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CROSSFIRE

Healthcare Showdown

Aired September 29, 2013 - 19:28   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


ANNOUNCER: Tonight on "CROSSFIRE", your doctor's office and your boss's bottom line. What really will improve healthcare in America?

On the left, Stephanie Cutter; on the right, S.E. Cupp. In the "CROSSFIRE", Ralph Nader who thinks Obamacare doesn't go far enough; and Carly Fiorina who thinks it hurts business. What's the best prescription for improve healthcare? Tonight on "CROSSFIRE".

S.E. CUPP, CNN HOST: Welcome to "CROSSFIRE". I'm S.E. Cupp on the right.

STEPHANIE CUTTER, CNN HOST: And I'm Stephanie Cutter on the right.

In just three days people can start signing up for private health insurance -- new options, better choices, lower prices, greater competition. It is a victory for millions of Americans. Of course, I may be the only person sitting at this table who agrees with that.

CUPP: I know. It's going to be an interesting night. I think Obamacare is an unmitigated disaster. I think the U.S. economy and employment are going to be crushed under its weight. I think it is a moral hazard disguised as social justice, and I think it's going to fail.

Now some people might say that was the plan all along. But we'll get to that in a minute. In the "CROSSFIRE" consumer advocate, Ralph Nader, his latest book is called "Told You So: The Big Book of Weekly Columns". He doesn't like Obamacare but doesn't want it repealed either. And Carly Fiorina, a former CEO and Republican senate candidate who thinks Obamacare is hurting business.

Mr. Nader, I know you favor a single payer option and think Obamacare doesn't go far enough. And we will get to that. But as someone who fought for consumer protection for so long, tell me where Obamacare fails consumers most.

RALPH NADER, AUTHOR, "TOLD YOU SO": Well, first of all, it is full of trap doors. So even when it's fully implemented there will be about 25 million people not covered.

Second, it doesn't control cost of hospitals, drug companies, doctor practices because it is the same fee for service process.

And third, it is enormously complex to administer which of course irritates people, raises costs, develops too much uncertainty and ambiguity. Having said that, if it is fully implemented, it will lay the basis because of its firm infirmities for single payer.

CUPP: Right.

NADER: Full Medicare for all, everybody in, everybody out. Just like in Canada they do it for half the price per capita and businesses and consumers like it that way.

CUPP: Do you think that that was the plan all along, by the way?

NADER: No.

CUPP: Ok.

NADER: Because Obama --

(CROSSTALK)

CUTTER: It wasn't.

(CROSSTALK)

NADER: Right from the beginning, Obama dumped the public option which is government insurance to hold the private insurers in these exchanges feet to the fire. And right the beginning he was conceding to the big drug companies and the health insurance companies.

CUTTER: Let's talk about holding insurance companies' feet to the fire.

Carly, you have been critical of the plan because you think it takes away competition. And a couple of just -- to point out a couple of elements of the plan. Greater transparency for the first time ever, insurance companies have to tell consumers how they get to their numbers. Their premium rates. Anything over 10 percent in terms of an increase, they have to prove it. They have to spend 80 percent of your premium dollar on your healthcare instead of their personal bonuses.

And they're competing against each other. They're going door to door to try to get people to sign for their policies.

How is that not competition? And how does that -- just that instilling competition holding their feet to the fire?

CARLY FIORINA (R), FORMER CALIFORNIA SENATE CANDIDATE: Well, let me start out by saying that amazingly I agree with absolutely everything Mr. Nader just had to say.

(LAUGHTER)

In terms of the problems with this healthcare law. I think there -- let's just start by stipulating that believe it or not, I think people on both the right and the left share a common goal, which is let us make sure that everyone has access to affordable health care. There are lots of ways to achieve that but unfortunately Obamacare won't achieve it. I personally, as a business executive, take offense to the frequent charge that insurance companies were spending all of their premium money on CEO bonuses and not spending it on premiums. I find that kind of villainization of insurance companies which is well --

(CROSSTALK)

CUTTER: Well, there was no accountability.

FIORINA: From the very outset.

CUTTER: No accountability of how those premium dollars were spent --

FIORINA: Well actually --

CUTTER: And nobody had any transparency into how they were spent.

FIORINA: Well, as public companies there was a great deal of transparency on how those the companies were run, where's the money went.

CUTTER: And consumers.

FIORINA: And a greater degree of transparency than there has ever been on government agency.

(CROSSTALK)

CUTTER: No Medicare, no Medicaid.

FIORINA: But let's go back to a comment that Mr. Nader just made. This law was written with big insurance companies, big -- exactly right. I think Ted Cruz, honestly, has been irresponsible by charging a hill that he has no hope of taking, which means all that we get are casualties. But I honestly believe that President Obama and the Democrats have been equally irresponsible by not acknowledging what are true problems.

Small business is getting hurt in the process of this law being implemented.

CUTTER: Right.

FIORINA: Small business all over this country are saying, you know what, I'm throttling back on my ambition. I'm hiring fewer people. My cost are going up.

CUTTER: Right. And --

(CROSSTALK)

FIORINA: And when the head of the IRS --

CUTTER: There's a couple of facts on that.

FIORINA: -- can say, I'd like to keep my plan so as a government employee I don't think I want it.

S.E. CUPP, HOST: Well, let me ask -- let me ask Mr. Nader about that.

FIORINA: But union households can't keep theirs?

CUTTER: Exactly.

(CROSSTALK)

CUTTER: Small businesses are impacted by this. There is --

FIORINA: Oh, yes, they are impacted by this.

CUTTER: Anything 50 employees is not impacted but they are --

CUPP: When they have 51 they are --

(CROSSTALK)

CUTTER: And you know, you're a business woman.

FIORINA: That's right.

CUTTER: Small businesses have paid up to more than 25 percent --

FIORINA: Oh my god.

CUTTER: Now they can pull together and they compete.

CUPP: Small businesses are absolutely --

CUTTER: They're on the same playing field as big business.

FIORINA: What about the prospect of this?

(CROSSTALK)

FIORINA: I think what would have been much more useful is in crafting this law, the Democrats would have listened to recommendations that were delivered to them by the National Federation of Independent Businesses, small businesses, who as you may recall, sided with attorneys generals in the states because they know this law will hurt them vastly. And who said, what we need is small business owners is competition.

CUTTER: And for many political reasons.

FIORINA: Actually the most small business owners that I met don't have time --

CUTTER: Let me --

FIORINA: They are too busy running their business.

CUPP: Let me bring Mr. Nader in. I have a question about the whole premise of this legislation that I want you to help explain to me. The whole premise is that it hinges on signing up millions of young people, who for the most part did not get health insurance when it was cheap.

And now it's even more expensive under Obamacare in many cases, why are we expecting millions of young people who didn't want it before to sign up now and what happens if we build it and no one comes? Does this thing collapse?

NADER: That's another uncertainty. That's another risk factor. And if the young people don't go in, the premiums will have to be jacked up for the rest of the people.

CUPP: Right.

NADER: We're twisting ourselves into pretzels. Go to the business people in Canada. Everybody in, nobody out. It costs half as much per capita. They cover everybody. You have your free choice of doctor and hospital because it's government insurance and private delivery. Much better outcomes in terms of saving lives and preventing injuries. And it lifts the burden from business.

As a former head of Westin Industries in Canada said, why shouldn't this be a government function? Insurance. Why should we employers have to deal with this? Well, you know what that means? That means the Canadian companies are more competitive than U.S. companies which is why the former head of General Motors, Jack Smith.

CUPP: Yes.

NADER: When he headed General Motors Canada, and because head of General Motors USA --

CUPP: Yes.

NADER: He said, Canadians are --

CUPP: And we're going to get to the Canadian system in a minute.

NADER: Fine. Yes.

CUPP: Because I do want to ask you about that. I know you're against employer based health care at all, right?

NADER: Yes. It's --

CUPP: But --

NADER: Full Medicare for all.

CUPP: But, Carly, I mean, you still want employers to be able to offer healthcare to their services. It's a way of attracting good employees.

FIORINA: Yes. But I do think that -- I recalled in the 2008 presidential campaign, John McCain put forward a proposal that would have separated employees from employers and made individuals responsible for their own health care. That plan was roundly criticized. But the truth is, there is no reason why an employer has to be responsible for an employee's healthcare.

However, however, I have no faith in the federal government's ability to run anything particularly efficiently. Why is it that doctors leaving Medicare in droves? Because it's a broken system. So I would much rather have individuals be responsible for buying their insurance, put real competition in place where insurance companies have to compete across all 50 state lines. That is something the National Federation of Independent Businesses has been asking for years.

(CROSSTALK)

CUPP: Mr. Nader has --

FIORINA: And has been ignored.

CUTTER: Individuals that have --

FIORINA: I don't trust the government --

CUTTER: The private sector --

FIORINA: Do you?

CUTTER: You know think that --

NADER: Medicare is -- Medicare is working well. There is fraud --

CUPP: One person at a time, guys.

FIORINA: Would run exchange much better than the government will.

CUTTER: And there are many of them. And they've got that option. The states have the option to build it the way they wanted to.

FIORINA: The government is trying to run --

CUTTER: So the states that chose not to implement the law --

CUPP: I want to get Mr. Nader's answer.

CUTTER: Republican governors decided to implemented --

CUPP: Why do -- why do you have confidence that the government will be able to oversee something as complex -- I mean, this is law of the land for three years. We are still debating and trying to explain it to the American people. Why do you believe the government is capable?

NADER: This is government insurance, private delivery.

CUPP: Right.

NADER: You know, in Canada, S.E., they have to look like us. And they've had a system over 40 years and it is -- on every criteria it's better. Every criteria. Efficiency, life-savings, less burden on industry. Do you know the Canadian Medicare bill was 13 pages? You know how many pages for Obamacare? 2700. You know what that means? That means unbelievable complexities, trap doors, special interest hooks, and all the rest of it.

FIORINA: This I completely agree with in terms of complexity and trap doors. The only thing that I would say, I'm a cancer survivor. And the facts are these. The cancer survival rates are better in this country than anywhere else in the world.

CUPP: Hundred percent accurate.

FIORINA: In Canada and the UK. Why? Because we have had an emphasis on early prevention. When you start to put everything around let's get healthcare as low-cost as possible, yes, there are ways to lower cost and raise quality. But it's also true that people with complex conditions come here to be treated as a breast cancer survivor. , I have a better chance of surviving in this country than in Canada or in the U.K. by actually wide margins.

NADER: There's a reason --

FIORINA: So it's not accurate to say the outcomes are exactly the same.

NADER: There is a reason for that is because our government has spent a huge amount on medical research and development compared to all of the other governments in the world. It wasn't -- it was Pfizer, it wasn't HCA, it was our government. Massive research.

And the other thing is this, the outcomes overall in Canada are better. I mean, the facts are pretty clear. Next door. Nobody dies in Canada because you can't afford health insurance.

CUPP: No, but they wait nine and half --

NADER: The Harvard Medical --

CUPP: But they wait nine and a half weeks.

NADER: S.E. -- no, no, no. No, no, no.

CUPP: Yes, 100 percent.

NADER: Not for essential services.

CUPP: No. For specialists.

(CROSSTALK)

NADER: No bigger delays when you can't pay for it. Right? When -- look at this.

CUPP: Mr. Nader, average wait times for specialists in Canada are three times as long.

NADER: Yes.

CUPP: Cancer mortality, as Carly pointed out, the rates there are higher here.

NADER: Yes.

CUPP: If you are a low-income American, you have better healthcare than you do as low-income Canadian. Why is your single pair going to work in America better than it's working in Canada?

NADER: Well, first of all because people don't die in Canada because they can't have health insurance. The Harvard Medical School Research and the American Journal of Public Health, 2009, 45,000 Americans die every year because they can't afford health insurance, get diagnosed and treated in time. This is a Peer Review study.

Nobody in Western Europe dies because they can't have health insurance. You have 800 people a week, 800 people a week dying in this country.

FIORINA: By the way, I think we would all agree, I think we would all agree, that is an abomination. It is. There are problems with the current healthcare system in the United States. I don't think anyone is going to defend the current healthcare system. And Obamacare is going to become the law of the land. But for Democrats to claim it is a perfect program for political reasons --

(CROSSTALK)

CUTTER: No one has ever said --

CUPP: I want to ask -- I want to --

CUTTER: Even the president. That he's open -- he is open to change.

FIORINA: No one has been willing --

CUPP: I want to ask Mr. Nader a little bit more about the Canadian system when we come back. The future according to Ralph Nader.

I want you to explain what happens when I get sick, sir.

(COMMERCIAL BREAK)

CUPP: Welcome back to CROSSFIRE.

Pretend it's 2050. The end is (INAUDIBLE). Obamacare is failing. And we're now contemplating a single-payer solution for health insurance. Let's find out what happens.

In the CROSSFIRE, tonight Ralph Nader and Carly Fiorina.

Mr. Nader, you've already explained that you want a single-payer healthcare system. Compared it to the Canadian system. One question I think anyone would want to know is how does that get paid for?

NADER: Paid for by government taxes.

CUPP: OK. So me.

NADER: Yes.

CUPP: I pay for it.

NADER: Yes. Just like you -- we pay for Medicare. Just like the V.A. is based on taxes. Just like a lot of local and state plans are based on taxes.

CUPP: So my taxes would go up.

NADER: Well, they would go up but you wouldn't have to buy health insurance.

CUPP: OK --

NADER: In Canada --

CUPP: That means now, are you suggesting?

NADER: In Canada they never see a bill. They have a Medicare card like this. And the prices are much lower. Have you read Steve Bril's report in "TIME"? The staggering prices differentials around the country.

CUPP: Right.

NADER: Fifteen hundred times more. A thousand times more.

CUPP: Right.

NADER: It's like a Wild West. But in Canada --

CUPP: But isn't that competition that allows people to go with their feet?

NADER: Yes. Yes, it's competition going up. And as you have only one hospital left in more and more communities after mergers because the antitrust laws aren't involved, you can go to Canada and have a hernia repair, four days, at a palatial hospital called (INAUDIBLE), right. It's the best quality in the world and it cost one-third of what a hernia cost in this country.

CUPP: That's the good story. There are plenty of not so great outcomes of Canadian healthcare and British healthcare and Cuban healthcare, for example.

FIORINA: Well, it's true. I mean, the wait times are extremely long. The quality of care particularly for complex cases is not as good.

CUPP: Yes.

FIORINA: On the other hand, I think it's fair to say that there is a lot wrong with our current healthcare system. CUPP: Sure.

FIORINA: Mr. Nader is absolutely right. It's too expensive. However, it's important to step back and say, why is it too expensive? And one of the reasons it's too expensive is because there has not been robust competition among insurance companies. There have been state-run oligopolies which prevent robust price competition among insurance companies.

But frankly one of the other reasons it's out of control expensive is because Medicare is an incredibly inefficient and ineffective program. Government usually is inefficient and ineffective.

NADER: No, wrong. No, no.

FIORINA: One of the things that I -- I think there is a --

NADER: No, no.

FIORINA: There is a wealth of evidence that says government bureaucracies don't work very well. And talk about no transparency. What is less transparent than a government bureaucracy?

NADER: Carly, Carly, listen. The administrative expenses of Medicare are 3 percent. Aetna is about 25 percent.

FIORINA: Is this why more and more doctors are exiting from Medicare? Why? Because Medicare won't cover their cost.

NADER: Because they want to make more money elsewhere. They're covering the cost. And that's exaggerated. People don't --

FIORINA: So now -- I --

NADER: We don't have enough primary doctors.

FIORINA: In the health insurance -- in order to get Obamacare passed -- that's absolutely true. I agree with that. We don't have enough primary care providers. One of the things that happened to get Obamacare passed was absolutely everyone who is -- who plays in the space was villainized.

Insurance companies are terrible people that only care about CEO bonuses. Doctors only want to get rich. None of that is true. There is a ton of inefficiency in the system, absolutely right. But one thing I think we should just pause on. If you set aside the politics for a second, if both sides would focus on what is policy that's going to work, I think a lot of Americans would breathe a sigh of relief.

And I also think that we need to acknowledge that one of the reasons people are so uncomfortable about Obamacare, even if they don't understand all the nuances of it is, people don't trust government any more. And they don't trust government because they have seen example after example after example of government waste, government abuse, government fraud.

CUPP: Corruption.

FIORINA: Government corruption and just plain incompetence.

NADER: Carly, you have the wrong adjective. It's corporations ripping off Medicare, for example. The studies at Harvard show $270 billion a year in computerized billing fraud and abuse.

FIORINA: You will never hear me -- you will never hear me defend a business that is committing fraud or being corrupt. However, I will also tell you, that you and I agree on the fact that there is no greater force for lowering prices, improving transparency and accountability than competition. And there has been an insufficient amount of competition --

NADER: Yes. But it's perverse --

FIORINA: -- in health insurance industry, in the medical device industry. All that.

NADER: Yes, sure.

FIORINA: The government doesn't fix that. Government never fixes that.

NADER: It does to break up the monopolies. That's one. Like --

(CROSSTALK)

FIORINA: Allow 50-state competition amongst -- allow a small business owner or family to buy insurance from state and any company they want.

NADER: Carly, unlike the business you were in, health insurance companies make money by the more they deny claims. In California they are denying 30 percent of claims put forth by doctors.

FIORINA: I will not argue the -- I am not going to argue the fact that health insurance companies are perfect. I agree with you.

NADER: No, no. It's perverse competition. It's completely different from the industry you were in.

FIORINA: I agree with you. I agree with you.

NADER: Yes.

FIORINA: The only disagreement we have, you believe the answer to perverse completion is the government takes it over. I believe the answer to perverse competition is real expedition. And we don't have that today.

NADER: We're not talking government taking over the healthcare system. It's public insurance. Private delivery. Competitive --

FIORINA: But Mr. Nader, you know as well as I do, that an insurance company determines care. That's what everybody is up in arms about. As a cancer patient, I sat in a hospital and watched people -- doctors say to a patient.

NADER: Yes.

FIORINA: I can't give you this particular treatment because your insurance company won't permit it. If government runs insurance, government will determine healthcare. That's just the facts.

CUTTER: OK. Let me ask you a question, government is not running Obamacare. Obamacare is the law. It is a private delivery system. If I go to sign up for healthcare, I'm actually getting it from Aetna or Blue Cross Blue Shield or United or some other private insurance company.

CUPP: Except there is a mandate to get it.

CUTTER: Right. And I want to talk to you about the mandate.

FIORINA: The government is running the --

(CROSSTALK)

CUTTER: I want to talk to you about the mandate.

CUPP: We are turning everybody --

CUTTER: Carly, you mentioned that you were a breast cancer survivor. Let's put emphasis on the last word, which is wonderful. Part of what the new law is trying to fix is people showing up at the emergency room without insurance and then passing on their cost to businesses, individuals who do take responsibility for their own care. Because now there is a requirement for people to take responsibility, which you know most people have insurance, most businesses provide insurance, talking about a small amount of people, matched with a ban on preexisting conditions, we are actually lowering costs.

So do you agree with the mandate idea, that is Republican idea, came out of the Heritage Foundation, one of our co-hosts, Newt Gingrich, was behind it? And the band on preexisting conditions? Do you agree with those provisions?

FIORINA: I actually do agree with those two provisions. And I think Obamacare remains an abomination. And let me tell you why. So, first of all, I think no one should be denied healthcare because of preexisting conditions. And I think there are many more efficient ways we could have dealt with this than Obamacare.

But let me just also make this point to you.

CUTTER: How do you deal with that?

FIORINA: Let me make this point to you. We could have subsidized high-risk pools. That's a lot less expensive than what we're doing now. And a lot less --

CUTTER: But it actually doesn't work without supervision.

FIORINA: But let me -- sure, it does.

CUTTER: Skyrocket prices.

FIORINA: But let tell you a real --

(CROSSTALK)

FIORINA: Let me tell you a real example -- I would argue those facts. Let me tell you a real example in California. In California, there are 25,000 people whose job it is to answer the phone and tell people whether they are eligible for government provided insurance. Virtually I happen to know this because of the foundation that I sit on, the foundation for health coverage education. It turns out that an amazingly high percentage of people who are eligible for government-provided programs like Medicaid and Medicare don't know it.

Why? Because the government is ineffective at determining their eligibility. Example after example after example. Government doesn't run --

CUTTER: So get back to the individual mandate and the actual question that I asked.

FIORINA: Well, I answered your question.

(CROSSTALK)

FIORINA: I answered your question. I said --

CUTTER: You think that it can be implemented? Is that it?

FIORINA: No. No, what I am saying is that we have now a situation in Obamacare where we have insufficient competition in private industry for insurance.

CUTTER: Yes. I --

FIORINA: And we have the government.

CUTTER: You mentioned that --

FIORINA: Playing a larger and larger role in what they will pay for.

(CROSSTALK)

CUTTER: Responsibility provision, people have to take responsibility for their own care and you are for the ban on preexisting conditions.

FIORINA: Yes, I am.

CUTTER: OK.

CUPP: OK. Mr. Nader --

FIORINA: But, but do not put words in my mouth. I am not for Obamacare . (CROSSTALK)

NADER: Ending the preexisting conditions. There are some good preventative factors in 2700 -- 2700 pages that will, you know, push out. The key is to transfer a little bit more power to the consumer.

FIORINA: I agree with that.

NADER: The consumer sort of -- kind of on the table. Like passive. We need more organized consumer involvement in healthcare. They're more likely to focus on prevention, for example.

FIORINA: I agree with that.

CUPP: Right.

NADER: Because prevention is not very profitable for the corporation. But it sure is profitable for human beings.

CUPP: Now if you think --

CUTTER: Which is -- and Obamacare provides prevention. No out-of- pocket costs.

CUPP: If you think --

FIORINA: Is this an example of saying that Obamacare does everything? It doesn't many things well.

CUTTER: Carly, that's a fact. It provides preventive care with no out-of-pocket costs. That is a requirement that insurance companies have to comply with now. I would think that would be a good thing. I think we'd all agree with that.

NADER: Yes, that's --

CUTTER: So why shouldn't we focus on at least one benefit instead of the gloom and doom --

CUPP: I want to ask -- while we have them here, I want to ask Mr. Nader one more question, if you think that single-payer is the future, why not consider running on that platform for president in 2016?

NADER: Well, I already have in 2000, 2004, and 2008.

(LAUGHTER)

CUPP: But it's a different -- it's a different era now.

NADER: No, but --

FIORINA: Now we have --

NADER: What's interesting is for decades, single-payer, otherwise known as full Medicare all, everybody in, nobody out, free choice of doctor and hospital. Supported by a majority of the American people going back to President Truman.

CUPP: So -- so why not run again?

NADER: And recently by majority of doctors and nurses who want to practice medicine, not bookkeeping.

CUPP: So why not run again?

(LAUGHTER)

I want you on the record.

(CROSSTALK)

CUPP: Get on the record here. Are you going to run again or no?

NADER: There are other people who run. I think it's going to be a multi-billionaire running in 2016.

CUPP: Yes?

NADER: I'm going to be putting out a list of potential runs. With someone like background. Because small third party candidates, they get overwhelmed by general access, obstacles and money that prevail.

CUPP: Yes. OK. We'll check in with you later.

NADER: Yes. It will be a good program.

CUTTER: Thanks to Ralph Nader and to Carly Fiorina.

Next we cease fire. Yes, there's one thing we both agree on, believe it or not.

(COMMERCIAL BREAK)

CUPP: Tonight on CROSSFIRE, we've been debating healthcare. Now let's call a ceasefire. Is there anything we can agree on? I think we both agree, single payer, no bueno.

CUTTER: Well, I have issues with it.

CUPP: Yes.

CUTTER: I actually think we need to let the current law be implemented and see if it works. Stop this doom and gloom.

CUPP: OK.

CUTTER: The debate continues online at CNN.com/crossfire as well as Facebook and Twitter. From the left, I'm Stephanie Cutter.

CUPP: From the right, I'm S.E. Cupp. Join us Monday for another edition of "CROSSFIRE."