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CNN: Sens. Collins, Feinstein and Shaheen on Health Care

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Sunday, September 13, 2009; 12:14 PM

JOHN KING (host): The president gives a big speech. One of the goals is to bring Republicans on board. More likely or less likely after that speech to join the Democrats?

SEN. SUSAN COLLINS (R-MAINE): Well, I don't know that the speech really changed the dynamic, but I was glad that the president has followed up with some individual meetings and bringing people together.

I believe all of us want to see a bipartisan bill. That, obviously, would be the best approach. But what's in the bill will determine whether...

(CROSSTALK)

COLLINS: ... it has bipartisan support.

KING: You have said, Senator Collins, you don't want a public option.

COLLINS: That's right.

KING: What about a trigger? Would that be acceptable, if you have, maybe, co-ops and you see if competition takes place, but there's a trigger in there; if two or three years down the road, that hasn't happened, then the public option kicks in. Is the trigger acceptable?

COLLINS: No. The problem with the trigger is it just delays the public option. Because the people who are going to be making the determination about whether the market's competitive enough want the public option. So I think the trigger is just a delay.

KING: Senator Shaheen, you were in the meeting with the president the other day, and this issue came up. You were a supporter of the public option. Did you tell the president, sir, we can't get it; it's time to move on, or do you want to fight for it?

SEN. JEANNE SHAHEEN (D-N.H.): I am a supporter of the public option. I think that's a reasonable way to go. But I think it's important to stay focused on what we're trying to accomplish. And the president pointed this out in his speech.

We want to get competition in the health insurance market. We want to make sure that people who can't afford health insurance are going to have an affordable option that they can use. We want to improve health outcomes for people. And we want to, long-term, lower the cost of health care.

So I think keeping our eye on what we're trying to accomplish, what our goals are, are what we need to do. There are a number of ways to get there, and we need to -- to keep focused on the goal.

KING: If we keep focused on the goal, though, Senator Feinstein -- you have been here before, and reporting when you go home, people are worried about how much this is going to cost. The president says $900 billion. He promises it won't add a dime to the deficit. He says he can squeeze from Medicare and Medicaid most of the money he needs.

Does the math add up to you?

Have you seen enough details to convince you, yes, I can sign on to that math?

SEN. DIANNE FEINSTEIN (D-CALIF.): Well, for the first time, yesterday, I met with Finance Committee staff and White House staff, and for the first time, did see some of these details. And, yes, I believe it is possible to put together a bill which does not adversely impact the deficit and may -- I say, may -- even reduce it over time. Important to me is, one, that you have insurance reform, major insurance reform. And that's not easy to accomplish, but it can be; secondly, that you have the individual mandate in a way that it does not create another entitlement; thirdly, that you don't just simply push the costs on to the states. I have a huge state, unable to bear more cost.

And if you can do these things, I think we've got a very good chance to put together a bill. The key to the public option and the reason people want the public option is to keep costs down. There is more than one way to skin that cat.

And I think the Finance Committee is aware of it. And, for example, an idea that's been put forward is to have, instead of the walls around every state with respect to purchasing pools, extend those purchasing pools nationally, have federal standards and regulations that must be followed.

I think the health insurance industry, the nine big, public companies do not have antitrust. Only baseball and health insurance is outside of antitrust. And they don't have a strong moral compass. And so they've made huge profits, and premiums have doubled in the last eight years.

So I think how you reform that industry is key to the bill. And for the first time now, I believe that ideas are floating which can enable a very prudent bill to be on the floor of the Senate.

KING: Well, Senator Shaheen, let me come back to you. Senator Collins says she can't support even a trigger.

So does the president have to make a decision? If a moderate Republican voice like Senator Collins, who is known to try to deal with Democrats, who voted for the stimulus -- if she can't support a trigger, does the president -- has two choices, one, give it up, or two, do this with all Democrats. What should he do?

SHAHEEN: Well, first of all, I think that we're going to have a bill that has significant bipartisan input, regardless of how the votes come out.

The bill that came out of the health committee in the Senate had 167 Republican-sponsored amendments that were adopted. So there has been significant Republican input already into the legislation.

And, you know, I think -- I think we can do what Senator Collins would like to see us do, what others in the Senate have said they would like to see, with a bipartisan bill.

We can lower costs. We can improve health outcomes. Senator Collins and I have legislation that I think is going to get incorporated into the Finance Committee bill that would lower Medicare costs for people who are hospitalized. We know that a number of them go back into the hospital within 90 days. We can reduce that number. We can save $5,000 per Medicare patient. We can make them healthier. And those are the kinds of improvements we want to get into any health care bill.

KING: I want to get up for a second and walk over to the wall here. Because, as we discussed the substance of the health care debate, I want to show you something that I found stunning about the politics of the health care debate. And I'm going to pop this graph up here.

This is our latest polling; "Approve or disapprove of the president's handling of health care policy?" And the number that jumps out at me is this one right here.

Senator Collins and Senator Shaheen especially; Senator Feinstein from California are from states with a great number of independents in them, in some cases, more than Democrats and Republicans.

Sixty-one percent of independents -- 61 percent -- now disapprove, Senator Collins, of the president's handling of the health care issue. Your state has more independents than it does Democrats or Republicans.

KING: How did the president lose all those Independents?

COLLINS: Because he did not initially focus on cost. That is the number one concern, as I talk to my constituents. They're concerned that we may be creating an expensive new entitlement program. They're worried about the amount of debt that we already have accumulated. They're worried about the expansion of government's role in the financial system and the automobile industry and now in health care. They're very concerned that we're not dealing with the number one issue. And that is the escalating cost of health care. Jeanne Shaheen just mentioned the bill that we joined on together. There are a lot of bills like that that could save billions of dollars in health care costs while improving quality. That should be our focus. We should focus on delivery reform.

KING: If that's the case, Senator Feinstein, and there's a credibility question out there with the American people, can we afford this, post-Katrina America, a lot of people just think the government can't do anything big and get it right, should the president do this incrementally? Maybe take this legislation, take other legislation, prove that you're bringing down costs and do this in pieces, or do you have to do it in one, big sweeping bill?

FEINSTEIN: Well, I tend to be an incrementalist when I look at huge programs. It's very difficult to remake one sixth of the American economy at a time of tremendous economic angst out there. So I think that's part of it.

KING: Why doesn't the president disagree with you?

FEINSTEIN: Well, but I think the way -- now, I'm talking about the Finance Committee bill because I actually think that's the bill that is going to matter greatly in the Senate. And they have Medicaid and Medicare jurisdiction. Medicare begins to run out of dollars in eight years. So the entitlement issue that Susan mentioned is really a very important one. And I won't vote for a bill that creates a new entitlement. And we pay, this year, over one-half of all the dollars go just to entitlement -- Medicare, Medicaid, Social Security, veterans' benefits. And they are going up.

If you add interest on the debt, you come up to about 56 percent of every dollar is spent that way. This, long-term, is a very, very unsustainable system. So we've got to make these reforms. So the key is that cost curve. Not that it goes like this, but that it continues to go like that, in the out years. And that will be the test of the bill that the Finance Committee puts forward. And I think Susan is absolutely correct that the cost is a big factor for people, insurance reform is a big factor, and, you know, eliminating the prohibition on precondition -- pre-existing conditions, having a sound, competitive system, bringing down the price of premiums. I talked to somebody who just got a 20 percent increase in their premium. They can't sustain those kinds of increases. It must be changed.


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