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Health Care Summit

Aired February 25, 2010 - 16:00   ET


WOLF BLITZER, CNN ANCHOR: The president has extended his conversation with House and Senate Democrats and Republicans for another 30 minutes at Blair House.

We are going to continue to cover it extensively, obviously, but I want to bring in Mary Matalin right now, our Republican strategist, formerly in the Bush administration.

Mary, would it -- would it be realistic to assume, if the -- if the Democrats and the president said, OK, Republicans, we will do it incrementally, step by step, let's agree on what we can agree on, we will pass legislation, the president will then be able to say he passed health care reform, is that something Republicans want to see him be able to achieve?

MARY MATALIN, CNN POLITICAL CONTRIBUTOR: I -- I honestly believe -- and they discussed it over and over today -- there are five or six specific, targeted, real, timely reforms that he could have on his desk by next week, and everybody could enjoy the political success of -- of -- of those measures that --


BLITZER: But the question is, Mary, would the Republicans like to see the president be able to bask in that kind of political success?

MATALIN: Well, they would be -- they would be joining in. This is not an either/or. The president now has two options.

He can either jam through something that's intensely unpopular with a reconciliation process, which he thinks the American people don't understand -- but they do -- or he can -- he can take up the Republican offer here, which everyone has made, tort reform -- you know what they are -- preexisting, catastrophic, state lines, put those timely, targeted reforms on his desk in a week.

Then everybody can share in the benefits that would accrue to the health-care-improvement-needing public out there. It is not an Obama victory or a Republican victory. These are things that Bush put on the table. It is an American victory.

So, I don't -- I don't get what we are fighting about here. This is like primal therapy for junkies and wonks. But unless he picks one of those two options, to jam it through on an -- on an unpopular -- in an unpopular process, or take up the Republican offer to do specific, narrow reforms, we are where we always were and have been for a year.

BLITZER: Well, when you say jam it through, the president says it would be a majority vote, an up-or-down majority vote. Fifty-one votes in the United States Senate is a majority. Why would that be jamming it through?

MATALIN: That is a reconciliation process, the majority vote that would have to be used to jam it through. It has never been used on legislation of this nature. The inventor of it, the creator of it, Senator Byrd, said it is for raising taxes or lowering deficits. It's -- it's composed foreign a completely different process.

Everybody knows this is a jam-down, cram-down process. And the American people get it, too. They don't like it. But they do like -- and the president has said repeatedly they do like these specific reforms, would have immediate impact. I don't -- it just defies common sense. Why not do things today that could have an impact literally within weeks, instead of overhauling the whole system, and not putting it into effect for 10, 12, 18 years?

BLITZER: All right.

Candy Crowley, what's the answer to that? Is that likely to happen, to do some sort of much more modest agreement that they can work on and get that passed in the coming weeks?

CANDY CROWLEY, CNN SENIOR POLITICAL CORRESPONDENT: I get the sense -- the president has not signaled that he's ready to do a smaller bill. There's just -- I have seen no sign of that.

Now, part of that may be negotiating. You don't really show your hand until you have to. But I think that there is a real question as to whether his own Democrats can get together to pass something more comprehensive.

So, there's going to be a lot of counting noses, I think, over the weekend, as to what will fly and what won't.

BLITZER: We are getting a lot of reaction. I'm getting tons of reaction on Twitter. I know you are as well, John.

JOHN KING, CNN CHIEF NATIONAL CORRESPONDENT: This is lighting up the political blogs, the activist blogs --


KING: -- MySpace, Facebook, Twitter. We have put -- on this morning, we put up a little thing saying, text us in. We hope you are going to watch this online or watch it at home. Text on what you see.

Let me read some of the texts, because it is a pretty lively discussion, just like we are having here.

Here is one from East Pennsylvania: "I think they should have their health care suspended until things are fixed for everyone." (LAUGHTER)

KING: "When they pass reform, they can have the same options as everyone else."

Florida texts in: "Please do something, even if it is less than perfect. Compromise on a health care bill as a start. Make a framework to be a working government. Show us our government works, please."

Here's another one. We come up here: "I trust my government more than the current unregulated health insurance industry. This industry has created the current mess."

And here is another one here. It says: "While they are still drawing a line in the sand, I'm finding it informative. I would love to see them build on what is agreed and really work to common ground."

And, Wolf, a couple of the tweets. I also reached out to people on Twitter and said, what do you think? Are you learning from this experience? Do you like it, not?

Here is another one. It echoes something we heard: "None of them can understand what it is like to have no coverage."

Dragonflypath (ph) says: "I'm learning that, if we drop health care coverage for everyone sitting in that room, they would figure out real quick how to do it."

And Lieberblue (ph) wrote in: "This is a talking points tug-of- war accomplishing nothing. But it does let the American people see how lame these guy are."


BLITZER: It also -- I'm a lot less -- it does let us all see the serious differences, substantive differences between the Democrats and the Republicans.

Rick Sanchez has been watching and listening.

What do you -- what do you think about all of this, Rick?

RICK SANCHEZ, CNN ANCHOR: Now, look, the fact of the matter is, Wolf, here is what's going on in America right now.

Yesterday, in 11 different states, insurance premiums were jacked up for people. That means, if have you an individual policy, if you are one of those poorer persons in this country who has an individual policy, you could be paying up to 50 percent of what you were paying before, 50 percent. Stop and think if that was you. Stop and think if that wasn't one of these senators or one of these congressmen in Washington or all us guys who wear suits and gals and go on TV and talk about this.

People who have small businesses are being jacked up in some states as much as 34 percent, a 34 percent increase. That's a lot of dough. And that's what Americans are talking about. They are talking about how they are specifically being affected by this, not about the politics, not about the policies, but how this affects their lives, the reality of their lives.

Here, let me show you some of those. I mean, John was sharing some of the ones that he has gotten. I mean, some of these, I read them, and -- and I get a little misty-eyed. Listen.

"When my daughter -- when my diabetic daughter turns 21, she will lose her insurance," Wolf. "If she's denied insurance, she will be forced to go on disability, won't be able to get a job."

Look at this guy: "Rick, we are paying about $1,000 a month, with $5,000 deductible per person," a $5,000 -- stop and think what a $5,000 deductible is. And that's for three people.

And "Anthem" -- that's Anthem Blue Cross Blue Shield -- he says, "wants to raise us to $7,500."

I mean, it is literally one after another. There's another one I saw just here a little while ago. It says: "In two years, I won't have health insurance and likely won't have a good job. So, I won't be able to get one."

And this one here says: "Lost husband, lost health coverage, lost income, lost house. Paid for funeral with donations from baby group." And then, she said, when she first started this, "My husband lost his job shortly after I found out I was pregnant with eldest, got new job, died of cancer, age 38 -- 20-month-old baby."

That's what Americans are saying, Wolf.

BLITZER: Yes. Well, we are getting a ton of reaction. And I know you are on Twitter. All of us are.

Stand by, Rick. We are coming to you soon.

Candy Crowley, if -- if you take a look at this threat that the Democrats have -- and the president basically acknowledged it, that -- today -- that, if they can't work out a deal, they are going with that 51-majority vote. They will -- they will try to get that through the Senate. No guarantee it will go through the House, because it is a very, very tight market out there.

How -- how realistic is that threat?

CROWLEY: I think the threat is pretty realistic, because they have determined that having a bill, however faulty it might be in parts, is better than not having a bill, and that you have to start somewhere. We have seen lots of legislation that's gone through with unintended consequences. You can fix it.

They want something to take to the voters. It is -- it is just unpalatable for them to go in November and say, yes, we have a Democratic House and a Democratic Senate and a Democratic -- but we couldn't get you health care.

KING: In a mid --

CROWLEY: It won't work.

KING: In a midterm election year, where turnout is traditionally down, and you need your base, the intensity is on the Republican and the conservative side right now. That's not always the same thing, but that's where the intensity is right now, on the right of American politics.

If the Democrats don't pass a -- pass a health care bill, they will not get the left fired back up.

GLORIA BORGER, CNN SENIOR POLITICAL ANALYST: It could be a Pyrrhic victory, right, but they still need a victory, because they have to prove they can govern.

But I -- I just want to talk about this -- this notion. Everybody really says, OK, let's get together. We heard Mary Matalin talk about, you know, let's do a -- a smaller version of health care reform.

And -- and the president at one point today -- it was interesting -- he pushed back on -- on the preexisting condition, because that sounds great to everybody. Nobody wants anybody to cut out -- be cut out for preexisting conditions. You -- you don't want any lifetime limits on -- on your health insurance coverage.

But that goes to the main question of this debate, which is, if the insurance pool is not large enough, how can you do that? And it is the question that bedeviled Barack Obama during the campaign, when he ran against Hillary Clinton. Do you, in this country, can you mandate people to buy health insurance coverage, the way you say you ought to mandate them to -- to insure your -- your car, right, or -- and -- and so, that's -- you know, that's kind of at the center of this debate right now.

Can government tell you need to buy health insurance, as a small business or a person?

BLITZER: It's a good -- it's a good question, David, because the whole question about health care-lite, as some people call it, is that even realistic, given the fact you won't have that huge pool of younger people involved?

DAVID GERGEN, CNN SENIOR POLITICAL ANALYST: It is unrealistic to think that you can drop preexisting conditions and drop recisions, you know, getting rid of people's health care right in the middle of a crisis, and not have a bigger pool.

But I think, Wolf, where we are now is, at the end of this day, the president is probably not going to get the lift the White House hoped out of this day. We will have to wait and see.

But I imagine the president will go back to the Oval Office, in the next few days, he will do two things. He will explore with the leadership on the Hill, on the Democratic side, do we have votes to get the reconciliation bill through? And it may be very, very close. It may -- they may behind.

At the same time, I hope that he has an emissary, a Tom Daschle- type figure, go explore with the Republicans, is it realistic, if we decide not to go down the reconciliation route, that we could actually sit down and do five or six things that were really -- would be helpful, and would help these people who are suffering?

It seems to me somebody has to be a diplomat --


BLITZER: Well, it's a good question, because, Joe, you covered the Hill for a long time.


BLITZER: Is it realistic to think that, on health care, the Democrats and the president can do what they did on the jobs bill, get five or six, seven Republicans in the Senate to cross over and join them?

JOHNS: It doesn't look like it right now. It looks like the -- so far, at least, people are pretty far apart.

And they are kind of dug in, and -- and --

GERGEN: On small bills?

JOHNS: Oh, no, not on a small bill. I thought you were talking about on the big bill.

BLITZER: I was talking about a big bill.

JOHNS: On a big bill --

BLITZER: But a scaled-back big bill, not as big as --


JOHNS: On a scaled-back bill, it looks --

BORGER: Medium-big bill.


JOHNS: Right. You talk to people on the Hill -- right. You talk to people on the Hill, there might be -- there might be some wiggle room on that. The president can't give up too much, because he will lose the left.

And -- and that's his base. And this is an election year. So, it is a tough position for them. But you look at this, and you look back at 1994, was it, the Clinton thing, it is a very tough spot for them. And they understand, to walk away with nothing will -- will cause -- could cause them just huge problems.

BORGER: They look like they can't run government, right?

BLITZER: Well, they're getting ready to, I guess, have some final statements.

I think we want to take another quick break, right?

Let's take a quick break. We will resume our coverage inside right after this.


BLITZER: Let's go back inside.

Peter Roskam, the Republican congressman from Illinois, is speaking.

REP. PETER ROSKAM (R), ILLINOIS: -- changes in Medicaid.

That is making our states, I think, ultimately, hidebound in how they approach these things. This is -- this is something that, in my view, isn't sustainable.

Governor Brian Schweitzer of Montana said -- let me give you a quick quote -- "One of the least effective programs in terms of health care in the history of the country is called Medicaid. About 20 percent of America is on a Medicaid program, and they'd like to shift" -- they, meaning Washington -- "would like to shift it and grow it to somewhere around 25 percent or 30 percent."

Now, Medicaid is a system that isn't working. Almost everyone agrees. But what Congress intends to do is to increase the number of people on Medicaid so that they can do it on the cheap. It isn't working for anybody.

Look, the foundation of the expansion is Medicaid. And in my view, and I think the view of folks in my district and I think many, many people across America, it is a flawed foundation. And we can do much, much better.

A Republican proposal that's out there would reduce the number of uninsured by 3 million people.

So, look, you've heard it today in many, many forums. This -- remember the old -- in closing, you remember the old game you used to play as a kid, Etch A Sketch? And you'd start out with the Etch A Sketch, that little thing where you try and draw something, and you dial the dials, and over a period of time, the more you dial, the more crazy it looked? And then, finally, you'd say, oh, let's just go like that and do the Etch A Sketch. I'll tell you what: A year's worth of work and this is what is come up with? The American public, as far as the ones that I have heard from, are vehemently opposed to this. And they say, look, take the Etch A Sketch, go like this, let's start over, let's do incremental things where there's common ground.

I yield back.

BARACK OBAMA, PRESIDENT OF THE UNITED STATES: I want to make sure that everybody gets -- gets an opportunity to -- to speak, but I just want to caution everybody. It's now 4:15. There are a number of folks who haven't had a chance to speak.

You know, the question I had was, were there ideas about expansion beyond the 3 million that was in Leader Boehner's bill, and I didn't get an answer to it. So -- so, in addition to -- and it may be that the answer is that's all we can do.

I should point out this one issue about Medicaid that I think that's important. Most of the people we'd like to be in the exchange and giving them subsidies. And I think, over time (INAUDIBLE) evolution, if you created a large enough pool, where people could purchase it through an exchange the same way that members of Congress do.

The problem we've got right now is that very poor people, they've got coverage through Medicaid. And it's somewhat flawed. There are problems with doctor reimbursements. There are problems long term, in terms of solvency, both for the state and the federal level, so all those things need to be fixed. But the fact of the matter is, if their kid gets sick, they can go to a doctor.

The people who are really left in the cold are working families who make too much for Medicaid and don't have anywhere to go. That's the group that right now is getting the worst deal. They're paying taxes. They're working, but they've got nowhere to go.

Now, for those 15 million people who've got nothing, I promise you, they would say to themselves, having some coverage through Medicaid is a pretty good deal. I'd prefer to have them in an exchange where over time we've got everybody in a pool, similar to the pool that members of Congress enjoy, but that's not the situation that we have right now.

I just want to remind everybody, though, that the group that is being left out -- because you threw out the word "welfare," which is, you know, one that obviously most American people, they don't want to be part of welfare -- the fact of the matter is that very poor people right now have coverage that is superior to what a lot of folks who make a little more money, are working very hard, trying to support their families, do not.

Now, I know that Max has been trying to get in for a while, but there are some other folks that haven't had a chance to speak, so I want to call on them first.


OBAMA: And then, if I've got time, Max, I'll allow you to wrap up. But I'm going to go to -- Chris and Murray, Chris and Patty Murray on our side, as well as Charlie Rangel who want to speak. And I'm -- and what we'll do is we'll alternate to make sure that we've got -- oh, and I -- I know that Joe Barton is interested in speaking, as well, and there may be a couple other Republicans.

UNIDENTIFIED SPEAKER: Mr. President, can I follow Jim?

OBAMA: OK. Go ahead.

SEN. CHRISTOPHER J. DODD (D), CONNECTICUT: Well, thank you, Mr. President. And I'll try and keep this brief and turn it over to Patty, so we'll take the time for one person and divide into two.

Let me -- let me, first of all, thank you, as well, and thank all of our colleagues who've done this. It's been tremendously helpful, I think, today.

And it's been said earlier, maybe it needs to be focused, as well. Like many of you, like all of you here, my state, there are 31 hospitals, and they're terrific people. And whether or not the quality of care is equal for everyone in this country is certainly questionable, but certainly the quality of the people who are our health care providers -- the nurses, the doctors, and others -- do an incredible job every single day.

And in a sense, I was struck when Congress was talking about the death penalty issue that was debated sometime ago in Illinois. I think most of us around this table here would agree today that every person, if they're confronted with a legal problem, has a right to a lawyer. That's something we've accepted as a country.

It's somewhat ironic, I suppose -- and history may judge us accordingly -- that while everyone is entitled to a lawyer, regardless of what you've been charged with, that you don't have a right to a doctor. And yet, at the same time, we acknowledge that we provide care: If you show up in an emergency room, we take care of you. And that's a great testimony about who we are as a people.

The problem is, of course, that the costs associated with that, I think there's a false assumption that that's one group of people, and they're out there, and they have no impact on what happens to those who have insurance today.

And somehow they should be taking better care of themselves. They should quit smoking. They should eat better. They should get a job. That somehow the responsibility rests with them.

If you can accept that, which I don't, the fact of the matter is, that -- that sector of our population affects everyone else. It costs us about $248 billion a year in lost productivity when you have increased numbers of uninsured people in the country.

At this very hour, there's a cost with every single insured person in this country of roughly $1,100 a year, to pay for that cost of that person showing up in that emergency room or getting that care. That's a hidden tax that Americans are paying today when people show up for that kind of -- kind of support.

There are -- today before this -- we wrap up and go back to our offices and go back to our homes this evening here in the District of Columbia, 14,000 of our fellow citizens will have lost their health care today. And every day that we're here debating and discussing this, 14,000 Americans lose their health care.

Roughly six to eight people will have lost their lives today as we gather around this table because they're uninsured. Based on a Harvard study and National Science Foundation study, that we lose that many people on a daily basis because we lack -- because they lack health insurance.

So there are tremendous costs associated with it. Henry said it well, Tom said it well, and, Mr. President, you certainly have capsulized it very well.

These are not segmented issues. And while incremental approaches are something I generally support and approach after 30 years here in dealing with major issues, but this issue defies incremental approach. You can't get from one point to the next incrementally unless you deal with it holistically.

That's what we are trying do. Now, you may disagree about whether or not we're doing too much in mandates or too much here and there, and that's a legitimate debate.

But you can't get to affordability, you can't get to quality, you can't deal with the major economic issues if you don't deal with coverage. You just can't. There's no way to do it. You've got to have broadening coverage if you're going to have any effort or any successful effort in reaching those questions.

Lastly, I'd just say this to you: A guy in my state, Kevin Galvin (ph), Kevin is -- he employs seven people. A maintenance operation in Hartford, Connecticut. He decided he wanted to provide health care.

And, like the stories you've all heard, he lost a fellow of 24 years because the guy had a health care issue. He finally had to take less pay, took another job, because of his health care provider.

But Kevin did more than just tell me a story about himself, Mr. President, what happened to his seven employees because he couldn't get health care. He went out in my state of Connecticut and organized 19,000 small businesses. And they changed the law in Connecticut regarding pooling of small businesses.

Because here was a small business guy who wanted to take care of his people and watched tragically day after day what happened to individuals because he could not provide it for them any longer.

And I think people like Kevin Galvin (ph) exist in every district, in every state who want to provide that health care, understand how valuable it is to them, their productivity and, of course, the importance to their employees.

But coverage is the critical issue. We know that in the next 10 years, factually, Mr. President, in the next 10 years, every state in this country will have a 10 percent increase in uninsured people. We know that in 30 states in our country in that same 10-year period, there'll be a 30 percent increase in the uninsured. And half the population under the age of 65 will at one point or another in the next 65 -- in the next 10 years, be without insurance.

So it's not some isolated group out there. This is the critical constituency that is this -- that are the linchpin that holds all of this together. So coverage is absolutely critical.


REP. JOE L. BARTON (R), TEXAS: Thank you, Mr. President. I want to commend you for asking us to come here. And I will saying that never have so many members of the House and Senate behaved so well for so long before so many television cameras. So if we ever get to a conference committee, we may want you to be the moderator.

I do think, though, that there is a fundamental difference in the vision that you and your friends on the majority have put forward and the vision that myself and those of us in the minority have put forward. It's the pivotal (ph) role of the government.

We believe that we should use free markets to empower people and give them choices. And for the best of intentions, yourself and most of your allies in the Democratic Party seem to believe that the government, either through a mandate or through a regulatory requirement, knows better and will do better for health care for most Americans.

Now, whether you have a mandate or simply give the secretary of health and human services the ability by regulation to require something, that's a difference without -- that's a distinction without much of a difference.

So the six common-sense ideas that various Republicans have put out here is not incrementalism in the sense that it doesn't go together, but it does not radically change the basic health care system of America.

If you give the ability to sell insurance across state lines and prevent a state from precluding it if the insurance company can prove that it's solvent and that it will pay the benefit, health care costs will go down in that state and premiums will go down.

There's a study just out that in the state of California, health care premiums would go down 50 percent if Californians could buy insurance from Nevada or Oregon.

If you create a catastrophic high-risk pool and put the cap on it that Leader Boehner did on his alternative on the House floor and allow -- allow small businesses to create the kind of pools that we've talked about, you're going to be able to give those Americans who can't get insurance because of a preexisting condition and want it, the ability to get into those things.

And they -- their premiums will not go up catastrophically. They will not go up astronomically.

And one of the things that we seem to have agreement on, according to yourself and Mr. -- Senator Durbin, is medical malpractice. Now, your proposal and the House bill and the Senate bill paw lip service to medical malpractice. But they don't really do it.

Again, if you take the Boehner proposal that was put together and put up on the House floor, and it's based on what's happened in Texas, in Texas which put in medical malpractice reform in -- in 2003, premiums for medical malpractice have gone down 27 percent.

Texas has gained 18,000 doctors since this reform was put in. There are 55 rural counties in Texas that now have an obstetrician.

If that is extrapolated nationally, you're not going to save the $54 billion that Senator Durbin alluded to and that yourself alluded to, if you combine the direct savings with the indirect savings, because the price of practicing defensive medicine goes down, you probably save $150 billion a year. Now, that's real money.

So what we're saying, Mr. President, we're not talking about incrementalism. We're talking about, as Leader Boehner said and Mr. McConnell -- Senator McConnell said, let's start over in the sense that we change the vision and work together to do the things that we agree upon, but do it in way that doesn't destroy the fundamental market system that's made the American health care system the best in the world. And if we do that, we can make a deal.

OBAMA: Well --


UNIDENTIFIED SPEAKER: Thank you, Leader Boehner.

OBAMA: Well, Joe, I'll respond to you right at the end, because I think that we should wrap it up. You're right. The proposal that John Boehner's put forward doesn't radically change the existing system. And that, I think that's why 3 million out of 30 million who don't have coverage, or 40 million, don't get coverage.

The proposal that's been put forward by the House and the Senate Democrats also doesn't radically change it in the sense that the vast majority of people who currently have health care will still get it, it's just they'll see it a little cheaper. People who do not have coverage will start getting it.

So that's -- it is not a -- neither of these proposals are radical. The question is which one works best for the American people, and that's what, you know, we'll see if we can determine. We're running short on time. I know that some folks are going at some point start have to get going.

I'm going to reserve the prerogative of making sure that everybody who has not had a chance to speak is allowed to speak. And then I will wrap up. That means that we're probably going to go a little bit later than we had anticipated. But, as I said, by the standards of Washington, we're still in the ballpark here.


I'm going to call on Charlie Rangel first. We'll go to one of our Republican colleagues. Patty Murray is going to have an opportunity to speak.

Again, there may be some comments.


OBAMA: There may be other Republicans who are interested in speaking. We'll go to -- we're going to actually go to Ron Wyden first. Then we're going to go to another Republican.

And we're going to end with John Dingell, who was mayor when the idea of everybody having health care was first introduced by his father many decades ago.

UNIDENTIFIED SPEAKER: Mr. President, why don't you just call on Republicans who haven't talked, because some of them have talked numerous times.

OBAMA: I agree, but I want to make sure that they may want to respond to whatever is -- is said.

Go ahead, Ron.

BLITZER: All right. It looks like they're going to do at least another half an hour worth of comments, questions, answers, dialogue, discussion.

We'll take a quick break. We'll continue our coverage of these historic talks at Blair House right after this.


BLITZER: Ron Wyden, the Democratic senator from Oregon, is making the case for a comprehensive plan, not a step-by-step incremental plan.

SEN. RON WYDEN (D), OREGON: -- a very gracious offer to try to bring both sides together, it allows us to build on the exchanges that we have today, which begin to empower people with more choices and competition. And if we just keep building on that, starting with this effort to bring both sides together on interstate competition, looking, in my view, at the federal employee system to do it, I think we can resolve a lot of our differences. So I appreciate the opportunity to speak, Mr. President. I want colleagues to know that I'm going to be following up with both sides of the aisle this afternoon, and your administration, to bring this group together.



MCCONNELL: All of my members have had a chance to speak at least once, several of them a number of times. John Kyl reminds me that HSAs, for example, are not exactly for rich people, that the median income of a user of an HSA is $69,000 a year.

All of us are representatives of the American people, but I have a feeling we haven't been listening to them very carefully. Congressman Roskam mentioned what the people in his district think, and I expect all of you are experts on what the people in your districts think. But we know from the polling that's been done in this country how the American people feel about this 2,700-page bill. We know how they feel about it.

This is not a close call. If you average all of the polls in America, we know that the American people oppose this proposal by an average of 55 to 37 percent. They have also been asked, and we keep reading in the newspaper that where we're headed next is to the reconciliation approach. Gallup also asked that question, and explained to the American people what it meant so they understood what this word that we use around Washington actually means. And in the Gallup poll, the American people were opposed to using that 52 to 39.

So this has been a fabulous discussion, Mr. President. We have a lot of experts around the room, but I think it's really important, since we represent the American people, that we not ignore their view on this. They have paid attention to this issue like no other issue since I have been in the United States Senate. Health care is a uniquely personal issue. Obviously, you get more interested in the subject the older you get, but every American cares deeply about the quality of their health care and access to health care and costs of health care.

They have followed this debate like no other, and they have rendered a judgment about what we have attempted to do so far. The solution to that is to put that on the shelf and to start over with a blank piece of paper and go step by step to see what we can agree on to improve the American health care system which is already, as all of us agree, the finest in the world.

OBAMA: I'm just going to make this remark and then I'm going to call on Patty Murray. I'm going to save the two lions of the House here for the end, because there's been a lot of comments from every Republican about the polls and what they're hearing from their constituents. And as I said, I hear from constituents in every one of your districts and every one of your states. And what's interesting is actually when you poll people about the individual elements in each of these bills, they're all for them. So you ask them, "Do you want to prohibit preexisting conditions?" "Yes, I am for that." "Do you want to make sure that everybody can get basic coverage that's affordable?" "Yes, I'm for that." "Do you want to make sure that insurance companies can't take advantage of you and that you've got the ability, as Ron said, to fire an insurance that's not doing a good job and hire one that is, but also that you've got some basic consumer protections?" "Yes, we like that."

So polls I think are important in taking a temperature of the public. If you polled people and asked them, "Is the system working right now and should we move forward with health reform," they'd also say yes to that.

And my hope had been and continues to be, based on this conversation, there might be enough areas of overlap that we could realistically think about moving forward without -- without a situation in which everybody just goes to their respective corners and this ends up being a political fight, because this is something that really has to be solved.

We've got three people who have not had an opportunity to speak today. If you don't mind, I will -- would like to, in the interest of time, just go ahead and let each of them speak. If there's an intervention that somebody on the Republican side wants to make, then I will recognize them.

Then I will allow anybody of your choice, Mitch, to wrap things up. I think Speaker Pelosi may want to say just a quick summary of what she's thinking, and then I will talk a little bit about next steps. And if everybody could keep their remarks relatively brief, that would be very helpful.


SEN. PATTY MURRAY (D-WA), SECRETARY OF THE CONFERENCE: Mr. President, thank you, and this has been I think a very good discussion. And I think all of us come to this table today having heard a lot of stories and talked to a lot of people and bring their passions with us today. And I certainly am one of those.

Every time we talk about this, every time I think about this, I remember a little boy who I met last spring, who was 11 years old, whose name was Marcellus. And he told me that his mom, single mom, taking care of him and his two younger sisters, was going to work every day, had a job managing a fast-food restaurant, was doing OK, but she got sick. And when she got sick, she had to take time off from work. And because she was missing so much work, she lost her job. When she lost her job, she lost her health care. And because she lost her health care, she couldn't get in to see a doctor and sadly, Marcellus' mom died.

I think about him every time we talk about this bill. And what happened to her is happening to so many Americans who when they get sick today don't have any choices. They have nowhere to go. Either they don't have insurance or they've been denied insurance because they don't have -- because they have a preexisting condition or they're a small business whose premiums have gone up so dramatically that they can no longer afford to provide it for their employees.

Too many Americans today are in a box and they don't have a choice. Frankly, it's why so many Americans today are passion about a public option. It was a choice for them that they felt was important to them.

But in the bill that you have presented and that we have been working on, that is so important, is it finally gets some people out of that box of no choices by giving them an exchange that they can go to, by taking care of the insurance reforms so they're not denied coverage, by opening up community health centers so people have choices, by making sure that we lower the cost for all Americans because when we provide coverage for 30 million Americans, it lowers the cost of everyone who has insurance today by $1,000 a year a family.

This is why this is so important. And what I have listened for today is whether the alternative proposal that has come before us gives people those choices that they need. And that's what I'm listening for and I go back to Marcellus (ph) and I think will that proposal make sure that nobody loses their mom again because they didn't have a choice?

And that's why it's so important that we move forward with what we have and open that door for so many Americans.

OBAMA: Thank you.

Mitch --

MCCONNELL: Mr. President, Dr. Coburn.

SEN. TOM COBURN (R), OKLAHOMA: (OFF-MIKE) if we don't think about what the key goal is. The key goal is to reconnect purchase and payment so we become good purchasers. Whether we create -- what system we do, if we don't reconnect the mechanism of payment with purchase, we're not going to get good value out of our health care system.

And I outlined one out of every three dollars that doesn't help anybody get well, doesn't prevent them from getting sick. And there's enough potential there in that pool of money that we don't have to have the government run it. What, in fact, we can do is we can create and allow that money for everybody to have the kind of access that Senator Murray wants that individual to have.

The thing that I think is -- draws us apart is the level of involvement in the government in making those choices. And I would just put forward to you that we ought to have another talk like this as we can get closer and closer on some ideas because we all want the same thing.

But how we get there, whether or not we're in charge of it or the individual patient's in charge of it, personally making their own choices with the asset value that is capable, based on what we're already spending in health care.

We don't need to spend a penny more on health care in this country. What we need to do is spend it much more wisely and much more effectively.

OBAMA: I'll pick up on some themes in my close.

Charlie Rangel?

RANGEL: (INAUDIBLE) Mr. President. I appreciate the fact that you saved the best for last.

OBAMA: Absolutely.


REP. CHARLES B. RANGEL (D), NEW YORK: I had really hoped that when we came here that we were really going to push over the top. We are so close to national health insurance. We are so close to allowing people that go to work every day and don't know what can happen to them, whether they lose their job and lose their health insurance.

I know that they call the Senate the upper house, but I was amazed how it seems as though they believe that the American people only listen to those from Wyoming and Kentucky.

But having said that, for my New Yorkers, even though we have more self-confidence than we need, I would want them to know that they are Americans and we do listen to them and that the states that oppose this great plan doesn't speak for all of America.

Having said that, some people have called those who oppose us as being the party of no. I don't think so. Notwithstanding the fact we got five Republicans from the Ways and Means Committee here at your summit.

Now, we spent hundreds of hours in three committees and Ways and Means, and there wasn't one bill before us. And I would think that instead of taking the president's time, that this is where the House and Senate would take care of legislative business, especially if we agree on 70 percent. For God sake, then for the 10 or 20 percent, why do you say scrap what we got unless it ends up with that you have made up your mind that we are not going to have a health bill?

And then I would say that most all of America would find it not more difficult to understand why the bill is so big or why we (INAUDIBLE) reconciliation, I think one of the big problems America would have is why does it take 60 to get a majority? And I have to explain, well, that's the Senate and they are different than most Americans in understanding it.

So what I would hope would happen is that we leave here not thinking that we're going to start all over. We can't get back those times. This is the last year for a whole lot of people in the House of Representatives who we believe we represent the people, too.

Why can't we take what we've agreed to? I mean, sick people, scared people, are not Republican and Democrats. They're Americans. And you've made it abundantly clear that you have the same sensitivity, recognize the fiscal crisis, you know what can happen to our country if we're not educated, we're not strong in a healthy way. Have staff or somebody bring together those issues that cannot be contradicted in terms of what you want.

And I know you want more than just 3 million people insured. You can explain why it's difficult for you to do it. But I know you would want to achieve having most all Americans, or all Americans with the same health benefits because that's so important.

And then, Mr. President, after we start learning to agree with each other and it's not a question of no but it's the Congress working its will for the good of people, then we can work out, and God knows Mr. Camp and I have tried desperately hard, and Jim McCrery before him to realize people aren't concerned with the debate. They're concerned with what are we going to produce.

And I don't care what your color is, I don't care what your party is, that if you're sick, you're sick, and you don't check out the doctor. And they're not going to check out whether or not you're Republican or Democrat.

So I just hope that we can change this to a positive thing where you can say let's leave here at least talking about what we agree on.

BLITZER: All right. Let's take a quick break just for a moment.

We'll continue our coverage. Charlie Rangel will continue talking. We're going to hear the president's summation of what happened today and the Republican concluding remarks.

Much more coming up right after this.


BLITZER: The longest serving member of the House of Representatives ever, Democrat John Dingell of Michigan, is offering his comments.

REP. JOHN DINGELL (D), MICHIGAN: -- insurance coverage when -- when the patient gets sick. But we don't -- and the Republicans do, too. But they don't cover preexisting conditions.

Both of us prohibit annual and lifetime limits. High-risk pools, we have and they have. But high-risk pools carry with them some risk, because constitutes an incentive for a race to the bottom, whereby people will -- will move their insurance companies to the place where they have the least regulation and the least protection for the consumers.

And it also includes, amongst the other 14 items, where we're agreed on, is the availability of health savings accounts. There are a lot of other things here that we have and we -- we need.

I would say that I've seen some of my friends who I knew before they were virgins (ph). They were -- they were pushing, for example, use of the-- of the -- of the extraordinary budgetary mechanism. And I -- as to get -- get this decided by 51 votes.

Seemed like a great idea if -- and I'm curious, why in the name of common sense are we being so fussy about having the decisions in the people's House and the people's Senate decided on the basis of a simple majority -- 51 votes?

And if there's something wrong with that, I wish somebody would tell me why we ought not give the people that kind of representation.

I would note that also mandatory coverage mandates, that was in a -- a bill that introduced by my good friend Bill Thomas, chairman of the Ways and Means Committee, and 20 members in the U.S. Senate. They said -- and -- they were not fussy about that.

And I think we ought to look to see, here we have a chance to serve the people. I have people coming to my office with tears in their eyes. They can't get coverage. They have preexisting conditions. A young dental surgeon I knew couldn't get health care. Why? Because she had breast cancer years before. She couldn't get care. And I've seen a lot of other cases like that.

People who would have drive-through pregnancies or drive-through vasectomies. All manner of high-handed abuse by the insurance companies.

I'm surprised -- I'm always surprised when I confront somebody that's -- that's defending the insurance companies after the things that they do to the ordinary people in this country.

They could cancel your insurance policy while you're on the gurney headed into the operating room. Somebody would -- if somebody would explain that to me, I would be deeply grateful.

But the fact of the matter is, we have a chance to do something that -- that Dan Webster one time observed, I thought it was -- I thought it was a very useful thing. And he said, and I think that we ought to say -- he said, "Let us see whether we also in our day and generation may not perform something worthy to be remembered."

It's on -- Madam Speaker, as you well know, it's on the wall of the House of Representatives. It's there for us in the House, and my colleagues in the Senate will know it, those few who I see again and who've served with us will recognize it as something.

We have before us a hideous challenge. The last perfect legislation that was presented to mankind was delivered to the Israelis at the base of Mt. Sinai. It was on -- it was on stone tablets written in the fingers of God. Nothing like that has been presented to mankind since.

What we're going to do is not perfect. But it sure will make it better and it's going to ease a huge amount of pain and suffering at a cost which we can afford, which has been costed out by the Office of Management -- by the Office of Management and Budget and the Congressional Budget Office, saying it's budget neutral. It, in fact, reduces the budget.

I beg you, my friends, let us go forward on this great task.

OBAMA: Thank you, John.

DINGELL: Thank you, Mr. President.

OBAMA: Speaker Pelosi wants to say a brief word.

John, do you want to say anything in closing?

And then I will wrap up.


REP. NANCY PELOSI (D-CA), SPEAKER OF THE HOUSE: Thank you very much, Mr. President. As one who has abided by the three and a half minutes, I'm going to take a few seconds more now in closing to extend thanks to Mr. President for bringing us together, for your great leadership.

And without it, we would not be so very close to affordability, accountability for the insurance companies, and accessibility for so many more Americans to improve their health care, to lower their cost.

Mr. President, I hearken back to that meeting a year ago. At that time, Senator Grassley said to -- questioned you about the public option. And you said, "The public option is one way to keep the insurance companies honest and increase competition. If you have a better way, put it on the table."

Well, I bring that up because we have come such a long way. We're talking about how close we are on this, how far apart we are here. But as -- a representatives of the -- a representative of the House of Representatives, I want you to know that we were there that day in support of the public option, which would save $120 billion, keep the insurance companies honest and increase competition.

We've come a long way to agreeing to a Republican idea -- the exchanges. Senator Enzi has been a leader in that. Senator Snowe, along with Senator Durbin, had legislation to that -- to that effect, a bipartisan. Because the insurance companies opposed the public option. They couldn't take the competition.

We have in our bill market-oriented encouragement to the private sector initiatives.

I think the insurance industry, left to its own devices, has behaved shamefully, and we must act on behalf of the American people. We have lived on their playing field all this time. It's time for the insurance companies to exist on the playing field of the American people. I believe I have news for some of my colleagues, because we have very much more in common.

Senator Coburn, you had so many positive suggestions, which I -- I didn't hear much else of, but from you, we did.

And I think you'd be pleased to know that after much debate in our House, we came up with the value, not volume, others have called it quality, not quantity, in terms of utilization, overutilization.

And, Senator McCain, when you talk about (inaudible), we're talking about addressing the regional disparities in terms of compensation and health care.

So we have addressed many of these issues in the bill. I think it's really important to note, though, and I want the record to show, because two statements were made here that are not factual in relationship to these bills.

My colleague, Mr. Leader Boehner, the law of the land is there is no public funding of abortion, and there is no public funding of abortion in these bills. And I don't want our listeners or viewers to get the wrong impression from what you said.


PELOSI: Mr. Camp -- Mr. Camp, you said that the -- that the -- the Medicare cuts in this bill cut benefits for seniors. They do not. They do not.

So I want the record to show just in those two cases where -- we may have differences of opinion and of approach and evaluation of the value of different things, but certain things are facts about our bills that I cannot let the opposite view stand when they are stated.

Yes, it's hard to do this. The misrepresentation campaign that has gone on about these bills, it's a wonder anybody would support them, as Mr. Waxman said.

But the fact is, as the president said, many of these provisions on their own are largely supported by the American people.

So this will take courage to do. Social Security was hard. Medicare was hard. Health care reform for all Americans, insurance reform, is hard. But we will get it done.

And as we leave this debate, I think that many of the differences we have are complicated. And they're legitimate. They're differences of opinion about the role of government (inaudible).

But I think it's really clear on one point that the American people understand very clearly: They understand that there should be an end to discrimination on the basis of preexisting conditions. The proposals we put forth end discrimination on the basis of preexisting conditions. The Republican bill does not.

With that, Mr. President, I thank you again for the opportunity to discuss the differences and to try to find some common ground.

OBAMA: Well, listen, this has been hard work. And I want to first of all thank everybody for being here and conducting themselves in an extraordinarily civil tone.

And, as I said, given the number of folks that were around this table, the fact that we're only an hour late, is -- it beats my prediction.

Here's what I'd like to do. And I'm going to take about 10 minutes.

I want to go through where I think we agree and I want to summarize where I think we disagree. And then I'll address some of the process issues that have been brought up by a number of the Republicans.

We agree that we need some insurance market reforms. We don't agree on all of them, but we agree on some of them.

I think that, if you look at the ones that we don't agree on, since there's been a lot of reference to what the American people want, it turns out that the ones that are not included in the Republican plans right now but are included in the Democratic plans are actually very popular.

I know that there's been a discussion about whether a government should intrude in the insurance market. But it turns out, on things like capping out-of-pocket expenses or making sure that people are able to purchase insurance even if they've got a preexisting condition, overwhelmingly, people say the insurance market should be regulated.

And so one thing that I'd ask from my Republican friends is to look at the list of insurance reforms and make sure that those that you have not included in your plans, right now, are ones, in fact, that you don't think the American people should get.

Because I strongly belief in these insurance reforms. I've talked to too many families who have health insurance and find out that what they have does not provide them with the coverage they needed, and they end up being bankrupt or they end up going without care, or they get care too late, as was the case in the story that Patty Murray mentioned.

The second thing I think we agree on is the idea that allowing small businesses and individuals who are, right now, trapped in the individual market and, as a consequence, have to buy very expensive insurance and effectively, oftentimes, just go without insurance could be solved if we allowed them to do what members of Congress do, which is be part of a large group.

Again, the idea of an exchange is not a government takeover. It is how the market works, which is, if you have a lot of purchasing power, you get a better deal. That's how Wal-Mart drives its prices down, because everybody who wants to supply Wal-Mart, Wal-Mart tells them, "You give me the best deal possible."

And as a consequence, the supplier gives them a much better deal than they do the mom-and-pop shop on the corner.

Well, we should be able to give small businesses and individuals who are self-employed, who aren't able to get insurance through a large employer to have the same deal.

It sounds like we've got some philosophical difference as to whether there should be some minimum benefits in that exchange, some baseline of coverage.

Again, there's a baseline of coverage for members of Congress. And the reason we set that up is because we want to make sure that any federal employee who's part of this big pool is getting good, quality coverage -- not perfect coverage, not gold-plated coverage but adequate coverage.

It may be -- and I'd ask my Republican colleagues to look and see, is that an area that can be resolved?

There's been a lot of discussion, and one of the main tools the Republicans have offered to drive down costs is purchasing insurance across state lines. This is an idea that is embodied in the House and Senate bill, but again, the details differ.

The approach that John Boehner and some of the Republicans appear to take is to say, let's just open things up; anybody can buy anything anywhere, regardless of what state insurance laws are, and that will drive competition and cost.

The philosophical concern I have on that is that you potentially get what's been referred to as a race to the bottom.

And for people who may not be following the intricacies of the insurance market, let me give an example that people understand, and that's credit cards.

You know, in the credit card market, part of what happened was we ended up allow allowing people to get credit cards from every other -- you know, whatever state. And there were a few states that decided, you know what, we're going to have the least restrictions on credit card companies that we could have.

And what ended up happening was that every single credit card company suddenly, lo and behold, started locating in that state which had the absolute worst regulations and consumer protections and all these fees and practices that people don't like. Folks weren't happy about it.

So the question I'm going to have is, is there a way for to us to deal with the interstate purchase of health insurance but in a way that provides, again, some baseline protection. Because what we don't want is a race to the bottom. We want everybody to have the basic protections that make sense. And that's not a big government takeover. That is a standard thing that we do in almost every area of life. We protect people with respect to the food that they buy, with respect to the drugs that they purchase.

We license and regulate the medical profession because we don't think anybody should just be able to cut somebody open. We want somebody like Tom or John to actually know what they're doing before they start practicing medicine.

And the same should apply when it comes to how we think about insurance.

Medical malpractice has been mentioned. Now, look, let me be honest. This is something, historically, that Democrats have been more resistant to than Republicans. I will note that, when we had a Republican president and Republicans controlled the House and Republicans controlled the Senate, somehow it didn't happen. And I'm surprised.

UNIDENTIFIED SPEAKER: We needed 60 votes in the Senate, too, Mr. President.

OBAMA: Well, the -- see...


See there?

So -- so, as a consequence, what I have suggested is that we explore building on what we've already done, administratively, without law, asking Kathleen to help states come up with new ideas.

I've suggested, well, let's take a look at -- Tom, the suggestion you had that gives states even more incentive to start thinking about reducing defensive medicine.

I have to tell you, Joe Barton, that how you got from $5 billion to $150 billion, I didn't quite follow the math. You know, it sounded...


I'm not sure you did, either, but it's OK. But -- but here's my commitment, is that, if folks were serious about getting this done, I'd be interested in seeing if we could work on something.

I actually agree with Dick Durbin with respect to hard caps, because of the story that he told about the woman who burned her face. I think there are situations in which there is actually a very severe problem. And I would distinguish that between some of the frivolous lawsuits that are out there that really do create a defensive medical problem. And OB/GYNs are the ones who get hit the hardest because people are so sympathetic when a child is born with severe disabilities. And it can just be crippling on OB/GYNs.

The same is true on -- for neurologists and so forth. So there may be some ways that we can work on that.

Now, I guess what I'm saying is I've put forward, then, very substantial ideas that are embraced by Republicans.

Peter, they're not -- I forget what metaphor you used about before you popped it in the microwave, whether it was bacon bits or sprinkles or...


OBAMA: Breadcrumbs -- that was what it was.


When it comes to the exchange, that is a market-based approach. It's not a government-run approach.

There were criticisms about the public option. That's when, supposedly, there was going to be a government takeover of health care. And even after the public option wasn't available, we still hear the same rhetoric.

And it turns out that what we're now referring to is we have an argument about how much we should regulate the insurance industry.

We have a concept of an exchange, which, previously has been an idea that was embraced by Republicans, before I embraced it, and somehow, suddenly, it became less of a good idea.

With respect to the most contentious issue, I'm not sure we can bridge the gap. And that's what we're going to have to explore. And that's the issue of how do we provide coverage not only for people who don't have health insurance right now, but also for people who have pre-existing conditions and are being priced out of the market, or potentially lose their jobs and will find themselves in a situation where they don't get coverage.

An interesting thing happened a couple of weeks ago, and that is a report came out that for the first time, it turns out that more Americans are now getting their health care coverage from government than those who are getting it from the private sector. And you know what? That's without a bill from the Democrats or from President Obama. It has nothing to do with, quote-unquote, "Obamacare."

It has to do with the fact that employers are shedding employees from health care plans. And more and more folks, if they can, are trying to get into the Social Security system and the Medicare system earlier through disability or what have you, so that they can get some help.

The point that Tom Harkin made, the point that Chris Dodd made, the point that Henry made and a number of other people made I think is very important to understand. I did not propose and I don't think any of the Democrats proposed something complicated just for the sake of being complicated. We'd love to have a five-page bill. It would save an awful lot of work. The reason we didn't do it is because it turns out that baby steps don't get you to the place where people need to go. They need help right now. And so a step-by-step approach sounds good in theory, but the problem is, for example, we can't solve the preexisting problem if we don't do something about coverage.

Now, it is absolutely true, and I think this is important to get on the table, because we dance around this sometimes, in order to help the 30 million, that's going to cost some money. And the primary way we do it is to say that, for example, people who currently get all their income in capital gains and dividends, they don't pay a Medicare tax, even though the guy who cleans the building for him does, on his salary or his wages.

And so what we say is you make more than $200,000, $250,000 a year, if you're a family, and your income is from those sources, then you should do -- you should have to do the same thing that everybody else has to do. Somebody mentioned the fact that we say to small businesses -- I think John, John Kyl, you said, you know, we're taxing small businesses.

Look, we exempt 95 percent of small businesses from any obligations whatsoever because we understand that small businesses generally have a tough time enough. They don't need any more government burden. What we do say is if you can afford to provide health insurance, you have more than 50 employees, meaning you're in the top 4 percent of businesses, and you're nor providing coverage and you're forcing other businesses or other individuals to pick up the tab because your employees are either going in the Medicaid system or they're going to the emergency room, we don't think that's fair. So we say you've got to pony up some. It's not an employer mandate. It just says you've got to pay your fair share, because otherwise all of us have to pick up the tab.

And that, by the way, contributes to the overall deficit that Medicaid is running. In fact, most small businesses through this program get huge subsidies by becoming members of the exchange. That's where the money's going. The money's not going to some big welfare program. The money is going to give tax credits to small businesses, tax credits to those who are self-employed to buy into this pool. And that's not a radical proposition. It's consistent with the idea of a market-based approach.

And finally, with respect to bending the cost curve, we actually have a lot of agreement here. This is an area where if I sat down with Tom Coburn, I suspect we could agree on 95 percent of the things that have to be done, because the things you talked about in terms of -- and I wrote some of them down. In terms of reducing medical errors, in terms of incentivizing doctors to coordinate better and work in groups better, in terms of price transparency, improving prevention, those are all things that not only do I embrace, but we've included every single one of those ideas in these bills.

Now, the irony is that that's part of where we got attacked for a government takeover, because what happened was when we set up the idea of a MedPAC, which is basically a panel of doctors and health care experts who would recommend ways to make the delivery system so that we can squeeze out that one-third in Medicare and Medicaid that's wasted, a Republican idea, that was part of the ammunition you all used to say that the government's going to take away your health care.

So if we're serious about delivery system reform, if we're serious about squeezing out the waste that Tom Coburn referred to, you should embrace those mechanisms that are in this bill.

I will end by saying this. I suspect that if the Democrats and the administration were willing to start over and then adopt John Boehner's bill, we'd get a whole bunch of Republican votes. And I don't know how many Democratic votes we'd get, but we'd get a whole bunch of Republican votes.

The concern, I think, that a lot of the colleagues both in the House and the Senate on the Democratic side have is that after a year- and-a-half, or more appropriately after five decades of dealing with this issue, starting over, they suspect, means not doing much, or doing the proposal that John Boehner or other Republicans find acceptable.

And that it's not possible for our Republican colleagues to move in the direction of, for example, covering more than 3 million people. It's not possible to move more robustly in the direction of dealing with the preexisting condition in a realistic way. It's not possible to make sure that we get people out of a high-risk pool and get them into a situation where, as Tom Harkin put it, healthy people, young people, rich people, poor people, old people, the sick, everybody is part of a system that works. That, I think, is the concern.

Having said that, what I'd like to propose is that I've put on the table now some things that I didn't come in here saying I supported, but that I was willing to work with potential Republican sponsors on. I'd like the Republicans to do a little soul-searching and find out are there some things that you'd be willing to embrace that get to this core problem of 30 million people without health insurance and dealing seriously with the preexisting condition issue.

I don't know, frankly, whether we can close that gap. And if we can't close that gap, then I suspect Mitch McConnell and Harry Reid, Nancy Pelosi and John Boehner are going to have a lot of arguments about procedures in Congress about moving forward.

I will tell you this, that when I talk to the parents of children who don't have health care because they've got diabetes or they've got some chronic heart disease; when I talk to small business people who are laying people off because they just got their insurance premium, they don't want us to wait. They can't afford another five decades.

And the truth of the matter is that politically speaking, there may not be any reason for Republicans to want to do anything. I mean, we can debate what our various constituencies think. I know that -- I don't need a poll to know that most of Republican voters are opposed to this bill and might be opposed to the kind of compromise we could craft. It would be very hard for you politically to do this. But I thought it was worthwhile for us to make this effort. We've got a lot of other things to do. I don't think, Tom, that we're going to have another one of these because people don't have seven, eight hours a day to work some of these things through.

What I do know is this. If we saw movement, significant movement, not -- not just gestures, then you wouldn't need to start over because essentially everybody here knows what the issues are. And procedurally, it could get done fairly quickly.

We cannot have another year-long debate about this. So the question that I'm going to ask myself and I ask of all of you is, is there enough serious effort that in a month's time or a few weeks' time or six weeks' time we could actually resolve something?

And if we can't, then I think we've got to go ahead and some make decisions, and then that's what elections are for. We have honest disagreements about -- about the vision for the country and we'll go ahead and test those out over the next several months till November. All right?

But I very much appreciate everybody being here. Thank you for being so thoughtful. And, you know, hopefully we'll all keep our constituents in mind as we move forward. Thank you, everybody.