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updated 2/18/2010 2:28:20 PM ET 2010-02-18T19:28:20

MR. DAVID GREGORY: This Sunday: Back from Asia, but now the president
faces headaches at home. The Senate takes its first crucial step on its
healthcare reform bill, a yes vote last night to allow debate to move
forward. Still, Democratic moderates have big problems with elements of
the bill and Republicans are spoiling for a fight.

(Videotape)

SEN. MITCH McCONNELL (R-KY): This bill itself is a massive monument to
bureaucracy and spending.

(End videotape)

MR. GREGORY: And the economy takes a heavy political toll, with the
president's Treasury secretary grilled over bailouts and high
unemployment.

(Videotape)

REP. KEVIN BRADY (R-TX): The public has lost all confidence in your
ability to do the job.

(End videotape)

MR. GREGORY: Plus, as a debate erupts over what if anything the White
House accomplished overseas, more questions about what the president will
decide to do about Afghanistan and when. Four key voices on the Hill
weigh in on it all: Assistant Majority Leader Senator Dick Durbin of
Illinois, Republican Senator Kay Bailey Hutchison of Texas, Democratic
Senator Dianne Feinstein of California and independent Senator Joe
Lieberman of Connecticut.

Then, major medical confusion and controversy over new breast cancer
screening guidelines. We'll take a hard look at the issues at the root of
the cancer debate: screenings, insurance, research, politics and funding.
Joining us: Ambassador Nancy Brinker, founder of Susan G. Komen for the
Cure, and NBC's chief medical editor, Dr. Nancy Snyderman.

Plus, our MEET THE PRESS MINUTE. This week, Senator Robert Byrd of West
Virginia became the longest serving member of Congress. We look back to
1972, his first appearance here on MEET THE PRESS.

MR. DAVID GREGORY: But first, on a party-line vote, the Senate voted yes
last night to allow debate to move forward on the Democrats' healthcare
reform bill.

(Videotape, November 21, 2009)

SEN. HARRY REID (D-NV): We can see the finish line now, but we're not
there. We haven't yet crossed that, and that's an understatement. The
road, road ahead is a long stretch, but we can see the finish line. We're
going to get healthcare reform. The American people need it and they
deserve it.

(End videotape)

MR. GREGORY: We are joined now by four senators at the center of the
debate: Senate Dick Durbin of Illinois, Senator Joe Lieberman of
Connecticut, Senator Dianne Feinstein of California and Senator Kay
Bailey Hutchison of Texas.

Welcome to all of you. A lot to get to this morning. Let's start with the
big news; Senator Durbin, that's health care. What kind of victory does
this represent for the president?

SEN. DICK DURBIN (D-IL): It's an amazing victory for the president and
Majority Leader Harry Reid to put together all 60 Democrats. We have a
lot of different opinions in our side of the caucus, and we came together
last night. And it's basically for one reason: Millions of American
families cannot avoid this important debate about health care. They face
it every single day. The Senate shouldn't avoid this debate. I hope in
the end that some Republicans will cross over and help us to put together
a good bill that will serve this nation. Last night we didn't have a
Republican vote, it was all Democrats. But we are going to move forward.
And after Thanksgiving, everyone will have had a chance to take a close
look at this bill on the Internet and we can start this debate. I hope it
will be a meaningful one and a positive one, not a filibuster-loaded
debate where we really don't get down to the basic issues.

MR. GREGORY: Senator, Senator Hutchison, is this
a...(unintelligible)...for the Democrats; a procedural victory, but not
ultimate victory on healthcare reform?

SEN. KAY BAILEY HUTCHISON (R-TX): Well, I certainly hope not. I think
this bill is a disaster for our country. President Obama said that it
would be under $900 billion. It is not. President Obama said it would not
add to the deficit. It will. President Obama said that no one would lose
the health care that they have, and they will. This is a terrible bill.
What I would hope is that we could start all over with Republican input,
which was not in this bill, and try to do something for the American
people that will bring down costs, will not cut Medicare and especially
will give more access to people for affordable health care.

MR. GREGORY: You, you said that you would like to see this stop. What
would you do to stop this bill?

SEN. HUTCHISON: Well, we're--our only avenue to stop it is to let the
American people know that their taxes are going to increase, that their
premiums are going to increase, that Medicare's going to be cut, and hope
that then the Democrats will bring Republicans to the table and let's do
something that will cut costs but not have a massive government takeover
of health care.

MR. GREGORY: Senator Feinstein, the issue here is that yes, a vote was
cast positively to get the debate started. But there are centrist
Democrats, as you know well, who are not on board with this healthcare
bill in terms of cost, in terms of taxes and notably, in terms of the
public option. They don't want it, and it's in there. What do you do?

SEN. DIANNE FEINSTEIN (D-CA): Well, I, I think what you do is you have
the vote and the vote will decide. I think not to vote, not to consider
this question--America's in serious problems with respect to health care.
We--virtually every other developed country has a better system than we
do. Ours is costly, in places it's ineffective, it's deeply troubled, and
the time has come to really see that people who have no insurance can get
insurance. Now, the good part about this bill is that it is structured so
that it is phased in, so that over time we can watch it, we can change
it. For example, this next year small business tax credits go in place
and $5 billion is available for insurance for those who have been denied
because of preconditions. So these people will be able to get insurance
right away. Things like the exchange and the public option come online on
2014. So the bill, in a sense, is incremental. We can watch it, we can
change it. The important thing is that we debate it, that there be a
flee--free flow of amendments that some will pass, some will fall. The
bill will go to conference, it has to be reconciled with the House bill.
So we're at the beginning now of what is a great national and key debate.

MR. GREGORY: All right, but, Senator Lieberman, let me pick up with where
the real difficult areas are in getting the votes.

SEN. JOE LIEBERMAN (I-CT): Sure.

MR. GREGORY: Are you a no vote on this bill?

SEN. LIEBERMAN: Well, I voted last night, as 59 others did, to go ahead
with the debate because I, I want us to begin not only debating
healthcare reform, but doing something about healthcare reform. But I
don't think anybody feels this bill, as Senator Reid put it down, though
he made a lot of progress in blending bills together, I don't think
anybody thinks that this bill will pass as it is.

MR. GREGORY: As written. It's got a public option; you said you would not
vote for it as a matter of conscience, that you would even filibuster it
if that stays in there. Still the case?

SEN. LIEBERMAN: That's right. Just to explain, once the bill is on the
floor the, the only alternative--amendments will be offered, but
essentially every amendment is subject to a filibuster and will take 60
votes to pass. My only resort, and, and every other senator--and there'll
be others who feel exactly the way I do about the public option. If the
public option is still in there, the only resort we have is to say no at
the end to reporting the bill off the floor. But let me explain very
briefly why I feel this way about the public option. And you--we've got
to make choices. We have a healthcare system that has real troubles. But
we have an economic system that is in real crisis. And I don't want to
fix the problems in our healthcare system in a way that creates more of
an economic crisis, either short-term to inhibit businesses from hiring
more people, creating jobs, or long term to add to the debt. And I'm
convinced that the public option, a government-run insurance
company--basically, people don't understand what it, what it's going to
do. It doesn't offer free insurance. It won't get one more poor person
insurance. It won't force one insurance company to give insurance to
somebody who's got a pre-existing condition. And it won't even lower the
cost of health insurance, which the advocates said it originally would,
because the Congressional Budget Office has now said to us that the
public option in Senator Reid's bill will actually charge more for
insurance than the average charge by health insurance companies. What
I--I can tell you one thing I'm sure it will do. If we create a
government insurance company, it's going to run a deficit and it's only
the taxpayers who are going to pay for it.

MR. GREGORY: I just want to...

SEN. LIEBERMAN: I don't want to do that.

MR. GREGORY: Are you consistent on this matter? If you say you don't like
a public option because of how it might influence the debt, will you
apply that same standard to escalating the war in Afghanistan? Should
that be deficit-neutral, what we spend on Afghanistan?

SEN. LIEBERMAN: Incidentally, over the years, back in the Bush
administration, I put forward tax programs to pay for the wars because I,
I don't know of another time in our history when we went to war and
didn't pay for it. That's part of why we have the enormous debt that we
have now, $12 trillion today, predicted to add $9 trillion in the next 10
years.

MR. GREGORY: All right, so that's the question.

SEN. LIEBERMAN: It, it's going to...

MR. GREGORY: You, you would pay for escalation in Afghanistan? It would
have to be paid for?

SEN. LIEBERMAN: Absolutely.

MR. GREGORY: Senator, but what do you do to bring Senator Lieberman
around? Because as an independent, you have other centrist Democrats who
say no way on the public option. Is that negotiable?

SEN. DURBIN: I hope we can get to the bottom line here--and I hope that
Joe, my friend Senator Lieberman, agrees--we need competition, we need
choices. We have to put some honesty back into this insurance market. At
this moment, private healthcare companies dominate the markets in most
areas. They are exempt from the antitrust laws. They fix prices, they
allocate markets, they control it. And when the American people hear
this, they say, "For goodness sakes, at least give us a low cost option."
And that's what I'm for. They call it the public option, but it's a
not-for-profit company that doesn't have to generate profits for the
shareholders or spend a fortune on advertising or administrative costs. I
hope we can move to a point where we satisfy Joe Lieberman's concerns
that this does not end up being a government debt, but creates a public
option.

MR. GREGORY: But let's get to a bottom line, which is, is it negotiable?
I've talked to Senate sources who say there is a backup plan, which is
that you ultimately scrap the opt-out option, you put in a trigger, which
means that somewhere--there's no public option; down the road, if there's
not adequate competition, a public plan gets triggered. That's how you
might get centrist Democrats and my--it's how you get Senator Snowe as
well, potentially. Is that negotiable?

SEN. DURBIN: There are many variations on the theme. I am committed to
public option. I think we've put together a good bill. We are open
because we want to pass this bill. At the end of the day we want
insurance to be more affordable, we want to stop the insurance industry
abuses, we want to give American people a choice in this decision.

MR. GREGORY: So the public option is negotiable.

SEN. DURBIN: They don't have to...

SEN. FEINSTEIN: Yeah.

SEN. DURBIN: It has been. Putting in the opt-out was clearly a variation
on the theme from the beginning.

MR. GREGORY: All right, Senator Feinstein.

SEN. FEINSTEIN: No developed country on earth has the huge for profit
medical insurance industry that we have; 480 percent profit in eight
years, premiums going sky rocketing. Let me give you an example. Day
before yesterday, representatives from five hospitals in California came
in, Daughters of Charity Hospitals, 6,000 employees. Their premium had
just risen 17.5 percent. The money they got back in provider payment was
one-third that--less than one-third, 5 percent. That premium increase
wiped out their entire operating capital for '09. Now, this is the
problem. And I have person after person coming to say, "I can't handle
the 20 percent increase in my insurance. So this is the reason for the
public option, to put out there some competition that will sober this
huge for-profit 800-pound gorilla of medical insurance in this country.

MR. GREGORY: So would you vote for a plan, a bill that did not include
the public option?

SEN. FEINSTEIN: Well, I would vote for it if it had a rate authority to
be able to control the increase in premiums, at least to keep it to
medical inflation.

SEN. HUTCHISON: The very hospitals that she's talking about I'm sure
serve patients who don't pay. Those hospitals are going to be cut in this
bill. Every hospital that treats patients that don't pay will be cut. So
what are they going to gain? We don't have to tear down our whole system
and the choices that we have and the quality health care we have in order
to give more affordable health care. There are two things in this bill
that could be modified to do what everyone says we want to do. I agree
with what you stated are the goals. You have in, in this bill the ability
for companies to go on an exchange, but it's more like the Massachusetts
plan, which adds cost, instead of the Utah plan, which adds no cost but
does have competition, will have transparency so that insurance companies
will have to come back down. And secondly, the ability to have small
business health plans. If we took your part of that bill out and just had
small business health plans, we would have more affordable options, more
people would be insured...

MR. GREGORY: Yeah...

SEN. HUTCHISON: ...and you would have lower costs for everyone.

MR. GREGORY: All right. Let me, let me--Senator, let me get to a final
point on this, which is what are we achieving out of healthcare reform
really? The president said the priority was cutting costs.

SEN. LIEBERMAN: Right.

MR. GREGORY: Polling's indicated that most Americans think this will bust
the budget...

SEN. LIEBERMAN: Yeah.

MR. GREGORY: ...no matter what congressional scorekeepers say. What you
have here is an expanded entitlement program and higher taxes.

SEN. LIEBERMAN: Right.

MR. GREGORY: Does it really cut healthcare costs?

SEN. LIEBERMAN: Not enough. That's the hope. Look, in the first place,
the president and Congress are trying to do two things that are hard to
do together. One is to fulfill our moral and governmental
responsibility to enable more people who can't afford insurance now to
buy that insurance. That costs money. It's not going to come out of
nowhere. And how do you raise that money, even though we're saying to
people we're going to reduce the cost of insurance? You raise it by
raising taxes and, and cutting or reforming Medicare. A very important
question here, and it, it goes back to what I said before, I want to
solve healthcare problems but I don't want to do it in a way that
inhibits our recovery from this terrible economic recession. I want to
see what CBO says, Congressional Budget Office says about the effect this
will have on premiums. So this is--these are all questions.

One last word on the public option. I understand that some who have, who
have advocated say we need to have a government insurance company in the
market to keep the insurance companies honest. This is a radical
departure from the way we've responded to the market in America in the
past. Here's what I mean. We rely first on competition in our market
economy. That's brought us a lot of wealth and given people a lot of
jobs. But when the competition fails, then what do we do? We regulate or
we litigate. We have never before said, in a given business, we, we don't
trust the companies in it so we're going to have the government go into
that business. And irony of all ironies, Congressional Budget Office
says, I repeat, the government-run public option company will charge more
than the private companies will. That's not going to...

MR. GREGORY: Senator Durbin, does this...

SEN. FEINSTEIN: That's counterintuitive, though. There's no way.

MR. GREGORY: Does it get, does it get passed by the end of this year?

SEN. DURBIN: It must. We have to do our job here.

MR. GREGORY: No option.

SEN. DURBIN: We have to finish it in the Senate or it's going to be
a--maybe a long lunch break over Christmas. We're going to stick around
and get it done.

MR. GREGORY: Are you saying if the vote is put off until the first of the
year, an election year, that health care dies?

SEN. DURBIN: No, I don't say that. But it becomes more complex, because
both the president and the Congress want to shift this in--from this
critically important issue...

MR. GREGORY: Yeah.

SEN. DURBIN: ...which is central to our economy to the economy and jobs.
We want to--we want to really get this done. We spent a year at it. But
we've got to really focus--refocus our attention, all of our attention,
on getting people back to work. Health care's part of this, make no
mistake.

MR. GREGORY: Right.

SEN. DURBIN: But that's why we're anxious to get it done. And
unfortunately, our friends at the other side have slowed us down every
chance they've had. I hope that changes.

MR. GREGORY: All right. Let me--I want to move on to some questions about
the...

SEN. HUTCHISON: But we only saw this bill Thursday. We saw this bill
Thursday.

SEN. DURBIN: This bill's been there for a year.

SEN. HUTCHISON: This--no. This is not the Finance Committee bill...

SEN. DURBIN: It's been through committee after committee.

SEN. HUTCHISON: ...and it's not the Health Committee bill.

MR. GREGORY: OK. I want to, I want to, I want to move on, Senators.

SEN. HUTCHISON: It's a new bill with new taxes.

MR. GREGORY: I want to move on, I want to move on to the broader economy,
and there was a lot of anxiety and anger that played out on Capitol Hill
this week and it was directed at Treasury Secretary Timothy Geithner.
Here was in exchange with the Republican congressman from Texas, Brady,
on Capitol Hill this week. Watch this.

(Videotape, November 19, 2009)

REP. KEVIN BRADY (R-TX): Conservatives agree that as point person, you
failed. Liberals are growing in that consensus as well. Poll after poll
shows the public has lost confidence in this, in this president's ability
to handle the economy. For the sake of our jobs, will you step down from
your post?

SEC'Y TIM GEITHNER: Congressman, I--it is a great privilege for me to
serve this president, and I am very pleased at a chance to address the
range of concerns you said. I, I agree with almost nothing of what you
said, and I think almost nothing in what you said represents a fair and accurate
perception of where this economy is today. Now, I think it's important to
start, welcome the advice that you're providing after you left the--you
gave this president an economy falling off the cliff, values of American
savings cut almost in half, millions of Americans out of work; again, the
worst financial crisis we've seen in generations.

REP. BRADY: Remind me, remind me, Mr. Secretary, what post were you
holding when President Bush left office? Just remind me what economic
post you were holding.

SEC'Y GEITHNER: I was the president of the Federal Reserve Bank in New
York.

(End videotape)

MR. GREGORY: Senator Lieberman, should Timothy Geithner keep his job?

SEN. LIEBERMAN: Well, that's up to the President Obama, but I, I'd say he
should. In other words, I, I wouldn't call for his resignation. I think
it's too easy to make one person a scapegoat. The fact is that a lot of
the things that have been done--the economy's not where we want it to be,
particularly with unemployment over 10 percent, probably real under and
unemployment almost 17.5 percent. That's, that's horrible. People are
really hurting. But a lot of the things that were done beginning in the
Bush administration with the TARP program and all the rest and then the
Stimulus Act I think are bringing up back. And the stock market is saying
that, with the heights it's reached. We've got work to do. I think the
most important thing we can do, for instance, on healthcare reform, is do
no harm. Don't add to the debt. That's the thing I'm, I'm really worried
about. Second, there are some more things we can do without spending a
lot of money to stimulate the economy a little more after the first of
the year. And then I'd say fiscal regulatory reform.

MR. GREGORY: Right.

SEN. LIEBERMAN: Close the gaps that allowed the people on Wall Street and
the banks to basically cheat us.

MR. GREGORY: But this is a big debate, Senator Feinstein. What should be
the priority right now, more jobs or cutting the debt?

SEN. FEINSTEIN: Well, right now it's more jobs, because
unemployment--I've got nearly two and a half million people unemployed.
That's bigger than the population of 12 states. It's a real problem,
because California is an economic dynamo for the rest of the country and
when it's off, it has a repercussion all throughout America. And it is
off.

Having said that, I think we need to do some very careful things with
respect to some lending for big infrastructure. An interest that I have
had for a long time is in high-speed rail, and there are three regional
high-speed rail systems being planned in the United States. I'd like to
see an infrastructure bank developed with some of the remaining TARP
money that could lend to communities to move those plans forward quicker
so that--because transportation has a billion--it has 40,000 jobs for a
billion dollars spent, and so it's a good investment of funds right now.
We have to be concerned with jobs. I mean, I cannot tell you what it's
like when college graduates come and say, "Look, I've sent out 40
resumes. I've been turned down 40 times. I've got a degree. I'm a 4.0
student. What do I do?" Let alone the person that has worked in a, in a
machine shop who is laid off. It is a real problem in our country.

I think for many of us, we've got to look out there and look for American
products candidly and buy American products. I think we have to
understand that other countries obviously want to import into our
country, export into our country, but I think we have to begin to, to
sort of star our own products and say, "Mr. and Mrs. America, buy them."

MR. GREGORY: Senator Hutchison, back to Secretary Geithner. Do you think
he should keep his job?

SEN. HUTCHISON: Well, I think what Kevin Brady did in, in challenging him
and talking about this economy was the right thing to do. But look, it--a
jobless recovery is not a recovery. And you cannot separate this huge
debt that we have--we're hitting the debt ceiling, $12 trillion, at the
same time that one in 10 people in this country are jobless. And to talk
about passing a healthcare bill that is going to add $2.5 trillion in
costs, because that's what the real costs are when it starts. The taxes
are going to start in six weeks, the taxes that are going to raise the
premiums and cause people not to hire people--job--we're trying to ask
people to create jobs when we're going to put a cost on every business
person in this country...

MR. GREGORY: Right.

SEN. HUTCHISON: ...that will take them away from the goal of adding jobs.

SEN. FEINSTEIN: I have this...

SEN. HUTCHISON: How can we be talking about more cost, more debt at a
time when we're...

MR. GREGORY: Well, hold on. You, you said Brady did the right thing. I
just want to be--the question I'm asking is do you think Geithner should
keep his job?

SEN. HUTCHISON: Look, I think Kevin Brady was right to bring it up. I, I
think that we are going in the wrong direction. I think the president, I
think the Congress, I think the secretary of Treasury...

MR. GREGORY: Brady said he should resign.

SEN. HUTCHISON: ...are all...

MR. GREGORY: It's a simple question: Do you think he should keep his job?

SEN. HUTCHISON: I think they're all--look, then we shouldn't keep our
jobs, either. The president, the Congress and, and Mr. Geithner are all
responsible for going in the wrong direction. This stimulus package is
wrong.

MR. GREGORY: All right. Quick, quick, one second.

SEN. FEINSTEIN: Well, you know...

SEN. HUTCHISON: The healthcare bill is wrong.

SEN. FEINSTEIN: I mean, I, I really differ. You know, the times get
duff--tough, so what happens? Somebody has to point a finger. Tim
Geithner isn't responsible for the entirety of what's out there today,
and it's nonsense to think that he is. It, it really makes me very angry,
because we always tend--we've got to find somebody to blame. There are
some very deep-seated problems in the economy. What I wanted to correct
is I, I looked at the Republican talking points on the $2.5 billion
figure that is the cost.

SEN. HUTCHISON: Trillion.

SEN. FEINSTEIN: Trillion figure that's the cost. There's no
substantiation for that. But if you go down the column...

SEN. HUTCHISON: No, that's not true. That's not true.

SEN. FEINSTEIN: ...what it does says is that the deficit...

SEN. HUTCHISON: It...

SEN. FEINSTEIN: ...saving is $170.

SEN. HUTCHISON: No, that's not true.

MR. GREGORY: All right, let me--I want to move on. We've got to...

SEN. HUTCHISON: It is $2.5 trillion, because the...

MR. GREGORY: Well, this is--wait, hold on a second.

SEN. HUTCHISON: ...the CBO study...

MR. GREGORY: This, this can be debated in different ways, whether that
came out of Finance Committee or actually CBO...

SEN. HUTCHISON: ...starts before the costs start.

MR. GREGORY: ...and I don't want to get into that, that level right now.
I want to move on to some other topics, including a huge one, which is
Afghanistan.

Senator Durbin, when are we going to get a decision from the senator? And
has he taken too long to announce the strategy? The president, we're
talking about, of course.

SEN. DURBIN: No, I want him to take the time that's necessary. I think
the president is trying to reassess the overall strategy, as he should.
Many of us believe that we've missed an opportunity in Afghanistan by
diverting our attention to Iraq. I was one of 23 who voted against that
war. I think that was a serious mistake. It has cost us many lives and
great treasure. But equally important, it has diverted our attention from
the task at hand, those responsible for 9/11, al-Qaeda and their Taliban
allies. I want the president to take the time to get it right, and I
think he should. And I don't know when that's coming, but I'm going to
defer to the president's decision, working with his secretary of Defense,
secretary of State and the generals in the field.

MR. GREGORY: Senator Lieberman, Ike Skelton, which is the chairman of the
House Armed Services Committee, supports General McChrystal's policy of,
of additional forces. He said this about the endgame, the exit strategy:
"When the area has been stabilized... then it's time to go home." Is that
the obligation for the United States, that Afghanistan must be stabilized
before we leave?

SEN. LIEBERMAN: Yeah. Yeah, that's our goal, and, and it's our goal for
good reason. As Senator Durbin just said, we were attacked on 9/11 from
Afghanistan. If we leave Afghanistan with less than success as a, as a
country that can govern itself and protect itself, it's going to have a
terrible destabilizing effect on the rest of the region. So I don't like
it when people say we have no long-term interests in Afghanistan or we're
looking for an exit strategy. We, we, we have--we don't want to have a
long-term interest in having our military there long term, but we have
real long-term interests in this place being stabilized. And...

MR. GREGORY: How long will it take?

SEN. LIEBERMAN: I don't know. We didn't know when we adopted the surge in
Iraq. But the surge in Iraq, the additional troops following the same
strategy that General McChrystal wants to apply here in Afghanistan
worked in about a year. I think we have the same potential to turn this
tide and set back the Islamist extremists who are our enemies in this war
that we're in.

MR. GREGORY: Still on the topic of national security, I want to ask the
question, Senator Feinstein, about the decision by the attorney general
to try Khalid Sheikh Mohammed, the self-proclaimed mastermind of 9/11, in
New York City. Charles Krauthammer wrote in his column in The Washington
Post this on Friday: "What happens if KSM (and his co-defendants) `do not
get convicted,' asked Senate Judiciary Committee member Herb Kohl.
`Failure is not an option,' replied Holder, the attorney general.
Everyone knows that whatever the outcome of the trial, KSM will never
walk free. He will spend the rest of his natural life in U.S. custody.
Which makes the proceedings a farcical show trial from the very
beginning." Isn't he right?

SEN. FEINSTEIN: No, I, I don't believe he is.

MR. GREGORY: Have you ever an attorney general say "failure is not an
option" to their prosecutors in the field?

SEN. FEINSTEIN: Well, I'm sure some have, have said that. I haven't heard
it, no. Having said that...

MR. GREGORY: Though it's unusual, isn't it?

SEN. FEINSTEIN: But what I have seen is the failure of military
commissions up close up and personal. And what, what I have seen is only
three people tried in eight years.

MR. GREGORY: But wait. But if you presuppose the outcome...

SEN. FEINSTEIN: And those...

MR. GREGORY: ...and you say he'll never...

SEN. FEINSTEIN: Let me--David, let me...

MR. GREGORY: ...he will never be out of custody, doesn't it make it a
show trial?

SEN. FEINSTEIN: Look, I don't think this is a show trial. Will the press
gravitate to it? Probably, yes. But that's not the point. The point is to
try him in federal court, where a couple of hundred other terrorists have
been tried, as opposed to in a military commission whose record is
extraordinarily poor; three people tried--David Hicks, one other, two
others--and very short sentences came out of it. I think they're all out
now. To put him in the second district of New York, which is accomplished
at this, with our best judges, our best prosecutors, and prosecute him so
the world can see American justice rather than hidden somewhere. And I
think--as in a military commission. I think it's an important thing to
do.

MR. GREGORY: Senator Durbin, is saying to a prosecutor "failure is not an
option"...

SEN. HUTCHISON: David...

SEN. DURBIN: Well...

MR. GREGORY: ...is that appropriate?

SEN. HUTCHISON: David...

SEN. DURBIN: Well, of course, when I send in my team for a prosecution, I
tell them that.

MR. GREGORY: Right.

SEN. DURBIN: You wouldn't want to say, "Good luck, we--it may go one way
or the other." He said "failure is not an option," and then he went on to
say--and I hope that Krauthammer's clear on this, "the president has the
power to keep Khalid Sheikh Mohammed in custody regardless of the verdict
in this trial." But as Senator Feinstein said, since 9/11 we have
successfully prosecuted 195 terrorists...

MR. GREGORY: Right.

SEN. DURBIN: ...in the courts of America, only three in military
tribunals.

MR. GREGORY: But how, but how is that, but how is that highlighting the
strength...

SEN. HUTCHISON: Right.

MR. GREGORY: ...of the American judicial system if you say, "Well,
conviction or no, we'll still hold on to him," but--and "failure is not
an option, do whatever it takes to get convicted"?

SEN. HUTCHISON: Well, we shouldn't be bringing these people from
Guantanamo Bay, who are enemy combatants, into our court system, giving
them the rights of American citizens. When the World Trade Center bombers
were tried in New York City, it was said right then that intelligence
gathering information and people who had gathered intelligence were put
in jeopardy. That's what happens in a court of law. They have the right
to face their accusers. So we are going to lose intelligence gathering
capabilities because it's going to be revealed.

Number two, on Afghanistan, the president must make a decision. We need
to make sure that the world knows we will not back away from Afghanistan.
That is in the American interest, it's in every freedom loving country's
interest not to have al-Qaeda build up, Taliban help them and have them
export terrorism all over the world. And if the president would go to our
NATO allies and say, "It's time for you to step up to the plate. America
is carrying the heavy burden here, but it is in your interest to give
more troops, to give more help in this cause." This is a NATO mission.
The--whether NATO survives or doesn't is going to be determined by
whether we stick to it and we do our job and we stop the export of
terrorism to America and the rest of the world.

MR. GREGORY: Let me ask both of you. You both have been heavily involved
over the years in raising money for breast cancer research, going back
to, to, to the stamp act that you were behind 10 years ago.

Senator Feinstein, I'll start with you. What do you think about these
guidelines issued this week? Do you think that women should continue to
have mammograms in their 40s?

SEN. FEINSTEIN: I think the jury's out. I think women should talk to
their physicians. The bill that's now on the floor of the Senate would
not do anything to disrupt any preventive mammogram. Those are all still
available in this bill. I think there's a conflict in the science. The
conflict has to be worked out. The technology of mammograms has to be
improved, because this is an old technology now. And I think that a woman
should consult her physician and go ahead and have the mammograms. To be
candid with you, that's what I would do.

MR. GREGORY: What about--Senator Hutchison, you said this is the
beginning of rationing.

SEN. HUTCHISON: I think it is.

MR. GREGORY: Why did you say that?

SEN. HUTCHISON: It's because it's whether the insurance and the public
option are going to pay for a woman who decides that she wants to have
the mammogram before the age of 50 or more than every other year after
50. If the public option doesn't pay for that--and the task force
recommendations are what the public option is going to rely on. So this
task force says all of a sudden we're going to change the guidelines that
we have had for all these years. And now the public option may not pay
for those, and that means the insurance companies are going to follow.
The key is that these are covered by insurance so women will not have to
decide if they're going to spend $250 to get a mammogram because they and
their doctors believe it is right to do so.

MR. GREGORY: All right, I'm going to make that the last word. Thank you
all very much.

Up next, more on this topic, the cancer controversy. What should women do
now, and what are the real issues and the politics behind the debate? Our
guests: Nancy Brinker of Susan G. Komen for the Cure and NBC's Dr. Nancy
Snyderman. Then it's our MEET THE PRESS MINUTE. He is now the
longest-serving member of Congress, but back in 1972 Senator Robert Byrd
made his very first appearance right here on MEET THE PRESS.

(Announcements)

MR. GREGORY: The politics of cancer and the controversy over new
screening recommendations, after this brief commercial break.

MR. DAVID GREGORY: It has been a busy and confusing week for women's
health as two new recommendations on breast and cervical cancer screening
sparked a political and medical controversy. On Monday, a
federally-funded task force made up of 16 academic and practicing doctors
said in part that most women in their 40s do not need routine mammograms.
New research, they say, does not support the theory that the benefits of
those early screenings outweighs the risks, which can include false
positives and increased anxiety. On Friday came news from the American
College of Obstetricians and Gynecologists saying young women should
begin Pap smears at a later age and get them less frequently as well. And
the timing of it all couldn't have been worse for the Obama
administration. As the fight continues over healthcare reform, some argue
these new guidelines will cause insurance companies to cut coverage and
risk women's health in order to reduce costs.

(Videotape, November 18, 2009)

REP. MARSHA BLACKBURN (R-TN): This is how rationing begins. This is the
little toe in the edge of the water. And this is where you start getting
a bureaucrat between you and your physician.

(End videotape)

MR. GREGORY: The backlash eventually forced the secretary of Health and
Human Services, whose department appointed the independent panel that
issued the new mammogram guidelines, to back away from its
recommendations. Secretary Sebelius issued a statement saying, "Our
polices remain unchanged." She was also questioned on NBC's "Nightly
News."

(Videotape, November 18, 2009)

MS. ANN CURRY: Are you saying that women should still consider having
mammograms beginning at age 40?

SEC'Y KATHLEEN SEBELIUS: Absolutely, based on their health history and
their physician's recommendation.

(End videotape)

MR. GREGORY: At a time when health care is at the top of the agenda in
Washington, these very personal women's health issues have turned
decidedly political.

Joining us now is Ambassador Nancy Brinker, founder of the largest breast
cancer charity in the world, Susan G. Komen for the Cure; and NBC News'
chief medical editor, Dr. Nancy Snyderman. The two Nancys here this
morning...

DR. NANCY SNYDERMAN: I know.

MR. GREGORY: ...on this important topic. Welcome to both of you.

DR. SNYDERMAN: And old friends.

AMB. NANCY BRINKER: Yeah.

MR. GREGORY: Well, let's talk about what's happened this week. And again,
at the end there we talk about Secretary Sebelius, who in her statement
said, "Keep doing what you've been doing for years, talk to your doctor
about your individual history, ask questions, make the decision that is
right for you." Ambassador Brinker, what kind of scientific mess has the
government created this week?

AMB. BRINKER: Yeah. This is, this is--David, this is really a nightmare.
Our phones have been ringing off the hook, as you can imagine. We need
clarity. You know, people--this is scary for people. We've spent a
generation at Susan G. Komen acculturating people to be engaged in their
breast health, to understand the messages, to screen--have screening,
breast self-exam. Plus, we brought a lot of low-resource women into
the--into health care for the first time. And now people are scared. So
we need clarity. We at Susan G. Komen are not changing our
recommendations. We're going to take a long look at scientific-based
evidence and we're going to figure out, you know, what we do going
forward. But we know we're not going to change our recommendations right
now. One thing we want to make very sure of is there's still a lot of
women, a third of American women don't have access to anything yet, and
we're working very hard to make that happen. I, I worry about fragile
women in our society who now may move away and could present with much
later-stage disease.

MR. GREGORY: Right.

AMB. BRINKER: But the real point, the real centerpiece of this, which
people aren't focusing on, is the huge technology gap. The real issue is
that mammography screening isn't effective enough, it's, it's expensive,
it needs to be more available, it needs to be, you know, operated with
low-power resources around the world, it needs to be better. We have this
debate every 10 years. And yet we've got to, we've got to close the gap.
And to that end, Susan G. Komen is going to host a world class summit on
breaking down and fixing the technology gap...

MR. GREGORY: All right, let's...

AMB. BRINKER: ...once and for all.

MR. GREGORY: Dr. Nancy, let's talk about some of the data behind the new
guidelines. And we'll put them up on the screen. This is from the U.S.
Preventive Services Task Force. Cancer deaths prevented from mammography
screening, and you see the numbers there for 39 to 49-year-olds, one in
1,904 as opposed to if you're between 60 and 69, one in 377.

DR. SNYDERMAN: So, David, let me stop you there.

MR. GREGORY: Yeah.

DR. SNYDERMAN: Because that's a very important number to look at. That
means that over 1,900 women screened over a 10-year period of annual
mammograms, one life is saved and there are a thousand false positives,
which means ongoing, unnecessary tests. Now remember, the scientists who
did these numbers, their role is, as scientists, to take the anecdotes
and the passion and the emotion out of it. And I recognize that's hard as
part of the message. But they're to look at the public health issues of
how we screen. And we've always known that mammography for women in their
40s has been fraught with problems. It is not as precise for older women.
On that Nancy and I have great agreement. So what their consensus was is
that there are a lot of unnecessary screenings for that one life. Now, if
you're that one life, it's 100 percent. I get that. But their charge as
an independent body was to look at the cumulative research as scientists.

MR. GREGORY: And the issue here, there's, there's kind of a culture clash
here...

DR. SNYDERMAN: Right.

AMB. BRINKER: Mm-hmm.

MR. GREGORY: ...Ambassador Brinker, which is, which is this. The New York
Times wrote about it. "This week the science of medicine bumped up
against the foundations of American medical consumerism: that more is
better, that saving a life is worth any sacrifice, that health care is a
birthright."

AMB. BRINKER: You...

MR. GREGORY: But what about the data?

AMB. BRINKER: Well, the data are important, and that's why we look at it
all the time. But, David, part of this is that it was very clumsy. You
know, this--the way this task force information was revealed, it was very
clumsy. And the other part of it is, let's not forget, mammography saves
lives. And I would argue, you know, I wish my sister, Susan Komen, had
been able to have a mammogram 30 years ago when she died. I had one when
I was 37, and, and I'm living today, and I credit a lot of that to early
screening. A lot of women have different circumstances. What we want to
protect is continued access to this technology until we have something
better, until we know more. We just shouldn't change what we're doing
now, because it's working. Yeah, we have to screen a lot of people, but
one out of 1,900 being diagnosed with, with breast cancer is still a lot
of women. It's still a lot of women.

DR. SNYDERMAN: But at the same time, it's interesting. We--this task
force did not look at the economics. Their job was to look at the pure
science. And I think in some ways we hear from the scientists, don't like
the message, and this week I believe we threw the scientists under the
bus. We in this country have three hot button scientific issues. We have
stem cells, vaccines, cancer screening. We need to step back as a society
and let the scientists present their data and then, as an informed
populace, look at it, talk about it. And what happened on Monday was that
the headlines then ran with the week...

AMB. BRINKER: Right.

DR. SNYDERMAN: ...instead of intelligent people saying, "OK, what does
this mean and how do we mean it?" And the task force basically said to
women in their 40s, individualize yourselves, talk to your doctor. This
is all about, and I think Nancy and I agree on this, better technology.

AMB. BRINKER: Yeah.

DR. SNYDERMAN: Spending money wisely, but telling women each of you has
your own life and your own family history and your own risk factors. But
this is the individualization of medicine.

MR. GREGORY: What--go ahead.

AMB. BRINKER: No, no, no. I was just going to say, and the problem with
risk factors, you know, low resource women don't have an opportunity to
take D--to have DNA studies and sometimes can't even reach a computer to
go to a Web site to see what the risk factors are. So low cost screening
is sometimes the only thing that we can use. And, and the other thing I
have to say, in a, in a healthcare system where we spend over $2
trillion, getting better technology is but a small part of it. And we
just have to have a call to action. That's what this should be, this is a
call to action. This is not about rocket science.

MR. GREGORY: Right.

AMB. BRINKER: It's about having the political will to get the technology
we need to be able to screen properly.

MR. GREGORY: I--but it seems to me in the middle of a, of a huge
healthcare debate--and you heard that throughout the program--there is
this fundamental question about how involved the government should be in
setting our health care, setting healthcare standards. And here in this
course of this debate, the goal has been cutting healthcare costs. This
is the president in July selling healthcare reform and the idea of using
health care less. This is what he said.

(Videotape, July 1, 2009)

PRES. BARACK OBAMA: We are--we've been under the illusion that the more
health care we get, the healthier we become. And it turns out that every
study shows that the question is are you getting the right care, are you
getting the best care, the high quality care; rather than are you having
a whole bunch of tests ordered that are unnecessary, getting a bunch of
treatments that are unnecessary, staying in hospitals longer than maybe
necessary? All of which drives up your costs, but doesn't make you
better.

(End videotape)

MR. GREGORY: And is it the issue that if the only acceptable number is
zero on that chart of, of how many deaths can be avoided, that that goes
a long way toward explaining, as Steve Pearlstein pointed out in The
Washington Post in his column this week, why we have the least effective
and most extensive--expensive healthcare system in the industrialized
world?

AMB. BRINKER: Well, David, I, I don't--yeah, I want to leave the, the
politics to the politicians.

MR. GREGORY: Right.

AMB. BRINKER: You had great politicians on earlier in the day. What I
really want to focus on is where we have gotten with screening and where
we need to go, and not scaring people who are already in the system. And,
and by the way, if private insurers are looking at this today and
deciding they're going to cut down their recommendations or cut access, I
would tell them that there are tens of thousands of women who have lined
up at our Komen Advocacy Alliance ready to, you know, just bring it on. I
mean, we're, we're going to, we're going to push back until we have what
we need to accurately diagnose and predict when women...

DR. SNYDERMAN: But we can't take the science out of it completely.

AMB. BRINKER: No.

DR. SNYDERMAN: Because in 19--I mean...

MR. GREGORY: Nor can you take the politics out of this.

AMB. BRINKER: We can't take the science or the politics, but...

DR. SNYDERMAN: And we can't, we can't take the two apart, because in 1971
President Nixon threw down the mantra and said--declared his war on
cancer. In 1997 the Senate, 98-to-0, voted to arbitrarily say, you know,
we will support funding of, of mammography for women 40 to 49. Arlen
Specter...

MR. GREGORY: Mm-hmm.

DR. SNYDERMAN: ...had his hands in deciding whether NCI would go ahead
and get further funding. And now we're looking at politics again. So
politics and science are always enmeshed. But I would argue that we are
on the verge of becoming a scientifically illiterate country if we don't
at times separate the two...

MR. GREGORY: Right.

DR. SNYDERMAN: ...and really talk about that.

MR. GREGORY: And you actually--you made this point speaking on "Morning
Joe" on MSNBC this week: "We just came out of October, what I call the
pinking of America. We have taken a woman's breasts and we have
politicized it, we have marketed it, we have made millions of dollars for
agencies and nonprofit groups off the breast. But in some ways, we've not
let women know the data."

DR. SNYDERMAN: That's right.

AMB. BRINKER: And...

DR. SNYDERMAN: We haven't.

AMB. BRINKER: And I don't think anyone's pushing back on the data. What I
think...

DR. SNYDERMAN: Oh, I think people...

AMB. BRINKER: ...we have to, we have to--wait a minute. I, I, I think
people understand the data. I know, I know we're looking very, very
carefully.

DR. SNYDERMAN: If people understood the data, we wouldn't be arguing all
week long.

AMB. BRINKER: But here's the issue. Nobody's also studying the real
behavioral side of this. Again, we have acculturated a generation of
people to become active in their health care. There is a huge public
health piece here.

MR. GREGORY: Right.

AMB. BRINKER: And as far as the pinking of America, I have one thing to
say. There's not enough pink in America, David. If there hadn't been red
in America, we wouldn't have had antiretroviral drugs.

DR. SNYDERMAN: Well, there are, there are people, there are people with
other illnesses...

AMB. BRINKER: And our goal...

DR. SNYDERMAN: ...who think that perhaps the pinking has sort of taken
over.

AMB. BRINKER: Well, well...

DR. SNYDERMAN: But it's--but I'll tell you.

MR. GREGORY: But why is it bad for the behavioral piece for the
government to say "Look at your case individually and, if you're in your
40s, you may not need a mammogram"?

AMB. BRINKER: Yeah.

MR. GREGORY: Why do you think that that inexorably stops the momentum for
mammography testing?

AMB. BRINKER: Because with all of our experience, David, on the
ground--I've been doing this for 30 years. Our organization is active
very, very much all over the world. And I will tell you that change in
people's health behavior is a fragile proposition. And so that I'm
worried again, mostly, at the women, the low-resource women...

MR. GREGORY: Mm-hmm.

AMB. BRINKER: ...who've now been in--broadened the system...

MR. GREGORY: Mm-hmm.

AMB. BRINKER: ...who are engaged in some way in, in good breast health
care. We have to do these things carefully, we have to look at the
evidence-based science and we have to translate to the best of our
knowledge...

MR. GREGORY: Do you think--back to my--should the government stay out of
this completely in terms of setting healthcare standards?

AMB. BRINKER: Well, again, I don't, I don't want to politicize it. I
don't think government...

MR. GREGORY: But what--how can you say you don't want to politicize it?
You, you--but, but...

AMB. BRINKER: Government should stay out of it, David. But I also think
that people have to be very engaged with the government.

MR. GREGORY: All right. Right.

AMB. BRINKER: That it's, it shouldn't just come down as a mandate.

MR. GREGORY: You're petitioning the government and you're engaged in
politics all the time.

AMB. BRINKER: Well...

MR. GREGORY: Which is not a bad thing, but it's a reality.

AMB. BRINKER: But, but the fact is...

DR. SNYDERMAN: Nancy, I mean, the fact that the American Cancer Society
has lobbyists...

AMB. BRINKER: Yeah.

DR. SNYDERMAN: ...the fact that you have lobbyists, that is an absolute
statement that there are politics enmeshed in advocacy groups and in
setting standards. So, I mean, we can't be politically naive about this.
There are big stakeholders in this.

MR. GREGORY: Right.

DR. SNYDERMAN: And...

AMB. BRINKER: Yeah.

MR. GREGORY: And, Dr. Nancy, should the government be involved in making
these decisions?

DR. SNYDERMAN: The government has to be. I mean, as long as there's
Medicare, the government has to be in it.

MR. GREGORY: Right.

DR. SNYDERMAN: But we should all...

AMB. BRINKER: But...

DR. SNYDERMAN: But there should be greater transparency. And I think
the...

AMB. BRINKER: Greater transparency and continuation of advocacy.

DR. SNYDERMAN: And I think that's one of the things that got screwed up
this week.

AMB. BRINKER: If we don't have patient advocacy, we, we're not going to
get to where we need to get to.

MR. GREGORY: Right.

DR. SNYDERMAN: I agree with you on that, too.

MR. GREGORY: We're going to make that the last word.

AMB. BRINKER: Thank you.

MR. GREGORY: And I'm sure the debate will continue.

AMB. BRINKER: Thank you.

MR. GREGORY: Thank you both, the two Nancys.

Up next, this week Senator Robert Byrd of West Virginia became the
longest serving member of Congress in history. Back in 1972 he made his
very first appearance on this program. We'll look back in our MEET THE
PRESS MINUTE at what he had to say nearly four decades ago, after this
brief station break.

MR. DAVID GREGORY: We're back with our MEET THE PRESS MINUTE. This week,
after nearly 57 years representing his home state of West Virginia,
Democratic Senator Robert Byrd became the longest serving member of
Congress in history. On December 31st, 1972, Senator Byrd made his very
first appearance here on MEET THE PRESS and engaged in a discussion of,
what else, the merits of the seniority system in the Senate.

(Videotape, December 31, 1972)

MR. SAMUEL SHAFFER: How can Congress adequately present its own legislative
program when, by the testimony of some of its most respected members, it
badly needs to reorganize its procedures; and some, such as a good Senate
man like Senator Goldwater, who's also conservative, believes we ought to
do away with the seniority system?

SEN. ROBERT BYRD (D-WV): Well, I don't agree that the Senate is an old
creaking machine that can't act. It has shown time and again that it can
act quickly. Now, the seniority system has worked in the past. I know it
has its faults, but I have seen no other system that wouldn't have as
great faults or worse.

MR. SHAFFER: On seniority, it does not apply to the election of the majority
leader of the Senate and the assistant majority leader. Now, you, Senator
Byrd, are number 25 in seniority in the Senate. Senator Mansfield, if I
recall correctly, is number 13. Yet your colleagues, voting by secret
ballot, chose the two of you because they figured you were the men best
calculated to lead the Senate. Why shouldn't that apply to committee
chairmen?

SEN. BYRD: Well, because you've got 17 committees in the Senate, standing
committees, not counting the special and select committees. You have 110
subcommittees. And if we're going to have a political campaign in each of
these 110 subcommittees and each of the 17 standing committees and each
of the five select and special committees, we're going to get nothing
done except log rolling and interference by the White House and lobbyists
and special interest groups in, in the interest of their own favorites.

(End videotape)

MR. GREGORY: Over the course of his now 20,778 days in Congress, Senator
Byrd has held more leadership positions than any other U.S. senator in
history. He's been majority whip, minority leader, majority leader and
president pro tem. On Friday, Senator Byrd celebrated another milestone,
his 92nd birthday. As he himself once said on this program, presidents
come and presidents go, but senators don't fade away very easily
sometimes.

And we'll be right back.

MR. DAVID GREGORY: That's all for today. We'll be back next week with a
special Thanksgiving weekend edition, celebrating the spirit of giving
with Pastor Rick Warren and Bill and Melinda Gates, who will discuss the
work of the Gates Foundation. Have a safe and happy Thanksgiving. If it's
Sunday, it's MEET THE PRESS.

Discuss:

Discussion comments

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