporations and the little ones — and that’s why we have a flat 171/2 percent — so we keep the little guys paying the same rate as the big guys who have — right now, with this very complex code, a lot of folks in there trying to reduce rates by using the tax code to shrink their tax liability.
So we’ve leveled the playing field for the guys here in this country and we’ve created a competitive environment for the manufacturer. I want to make a point about Newt and his plans because they are not bold. And they’re not — in the case of Governor Romney.
SANTORUM: And they are — and they're irresponsible. And I say that against Newt because there’s nobody for the last 15 years that’s been more in favor of personal savings accounts than I have for Social Security. But we were doing that when we had a surplus in Social Security. We are now running a deficit in Social Security. We are now running a huge deficit in this country.
Under Congressman Gingrich’s proposals, if he’s right, that 95 percent of younger workers taken, there will be hundreds of billions of dollars in increased debt, hundreds of billions of more debt being put on the books, which we can’t simply — we’re going to be borrowing money from China to fund these accounts, which is wrong. I’m for those accounts, but first we have to get our fiscal house in order, balance this budget and then create the opportunity that Newt wants. But the idea of doing that now, is fiscal insanity.
BAIER: Speaker Gingrich?
SANTORUM: And Mitt Romney's plan is simply not bold. We have a deficit now in Social Security. We have deficits now in Medicare. And he wants to say, well we’re not going to touch anybody now. There’s 60,000 people in this country who are earning over $1 million a year as a senior and he’s saying, no let’s not touch them. I’m saying, yes. We should absolutely do something about people who don’t need Social Security when we’re borrowing money from China to pay those millionaires.
BAIER: Okay, first Speaker Gingrich, your response?
GINGRICH: Well if you actually look at the plan at newt.org, you’ll see that one of the ways we pay for it is we take 185 different federal bureaucracies that deal with low income Americans. Think about this, there are 185 separate bureaucracies with separate regulations, all dealing with low income Americans. We can consolidate them into a single block grant. We send it back to the states and we take the billions of dollars in federal overhead that saves and put that into Social Security in order to make up the difference.
So in fact Rick, it is a very sound plan and I say this as somebody who helped balance the budget four times in a row.
BAIER: Quickly. Quickly.
SANTORUM: Newt, I support that idea. But we need that to reduce the deficit we have now, not doing what you’re suggesting, which is ballooning the deficit by hundreds of billions of dollars more and then using things that we should be doing now to strengthen this budget deficit, to add more fiscal — financial responsibility on to the federal government.
BAIER: Last one.
GINGRICH: Okay, Martin Feldstein estimates that if you have a personal savings account model, you increase the size of the economy by $7 to $8 trillion over a generation because of the massive reinvestment. In addition, I would just suggest having helped balance the budget for four consecutive years, for the only time in your lifetime, I’m reasonably confident I can find ways to balance the budget.
GINGRICH: Without hurting young people and blocking them from Social Security.
BAIER: Governor Romney, do you want your 30 seconds? Or are you just enjoying this back and forth? Would you like to weigh in?
ROMNEY: Rick is right. I — I know it’s popular here to say, oh we could just — we can do this and it’s not going to cost anything. But look, it’s going to get tough to get our federal spending from the current 25 percent of the GDP down to 20, down to 18 percent, which has been our history. We’ve got a huge number of obligations in this country and cutting back is going to have to happen. I know something about balancing budgets.
In the private sector, you don’t have a choice. You balance your budget, or you go out of business. And we — we simply can’t say we’re going to go out and borrow more money to let people set up new accounts that take money away from Social Security and Medicare today. Therefore, we should allow people to have a voluntary account, a voluntary savings program, tax free. That’s why I’ve said anybody middle income should be able to save their money tax free. No tax on interest, dividends or capital gains.
That will get American’s saving and accomplishes your objective, Mr. Speaker, without threatening the future of America’s vitality by virtue of fiscal insanity.
GERALD SEIB: Speaker Gingrich, a super PAC supporting Governor Romney is running an ad here citing a pro-life’s group charge that you voted for a bill in Congress, co-sponsored by Nancy Pelosi, that supported China’s one-child policy. And they say that means you provided government funding for abortion, but you oppose abortion. What’s your response to that charge?
GINGRICH: Well, this is typical of what both Senator Santorum and I have complained about with Governor Romney’s super PAC, over which he apparently has no influence, which makes you wonder how much influence he’d have if he were president.
Well, let me take that particular bill. That bill was introduced by Claudine Schneider, who is a Republican from Rhode Island. It was introduced at a time when Ronald Reagan’s Mexico City policy was enforced. The Mexico City policy said no U.S. funding will be used to fund any activity that relates to abortion.
So it is explicitly a falsehood to suggest that a bill introduced under Mexico City policy would have paid for China’s one-child policy. In fact, I have explicitly opposed it. I have a 98.6 percent National Right to Life voting record in 20 years. And the only vote we disagreed on was welfare reform, which had nothing to do with abortion. So I think it is an absurdity and it would be nice if Governor Romney would exercise leadership on his former staff and his major donors to take falsehoods off the air.
Topics: Politics, Public Health, States
In Saturday night's ABC News/Yahoo debate, former Mass. Gov. Mitt Romney and moderator George Stephanopoulos had a few disputatious moments on social issues which included abortion, Roe vs. Wade and contraception.
Here is a complete transcript of this portion of the debate:
GEORGE STEPHANOPOULOS: Back in Manchester. Governor Romney, I want to go straight to you.
Senator Santorum has been very clear in his belief that the Supreme Court was wrong when it decided that a right to privacy was embedded in the Constitution. And following from that, he believes that states have the right to ban contraception. Now I should add that he said he’s not recommending that states do that...
RICK SANTORUM: No, I said -- let’s be clear.
STEPHANOPOULOS: Absolutely. I’m giving you your due...
SANTORUM: I’m talking about -- we’re talking about the 10th Amendment and the right of states to act.
STEPHANOPOULOS: But I do want to get to that core question.
STEPHANOPOULOS: Governor Romney, do you believe that states have the right to ban contraception? Or is that trumped by a constitutional right to privacy?
MITT ROMNEY: George, this is an unusual topic that you’re raising. States have a right to ban contraception? I can’t imagine a state banning contraception. I can’t imagine the circumstances where a state would want to do so, and if I were a governor of a state or...
STEPHANOPOULOS: Well, the Supreme Court has ruled --
ROMNEY: ... or a -- or a legislature of a state -- I would totally and completely oppose any effort to ban contraception. So you’re asking -- given the fact that there’s no state that wants to do so, and I don’t know of any candidate that wants to do so, you’re asking could it constitutionally be done? We can ask our constitutionalist here.
STEPHANOPOULOS: I’m sure Congressman Paul...
ROMNEY: OK, come on -- come on back...
STEPHANOPOULOS: ... asking you, do you believe that states have that right or not?
ROMNEY: George, I -- I don’t know whether a state has a right to ban contraception. No state wants to. I mean, the idea of you putting forward things that states might want to do that no -- no state wants to do and asking me whether they could do it or not is kind of a silly thing, I think.
STEPHANOPOULOS: Hold on a second. Governor, you went to Harvard Law School. You know very well this is based on...
ROMNEY: Has the Supreme Court -- has the Supreme Court decided that states do not have the right to provide contraception? I...
STEPHANOPOULOS: Yes, they have. In 1965, Griswold v. Connecticut.
ROMNEY: The -- I believe in the -- that the law of the land is as spoken by the Supreme Court, and that if we disagree with the Supreme Court -- and occasionally I do -- then we have a process under the Constitution to change that decision. And it’s -- it’s known as the amendment process.
And -- and where we have -- for instance, right now we’re having issues that relate to same-sex marriage. My view is, we should have a federal amendment of the Constitution defining marriage as a relationship between a man and a woman. But I know of -- of no reason to talk about contraception in this regard.
STEPHANOPOULOS: But you’ve got the Supreme Court decision finding a right to privacy in the Constitution.
ROMNEY: I don’t believe they decided that correctly. In my view, Roe v. Wade was improperly decided. It was based upon that same principle. And in my view, if we had justices like Roberts, Alito, Thomas, and Scalia, and more justices like that, they might well decide to return this issue to states as opposed to saying it’s in the federal Constitution.
And by the way, if the people say it should be in the federal Constitution, then instead of having unelected judges stuff it in there when it’s not there, we should allow the people to express their own views through amendment and add it to the Constitution. But this idea that justice...
STEPHANOPOULOS: But should that be done in this case?
STEPHANOPOULOS: Should that be done in this case?
ROMNEY: Should this be done in the case -- this case to allow states to ban contraception? No. States don’t want to ban contraception. So why would we try and put it in the Constitution?
With regards to gay marriage, I’ve told you, that’s when I would amend the Constitution. Contraception, it’s working just fine, just leave it alone.
(APPLAUSE) STEPHANOPOULOS: I understand that. But you've given two answers to the question. Do you believe that the Supreme Court should overturn it or not?
ROMNEY: Do I believe the Supreme Court should overturn...
(SOMEONE IN AUDIENCE YELLING)
ROMNEY: Do I believe the Supreme Court should overturn Roe v. Wade? Yes, I do.
REP. RON PAUL: He mentioned my name.
STEPHANOPOULOS: Go ahead then.
PAUL: I didn’t know whether I got time when it was favorable or not. But thank you. No, I think the Fourth Amendment is very clear. It is explicit in our privacy. You can’t go into anybody’s house and look at what they have or their papers or any private things without a search warrant.
This is why the Patriot Act is wrong, because you have a right of privacy by the Fourth Amendment. As far as selling contraceptives, the Interstate Commerce Clause protects this because the Interstate Commerce Clause was originally written not to impede trade between the states, but it was written to facilitate trade between the states. So if it’s not illegal to import birth control pills from one state to the next, it would be legal to sell birth control pills in that state.
STEPHANOPOULOS: Senator Santorum?
SANTORUM: What’s the question?
STEPHANOPOULOS: On the right to privacy and the response to Congressman Paul.
SANTORUM: Well, Congressman Paul is talking about privacy rights under the Fourth Amendment, which I agree with him in, I don’t necessarily agree that the Patriot Act violates that. But I do agree with -- obviously we have a right to privacy under the Fourth Amendment. But that’s not what the Griswold decision nor the Roe v. Wade decision were about.
They created through a penumbra of rights a new right to privacy that was not in the Constitution. And what I’ve -- and that’s, again, I sort of agree with Governor Romney’s assessment -- legal assessment, it created a right through boot-strapping, through creating something that wasn’t there. I believe it should be overturned.
I am for overturning Roe versus Wade. I do not believe that we have a right in this country, in the Constitution, to take a human life. I don't think that's -- I don't think our founders envisioned that. I don't think the writing of the Constitution anywhere enables that.
While health care issues did not take up much of Sunday morning's debate, the candidates agreed that Medicare should be a Rep. Paul-Ryan-style "premium support" system and former Mass. Gov. Mitt Romney said that, in the future, he believes wealthy Medicare recipients should have to pay more for the program.
Here is a complete transcript of the parts of the debate that included some discussion of health care:
DAVID GREGORY: So Governor Huntsman, name three areas where Americans will feel real pain in order to balance the budget?
JON HUNTSMAN: Well, I would have to say that I agree with the Ryan plan. I think I'm the only one standing up here who has embraced the Ryan plan. It's a very aggressive approach to taking about 6.2 -- $6.2 trillion out of the budget over 10 years. And it looks at everything. And what I like about it is it says there will be no sacred cows.
JON HUNTSMAN: Medicare won't be a sacred cow. Department of Defense won't be a sacred cow. As president of the United States I'm gonna stand up and I'm gonna say, "We are where we are. 24 percent spending -- as a percentage of GDP. We've gotta move to 19 percent --
DAVID GREGORY: Three programs that will make Americans feel pain, sir?
JON HUNTSMAN: Well, let me just say on-- on-- on entitlements. Across the board, I will tell the upper income category in this country that there will be means testing. There are a lot of people in this nation--
DAVID GREGORY: Social Security --
JON HUNTSMAN: -- who don't need some of the benefits?
DAVID GREGORY: -- and Medicare?
JON HUNTSMAN: Absolutely. Absolutely. And also I'm not gonna tie Department of Defense spending some percentage of GDP. I'm gonna tie it to a strategy that protects the American people. And if we think that we can't find efficiencies and cuts in the Department of Defense budget, then we are crazy.
DAVID GREGORY: Senator Santorum, same question. Three programs that would make -- would have to be cut to make Americans feel pain, to sacrifice, if we're gonna balance the budget.
RICK SANTORUM: I’ve gotta agree with go -- Governor Huntsman, the means test. And I talked about that in Hollis yesterday. We had about 1,200 people there. And I walked through and talked about how we have to make sure that -- we're not gonna burden future generations with a Social Security program that's underfunded. It's underfunded right now.
And-- we have to take those who have-- that have been successful, who are seniors, who have a tremendous amount of wealth and we oughta reduce benefits. It -- it makes no sense for folks who are struggling right now to pay their payroll tax, which is the biggest tax, it's a tax on labor, it makes us uncompetitive, and the idea that someone to the left would (UNINTEL) to raise those taxes to make labor even more uncompetitive for those working people who are trying to get a job, to subsidize high income seniors, doesn't make any sense to me.
Foods stamps is another place. We gotta block grant and send it back to the states, just like I did on welfare reform. Do the same thing with Medicare. Those three programs. We gotta -- and -- and -- and including -- housing programs, block grant them, send it back to the states, require work and put a time limit. You do those three things, we will help -- take these programs, which are now dependency programs which people are continually dependent upon, and you take them into transitional programs to help people move out of poverty.
DAVID GREGORY: Speaker Gingrich, on the issue of Medicare-- when you were on Meet The Press-- earlier in the year, you had talked about what-- Paul Ryan was talking about as a step too far, which is moving seniors onto a premium support, or a voucher program, depending on how you phrase it. As you know, Senator Santorum thinks that current seniors-- should be moved off of that program into premium support or a voucher program. Do you agree with doing it that quickly and making current seniors-- bear the brunt of that?
NEWT GINGRICH: Well, the fact is that the-- Ryan Wyden bill, which was just introduced recently, actually incorporates allowing people to choose and allows them to stay in traditional Medicare with the premium support model, or go to new methods. And I think it's a substantial improvement. It allows for a transition in Medicare in a way that makes sense.
But David, you know, I-- I find it fascinating that very, very highly paid Washington commentators and Washington analysts love the idea of pain. What-- who's gonna be in pain? The duty of the president is to find a way to manage the federal government so the primary pain is on changing the bureaucracy.
On-- on theft alone we could save $100 billion a year in Medicaid and Medicare if the federal government were competent. That's a trillion dollars over 10 years and the only people in pain would be crooks. So I think a (APPLAUSE) sound approach is to actually improve the government, not punish the American people because of a failure of the political class to have any sense of cleverness.
DAVID GREGORY: And-- before the break-- we were talking about Medicare. Paul Ryan, Senator Santorum had a plan where he'd like to move-- seniors off, give them a voucher or premium support and then they would-- take care of their health care from there. There's a lot of debate about that. And I mentioned you said seniors should be affected right now. 55-plus-- have them affected right now, which has been somewhat controversial. You wanna respond to that?
RON PAUL: Well, you know, I hear this all the time when I was -- have been campaigning around -- the state. You know, we should have the same kind of health care the members of Congress have. Well, that's pretty much what Paul Ryan's plan is. That the -- the members of Congress have a premium support model. So does every other federal employee.
I mean it works very well. As -- you know, the- - the federal government has a liability. They put -- put money out there. And then if you want, you -- you have -- about this thick. If you're an employee in Washington, D.C. it -- got a -- whole bunch of different plans to choose from and you have all sorts of options available to you. You want a more expensive plan, you pay more of a co-insurance. If you want a less expensive plan, you don't.
But here's the fundamental difference between Barack Obama and -- and everybody up here. It's whether you believe people can be free to make choices or whether you have to make decisions for them. And I believe seniors, just like every other American, should be free to make the choices in their health care plan that's best for them.
MITT ROMNEY: Well, who knows more about tax policy? I'm not sure that we're gonna choose from the two of them, but I can tell you this. The right course for America is not to raise taxes on Americans. I understand that President Obama and people of his political persuasion would like to take more money from the American people. And they want to do that so they can continue to grow government.
The answer for America is not to grow government. It is to shrink dro -- government. We've been going -- over the last 20, 30, 40 years, government keeps growing at a faster rate relative to inflation. We have got to stop the extraordinary spending in this country. That's why I put -- a plan that (APPLAUSE) reduces government spending. I'd cut -- I'd cut programs, a whole series of programs. By -- by the way, the number one to cut is Obamacare. That saves $95 billion a year. (APPLAUSE).
Return -- this, as Rick indicated, return to states a whole series of programs, food stamps, housing vouchers, Medicaid and then set how much goes to them. And finally, with regards with entitlement, in the entitlement reform area, I do not want to change Medicare and Social Security for current retirees. But for younger people coming up they have to recognize that in the future higher income people will receive less payments in the premium support program.
DAVID GREGORY: But Governor Romney, on this economic question, you blame President Obama for the jobs crisis, but when you look at the data, and a positive trend line, he still only gets the blame and none of the credit. How come?
MITT ROMNEY: Actually, I don't blame him for the recession and for the decline, what I blame him for is having it go on so long and going so deep. And having a recovery that's been so tough it-- businesses I talk to all over the country that would normally be hiring people are not hiring. And I asked them why. And they say because they look at the policies of this administration and they feel they're under attack.
When you have an administration that tries to raise taxes and has on businesses. When it puts in place Obamacare that's gonna raise the cost of health care for businesses. When they stack the National Labor Relations Board with labor stooges, which means that the policies relating to -- to labor are now gonna change dramatically in a direction they find uncomfortable. When you have Obama Care -- that -- tha t-- places more mandates on them. When you -- when you have -- Dodd-Frank, which makes it harder for community banks to make loans.
All these things collectively create the -- a reality of a president who has been anti-investment, anti-jobs, anti-business. And people feel that. And if you want to get this country going again, you have to recognize that the role of government is not just to catch the bad guys, important as that is. It's also to encourage the good guys.
DAVID GREGORY: Senator Santorum, Governor Perry, you-- you called the president a socialist. I wonder-- Senator Santorum, when you voted for a new prescription drug benefit that did not have a funding mechanism, were you advancing socialism?
RICK SANTORUM: Well, I-- I said repeatedly that-- we should have had a funding mechanism. And-- it's one of those things that I had a very tough vote, as you know. In that bill, we had health savings accounts, something I'd been fighting for 15 years, to transform the private sector health care system into a more consumer, bottom-up-- way of doing it. We also had Medicare Advantage to transform the entire Medicare system into-- Medicare Advantage is basically a premium support type model.
DAVID GREGORY: So advancing socialism, though, that's the point.
RICK SANTORUM: Well, I-- I-- I think I'm just answering your question. Maybe-- maybe we're not communicating well. But I just talked about-- that-- medical-- health savings account is an anti-socialistic idea to try to build a bottom-up, consumer-based economy-- in health care. The same thing with Medicare Advantage. And we also structured the Medicare, part D benefit, to be a premium support model, as a way of trying to transition Medicare. So there were a lot of good things in that bill. There was one really bad thing. We didn't pay for it. We should have paid for it. And that was a mistake.
DAVID GREGORY: Do you have another follow up on that?
ANDY HILLER: No, I'm gonna switch to Congressman Paul. And I'm gonna say many Americans, particularly Democrats, believe that health care is a right. In your opinion, what services are all Americans entitled to expect to get from government?
RON PAUL: Entitlements are not rights. Rights mean you have a right-- (APPLAUSE) entitle -- rights mean you have a right to your life and you have a right to your -- your liberty, and you should have a right to keep the fruits of your labor. And this is quite a bit different, but earlier on -- there was a little discussion here about gay rights. I, in a way, don't like to use those terms, gay rights -- women's rights -- minority rights -- mon -- religious rights.
There's only one type of right. It's your right to your liberty. And I think it causes -- divisiveness, when we see people in groups. Because for too long we punished groups. So the answer then was -- let's -- let's relieve them by giving them affirmative action. So I think both are wrong. If you think in terms of individuals and protect every single individual, no, they're not entitled -- one group isn't entitled to take something from b -- somebody else.
And -- the basic problem here is there's a lot of good intention to help poor people. But guess who gets the entitlements in Washington? The big guys get -- the rich people. They run the entitlement system. The military industrial complex, the banking system. Those are the entitlements we should be dealing with.
Both Newt Gingrich and Mitt Romney welcomed the Ryan-Wyden plan, announced yesterday. Gingrich went on defense after Rep. Michele Bachmann actually him on his record on abortion legislation while he was in the House of Representatives.
Topics: Politics, Health Reform, Medicare, Medicaid
At Saturday night's debate in Des Moines, Rep. Michele Bachmann, former Speaker of the House Newt Gingrich, Rep. Ron Paul, Texas Gov. Rick Perry, former Mass. Gov. Mitt Romney and former Sen. Rick Santorum spent a considerable amount of time discussing the 2010 health law. Romney and Gingrich were both attacked for supporting the concept of a requirement to buy health insurance. In the debate's most talked-about moment, Romney offered to bet Perry $10,000 that what Perry was saying about Romney's book wasn't correct.
The ABC News/Yahoo News debate was anchored by George Stephanopolous and Diane Sawyer and was co-sponsored by WOI-TV, The Des Moines Register and Drake University.
Courtesy of ABC, here is a transcript of the portions of the debate that dealt with health care, lightly edited:
MICHELE BACHMANN: I'm 55 years old, I've spent 50 years in the real world as a private business woman living real life and-- and building a real business. But you have to take a look at the candidates that -- that are on the stage. You started out with Mitt Romney with Newt Gingrich, asking them about whether or not they're the conservative in this race.
But you have to take a look. You -- when you look at Newt Gingrich, for 20 years, he's been advocating for the individual mandate in healthcare. That's -- that's longer than Barack Obama. Or if you look at Mitt Romney as the governor of Massachusetts, he's the only governor that put into place socialized medicine. No other governor did. Our nominee has to stand on a stage and debate Barack Obama and be completely different.
I led 40,000 Americans to Washington D.C., to the Capitol, to fight ObamaCare. I didn't advocate for it. If you look at -- at -- at Newt/Romney, they were for ObamaCare principles. If you look at Newt/Romney, they were for cap and trade. If you look at Newt/Romney, they were for the illegal immigration problem. And if you look at (LAUGH) Newt/Romney, they were for the $700 billion bailout. And you just heard Newt/Romney is also with Obama on the issue of the payroll extension.
So if you want a difference, Michele Bachmann is the proven conservative. It's not Newt/Romney.
GEORGE STEPHANOPOULOS: You threw-- you threw a lot out there. (APPLAUSE) So let's get both -- both of them a chance to respond, Speaker Gingrich, you go first, because you were in there twice...
NEWT GINGRICH: Well, Michele, you know, a lot of what you say just isn't true, period. I have never -- I have -- I oppose cap and trade, I testified against it, the same day that Al Gore testified for it. I helped defeat it in the Senate through American solutions. It is simply untrue. I fought against ObamaCare at every step of the way. I did it with -- the Center for Health Transformation was actively opposed, we actively campaigned against it. ...
BACHMANN: Can I respond? (APPLAUSE)
STEPHANOPOULOS: Thirty seconds, then Governor Romney.
BACHMANN: Well you'd have to go back to 1993 when Newt first advocated for the individual mandate in healthcare, and as recently as May of this year, he was still advocating for the individual mandate in healthcare. And Governor Romney sent his team to the White House to meet with President Obama to teach them how to spread the RomneyCare model across the nation.
That's why I say, Newt/Romney, you've got to have our nominee as someone who is a stark, distinct difference with President Obama. Who can go toe to toe and hold him accountable. President Obama knows me in Washington D.C. I've taken him on on issue after issue. Our nominee has to be willing to not agree with Barack Obama the -- on these issues, but stand 180 degrees opposite of all the candidates on this stage I've been fighting President Obama for every year that I've been there, and I've taken him on. And I will take him on in the debate and defeat him.
STEPHANOPOULOS: Governor Romney. (APPLAUSE)
MITT ROMNEY: I know Newt Gingrich. And Newt Gingrich is a friend of mine. But, he and I are not clones, I promise. (LAUGH) That -- that is not the case. So this Newt Gingrich thing, we gotta get that out of our mind altogether -- Newt and Romney thing, sorry. Let -- let me say this about -- about health care. One, I didn't send a team of anybody to meet with Barack Obama. I wish he'd have given me a call. I wish when he was putting together his health care plan, he'd have had the courtesy and-- and perhaps the judgment to say, "Let me -- let me talk to a governor. Let's talk to somebody who's dealt with a real problem that -- that understands this topic," and get on the phone.
I'd have said (BACKGROUND VOICE), "Mr. President, you're going down a very, very bad path. Do not continue going down that path because what you're gonna do is you're gonna raise taxes on the American people. You're gonna cut Medicare. Let's not forget, only one president has ever cut Medicare for seniors in this country, and it's Barack Obama. We're gonna remind him of that time and time again.
And finally, the plan we put in place in Massachusetts, it deals with the 8 percent of our people who didn't have insurance. The 92 percent of people who did have insurance, nothing changes for them. If I'm President of the United States, we're gonna get rid of ObamaCare and return, under our constitution, the 10th Amendment, the responsibility and care of health care to the people in the states.
STEPHANOPOULOS: I wanna bring Governor Perry -- (APPLAUSE) you've heard this argument, I wonder which side you come down on.
RICK PERRY: Yeah, well, I -- I'm -- I'm stunned, 'cause -- the fact of the matter is, you know, Michele kinda hit the nail on the head when we talked about the individual mandate. Both of these gentlemen have been for the -- individual mandate. And I'm even more stunned, Mitt, that you said you wished you could've talked to Obama and said -- "You're goin' down the wrong path," because that is exactly the path that you've taken Massachusetts. The Beacon Hill study itself said that there's been 18,000 jobs lost because of that individual mandate.
The study continued to say that there've been over $8 billion of additional cost. I wish you coulda had the conversation with the people of Massachusetts a long time before that phone call would've been with -- the -- President Obama, 'cause the fact of the matter is, you're for individual mandate. And you can get up and stand -- up and talk about, you know, "I'm against it now. And I'm gonna -- rescind ObamaCare. I'm gonna repeal ObamaCare." But the record is very clear. You and Newt were for individual mandates. And that is the problem. And the question is then, "Who can stand on the stage, look Obama in the eye, and say, 'ObamaCare is an abomination for this country,'?" And I'm gonna do that. And I can take that fight to him and win that fight.
DIANE SAWYER: Governor Romney, (INAUDIBLE). (APPLAUSE)
ROMNEY: A good deal of what you said was right. Some was wrong. Speaker Gingrich said that he was for a federal individual mandate. That's something I've always opposed. What we did in our state was designed by the people in our state for the needs of our state. You believe in the 10th Amendment. I believe in the 10th Amendment. The people of Massachusetts favor our plan three to one. They don't like it, they can get rid of it. That's the great thing about a democracy, where individuals under the 10th Amendment have the power to craft their own solutions.
By the way, the -- the problem with President Obama's plan is it does three things we didn't in my opinion, among others. I understand we disagree on this. But among others, one, it raises taxes by $500 billion. We (NOISE) didn't raise taxes. Two, it cuts Medicare by $500 billion. We didn't do that, either. And three, it doesn't just deal with the people that don't have insurance. It's a 2,000-page bill that takes over health care for all the American people. It is wrong for health care. It's wrong for the American people. It's unconstitutional. And I'm absolutely adamantly opposed to ObamaCare.
And if I'm the President of the United States, I will return to the people and the states the power they have under the constitution and they can craft the solutions they think are best for them. And my view-- you had a mandate in your state. You mandate that girls at 12 years old had to get a vaccination for-- for a sexually-transmitted disease. So it's not like we have this big difference on mandates. We had different things we mandated over. I -- I wanted to give people health insurance. You want to get young girls -- a vaccine. There are differences.
SAWYER: Governor, if we could ask Speaker Gingrich to respond.
NEWT GINGRICH: Yeah, I -- I just wanna make one point that's historical. (CLEARS THROAT) In 1993, in fighting HillaryCare, virtually every conservative saw the mandate as a less-dangerous future than what Hillary was trying to do. The Heritage Foundation was a major advocate of it. After HillaryCare disappeared it became more and more obvious that mandates have all sorts of problems built into them. People gradually tried to find other techniques. I frankly was floundering, trying to find a way to make sure that people who could afford it were paying their hospital bills while still leaving an out so libertarians to not buy insurance. And that's what we're wrestling with. It's now clear that the mandate, I think, is clearly unconstitutional. But, it started as a conservative effort to stop HillaryCare in the 1990s.
STEPHANOPOULOS: Governor Perry.
RICK PERRY: I'm listenin' to you, Mitt, and I'm hearin' you say all the right things. But I read your first book and it said in there that your mandate in Massachusetts which should be the model for the country. And I know it came out of -- of the -- the reprint of the book. But, you know, I'm just sayin', you were for individual mandates, my friend.
ROMNEY: You know what? You've raised that before, Rick. And -- you're simply wrong.
PERRY: It was true then. (CHUCKLE) It's true now.
ROMNEY: Rick, I'll -- I'll tell you what. (CHUCKLE) 10,000 bucks -- (APPLAUSE) $10,000 bet?
PERRY: I'm not in the bettin' business, but, okay.
ROMNEY: Oh, I -- I'll --
PERRY: I'll show you the book.
ROMNEY: I wrote -- I've got the book. And --
PERRY: And we'll show -- (LAUGH)
ROMNEY: And I wrote the book. And I haven't- - and chapter seven is a section called The Massachusetts Model. And I say as close as I can quote, I say, "In my view, each state should be able to -- to fashion their own program for the specific needs of their distinct citizens." And then I go on to talk about the states being the laboratories of democracy. And we could learn from one another. I have not said, in that book, first edition or the latest edition, anything about our plan being a national model imposed on the nation. The right course for America, and I said this durin' the debates the last time around, I'll say it now and time again, is to let individual states -- this is a remarkable nation. This idea of federalism is so extraordinary. Let states craft their own solutions. Don't have ObamaCare put on us by the federal government.
BACHMANN: George and Diane, can I just say something? This is such an important issue. We have one shot to get rid of ObamaCare, that's it. It is 2012. Do we honestly believe that two men who've just stood on this stage and defended RomneyCare when it was put in place in Massachusetts and the individual mandate when he proposed it in 1993, are they honestly going to get rid of it in 2012?
MITT ROMNEY/NEWT GINGRICH: Yes.
BACHMANN: This is going to be a very-- (LAUGH) but, I don't think so. (CHEERING) It's gonna be a very heavy lift.
STEPHANOPOULOS: I gotta get Senator Santorum in here.
BACHMANN: It's gonna be a very heavy lift.
RICK SANTORUM: This is not about what you say at a debate or what you say in a campaign when you're talking to audiences that you wanna get -- that you -- that you know what you wanna hear. Back in 1994 when they would-- I was running for the United States Senate and I did not support an individual mandate and I was a conservative, I supported something called Medical Savings Accounts that I drafted with John Kasich when I was in the House because I believe in bottom-up solving the problems in America, not top-down government solutions.
That's what I learned -- I actually learned it, some of it, in listening to some of your GOPAC tapes. But, you've strayed on that issue, as you have on others. The record is important. But what the question was about a consistent conservative, well, you can't talk about whether someone's consistent unless you look at their record. And I'd agree with Michele. I mean, I think Michele has been consistent in -- as -- as a consistent conservative. But, she's been fighting and losing. I fought and won. I was in the United States Senate and I fought and -- and passed Welfare Reform. It -- I was the principal author when I was in the United States House and was -- and -- and managed the bill on the floor of the United States Senate.
I was the -- leader on -- on pro-life issues and pro-family issues. And I fought those issues and endured tough debates and won. I went out and fought on na-- national security issues, conservative things like putting sanctions on Iran. And again, the consistent track record of being there in good times and in bad, and I think you heard the difference -- you're not gonna hear them talk about all the positions I took and flip-flopped on. I was there. I led. And I won.
And if you're lookin' for someone who can be a consistent conservative, and there's others on this platform, but who can lead the fight, win the issues, and plus, win in states that are important for us to win elections like Pennsylvania and —
STEPHANOPOULOS: I'm tryin' to be-- we've tried to-- I'll risk using the word, we've tried to be liberal with the time. But, the time (LAUGH) -- (UNINTELLIBIGLE) close as we can. We -- and we are running up against a commercial break, but it did invoke you kinda swimming backwards, so 30 seconds to respond.
BACHMANN: Well, you know, I think the important thing to know is that you fight and that you lead. And I led when I -- I was -- when I was in the United States Congress, we were in the minority. Nancy Pelosi wasn't interested in my pro-growth policy on health care. But, I didn't sit on my hands. I saw what was happening to this country. Our country was going to lose because of socialized medicine.
And so I did everything I could, including bringing and leading 40,000 people to the Capitol to get the attention of the -- of the Congress to get rid of ObamaCare. As President of the United States, my proven consistent record will be that I will take on every special interest. I will take on K Street. And I will pre-lobby. And I'll make sure that I help elect 13 more Republican U.S. Senators so we have 60 senators in the Senate, a full complement in the House. And I won't rest until we repeal ObamaCare. You can take it to the bank.
SANTORUM: But, if I can -- if I can respond to that, because she referenced that -- she referenced there (BACKGROUND VOICE) are differences between the two of us, I was in the minority in the House of Representatives, too. And along with Jim Nussle from here in Iowa, I -- we formed a -- a group called the Gang of Seven and we won. We exposed the House banking scandal. We overturned a huge scandal. We -- we sent the -- eventually sent the Chairman of the Ways and Means Committee, Dan Rostenkowski ended up in jail, because, no, we didn't just fight. But we fight and we figured out a way to win, even in the minority.
SAWYER: And we wanna thank all of you. And again, these are the rules that you set up. We wanna be fair. And we wanna hear everything you have to say. These issues are so important. But, it really does help if you stick to the rules that were agreed on. And we appreciate that. And if-- we could, when we come back, we're gonna tackle some other very big issues, immigration, big questions about foreign policy, and also one about states and family values. And that will be when we come back. (MUSIC)
STEPHANOPOULOS: I wanna stick with Yahoo because as you -- we said at the start, we're getting real-time feedback from our Yahoo audience. Over 12,000 people have already weighed in on Yahoo and ABCNews.com. An -- and this is directed at -- at Speaker Gingrich and -- and -- and Governor Romney, because more than 72 percent say right now they want to hear more from you about your past support for health care mandates.
That's something that they're still not fully satisfied with what they've heard -- (NOISE) from you. And -- and Speaker Gingrich -- I mean, Governor Romney, let me begin with you because -- you were clear. You've said you've always been against a federal mandate; you supported it in the State of Massachusetts. Where there has been some ambiguity, at least in the past, is whether you think that other states should try the mandate. Back in 2007, you said that you thought it would be good for most states to try it; now you say you wouldn't encourage other states to try. Can you explain that?
ROMNEY: States can do whatever the heck they want to do; that's the great thing about -- (APPLAUSE) about our system. I -- I think there's a good deal that we did that people can look at and find as a model, that could —
ROMNEY: --help other state -- if some -- if they want to, sure. They could try what they think is best. I -- that's -- it's up to other states to try what works for them. Some will like that; some will think it's a terrible idea. We had this idea of exchanges where people could buy insurance -- from companies, private companies -- we have no government insurance, by the way, in our state. It's all -- other than the federal Medicare/Medic -- Medicaid programs. It's all private pay. So people can learn from one another.
But my-- (LAUGH) my plan-- was designed for our state, and other states should have the right to create plans that work for them. And if they come up with something better than we did, then we can learn from them. But the idea of a federal government or a federal mandate, as you see with Obamacare, flies in the face of the Constitution, violates the tenth amendment. I think the Supreme Court will strike it down. If they don't, I will.
STEPHANOPOULOS: Speaker Gingrich -- Congresswoman Bachmann pointed out that as -- as late as May of this year, you supported some form of the mandate when everyone else had -- had come out against it. What finally tipped you over and convinced you that it was unconstitutional?
GINGRICH: Well, I think first of all for the federal government to do it is unconstitutional because it means the Congress -- the Congress, which could compel you to purchase this item, could compel you to purchase any item. And so the question of freedom would be d -- would be missed. And any (MIC NOISE) majority could then decide to make you do virtually anything. I think that's part of why you're seeing a dramatic shift back towards limiting the federal government and towards imposing the tenth amendment as a very serious barrier.
I -- I've been working on health issues since 1974. And I've been -- and I tried to find a way to break out of where we are, because the fact is the whole third-party payment model, whether public or private, has grown more and more expensive, more and more difficult to sustain. And helped found the Center for Health Transformation that -- for that reason, wrote a book called Saving Lives and Saving Money back in 2002.
We need to fundamentally rethink the entire health system to move back towards a doctor-patient relationship, and back toward something like what Rick Santorum talked about with health savings accounts where people are directly engaged in their own health and in taking care of themselves to a much greater degree than they are in the current insurance system.
SAWYER: If I can switch to this question, and -- and it is about health care, because a number of people -- in fact, I was just at a pharmacy here -- I -- have a cough. But I was (LAUGH) at the pharmacy here in Iowa, and the pharmacists were talking about a big driver of health care costs. And they specifically mentioned habits, unhealthy habits that we all need to learn to be better on at a young age. They talked about obesity, they talked about exercise. If I can ask you, Congressman Paul: Anything government should do on these fronts?
REP. RON PAUL: On -- on medical? Or?
SAWYER: On these fronts, specifically, of healthy behavior at very young -- ages for -- it's —
PAUL: No, essentially not, but they have to be -- a referee. If people are doing things that hurt other people, yes. But if you embark on instituting a society where government protects you from yourself, you're in big trouble, and that's what they're doing. (APPLAUSE) I think -- I think what we've had here is a demonstration of -- why should we have a candidate that's gonna have to explain themselves? 70 percent of the people want further explanations on what your positions are. So I think that it is endless. But you talk about the- - the Obamacare using force, but that's all government is, is force.
I mean, do you have a choice about paying Medicare taxes? So there's not a whole of different -- you're forced to buy insurance. That's one step further. But you have to stop with force. Once government uses force to mold behavior or mold the economy, they've overstepped the bounds and they've violated the whole concept of our revolution and our Constitution. (APPLAUSE)
STEPHANOPOULOS: We -- we are running short on time. I just want to ask quickly, does anyone disagree with the first part of Congressman Paul's answer there, where he said the government really shouldn't be getting involved in these broader issues of behavior?
PERRY: Listen, I happen to think that the states -- that's their call, not the federal government.
Last night's Republican presidential debate in Washington D.C. was centered around national security and foreign policy. But the subject of the super committee's failure to deal with entitlements came up. CNN moderator Wolf Blitzer asked the candidates how they would work to fix the growth of the federal budget. Courtesy: CNN.
Here is a transcript of their relevant remarks:
MITT ROMNEY: They're cutting a trillion dollars out of the defense budget, which just happens to equal the trillion dollars we’re putting into "Obama-care."
And so what you have is a president that has a priority of spending us into bankruptcy, but he’s not just spending us into bankruptcy, he’s spending the money foolishly.
We need to protect America and protect our troops and our military and stop the idea of "Obama-care." That's the best way to save money, not the military.
WOLF BLITZER, DEBATE MODERATOR AND CNN LEAD POLITICAL ANCHOR: Hold on one second because Ron Paul wants to respond to that point.
REP. RON PAUL: Well, they’re not cutting anything out of anything. All this talk is just talk.
PAUL: Believe me. They’re cutting — they’re nibbling away at baseline budgeting, and its automatic increases.
BLITZER: Let me bring in Governor Perry into this conversation.
As you know, the so-called supercommittee failed. And as a result, unless Congress takes action next year — in an election year, that would be difficult — there's not going to be any change in that automatic trigger as it's called. That sequestration, $1.2 trillion cut, including $600 billion in defense, will go into effect.
Here's the question. If you were president of the United States , would you compromise with Democrats in Congress in order to avoid that Washington gridlock that, if you believe the polls, the American people hate?
GOV. RICK PERRY: I don't think anybody is particularly surprised that a supercommittee failed. It was a super-failure. And I think we expected that. We had a president of the United States who is not a leader. He pitched this over to them and said, here, you all figure this out.
I've signed six balanced budgets as the head of the state of Texas. I worked with those legislators on a daily basis, or my staff.
This president has been an absolute failure when it came to this budget process. And the idea — it was almost reprehensible to me. I've worn the uniform of this country. I've been the commander in chief of the 20-plus-thousand National Guard troops that we have in Texas , Dr. Paul.
But it was reprehensible, for me, for this president to stand in front of Americans and to say that that half a trillion dollars, $500 million-plus is not going to be on the table and we're just going to have to work our way through it, putting young men and women’s life in jeopardy.
And I will tell you, as a commander in chief, as an American citizen, that is totally and absolutely irresponsible. Even his own secretary of defense said it was irresponsible. As a matter of fact, if Leon Panetta is an honorable man, he should resign in protest.
BLITZER: Here's the question, though. Would you compromise — all of you have said you wouldn’t accept any tax increases at all, even if there were 10 — 10 times as many spending cuts. So would you just let the gridlock continue, Governor Perry, or would you compromise under those circumstances?
PERRY: Listen, I’ve had to work with Democrats for the 10 years that I’ve been the governor of the state of Texas.
So the idea that you can’t sit down and work with people on both sides of the aisle, but just to, you know, throw us into — into that briar patch at this particular point in time and say, what would you do — we would never have gotten into that situation if I were the president of the United States. I'd have been there working day in and day out so that we had a budget that not only — I've laid out a clear plan to — flat tax of 20 percent; cut the spending; and put a 20 percent corporate tax rate in. And, as a matter of fact, they ought to make the legislature, the Congress, part-time, and that would make as big an impact in this city as anything I can think of.
BLITZER: Let me bring Senator Santorum into this, because I covered Ronald Reagan’s presidency. And, as you know — and I’ll read a quote. He wrote in his autobiography this: “If you got 75 of 80 percent of what you were asking for, I say you take it and fight for the rest later."
If you got 75 percent or 80 percent of what you wanted, would you make a deal with Democrats, increase some taxes in order to move on and fight the next battle the next day?
RICK SANTORUM: It all depends on what the 75 percent and 85 percent is. If the — if the things that you have to give up make what you’re trying to accomplish harder to do — in other words, reduce the deficit, what the Republicans — why the Republicans are drawing a line in the sand, rightfully so, it’s because what they’re — what the Democrats are attempting to do is increase taxes, which will slow down to the — this economy, which will increase the deficit, reduce tax revenues, ultimately, and — and increase government payments.
So you don’t work against yourself. You — you won't — you — you take ideas from the other side that you may not find particularly valuable, like spending cuts that you may not want. There are spending cuts that I would like to, you know, I mean there's things that it mentioned before, that I would stand — stand firm on.
But in a compromise, yes, you do give up some things that you think maybe are critical spending. But you don’t undermine the ability of this con — economy to grow because of politics. This president has poisoned the well. He's campaigned all over this country, trying to divide group from group in order to — to — to win, you know, to — to position himself to win this election and rally his troops. And what he’s done is poisoned the well here in Congress.
I've worked together, I’ve got a long track record of bipartisan accomplishments where I kept to the principles. I use welfare reform as an example. Welfare reform, I stuck to my principles. We cut the welfare budget. We had — we had time limits. We block granted to the states and we put a work requirement.
Did I compromise on things?
Yes. I compromised on some — on some child care. I compromised on — on some transportation.
So I got 75 percent. But it 100 percent changed the welfare system because we…
BLITZER: Thank you.
SANTORUM: – stuck to our principles.
BLITZER: Let — but let’s stay on this subject, because I know many of you want to weigh in.
BLITZER: We have another question.
ALEX BRILL: My name is Alex Brill and I'm a research fellow in the economics department at the American Enterprise Institute.
Even if the super committee hadn’t failed, the savings that they would have proposed would have been a drop in the bucket relative to the $11 trillion deficit our country may face in the subsequent decade. In the decades after that, without entitlement reform, we’ll borrow even more.
To strengthen our economy, to strengthen our country, what entitlement reform proposals would you make to address our long-term structural deficit?
BLITZER: Good question.
NEWT GINGRICH: It’s a great question and it raises the — the core issue of really large scale change.
Yesterday in Manchester , I outlined a Social Security reform plan based on Chile and based on Galveston , Texas . In Chile , people who have now have the right to a personal Social Security savings account, for 30 years, the government of Chile has promised that if you don’t have as much savings as you would get from Social Security, the government would make up the difference.
In 30 years time, they’ve paid zero dollars, even after ’07 and ’08 and ’09, people slid from three times as much to one-and-a-half times as much, but they didn’t go below the Social Security amount. The result is in Chile , for example, 72 percent — they have 72 percent of the GDP in savings. It has — it has increased the economy, increased the growth of jobs, increased the amount of wealth and it dramatically solves Social Security without a payment cut and without having to hurt anybody.
So I think you can have a series of entitlement reforms that, frankly, make most of this problem go away without going through the kind of austerity and pain that this city likes.
BLITZER: Let's talk about that, Congresswoman Bachmann.
Social Security, Medicare, health care — what would you cut first?
What would you tackle if you were president of the United States?
REP. MICHELE BACHMANN, R-MINN., PRESIDENTIAL CANDIDATE: Let me answer that in the context of the super committee, because I was involved in the middle of that fight as a member of Congress this summer. And my voice said this. I said it’s time for us to draw a line in the sand. We have sufficient revenues coming in to pay the interest on the debt.
But the real issue was, were we going to give Congress another $2.4 billion in borrowing authority?
In other words, another blank check to the president. Because, again, consider the context. A little of four years ago, we were just over $8 trillion in debt. We are now $15 trillion in debt in just over four years. Now we’re talking about — if the gentleman is correct — adding another $11 trillion in debt over 10 years, or potentially $8.5 trillion, according to the super committee.
All that they were asked to do is cut back on $1.2 trillion of that increase in debt. We aren't even talking about the central issue, which is balancing the budget. We need to balance the budget and then chip away at the debt. This isn't Monopoly money.
Because what we need to recognize is that when we are sending interest money over to China , with whom we are highly in hock, we’re not just sending our money. We're sending our power.
Topics: Health Costs, Politics, Health Reform
The GOP presidential candidate, speaking to the Congressional Health Care Caucus, a Republican group, outlined his plans for controlling health care costs by reducing the role of the federal government in the health system.
In last night's CNBC debate, moderator Maria Bartiromo asked the eight candidates – Ron Paul, Mitt Romney, Newt Gingrich, Rick Perry, Herman Cain, Michele Bachmann, Jon Huntsman and Rick Santorum – to describe, "in 30 seconds, if you repeal Obamacare, what's the answer?" They all urged more power to the states, medical savings accounts and some discussed malpractice reform.
Here is a complete transcript of the health care portion of the debate, (courtesy CNBC):
MARIO BARTIROMO: Let's stay on regulation for a moment. You have all said that you will repeal President Obama's health care legislation.
Down the line, 30 seconds, if you repeal Obamacare, what's the answer?
JON HUNTSMAN, former Utah governor: I would say -- and I would meet with the 50 governors of this country, and I would say, I did health care reform in my state, it took us three years to get it done. We delivered an insurance connector that was not a costly mandate.
You can sit down with the 50 governors and you can address cost containment. This is a $3 trillion industry, half of which any expert will tell you is totally nonsense and superfluous spending.
How do you get costs out of the system? How do you empower patients to better understand what they are getting when they go into the doctor's office?
Number two, we need to do a better job in harmonizing medical records so that we can pull up on a consistent basis the most efficacious course of treatment for patients.
HUNTSMAN: And third, we need to close the gap on the uninsured without a costly mandate, letting the free market work and bringing people together with truly affordable insurance.
BARTIROMO: That's time. We want to get each of your comments on what the plan is. Ron Paul?
REP. RON PAUL, R-Texas: We need to get the government out of the business, and we do need to have the right to opt out of "Obama-care." But we ought to have the right to opt out of everything. And the answer to it is turn it back over to the patient and the doctor relationship with medical savings accounts.
So I would say that we have had too much government. I have been in medicine, it has gone downhill. Quality has gone down. Prices have skyrocketed because of the inflation. So you need to get a market force in there, a medical savings account.
But this mess has been created -- it's a bipartisan mess. So it has been there for a while. So what we need is the doctor-patient relationship and medical savings account where you can deduct it from your taxes and get a major medical policy. Prices then would come down.
BARTIROMO: Thirty seconds, Governor Perry?
GOV. RICK PERRY, Texas: Obviously on the Medicare side, you have to have an insurance type of a program where people have options of which -- give them a menu of options of which they can choose from. I think you have to have the doctors and the hospitals and the other health care providers being given incentives on health care rather than "sick care."
And then on Medicaid, it is really pretty simple, just like Jon and Mitt both know, you send it back to the states and let the states figure out how to make Medicaid work, because I will guarantee you we will do it safely, we will do it appropriately, and we will save a ton of money.
BARTIROMO: Mr. Cain.
HERMAN CAIN: The legislation has already been written. H.R. 3000. In the previous Congress it was H.R. 3400. And what that does -- it has already been written. We didn't hear about it in the previous Congress because "Princess Nancy" sent to it committee and it stayed there. It never came out.
CAIN: H.R. 3000 allows the decisions to be with the doctors and the patients, not with the bureaucrat in Washington, D.C. The legislation has already been written.
BARTIROMO: Governor Romney?
MITT ROMNEY, former Mass. governor: Health care in 30 seconds is a little tough. But let me try. Number one, you return to the states the responsibility for caring for their own uninsured. And you send the Medicaid money back to the states so they can craft their own programs. That's number one.
Number two, you let individuals purchase their own insurance. Not just getting it through their company. But buy it on their own if they want to, and no longer discriminate against individuals who want to buy their insurance.
Number three, you do exactly what Ron Paul said. I don't always say that. But I have got to say it right now.
ROMNEY: And that is, you have to get health care to start working more like a market. And for that to happen, people have to have a stake in what the cost and the quality as well as of their health care. And so health savings account, or something called co- insurance, that's the way to help make that happen.
And finally, our malpractice system in this country is nuts. We have got to take that over and make sure we don't burden our system with it.
BARTIROMO: Mr. Speaker?
NEWT GINGRICH, former Speaker of the House of Representatives: Well, I just want point out, my colleagues have done a terrific job of answering an absurd question. To say in 30 seconds...
BARTIROMO: You have said you want to repeal "Obama-care," correct?
GINGRICH: I did. Let me finish, if I may. To say in 30 seconds what you would do with 18 percent of the economy, life and death for the American people, a topic I've worked on since 1974, about which I wrote about called "Saving Lives and Saving Money" in 2002, and for which I founded the Center for Health Transformation, is the perfect case of why I'm going to challenge the president to seven Lincoln- Douglas style three-hour debates with a timekeeper and no moderator, at least two of which ought to be on health care so you can have a serious discussion over a several-hour period that affects the lives of every person in this country.
BARTIROMO: Would you would like to try to explain...
BARTIROMO: Would you like to -- would you like to try to explain in simple speak to the American people what you would do after you repeal the president's health care legislation?
GINGRICH: In 30 seconds?
BARTIROMO: Take the time you need, sir. Take the time you need.
GINGRICH: I can't take what I need. These guys will gang up on me...
BARTIROMO: Do you want the answer the question tonight on health care or no?
BARTIROMO: Do you want to try to answer the question tonight, Speaker?
GINGRICH: Let me just say it very straight. One, you go back to a doctor-patient relationship and you involve the family in those periods where the patient by themselves can't make key decisions. But you re-localize it.
Two, as several people said, including Governor Perry, you put Medicaid back at the state level and allow the states to really experiment because it's clear we don't know what we are doing nationally.
Three, you focus very intensely on a brand-new program on brain science because the fact is the largest single out-year set of costs we are faced with are Alzheimer's, autism, Parkinson's, mental health, and things which come directly from the brain.
GINGRICH: And I am for fixing our health rather than fixing our health bureaucracy because the iron lung is the perfect model of saving people so you don't need to pay for federal program of iron lung centers because the polio vaccine eliminated the problem. That's a very short (inaudible).
REP. MICHELE BACHMANN, R-Minn.: The main problem with health care in the United States today is the issue of cost. It's just too expensive. And President Obama said that's what he would solve in Obamacare, we'd all save $2,500 a year in our premiums.
Well, we have Obamacare, but we didn't have the savings. So what I would do to replace it is to allow every American to buy any health insurance policy they want anywhere in the United States, without any federal minimum mandate. Today there's an insurance monopoly in every state in the country. I would end that monopoly and let any American go anywhere they want. That's the free market.
Number two, I would allow every American to pay for that insurance policy -- their deductible, their co-pay, their pharmaceuticals, whatever it is that's medical-related -- with their own tax-free money.
And then, finally, I'd have true medical malpractice liability reform. If you do that, it's very simple. People own their own insurance policies, and you drive the costs down, because what we have to get rid of is government bureaucracy in health care. That's all we bought in Obamacare, was a huge bureaucracy. That has to go away.
RICK SANTORUM, former Penn. senator: This is, I think, the difference between me and a lot of the candidates here. I heard a lot of responses, but I haven't -- I haven't seen a lot of consistency in some of -- some of those responses on the last few questions.
When it comes to health care, back in 1992, I introduced the first health savings account bill that everybody up here said was the basis for consumer-driven health care. I was leading on that before anyone else was even talking about it. Secondly, I was someone who proposed a block grant for Medicaid way back in 1998 with Phil Gramm, again, leading on this issue. Same thing, reforming the Medicare program back in the 1990s, again, I led on these issues.
I was always for having the government out of the health care business and for a bottom-up, consumer-driven health care, which is different than Governor Romney and some of the other people on this panel.
Number two -- and I didn't get a chance to answer any of the housing questions. I was on the banking housing committee in -- in the United States Senate. I was one of 24 people who wrote a letter to Harry Reid saying, please let us bring up this housing legislation, which I voted for in the committee, that would have put curbs on Fannie and Freddie. I -- I was out there before this bubble burst saying this was a problem. I -- I was in Scranton, Pennsylvania, the other day, and I had one of a -- a home-builder, who was a head of the association, came up to me and said, Rick, I'm here to apologize. We came here to push you so you would oppose, you know, putting caps on Fannie and Freddie. You were right; we were wrong.
Time and time again, Wall Street, the Wall Street bailout, five of the eight people on this panel supported the Wall Street bailout. I didn't. I know that we saw problems best from the bottom up, not the top down and government intervention in the marketplace.
BARTIROMO: Governor Romney, you have 30 seconds to respond.
ROMNEY: That's -- that's fine. I believe very deeply in the functioning of markets. The work I've done in health care, actually worked as a consultant to the health care industry, to hospitals and various health institutions. I had the occasion of actually acquiring and trying to build health care businesses. I know something about it, and I believe markets work.
And what's wrong with our health care system in America is that government is playing too heavy a role. We need to get our markets to work by having the consumer, the patient have a stake in what the cost and quality is of health care, give them the transparency they need to know where the opportunities are for lower cost and better quality, to make sure that the providers offer them the broadest array of options that they could have.
And once we have that happening, you'll see us -- 18 percent of our GDP is spent on health care. The next highest nation in the world is 12 percent. It's a huge difference. We have to get the market...
ROMNEY: ... to work to make sure that we get the kind of quality and value that America deserves.
HARWOOD: But, Governor, let me ask you about health care, because Congressman Paul said, put it back to the doctor and the patient. You said a few moments ago that you thought states should have the responsibility for insuring the uninsured. And, of course, in Massachusetts, you enacted an individual mandate and subsidies to have people who didn't have insurance get it. So you think there's a pretty large role for government in this area.
ROMNEY: Well, I think that people -- that people have a responsibility to receive their own care, and the doctor-patient relationship is, of course, where that -- where that exists -- where that exists.
HARWOOD: But the government has the responsibility to force them?
ROMNEY: I -- I didn't know whether Ron Paul was saying we're going to -- he's going to get rid of Medicaid. I would not get rid of Medicaid. It's a health program for the poor.
What I said was I would take the Medicaid dollars that are currently spent by the federal government, return them to the states so that states can craft their own programs to care for their own poor, rather than having the federal government mandate a one-size- fits-all plan in the entire -- entire nation. Obamacare is wrong. I'll repeal it. I'll get it done.
JOHN HARWOOD, CNBC: Congressman?
PAUL: My plan of cutting the budget by a trillion dollars does deal with Medicaid. And that is that it preserves it, and there is a transition period, with the goal that eventually we would hope to move that back into the economy. But right now, it would be too much to do it in one year.
You know, finding a trillion dollars was a job and a half, and getting rid of five departments.
So, yes, my budget takes into consideration health care for the elderly, health care on Medicaid, as well as child health care. At the same time, we deal with the bailouts, the banks, and all the benefits that they get from the financial system, because what we're facing today is the crisis in this housing crisis.
HARWOOD: Governor Romney, you've shown that you can work with Democrats. When you were governor, of course, you collaborated with Ted Kennedy on the health care plan that you enacted. You raised fees to balance the budget, and you used that as an argument to get the credit rating of your state upgraded. Independent voters might like that. Should Republican primary voters be nervous about it?
ROMNEY: Thanks for reminding everybody.
You know, what I found is, in a state like mine where there are a few Democrats in the legislature -- 85 percent of my legislature was Democrat -- to get anything done -- I was always in an away game, if you will. And to get something done, I had to see if there were Democrats who cared more about the state than they cared about their re-election or their party, and there were.
Watch video excerpts from the Republican presidential candidate's address to the Congressional Health Care Caucus, where he outlined his plans for health policy.
Health care took a prime role in the Republican presidential candidates’ debate in Las Vegas Tuesday. Former Sen. Rick Santorum led off with a strong criticism of former Mass. Gov. Mitt Romney’s role in revamping the state’s health care system. Romney defended his position hard and noted that other Republicans, including former House Speaker Newt Gingrich who is also running for president, had previously endorsed an individual mandate. Also, Rep. Michele Bachmann pointed to the Obama Administration's freeze of the CLASS Act as evidence that the law can be repealed.
Here is a transcript of the exchange between the Republican candidates at the Las Vegas debate Tuesday. The moderator is Anderson Cooper of CNN. The full debate transcript can be found on CNN.
RELATED: Read where the GOP Candidates stand on health care.
SANTORUM: The final point I would make to Governor Romney, you just don't have credibility, Mitt, when it comes to repealing Obamacare. You are -- you are -- your plan was the basis for Obamacare. Your consultants helped Obama craft Obamacare. And to say that you're going to repeal it, you just -- you have no track record on that that -- that we can trust you that you're going to do that.
COOPER: Governor Romney, 30 seconds.
SANTORUM: You don't.
ROMNEY: You know, this I think is either our eighth or ninth debate. And each chance I've -- I've had to talk about Obamacare, I've made it very clear, and also in my book. And at the time, by the way, I crafted the plan, in the last campaign, I was asked, is this something that you would have the whole nation do? And I said, no, this is something that was crafted for Massachusetts. It would be wrong to adopt this as a nation.
SANTORUM: That's not what you said.
ROMNEY: You're -- you're shaking -- you're shaking your head.
SANTORUM: Governor, no, that's not what you said.
ROMNEY: That happens -- to happens to be...
SANTORUM: It was in your book that it should be for everybody.
PERRY: You took it out of your book.
SANTORUM: You took it out of your book.
ROMNEY: Hey, his turn. His turn, OK, and mine.
ROMNEY: I'll tell you what? Why don't you let me speak?
SANTORUM: You're allowed -- you're allowed to change -- you're allowed to change...
ROMNEY: Rick, you had your chance. Let me speak.
SANTORUM: You can't change the facts.
ROMNEY: Rick, you had your chance. Let me speak.
SANTORUM: You're out of time. You're out of time.
COOPER: He ate into your time.
ROMNEY: I haven't had a chance to respond yet, because you were interrupting the entire time I was trying to speak.
ROMNEY: Let me make it very clear.
COOPER: I'll give another 20 seconds.
ROMNEY: And -- look -- look, we'll let everybody take a look at the fact checks. I was interviewed by Dan Balz. I was in interviews in this debate stage with you four years ago. I was asked about the Massachusetts plan, was it something I'd impose on the nation? And the answer is absolutely not.
It was something crafted for a state. And I've said time and again, Obamacare is bad news. It's unconstitutional. It costs way too much money, a trillion dollars. And if I'm president of the United States, I will repeal it for the American people.
COOPER: All right. Senator Santorum?
SANTORUM: Mitt, the governor of Massachusetts just is coming forward saying we have to pick up the job left undone by Romneycare, which is doing something about cutting health care costs.
What you did is exactly what Barack Obama did: focused on the wrong problem. Herman always says you've got to find the right problem. Well, the right problem is health care costs. What you did with a top-down, government-run program was focus on the problem of health care access. You expanded the pool of insurance without controlling costs. You've blown a hole in the budget up there. And you authored in Obamacare, which is going to blow a hole in the budget of this country.
COOPER: Governor Romney, I'm going to give you 30 seconds.
ROMNEY: I'm -- I'm sorry, Rick, that you find so much to dislike in my plan, but I'll tell you, the people in Massachusetts like it by about a 3-1 margin.
And we dealt with a challenge that we had, a lot of people that were expecting government to pay their way. And we said, you know what? If people have the capacity to care for themselves and pay their own way, they should.
Now, I can tell you this, it's absolutely right that there's a lot that needs to be done. And I didn't get the job done in Massachusetts in getting the health care costs down in this country. It's something I think we have got to do at the national level. I intend to do that.
But one thing is for sure. What Obama has done is imposed on the nation a plan that will not work, that must be repealed. And when it comes to knowledge about health care and how to get our health care system working, I may not be a doctor like this one right over here, but I sure understand how to bring the cost of health care down and how to also make sure that we have a system that works for the American people.
SANTORUM: It didn't do it. It didn't do it.
COOPER: Speaker Gingrich, you've also been very critical of Mitt Romney's plan not only on Obamacare, but his plan to lower the capital gains tax only on those earning under $200,000.
GINGRICH: I want to say on health for a minute -- OK, let's just focus. "The Boston Herald" today reported that the state of Massachusetts is fining a local small business $3,000 because their $750-a-month insurance plan is inadequate, according to the bureaucrats in Boston.
Now, there's a fundamental difference between trying to solve the problems of this country from the top down and trying to create environments in which doctors and patients and families solve the problem from the bottom up.
And candidly, Mitt, your plan ultimately, philosophically, it's not Obamacare, and that's not a fair charge. But your plan essentially is one more big government, bureaucratic, high-cost system, which candidly could not have been done by any other state because no other state had a Medicare program as lavish as yours, and no other state got as much money from the federal government under the Bush administration for this experiment. So there's a lot as big government behind Romneycare. Not as much as Obamacare, but a heck of a lot more than your campaign is admitting.
ROMNEY: Actually, Newt, we got the idea of an individual mandate from you.
GINGRICH: That's not true. You got it from the Heritage Foundation.
ROMNEY: Yes, we got it from you, and you got it from the Heritage Foundation and from you.
GINGRICH: Wait a second. What you just said is not true. You did not get that from me. You got it from the Heritage Foundation.
ROMNEY: And you never supported them?
GINGRICH: I agree with them, but I'm just saying, what you said to this audience just now plain wasn't true.
ROMNEY: OK. Let me ask, have you supported in the past an individual mandate?
GINGRICH: I absolutely did with the Heritage Foundation against Hillarycare.
ROMNEY: You did support an individual mandate?
ROMNEY: Oh, OK. That's what I'm saying. We got the idea from you and the Heritage Foundation.
GINGRICH: OK. A little broader.
COOPER: He still has time. Let him finish.
ROMNEY: I get a little time here.
Number two, we don't have a government insurance plan. What we do is rely on private insurers, and people -- 93 percent of our people who are already insured, nothing changed. For the people who didn't have insurance, they get private insurance, not government insurance.
And the best way to make markets work is for people to be able to buy their own products from private enterprises. What we did was right for our state, according to the people in our state. And the great thing about a state solution to a state issue is, if people don't like it, they could change it.
Now, there are a lot of things.
COOPER: Congresswoman Bachmann.
BACHMANN: Anderson, I think it has to be stated that Obamacare is so flat-out unpopular, that even the Obama administration chose to reject part of Obamacare last Friday, when they tried to throw out the CLASS Act, which is the long-term care function.
Secretary Sebelius, who is the head of Health and Human Services, reported that the government can't even afford that part and has to throw it out. And now the administration is arguing with itself.
When even the Obama administration wants to repeal this bill, I think we're going to win this thing. We're going to repeal it! And I will!
COOPER: We've got to take a quick break. We will continue this discussion on the other side.
We have a long way to go. We'll be right back.
COOPER: And welcome back to the continuing debate. We got a Twitter question. We ended talking about medicine, Obamacare. We actually have a Twitter question about it. It was a question left at CNN debate.
If Obama's health plan is bad for the U.S., what is the alternative, and how will you implement it?
Congressman Paul, is there any aspect of Obamacare that you would like to keep, whether it's keeping kids to stay on their parents' insurance until they're 26 or no pre-existing conditions?
PAUL: Really not, because he's just adding on more government. There's been a lot of discussion about medicine, but it seems to be talking about which kind of government management is best. Our problem is we have too much. We've had it for 30, 40 years. We have Medicare. We have prescription drug programs. We have Medicaid.
And what we need -- I mean, there's a pretty good support up here for getting rid of Obamacare, because it's a Democratic proposal, and we want to opt out. I think we'd all agree on this.
But if you want better competition and better health care, you should allow the American people to opt out of government medicine. And...
And the way to do this is to not de-emphasize the medical savings account, but let people opt out, pay their bills, get back to the doctor-patient relationship. There is inflation worked into it. When a government gets involved in an industry, prices always go up. We have tort laws to deal with. And we need more competition in medicine.
But the most important thing is letting the people have control of their money and getting it out of the hands of the third party. As soon as you go to the government, the lobbyists line up, the drug companies line up, these insurance companies line up. And even with Obamacare, the industries, the corporations get behind it and affect the outcome, and already insurance premiums are going up.
COOPER: Herman Cain, same question. Is there any aspect of so- called Obamacare that -- that you would keep?
CAIN: No. I think we all agree that Obamacare must be repealed because it is a disaster. And the more we learn about it and the more time goes along, the more we see. We're all in agreement with that.
But here's where I would start in answering that question. It's called H.R. 3400. This was introduced back in 2009, but you didn't hear a lot of talk about it. Instead of government being imposed on -- on our system, it imposes -- it basically passes market-centered, market-driven, patient-centered sort of reforms to allow association health plans, to allow loser pay laws, to allow insurance products to be sold across state lines, and a whole list of other things. So that's a great place to start.
It allows the patient and the doctors to make the decisions, not a bureaucrat. I'd start with HR-3400.
COOPER: Governor Perry, in the last debate, Governor Romney pointed out that Texas has one of the highest rates of uninsured children in the country, over one million kids. You did not get an opportunity to respond to that. What do you say? How do you explain that?
PERRY: Well, we've got one of the finest health care systems in the world in Texas. As a matter of fact, the Houston, Texas, Medical Center, there's more doctors and nurses that go to work there every morning than any other place in America. But the idea that you can't have access to health care, some of the finest health care in the world -- but we have a 1,200-mile border with Mexico, and the fact is we have a huge number of illegals that are coming into this country.
Topics: Delivery of Care, Politics, Health Reform, States
The Republican candidates for president spent their latest debate Tuesday night criticizing features of the health care law, including the IPAB. Newt Gingrich brought up "death panels" and Gov. Rick Perry faced questions about Medicaid and the uninsured in Texas.
Here is a transcript of the sections of the debate concerning health care:
KAREN TUMULTY, The Washington Post: Speaker Gingrich, Medicare is going broke. Consider the fact that half of all Medicare spending is done in the last two years of life, and research that has been done right here at Dartmouth by “The Dartmouth Atlas” would suggest that much of this money is going to treatments and interventions that do nothing to prolong life or to improve it. In fact, some of it does the opposite. Do you consider this wasteful spending? And, if so, should the government do anything about it?
NEWT GINGRICH: I am really glad you asked that, because I was just swapping e-mails today with Andy von Eschenbach, who was the head of the National Cancer Institute, the head of the Food & Drug Administration. But before that, he was the provost M.D. Anderson, the largest cancer treatment center in the world. And he wrote me to point out that the most recent U.S. government intervention on whether or not to have prostate testing is basically going to kill people.
So, if you ask me, do I want some Washington bureaucrat to create a class action decision which affects every American’s last two years of life, not ever. I think it is a disaster. I think, candidly, Governor Palin got attacked unfairly for describing what would, in effect, be death panels.
And what von Eschenbach will tell you if you call him is, the decision to suggest that we not test men with PSA will mean that a number of people who do not have — who are susceptible to a very rapid prostate cancer will die unnecessarily. And there was not a single urologist, not a single specialist on the board that looked at it. So, I am opposed to class intervention for these things.
TUMULTY: Well, Congresswoman Bachmann, of course no one wants the government to come between a doctor and a patient. But do you think that Americans are getting the most for their money in Medicare spending? And how can we make sure that the money that is being spent is being spent on the treatments and the preventive treatments that do the most?
Rep. MICHELE BACHMANN: We have a big problem today when it comes to Medicare, because we know that nine years from now, the Medicare hospital Part B trust fund is going to be dead-flat broke, so we’ve got to deal with this issue. I was in the White House with President Obama this summer. We asked him not once, but three times, “President Obama, what is your plan to save Medicare?”
And the president mumbled and he didn’t give an answer the first time, the second time. And the third time the president said something very interesting, Karen. He said Obamacare. I think that senior citizens across the country have no idea that President Obama plans for Medicare to collapse, and instead everyone will be pushed into Obamacare.
And just like Newt Gingrich said, the way that Obamacare runs, there’s a board called IPAB. It’s made up of 15 political appointees. These 15 political appointees will make all the major health care decisions for over 300 million Americans. I don’t want 15 political appointees to make a health care decision for a beautiful, fragile 85- year-old woman who should be making her own decision.
RICK SANTORUM: We need to repeal Obamacare. That’s the first thing we need to do. You want to create jobs? I went to Ossipee [N.H.] yesterday and I talked to a small businessman there, and he said, “I will not hire anybody, I will not make a move until I find out what is going to happen with this health care bill and how it’s going to crush me.”
And so, repealing Obamacare, and we can do it, not by waivers. That’s the wrong idea, Mitt. The reason it’s the wrong idea, because you get a waiver, California going to waive that? No. New York going to waive it? No. All of these states, many of them, liberal states are going to continue on, and then states like New Hampshire that will waive it will end up subsidizing California. (CROSSTALK)
SANTORUM: We need to repeal it…
CHARLIE ROSE, Moderator: All right. But the time…
SANTORUM: I know. (CROSSTALK)
ROSE: You see the red light, time.
SANTORUM: We need to repeal it by doing it through a reconciliation process. And since I have experience and know how to do that, we’ll take care of it…
MITT ROMNEY: Rick, you’re absolutely right. On day one, granting a waiver for all 50 states doesn’t stop in its tracks entirely Obamacare. That’s why I also say we have to repeal Obamacare, and I will do that on day two, with the reconciliation bill, because as you know, it was passed by reconciliation, 51 votes.
ROSE: All right. We can get rid of it with 51 votes. We have to get rid of Obamacare and return to the states the responsibility… (CROSSTALK)
ROMNEY: No, not if you get rid of it. And particularly — by the way, the Supreme — the Supreme Court may get rid of it. (CROSSTALK)
ROMNEY: Let me finish. Let me finish.
ROSE: OK, let’s — then we’ll go to Huntsman, then we’ll go to the break, and then when we come back, each of you can question each other.
ROMNEY: Let me just — let me just say this, which is we all agree about repeal and replace. And I’m proud of the fact that I’ve put together a plan that says what I’m going to replace it with. And I think it’s incumbent on everybody around this table to put together a plan that says this is what I’ll replace it with, because the American people are not satisfied with the status quo. They want us to solve the problem of health care, to get it to work like a market, and that’s what has to happen.
ROSE: All right. Governor Huntsman, then we go.
JON HUNTSMAN: It’s disingenuous to — to just say that you can — you can waive it all away. The mandate will be in place. The IRS is already planning on 19,500 new employees to administer that mandate. That will stay, and that’s the ruinous part of — of Obamacare. And that — Mitt, your plan is not going to do anything.
ROMNEY: I said we had to repeal it. Did you miss that?
HUNTSMAN: No. It doesn’t — it doesn’t repeal the mandate.
ROMNEY: No, no, I said I’m going to repeal it through reconciliation.
SANTORUM: Through reconciliation, you can repeal the taxes, you can repeal the spending, and therefore, the mandate has no teeth, because there’s no tax penalty if you don’t enforce it.
Gov. RICK PERRY: Governor Romney, your chief economic adviser, Glenn Hubbard, who you know well, he said that Romneycare was Obamacare. And Romneycare has driven the cost of small-business insurance premiums up by 14 percent over the national average in Massachusetts. So my question for you would be: How would you respond to his criticism of your signature legislative achievement?
ROMNEY: You know, the — the great thing about running for president is to get the chance also to talk about your experience as a governor. And I’m proud of the fact that we took on a major problem in my state. And the problem was that we had a lot of kids without insurance, a lot of adults without insurance, but it added up to about 8 percent of our population. And we said, you know what, we want to find a way to get those folks insured, but we don’t want to change anything for the 92 percent of the people that already have insurance. And so our plan dealt with those 8 percent, not the 92 percent.
One of the problems with Obamacare is he doesn’t just deal with the people without insurance. He takes over health care for everyone. Then he does something else that Chris Christie said today. He said the problem with Obamacare is he spends an extra trillion dollars and raises taxes. And raising taxes is one of the big problems, something we didn’t do in Massachusetts. He also cuts Medicare. Only — but people out there are talking about cutting Medicare, it’s President Obama that did that.
And I’m proud of what we are able to accomplish. I’ll tell you this, though. We have the lowest number of kids as a percentage uninsured of any state in America. You have the highest. You… (CROSSTALK)
ROMNEY: I’m still speaking. We — we have — we have less than 1 percent of our kids that are uninsured. You have a million kids uninsured in Texas. A million kids. Under President Bush, the percentage uninsured went down. Under your leadership, it’s gone up.
I care about people. Now, our plan isn’t perfect. Glenn Hubbard is a fine fellow. Take a look at his quote. Some people say that. Just because some people say something doesn’t mean it’s true. The truth is, our plan is different, and the people of Massachusetts, if they don’t like it, they can get rid of it. Right now, they favor it 3 to 1.
But I’m not running for governor of Massachusetts. I’m running for president of the United States. And as president, I will repeal Obamacare, I’ll grant a waiver on day one to get that started, and I’ll make sure that we return to the states what we had when I was governor, the right to care for our poor in the way we thought best for our respective states.
ROSE: I want to go to Governor Perry. Explain to me what you think the difference is about your health care ideas and Governor Romney’s health care ideas, and how you see mandates and how he sees mandates and the Constitution, because not only has there been some exchange here, Governor Christie got involved today.
PERRY: Well, certainly the issue of health care is probably one of the biggest ones that’s facing us. I mean, there are a lot of Americans sitting out there today, and getting those people back to work is the most important thing that we do as a country so that they can have the opportunity to purchase health care. ... in the state of Texas, from the standpoint of what we have done to make access of health care better, we passed the most sweeping tort reform in the nation in 2003. We also passed Healthy Texas, which expands the private sector insurance. And we have driven down the cost of insurance by 30 percent.
So, those are some of the ways that the states — but the real issue for us is Medicaid and how to get the flexibility on Medicaid so that the innovators can occur in the states. I can promise you, whether it’s Governor Jindal or myself or Susana Martinez over in New Mexico, that’s where you will find the real innovation in health care. The way to deliver health care more efficiently, more effectively is to block-grant those dollars back to the state and keep this federal government that has this one-size-fits-all mentality from driving the thought process that we have seen destroy health care in this country today.
TUMULTY: But, Governor Perry, Texas as "The Washington Post" fact-checker noted, Texas has had 16 waivers for Medicaid. So how can you say that the problem is that the federal government has not given Texas enough flexibility?
PERRY: They haven’t anywhere near given the states — I think what you should see is the block-granting, not having to go to Washington, D.C., and ask them, mother, may I every time you come up with a concept or an idea. Block-granting back to the states, I’ll guarantee you, the governors and their innovators in their states will come up with ways to better deliver health care more efficiently, more effectively, more cost-efficiently, and that’s what this country is looking for, is a president who understands that we have these 50 laboratories of innovation, free up these states from Washington, D.C.’s one size fits all.
Topics: Politics, Public Health, Health Reform, States
Exchanges on health policy were limited in Thursday’s Republican presidential debate, but Texas Gov. Rick Perry and former Mass. Gov. Mitt Romney once again lashed out at each other on the issue and Rep. Michele Bachmann renewed her criticism of Perry’s efforts to get Texas children vaccinated against HPV.
Here's a partial transcript of the debate's health care points:
PERRY: Speaking of books and talking about being able to have things in your books, back and forth, your economic adviser talked about Romneycare and how that was an absolute bust. And it was exactly what Obamacare was all about.
As a matter of fact, between books, your hard copy book, you said it was exactly what the American people needed, to have that Romneycare given to them as you had in Massachusetts. Then in your paperback, you took that line out. So, speaking of not getting it straight in your book sir, that would be a –
KELLY: Governor Romney?
ROMNEY: Governor Perry, we were talking about Social Security, but if you want to talk about health care, I’m happy to do that.
BAIER: We are going to have a round on that.
ROMNEY: I actually wrote my book, and in my book I said no such thing. What I said, actually — when I put my health care plan together – and I met with Dan Balz, for instance, of The Washington Post. He said, "Is this is a plan that if you were president you would put on the whole nation, have a whole nation adopt it?"
I said,"Absolutely not." I said, "This is a state plan for a state, it is not a national plan."
And it’s fine for to you retreat from your own words in your own book, but please don’t try and make me retreat from the words that I wrote in my book. I stand by what I wrote. I believe in what I did.
And I believe that the people of this country can read my book and see exactly what it is.
WALLACE: And we’ll get right to that question of Obamacare.
Mr. Cain, you are a survivor of stage 4 colon and liver cancer. And you say, if Obamacare had been…
WALLACE: …and we all share in the happiness about your situation. But, you say if Obamacare had been in effect when you were first being treated, you would dead now. Why?
CAIN: The reason I said that I would be dead under Obamacare is because my cancer was detected in March of 2006. From March 2006 all the way to the end of 2006, for that number of months, I was able to get the necessary CAT scan tests, go to the necessary doctors, get a second opinion, get chemotherapy, go — get surgery, recuperate from surgery, get more chemotherapy in a span of nine months. If we had been under Obamacare and a bureaucrat was trying to tell me when I could get that CAT scan that would have delayed by treatment.
My surgeons and doctors have told me that because I was able get the treatment as fast as I could, based upon my timetable and not the government’s timetable that’s what saved my life, because I only had a 30 percent chance of survival. And now I’m here five years cancer free, because I could do it on my timetable and not a bureaucrat’s timetable.
This is one of the reasons I believe a lot of people are objecting to Obamacare, because we need get bureaucrats out of the business of trying to micromanage health care in this nation.
WALLACE: Governor Huntsman, you say President Obama’s health care plan is a trillion dollar bomb dropping — dropped on taxpayers and job creation. But I want to show you the top voted question on YouTube that was submitted on health care. And it comes from Ian McDonald of Michigan who says he has a health problem. Watch it, sir.
(BEGIN VIDEO CLIP)
QUESTION: Hi, I’m a student. And I have a chronic heart condition. So for me, and those like me, the Democrats’ health care reform, allowing us to stay on our parents’ insurance longer was a godsend.
If were you elected, would you work as is the stated position of your party to repeal this reform? And if so, are we supposed to pray really hard that our ailments don’t prevent us from going to class?
(END VIDEO CLIP)
WALLACE: Governor, what about provisions that Ian talks about? For instance, the one that allows kids to stay on their parents’ policies until they were 26, or not limiting coverage for preexisting conditions. President Obama says the only way that insurance companies can afford to provide those kinds of reforms is with the individual mandate where they get a lot of new customers.
HUNTSMAN: When I hear this discussion, I think of my daughter Elizabeth who is sitting on the front row who suffers from juvenile diabetes. And I also am reminded that we are fundamentally approaching health care reform the wrong way.
This one trillion dollar bomb that Obamacare means to this country over 10 years is creating such uncertainty in the marketplace that businesses aren’t willing to hire, they’re not willing to deploy capital into the marketplace. It everyone it has gummed up our system.
So you say what do we do? I say we go out to the states and let the states experiment and find breakthroughs in how we address health care reform. Health care reform, it’s is a three trillion dollar industry.
It’s the size of the GDP of France. It’s large. It’s complicated. All I want to do is do the kind of thing we did in the state of Utah.
In direct response, we need affordable insurance policies. We don’t have affordable insurance policies today. We got one in Utah a stripped down bare bones catastrophic coverage policy that young people can finally afford.And then you can start whittling down the high percentage of the people who are uninsured in this country because they have an affordable policy. That’s number one.
Number two, we have to deal with cost containment measures like harmonizing medi