>> rose: wcome to the broadcast. we beg this ening with an update on alth care reform and ezra klein of the ashington post". >> thiis going to simultaneously be e largest step forward in social policy since the great society. and a sharp rinder of h little our system can do about proble we all admit that have this wl be an enormous achievement for president oba and the demratic congress. but much of itwill come becau they recognized the limits of the process i which ey operate. >> rose: we ctinue with katti martin her story of her parts coming fro hungy to the united states is cled "enemies of the people." the core of the book are these file wch is contaed many shatteri revelations durg 20 years of near total surveillance of my parents as well their brutal treatment in prison. what i disvered along the way was very painful rsonally but i think tha as we are celebrating the 20th anniversary of the fall of comnism it's impoant not only to hear the historians' perspective but to actually hear howeople lived during a hal a century. millions of ople, it wn't just my family that liv under this awful regime. this is the humantory from the ground up. >>rose: anothertory of immigratn this evening from steve rerts. e book is caed "from every end of this earth." >> when you think about obama's stories and soany other migrant stories, it' the most tenacious, the mt resilien the most ambitious whoan imagine a life outside their couny and have t strength and courage toake it here. so it's a self-selected pross. someone called it t american r i agree. >> rose: a proam note,en ouillette a was scheduled this eving, his book called "google e story of the google company and s founders is getting a lot of attention. pa two of that conveation will be se at another date so wean bring you update on health care rorm and two stories of immigrion. one from katti marton andthe other from steve robts. next. if you've had coke in the last years, ( screams ) you've had hand in giving colle scholarships... and support to thoands of ouration's... most prosing students. ♪ ( coca-cola 5-note mnenic ) captioning snsored by ro communications from our studios inew york city, this is charlirose. >> rose:e begin tonight wh the intense debate in washington over healtcare reform days after edicting a reforbill would passhe senate by christmas,resident obama summoned senate decrats to the white house. the presint urges senatorsto ach a compromise to achieve the party's t domestic priori. >> now, let's be clear, the final ll won't inclu everytng that everybo wants. no bilcan do that. but what i told my former colleagues today is that we simply cannot allowifferences over individual elemen of this plan to prent us from meetg our responsibilityto solve a long-standing d urgent problem for the arican people. they are waiting for us to act. they are coting on us to show leadership. and i don't intend to let them down and nther do theeople standing next to me. rose: much of washington w also focused on independent senator jo lieberman of connticut. his vo is essenti if no republics support this bill. lieberman ha voiced dutsbout the democrac propol but today he sai rect concessns haveade a difference. >> if asppears to be happening the so-called public option governmentun insurance program is out and the medicarbuy in whh i thought wod jeoparze medicare cost taxpayers billis of dollars ove the long ul, inease our deficitis out and there's no otr attempt to bring thingsikethat in then i'm going to bin a positio where i can stay... i'm getting toward that posion where i can say what wanted to say saul along: that i'm ready t vote for health care reform. >> rose: joining me no from washington ezra klein, he reports and ogs on hlth care ises for the "washington post." am pleased to hav him back on thisrogram. welcome. >> tha you for havin me. >> rose: tell me where we are in is sort of legislative process we're moving forward day by day ek by week. what happened lastight was very big. they made a massive concession to joe lieberman to ge the... what lookso be their 60th vote. and i want tomake onepoint on this which is the big story, right, is that e liebman di't want to comprise. t the other sidef that story-- and i think the one that mas me think that health care will get done sds that 55 democrats or, manyof whom wanted a public option terribly, chuck schumer and nator sherrod own, they were willing to comprise. they gave lierman everything he wanted for his vote so there a real flexility righnow to get this bill done. >> rose:nd what is the thought process in tir minds that enabled them to ach that conclusi? >> tt fundamently as important as the medicare buy-in and the public option were and the thgs senator lierman said a moment ago out the medica buy in wereot, frankl te, but fundamently they're not the imrtant parts of this bill. th just aren't. what is important abt this bill is that beneath it is900 billion over ten yearshat we expect wl ensure 35 mlion or so people. and that will se thousands of lives,keep people from medical bankruptcy, from becoming infirm or in chronic pain. it willdo an enmous amount of goodnd for the very first time in this count create a univerl structure. upon that you can prove. you can build. you can add a plic option lar if you have the votes for it. but what you n't do you lose this, it is not easy toet that $900 bilon back. so you take th first step now d you take the ne oneater. rose: it so has political rercussions for those democrats, too, because they believe that unless theyave health care reform it ll look like a flure and trefore rt them wn they go t the voters again. >> of cour. and i ink they're probably right about that. they remember thisrom 1994 when gingrichnd dole kill the reform plan on theadvice of many, many republican strategists and then destroyed them in the following electn. e american people do not reward faire. >> rose: what wereyou saying aboutieberman, the poi he made is not true? what points are not true? so senator lieberman said three things there abouthe medicareption, and ts is why democrs are so upset at him. he ved... and in the senate, this is quite rude. he moved before the congressional buet office rendered its verdict on medicare buy-in. and ma people believe t reon he did that is that the measurese put out,that he meioned there, were goingo be disproven. the congresonal budget office has lked at medicare buy in fore, they say it lengtheit is life expectancy of medicare because it bngs in healter peopleho aren't as cosy to the system. it would have had no affect o thedeficit because the subsidies cost money,ot where people go with the subsidies. i mean, therwas a rl sense in congrs-- and i spoke to many moderate offices about this not liberal os here- that he just sort of decided that there was not gog to be any give in his posion. and that, again, isort of why i pointut tha.. and that these senatorsho did want give and did el that he was not being... acting in good faith here, that they comprised becae at this point the overriding imperative for them is to get th bill done and not to win the fight. >> rose: are there republicans that might come with the democrats? >> y know, there'sstill talk about nator snowe and senator collins. i occasially hear mention of senator voinovich fromhio who's reting this year. is but the reasonhey hado go to lieberman was basically that senator snowsaid that if you nt my vote you will have to slow this wn. that we're moving o quickly. democrs who want to gethis out of the senate by christmas because ey want to move it back throughhe house and get evything done by the state of the union, they basically realized or decide that putti this on for moreime was not ing to be a friend-to-psing the bill. that uertainty was nothe iend of refmment these things don't tend get voted down, they bleed out, theyet delayed. so lierman at the very least, you knew how t placa him. you knew how to move himn to the bill anduickly, which i why they did it and so very quickl it was one daynd this anged. >> rose: but are there... where would tho democrats who are willing to bite the bullet on public option, are there certain issu that they will say no i'm not goinghere for the sake of compromise and for e sake of health care reform in 2009 or 10? >> affordability. so what you havein health care reform are three stools, three legs o a stool tt interact very qckly. and one is subsidi, right? th $0 billion. the money we give to people beloa certain level of income to help them buy e plan. the other is the indivual mandate. and this is very important the invidual mandate says pretty much everybody except people who rlly can't afford it has to d with a perceage of iome, they have to buy in and if they don't they face a penalty. now, the subsies aren't enough and the insurance regulatns aren't enough make coverage affordable for peopl, you can't have the mandate, because it's penaling people for something they can't d if subsidies drop really all at thispoint--we're probably too low as it is-- i think president obama's vel of $900 billion was too low for this bill. that dropped, then you would see peop fleeing the bill, not just becausehey think the bill is becing bad but because it' becoming a political liability. the individualmandate, if it ends up apying to a bill at's notffordable, it's going to be tremely unpopular. >> rose: when you look at the co of this, where do you think the real number is? >> sothere are two ways to answer that, rht? the real number is somewhe around $900 billi. but one thing we forgetn washington, i think it's a remnant of the e of surpluses and defit spend, is tha government, likeou or me, can buy somethinand not pay for it on a creditard,ight? that sometimesou go out for dinner and you don't put it on the edit card, you actually pay for it. and so the cost, t price tag, may $900 billion. but just as se iestments retu money over time, i belie this one will, too. wh we have from the congressionabudget office rit now, the sort of best estimates we can go on, is that this bill wi save money and the reasont saves ney is that it raises re renue and aceves more sings in medire and medicaidnd other elements othe health car syem than it cts. now, some people are skeptical how those will manifest and u could see some changes on the margins. t the basic arithmetic of the bill is pretty sound d nerally speaking congress do follow through on what it says it's goingo do. a couple peoe looked int this and tracked o medire saving efrts and mainly they've worked so we should see slight reduction the deficit in the first ten years a a slightly largerne in the second ten years. health care is not going to be a huge cost control device, a ast at this point as it is currently written. but it willnot cost taxpayers anythingore in terms o borrowing. >> rose: whe is the discussion on medicare in terms what will happen medicare? beuse i read a piece in politico that jim webb, the democrat senator from rginia was concerned abt medice becae there were a lot of people in the constituency who were onmedicareand woied out costs. >> there was a lot of... there's obviously some concern about medicare and some effts to gin up concern about medicare. what we're looking at is about a 6% cut for t program. we have implementedlarger cuts than that ny, many tim in the past. and most of it is not happening through straightuts but reforms. so aig chunk of the mon comes from what's called the medicare advantage program anthese are private insurance programshat came int medicar yes ago. anthe idea is we would pay them the samemount we pay medicare, but they're private. they wld be more efficient. anthey weren't. and they cost mor, about 1% of what weay medicare. so wee ratcheting those payments back and 're paying somewhat less to hpitals. i don't expt-- and i don't think most experts expects that we will see changes in medicare that most beneficiaes will be able to notice. if we do, you know, i imagine congress will hear aut that and look atther things. the her piece of ts, thou, ishis medicare commission which, you know senato jay rockefeller is aempting to rengthen and the administration suppos. and what thisommission doess basically cate arocedure for fast trackingeforms for medicare to help in the lon term ctrol costs, save money, that sort thing. that could have a big affect, buwe don't know whatthe affect will be. but one way or another we should justay that medicare as it is now, like other parts of the system, is unsustainle. if y let it go as it is, it willo not only bankrupt but ke down the government it with. so at some point we are ing to haveo figure o how tosave money there. d we're no doings much of in the this bl as we will need to do. but maybe we're making a start and putting in place some procedures to lp us do hit in th future. >> re: doost people whaver th numbers and wtever the ta says believe that medicare works? >> i believe that mosteople o are on it believe medicare works. does medicare wor in sort of an abstract policy wk way? yeand no. it's extremy efficient at providing insurancto seniors and it gis them generally speaking a very good experience. it, like therivate market, is not a very efficient health care system, in pticular the way it pays doctors, right? we pay doctors the way we pay salesm at best buy. say if you sells more stuff we give you more mon. that's good foa salesn at best buy, butaybe we don't want doctors thave the incentiv to do more treatment more surgery. so that is one of the places people likto see that change. and one thing you shoul say about this bill and there's a wonderful piece in the "ne yorker" a weekgo on is exa suect, this bill tries everything everybodyan think to save money in medicare. there are... most the bills when you hear 2,074 ges, most are ese pilot program in medicare and th're pilot programs about changing e paymt structure, about bringing more evidence to be, about penaling hospitals that have hh postoperative infection rates. they're honesy putting in a small version of everytng pretty much anybody s thought of here. so they are trng. e question of whether the programs work and w well they get moved up to scale is an open one for now. but there's simply nodoubt that this bill-- insufficient as may be-- isn't the single largt cost conol effort we have ever made in thehealth re system. nothing we have done isven close. >> rose: what wil happen if there is a bill that makesits way through senate a they get it othe floor andhey get 60 vos and there is no filuster and th senate passes it and it th goes to conference? whatappens then? >> it's very hardo say. i' actually hearing moreand more, andarticularly today, that the house is going t bite the bullet and pass something ry, very clo, ifot actly tohe senate bill. so when we talked abt coerence, we're talking about a procedure in wch the nate... negotiators from the senatend house meet to hammer out a bill but thers aually another way to do , too, that'scalled ping-ponging. basically in this y the house mply passes the senate bill unanged and then it dsn't eveno back to the sate. it goes dictly to the president. i think there's a lot mortar discussion now among members in the house thathe compromise is so delicate and there's such a undeniable williness on the part of senors like lieberman, wilson, snoweand others to fill buster that the hou can't do what it would like to do and change this bill substantially. that it's too fragile if that's thease, the house i mu more afraid than senate because they're all cing the voters. so they y opt to this quickly, gett done this year or very, very early next year and get it to the psident so come t state of the union democrats have a major accompshment. and this is importt to them. can pivot hard to jobs and the economy and far matter deficit. but t they letit drag out, if coerence drags on, they're sitting there withhis giant bill bad press covere for a lot longer and thr message gets steppeded on. >> rose: if it is accomplished, what do we say about it? that thipresident after so many others fled did it right and got health care reform? >> wsay, i think, two things. this is going t simultaneously be the largest step forwd in social policy sie the great societ and a sharp reminder of holittle our system can do about probms we all admit that we have. this wl be an enormous achievement for president obama d the democratic coress. but much of it will come because they rognized theimits of the process in ich they opere. we talk about how big this bill is, ithanges a fifth of the economy. it doesn't. th bill will not affec the vast majority of americans. it will affect e insunce status of about 35 milli people. will not solve the cos probm that we know we have. we will not cov all of the uninsured even tugh we know we uld and can affor it. we will not all we need to do. weill make a startof it. but this bill is less ambitious than what clinton did, than what nixon proposed, than whatruman wanted, then what f.d. contemplated adding in the soci security act. this bill is a both quiten achievemt but a recognitionof our limits. and at someoint we are not going to be able to content ourselves with having picked the low-hanging frui we are going to have to sit down and ma hard decisions and hard choices on cost and ere won't the spur and the shini goal of covering the uniured. the will be a lot less. and we're still going to have to do i so ts bill, 's a goo first step, it will make the next one easier, but the nextne is going to be the harder one and i don't think anybody looking at this process should very confident that we wi be able to take it. rose: what's the next one? >> in very hard y, cost control. not just startg the procedures and the pilot programs, but telling doctors and hospitals and device manufacturers and pharma "you are going to make less mon next year tha you made this year." or "you areoing toake a lot ss money in ten years than you expect tbe makg now." that's going to be very hard. >> rose: i mean,om friedma makes thargument in conversaons that finding out... i thk this is exactly what you just said another way. we're findin out thathe system we have, the political system, does not produce the best option, the most attractive means of dealing with public problems. can you to that point or are you someere less than that? >> absolutely. . i would... i would inde go further. the law professor lawnce lessig has a le he es about congreional corruption, and i would apply it to this-- althgh i'm not talking about corruption. imagine an alcoholic, he says. th alcoholic could be losing his family, he uld be deep in de, he could have cirrhosis o the lir. and yomight look at him and say thatis worst problem is not that he has three or four drinks befe he goes to bed at night. but it is the fir problem. it's t one you'r going to have to solveefore you can solve all the others. and i have ce to believe in this process th our first problem is at this point congress. our government. i doot believe we can sve our problems. i do not believe that we have the capacity to sol cap and trade. and in t future to solve health care, the entlement crisis, to reform the tax code. the filibuster has bece a central governg reality of thisountry. it wasot that w 40ears ago. i found actual in some storical research that somebody sent toe a mo sent to lyndon johnson abo passing medicareith 55 votes. you would neversend that memo that way. you don't pass thingshat way. at the same te, wve become much moreolarized, it's harder r the parties to work together. we have a syem in which on t one handou need more nsensus and on the other we are able to achieve less of it. and if you want see where thatnds up, look over at california where i come fm ere weaw governntal dysfunction for manyears and we assumed wn it came down to it thewould be able