More than 20 states have passed so-called "Right-to-Try" laws that give terminally ill patients access to experimental drugs. What bypassing the F.D.A. could mean for clinical trials, treatment outcomes and patient safety.
Apologies from the Obama administration over rollout of the Affordable Care Act website. Congressional budget negotiators meet for the first time. And the deficit falls to the lowest level since 2008. A panel of journalists joins Diane for analysis of the week’s top national news stories.
- Major Garrett chief White House correspondent, CBS News.
- David Welna congressional correspondent, NPR.
- Liz Sidoti national political editor, AP.
A listener says the failure of the Affordable Care Act website reflects the “abominable state of government procurement, especially in IT services.” Liz Sidoti of the AP says a lot of people are wondering why it took a crisis like Healthcare.gov failing for the government to enact accountability measures.
MS. DIANE REHMThanks for joining us. I'm Diane Rehm. The Obama administration offers apologies for the rocky rollout of the Affordable Care Act. Republicans block the Senate from voting on two White House nominees and congressional budget negotiators meet for the first time since the shutdown. Here for the national hour of the Friday News Roundup, Major Garrett of CBS News, Liz Sidoti of the Associated Press and David Welna of NPR.
MS. DIANE REHMDo join us, 800-433-8850. Send us an email to email@example.com. Follow us on Facebook or send us a tweet. Thanks for being here everybody.
MR. DAVID WELNAHello, Diane.
MR. MAJOR GARRETTHi, Diane.
MS. LIZ SIDOTIHi.
REHMGood to have you all here. Major Garrett, you were the only network correspondent in Boston yesterday.
GARRETTRight. For the president's remarks, yes. And let's try to unpack the entire week. A lot went on with the healthcare law implementation.
REHMThat's for sure.
GARRETTSo in sequence, the president was in Boston hours after Health and Human Services Secretary Kathleen Sebelius had some rough moments, but I'd say, in general, fairly placid performance before the House Energy and Commerce Committee.
REHMAnd David Welna was there for that.
GARRETTExactly. So the president in Boston said the following. Massachusetts did this first. Massachusetts did this in a bipartisan way. Massachusetts had problems with its website early on. Massachusetts had very low enrollment numbers when it first started to roll out its universal compulsory health insurance law and because all sides worked together and were invested in making the law work, it has achieve some, though not all, of its goals and it takes time.
GARRETTAnd the Massachusetts model, not just legislatively, but as an implementation strategy ought to reassure the country that this national law can, in fact, work if you give it time, if you do not place obstacles in front of it and if you work to see it actually succeed as opposed to working to see it fail.
REHMAnd the thing he had to address was his statement that in 2009, that no one would lose their coverage if they wanted to keep it.
GARRETT2009, 2010, 2011, 2012 and as recently as March of this year, the president said if you like the plan you have, you can keep it, period. During the intense debate over this, he called accusation that you might lose your plan a myth. And the White House now falls back on what any administration does when it finds itself trapped by the clarity of its own rhetoric.
GARRETTThey say, well, you need to look at this in context. What we meant was if you had a policy when the law was signed, that was grandfathered in as is, even if it didn't meet the minimum requirements of health insurance under Obamacare. So the administration says, yes, we took in a bunch of bad policies in the individual market because we wanted to tell people they could keep the plan.
GARRETTBut the administration also knew that in a cyclical basis, almost every year, insurance companies alter the terms of individual health insurance coverage and every time that policy is changed, the premium either has gone up or the deductible is raised or the mix of coverage is changed, the administration says that policy now is no longer grandfathered. It must confirm to the Obamacare minimum requirements and that's why it has to change.
REHMAnd David Welna, Kathleen Sebelius faced the same kinds of questions.
WELNAWell, she faced a much more hostile audience than Obama did in Boston, but she kept up a pretty good game in front of those hostile questions. She was quoted as calling the rollout a debacle, that was using the word as one of her questioners to say that she was taking responsibility for the debacle, rather than blaming it on the president.
WELNAShe said that, you know, give it a bit more time. It will work out. She really didn't back down. She was not asked by a single member of that committee --not one of the Republicans asked her to resign. One suggested that one of her subordinates resign and she pushed back and said she would not ask him to do so. So she resisted them, but I was heavy weather there, whereas it was fair weather in Boston later in the day.
REHMSo Liz Sidoti, what does all this mean for the administration's desire, intention to get people signed up to this plan?
SIDOTIWell, I think what this means is that they're doubling down. They're saying, we recognize that there are problems here and -- but it's going to take time. Anything that's new and as fundamentally sweeping as this kind of change is isn't going to be smooth. I think the administration is committed to making sure that this works.
SIDOTII think they have little choice but to do whatever it takes. Politically, this is shaping up to be the defining issue heading into the 2014 midterm election cycle and Republicans who, earlier in October, missed an opportunity to make political hay out of this because the shutdown consumed the first half of October, now are coming back and believe that they have a really strong opportunity to use this to their political advantage and that they can recover from the shutdown drag on their numbers through this.
SIDOTIAnd the reason way is that everyone relies on healthcare. You know, healthcare is something that affects every single person in the country. And even if you are under an employee-sponsored healthcare plan right now, those plans are changing. Every company is taking a look at what the implications of the healthcare overhaul mean to them and they're shifting those plans as well.
SIDOTISo no voter in America is immune to this. And the Republicans think they have a really winning strategy heading into 2014 because of the, in Sebelius' words, debacle that is Obamacare at this point.
WELNAYeah. Well, I think, you know, you look at this and it's a program that clearly President Obama wants to be his legacy. You compare that to Mitt Romney back in Massachusetts, back in Faneuil Hall in '06 where he had a state legislature that almost entirely Democratic totally behind him on this, backing him up so that when his rollout went bumpy, he didn't have the kind of pushback that you're getting now from Republicans.
REHMHe was standing next to Ted Kennedy when he announced it.
WELNAAbsolutely. Yes. This was to be his legacy as governor...
GARRETTAnd a springboard to a presidential campaign later.
WELNAAbsolutely. And a program he would later almost disown. And, in fact, before Obama spoke in Boston on Wednesday, Romney put out a statement saying, you know, this is a program that can be done on a state level, but to try to do it on a national scale, I don't endorse that at all.
GARRETTThere's a really a couple of very important things for the administration to confront. Jeffrey Zients, who is about to become the new head of the National Economic Council for the president, is taking on a consultancy job for the president in emergency triage to save the website and get it working and to be fully functional by the end of November.
GARRETTThat's a target date that simply has to be met for a couple of practical reasons. Not just for the political conversation and getting out from underneath the onslaught of criticism, that's one issue, but on a practical level, this website has got to start functioning because those who were in the individual market, who the administration knew would have their policies changed and would have to find out information about to get new policies in this competitive marketplace, have to have a functional website to do that.
GARRETTThe administration contends of the 11 to 14 million Americans in this individual health insurance marketplace, about 50 percent of them will qualify for some cost-saving government subsidies on their policies. How do you find them? One way. Principally, the website. Now, yes, you can go to a community health center, but let's be honest. That's no practical for a lot of people who are working and struggling and doing a bunch of other things with their family and their small business.
REHMBut question lots of people are asking is, did the president really not know that people would have to change their healthcare plans?
GARRETTI'm sure he knew that they would have to change their plans and he said -- and what he administration says is, look, you have to listen to our whole speech about this because we said we're going to place all these new standards in there and these new standards are going to change your insurance. They're going to make the product you ultimately purchase better.
GARRETTWhat they left out, I believe intentionally for clarity but also to sort of reassure people while they were debating it and then you can deal with the practical effects later, that's not an uncommon strategy in politics, though it rankles understandably, people who thought they were being told one thing and it turns out to be another, that your policy will change and it will be better and you can afford more coverage later.
GARRETTThat better be true, first of all. And the only way people can find out whether or not that's true is to have a functioning website.
SIDOTIA lot of this and what seems to be the disconnect between -- well, is a disconnect between what the president said and what's actually happening, comes down to the conflict between rhetoric when you campaign and rhetoric when you govern. The fact of the matter is, is that, you know, campaigns, particularly in America these days, are filled with sound bytes and, you know, the catchy line, the phrase that's going to carry the tide.
REHMAnd they keep coming back.
SIDOTIYep. And, you know, some are rooted in reality, some are rooted in half truths. Most of them lack context and so in the course of a campaign boiling down, you know, a pitch than when you actually get to governing, it's never as simple as it seems in the campaign.
REHMHow nervous are Democrats getting about all this, David Welna?
WELNAThey are nervous. You have 11 Senate Democrats now having signed a letter suggesting that it might be wise to delay the requirement that individuals buy health insurance under the Affordable Care Act. And they have exactly about a year to try to recover from what's happened so far before the midterm elections take place. You can see why Republicans were pushing, about a month ago, for there to be a one-year delay in the implementation so it would be October 1 of 2014 when all of this would be happening.
WELNAThat would clearly by a godsend for them. Democrats are just hoping that, in fact, the White House makes good on its promise to fix the problems with the website by the end of the month.
REHMDavid Welna, he's congressional correspondent for NPR. Short break here. When we come back, we'll talk further, take your calls, you email. I look forward to speaking with you.
REHMAnd here is our first email for Major Garrett of CBS, Liz Sidoti of The Associated Press and David Welna of NPR. It's from Edward in Tallahassee, Fla. He says, "I am sick and tired of hearing people complain about losing their coverage or having their coverage change. Long before Obamacare my health care plan changed on an annual basis and always to the benefit of the insurance company. These insurers are now striving to beat the clock by raising rates, deductibles and co-pays in advance of the law's restrictions on such next year. I'm one who is not satisfied with the ACA because it simply did not go far enough." What do you think about this insurance company allegation?
GARRETTWell, it's true. And I mentioned this earlier that policies change either at the group level or at the individual level every year. And the administration knew that and they often describe this individual insurance market as the Wild West, the place that the practices of insurance companies, to the administration's point of view, are particularly unscrupulous or predatory. That is people are offered coverage. There are often codicils buried in policies that when costs really get very high, there's something not covered. If you're a woman you can be charged more than a man. There could be age restrictions. There could be caps on lifetime coverage.
GARRETTAnd so what the administration said, in this policy market we're going to create standards that everyone has to meet and policies that have to conform. And if they don't conform, they're not purchasable. So it's basically taking the long arm of the federal government and going to insurers and saying you have to meet these standards and the standards will come with a cost.
GARRETTNow one of the debate points for this is someone who's let's say 54 years old and a man. Does he need maternity care? Quite obviously not but that's covered and that's part of his premium package. He says, why should I do that? So there is a sort of whiff of paternalism from the federal government saying, all these policies have to have uniform standards because the administration said it would be impossible to negotiate individual's standards.
REHMLet me give you an analogy. Even elderly people without young children pay income taxes on their homes for schools even thought they have no children.
REHMSo you've got these overall umbrellas.
GARRETTTo umbrella -- use an umbrella approach.
GARRETTIt's exactly what the administration's philosophy was on this. And now it's having to explain that. And there's an absolute rational policy perspective to have on that that was just sort of left out of the early presentation.
WELNARight. This is all about forming risk pools. And that's the way insurance works. And people might say, why should I have to pay into something that I'm never going to get a benefit from? Well, you're probably going to get benefits that other people are paying into that they won't get. So it's sharing the risk and the burden.
REHMSo has the administration brought in enough good brains to fix the website as promised by late November?
SIDOTII guess we'll see when they meet the deadline or if they don't meet the deadline. I mean, at the very fundamental level, at a time when, you know, most Americans look at Washington and say it's not working for me, this is a huge signal that Washington is broken. And I think the American public is questioning whether or not Washington can work. The onus is on the administration to prove that with this new team it's brought in to fix the website that Washington can work.
WELNAOne thing to remember, of course, is that most people are not affected whatsoever by this program.
WELNAOh, it's about 85 percent...
WELNA...are getting their coverage one way or another through employers or through their spouse's employer plan. Those who are getting letters saying that you're going to have to get a new insurance plan might number 5 or 6 million people out of 310 million. But at the same time, the stories that are coming out of this do portray the government as incompetent. And that's something that the administration hasn't adequately dealt with.
SIDOTIBut even those -- the folks out there who get their health care through employers, their policies are changing. Their situations are changing. And so they're being impacted by this in some way.
REHMAll right. Here is an email from Barbara in San Antonio. She says, "According to Politico, Republicans have fought the ACA from the start. They held out sufficient funds to get the website started and the administration had to cobble together funds from other areas. Why don't we hear more about this," David Welna.
WELNAWell, there was a lot of uncertainty about how the program would move forward. The Supreme Court ruled in June of last year upholding the constitutionality of it. But I think the administration never had full confidence that things would roll out as they were supposed to. And I think in many cases, they held back in terms of getting things set up. One big problem was not knowing how many of the governors would actually go along with the Medicaid expansion. And, in fact, 24 governors did not.
WELNAAnd so the federal government suddenly was scrambling both to provide for the change in that program, but also setting up exchanges for those states that chose not to do state-run exchanges. I mean, it was all a very sort of unforeseeable and fraught period before this rollout.
GARRETTOr, in some respects, entirely foreseeable. I mean, this story that she talks about has sort of been hiding in plain sight for four years. Entrenched Republican opposition to the Affordable Care Act has been a reality in Washington since it was proposed. And then after it was signed in, immediately you saw statewide legal challenges, all the statewide legal challenges plus the regulatory framework, all of which were slowed down for political reasons and for legal reasons.
GARRETTAnd the administration, as David said, had to wait for the Supreme Court to say this law was even constitutional before it could in full confidence put together everything that was required to implement it. And this is one of the things the president referred to and Governor Deval Patrick did in Massachusetts as well. Even with cooperation in Massachusetts, some parts of that law were delayed in implementation. Even when you had everyone sort of pulling in the boat together, all oars in the water in the same direction, they delayed implementation of a couple things because they weren't quite workable on the front end.
REHMAll right. We're going to take a couple of callers on this subject before we move on. First to Denise in San Francisco, you're on the air.
DENISEThank you. You know, there's one thing that has to be said that I'm not hearing. This is more than just a website. This is an entire perspective on how to make health care better for all Americans, to make it fair and equitable. And the fact that there's been money from the very beginning in opposition to this, hundreds of millions of dollars in lobbyists pushing against this, at some point some smart reporter's going to ask why there was such a concentrated effort to push back against these reforms.
DENISEAnd every president deserves to have, you know, the appointments and his legislation move forward. And you know what's going to happen in 2014? The Democratic Party and the people of the United States who voted this president to be president are going to vote in a congress that will cooperate with him. Thank you.
REHMAll right. And thanks for calling. She talks both about the Affordable Care Act and about the Republicans blocking two nominees put forward. First speak to the nominees, David.
WELNAWell, yesterday the Senate voted to block two of President Obama's nominations. One was of a sitting congressman, Mel Watt, a Democrat from North Carolina who had been nominated to be the federal overseer of mortgage loans. And he was, said by Republicans, to be too political and not prepared technically for the job. That was the excuse they gave. He was the first member of congress since before the Civil War actually to be denied a confirmation by the Senate.
WELNAAnd then right after that the Senate voted to block the nomination of Patricia Millett to be on the D.C. Circuit Court of Appeals. That was a pretty key vote in so far as there are three vacancies on that court right now. There are two other nominees who have both cleared the Senate judiciary committee and are on dock also to face filibusters in the Senate. And all of this is coming to a head because that D.C. circuit is extremely important. It's the court that usually rules on the constitutionality of the president's actions, and also the constitutionality of federal regulatory rules.
REHMAnd what reasons did Republicans give for the holdup?
WELNAWell, it was competence in the case of Mel Watts. They had no problem at all with Patricia Millett and her qualifications. They said, this is a court that doesn't have enough work to keep it busy. And so these three vacancies, there's one proposal to move two of them to other courts and then just eliminate the third position.
WELNAThe fact is that right now you have a court with eight members, four of them appointed by Democratic presidents, four by Republican presidents. And at the same time you have part time judges who participate in decisions. There are six of them. Five of them were appointed by Republicans. So Republicans, I think, are worried that if Obama were to get his nominees onto the court that the decisions would pretty much swing in his favor and they're accusing democrats of court packing.
SIDOTIYeah well, what's fascinating about this is that the Republicans would pick this fight right now and would do this right now. You know, the NBC and Wall Street Journal just came out with a poll today that said 74 percent of Americans say that congress is contributing to the problem in Washington -- the problems in Washington rather than solving those issues. And with the approval rating of Republicans nationally down to bottom barrel levels, the Republicans would be willing to simply to avoid giving Obama any kind of victories, that they would be willing to challenge these nominees. It's actually pretty interesting when you think about it.
REHMInteresting or sensible or foolish?
GARRETTWell look, the voters will decide that. And Republicans have a very hard time, I think, making this argument that the D.C. Circuit Court of Appeals doesn't have enough workload. I think workload is not the issue. I think vote load is their problem, as David just articulated. They know that these appointments, if confirmed, would tilt the balance on that court. And they don't want the balance tilted on a court that will be the recipient of and absent action by the Supreme Court, the legal final word on a vast array of pending Obama regulatory decisions.
GARRETTAnd that's a pretty negative political perspective to take toward judgeships, something that the Republicans objected to strenuously when they thought the exact thing was happening to President George W. Bush. Because this is a familiar pattern in the Senate of confrontations over courts and vote allocations. What's at issue here in the Mel Watt case is Republicans want to force the administration to come in their direction on the reform of Fannie and Freddie, which the Federal Housing and Finance Administration, which Mel Watt would lead, oversees.
GARRETTAnd they want to extract from the administration policy concessions the administration is not prepared to make and they're using...
REHM...like doing away with Fannie and Freddie.
GARRETTYes, dramatically reducing their influence in the mortgage market. And Mel Watt has now become a tool in that argument.
REHMMajor Garrett of CBS News and you're listening to "The Diane Rehm Show." One last question on that, how likely is this to spark a larger debate over the use of the filibuster?
GARRETTThere are indications that Senate Majority Leader Harry Reid is keeping that option open. There was a big...
REHMHe's threatened it previously.
WELNA...there was a big flare up in July. It ended with a compromise on executive nominations, nothing to do with judicial nominations because executive nominations last as long as the president is in office. Judicial nominations are for a lifetime. And the Senate decided that they'd regard those two differently. However, with this case of the District Circuit Court, I think that it's pushing that issue right to the limit.
WELNAThe other things is that you have two executive nominations coming up soon. Janet Yellen to head the fed and Jay Johnson to head the homeland security.
REHMAnd they threatened to hold off on those.
WELNAWell, there will be Republicans who will try to filibuster both of those as well. But I think you've got four big nominations coming up, two on that circuit court and these two others just in the coming weeks. And this could come to a head. And it's a question of whether Democrats want to permanently change the rules to make it easier to get nominations through. Part of the calculus is are they going to hang on to the Senate after next year's midterm elections? Right now, especially coming out of the shutdown it looked like their chances of hanging on were pretty good. But a lot of this rides on what happens with the Affordable Care Act.
REHMInteresting. All right. Let's turn to a Federal Appeals Court ruling yesterday reinstating most of the Texas controversial law restricting new restrictions on abortions, Liz.
SIDOTIRight. What we're seeing in Texas is to a certain degree what we're seeing play out all across the country where Republicans know that given the makeup of the Supreme Court right now that they have very little hope if any hope of overturning Roe v. Wade. So state by state Republicans, particularly in states where the legislature's in control and where there's a Republican governor, are seeking to restrict access to abortion by passing laws that, for example in Texas, say that a doctor who performs an abortion must be within 30 miles of a hospital where they have admitting privileges.
SIDOTIThat is designed -- what that means is about a dozen doctors who perform abortions mainly in rural areas are no longer able to do that because of the law that was put in place because they don't meet the requirement. So what's happening is the right flank of the Republican Party is pushing to restrict abortions on the local level.
REHMBut is the court's order permanent?
GARRETTNo, this is something that can be appealed of course. And it may end up before the Supreme Court. Four other states issued similar laws and all four of those states had those laws blocked by federal courts. So you have very different outcomes. And I would be surprised if this doesn't end up being decided by the highest court.
REHMI gather the court's order however is temporary until January. Isn't that correct, Liz?
SIDOTII believe that's correct. I think we're going to see a lot of challenges to laws like this across the country.
REHMAll right. And let's talk about Yahoo and Google and what's going on there. The Washington Post reported the NSA is tapping into Yahoo and Google overseas. Explain briefly what this means for us.
GARRETTOh, thank you. Briefly. All right. You have -- and I will get quickly out of my technological can here, but you have connection points that Yahoo and Google have where vast amounts of data come overseas. And there's like a switch or a turnstile, if you will metaphorically imagine, where this information is unencrypted. It is easier to gather and to put into a big cache. The government figured out a way to do that without Google and Yahoo understanding that. That way they could sift it faster.
GARRETTGoogle and Yahoo thought they were participating in a much more limited form but now they realize much of their data is in these government hands and they're not happy about it.
REHMYou've done a great job. Major Garrett with CBS News. Short break. Your calls when we come back. Stay with us.
REHMAnd welcome back. Time to go to the phones. First to Baltimore, MD. Carrie, you're on the air.
CARRIEHi, thank you for taking my call.
CARRIEI wanted to say two things. First of all, I was a contractor. I'm a contractor and my husband is a contractor. And we have to buy insurance from the state. And we knew from the very beginning of the Obamacare that we're not going to be able to renew coverage as it's not a fully covered health care. Yet on NPR the other day, somebody did a story a story on a woman who was not able to get coverage because she was a contractor.
CARRIEAnd she should have known that she wasn't going to be able to continue that coverage anyway. So I was kind of surprised about that. But the second thing I want to point out is that my current plan has a $5,000 deductible and it costs $831 a month. The new plan that I looked at has a $4,000 deductible, it costs under $500 and office visits are $45 in their pre-deductible coverage. After January 1st, that means my family is going to be able to go to the doctor's when we have a problem or for a wellness visit.
CARRIEVersus my current plan's cost of $180 per visit after they've taken to consideration the insurance. And right now nobody in my family can go to the doctor unless we're missing a body part.
GARRETTWell, Carrie, you may get a call from the White House where you can tell your story.
REHMYeah, exactly. Exactly.
GARRETTAnd the president told a couple of other stories in Boston, people who had written to the White House about this experience. And I wrote a long column this weekend, a long interview with David Simas who's one of the president's top health care advisers and he sort of answer all my questions about this individual market. And the administration believes that they can in fact create these better products that provide bigger risk pools, lower cost and subsidies for a lot of Americans and that their satisfaction will be very high.
GARRETTRight now in Massachusetts satisfaction with the health care law is about 65 percent. That's not where it began. That was another point the president made in Massachusetts. If you give this a chance to work and let people interact with this market, it can succeed.
REHMAll right, let's hear another view from David in Hyannis, MA. Hi there, David.
DAVIDHi, Diane. I'm another example. My family is losing coverage. And I've heard a lot of folks in the left say that it's people whose plans were inferior that are being tossed off insurance. That's not exactly true. My wife works for a large specialty grocery chain that had a reputation for doing well by doing right by their employees. And they sent us a memo that cited the ACA as the reason for terminating coverage for their part-time employees.
DAVIDI know this was a trend before the ACA, but surely the ACA represents a change in the social contract that tied health care to employment. Now employers are emboldened to toss people and their dependents to the curb in the theory they can buy insurance on the exchange. We're a family of five with a five-figure income. I can buy insurance through my employer, but it's very expensive. We don't qualify for any subsidies and it's going to cost us an additional $7,500 a year.
WELNAThat was one of the great unknowns about this plan, how many employers would basically throw their employees overboard and say good luck out there on the exchanges. And we're seeing in the case of this supermarket chain that some have chosen to take that route. And whether that's going to strengthen the pool of insured people in the Affordable Care Act isn't clear. And the more people you have covered under that act, the greater the burden is shared by all those enrolled.
WELNAAt the same time, it's not clear whether the subsidies will be sufficient to cover all the needs.
SIDOTIYeah, I was going to say one of the other great unknowns here is the impact, the ultimate impact on the economy that this entire, not just the website but all of health care is going to have as we're trying to recover. Even Democrats were warning the White House, you know, early on that, well, this is going to be very uncertain in terms of, you know, where we are globally in the country's positioning on the economy.
REHMWell, there is some good news on the economy, is there not, Major?
GARRETTWell, there are some good news if you are a budget hawk and if you are concerned as many people in Washington are about the trajectory of the federal deficit. And we found out this week, according to administration figures which nobody disputes, that the budget deficit for this year will be about $680 billion, under a trillion for the first time in five years. That's a bench mark significance.
GARRETTRepublicans say, yes, the deficit is going down, the economy is growing to a certain degree, but the deficit is not coming down fast enough. The economy is not growing fast enough and we still have this enormous debt load of $17 trillion. Couple that with the Democratic perspective as we head into these budget talks which are need to succeed, at least at some level, to avert another shutdown scenario on January 15th.
GARRETTAnd there is all a pending increase in the debt ceiling early on next year. Democrats say, look, look at the trajectories, look at the numbers. Deficits are going down. We should spend a little bit more on infrastructure. We should spend a little bit more on things we know work like federal research and education. And if we do that and maybe a little bit of revenue, we can turn the corner. Republicans say no.
GARRETTThe deficit numbers aren't good enough. The debt is still too high and austerity and federal spending reductions is the best way to turn this around. That is the same argument we've seen before. I predict a very difficult resolution ahead.
WELNARight. As Major said, Republicans are arguing on the one hand the deficit isn't coming down fast enough. On the other hand, the economy isn't growing fast enough. Now, they seem to subscribe to a theory that austerity is going to lead to growth. They've been disproven about that in the case certainly of Europe where European leaders are rethinking their austerity programs.
WELNAAnd, you know, I think that what we have is a fundamental disagreement between Republicans and Democrats about how to bring down deficits. Democrats are saying the level of taxation right now is inadequate to sustain the kind of government programs we all want to have. Taxation has been about 15 percent of gross product over the last few years when historically it's been closer to 18 or 20 percent.
WELNAThey're saying we have to get back closer to those historic levels. Republicans are saying, we gave you some more tax revenue at the beginning of the year by taxing the highest tax brackets. And that's all we're going to give.
REHMAnd that's it. You don't think there's any movement.
WELNAThat's it. Discussion is over. And Paul Ryan says if, you know, if we go that way, that's where things stop.
REHMAnd nobody goes anywhere.
SIDOTIWell, and that's kind of the point of divided government, right? I mean, the ideological positions are so -- there's such a division between the two of them that I don't see a way short of, you know, one party ruling on Washington for them to bridge this gap.
GARRETTWell, I wrote in National Journal a week and a half ago about the crisis vice, which is the only thing that works in this town. The vice applied by dates on a calendar that force people to come to some sort of compromise. That's all we have left right now in this dysfunctional...
REHMHow do you apply that vice?
GARRETTWell, you have default. The default was a classic example. Default was the vice. Fear of default...
REHMAnd you're saying it could happen again.
GARRETTWhat have we seen since Republicans took control of the House in 2010? We've seen five of these. And everyone acts as if they're irrational. It finally dawned on me, it's actually not irrational. It's the only way the system gets dislodged from its entrenched polarization.
WELNAAnd yet Republicans in their arguments for tax policy say, what businesses really need to thrive is certainty. All of this government by emergency is simply generating huge uncertainty.
REHMAll right, let's go back to the computer glitches. Here's an email from Gerry in Rockville, MD. He says the failure of the ACA website speaks volumes not about the policy itself but the abominable state of government procurement, especially in IT services. We have contractors contracting subcontractors who hire barely qualified technicians and programs and pay them perhaps a third to half of the funds they get. Keeping the rest for administration.
GARRETTThat's a good point. And this is one of the other areas where the president got himself into rhetorical trouble because before the rollout he said it would be like going on Kayak or Amazon.com. Okay? Well, first of all, that was just conceptually wrong because the process of going through health insurance acquisition, even on a three-page application form which had been trimmed down from the 27-page one that originally came out of the government mill was going to be more complicated. That's point one.
GARRETTPoint two, you had 55 contractors writing proprietary code in silos. Very little or no integration. So this goes to your question, Diane, about what's happening now that wasn't happening before October 1st.
GARRETTJeffrey Zients is now given the authority by the president to breakdown those divisions, get this code integrated and he produces for the president, and I wrote this last week at cbsnews.com. Before the president leaves the Oval Office every day he gets a report on every metric of improvement of the website. And he's briefed on it every single day. And that's when he says it's going to get fixed because somebody has to bring to the man at the end of every day how things are getting better.
REHMLiz, you're shaking your head.
SIDOTIWell, I'm shaking my head because if I'm sitting in a place like Ohio or Springfield in Illinois, I'm saying why wasn't this happening before, right?
SIDOTII think that a lot of people may be wondering, you know, why did it, again, take a crisis of the health care -- the health care website failing for this kind of accountability to be done? And that speaks a lot to, you know, the strength of management and leadership that we're seeing from the administration.
REHMAnd on Mitt Romney, Allan in St. Louis, MO points out, your guest neglected to mention that in 2009, Mitt Romney on NBC's "Meet the Press" stated his health care law should be used as a model for the nation. And on CBS' morning news show, he said he was glad to hear the president was planning to use some elements of the Massachusetts health law reforms. Also in 2009, Republican Senator Grassley stated there was bipartisan consensus forming around the individual mandate. David Welna?
WELNARight. In the summer of 2009, I went around with Senator Chuck Grassley in Iowa to town hall meetings where they talked about the Affordable Care Act that at that point was still at the committee level of discussion. And the Senate Finance Committee that Grassley sat on was still debating about what to do about it. So, you know, these Republican players were still somewhat open to talking about having such a plan.
WELNAIt wasn't until the fall when the Democrats said, okay, stop the talking, we have to act now because they realized that their 60-vote majority in the Senate could be over soon. Republicans closed ranks and said we're against this. Mitt Romney made his remarks before that happened.
REHMAnd the other question becomes how soon we are going to know about numbers. They're not going to release numbers until what, mid-November, Liz?
SIDOTIWell, they've been resisting releasing any sort of numbers from the start. And so there are bunches of numbers floating out there at this point. And so I think that getting an actual real answer is going to be difficult to come by even in November.
GARRETTAnd may not be altogether that relevant. And here's another point about this. At the state level, their numbers are available. And that some states are signing up a good number of people on their state-based exchanges. What's happening and this is what's predictable, most people are signing up for Medicaid, the low-income coverage not the individual market that is more complicated.
GARRETTAnd the administration, it seems to me, is just really creating another problem for itself by not releasing these numbers. Look, the number when you bring them out are going to be low and they're going to cause concern. Get that out. Talk about it now. Say, that's what happened in Massachusetts. Lastly on Mitt Romney, what he always said was, at the state level, health care reform is practical. At a national level it's not.
GARRETTThat's the distinction he always threw. Though he supported the idea of Massachusetts becoming a model, he said for other states not in a one size fits all federal application.
REHMAnd you're listening to "The Diane Rehm Show." Let's go to Mary on Gulf Shores, AL. Hi there.
MARYHi there. Thanks for taking my call.
MARYI wanted to get to the health care law. The site, I'm not even going near that because I don't even think it's secure and of course it's been just loaded with problems. But what I want to get to is the people that have been dutifully buying individual health insurance, maybe though it wasn't perfect in every way, they could choose. Last time I checked this was a democracy. I'm a Democrat. I voted for Obama.
MARYI am appalled by this health care because people in my family that have bought their insurance for 25 years, one of whom is single and engaged, is forced to buy maternity and pediatric coverage. I know the reasons for this. It's called spreading of cost in the insurance market. That's what these insurance companies do and that's what they're being mandated to do. This is unfair because it's like saying to somebody who doesn't own a motorcycle, you have to buy a motorcycle insurance.
MARYSo I'm appalled by that. There is no way to compare on a national side whereas if you go to, I don't know if I can name the site, but there's a site where you can compare 2013 policies purchased for 2014 with what you would purchase in 2014. And the prices double. In my two relatives' cases, one policy is going up 400 percent, the other one is going up 100 percent. And the one that's going up 100 percent is requiring maternity and pediatric for no children.
REHMAll right then.
MARYAnd no wife. So my point is...
MARY...that if you try to force people to spread the cost of things they don't need when they've been paying their dues for 25 years, this is appalling. And if the Republicans...
REHMAll right, I've got to stop you right there. David?
WELNAWell, I think this is a little bit like the discussion of Social Security. You pay into Social Security over lifetime of working, you might drop dead at age 64 and not collect a cent of it, there will be no refund to your family for that, the money that you paid in. It's a similar thing with insurance that you are buying into a risk pool and there are many people who are going to have needs that you will never have. But the whole idea is to share the risk.
WELNAAnd it's true that many things you're covered for you don't need, but that's the nature of insurance.
REHMAnd what about the analogy to real estate taxes and education?
WELNAThat's true that we live in a society and we share the burden of having civilized institutions such as public education. And that I think something that maybe the Obama administration hasn't emphasized enough that we're all in this together.
REHMDavid Welna, he's congressional correspondent for NPR. Liz Sidoti, national political editor for the Associated Press. And Major Garrett, chief White House correspondent for CBS News. Thank you all so much.
REHMAnd before we sign off today, let me take just a moment to wish all the best to our longtime producer Nancy Robertson. Nancy has been with the program for 17 years, producing outstanding discussions, bringing together marvelous guests, writing promos, pulling clips as she did yesterday for the great discussion we had on slavery. She's a beloved colleague who knows how to reach out and lend a helping hand.
REHMNancy is leaving for a very important reason. She is about to become a first-time grandmother. And though we understand and applaud her priorities, we are all going to miss her dearly. Thank you, Nancy, for all you've done to make "The Diane Rehm Show" so successful. Good luck. Best wishes to you and your family. Thanks for listening, all. I'm Diane Rehm.
Most Recent Shows
World leaders meet for the UN climate change summit in Paris to discuss plans for reducing carbon emissions. What's at stake for the talks, and prospects for a major agreement.
A molecular-biologist-turned-Buddhist-monk says altruism is the answer to many of the world's most pressing challenges. Can concern for others help solve wealth inequality, climate change and world hunger?
Kate Mulgrew, who stars as "Red" in the Netflix TV series "Orange Is The New Black", opens up in a new memoir about her complicated family and the baby she gave away for adoption as a young woman.