Day. Where are we in the continuing drama of what the hell is going to happen to greece . Eric trying to make sense of the story is exactly what were trying to do. It has been a heck of a day here in athens, greece, because as you mentioned, we learned earlier in the day that Alexis Tsipras made a counter offer to his european creditors, saying i will take most of what you put on the table, but with some conditions. These are not minor conditions. He has some issues with the value added tax, for example. He has issues with pension reform. He wants to delay pension reform. He wants to get the give the parliament an opportunity to weigh in on labor legislation. They sound like small, discrete points, but added up, they are very important. Its not clear how well they would go down with european creditors, and im talking about the imf and the ecb and the european commission, if they were willing to sit down at the table, but what we learned from Jeroen Dijsselbloem the dutch finance minister who leads the eurogroup of finance ministers today, is that the time for negotiation has come and gone. What the eurogroup and presumably the imf and ecb want to see now is a referendum. That is where we are headed on sunday. Charlie what is the likely outcome of that referendum . Erik no is no two of european bailout under the current offer and yes is yes to the bailout conditions. The way this is being framed is yes is yes to the eurozone, and no is yes to a grexit, so to speak. It looks like for the time being as though more athenians and grecians than not want to stay in the eurozone. Charlie is citrus supporting a cyprus supporting a no vote i understand he is . Eric absolutely. He went on state television in a taped address to urge his people to vote no. On that basis, there appears to be absolutely no room between him and jerome dyson bloom and John Claude Juncker and mario draghi and madame lagarde. Hes going his way, they are going the other way. It appears we will not know how this is resolved until some point late in the evening on sunday, and between now and then, its going to be some furious campaigning. Charlie if the vote is yes, will tsipras resign . Eric he promised on monday night that if the vote goes yes, he will resign. The open question is, if the margin of difference between victory and loss is very narrow, will he actually live up to that promise . I dont know. The reason i raise that question is because this government, not just the Prime Minister, but the finance minister and other members of the cabinet have made promises to which they have not lived up to, many steps along the way since january, since this drama began. It remains to be seen. Thats what he said he would do. We will see. What else can i say at this point . Charlie you said that well. Let me go to peter. So where are we . Peter eric mentioned mario draghi in passing. I think mario draghi is the key figure here. If youre talking about the crisis for greece now is that they dont have any money in the banks. Banks. That is because the ecb has put a cap on how much emergency loan it will allow the bank of greece to make available to the greek banks. Thats why when people show up at the atms, they are having trouble getting money out. Thats why there is a cap of 60 euros per day. That cannot go on. Something has to change there. The ecb is supposed to be apolitical, not mixed up in who is elected, who is in and out of office. We are just the technocrats who run the banking system. But they are getting pulled into this. What the ecb decides in the days and weeks ahead will pretty much determined whether greece stays in our goes out of the eurozone. Charlie two cases i want you to make citrus has a point its hard to get growth in an economy when you have to live under the restrictions that have been imposed on it by its creditors. Peter joe stiglitz said he cannot think of a time when the when a country has suffered through a depression as deep as this one that was essentially voluntarily imposed upon it. Stiglitz is sort of sympathetic to paul krugman. They have a point, which is that greece is suffering under major austerity. Raising taxes now and cutting the budget is only going to exacerbate that problem. The finance minister of greece has been making the point that this austerity is crushing the country. The problem is that tsipras has lost his credibility as a spokesperson. They have flipflopped so many times. Just this week, we have seen examples of that. So many offers and counter offers that nobody wants to listen to them anymore. Even though they have a point. Charlie Bloomberg Businessweek with a cover story called how greece can get past the pain. How can greece save itself . Peter in that article, we try to say, somehow we will get past the crisis stage, and then we will be on to what are the fundamentals of greece that it can use to rebuild the new economy. And what are they . Their number one moneymaker is shipping. It has to be a key. Tourism is another key. Its such a gorgeous country. Anybody who has been there loves it. Charlie what do you think the germans would say . Eric the germans would say that the greeks lacked discipline simple as that. [laughter] there is a point there, but the time for moralizing is passed. Lets try to move forward. The reason people arent listening to them is that they just dont trust the greeks to do the right thing. Thats why this latest offer from tsipras the europeans are not even willing to listen. We have heard from you guys. Charlie then you come back with conditions to accepting our offer no thank you. We will a you have for we will let you have your referendum. So eric, what should we watch for now . Just simply wait for the referendum, or whatever event could be influential . Eric at the moment, its a waiting game. As i have said, youre going to see furious campaigning from the government, which is plastering athens with signs and posters in favor of a no vote. The yes campaign has to get itself organized. Its not particularly wellorganized right now. We may see that beginning to play out. The polling numbers suggest that things are working in favor of yes, so they may not have to work that hard. But you know the Prime Minister and his cabinet are going to be out there on the streets and on television telling greeks to vote no. It doesnt appear as though the movement of international markets, whether it be european stocks, or for that matter the euro, are going to affect much at this point. I think that serves as a bit of a distraction. Its really what happens here on the ground in greece. The signs we get from the germans, and Jeroen Dijsselbloem, and his finance ministers in the eurogroup is that they are done. We are probably not going to hear from them between now and sunday in a substantial way unless something crazy happens here. I dont even know what that would be. Dyson bloom himself said there is no basis for us to reinitiate negotiations. The opportunities to do that ended last night with the expiration of the previous bailout program. Now its up to the greeks. Charlie eric, thank you so much. We may come back to you as the story unfolds. Al Sylvia Burwell is secretary of the department of health and human services. She presides over Government Health care programs including medicare and the Affordable Health care act. In the clinton administration, she was chief of staff to the treasury secretary, who said she was simply the best. She later was president of Global Development at the Gates Foundation and then president of the walmart foundation. She came back to government in 2013, when barack obama asked her to be director of the office of management and budget. Last year she was named the 22nd hhs secretary. When the Supreme Court ruled in favor of the Affordable Health care act last week, she said she cried tears of joy. A proud daughter of west virginia, she was a rhodes scholar. Shes often called the policy wunderkind. I was stunned to see last week she celebrated her 50th birthday. A belated happy birthday, and thank you for joining us. Sylvia thank you for the birthday wishes. I appreciate it. Im glad to be here. Al youve seen the reaction since the decision in the court last week. How does it change the landscape, if at all, and what are the major challenges you now face . Sylvia it gives us an opportunity to build on the progress we have seen in the areas of quality, affordability, and access in the health care space. I think we can turn and build on that and focus on some important things that we all need to focus on and do together. Access we need to work on those numbers and we can do that by having a strong open enrollment and doing further medicaid attention. Expansion. Now al 40 of subsidy eligible people are now enrolled. Is it sustainable at that rate, and what do you think you can get to . Sylvia with regard to the marketplace, what we saw last year when we saw 25 more plans coming into the marketplace, that you have something that is a sustainable marketplace where there is competition and choice that the consumer can come in and use. We still want to continue to reach those who are part of the uninsured and make sure were that we are helping them understand that they can afford quality care and help and support them in using that care. Al now that the court has said federal exchanges are part of the law, do you expect some of those 17 state exchanges, a number of which are having financial struggles, that they will switch to healthcare. Com . Sylvia we havent seen that. In terms of where we were before we were having those conversations with hawaii. Weve worked with a number of states as they work through how and where they want to be. In terms of changes, there are a number of states have had very successful exchanges. Whether that is connecticut kentucky, new york, a number of states. Our plan is to work with the state that want to be state exchanges, and for those that dont, we work on the federal exchanges. And where there are things they want to do, we will work with the states. Al you did see enrollment in the last sign up or greater on on the last sign up that was greater on the federal than the state exchanges. Sylvia we did see a strong enrollment on the federal exchanges. States had increases across the board. As we go into the next open enrollment, thats one of the things we are focused on. Had we make sure that the how do we make sure that the federal and state exchanges continue to bring people in . Al the Republican Congress is not going to repeal obamacare. We know that. They werent going to do it before and one do it now, wont do it now, but they can project difficulties. They can cut funding for cms try to eliminate the independent payment Advisory Board or patientcentered outcomes. What kind of problems with those windows create . Would those create . Sylvia lack of funding is a problem. Thats an issue across the entire government. The idea that as a nation, sequester would stay in place and we would have funding levels that some of the lowest levels in decades. It is cms that runs all of our health care programs. That is an issue for running medicare and other programs like that, but also the in ih and the nih and places like that, or the centers for disease control, that we depended on so much this year for so many things, whether ebola or our conversations around measles, or supporting a state like indiana as it is going through its difficulties with hiv. Al how optimistic are you . Sylvia i think you know i am an optimist. I came to town as an optimist. I came to town right as the sequester was beginning and people we were going to get thought we werent going to get there. Then there was a deal that led to all of the bills being passed. That was the First Time Since 1987 that all the bills passed together. I think it can be done again. We can get to a place where there can be agreement. Al youve got to do it pretty soon, though. Sylvia we will need to do it. October 1 is a very important deadline in terms of funding the government for the next year. Al bill frist, former Senate Republican leader, and generally a supporter of the Affordable Health care act, said the president has to start to do now what he says he has failed to do, which is try to bring the parties together to fix parts of the law. Are you going to do that, and what do you need to fix . Sylvia today the president is in tennessee. Thats a big part of the conversation. He is there because tennessee is a state where we have seen affordability and quality move together in a bipartisan way. Weve seen it move with the private and the Public Sector working together. He is there and tennessee to reflect that. I think that is where we need to go as a nation and build on the progress weve made, and focus on things like making sure people know how to use that care, how to access a doctor and understand the bills. Or if you are in the employerbased market, you know that there are Preventive Services you can get without copay. With regard to the legislative issues, there are number we have articulated. We want to hear and understand and have a real conversation about the substance. In our current budget before congress, we actually expand the tax credits for Small Businesses to companies that have more employees. We got feedback that the number was too low, so we have proposed that. Another proposal is something that gets to a topic that people talk about a lot. Giving the secretary of hhs the ability to negotiate on highcost pharmaceuticals. Thats something in terms of the price issues that people are focused on. Al im guessing you get some resistance from the industry on that. Sylvia i would think that we would, but we want to work to create a system. Its a historic time in terms of the energy from the private sector, meaning insurers as well as providers, as well as the Public Sector, on changing our Delivery System and how we deliver health care in the u. S. , in terms of improving the quality, spending the taxpayers dollar better, and putting the consumer at the center of care. Al to get some of that, youre going to have to give up some stuff. Thats what bargaining is all about. Would you be willing to put on the table the medical device tax . Which liberals like Elizabeth Warren have opposed to . Have opposed . Sylvia with regard to the idea of negotiations and knowing that you dont always get what you want, whether thats the ryan murray work that was done or in the most recent Sustainable Growth rate, there were so me so many things that were great about that bill. But there were things we would have liked as well. In any of these conversations, we know that that is going to be a place we will have to go. With regard to the medical device tax, as weve said in the space, were going to review things based on four basic things. Affordability, access and quality how does it impact those three things and what does it do to the economy . Increasing our deficit by 24 billion is something we have a real question about. We would want to understand why they want to take this step in terms of improving access affordability, and quality, and what you would do with regard to deficit impact. Al after the court ruling, you said now is a time to come together, but that wasnt really the reaction of a lot of prominent republicans. Paul ryan, whom may bbq republican on capitol hill blasted chief Justice Roberts for writing legislation from the bench. He said obama care is a bust because government control brings higher prices, fewer choices, and lower quality. Sylvia i think taking each of those this is what i need to do in this conversation. It will help bring us together. Lets look at the substance. In terms of the issues of higher prices, as we look at what happened before, thats an important part of the conversation. Where were we as a nation before . Having been in both the private and Public Sector, the issue is increased health care costs. The rates they were increasing could not be sustained. What we see now is we see some of the lowest price growth in health care that weve seen in the history of keeping records. With regard to issues of quality, i think most people agree, and even mr. Bush agreed, because he said keep those preexisting conditions, he said it should be preserved. Al are we talking about the president , or the candidate . Sylvia mr. Jeb bush. Al ok. Sylvia i think there are a lot of places where we start having the conversation of substance and quality preexisting , conditions can no longer keep you off your insurance. As a woman, you cant be discriminated against anymore. In terms of Preventive Care copays for many things like immunizations as well as preventive Cancer Services in terms of screenings, many of those things no longer have copays, and most people want that. I think what we need to do is connect the conversation to the substance of what is happening and where there are issues, lets find places where we can improve the problem we want to work on. Al and his charge about fewer choices . Sylvia with regard to the question of choices, when we look at the marketplace, and 25 more folks came into the marketplace. Its important to reflect, its a marketplace. When i think is a great thing about the system the marketplace means youre making choices as an individual between private plans. Thats what it is. It is a market. One of the things that i think we seek is getting to the consumer at the center. 29 of those individuals who reenrolled this year came in shopped, and selected new plans. That is a consumer that is informed and making choices. Al there are widespread reports that after the experience this year, the premiums, some people say are going to soar 10 or more. In south dakota, i think the request is 42 . Does that worry you . Sylvia i will always focus on premiums, deductibles, and outofpocket costs. One thing is about the total cost of the end of the individual thats something the Affordable Care act and our efforts are very focused on. With regard to the specifics, there are number of things