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updated 2/18/2010 4:40:05 PM ET 2010-02-18T21:40:05

MR. DAVID GREGORY: This Sunday: The Democrats now appear to have the
votes to pass sweeping healthcare reform in the Senate, and the president
stands at the brink of a major legislative victory.

(Videotape)

PRES. BARACK OBAMA: It now appears that the American people will have the
vote they deserve.

(End videotape)

MR. GREGORY: But the White House failed to win any Republican support for
the measure.

(Videotape)

SEN. MITCH McCONNELL (R-KY): This bill is a legislative train wreck of
historic proportions.

(End videotape)

MR. GREGORY: Before the final vote, the debate over whether this is real
reform, pitting Democrats against Democrats.

(Videotape)

DR. HOWARD DEAN (D-VT): For me, I'd kill the bill all entirely.

(End videotape)

(Videotape)

MR. ROBERT GIBBS: I don't think any rational person would say killing a
bill makes a whole lot of sense at this point.

(End videotape)

MR. GREGORY: What's next? And what is the political impact of this
legislation in 2010 and beyond? Joining us, the president's senior
adviser, David Axelrod; and then the man who helped ignite a debate over
health care within his party, former DNC chairman and 2004 Democratic
presidential candidate, Howard Dean. Our roundtable weighs in as well on
the politics of health care and the huge political challenges facing this
White House in the new year as it tackles high unemployment and a sour
mood in the country. With us: MSNBC's Joe Scarborough, the Daily Kos'
Markos Moulitsas, former RNC Chair Ed Gillespie and PBS' Tavis Smiley.

MR. DAVID GREGORY: But first, the great blizzard of December of 2009
blanketed the East Coast. It dumped nearly 22 inches of snow on the
nation's capital. It served as a backdrop for a flurry of activity in the
halls of Congress this weekend, as Senate Democrats reached a compromise
agreement to move healthcare reform one step closer.

Joining me live this morning, the president's senior adviser, who traded
loafers for snowshoes this morning, David Axelrod.

MR. DAVID AXELROD: We call this a dusting in Chicago, David, I just want
you to know.

MR. GREGORY: Yeah, I know, I know. Well, I'm from L.A. and this is a big
deal. Thank you very much for being here.

MR. AXELROD: Uh-huh.

MR. GREGORY: You appear to have this compromise now in the Senate, 60
votes now that Ben Nelson is onboard. Is this mission accomplished, or
does this represent a selling-out of key principles that the president
fought for initially on health care?

MR. AXELROD: Oh, no, I think this, this adheres to the key principles
that the president set. It's going to bring more security to people who,
who have insurance today in relation to their insurance companies, it'll
reduce their costs over time as well. It's going to help people who don't
have insurance, including small businesses who can't afford it or people
who don't get it through their employer, get it at a cost they can
afford. It's going to extend the life of Medicare and give seniors some,
some more support in terms of prescription drugs and better care. And in
the long run, it's going to reduce our deficits, the CBO said yesterday,
by $132 billion in the first 10 years, over a trillion in the second,
and, and, and stop the inexorable rise of healthcare costs that threatens
to crush our budget...

MR. GREGORY: Right.

MR. AXELROD: ...family budgets, business budgets.

MR. GREGORY: Well, we'll--I want to break some of these down. But do you
describe it as mission accomplished?

MR. AXELROD: No. I, I think it is a--it's a landmark step, it's a, it's a
great step. I agree with much of what Paul Krugman wrote in The New York
Times last Friday, he's been a strong advocate for healthcare reform, and
he said this is a great foundation for the future. It is light years
ahead of where we were. Look, David, if you're a person with a
pre-existing condition today, you're excluded from getting insurance by
most insurance companies. I went through that with my child--has a
chronic illness, could not get her on insurance. A huge--this was when I
was a young reporter and couldn't afford the out-of-pocket expenses.
Millions of people are going through this in this country, and there are
myriad other examples of, of people who will benefit from these changes.

MR. GREGORY: Let me back up, talk about just some procedure. Is this a
done deal? Will this pass the Congress?

MR. AXELROD: I think it will pass the Congress. I mean, obviously, it is
a big step along the way. We've got additional steps to take. The House
has a bill, the Senate has a bill, they'll have...

MR. GREGORY: And there are some key differences, including the House has
a public option to create more competition, the Senate bill does not.

MR. AXELROD: No. But the Senate, the Senate bill has some very tough
restrictions in terms of how insurance companies can spend the money that
they collect from premiums, it has a great accountability for insurance
companies, it creates competition between private insurers and gives
people options and choice, and that's what we were after.

MR. GREGORY: But how hard will it be to reconcile the two?

MR. AXELROD: Well, I think we're going to get it done. I think people
understand that this is a historic crossroads, David. Seven presidents
have tried to pass comprehensive health insurance reform, seven
presidents have failed. We've been talking about it for 100 years. We're
on the doorstep of getting it done, and it'll be a great victory for the
American people.

MR. GREGORY: Some people have raised the question about whether the
Senate rules ought to be changed. In order to avoid a filibuster you
needed the 60 votes, and you were able to get there with Senator Nelson.
But a lot of people, including Planned Parenthood, condemning the
abortion agreement where it would place greater restrictions on getting
abortions in the states in these exchanges that had to be struck to get
Senator Nelson onboard. He also got extra money for Medicaid. Do you
think it ought to be changed in the Senate so it doesn't rely, all of
this healthcare reform, on one senator?

MR. AXELROD: Let me say first on the, on the issue of abortion, there
have been concerns expressed both from the pro-choice groups and some
anti-choice groups, pro-life groups on this. But the fact is it really
doesn't change the status quo, and that's what we were after. The
president said this should not be the vehicle through which the abortion
debate and changes in the abortion law should come. In terms of the
Senate...

MR. GREGORY: Yeah.

MR. AXELROD: ...look, I'm not--these are time-honored rules. I'm not
going to--I mean, obviously it makes it more difficult, they were
structured that way. What we should be able to do, though, is move
forward in, in, in good faith, and what we've seen is the rules being
used time and time and time again to delay votes, to try and scuttle the
legislation by--through parliamentary maneuvers, because there's a
majority of senators who support health insurance reform. We ought to
have an up or down vote, and that's what all of this has been about.

MR. GREGORY: Are you going to get this by the end of the year?

MR. AXELROD: Well, I think that the--I'm, I'm confident that the Senate's
going to vote on this before they go home.

MR. GREGORY: Before Christmas. But then a final bill, a reconciled bill,
do you think you get it by the end of this year?

MR. AXELROD: Oh, no. I mean, I think that we're going to have some work
to do when we come back. But obviously, this is a major step forward.

MR. GREGORY: Let me talk about where the public is on this. This was our
poll this week, Wall Street Journal/NBC News. Good idea, bad idea, the
president's healthcare plan? Forty-seven percent say it's a bad idea, 44
percent say they thought it'd be better to keep the current system. Is
the public really for this?

MR. AXELROD: I think that there's a big anomaly in the polls that's worth
discussing. When you ask people "do you support the bill that's working
through Congress, the president's bill" and so on, they give you that
result. When you describe what's in the bill, when you describe the fact
that there are all kinds of protections for patients and consumers within
the system, a, a, a, a patient's bill of rights on steroids, as--we've
had that debate for years, are we going to protect patients? When you'd
say--when you explain that small businesses are going to get tax credits
and assistance so they can offer health insurance, and that individuals
who don't get it through work are going to be able to get health
insurance at a price they can afford, when you talk about the fact that
it reduces deficits, extends the life of Medicare; when you talk about
all of those things, people are very strongly supportive. But that's not
the picture they've gotten through this kind of narrow debate we've seen
on television in Congress.

MR. GREGORY: The fact that you have no Republican votes is striking here
for healthcare reform. If you go back to Social Security or the Medicare
vote in the '60s, significant Republican support. Is this a failure of
leadership, that the president can't get one Republican to support this?

MR. AXELROD: Well, obviously we live in different times. I wish we had
the kind of spirit of, of cooperation that you saw in, in past
generations. We live in a, a, a different time. As you know, at the
beginning of this debate one of the Senate Republicans said, "If we can
just defeat this bill, we can inflict a great political loss on the
president and that will help us as a party." We shouldn't be thinking in
those terms. We should be thinking about the people who can't get
insurance today. We should be thinking about the people who get thrown
off of insurance because they become seriously ill or go bankrupt because
of a serious illness.

MR. GREGORY: But how do you describe...

MR. AXELROD: They will be helped by this legislation. And that's what we
should be doing, Republicans and Democrats.

MR. GREGORY: But talk about Republicans. How do you describe, how do you
describe and assess the Republican minority in Washington today?

MR. AXELROD: Oh, in what, in what regard? I mean, I think what's clear...

MR. GREGORY: You--do you...

MR. AXELROD: ...is that they, they have adopted a strategy of opposition,
and they have not offered alternative--significant alternative ideas,
other than to go back to what we've done before. Look, historically these
health reforms have been beaten by the special interests, the insurance
industry.

MR. GREGORY: Right.

MR. AXELROD: They are trying to defeat it now. The Republican Party
historically has stood with the insurance industry in trying to beat back
reform. And they're playing that traditional role, and that's a shame.

MR. GREGORY: You've got it not just from the right, but you've also got
criticism from the left. There was something of a, of a revolt in the
Democratic Party over health care this week, led by former DNC Chairman
Howard Dean, who we'll be speaking to on the program in just a couple of
minutes. And essentially, he said, "This is not reform. And if I were a
senator, I would vote against it." How do you react to that?

MR. AXELROD: Well, first of all, let me say I respect Howard Dean. I
think he's someone who cares passionately about this issue. He's a
medical doctor. He--but what--but he just wasn't familiar with some of
the aspects of this legislation. He said, for example, that insurance
companies could skim off unlimited amounts of money for bonuses and CEO
pay and administrative costs. This strictly limits what they can do, and
consumers will get rebates if they exceed those limits. And those limits
are high and they're reasonable. He said that people would be forced to
buy insurance at a price they can afford. There's a hardship exemption in
this legislation, no one would have to pay more than 8 percent, be forced
to buy a policy for more than 8 percent of their income, and they get all
kinds of assistance in terms of tax credits to do so. So I just think
when you look at the bill in its totality, it, it doesn't square up with
his critique.

MR. GREGORY: But, but look--here--but here's the issues. Look--what
liberals say is look at what you gave up along the way: Medicare
expansion, a public option. And then go back and look at the president's
performance when it came to getting this compromise vs. how he campaigned
for health care as a candidate. And I've got a few of the bullet points
of campaign promises made: that it--there would be universal coverage
when it came to getting health care. He opposed an individual mandate,
which, of course, is part of this bill. And he indicated this would be
paid for by rolling back Bush tax cuts, tax cuts. There's not universal
coverage here. The individual mandate is in there and, in fact, there are
a slew of taxes that are part of this legislation, including on the
Cadillac plans that a lot of union members hold. So can't you understand
that the left in this country says, "Hey, this is not how you
campaigned"?

MR. AXELROD: No, David. I--what--here's what I see. What I see is a bill
that will afford 30, 31 million people who don't have insurance today a
chance to get it. It will help small businesses who can't give their
employees a chance to get it. It will help people who have insurance so
that they have the power in their relationship with their insurance
companies. It will reduce--the president talked about reducing this
inexorable rise in premiums and in the cost to our budgets. It will do
that. It will improve care. I think this is major reform, it's the reform
he spoke about. Obviously...

MR. GREGORY: But this is a compromise.

MR. AXELROD: ...in any legislation...

MR. GREGORY: It is not the major reform he talked about.

MR. AXELROD: There is no...

MR. GREGORY: It is different.

MR. AXELROD: ...major piece of legislation that's ever been passed in
this country, David, that doesn't include compromise. That's the
legislative process. But the question is, in the main, does it achieve
what we wanted to achieve? This is--it's not perfect. It--and over time
it may be improved, as all legislation is.

MR. GREGORY: Do you think it should be improved?

MR. AXELROD: I, I--well, look, the president had a--the president
supported a, a public option. But there are other ways to get competition
and choice. You know, we'll see what happens over time.

MR. GREGORY: He supported a public option. He did not fight for it till
the end of the day.

MR. AXELROD: Well, look, he made the case again and again for it. But
understand, he--this is a small part of a large healthcare reform. The
public option was within this health insurance exchange for the 30
million who can't get health care.

MR. GREGORY: Right.

MR. AXELROD: The estimates of the CBO that--is that, you know, about five
million people would have availed themselves of it in a country of 300
million.

MR. GREGORY: But here's, here's New York...

MR. AXELROD: Let's not overemphasize it.

MR. GREGORY: Yeah.

MR. AXELROD: It is important, it's valuable, but so are the reforms that
are in there now. There's going to be competition and choice for everyone
who doesn't have insurance today. They're going to get it at a price they
can afford. And, and we won't have this horrible situation where if you
move job--if you change jobs or lose your job, that you find yourself
suddenly vulnerable to catastrophe.

MR. GREGORY: I want to press you on one other point that needs to be
challenged, it seems to me. The president said this week that this
legislation will bend the cost curve. Now, I take that to mean you bend
the cost curve, that healthcare costs begin to come down. In fact, in
this legislation--and not just those familiar with it, but other experts
I've talked to say it's not the case, it will not actually bring costs
down. In fact, over a 10-year period, costs will go up. They may be
contained, but they are going to go up. Healthcare costs do go up. There
are only pilot programs in this legislation, only pilot programs that
actually bend the cost curve. This is not reform when it comes to
bringing down overall healthcare costs.

MR. AXELROD: Well, I'd say a few things about that. Every--all of the
healthcare economists look at the, look at this bill and say it contains
many or most or all of the, the sort of major devices that have been
talked about for lowering care. The bill--the amendment that was added
yesterday will quickly expand these pilot projects as they work
nationally. And, you know, you can look at what the CBO has said: it's
going to reduce deficits by $132 billion in the first year, by a trillion
in the next year, and it's going to slow the advance of health costs and
it's going to save thousands of dollars in premiums for the average
family over the next decade.

MR. GREGORY: But that's slightly different than saying that
healthcare costs are actually going to start coming down.

MR. AXELROD: David, we're going to insure...

MR. GREGORY: And that was the priority initially the president talked
about.

MR. AXELROD: David--no, the president said we have to slow the growth of,
of these premiums, which have doubled in the last 10 years and will
double again in the next 10 years or more if we don't act.

MR. GREGORY: Let me ask you, finally, about the political impact of all
of this. This is the president's approval rating as it stands now,
according to our poll: he's below 50 percent in approval at 47 percent.
Among independents, look at this, his approval rating is at 40 percent,
down from 58 percent back in March. Peter Hart, the Democratic pollster,
indicates that for Democrats, the red flags are flying at full mast. At
what political cost to the Democratic Party in 2010 and 2012 have you
achieved this victory?

MR. AXELROD: Well, first of all, I don't ascribe poll numbers to, to this
particular, to this particular issue. I think that we're governing,
remember, in an economically difficult time. We came to office in the
greatest economic downturn since the Great Depression, and so of course I
could've told you a year ago that our numbers were not going to be, were
not going to be as strong a year later. But here's the thing, David. If
we--I guarantee you, the one thing the president's not doing is spreading
the NBC or any other poll in front of him and pondering the political
ramifications. What he's looking at are the, the millions and millions of
people who have pre-existing conditions who can't get health care; the
millions of people who--working people who can't get health coverage
because they can't afford it. He's looking at the implications for our
long-term budget if we don't act. He's looking at Medicare and its
survivability. We'll add 10 years to Medicare through this health reform.
Those are the numbers he's looking at. If the president--the president's
belief is if he does his job and moves this country forward, the rest will
take care of itself. I don't think anybody wants a president who's
governing according to the NBC/Wall Street Journal poll or any other.

MR. GREGORY: He spent a lot of political capital on this fight. Will it
cost Democrats House seats or Senate seats in 2010?

MR. AXELROD: I think a year from now, when this bill passes and this wave
of insurance reforms are implemented that give people more power in their
relationship with their insurance companies so they don't--they're not
the victims of arbitrary decisions; when, when seniors realize that their
prescription drug costs are less because we've begun to fill in that
doughnut hole; when small businesses begin to get those tax credits to
help them get health care, they're going to say, "You know what? This was
a pretty good deal for us."

MR. GREGORY: Are they--are the Democrats going to lose seats in the House
or the Senate because of this legislation?

MR. AXELROD: I think we're going to have a good result next, next
November. I'm not going to predict where we are. Again, we're governing
through difficult times. I think we're going to be in a better place. And
what I suggest is that you guys wait until next October to talk about
polls, when they're actually germane to an election, because that's a,
that's an eternity away.

MR. GREGORY: All right, David Axelrod, thank you very much.

MR. AXELROD: Good to be with you.

MR. GREGORY: Continued good luck with your hard work.

MR. AXELROD: Thank you.

MR. DAVID GREGORY: Now we are joined by a Democrat who has been openly
critical of the Senate healthcare bill, Dr. Howard Dean.

Governor Dean, welcome to the program from Vermont. You heard David
Axelrod here, that this is significant reform but something short of
mission accomplished. What do you say this morning?

DR. HOWARD DEAN (D-VT): Well, first of all, you've got more snow than we
do up here in Vermont.

MR. GREGORY: Yeah.

DR. DEAN: Well, let's start with the positive things. Over the last week
there were some things that were improved. David mentioned the so-called
medical loss ratio, the limits on what insurance companies make, and that
was true. That was added to the bill. It was, it was in a form that the,
the CBO wouldn't have allowed, and now it was allowed. It's not all that
strong, but it's strong. We can expect some, some gaming by the insurance
companies, but it's there. There were some cost control mechanisms that
were gutted; they got restored. So there are some things here, but there
are still big loopholes. The major cost control commission that was going
to control costs, which had been gutted in the bill as a week--as of a
week ago, is restored; except it doesn't apply to hospitals, which, of
course, are the biggest drivers of cost controls--I mean, of cost
increases. So the bill is better than it was, but it's still got a long
way to go. I, I--we're--right now I'm going to disagree with David on a
number of things, the pre-existing conditions and the aging. The Senate
bill says you can charge three times as much for somebody who's older
than who's younger. Now, the House says twice as much. In Vermont it's 20
percent more, it's 1.2 times what an ordinary person pays. That's clearly
not a--it is--there is going to be insurance that's unaffordable. Suppose
you make $70,000, $80,000 a year, you could end up paying $20,000 for
your insurance under the, under the Senate bill. So, you know, there are
some big, big problems.

Here's the major problem, David. We have committed--in this last week of
unseemly scrambling for votes, we have committed to go down a path in
this country where private insurance will be the way that we achieve
universal health care. That means we're going to have a 30-year battle
with the insurance industry every time when we try to control costs and
try to get them do things. It is not a coincidence, David Gregory, that
insurance company stocks, health insurance company stocks, hit a 52-year
high on Friday. So they must know something that the rest of us don't.

MR. GREGORY: The question is whether this is in keeping with the, the
president's principles on health care; the way he campaigned, the
promises he made in terms of how he would lead an effort to get
healthcare reform, including the public option, which you heard David
Axelrod say he supported. Did he fight for these principles, in your
view, the way he should have?

DR. DEAN: Well, look, I, I think this is, this is not universal health
Care, it's about 94 percent. But he certainly tried very hard. But
I think the absence of having choices for Americans, real
choices--including a system like Medicare, which only has 4 percent of
its expenditures go to nonhealthcare expenditures, as opposed to 25 or 20
percent in this bill that's just about to pass--I think that's a big
loss. And the bottom line is, in a unseemly scramble for votes that have
nothing to do with long-range public policy, we have really essentially
cut out the idea that Americans will have a choice of a different kind of
insurance system. The same kind of insurance system people over 65 have,
the same kind of insurance that veterans have. A lot of us would have
liked to have that system, because it's so much more effective and,
frankly, so much more satisfactory that what we see in the private
insurance sector.

MR. GREGORY: You say an "unseemly scramble for votes." For Senator
Lieberman, they had to give up Medicare expansion or else he would not
have voted for it. For Senator Nelson, much the same thing, and also
including this--these restrictions on whether abortions can be paid for
in a federal exchange of private insurance plans. Given this rush and the
compromises made for votes, do you stand by your words this week that you
would not vote for this bill?

DR. DEAN: I would certainly not vote for this bill if this were the final
product. But there are--the House bill is a--quite a good bill. This bill
has improved over the last couple of weeks. I would let this thing go to
conference committee and let's see if we can fix it some more, because
this...

MR. GREGORY: What needs to be fixed specifically?

DR. DEAN: Well, first of all, the cost controls need to apply to
hospitals. Second of all, we really do need some kind of a public option.
At least allow the states to have a public option, a real public option,
because they--you know, some senators have said, "Well, there's a public
option to the bill." Well, that's not really true. The public option in
this bill is allowing the federal government to, to negotiate with
private insurance companies. That's not a public option.

MR. GREGORY: But, Governor, do you really expect the White House to fight
for any form of a public option at this stage of the game?

DR. DEAN: Well, obviously we've been very disappointed by, by that. We,
we don't think that there has been much fight in the White House for
that. Another big piece that needs to be fixed is we--I don't think we
ought to be able to charge older people three times as much as you charge
younger people. The House has twice as much, that's still too much. So
there's a lot of things that need to be fixed. But if they are fixed, you
aim--may actually get the foundation of a bill coming out of the House.
If most of the House provisions survive, then we could have a bill that
we could work with. But this elimination of the public option is a real
sticking point, because that, in fact, is how you really save money and
bend the curve in expenses.

MR. GREGORY: But I just want to be clear. So your advice, former chairman
of the party, to House and Senate members who come to the point of a
final bill, if it does not have a public option, your advice would be
vote no.

DR. DEAN: I think it's got to have a public option, at least some of
this--some--at least allow some of the states. Now, there are two
countries that have done this without a public option, Switzerland and
the Netherlands, but they treat insurance companies as public utilities.
That's what we would have to do. And I don't have an objection to that.
The--my, my concern about the public option is not ideological. But I
just think a 30-year fight with the insurance industries over every
little detail about how they're going to control costs is something that,
judging by this past week, when the insurance companies...

MR. GREGORY: Right.

DR. DEAN: ...have essentially wrote the bill, is not likely to happen.

MR. GREGORY: All right. But, Governor, my, my question was, without the
public option, is your position say no to the bill?

DR. DEAN: My position is let's see what they add to this bill and make it
work. If they can make it work without a public option, I'm all ears. I
don't think that's possible.

MR. GREGORY: The question of compromise is a very interesting one. Back
in 1995, in the wake of the collapse of healthcare reform, you said that
you made a mistake, you and others made a mistake by not compromising on
health care with the Republicans. And Vicki Kennedy--the widow, of
course, of the late Senator Kennedy--has penned an op-ed this morning,
and this is what she writes. And the headline: The moment Ted Kennedy
would not want to lose. “Ted knew that accomplishing reform would be
difficult. ... He predicted that as the Senate got closer to a vote,
compromises would be necessary, coalitions would falter and many ardent
supporters of reform would want to walk away. He hoped that he wouldn't
do so--that they wouldn't do so. ... Ted often said that we can't let the
perfect be the enemy of the good. He also said that it was better to get
half a loaf than no loaf at all, especially with so many lives at stake."
You heard David Axelrod essentially say legislation like this is so
difficult. Can--you can never achieve perfection. In the light of what
Vicki Kennedy says, do you have a different view of whether compromise
has been worth it here?

DR. DEAN: I think there's been an enormous amount of compromise. I think
the compromise, frankly, has been too much. Here's the basic problem, and
I'll--I said it before and I'll say it again. We have set this nation
down a course where we're going to do this through public insurance. It
is--I mean, private insurance. It is possible to do that. Two other
countries that I know of do that exclusively in private insurance. It is
very, very difficult. It is very, very expensive. We are nowheres near
where Switzerland and the Netherlands are in terms of their regulatory
apparatus on the private insurance industry. So I, I, I just think this
is going to be a very, very difficult, tough row to hoe. She also wrote
in that editorial is we, we need to be sure we get this right, and I
agree with that.

MR. GREGORY: The politics of this are part of it, and people have talked
about it. Indeed, your opposition this week, which I had mentioned
before, set off something of a revolt within the party, led to some
strange political bedfellows for you. Senator John McCain, on the floor
of the Senate, said this.

(Videotape, December 17, 2009)

SEN. JOHN McCAIN (R-AZ): If you live long enough, all things can happen.
I now find myself in complete agreement with Dr. Howard Dean, who says
that we should stop this bill in its tracks. We should go back to the
beginning and have an overall bipartisan agreement. Dr. Dean, I am with
you.

(End videotape)

DR. DEAN: Wow

MR. GREGORY: How do you react to that?

DR. DEAN: ...I, I think, you know, the Republicans' behavior has been
reprehensible. They haven't lifted a finger. All their, their--they, they
have really put their party in front of their country here. You know,
they could have made this bill a better bill, but they choose just to
kill the bill because they thought they did do that for political
reasons. First--and I don't believe there's a bipartisan compromise
possible. As David Axelrod said, the Republicans of today and the John
McCain of today is not the same--not even the same as the Republican
Party of eight years ago, and it certainly isn't the same as the
Republican Party my father was in until the day he died. So it--you know,
I respect John McCain, but it's, he wouldn't be the first person who
twisted my words around and used them for something I had no intention of
endorsing, which is the Republicans' behavior in this bill.

MR. GREGORY: Given your own fight within the Democratic Party, and indeed
within the Obama administration, do you intend to stay in the Democratic
Party?

DR. DEAN: Of course. Absolutely. I, I've said I would vigorously support
the president's re-election in 2012. I have every intention of doing
that. Look, whatever fights we have inside the Democratic Party--and this
is a very, very, very sore one, because I really do think we're going
down a track that's not going to be helpful in the long run without some
really brutal fights ahead of us. But, you know, President Obama, first
of all, has had a terrific record on the environment. Despite his
struggles, I think he's actually moved the dialogue in Copenhagen
forward. He's--he restored America's good name around the rest of the
world. I mean, he is so far ahead of whatever the Republicans might
choose to do in 2012 that of course I'm going to support President Obama.

MR. GREGORY: The columnist for The Washington Post, E.J. Dionne, has
warned of, quote, "political catastrophe if Democrats still turn and keep
turning on one another over health care and other issues." What will be
the political consequence of this healthcare debate and the compromise
that's been achieved?

DR. DEAN: Look, first of all, I hope this isn't the compromise that's
been achieved. I think we have yet to see the compromise that we could
achieve. Secondly, this isn't personal. I like David Axelrod. We've
actually talked back and forth through the week, as I have with other
people in the White House as this has gone on. We're all in the same
family. But this is a serious business. We have seen, essentially, a
destructive political process in Washington where the insurance company
lobby essentially wrote a good piece of this bill. Now, I'll admit that
they have pulled back in this past week. There's some things in this bill
that weren't in there a week ago that make it a better bill. But this
can't be the final version of this bill. It simply sets us on a track in
this country which is expensive and which--and is where we're going to
have lots more political fights, where a few senators who are beholden to
the insurance industry can hold up what real--the kind of real progress
that we could have made had we passed what the president suggested when
he was running for president.

MR. GREGORY: So final question for you, as for David Axelrod. Do you
think healthcare reform, as ultimately passed by this administration,
will end up costing Democrats seats in the, in the House or in the Senate
next year?

DR. DEAN: It's hard to know without the final result. I think if this
bill doesn't go into effect until 2014, it'll be so complicated that the
Republicans will make it a target and we'll have a hard time explaining
it. Another benefit to the public option, especially to the Medicare deal
that was on the table a week ago in the Senate, is that people could have
gotten in in large number, four or five million people, within two or
three months after the president signed the bill. That would have gone a
long way to making sure that the American people understood it, because
their neighbors would have health insurance that didn't have death
panels, where you were allowed to charge your doctors and with all this
Republican nonsense propaganda would have been put to bed by the American
people.

MR. GREGORY: All right.

DR. DEAN: That would have made 2010 a lot easier for us.

MR. GREGORY: Governor, Doctor, Chairman Dean, thank you very much. We'll
send some of our snow up your way.

DR. DEAN: Thanks, David.

MR. GREGORY: Up next, the politics behind this healthcare debate and the
other major challenges now facing President Obama. Our roundtable weighs
in: Joe Scarborough, Markos Moulitsas, Ed Gillespie and Tavis Smiley,
only here on MEET THE PRESS.

(Announcements)

MR. GREGORY: The politics of the healthcare debate with our political
roundtable, after this brief commercial break.

MR. DAVID GREGORY: We're joined now by the Daily Kos' Markos Moulitsas,
MSNBC's Joe Scarborough, Ed Gillespie of the Resurgent Republic and PBS'
Tavis Smiley--who, unfortunately, because of the snow in Los Angeles,
couldn't make it here. Oh, wait. No, no, no, it was the snow here.

You couldn't make your flight, so you're, you're out in L.A. And I should
just say to you and our, and our audience, Tavis, there is a significant
delay between us, so we'll, we'll just--we'll try to manage all of that.

So welcome to all of you. There's so much to discuss.

Markos Moulitsas, I want to start with you. You heard David Axelrod say
this is in keeping with the president's principles; it is in keeping,
this compromise on health care, with the way the president campaigned on
this. And this is the bill, essentially, the reform that Americans
deserve. What do you say?

MR. MARKOS MOULITSAS: Yeah, I don't think this is a reform bill. I mean,
I think it's very clear, this is not insurance or healthcare reform. What
it is, it's allowing more people, 30 million people, to buy into the
existing broken system. It's very important to keep in mind that
healthcare insurance is not the same as health care. Insurance, not the
same as care. If you go up to Massachusetts, they have a, a mandate as
well, and last year 21 percent of people in Massachusetts could not get
health care because they could not afford it. Even though they had
insurance, the premiums--not the premiums, the deductibles, copays and
out-of-pocket expenses were too high. So really, this isn't reform. It's
expanding the system, it's almost rewarding the existing system. Now,
what is important about this is that it actually puts the federal
government, puts America on the place to say health care is a right, it's
not a privilege to just those who are--who can afford it or who are lucky
enough to have a good job that has good benefits. But as far as reform
goes, I think this is a long battle that we have ahead of us.

MR. GREGORY: Joe Scarborough, what has the president achieved?

MR. JOE SCARBOROUGH: Well, he's made a lot of people with insurance stock
a lot richer. I mean, this is great for insurance companies. They're
going to reform the system. Neither side wanted to take on the insurance
companies. Neither side wanted to get rid of the antitrust exemptions.
Neither side really pushed hard to allow you or me or anybody here to buy
across state lines. And as Howard Dean said, and this is a devastating
fact, insurance companies' stocks reached a 52-year high on Friday after
this so-called reform bill got its 60th vote. So David Axelrod, who I,
you know, love and respect, but David Axelrod kept saying, "We took on
the insurance companies. This is real reform. They're against it."
Really? I don't think so.

MR. GREGORY: Tavis Smiley, you've always advocated for the public option
being part of this. You heard David Axelrod say that, you know, the
president was for it, but we know that he didn't really fight for it. And
Governor Dean just said, "Look, without a public option in the ultimate
compromise legislation, this cannot be considered reform."

MR. TAVIS SMILEY: Yeah. Throughout the campaign, the president promised
change. We have change on the horizon here but, unfortunately, it's small
change. I find myself kind of like John McCain agreeing with Howard Dean,
here I am agreeing with my friend Joe Scarborough.

MR. SCARBOROUGH: Oh, God.

MR. SMILEY: I think the real winners here are the insurance industry.
They're, they're the--yeah, they're the ones who win here. I mean, you,
you, you walk through that list, David, of those points you put up
earlier. The president wanted the public option, the industry said no.
The president wanted to tax their windfall profits, the industry said no.
The president wanted to do a variety of things, the industry pushed back.
And here's the problem for me. It's not just, David, that we're not
getting the kind of health care that we were promised we were going to
get, it's that in the president's first big fight with a powerful lobby
in Washington, the White House lost and they lost big. And that, I think,
portends something very dangerous down the road for all the other issues
we have to deal with where lobbies are going to be pushing back on the
White House.

MR. GREGORY: Ed Gillespie, speaking for conservatives...

MR. ED GILLESPIE: Yeah.

MR. GREGORY: ...what has the president achieved?

MR. GILLESPIE: Well, I think he's achieved actually a lot in terms of
expanding the size and scope and power of the federal government. And the
fact is, this bill is an unmitigated disaster. It's going to increase the
cost to the federal government on health care, it doesn't bend the cost
curve down. Spending is going to go up on health care. It increases--it's
going to increase personal insurance costs to consumers, people are going
to have higher premiums. It's going to increase the debt and the deficit
before it's all over, because the savings are illusory. In fact, 98
percent of the spending in this bill actually occurs in the fifth year
on. So they back-load the spending, front-load the, the cost, the tax
increases, $518.5 billion in new and higher taxes, $471 billion in
Medicare cuts. People are going to see their quality of care go down both
in the--whether you're a Medicare beneficiary or a private insurance
beneficiary. And I think at the end of the day, this bill is going to
cost a lot of Democrats a lot of seats.

MR. GREGORY: Well...

MR. SCARBOROUGH: I was going to say, David, if, if, if I could answer
that. What this bill is going to do for conservatives is elect a lot of
conservatives, for a lot of the reasons that Ed just said. But also, if
you look at the Daily Kos polls and talk--and look how Democrats are
depressed right now. This is, this is really starting to seem a lot like
2006, where--I talk to Republicans off the record all the time, they're
like, "Why should we vote for Republicans? They're not doing what we sent
them to Washington to do." I think that's what this healthcare bill does
for the Democrats.

MR. GREGORY: Markos, the president, in his radio address yesterday, spoke
really to progressives, defending the merits of this bill. Let's watch a
portion of what he had to say.

(Videotape, December 19, 2009)

PRES. BARACK OBAMA: Simply put, the protections currently included in
both the health insurance reform bill passed by the House and the version
currently on the Senate floor would represent the toughest measures we've
ever taken to hold the insurance industry accountable.

(End videotape)

MR. GREGORY: You've heard--David Axelrod made that same point, but you
don't buy it.

MR. MOULITSAS: Well, it's a low bar. I mean, if you're going to say the
toughest efforts we've ever had, we've never had any efforts to hold the
insurance companies accountable. So therefore, yeah, this is--meets that
definition. But the fact is that we, we don't have a system that
really--that--we don't have an industry that has a history of
accountability. I mean, in California a couple of years ago, they
actually banned recisions. Blue Cross, which is the largest insurer in
the state, had 1700 recisions the last four years. The state tried to go
after them, they were outgunned by the insurance industry's lobbyists and
lawyers.

MR. GREGORY: Recisions. You mean people that are, that are excluded.

MR. MOULITSAS: People who paid for insurance...

MR. GREGORY: Yeah.

MR. MOULITSAS: ...thinking they had coverage, only to have the insurance
company come in later and say, "No, we're not going to cover that
expense." So we have a system that clearly--we have an industry that does
not believe in accountability, refuses it and fights it every step of the
way.

MR. GREGORY: What about the idea that, you know, there's realism and
there's idealism. You know, you may represent the idealistic wing of the
party, but getting legislation like this through is incredibly difficult.
And whether it's Vicki Kennedy and her op-ed--if Senator Kennedy were
here, she suggests he would be willing to compromise to get some kind of
foundation for real reform.

MR. MOULITSAS: Well, we're still fighting this thing. This, this is not a
done deal, we still have reconciliation to go to. But it's true, this is
a very difficult process. We have a Senate that is broken, where a
minority party that has no interest in governing, fights any effort
reform. They don't want to lend a hand in it, won't even engage in an
honest exchange of ideas. I mean, their, their idea of a debate is to
talk about death panels and killing grandmother. On the other hand, we
have $260 million spent by the insurance lobby to fight this bill. That
is double what was spent in 2004 by John, John Kerry and George Bush in
the presidential election.

MR. GREGORY: Do you--Tavis Smiley, do you think Democrats--that sort of
the political consequence of this, of, of this achievement, if it comes
to pass, ultimately hurts or helps Democrats next year? Think about Harry
Reid. Think about Blanche Lincoln and tough seats.

MR. SMILEY: I think ultimately it, again, depends on what the bill is
going to be. But I do believe that you have to stand on your principle.
And with all due respect to the White House and the president, who
deserves great credit for taking this issue on and pushing it further
down the field than any other seven presidents have done, you still have
to ask where is the principle that we started out with, and how firm have
we stood on that principle? I think that the danger of this White House
is this, that the president and his team appear to be incrementalists. I,
I warned the last time I was on this program, quoting Dr. King, about
taking the tranquilizing drug of gradualism. I don't know that we get
from here to there on all the issues that matter to Americans, that we
sounded off on at the polls last year. If the strategy on health care, on
torture, on climate change, on the economy, is going to be one of
incrementalism, that ain't going to get it done.

MR. GREGORY: All right, we're going to take a quick break here. We'll
come back. More on the president's political standing, the polls and some
of the other big issues that he faces. Our discussion, right after this
brief station break.

(Announcements)

MR. GREGORY: And we're back with our roundtable this morning, talking
about the president's political position as his first year in office
comes to a close.

Ed Gillespie, let's look at some of the numbers from our poll this week.
The president's approval rating, as I noted before, below 50 percent,
that's at 47 percent. Handling the economy, 51 percent disapproval.
Handling of foreign policy, this is the bright spot, at 49 percent over
42 percent. He was at a high in terms of approval rating of 61 back in
April. What's happened?

MR. GILLESPIE: I think he's moved way too far to the left, interestingly,
in contrast to others here on the panel today, and independent voters are
moving away from him in droves. Republican intensity is through the roof.
I think when you look at approval of Congress, Democrats in Congress vs.
Republicans in Congress--Resurgent Republic, the organization I founded,
did some research and found 55 years and older voters two-to-one say that they
trust Republicans to handle the issues they care about, independents
in that survey, over Democrats. We haven't seen numbers like that since
'94, when Joe Scarborough and others came in to win the House back for
Republicans. I think we're looking at that kind of scenario. It's early
yet; but if things remain constant between now and November, I think
Democrats are truly at risk of losing the House.

MR. GREGORY: It's interesting. Joe, on that point, look at this. The
right track, wrong track direction of the country, and we know that this
is also a measure of independent support in the country: right track, 33
percent; wrong track, 55 percent. Gets a little closer to where the
country was in November of 2008. And it was noted this morning, if you
look at our poll, the number of people who think this Congress is the
worst ever is actually higher than it was back in 1994.

MR. SCARBOROUGH: Unbelievable, I know. And, and even worse than when I
was in Congress, which is saying a hell of a lot. But, you know, David,
the real problem with Barack Obama's first year's been all these
distractions. And health care's been a huge distraction for him. I know
this is very, very important to the base, but he's been talking about
healthcare reform. We've been talking about Afghanistan. We've been
talking about cap and trade. We've seen him go to Copenhagen twice. I
mean, the--it is jobs, jobs, jobs. The campaign slogan of the year,
"Bob's for jobs." In the end, it's all about jobs. Tavis was talking
about four or five issues where he showed incrementalism, where he needed
to be more bold. No, it all comes down to the economy. If there's a
silver lining in this ugly healthcare debate that's finally coming to an
end, it's that the president can reset going into 2010 and focus on the
economy, focus on jobs. He needs to be in Youngstown, Ohio, instead of
Copenhagen. He needs to be in Cleveland instead of Oslo. He needs to
focus on reviving this economy.

MR. MOULITSAS: Well, you can't talk about health care and Afghanistan
being distractions. They're the reasons that Obama won the White House
and Democrats won control of Congress, including big, massive support
from independents. Independents knew what they were voting for when they
voted for Obama and the Democrats. I think the problem with Obama's
numbers and, and Congress' numbers is that people voted for a Congress
and a president that was going to take on entrenched interests. Now,
Republicans had jumped off the Obama bandwagon from day one. They were
never on board. Independents have sort of been unhappy because I think
independents really want results, and we haven't seen a lot of results.
We've seen a lot of bickering, and most of it has been internally within
the Democratic Party, and I think that's why they're turning off. And a
lot of Democrats are becoming disenchanted.

MR. GILLESPIE: I, I think one of the things that cost him with
independents is he has lost this--the--you know, one of the biggest
assets he had in terms of his identity was the post-partisan identity,
and that has gone by the wayside. I think people see this White House as
very partisan, partially partisan.

MR. GREGORY: But, Ed, you've been, you've been through this before.

MR. GILLESPIE: Yeah.

MR. GREGORY: I mean, George Bush came to town saying he was going to
change the tone, be a uniter not a divider, and, and ended up governing
from the right on issues, governing right out of the chute with tax cuts
and all the rest. So there is something about Washington, it's not just
the people who come here.

MR. GILLESPIE: But, David, let me say, when President Bush passed those
tax cuts, 12 Senate Democrats voted for his tax relief plan. No Child
Left Behind got bipartisan support. Medicare prescription drug bill got
bipartisan support. He did not jam these things through with a straight
party line vote, and that's what we're seeing right now.

MR. MOULITSAS: Yeah, you had a Democratic Party that was willing to
actually negotiate in good faith.

MR. GILLESPIE: You, you had a center right agenda...

MR. MOULITSAS: You do not have that. You do not have that.

MR. GILLESPIE: ...with a center right country, and Democrats voting for
something they knew was going to be popular back in their districts.

MR. MOULITSAS: Well, the center right agenda was...

MR. GILLESPIE: Not voting, not voting for bills that are opposed by a
majority of the, of the country.

MR. MOULITSAS: That center right agenda was completely repudiated by this
nation in 2006 and 2008.

MR. GILLESPIE: Well, we'll, we'll see.

MR. GREGORY: Well, well, but let me, let me...

MR. GILLESPIE: We'll see.

MR. GREGORY: On this unity thing, I want to bring something up. This was
the president talking about unity, that you're all talking about here.
And, Tavis, I want to bring you in on this. In--this is what he said in
October of 2008 about what he was going to do in Washington. Listen.

(Videotape, October 27, 2008)

PRES. OBAMA: In one week, we can choose hope over fear and unity over
division, the promise of change over the power of the status quo. In one
week, we can come together as one nation and one people, and once more
choose our better history. That's what's at stake.

(End videotape)

MR. GREGORY: Way back in January, if you look at our polling, the
question was, looking ahead, will 2009 be a time of unity? Forty-eight
percent division, 45 percent. In December, looking back, in fact, 12
percent unity, division 81 percent. Tavis:

MR. SMILEY: That's why campaigning and governing are obviously two very
different things. And that's why, back to the word of the day, you have
to stand on your principle. You have to know why you were elected, what
you came to Washington to accomplish, keep your eye on the ball. I
disagree here with Joe. These other issues, all of these issues the
president has tried to address this year are not distractions. Markos is
right about this. The president doesn't have the luxury of looking at a
checklist and walking it--walking down the list and checking off done,
done, done. It doesn't work that way. You have to work on all these
issues at the same time. Having said that, though, Joe is right about the
fact that it's about jobs, jobs, jobs. It's especially about jobs in
black America, where we are triple the national average, in some places
quadruple the national average of unemployment. And I think, quite
frankly, with all due respect to Time magazine, giving Ben Bernanke the
man of the year honor is like, how might I put this? It's like giving an
arsonist a citation of merit for starting a fire and then rushing to put
it out. I mean, no talk here about the role that he and others played in
getting us in this mess, but now we want to celebrate them for trying to
get us out. I think it's irresponsible. We got to keep our eyes on the
jobs.

MR. GREGORY: Right.

MR. SMILEY: But the truth has got to be told in Washington about how we
got in this mess, David.

MR. GREGORY: Joe, we're on, now, the brink of a new year.

MR. SCARBOROUGH: Mm-hmm.

MR. GREGORY: How does the president reset and move forward, change some
of this dynamic, his approval, relations with Republicans?

MR. SCARBOROUGH: Well, he's got to reach out to Republicans that want to
work with him on issues. He's got some great opportunities. Politico
reported a few weeks back he was going to focus on the deficit. Now, he
can't do a whole lot with the economy sagging, but he certainly can find
some allies there. Education reform, I'm really excited by what I hear
from Secretary Duncan, what I hear from the president about the fact that
he's going to take on teachers unions. He's going to go into schools that
have been problematic in the past and really talk about real reform. He
can do that. And also, he can, he can stop deferring to Nancy Pelosi and
Henry Waxman and Democrats on Capitol Hill. This year has been a year of
deference, where he's deferred--like, for instance, on the stimulus
package. This started very early, by the way, where the president came up
with an outline that a lot of Republicans said, "You know what? We may be
able to go along with that." They marched Axelrod and Larry Summers up to
the Hill. Democrats said, "No, we're in charge now." And so the division
started right away.

I would like to know, from either Tavis or Markos, where has he reached
out to Republicans in a meaningful way? Because I haven't seen it one
time.

MR. GREGORY: Well, let me--Markos, let me, let me--because we, we, we've
litigated some of that.

MR. SMILEY: Joe...

MR. MOULITSAS: I'll let Tavis take that.

MR. GREGORY: Well, no, no. But I, but I want to ask you, as you look
forward to the next year, Markos...

MR. SMILEY: And...

MR. GREGORY: ...and you, and you can--hold on, Tavis. What does the
president need to address to keep his own party in line? Should there be
personnel changes in the White House? What do you think the left is going
to demand?

MR. MOULITSAS: Well, 2006 is going to be a base year. It's going to be a
base election.

MR. GREGORY: 2010, you mean.

MR. MOULITSAS: I mean 2010.

MR. GREGORY: Yeah.

MR. MOULITSAS: And according to my own polling, we use an independent
pollster, 86 percent of Republicans plan on turning out or are likely to
turn out. Only 56 percent of Democrats are--similarly believe they're
going to turn out or likely to turn out. Only 32 percent of
African-Americans, only 41 percent of 18 to 29-year-olds. We have numbers
like that, we're going to get killed in 2010. So the Democrats have to
start paying attention to the base, have to start probably picking some
fights. I mean, maybe regulatory reform could be a way to do that.

MR. GREGORY: All right, thank you all. We're going to leave it there.

Tavis, way out there in L.A., thank you for being with us. Sorry about
the delay. Always great to have you.

Thank you all very much.

We're going to continue our discussion with Markos, by the way, and ask
him about the Obama agenda and the opposition from the left. It's in our
MEET THE PRESS Take Two Web Extra. It'll be up on our Web site this
afternoon at mtp.msnbc.com.

And we'll be right back.

MR. DAVID GREGORY: That's all for today. We'll be back next week. Merry
Christmas and happy holidays. And if you're on the East Coast, enjoy a
white Christmas, the remnants of the great December blizzard of 2009. If
it's Sunday, it's MEET THE PRESS.

Discuss:

Discussion comments

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