'This Week' Transcript: Karl Rove and David Plouffe

LOTT: What if the doctor says, no, I'm not going to take anymore Medicaid patients or I'm not going to take any more Medicare patients? And that's already beginning to happen.

DASCHLE: But they're -- but they're doing that now. And the status quo is simply unsustainable. We can't sustain the cost, we can't sustain the problems with regard to quality. We can't sustain virtually any aspect of health care as it's now delivered in this country.

LOTT: And, by the way...


LOTT: Let me jump in here with this, too. You mentioned Medicare and Social Security, both very popular, very important parts of our fabric in America, but both of them are in financial difficulty. Here we are, putting more weight on Medicare at a time when it's already facing tremendous problems because of the baby boomers that are coming along.

DONALDSON: But George is quite correct. Because of the demography of the country and the way it's changing, yes, we have to fix these things.

LOTT: When are we going to do it?

DONALDSON: Well, you're going to do it because you have to do it as we go along.

LOTT: We've been having to do it for the last 10 years. We didn't do it.

DONALDSON: That's right. And we fixed Social Security, apparently, in the early '80s. We had to fix it again. We may have to fix it down the line, Trent, but that's no reason to abandon it or abandon this kind of health care.

WILL: Tom talks about costs. One of the first and most predictable consequences of this bill is going to be that health insurance premiums are going to go up. They have to, Tom. We're changing the risk pool.

Once you say to people -- to insurance companies that they cannot discriminate against people who have pre-existing conditions, then when you bring the risk pool in, all these people who already have troubles, you're going to have the premiums go up. That's the first...


KARL: But it's also requiring you to have insurance...


DASCHLE: But George is right about premiums. I mean, there -- there -- there are issues involving premium, but what he hasn't mentioned is the increased transparency, the fact that we're finally going to get away from rewarding volume. We're going to start rewarding value.

We're going to have delivery reform for the first time. We're going to be dealing with the structural problems in our health care system for the first time in history. And those are, by -- again, by CBO account, going to have a profound effect in bringing costs down, not -- not raising them.

LOTT: Let me make one other point here. I know process in Washington consumes us, and the average American out there is saying, "What is all this?" But I have never seen such a contorted process to try to get a bill through the House, through the Senate. They talked about just deeming the bill passed. At least they were wise enough yesterday to back away from deem and pass, even though you didn't vote on it, and now it's going to go back to the Senate for reconciliation. Now, I used reconciliation, but not like this.

DASCHLE: Trent knows procedure as well as anybody in Washington, and he knows that the Republicans are very masterful, if they want to be, just as Democrats were in the minority, at stopping virtually every procedural opportunity there was, so...

KARL: All right. Let me -- let me get to...


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