How hospice became big business. A new investigation in The New Yorker reveals an industry that at times puts profits before patients.
Guest Host: Susan Page
Pressure is building for Congress to approve a spending measure and prevent a government shutdown at midnight on Monday. Another nerve-wracking deadline looms on Oct. 17, when the Treasury Department says the nation is likely to run out of money to pay its bills. Enrollment in the Affordable Care Act’s insurance exchanges begins Oct. 1, and President Barack Obama says he won’t negotiate delays or other Republican demands to keep the government operating. The FBI and Navy release documents on the motives of the Navy Yard shooter. And former President George H.W. Bush is a witness at a same-sex marriage ceremony.
- Ruth Marcus Columnist and editorial writer, The Washington Post.
- Todd Purdum Senior writer for Politico and contributing editor at Vanity Fair
- Janet Hook Congressional correspondent, The Wall Street Journal.
Sen. Ted Cruz (Texas-R) spoke to the U.S. Senate this week for more than 21 hours to advocate defunding the Affordable Care Act. Ruth Marcus of The Washington Post called his speech a “Cruz-athon”, adding that it wasn’t technically a filibuster and wasn’t meant to stop a vote. “He may be the best known freshman senator of all time because he has just thrust himself front and center, [and] alienated pretty much every one of his colleagues,” Marcus said.
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MS. SUSAN PAGEThanks for joining us. I'm Susan Page of USA Today sitting in for Diane Rehm. Diane has been out this week for a cause dear to her heart. She was in California starring in a play to benefit Alzheimer's research. She looks forward to being back with you on Monday. Congress scrambles as the government faces a shutdown early next week.
MS. SUSAN PAGEThe Treasury Department warns the debt ceiling will be reached on Oct. 17. And prices are set for the new federally-run healthcare marketplaces. Joining me for the domestic hour of our Friday News Roundup: Ruth Marcus of the Washington Post, Todd Purdum of Politico and Vanity Fair, and Janet Hook of The Wall Street Journal. Thank you all for being here.
MS. RUTH MARCUSHi.
MR. TODD PURDUMGlad to be here.
MS. JANET HOOKThanks.
PAGEWe're going to talk to our listeners later in this hour. You can call our toll-free number, 1-800-433-8850. Send us an email at firstname.lastname@example.org, or find us on Facebook or Twitter. Now I know hundreds of thousands of Americans like to watch the live stream of the first hour of the Friday News Roundup. We're in new studios this week. We're not doing the live stream today, but we hope to be back with it next week.
PAGESo just a few days until the government faces a shutdown. Todd Purdum, are we going to go over the cliff on Tuesday?
PURDUMYou know, no man can say. I think it changes by the hour. I was consulting with our congressional reporters yesterday, and it was just -- really, it was changing by the hour. The morning started out with one approach, and by afternoon they seemed to be taking another one. So what they can't seem to decide right now, the House Republicans, is whether they want to have the fight over the shutdown or whether they want to sort of punt on that and have a really honest to God fight over the debt ceiling. And I think the jury's still out on which they'll do.
PAGEJanet Hook, you are up on Capitol Hill every day. What do you think is going to happen?
HOOKWell, I agree with Todd. Not only can no man say, no woman can say. It really is...
MARCUSYou knew you were going to get that, Todd.
PURDUMSorry. I (unintelligible) news all-girl orchestra here, so...
HOOKAnyway, you know, one thing is I think the Republicans are in a position right now, the House Republicans, is that they're controlled by a faction that just wants to fight until the bitter end. So I think they're not going to decide whether they want to fight on the spending bill or the debt limit until the very last minute.
HOOKI mean, they can't do something today that leaves -- I mean, we've got three, four whole days before the shutdown, you know, so that that's the thing that makes it really kind of a cliffhanging moment is that somebody's going to have to blink, and nobody wants to do it until the very last minute.
PAGEWell, Ruth, in substantive terms, does it matter if the government shuts down? Does it have a big impact?
MARCUSIn substantive terms, it matters, but it matters way less than if the debt ceiling is breached. And that's no-man's land. Remember back in the Clinton Administration, we had a shutdown that lasted for something like 26, 28 days. And we survived. So it's unbelievably stupid to shut down the government. It's actually extraordinarily expensive to shut down the government.
MARCUSIt's already required all sorts of idiotic unnecessary planning for how long, if you're a semi-essential person, you'll be able to look at your BlackBerry to get your litigation done if the government is shut down. Throughout the government, we're going through all of this, but we can survive a shutdown. We cannot -- we don't even know if we can survive or how we will survive or how troubling and costly for years and years the notion of the debt ceiling will be.
MARCUSSo when I watch the Republicans, as Janet says, having this debate between shutdown and debt ceiling -- this is a little bit of a dangerous analogy -- but I really think it's like a debate between whether they want to use chemical weapons or nuclear weapons. Both are dumb. One is really, really terrible.
PAGEWe had a reporter, Gregory Korte, who did an analysis. It showed 59 percent of federal workers will work, will be on the job if there's a shutdown. So there are some limits on how extensive that will be, so that's the substantive answer. Todd, what about the political answer? Who gets blamed if there's a shutdown?
PURDUMWell, I think one of the things that are interesting is fewer than one in five current House members were around for the last shutdown, and there were actually two. And they lasted a total of 33 days, and most people think it cost over a billion dollars. It would cost more than twice as much today. So that part of the House caucus doesn't even remember what it was like.
PURDUMAnd they don't remember that before the shutdown, Bob Dole was leading in the polls against Bill Clinton for president. And the minute the shutdown was over, he was behind. And I don't think he was ever ahead again. So Speaker Boehner remembers that. A few grey beards left remember that. The hotheaded freshmen, the Tea Party caucus, they don't remember that, and they don't care. So I think that's really the challenge for the House leadership, is they're dealing with troops who don't want to be led.
MARCUSCan I say one thing to -- the thing, though, that has mystified me about Speaker Boehner's approach is that he understands full well the political cost that would imposed by a shutdown. But he is just gambling on having the showdown over the debt ceiling which, Lord knows what the cost is there. His assumption, I guess -- and there may be some reason for this -- is that president, who called him up to announce that he wasn't going to negotiate, that the president will blink in the end as he has in the past.
PURDUMAs he did in 2011.
MARCUSBut that's a -- take this caucus that is so out of control that you don't have any control over and say, hey, guys, let's have this fight over the debt ceiling, not over the shutdown, 'cause the shutdown's going to be really bad for us, if it happens, is a very, very high risk strategy.
PAGEYou know, Democrats, Janet, say that Boehner is the weakest speaker in modern American history. Is that fair?
HOOKWell, I think he has taken over the most ungovernable Republican conference in history, and I think his leadership style, in some ways, is well-suited to it because he has this kind of, let's listen to them, let them kind of express their views, and then figure out how we go forward so that it -- I don't -- I mean, when people say he should be a strong leader, I just don't know how -- what else he could do than what he's doing.
HOOKBecause these people were -- a lot of these -- the last two cycles of Republicans were elected precisely because they said they wouldn't follow their leadership. So this is their brief. This is what they bring to Washington. I'm not going to be told what to do by my party leaders.
PURDUMAnd, you know, it's a historically dangerous job he's in. No House Republican leader since 1958 when Joe Martin of Massachusetts has really left the job voluntarily. They've been forced out one way or another, by circumstances or by their members. And it's a kind of a dangerous place to be.
PAGESo those of us who sometimes view politics as theater had several great scenes this week. One was Ted Cruz's 21-hour speech on the Senate floor. What was he trying to do, Ruth?
MARCUSOh, that's a good question. I'm going to give you the incredibly cynical answer. He was trying to help Ted Cruz because, in the end, he was not technically filibustering, he was not trying to stop a vote on something, he actually voted for the measure that he was busy denouncing for the previous 21 hours, so it was basically a 21-hour Cruz-a-thon, which he may be the best known freshman senator of all time because he has just thrust himself front and center, alienated pretty much every one of his colleagues, except for Mike Lee, who, in one of his things, he sort of Darth Vadered, Mike Lee, you are my son, your father...
MARCUS...which was about as weird as reading "Green Eggs and Ham" to his children. I think this was all about Ted.
PAGEYou know, Ruth, you'd -- and others on the panel suggested to me who's going to blink. Obama blinked last time. But if the issue is delaying our defunding the Affordable Care Act, Janet, it's pretty clear Obama is not going to blink on that.
HOOKRight. And that's why this has been set up in a way that, somehow, whatever resolution we have isn't going to be on these terms because there's just no way that Obama's going to blink on, you know, the most important piece of legislation enacted in his first term. And, you know, the unfortunate coincidence is that a big part of the healthcare law takes effect on Oct. 1, which is also the end of the fiscal year and when this budget deadline is.
HOOKI just think that that may be the biggest difference between the leadership and the followership here, is that they think that this is kind of a losing proposition to make your -- ask at the negotiating table be abolishing the president's most important accomplishment.
PAGENow, the White House is convinced, I think, that Republicans are going to get the blame if there's a shutdown. And yet President Obama's own approval ratings are in kind of a dive. Ruth, tell us what's happening.
MARCUSWell, I think, actually, not only is the White House convinced that Republicans are going to get the blame. Republicans, at least the rational ones, which may be a dwindling band -- I'm sorry to be so tart here, but, really -- Republicans are convinced that Republicans are going to get the blame.
MARCUSBut, meanwhile, the president's job approval rating is going down to some of a -- matching some of the lowest numbers of his presidency. The public's view about the course that the country is on is similarly bad. Two-thirds think we're on the wrong track. And I just had the experience of spending five days in Germany, which was like a visit to another political planet because at the end of a very contested election -- and I know we're not in the second hour of the news roundup -- but at the end of a very contested election, imagine this, Angela Merkel had an 80 percent job approval rating.
MARCUSHer party got 41 percent of the vote, but that's how different their politics are there. And you just kind of have to just wish for some easing of the partisanship here.
PAGEIn a New York Times/CBS poll that came out this week, President Obama's approval rating was down to 43 percent. That's not a healthy level really for a president, is it, Todd?
PURDUMNo. It's not healthy. And the problem is also -- to pick up on what Ruth was saying -- we're living in a constitutional government with politics that have become as polarized as parliamentary politics. If we lived in a parliamentary system, President Obama's party would be in the majority. And he, for better or worse, would have a better chance of getting something done.
PURDUMAlthough the first two years of his presidency, when he did have both Houses of Congresses, were not necessarily, you know, the happiest times for him. But I think it's like the prince's speech at the end of "Romeo and Juliet." All are punished. I mean, we really are in a place where...
PURDUM...where the whole public is sick of Washington, and nobody looks very good. And Robert Gibbs, the president's former spokesman, said this morning on television -- I saw him saying that, you know, nobody's going to come off this on a white horse. They all...
MARCUSRight. Because so -- Obama's approval rating is 43 percent. Look at where Congress is. You know, by comparison, he's...
HOOKWe're heading into single digits, I think.
PAGEBut, given that, Janet, does it matter when he's trying to get things done in Congress, when they look and they see his approval rating is down? Does it affect what they're willing to do, how much they're willing to bend to his will?
HOOKYou know, I don't think -- especially the kinds of issues he's been bringing up that have come up this year, I don't think his personal approval rating matters as much as -- I mean, when they're voting on guns and defeating his gun control initiative, that's not because he's not popular.
PAGEWe're going to take a short break, and when we come back, we're going to talk about the launch of key provisions of the Affordable Care Act on next Tuesday. Stay with us.
PAGEWelcome back. I'm Susan Page of USA Today sitting in for Diane Rehm. With me in the studio for the Domestic Hour of our Friday News Roundup, Janet Hook. She's congressional correspondent for the Wall Street Journal. Todd Purdum, he's a senior writer for Politico and contributing editor at Vanity Fair. And Ruth Marcus, she's a columnist and editorial writer for the Washington Post. We're going to go to the phones and take your calls in just a few minutes, 1-800-433-8850.
PAGEFirst, let me read this email from Richard who writes us from D.C. He says, "The constitution requires the government to pay its bills. How can the debt limit legislation be constitutional?" Ruth, you're a lawyer. Is that an issue?
MARCUSI don't actually think that the constitution -- I'm going to get myself in trouble here with all the lawyers -- I don't think the constitution requires the government to pay its bills. The constitution gives the Congress the power to spend money. But there's an argument about whether the president could override the debt ceiling legislation but he says that he can constitutional do it.
MARCUSAnd no one has argued that that rule in itself, the debt ceiling which is unbelievably stupid because it really prevents us from paying money for bills that we've already incurred and agreed to incur. And when we've agreed to incur bill, by the way, that is because Congress has approved the legislation that are those bills. But nonetheless, the debt ceiling itself is a stupid idea but probably a constitutional and legal idea.
PAGELet's talk about the rollout of Obamacare next week. Janet, your newspaper put on its front page this morning a story about a hitch in the expected opening of these marketplaces on Tuesday. What is happening?
HOOKWell, there's a glitch in the ability of small businesses to file into the exchange system to apply for a policy. And it's sort of the latest in a series of glitches that have to do largely with the software that they're putting up for people to apply for insurance policies. And that's what's -- what happens on Oct. 1 is not the beginning of the program per say. It's the beginning of when small businesses and individuals can go to these online marketplaces and review different policies and apply for policy. The policies themselves don't take effect until Jan. 1.
PAGEAnd people are not required to have health insurance coverage until Jan. 1. That's another provision of the law. Well, Todd, we see the president doing some publicity for the Affordable Care Act in this rollout. What has he been saying?
PURDUMWell, the basic challenge he faces is that people don't like it very much, but they also don't understand it at all. And they especially don't understand that it includes things they approve of very highly, like, you know, no more preexisting conditions.
PURDUMI was going to try to find an elegant way to say that, but -- and also that dependent children can stay on your policy if you're a parent longer than they used to be able to. They can stay until age 26. So he's got to try to explain to people some of the essence of what's in the law.
PURDUMAnd he also is making the point that like a lot of other things that were looked at warily in the beginning, including President Bush's prescription drug benefit for Medicare, it's actually -- it's very costly. Probably not paid for, but it's working. And seniors are getting their coverage and it's by and large been accepted and it's become, you know, after some kinks in the beginning it's worked out.
MARCUSAnd actually the prescription drug benefit is costing way less than projected. And if we sort of did a time travel back to when that was being rolled out, it was all kind of sky is falling, sky is falling, this is a terrible program. Seniors who are dealing with it are tearing their hair out trying to figure out how to navigate these complicated choices. But, as you say, it's turned out to be a popular program. I think this is a much, much bigger change effecting more people and having more moving parts in it.
MARCUSIt's not surprising that some of those parts are creaky and not working very well at the outset. It's also not surprising that the opponents of the law are seizing on every tiny little glitch or major glitch or major change, like delaying the employer mandate, as yet another piece of evidence that the law's not working. We don't know that yet at all.
MARCUSPremium cots generally are down since the law was -- and health care costs in addition are down since the law took effect. That is not cause and effect but it makes it less costly and it suggests that some of the broader systemic changes were maybe helped by the law. But I think that Todd raises the most important point which is that people do not understand anything about what this does, including the fact that for most of us with employer-sponsored insurance, for senior with Medicare, for poor people with Medicaid, it doesn't really change things.
PAGEBut, you know, I was in Colorado last week doing a story for USA Today. We had a focus group of 10 people from the Denver area who do not have health insurance. So they're people who are the targets of this benefit. And there is a -- Colorado has been working very hard to set up its state exchange for a year-and-a-half. Not one of these 10 people understood what they were supposed to -- understood how the exchange was going to work, knew -- had any idea what it was going to cost them.
PAGEAnd while they have these terrible stories about how they've tried to deal with getting medical care or foregoing medical care because they don't have insurance, they were really suspicious of what's going to happen next, what it will cost them, what will get covered. Is this inevitable, Janet, because it's a big complicated program or does this reflect a failure on the part of the White House and the administration three years after the president signed the law, to explain it to people?
HOOKWell, I think that problem has dogged the law, the bill, the debate all along. That I think nobody's done a very good job of explaining how the law works. I think Ruth points to a really essential thing, which is that throughout the debate on the health care law, it wasn't -- it was often obscured that we were talking about a very small part of the population, a very -- I mean, not a tiny number of people, but most people have coverage through their employers. And then there's this population of people who have to get individual policies that now are unaffordable, and the goal is to make them affordable.
HOOKI think that a lot more people will understand once there's -- once this is up and running. I think the states are beginning to try to do a better job of explaining what's available through them. I think that one problem for Obama is that the states are calling their programs by something other than Obamacare. And so people are saying, OK, so I've got this state thing. What's with Obamacare? And I think that -- I mean, frankly, aren't we all confused about health insurance? It's not just the administration.
PURDUMWell, it's a complicated thing. And if you get health insurance through your employer -- I just started a new job. I'm not taking advantage of the benefits because my wife has health insurance. But they sent me about a ten-pound package trying to explain the options I have. And you have to go online. It's not easy.
PAGEBut here's one thing I think may be different with this debate than with previous ones when big social programs have come into effect. And Todd, I know you're a student of history, and that is that the opposition has never given up. Even though the law was signed and passed and upheld in the Supreme Court, there has been no let up in Republican efforts to either repeal it or to undermine it to make it fail.
PURDUMWell, you know, I'm reminded of what the late Senator Pat Moynihan of New York used to say in the last debate over health care 20 years ago, which was that the big important things in this country do not pass 51-49. They pass 70-30, or they don't pass at all. And the Civil Rights Act of 1964 passed 73 to 27 in the Senate with 27 out of 33 Republican votes.
PURDUMAnd the day after it passed its most ardent opponent, Senator Russell of Georgia said, it's the law of the land and it's our duty to abide by it. And that was because it passed overwhelmingly and the fight had been had. And I do think it's really a burden for the president, it's really too bad for him, that he was not able and, you know, many forces beyond his control. But it would've been much better for the country if this bill had passed with a little more support.
PAGELet's go to the phones. And I'd just like to note to our listeners that actually our live video stream is now working. So if you'd like to see what we're wearing and how we're gesturing to one another...
PURDUMI'm glad I wore a jacket.
MARCUSI'm glad because I dressed up, OK.
PAGE...just watch our live stream if you'd like. Let's got to Lucy. She's calling us from Syracuse, N.Y. Lucy, hi. Thanks for holding on.
LUCYGood morning, Ms. Page. Good morning, panel. My -- I'm very frustrated by constantly hearing Senator Cruz and House Speaker Boehner say the American people do not want Obamacare. The American people. This generalization is untrue. There are American people out there who want it, myself included. And I want to know why the press allows them to get away with it -- that generalized statement. And lastly, I would like to see the Obama Administration change it to Obamacares with an S. Thank you.
PAGEAll right. Lucy, thanks so much for your call. So, Janet, are we letting opponents get away with something when Sen. Cruz makes a statement like that?
HOOKI try not to quote people saying things like that because I don't think that anybody speaks for the American people. And especially on an issue like this where people are so divided and in many cases just don't have an opinion. I actually find polling on this very frustrating because there's such a high level of misunderstanding. So I think the caller is right that nobody is speaking for all of the American people.
MARCUSI'm going to actually stand up for John Boehner and Ted Cruz and say that if you were fact checking them you would have to say despite the lack of understanding that Janet correctly sites, a majority of American people in polls have consistently said two things. They do not like Obamacare. They -- you know, I'm getting ready to do "Green Eggs and Ham" -- they do not like it in a boat, they do not like it -- anyway.
MARCUSThey don't like Obamacare. It is unpopular. It is even unpopular among -- I think in your majority or close to a majority of Democrats. However, they do like individual components of it when you poll those. But as political statements go, this one is maybe truer than many.
PAGEYou know -- go ahead, Todd.
PURDUMI was going to say it's also true though that the majority of Americans do not want Congress to overturn it. They do not think that this backdoor route is the proper way to do something about it.
PAGEAll right. Let's go to another caller. We're going to go to Steven. He's calling us from Ashton, Md. Steven, you're on the air.
STEVENTodd, I think you misspoke earlier when you were discussing the parliamentary system. If we were in a parliamentary system, Mr. Obama would be a congressman, Mr. Boehner would be the president and the Affordable Care Act would've already been overturned because the Republicans hold the majority and the analog to the House of Commons, which is the House of Representatives. So in fact, in a parliamentary system we would have no Affordable Care Act.
PAGESteven, what an interesting point. Todd, what do you think?
PURDUMWell, I think actually the president would be the prime minister and I think Speaker Boehner would be the opposition. And I think -- but I appreciate the cleverness of your point and thanks for calling.
PAGEI'm Susan Page and you're listening to "The Diane Rehm Show." We're on the phones. 1-800-433-8850 is our toll-free number. You can send us an email to email@example.com. Well, let's go to Hammish who's calling us from Sycamore, Ill. Hammish, (sp?) I don't know where that is. Where is it?
PURDUMCindy Crawford's hometown.
HAMMISH...it's just outside of DeKalb about 70 miles west of Chicago.
PAGEAnd Todd you were saying who's hometown is that?
PURDUMIsn't it Cindy Crawford's hometown?
HAMMISHYeah, mm hmm.
PAGEOK. But presumably that's not why you're calling, Hammish.
HAMMISHNo, right. Good morning, everybody. The -- if they have a vote to shut down the government than they need to shut it down. And that means that Congress and the Senate go home. They're out of jobs, they don't get paid. The executive branch takes over the running of the government. It runs most of the government anyway. They run it for 90, 120 days. We hold new elections and get people in there. Those people who voted to shut down the government have admitted that they can't do their job so they aren't eligible to be elected.
PAGEHammish, that's such a good point and Janet, you were mentioning the low esteem in which Congress is held. Hammish sounds like he agrees with that.
HOOKYes. That sounds like we have Exhibit A. And is one of the obvious byproducts of this whole debate, whether the government stays open, shuts down, hit the debt ceiling or not. No matter what happens, Congress is going to come out looking worse for it. However, what he's talking about, that sounds like a real parliamentary system where you shut down the parliament and hold new elections. Unfortunately, we don't have that...
MARCUSAnd we can't -- we don't shut down the constitution when we shut down the government. And by the way, the question of whether Congress has a vote to shut down the government, it doesn't have to have a vote to shut down the government. The government shuts itself down because it hasn't provided the money for it to go on, except for, as you pointed out, Susan, there's a lot of people who stay on the job because we really can't shut down government. We can't turn off air traffic controllers and border agents and everybody we need to actually keep things moving.
PAGEYou know, we've just had a couple years of accelerating dysfunction. I think that's a fair statement. You're all nodding your heads so thank you very much. Is there -- do some -- what happens to break it -- what happens to make the system start to work more like it's designed to work?
MARCUSI don't think anybody knows the answer to that. And we've had these conversations leading up to elections that I think have been misguided where people have talked about breaking the fever and having clarifying elections on both sides if they would get enough of the majority to make it clear that the American people want X or the American people want Y.
MARCUSRight now in Prince George's County earlier this week, President Obama was making the point that, you know, we had a vote on Obamacare. It was the presidential election. He was reelected. I think he made that point. And in any event, it's true, it is hard to see other than a really a rising of a throw-the-bums-out mentality, which we may see after this, a change in our current situation of gridlock and accelerating dysfunction.
HOOKThough I don't know, the thing that's so difficult is we kind of had a throw-the-bums-out election in 2010. And people say sometimes, well, it's because we've got divided government. Well, we've tried divided government, we've tried unified government. Obama had, you know, a Democratic Congress for two years. We've tried every permutation and it still seems to be getting worse and worse.
PAGELet's talk about the Navy Yard shooter. We learned some things about his motives this week. Todd, what did we learn about this -- the man who carried out this terrible attack?
PURDUMWell, we learned that he was a deeply, deeply troubled man whose problems ran silent and deep, like the sonar waves he felt were, you know, beamed into his brain. I'm reminded, when I used to cover the police in New York years ago, a colleague who worked for the New York Post tabloid said that any story about a horrible crime could begin by describing the suspect. He led a quiet life and then. And, I mean, this guy in fact had led an increasingly evidently obviously troubled life and the system picked up some aspects of that and greatly ignored others.
PURDUMAnd I think it really highlights, once again, the need to have better understanding about mental health and the problems people face, and especially when these people are doing sensitive jobs either directly for the government or as government contractors. There were so many places along the way where something should've been tripped and it clearly wasn't. And we saw that the contractor that had been providing these services, as you know, has been discharged.
PAGEWhy so many red flags missed by the Navy, do you think, Ruth? Because it did -- in retrospect -- and maybe this is always clearer in hindsight -- there were any number of points where somebody should've stood up and said, hey wait a minute. This guy is troubled.
MARCUSIt is maddening and infuriating that there were so many steps along the way when somebody should've stepped in and stopped him, the police, the Navy, the contractor, local police. When he was shooting through floors, he was shooting out tires. We have I think two things going on simultaneously. We have a system that is not designed to bring this information together. It is separate stovepipes and it doesn't communicate with each other.
MARCUSAnd then we have an understandable reluctance to completely disable people from being able to work, from being able to obtain weapons -- I'm not agreeing with that -- because of mental illness. Because you want to encourage people to get treatment. You want to encourage people -- you don't want to have a system where somebody is completely stigmatized. But at the same time you don't want this.
PAGERuth Marcus with the Washington Post. And we're also talking this hour with Todd Purdum of Politico and Vanity Fair, and Janet Hook from the Wall Street Journal. We're going to take a short break. When we come back we'll go back to the phones and take some of your calls and questions. Stay with us.
PAGEWe've gotten a lot of listeners curious about getting more details about how the Affordable Care Act will work. We encourage you to listen to "The Diane Rehm Show" on Monday in the first hour. It's a show devoted to exactly how it's going to work, how the exchanges will work on Tuesday. You want to listen to that. And, you know, we've also had a lot of listeners sending us sections of the Constitution.
PAGESection of the 4 of the 14th Amendment saying that it makes it a constitutional imperative for the government to pay its debts. And we've given this Constitution to our lawyer panelist Ruth Marcus to explain.
MARCUSOK. So I'm going to just throw myself on the mercy of the court and say, I forgot about Section 4, but that doesn't get to our problem because Congress needs to pay its bills. But Congress also has a law in place that puts a limit on the debt ceiling. So Congress needs to fix that. The president has concluded and on advice of the Office of Legal Counsel which didn't forget Section 4 and a lot smarter than I am at the Justice Department that he doesn't have a way around this. So I hope I can get -- constitutional probation. Thank you.
PAGEAll right. Let's go back to the phones. We'll talk to Henry from Stantonsburg, N.C. Hi, Henry.
HENRYGood morning, and good morning to your guests. I'm concerned that the Affordable Care Act amounts to another tax on labor. That is to say, it increases the cost of labor, in the same way that the workman's compensation insurance increases the cost of labor. There are other things that you can lay taxes on. Intellectual property would be one. Capital in itself would be another.
HENRYTo just keep making labor more expensive and telling people that you're improving their lives, it doesn't make any sense. I've employed, people. I've paid workman's comp. It goes up all the time. You'd never get anything out of that. And it enriches attorneys and it is a complete waste and was never considered during the writing of the Affordable Care Act that they could get rid of workman's comp or incorporate it or consider it to be a pool of money already taken.
PAGEAll right, Henry. I'm very sorry I accidentally cut you off, I didn't mean to do that. It's because we're using this new system. Please accept my apologies. If you call back, I'll try to get you back on. But let's take what Henry was saying, Janet. Were these things considered during the debate over the Affordable Care Act?
HOOKOh, sure. And it continued to be an issue in the court case against the health care law about whether the -- there were fines or taxes involved in punishing people and companies for not having health insurance. I think that proponents of the law would argue that the other way of looking at it is if it increases the cost of labor, it also increases the health of workers. And that pays back to employers. That's why so many large employers have health insurance. It's good to have a healthy workforce. And it's part of what retains employees if you want a stable workforce.
PAGEHere's an email we got: Will any parts of the Affordable Care Act implementation that start Oct. 1 be affected if the government shuts down that same day?
HOOKThat's the great irony, as I understand it. Not really. It is -- it continues. Yeah, there are a lot of parts of the law that have been funded, first of all, through mandatory spending, which is like the Medicaid program, automatically paid programs that aren't affected by the discretionary spending that's in the bill at issue.
PAGELet's go to Michael from Washington, D.C. Michael, I'll do my best not to cut you off. You're on the air.
MICHAELThank you for the panel for the educational discussion. My question is this, we always hear of the chorus that the Affordable Care Act is a bad law, that is the chorus and that's the (unintelligible) from the GOP and those opposing the law. My question is this, is there any document by the GOP that is tangible, we can hold, we can distribute in flyers, in handouts to keep away the people or they say that we can hold on to say, look, Obama is offering X, Y, Z.
MICHAELGOP, we are offering A, B, C. Something that is tangible and not just rhetoric. Is there any document like that? Can they promise to do something like that?
PAGEOK, Michael, thanks for your call. Todd?
PURDUMWell, you know, I'm sure there probably is some document pretty close to that floating around somewhere in the bureaucracy or the Department of Health and Human Services or someplace in the White House. But your point is very well taken that this is a debate that often obscures those basically very simple questions. And one of the things the Republicans are suffering from and their own cooler heads realize this is they have not been so far in this debate very articulate about offering what their alternative proposals would be.
MARCUSWe used to talk about repeal and replace. The Republican mantra. Now we're just talking about repeal or if we can't repeal at least delay. There is not a lot of talk these days about particular alternatives.
HOOKAnd I do think that one byproduct of this really intense partisan debate about repealing is that I do think that there are parts of the law that even Democrats would like to tweak or improve and it's just really hard to have that kind of conversation when the atmosphere is so polarized.
PAGEAnd, of course, we don't have big -- most elections until next year but we do have a Virginia gubernatorial election coming up just in a couple of weeks. And the Republican candidate Ken Cuccinelli has begun ads focusing on Obamacare. And I wonder if Democrats are concerned that this could be a big issue not just this fall but next year in those midterm elections, a big issue and a tough one for Democrats.
MARCUSI think that by then much will be settled. So I think that there's less anxiety about that. And in House races, you remember that while the Republicans were all running in really safely conservatives districts, most Democrats are running in pretty safely Democratic districts.
PAGEHere's an email from Scott who writes us: Yesterday, James Clapper told Congress he's willing to consider limits on oversight of surveillance of Americans. Do our elected lawmakers have the authority to require greater limits in oversight? Or is that up to Mr. Clapper and General Alexander?
MARCUSThey totally have the authority. They pay the bills for General Clapper and his operation. So they get to set the rules. They can say we don't like this, shut it down.
PAGELet's go to Lafayette, Ind. and talk to Mark. Mark, hi.
MARKHi. I just want to comment on -- I drive a lot for my job and I listen to a lot of talk radio. All the reporters and you folks as well there, you know, are all just talking about how dysfunctional Congress and all these fights and everything that are going on. And I just think that so much of it goes back to the fact that they passed this health care bill, you know, with just all one side voting for it. And, you know, I just think it was a huge mistake.
MARKYou know, if we're going to have a great, big, new government program, it's got to be bipartisan or else this is what's going to happen. And I just think it was a huge mistake to go ahead and shove it through just because Democrats were in control of the House, Senate and the presidency. And, you know, I just don't think the Democrats are getting enough blame for all this because they shouldn't have done it.
PAGEAll right, Mark, thanks for your call. You know, Todd, this is similar to the point that you were making that some previous programs were passed by bigger majorities. But was there an option of getting a bigger majority in this political climate?
PURDUMWell, it's an interesting question because if the member of both houses had been left to their own devices, there was critical support in the Senate and probably to a lesser view in the House. But there would have been some Republican senators willing to vote for this. And there were many months of long negotiations with the Senate Finance Committee with Chairman Max Baucus and others trying to get someone like Olivia Snowe or Susan Collins to vote for it.
PURDUMAnd at the end of the day, Mitch McConnell, the Republicans leader, said you can take that vote and your career is over. And I think what the difference between the big programs of the past were, to go back to the Civil Rights Act, that passed with the crucial help of the congressman from Lafayette, Ind., Charlie Halleck, who was the Republican leader. And he realized that the only something like that could pass was with bipartisan support and that the country needed something like that to pass with bipartisan support. And so although he had no black people in his district, he supported it.
MARCUSBipartisan is way better than partisan. And we're seeing the implications of that now. But I think you're totally right, Susan. The reality is and after a lot of time wasted really trying to cobble together some bipartisan support, the only alternative was the partisan alternative. And I would ask the caller whether he was similarly upset when the Medicare prescription drug plan was passed through the House only after holding the vote open and arm twisting to get enough Republican support.
PAGELet's talk about the opportunity costs that we're seeing now in Congress. Janet, we're debating whether to fund the government not for a long time, for a couple months, right? We're debating whether to pay our debts with the raising of the debt ceiling. We're re-litigating Obamacare. There were some big things that Congress had said it was going to do this year including a comprehensive immigration bill. What's not getting done because of the work on these things?
HOOKWell, obviously the immigration has almost vanished from the face of Capitol Hill in all of this. It was already -- had an uncertain future because the Senate had passed it bill with a significant bipartisan margin. But the House hadn't -- the House was going to have to come under a lot of pressure to advance any kind of legislation this year. And now the pressure has vanished. Interestingly, one thing that also has vanished is any really serious talk about reducing the deficit.
HOOKBecause we're looking at these budget bills and the Republicans are focusing so much attention on Obamacare and repealing the health care bill that actually there's a lot less of the proposals to, you know, change entitlement programs or raise taxes. It's completely eclipsed the traditional focus of this big fiscal fights.
PAGEYou know, Obamacare was originally a name put on the Affordable Care Act by Republicans, I think, trying to make it toxic. Now the White House is kind of has kind of embraced it.
MARCUSThe president has explicitly embraced it. To go to your opportunity cost point, I think there's two costs embedded here. One is just time. There is not a lot of legislative time, as we all know, they don't work in session very many days of the week. And so if you're immersed in these fights, you are not getting to substantive things, things that actually could improve the situation, like in immigration reform bill.
MARCUSBut you're also just further turning up the incredibly already hot temperature of the political climate in Washington and probably making it less likely that you're going to get to a compromise on immigration reform. The only potential upside counter-argument to that is maybe people will feel so bad after whatever apocalypse happens, and so chastened and desiring to show their voters that they can actually get something done that there will be some incentive to come together on immigration reform.
MARCUSBut that's a rosy scenario that I'm not endorsing. I'm just imaging, for lack of a better one.
PAGELet's go to Charlottesville, VA. Mindy has been on the phone. Mindy, thank you for holding on. You're on the air now.
MINDYHi. Thank you. So my question is related to -- I try to understand other people's point of view. And the Affordable Care Act to me seems like a good idea to get more health care to more people at an affordable price. I'm not understanding why Republicans are against it. I hear they referenced it to socialism, which -- but do we know who's lobbying these guys? I'm a little bit jaded, so I tend to (word?) that if you follow the money, you kind of find the reason why people do things.
PAGEOK. Mindy, thanks for your call. So where's the money, Janet? What's the money behind the very sides on this?
HOOKWell, there's money and probably as important passion coming from the Tea Party activists. And I think they see this as a form of socialism because they argue that it's the government intruding in one of the most personal aspects of your life, your health. But that kind of overlooks the fact that what we're talking about is the people who don't get the health care that they need. And I think actually the launch of this new website, really -- the website for people to find health insurance policies kind of fuels this spooky sense of, oh, it's the government that's providing health insurance.
PAGEAlthough it's in fact insurance companies.
HOOKRight. And it is a private -- it is an exchange for reaching health insurance. I think a lot of Democrats think that this would be much better if it were closer to socialized medicine.
PAGEMore of a single-payer system like they have in Canada or...
HOOKMore of a single-payer system. Yeah.
PAGEI'm Susan Page, and you're listening to "The Diane Rehm Show." Well, we had the Senate make history on Tuesday unanimously -- and how often do we get to say that -- they confirm the nation's first openly gay federal circuit judge. Tell us about it.
MARCUSTodd Hughes confirmed to the federal circuit, which is a very specialized court. It handles intellectual property and claims matters. And what was astonishing about this vote was that it was so uncontroversial and such a kind of non-news issue. The only way I really knew about it was that the White House was emailing me saying, hey, don't you want to pay some attention to this? This is a great thing. And you sort of flashback and look at the controversy over an openly gay ambassador who was...
PAGEA couple of years ago, not that long ago.
MARCUSYeah, not that long ago who was held up, could not be confirmed, James Hormel. I don't think he was confirmed because, you know, because of this horrible, I don't know, sin. I'm not meaning that. Nobody email, beat me up on the Constitution part. Times have hugely change and this is another sign close to that and a welcome one.
PAGEIt's amazing Todd Hughes becomes the highest ranking openly gay judge in the nation's history. It's really, you know, we struggle with race, we struggle with sexism. It seems like attitudes toward gay men and lesbians have changed in a flash compared to those battles.
PURDUMI think that's fair to say. I mean, I think everything is relative. I'm sure for gay Americans it doesn't feel like a flash. But the truth is, just when you look, as Ruth is saying, just so recently and we saw this week also President Bush '41 witnessing, being one of the witnesses of a gay marriage in Maine of some shopkeepers there who are friends of his family's. And I mean, one is tempted to quote Martin Luther King that the arc of, you know, universe is long but it bends towards justice.
PURDUMAnd there does seem to be something -- demography is taking care of this particular problem in American life. And our children are growing up without any kind of feeling about it at all. And I think that's been something remarkable to watch.
PAGEDemography meaning the different attitudes that young people have.
PURDUMYes, young people are just coming into the world with different attitudes and different experiences and different approaches to the whole issues.
MARCUSAnd majority of young Republican voters support gay marriage. So demography is taking care of it and I think Martin Luther King, the arc of the universe may be long but it's actually a lot shorter in the internet age.
PAGEThat may be the case. We saw, as Todd mentioned, former President George H.W. Bush and his wife Barbara serving as witnesses at the marriage of Bonnie Clement and Helen Thorgalsen who own a store in Kennebunk and have known the Bushes for year. Well, let me thank our panel for joining us this hour. Janet Hook from the Wall Street Journal. Todd Purdum from Politico and Vanity Fair. And Ruth Marcus from the Washington Post. Thanks so much for joining us this hour.
PAGEI'm Susan Page of USA Today sitting in for Diane Rehm. Thanks for listening.
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