Transcripts For CSPAN Washington Journal 20090827

presidential race with co- authors of a book on the subject. "washington journal" starts now. . host: we want to focus this morning on help any state should fill a senate seat in the event of death or resignation. here is a photograph of the flags and half staff in honor of senator kennedy. obama says that "the extraordinary good that he did lives on." you may remember a letter sent to the senator asking for a change in the law in massachusetts. from the store this morning, governor patrick saying he is breaking his silence on the future. he is embracing the request that the governor be given the power to appoint someone to the seat until voters can appoint a permanent successor in a special election. we're joined by phone by tom. this question came up following the election of barack obama with a number of vacancies in delaware, illinois, and new work. there seems to be no clear mandate into what stage should be doing. is there? guest: the states have some discretion in this regard. the constitutional provision allows for state legislature to give it their governors the authority to make temporary, special appointments until an election is held. that has really been the pattern since the passage of the amendment providing for the direct election of senators, the 17th amendment. it was the practice before that when the legislature was out of session and there was a vacancy in the senate seat. the governor would often make a temporary appointment. that was the norm. but states have the authority to forgo that, that temporary appointment and keep the seat vacant until a special election can be held. roasted do just that, including in the immediate case -- several states do just that, including the commonwealth of massachusetts. host: under the prairie law there would be an election in january, and during the five- month period, the governor is facing whether an interim governor should be appointed -- that is under the primary lot. what is the history in massachusetts? guest: that is what makes it so politically awkward for the democrats are no. in 2004 mitt romney who is a republican was governor. john kerry was the democratic nominee for president. democrats in the state worried that if kerry elected, romney will appoint a republican to serve in his seat until the next election was held. therefore, they changed the law prohibiting any temporary appointments by the governor, and specifying that the general election was to be held between 145-160 days after a vacancy is created in the senate seat. now, as you indicated there is a lot of talk about changing the law again to go back to what had been the previous practice. the governor certainly favors that, but some of the democratic leaders in the legislature are a little reluctant since it looks so transparently an effort to help the democrats get someone in that seat during the critical legislative. this fall -- period this fall. host: here this headline says " who's in line to take the lion's seat surceas?" in other states including hawaii, utah, and wyoming the governor chooses a temporary center from the names submitted from prior @ incumbent from prior incumbent's party. oklahoma allows of women's only in limited circumstances. alaska has passed a law with legislation and a valid item providing for special elections. but their current status in alaska is now remains unclear. guest: yes, you can see the diversity in our federal system was states really having the power to use or not to use this special appointment power. they can condition it. with some states they say the appointee must be of the same party or must be nominated by that party's central committee in the state. but certainly the most common practice is to allow for those appointments by the governor. that has been the practice. there have been 184 such appointments, i believe, since 1913. of course, this year we have seen a number of appointments, and some like illinois have been very controversial. even new york state filling hillary clinton's vacancy in the senate was controversial. host: finally, in terms of the senate as an institution the story this morning in the paper, as the democrats now lose their 60-vote majority, does this have any impact on health care? guest: potentially. it was never clear that democrats could marshal all of those who caucus with the democrats on the closure but if there were no republicans in support of it. there are some moderate, conservative democrats like ben nelson of nebraska who might not have gone along. nonetheless, it is seen as potentially pivotal. it could come down to a single load. therefore, democrats are very, very concerned about getting that seat film as quickly as possible. guest: tom host: tom mann, thanr being with us. guest: happy to be with you, steve. host: we're joined from clifton park by jay. good morning, how do you think that states should fill these senate vacancies? caller: by the way, i thank you for c-span. i went through along with everybody else in my state the whole ridiculousness that went with replacing hillary clinton which sort of became a cult of personality thanks to caroline kennedy's nomination -- but i think that the gillibrand has been a perfect aplomb and. it puts the governor in the bull's-eye for various interest groups who want their interests address. the model floated right now in massachusetts as the governor appoints someone immediately so the state is not working with only one senator -- that is good, but there should also be a special alexian special180 days to give everyone in the state -- a special election within 180 days to give everyone the opportunity to get their person and beyond the field of special interests. host: thank you for the call. here are the lines. we're asking you how you think the states should fill a senate vacancy. good morning, pat. caller: personally, i applauded massachusetts in its intelligence to actually have an election to fill these vacancies when something happens like that. but i'm upset that the process could be circumvented with an appointment by the governor. and election -- an election is a true process of the democratic process. it will show exactly who, to the people's ability, will be the best representative. host: the me go back to the reporting from "the wall street journal" -- under law, a special russian must take place between january 18 and february 2. next is lee, joining us from oregon. good morning. caller: yes -- god rest his soul. he wanted it one way when they thought that kerry would be voted in, now they want it ever would. that is ridiculous. it seems like these guys get up there and on both sides they're just a bunch of elitists. but god rest his soul. host: in terms of massachusetts law or any other state, how you think the vacancies should be filled? caller: well, every couple of years one side or the other is not right, so. leave them so couple of years ago if it was it was because of romney. -- once other the other is not right, so leave them alone. kennedy was the one who made such a fuss about it last year. set it one way and leave it alone. host: here is the headline -- and here's a piece by george wilson calling ted the most important kennedy. we're joined from joinednow. caller: by women, we need to have a move where governors appoint women. down here in florida there is a strong movement among republicans to appoint a woman. there's a phone number that people can call the governor c rist to appoint a woman. host: would you think should get it? caller: paula here in lakeland is a wonderful person who has worked for environment and good transportation. she could work with senator olympia snowe and they could do wonders. host: next is david from springfield, massachusetts. how do you think that governor patrick should decide on this case? caller: think he should make an appointment until the special election comes around. host: who you think should get caller: iit? caller: there are a lot of great people out there, but i think he should appoint himself as his approval ratings are pretty low. host: vicki is urging murry to support her husband's request. he and the house speaker of massachusetts whose support would be key remain publicly non-committal yesterday. france's is joining us from tennessee on the republican line. caller: good morning. i want to say that i thought in the u.s. that the law was king. we do not change the law on time whim. they changed it in 2004 when they thought would be one way and now there with the ginger five years later for similar political reason. if it is supposed to be the law that is king. the current law if it was sufficient in to those of four should be workable today. host: carla is joining us from massachusetts in munson. caller: first of all, governor deval is not very popular with a lot of issues with taxes. we have waited so long. senator kennedy basically has not -- he has not voted in 97% of the votes for the state since the first of the year and i think that the state should be given a chance to elect someone into the position. host: let's look front page of this paper in connecticut. we're joined from utica, new york, by mike. you dealt with this last year with senator hillary clinton is resigning her seat. caller: yes, when you spoke with the gentleman in the beginning of the program and you showed some states and how they handled it -- host: yes, we can show it again. caller: one was to temporarily appoint a member of the same party, and i agree with that. if you have a governor of a different party putting in a senator from his party that was not elected, the party that was elected in this case it was the democrats -- if someone appointed republican, you're serving the election of the public which was to elect a democrat. yes, have the governor fill the vacancy from somebody of the same party, and then within 160 days or so, have the special election. host: we're getting this information from the non- partisanship research service and you can go to the website to learn more about the rules on a state-by-state basis. we'll look at some west coast papers. here is kevin joining us from silver spring, maryland. we will go to the jesse in deer river, minn.. caller: good morning. you should hear from the people who they want to place in the senate. massachusetts is an extremely liberal state. what is the current law there to replace senators? host: right now the election would take place in january, february for the senate seat which means there would be a vacancy until then. there would be a primary scheduled for november. then a special election in january. caller: i do not think liberals have anything to worry about because massachusetts is an extremely liberal state. host: the question is whether they should have an interim senator for the next five months. caller: personally, i think they should allow the people to decide -- period. host: will go to kevin next from maryland. caller: yes, i was looking at a documentary on msnbc last night and a lot of people do not realize that senator kennedy had written the letter months in advance. a lot of people think he did it just before he died, but it was months in advance that he wrote the letter. host: he did it about a month and a half ago. should they change the law in massachusetts? caller: they could. the republicans do it all the time when they want to justify what they are doing. what is the difference with the democrats? host: good morning, john. caller: i agree. i agreed with the woman who said he was so sick -- they have not had anyone there for months now. when you are that six you should have probably resigned months ago. they have had no representation. i'm calling on the independent line and my point is that we need another party. it is not even a free election. it will be a democrat or republican just like every election. there is no independent party in this country. i pretty much feel like it is a two-way street, not even a free choice because there is known to keep these guys honest. to hear them call in every day, being independent, i hear them every day -- you hear liberal this, a conservative that, the democrats, the republicans -- we need a couple of more parties just to get some real changes. obama is for change. if you want real change get a couple more parties in here and you will see some real representation, changed. until then it is just the same old two guys up there. host: 1 message from twitter. let me come back to more of your phone calls. here is some reporting from a couple of newspapers beginning with the front page of ""the new york times" -- ted kennedy was in a wheelchair at the end, struggling to speak. but from the time his cancer was diagnosed 15 months ago, he spoke of having a good ending for himself. by every account he did. he took phone calls from president obama, house calls from his peace. just a few weeks ago he crooned after dinner with his son patrick and also with his with his wife. it shows that he was at peace with the end of his life and grateful for the chance to savor the salty air with his loved ones. good morning, how do you think that senate vacancies should be filled? caller: they pushed kennedy, and i don't even remember how many years ago -- but he pushed to have it with the governor could pick because of the time they had a democratic governor. i do not understand how they could push that and nobody sees -- first, my condolences to his family. my heart goes out. but he was wrong then and is wrong now. i do not understand how they could even put this into motion. it has already been settled and the need to vote on it. they could expedite the vote. but to change just to benefit -- probably the democrats would win anyway. it they need to keep the law like it is. host: the hometown newspapers in boston were full of stories and a sidebar pieces on all of this. including this piece from the boston globe.com that says there is no shortage of potential successors. also, on the republican side, some names mentioned include the state's attorney general. the peace points out that vicki reggie kennedy, issue decides to run, would be interested in her husband's post, and should be a formidable candidate, a good speaker, but has denied interest in the seat up until now. we're joined now from boston by nick. caller: good morning. i want to listen i answer the question exactly. what should the state of massachusetts do, correct? host: yes, but we are also asking about other states as well. on the issues of states' rights, the french state stew of different ways. in some states you have to appoint someone from the same party. caller: to me is almost ridiculous question. what they should do is do what the law says. it says to "allegedelect" --andy the way, and democrats are the ones who did this. it is a little awkward for the democrats of a sudden to try to change the law. furthermore, this bonds against the other issue. most of the country has an issue in this. the states' rights are continually being stomped on by. federal by the state's laws should be here for the elections. that is how kennedy should be replaced. we can change the law again if we want to, but my feeling is that it is obvious the states should follow the law. what ever, thank you. host: one of the photographs from this from page of ""the new york times," says kennedy was working on the patient's bill of rights legislation. on the final days inside reporting, the reporter mark has the page -- this is the jump page -- his children had expected him to hold on longer. his son patrick and daughter kara could not get to hyanis port in time. the priest was called to his bedside. mr. kennedy spent his last hours in prayer. he told his friends recently that he was looking forward to reunion with his seven departed siblings, particularly his brothers whose lives have been cut short. caller: good morning. host: how do you think the states should fill these vacancies caller: they should allow the law to work the way it was designed to. they should keep the seat vacant until january and then have a special election. we cannot just keep changing the laws to suit the situation of the moment that is what everyone seems to be doing over the past couple of years. they should allow the law to work the way it was designed to. host: here is the front page of "the washington post" on his first day in the senate when he was elected in 1962 and took the position in january 1963. here is a message from twitter. thanks for your calls and comments. we will be joined later this morning by guests to share their stories of the 2008 campaign. we'll look back at some moments from the campaign. we want to continue right now our look at medicare. today is our focus on part b and networks. also, its impact on health care. ♪ >> as washington and the nation continue to focus on health care, sunday we will talk about those h1n1 virus, with this doctor from the center for disease control. and, a look inside the hospital system with our guest from the va hospital center. >> this month the nine circuit court of appeals will address veterans with post-traumatic stress and brain injury and if the appeals process can be speeded up. >> in 1959 in the heat of the cold war soviet premier nikita khrushchev took an unprecedented two-week tour of the u.s. we recount that trip with serge i, the son of khrushchev. >> as the debate over health care continues, c-span healthcare hub is a key resource. you can watch the latest events including town hall meeting to ensure your thoughts on the issue. you can have your own citizen video, including the deal from any town halls to have gone to. there is even more on c- span.org/health care. "washington journal" continues. host: we continue our series on health care. we will introduce you to bruce vladeck who was the health care finance industry head -- that government agency is not known for the centers for medicare and medicaid services. he is joining us to discuss medicare part a b. how would you describe medicare part b? guest: it is the part that covers physician services and a broad range of other outpatient services. it is a voluntary program in principle. when people turn 65 they are certified for social security disability. you have a choice of whether to enroll. the overwhelming majority of those eligible do because it is such a good deal. it is financed, one-quarter of the costs are financed by premiums beneficiaries pay themselves, about $100 per month generally deducted from people's social security checks. the balance comes out of general federal revenue. about half of all payments under part b are to physicians over office visits or house calls. another chunk is paid to a patient services. the whole range of other diagnostic and treatment services, laboratories, x-rays, durable medical equipment, people who need wheelchairs or assistive devices in their homes -- a whole array of other services and goods are covered under part b. host: was the thinking behind part a and b when it was first developed? guest: an interesting historical story, the great advocates of medicare who by 1965 had been working for 15 years to get something enacted made a conscious political decision to start with something very modest. the medicare proposal of the democratic party was just for inpatient hospital insurance and related post-hospital, nursing home care. in 1965 the republican party knowing that something would pass decided they had to come up within alternative. -- with an alternative. the camera with the program described as voluntary that would focus primarily on paying doctors. when i got to the ways and means committee its chairman said and what we do them both? so, he took the republican and democrat bill and stapled them together. that is why it medicare has had two parts ever since. host: who determines the rates paid to doctors under medicare part b? guest: in effect the congress does. there is an elaborate process that has widespread participation by representatives of all the medical specialty societies to establish the relative prices, what the surgeon gets paid as opposed to what a general practitioner gets paid. the details and level of payment are determined in law by congress. host: does a general practitioner in montana get paid the same as one in new york city? guest: no, because part of the formula is supposed to account for the cost of maintaining a medical practice. about half of the physician fee is not based on what they take time, but what it costs to run their office or practice. rents in new york city are substantially higher than in montana. those differences are built into the formula. host: is that where the national coverage determination comes into play? guest: no, that coverage speaks specifically to what medical procedures for tests medicare will pay for. technology is changing. medical practice is changing. medicare like every other insurer must decide if and when it will pay for some new treatment or approach. historic late, in medicare most of those decisions were made initially at the local level by the carriers, the private companies who under contract to the government manage the program. each had a medical director and they in turn had advisory committees. when something you came along they would decide whether medicare should cover its -- when something new came along. there is an effort and reason years to have greater uniformity in national decisions. there is an elaborate process. the problem is that when you have a very publicly open, broadly representative, scientifically based process it takes a long time. the number of decisions that can give made through the mechanism are not large enough. there is still a lot of reliance on medical directors and individual regions -- in individual regions of the country. host: you referred twice to the elaborate process of setting rates. where does it start? guest: it starts with the legal framework that enacted into law something called a resource- based relative value scale developed by a group of physician and social science experts based primarily at harvard in the late 1980's. they undertook this study to compare the value of something one physician did to something another did. in 1990 congress wrote into law that the scale should use. they also provided for a process of regular updating. as medical technology changes and new treatments become available, as new approaches receive consensus approval within the medical community, there is a committee that operates, but it is run largely by the medical profession who meet regularly. once a year the make changes in the code. they add new categories of service. there is an extensive, prolonged process to get a new procedure from the time it is first approved by specialty society or the fda through the experts into the payments system. host: do doctors lose money on medicare patients? guest: no, the question is whether they earn as much from taking care of medicare patients as from privately-insured patients or those to pay out of pocket. that really depends where they are. their ratio of what medicare pays for certain positions services to with the prevailing price is in the private insurance market varies dramatically from one part of the country to another. in some parts of the country medicare pays substantially less than private insurers do. in other parts it pays a similar amount. in a few parts medicare actually pays more than private insurers. it varies. it is a national program, but local insurance markets varied substantially. host: of the $460 billion or so that medicare spends every year, what portion comes from medicare part b? guest: just over a quarter at the moment. that is a little misleading because another 25% of the cost of medicare is paid to medicare advantage plans which we will talk about more. about half the payments eventually go to physicians. from part b from legal and accounting sense it is about a quarter of the cost. host: we want to hear from you. we are discussing medicare parts b, the health insurance, medical insurance portion of medicare. we have divided our numbers a little differently today. if you are 64 or under, the first line. if you're 65 or over, the second phone number. healthcare professionals particularly we want to hear from also. that is the third line. bruce vladeck is our guest. he was head of the agency during the clinton administration that is now known as the medicare and medicaid services. we're also joined by mary agnes . how is medicare part b debate going in congress with regard to reform? guest: they're looking at various things. bruce mentioned a possible change in the payments to insurers to help pay for reforming the they are also looking at possibly reducing payments to some medicare part b providers, skilled nursing facilities and such. there is data out there that indicates perhaps they are overpaid. i'm sure there would disagree. there could be savings from those payments. also, in the house democrats' bill that would pay more for primary-care services provided by doctors and other practitioners. they are looking at closing those holes in the prescription drug benefit. they're looking at way beenco- payment for some preventative measures. host: besides dr. payments, the nurse practitioners and home health care is paid by part b? guest: yes, and there is some concern that maybe there is too much spending on home health- care services. the advisory board to congress has indicated that the sector does not necessarily need more money. host: who sits on that medicare advisory board? guest: you have people from academia, people in the medical professions. you also have hospital administrators. they try to have a cross section of experts. the present those used twice per year to congress. host: in the current debate, which groups are quite active? guest: of course, it really all of them. the hospitals are concerned about what reform might do for them. physicians are concerned. all these providers whether home health agencies, skilled nursing facilities, durable medical equipment -- they are all concerned. they're concerned about how it is financed and hiking get more people covered. how can you make it more efficient? it is all part of the debate. host: bruce vladeck, if someone signs up for medicare part b, again, what are their premiums every month? are there out of pocket expenses? guest: the me begin backers. the out of pocket expenses is a real problem with medicare program not so by any proposed legislation -- let me begin back worwards. it is about $96 per month for it unless they are high in come in which case the pay more. there is an annual deductible in which most services have the 20% signsco-pimm a. medicare pays 80% of the approved price and the beneficiaries must pay the balance. -- the services have the 20% co-payment. if you spend more than $2,000 per year or so out of pocket, over that the insurance pays 100%. there is nocap in medicare and neck to be a problem for many beneficiaries. as a result, the limitations in part b, and high out-of-pocket expenses -- most you can afford to get some kind of supplemental insurance. some have a private retiree health insurance that fills in those holes. some and roll it in medicare advantage plants which frequently have lower out of payment -- out of pocket payments -- and some enroll in that. host: let's go to calls. ava, from orlando fla., on our 65 and over line. caller: thank you. the dirty little secret is that you can get any insurance if you're 65 or over except medicare. believe me, i know and do not trust the system. i got caught in the system. i got disabled and had to go on medicare. i have enough on my plate, so i chose to go to the advantage plan. this obama scheme will take money away from me. i'm using mybrain and trying to save the taxpayers' money -- i am using my brain. i had nearly died three times. host: thank you for calling in with your personal experience. mike, in la grange, texas. caller: yes, it is ridiculous what medicare pays for the hardware. i have a machine that medicare pays $75 per month for this machine. i founded on the internet where it retails for $239. they have been paying $75 per month for about 10 years. it is the same thing with wheelchair's. it is ridiculous. you're just giving money away. i cannot understand. host: bruce vladeck, medicare part b is for this durable medical equipment, right? guest: yes, and i could not agree more caller. every administrator in the agency going back to the 1980's has tried to change what medicare pays for durable medical. medical we have proposed changes in fees and -- what medicare pays for durable medical equipment. we have proposed changes in fees and changes in bidding. every single time live executive-branch under both parties to eliminate those overpayments, the congress has prevented it. my former colleagues continue a used to drive me crazy on a particular issue of pain for in- home oxygen where medicare pays about three times as much as the veterans administration or some private insurers for machines to provide people with it. i used to run around the office modern that we're pain $300 billion per year for air. yet every effort for the last 20 years or so to reduce medicare payments for oxygen has run into a large lobbying campaign from the supplier industry, generally organized to frighten beneficiaries to say that if you let this go ahead congress will cut off yourair supply. congress has stepped in to prevent reductions in oxygen payment every single time. host: mary, are there talks about cuts for medical equipment in the current debate? guest: last year it they had the entire system to set up competitive bidding. vendors were selected and in congressional pressures stopped it. representatives of the sector put a lot of pressure on congress saying that you heard beneficiaries with this step. critics say that your hurt and fishers. the obama administration and others are interested, but you can expect a strong political. host: can you both talk about the political aspect of the medical guest: fee structure please go ahead, bruce. there is always a local concern and pressure within congress. it is sort of a zero sum game. there is a stress between urban and rural areas. it plays out in the debate over medicare reimbursement. host: bruce vladeck? guest: a basic problem in american politics, the political scientist talk about this and have for years -- if you're the average taxpayer or member of congress, medicare's overpayment for oxygen which is egregious but it may cost you an extra $5 or $10 per year out of pocket as a taxpayer, for the oxygen suppliers it is their entire livelihood. whenever the issue comes up before congress the people who benefit from government payments are much more involved in vocal than the average citizen who has lots of other things to worry about and for whom it is a relatively small piece of a big puzzle. i used to say that medicare spent so much for oxygen and $1 billion went to provide for this, and someone to lobbying, and so on. host: here is a message from twitter. could you both talk about medicare and whether or not it leads to inefficiencies in the health care system? guest: we have had as a matter of policy and still do, including in president obama's proposals and bills that passed the house, an unwillingness to really take on the sellers in the marketplace and in the sense that the only way to get more effective control over the rate of health care costs is to give the buyers relatively more power. look at other countries which have universal coverage and lower-cost and many of them still rely heavily on private insurance. all except for britain. what is different is that they basically legally provide a mechanism by which the big paris, both government and private sector, can negotiate -- the big payers, negotiate with the sellers of the services. in the u.s. most insurance companies do not have enough clout to tell physicians what they can charge or negotiate with them. you have the following political cycle that occurs with medicare every year. the physicians, hospitals are able to basically charge what they want to the private health insurers. that creates a gap between what private insurers pay and what medicare pays. there are enormous pressures politically on medicare to catch up. as long as we have half or more of the business in a market where the sellers can charge any price they want, it will be hard to control costs. guest: there is very little coronation of care in the fee- for-service sector. there is a lot of concern that cents is paid by the service, you're simply providing an incentive to provide more services. that drives of cost. there is discussion concerning the coordination of care. how to do the better and how it could reduce costs. host: judy is a health-care professional in washington. caller: good morning. thank you for c-span and for this subject. i have been waiting for it. i have been in the medical care business since 1973. and the certified procedural and diagnostic coder as well as a medical practice management person. i discovered from the time i began dealing with all the insurance carriers that things are going fairly well until the cpt system came into a fight. there are over 10,000 procedural terminology coats -- came into effect -- in determining what doctors will get paid for what. i remember when another thing came into effect, and prior to that time the fees were based on the locality. if one doctor charge $50 for a procedure and another charged $40 for the same, then the powers that be would look at this and decide that it must be $40 and pay everyone that. but is an 80/20 plan. i also found that medicare, when it approved the medicare qualified hmo's which now call medicare advantage, that is when everything went to pot. i believe that through the hmo plans because they have a gatekeeper and try to corning care, they actually reduce care. the get incentives for not doing certain things. you know that that is true. -- they get incentives for not doing certain things. it seems that in order to revise medicare -- i do not think medicare per se is the problem. i think our seniors deserve that care. i think that part a works well. i do not believe in what they call the -- i am sorry, the diagnostics, the drg's. that is how hospitals get their payments. they are restricted in what they can actually do. they come up with clever ways of going above that. i remember when durable medical equipment was not covered at all. host: what kind of reforms would you like to see to medicare part b? and i have a follow up with you. caller: first of all, my thought on the whole health care reform is that medicare part b should go back to c for service in that durable medical equipment should be revised. it is ridiculous for an equipment company to charge $32.90 for the use of water per month you can buy over the counter for $139, but people are caught up -- for the use fo a walker. when you are in the hospital there are coordinators' of car . the patients are often elderly and do not understand. if you took away the hmo portion of the medicare part b and put it back to a fee for service, and make it instead a 75/25 plan with a more reasonable deductible. right now the deductible is about $500 for hospitals. i cannot remember where it is right now for part b -- what is it? guest: about $140. host: what is it that you do? guescaller: i am a procedural ad diagnostic specials. i have a boeing co. and do electronic billing and practice management -- i have a billing company. it was started in 1989 when billing was just in its infancy. host: who are your clients? caller: i have a physician's, durable medical equipment, and first assistant nurses. host: thank you for calling. let's see if we can get some response, beginning with bruce vladeck. guest: a couple of points, if i can. first on the cpt coding system now used by medicare and most other insurers, i agree with the callers criticisms. host: what is cpt? guest: common procedural terminology, and it is the allegra said of coats that says if you have to removal -- and it is itset of codes that says if it is the removal of a wart it is .17 and so on.. it is owned and copyrighted by the american medical association. every one of them generates a royalty to the ama. it is a major source of the association's income. ever since medicare began to use cpt in the late 1980's, every effort to replace it with something more streamlined and modern and effective has been energetically resisted by the largest physicians' group in the country. so, we ought to replace it. part of the political deal in effect between congress and the ama over the last 20 years is that there would accept some aspects of the fee schedule they did not care for as long as the government was committed to continue to using the coding system they owned. it is time that the changes. . . >> what is the talk on capitol hill and what is your view? guest: well, we have seen story after story of fraudulent medical providers, i think of miami as a part of that , there is an investigation and it's hard to talk about this, to quantify how much waste and abuse there is in medicare, and it's of great interest to finance the health reform bill, as more of us grow into the medicare population, it will be more expensive and take more of the government spending to pay per -- for the program. and waste and abuse plays into medicare now and into the future. host: bruce vladeck? guest: it's hard to tell how much waste is in the program, one's person waste is part of the medicare. medicare spends so much money that a small portion is still a lot of money. we have no idea how much fraud and abuse there is in the rest of the medical market. but we have no reason to suspect that it's less proportionately in medicare, and could be more, because the penalties are less severe than in a government program. the answer is that no one knows, it's clearly in the billions of dollars, because one percent of medicare is $4 billion. and we need to do a better job of not just protecting and prosecuting but preventing it in the first place. and interestingly congress is willing to spend more money on prosecutors and reluctant to invest in the companies that they have to prevent fraud at the onset. host: that caller said she wanted to see a fee-for-service plan to come into effect, do you agree with her? guest: i don't understand the question, three-quarters of medicare servers is under part "b" and i understand she was being critical of the hmo's and there is a lot of emotion around the quality of service provided by the advantage plans as opposed to the fee-for-service system. and i hate to tell advocates of either side, we have a lot of data of the managed care and those in the fees for service are not that great, doctors are doctors which ever service they are in. host: jamie, we have on the line of 65 or older. >> caller: i have a question, why doesn't medicare pay for physicals. when i called about physicals, they said they don't pay for them. that's question one, i am anemic and i have to take this here shot that costs $4,300, and it's run by the government, i can't get it whether on medicare or 60 or 40, why does the government choose to run that shot? and the other thing i would like to know, the inhome care that's gone to people. is there a lot of waste there? and sometimes people don't know that can get inhome health care through medicare, they are not told that by their doctor, ok. and the other thing i wanted to ask, which i have never heard in all the conversations in the health care system being discussed, is where does workers' comp fit in this at all? and i will take my answers offline. host: thank you, bruce, you want to start? guest: i didn't understand the question of anemia, could you restate that? host: the caller is gone. could you talk about physical. guest: medicare will first pay for a comprehensive exam, it does not pay for routine check-ups afterwards. it does pay for routine checks for breast cancer, and so forth, but it's a hole in the program and prior to 1965 private companies did pay for physicals, and when we try to get them covered, the budget feel it will cost too much money. it's a hole in the medicare system. host: inhome care, under part "b"? guest: most is paid under part "a," medicare pays inhome care only when a patient has a particular medical need, and the inhome services address the particular inhome need. it's the definition of who should get the inhome and shouldn't. and it's the norm in the insurance industry and private and public, basically if you need a nurse in your home to administer medications or vital signs or physical therapy or speech therapy, medicare will cover it to an extent, and if you need those services it will cover those in the home. it's tied to a medical treatment for a specific illness, generally after a hospitalization. host: and does workers' comp fit in this at all? guest: most are no longer working, but the law is specific, if you are entitled to health care payments or reimbursement under workers' compensation or under automobile insurance laws or tort laws, there is a very sophisticated way to make sure those insurance programs pay their share and medicare only pays the balance. and is there a very sophisticated operation which medicare collects back from the workers' comp company and auto programs, the share of the cost. host: we have a tweet from judy, it's about the money to get their laws passed by congress. this must stop for change, who are the ones under reform? guest: well, the health care providers are powerful and anyone that provides in the medicare are powerful. all of these extremists are at play and here in washington. and we have ads and it's a fee for pitch now and know that congress is looking for reform. host: what is the kaiser health news? guest: this is a national, not for profit news service, our stories run on our website and all over the country. we are a program of the kaiser family foundation but independent of that. host: next we have richard, from new york city, a health care professional. caller: yes, good morning, i am wondering as everyone harps on the medicare industry in terms of flaws. if you look at the overall pattern of medicare and the medicaid rates, i know is not a part of the discussion, but the current rates is so fraudulent, and no one seems to pay attention to that. host: richard, what do you do? caller: i am a surgeon. guest: i don't understand the comment that it's fraudulent. host: unfortunately he's gone. mary agnes, you want to touk to that? guest: of the congressional pressure involved, maybe that's what the caller is talking to and has a disagreement and thinks they are too low. host: mary agnes, are doctors satisfied with medicare part "b" and the reimbursement schedules? guest: i think it depends on who you talk to, most physicians would like to make more money, the benefits feel that some doctors are happy. and the data from the med-pac show that beneficiaries do have impact which indicates that doctors still take the program. host: how influential is med-pac and how important? guest: i think they are incredibly influential and when they come to congress and make recommendations, and we talk about the political pressures pushed back. sometimes congress doesn't always take their advice. there is discussion on capitol hill of elevating the med-pac and make recommendations to congress that would go into effect unless congress acted to stop them. so there is discussion to give med-pac more clout. host: bruce, was med-pac head of you? guest: we worked close with them, i was a member of a part of med-pac, we had respect of their work and we thought along similar lines about particular issues. and you know they do very good work. as some of their own members have said in recent months, one of the reasons they are able to perform as effectively as they do, is because they are making recommendations and not final decisions. that has two implications, one, they are not subject to the legal requirements that occur in the american governmental system of people that have to make formal decisions. and second, they have somewhat greater freedom of action in saying what they think, as opposed to satisfying various constituencies. a superb group of med-pac does not show how they would perform if people had to adopt their recommendations. host: ed, good morning, on line under 65. caller: thank you for taking my call, my wife and i are both in our 50's. my wife retired early and i am contemplating retiring. it's a scary proposition to do this these days with the cost of health insurance. during the presidential primaries, i heard governor richardson from new mexico talk about retirees and early retirees that retire in their 50's. the opportunity may be to buy-into medicare. and i know we are talking about medicare part "b," but i would like the opportunity to buy-into medicare as a whole. and the discussion of medicare having financial problem, if you have a younger group of people willing to buy in, instead of giving to the private insurance, i thought it would be a way to help medicare. host: mary agnes, discussion of that? guest: there is a discussion of that with a buy-in of if i -- of if i --55 or higher. there is a group that may not do this because of insurance they cannot afford, this is part of discussion on capitol hill, do you allow an early buy-in. host: go ahead. guest: could i comment, if you have mechanisms to ensure that everybody can buy insurance through a health care exchange, you don't need the early buy-in. the advantage of what is in the house bill as opposed to the early buy-in, again medicare benefits are not as generous as they should be. but no question that early retirees and people in their early 50's and 60's that don't have employee based health insurance, are totally in enormous trouble, and they are the folks that would be the biggest beneficiaries of health care reform. the reason i believe that the current administration has not opposed it, because they know it would be the immediate attacked but the most efficient and least expensive way to get coverage to people that are 55-65 of people that can't get it in the private insurance market. host: rela, go ahead. caller: thank you, i will cover this fast, the nursing home system is atrocious, and no one cares the fact that what medicare offers or is supposed to offer is not happening. i would like to see somebody walking around in different nursing homes without advising them they are coming, and this happens constantly. you know these people lay there in beds that are supposed to get physical therapy, it doesn't do any good to give someone physical therapy for six weeks and drop them. they are not getting the care that medicare supposedly ?g offers, it's like waste or something. i get so disgusted. i am well over 65 and hopefully i never end up in one of those places. but it's not just that, medicare needs to look at health care for the elderly preventative. you know teeth, hearing, glasses, stomach, whatever. those are the problems coming up. and it's not covering certain things, i don't understand why the people we elect, appoint or pay their salaries, they don't seem to care. host: we will leave it there, when it comes to nursing homes and medicare part "b," bruce vladeck. >> -- guest: it's not a part "b" problem, but that covering the inspections of homes, has not increased in 20 years. with the increase of the facilities and the increased requirements, as a nation this is a service that's gotten lost out on the pressures of the federal government on the desire to starve the beast, as a noted political commentator said, we are noting the problems of the facilities. and the kinds of problems that the caller talks about is a result of that. host: mary agnes carey, what is the role of doctor training? guest: they are paying from medicare to ñzhospitals for the transpositions. and that's part of the medicare program, that's how i understand it. host: bruce vladeck. guest: well medicaid paid the costs of the programs, when medicare moved away from cost- payment in 1993, there was a provision for recognizing those costs and still does. that's only the direct medicare cost, and there is a lot of discussion and pressure of how medicare ought to do more of training the shape of health professionals. medicare is the only insurer that subsidizes health care. and we have problems with the trust funds and expenditures. again this is another area that's vital to the public, over the last 20 years as a result of tax cuts and other decisions of public policy. we have stopped spending money, and have a growing shortage of physicians and nurses and other health professionals. and health reform is not going to fix that or medicare. it will only fix it as a nation, as we grow up and decide that it's a public responsibility to ensure the health care professionals. host: allen is a health care professional. what do you do? caller: thank you for taking the call, i have over 40 years of experience. i joined h.i. p. of new york, as a pre-paid private system. back then all the doctors were sal ride. -- salaried. and prior to medicare, it had problems because patients had to wait months to see doctors in some cases. and this is the model for the single payer that i am really against. but going back to medicare, the insurance companies to me need to be addressed. now the federal health care benefit program has all insurance companies go through an accreditation process. this is a process where they are evaluated. not all insurance companies can sell to federal employees because they don't meet their standards. this is one of the best cost controls we could have. and also other measures to bring down the cost. i had one person in our community who told me about seven injections, and the doctor got $27,000 from medicare. and that rang a bell with me so fast. i did call a supervisor at medicare to find out what that c.p.t. code was that allowed a physical with nerve-end injections to charge that kind of money. it was outrageous. host: allen, you are a doctor? caller: no, what i did, every piece of paper that came across from insurance companies and hospitals, like lagaurdia, at one time they came across my desk. medicare retentions and reform in 1993, and a pharmacist and drug committee and that was the team put together, and i was a member of that team. they saved $10 million in the first year. and for premium rates for h.i. p. for new york, there was enough for profit for insurance companies at that time and since then they have gone bust. host: ok, thank you, bruce vladeck. guest: i can only imagine in the content of political discussions in the last month, how people would react of some committee in the federal government to establish a national formary of which drugs can be used and not. i don't think we are prepared as a nation to accept that. we don't as a nation, as a political choice regulate dietary supplements. we are just not there. on the issue of certifying or approving health insurance companies, as is done for the federal health employee government. that's what the house of representatives would do, it would n+÷set a high set of standards for companies to participate in the new insurance exchanges and participate in the individual and small group market. and finally, i want to reassure the caller that h.i. p. is alive and well in new york.qo after their merger with group health, they have changed their name to amle health, but it's the same company and many of the same folks in management enrolled in the program and they are doing fine. host: and bruce vladeck, what are you doing today? guest: i am working as a consultant on policy and management issues, primarily with hospitals in the northeast and part of policy makers. host: and you are a senior advisor of nexaria? guest: that's part of the senior policy hospital association and i can care that hat. host: steve, on the line of under 65. caller: yes, i recently got on social security disability, and i received $845 a month, they wanted to give me part "a" and "b" medicare, and were going to charge 94.65 a month for the part "b" premium, i have emphysema and i found out i would have to pay $175 a month for that coverage to pay for what medicare part "b" doesn't pay. i would have to pay almost $275 a month out of my $824. so i had to tell them, i had to refuse medicare part "b," because i couldn't afford $275 a month, and they looked at me kind of funny. i said, i have been going to the community health free clinic for the last three years or more, and doctors there take care of me, and get me my medications for free. and i thought, well, you know they have taken good care of me for the last three years, they give me my inhalers and all the medicine i need. so i had to turn down part "b" because i actually couldn't afford, the part "b" premium itself wasn't so bad, but due to the fact of the 20% co-pay, that forced me to get a medicare supplement policy. host: mary agnes carey, you want to start? guest: one question for the caller, there are programs through medicare that can help people and offset those costs. maybe it could help with those supplementals. that caused me concern of that situation. guest: if his whole income is $128 a month, he's eligible for the extra help in the medicare program, for low income assistance, that's administered by the state medicare agency. any programs that provide counseling to the seniors and disabled, and in iowa they should be able to point him in the right direction, and those for the social security administration that didn't forward him, should be fired. while it's cumbersome, people should be able to get assistance with the premiums and co-payments. and while it's wonderful there is a free clinic in town, those will go out of business if patients who can get insurance, don't. i would encourage him to see if there is a way to get help with that so that he can use part "b". because by law he's entitled to those additional payments. host: finally on our 65 and older line, cheryl from michigan. caller: i was going on the patients' responsibility and checking the bills from the doctors. my primary doctor overcharged me for an x-ray on my shoulder for $169 which i did not have. i didn't care medicare, i give them the chance to rectify that and he removed the charge. and i went to the foot doctor and i am a diabetic and have my nails done, and it was $59, but she had charged me for two other items for $59 each. so i called their offices and said, this did not happen. the charge should be $59, where did the other $118 come in? and they rectified that and took it off the bichlt -- bill. and everyone should check their bills and at least try to do something about it. host: bruce vladeck, are there a lot of private contractors that work with medicare part "b"? guest: there is a lot of contractors over the last years to try to save money and get scale in the processing. but there are contractors that pay the bills and work with the physicians. there are separate contractors for seeking prevent, fraud and abuse. and other contractors whose focus is the quality of care. again it's a government health insurance program, bus -- but most of the day-to-day street administration is done by contractors. host: finally what would you like to see done to part "b"? guest: i think it's important to fill in the holes and gaps, and the most would be the cap of pocket payments, so that no beneficiary would be bankrupted by the 20% they need. and i think in a saner world, we would in fact cover dental services, hearing aids, eye glasses for people that are 65 and older and for disabled people who need them to function. host: and mary agnes carey, what is the debate on capitol hill? guest: i think looking at payments to providers and talking about the issues of coordination of care and being sure that the best care is delivered. to be cost effective to taxpayers. host: thank you very much, tomorrow we have bruce vladeck and to have others from medicare and medicaid. >> as washington and the nation continue to focus on health care, sunday on c-span, we will talk about dealing with the h1n1 virus, with dr. thomas frieden, and on "q & a"," dr. john garret. this month for veterans of post traumatic stress, and if the v.a. could be ordered to speedup the claims and process. in 1959 in the heat of the cold war, soviet premier took a tour, this is recalled. >> "washington journal" continues. host: for the next minutes we want to open the phone lines, for the republicans and democrats, and the number for independents is on your screen. at the top of the hour, conversation with dan balz and haynes johnson, they are co-authors for "battle for america 2008," and to talk w÷ú about the moments that shaped the 2008 campaign. and from "the washington post", a story of expanded sick leave, would cover swine flu caretakers. >> the piece goes on to point out for federal employees they would be eligible to use accrued sick leave if they detect that their presence in the workplace would jeapordize a worker. that's in the washington post, and also is a story that continues to develop with the meeting next month in new york, and top officials are saying no to libya leader, gaddafi. there are democrats protesting the expected plans by gaddafi and that he should be barred from new jersey. and a lot of stories this morning about governor mark sanford, he refuses to heed to we sign. in south carolina this story, a defiant south carolina governor, says he will not resign. >> but that he's left the state paralyzed about the ne -- legality, we have first caller, j.b. from north carolina. caller: yes, good morning, i had a problem getting through, i wish i had gotten through earlier, there were questions i wanted answered. host: put them on the table, we will continue to address medicare tomorrow, and over the weekend we look at medical programs in canada and great britain, and will have a representative from virginia to look at those issues. go ahead, j.b. caller: yes, first thing i got retired at 60. so by the time i was 65, i had used up one-third of my i.r. a. to get medical coverage because i have heart problems. anyhow we need to get this system and change it so that it is not so unkind to old people. for some reason or other, i have been paying into this system for 45 years. and a child is just got put on the medicare system, that's never paid in. they don't have any co-pay. they don't have áñany deduction taken out of their social security. they don't have to make any supplemental insurance policy, but they are going to take that money out of the system that i have been paying into. i don't think it's fair. i think everybody should be, if they use the system, they have to pay in like i do. i don't think it's fair to be unfair to old people. and the next thing, i was born in montana about 30 seconds from the canadian border. all my people in montana go to canada for their medical help. hope you tune i weekend as we look at canadian system. and more news on who will replace mike decaucus, who is 75 years old and that possible replacement. next we have charles, joining us. if you will turn down your volume. caller: yes, how are you? for the past 12 years i have researched and designed an economic policy for the health coverage for the united states. to cut a long story short, for the revenues to pay for health care. it's designed to bring forth increase to our nation's economy, strengthen and position the relationships for the hippocratic oath. it's a different approach of financing health care. what i have been doing for the past three days is to try to contact people and tell them more about it. but being financially challenged, when i go to people and talk to pastors or anybody, they just hangup the phone when you talk about national health care, they think it's a government problem, but it's a people problem. we as the people can bring forth the finest care that this world is to see, and it's not socialized medicine. the problem with ted kennedy's plan is not a federal plan, it's a plan with government controlling everything. as far as the health care arena. my care is designed for the physicians and patients and to have their workings in the medical institutions of their practicing. host: thanks for the call, and we have richard next from tampa, florida. good morning. caller: i ññhhave two comments first i am on medicare, and i am an h.m.o., and based on the comments of the previous half-hour, the h.m.o. i have pays for glasses and dental. and the other comment i have, a simplified way to handle a tort issue in some sort 1÷fof a new health program, and that's very necessary to get the tort out in order to save a lot of money. the simplified way is to use the model of h.m.o., people don't realize they do it a waw cheaper and by federal law they can't be sued. if you allowed doctors to adopt a program, which they can adopt without having congress approve it, where they allow regional organizations to be formed by doctors and hospitals, which for working people and giving more services, they would be able to be under the same program, and you would see a tremendous drop in the cost of the health care system. now, to answer the lawyers argument. if you had a real good oversight by some group including citizens, you could eliminate most of the problem. if you found incompetent individual in the organization, you just kick them out. host: thank you, we have dr. john garret head of a hospital and be a guest on "q & a" and we will continue to look at aspects in this country. a tweet from a viewer, my brother said he did not need a walker, but given one anyway, saying that insurance will pay. we have a caller from connecticut. caller: thank you, i listen to you everyday. i have two comments this morning, i am a nurse. and one thing i would wish you will consider, i have called for years asking for dr. jane orient, she's an executive director of the american association of physicians and surgeons to come on your program and speak. jane is a brilliant woman that understands medical care and insurance. so would you at least take that to heart? host: orient? caller: yes, dr. jane orient, and their website is aaps. american association of physicians and surgeons. she would do your audience justice. the second thing i wanted to add, when you consider medicare, medicare isn't supposed to be -- insurance is all about risk. but how do we deal with the situation when you are over 65 and all in one pool? hello? host: yes, i am hearing you. caller: right, there you have it. in other words when you take a look at what it would cost if you would fold all of those people into the general public, the costs come down automatically. i could say more but i know you have people waiting. host: thank you mary, and we appreciate the call and will look into dr. orient. the funeral services for senator kennedy that will include a mass on saturday morning and expected to begin at 10 a.m. eastern time and the hours are posted on the kennedy library website. susan is joining us from ft. worth, texas. caller: they need to impeach sanford, when our congressmen turn 65, are they required to go to medicare and/or lose their social security or the huge pension that the taxpayers pay for? lobbyists so obviously tell the politicians how to vote on these issues, and i don't understand why citizens are opposed to reform at these town hall meetings, but i would love congressmen at 65. host: thank you, the front page of u.s.a. today have the three brothers, ted kennedy and robert and john. and the headline is, the lion of the senate. we have jim from georgia, good morning you are on the air. caller: good morning, i have one comment, i have a couple about mr. kennedy's replacement. it seemed that earlier in the country, that state legislators, not voters put the senators in the office, for more representation from your state. if your state was the ones to vote to represent that state. and my second comment and question or comment is about our national health care system and the way it works. i am 50 years old, i have worked my whole life, i have emphysema and diabetic, and i wondered why they haven't looked at the possibility of national health care program in the country that's supposed to have liberty and justice for all, and it is set up that goes cradle to grave for everybody. that would allow for -- they would have to look at the budget and see what they are spending on the v.a. system, i am also a veteran, i spent years in the infantry. they can look at the v.a. system and the money they are spending on medicare and medicaid, and look at large companies and what they spend on health care for their employees. host: hey, since you brought it up, can i ask you a question? caller: yes. host: why haven't you taken better care of yourself? caller: i don't know, i figured that i live hard and enjoyed my life, and those things may not be conducive to a long life. and i work with metal, i do a lot of grinding, and you tend to have a bad environment in those shops. even with osha in place, i understand it, but you can't protect everybody. and people or more or less responsible for their health. with that said, there are two ways to look at it, either we don't offer any health care, or we offer cradle to grave. if you represent the citizens of this country, they need to represented equally across the board. otherwise you are looking at discrimination. you have age discrimination and you have medicare and medicaid set up for the elderly and disabled, and that leaves the other people out. host: thank you for your point, we did address the issue of what states should do in light of massachusetts, they changed the law prior to 2004 election that calls for a special election, a law that a governor, mitt romney, and that change. 41 states now allow governors to appoint a replacement if there is a vacanciy. and some background, what it was like between 1789 and 1913, the constitution empowered governors to make the temporary appointments until the next meeting. host: so in other words if there was some appointment in some state, and wait for the next election, 2010, and that's the case in some states. but 41 states allow the governor for an appointment. but massachusetts is asking for a special election, and an election for the senate seat could come in january unless the laws change. we have jo ann joining us -- we will go to mike from oregon. caller: good morning steve, and thank god for c-span. to put my two cents in, people out there, please understand that what we are seeing happen before us is propaganda. put out by the pharmaceuticals and also the lawyers of this country, and as well as lobbyists who are fighting this tooth and nail. what we have to understand, that the rest of the industrialized world for some reason has some form of national health care system, be it single pair or in conjunction with a private form of insurance offered to their citizenry, and somehow they make it work. i know this for a fact, i spent 14 years in europe. i +am what you call a transplanted street artist type. i have done that all my life and that's how i make my living. i am 58, and i am also a vet. and thank god for the v.a. now the v.a. is not without its problems. sometimes it takes a bit of time to get in to see your doctor. but once you get in and see your doctor, you are well cared for. a perfect example of the priority industry taking over what the government does, there is the situation of walter reed. that's an example of when the government takes over something. host: we have a tweet, government plan versus the private people, there is no difference. we have jennifer writing, some republicans named include carrie heely, the governor of massachusetts and also lieutenant governor of the state. john, caller, what on your mind? caller: yes, i am independent and i try to find solutions. i was thinking on the health care cost, i know that some companies do it, to have a surcharge at the force of entry, where canada and mexico, a minimal fee, not to impede traffic at border crossing. but it would assist in the overall cost of health care in our country. i would like to know what you think about that. host: thank you for the call, we have ruth from alabama, a couple more minutes in the open phones and then we have dan balz. good morning, ruth. caller: good morning, i am wringing my hands wondering what to do about medicare going broke and social security going broke. the problem is there is not much we can do, what should be done is when these laws are passed. we have politicians promises things that can't be fulfilled. for instance, over 40 years ago, we were told if we paid into the medicare, that we were covered at 65. we w$nweren't told at 65 that w would be charged $100 a month. and another thing, if we were told that in the congressman would not have got enough support to pass the laws. the problem is they promise us unreasonable things that they aren't going to be around when the problems show up. host: the headlines this morning, the state to reach even further into taxpayers' walt -- wallets. in california officials are cutting back deduction, everyone will pay more, even people whose bracket doesn't change. catherine, is joining us, good morning. caller: good morning, i am calling about the health care issue, we should have a national health care plan, like the gentleman that called earlier and it should be from birth to the grave. it would be so much less expensive than this mish-mash we have now. he mentioned the v.a. and cost and medicare and medicaid, and he mentioned the cost to employers. but there is 250 billion, with a "b," you see that taxpayers are subsidized the employees insurance policies, that's $250 billion every year, it comes out of the treasury. and that also would be saved. host: another comment from joe, that says in this tweet, i am tired of hearing of the rest of the industrialized world, we didn't make america to be like the rest of the world. we have don joining us from kansas. good morning. caller: yeah, hang on a second. i wanted to make the point that all of this talk about you national health care system and cradle to grave is welfare, we should call it what it is, it's welfare. we are having the government pay things we should be paying ourselves. either we are too cheap or lazy to pay it ourselves. 75 years people didn't have this and life went on perfectly fine, they didn't have health insurance, or if they could, they did. it's simply welfare. and the second point i would like to ask about is some years back when i started getting prescriptions for blood pressure and stuff like that, i would try to take my pill bottles back and have them refilled and my pharmacist told me that was illegal. congress had passed a law that you have to have new bottles to get your prescription filled. this is probably costing consumers tens of millions of dollars because you have to get new pill bottles. is this a law passed by congress to benefit pill bottle manufacturers? . host: it was not until tuesday evening that the elite members were summoned for his final hours. it was a week ago sunday on a hot sunday, and last week he was driven around the town by his son and daughter. that story is available online at bostom.com. houston, texas, you get the last word. caller: i have been listening. that last man called the welfare. then, i guess all the congressmen and military are on welfare. what is ridiculous is that you go to a hospital and need something done. you can get a $50 can or ultrasound and a charge your insurance company $7,000. here is how to pay for health care -- you take the cap off of the fica contributions and the people that all the way through their salary scale, model it after the military health-care system, or do like france does. france has the best health care in the world and are much cheaper than us. even cuba has a better health- care system. the way that you pay for health care -- another thing, congress did not write that bill. the lobbyist road it. that is what people should be upset about. congress does not write legislation anymore -- the lobbyists wrote that bill. host: thank you. earlier a question by your -- a message by twitter about fraud. a month-long series concerning authors and other books on the 2008 campaign. the next guest will be with us with his book about the 2008 campaign. first, a news update from c-span radio. >> a commerce department report this hour says the economy shrank at an annual rate of 1% in the spring, a better than expected showing and more evidence that the recession is drawing to a close. first-time unemployment claims are down this week. more on the arrangements for the late senator ted kennedy. this saturday all four former living presidents are expected to join president obama at a private funeral mass. earlier, speaking on "good morning america" the massachusetts governor said that the focus should be on morning senator kennedy and questions concerning his vacancy can wait. under existing law a special election must happen within 160 days of the vacancy and the governor has no authority to name an interim senator. the fight continues in afghanistan today. a u.s. serviceman was killed. the death puts august into a tie with delight as the debt this month of that eight-year war. the u.s. navy says one of its helicopters was fired on by somali pirates, holding a hijacked ship. the spokesman for the fifth fleet says that it is the first time pirates have shot at a u.s. navy helicopter conducting daily surveillance flights over areas where pirates anchor hijacked vessels to wait for ransom. the justice department has decided not to pursue indictments against the new mexico gov. and former members of his administration after year-long investigation into pay-to-play allegations. he was nominated by obama for commerce secretary, but refrained due to the allegations. "washington journal" continues. host: dan balz, haynes johnson with his book "battle for america 2008." let me begin with the cover of the book. it includes tina fey and jon stewart. what does that tell us? guest: they're not candidates, but played a big role. they are cultural icons. sarah palin became a big item and there was an enormous impact on young people. they were part of this political cast. an incredible cast that we try to capture a. host: will go through some moments of the campaign. let me get to the final chapter with an interview with obama. guest: it was december 16, 2008 at his transition office in chicago, the federal building downtown. it was the day we learned later that he had a meeting with the economic team where he was told that the sky is falling. they later learned it was even worse than they thought. that was the day that the world grew quite dark for him in terms of the economy. it was a 40-minute interview before that. he was in a very upbeat mood, open, revealing, and awful about the campaign. [laughter] he sat down. he drinks bottled tea. he had been of the morning with arne, his designee to be the secretary of education, and vice president joe biden. he started just munching on these almonds. at one point you could hear him on the tape of the interview when you listen to a kind of rubbing the salt off his hands. and he apologized for being famished. host: in the interview you talk about big and small government, and he said he is more effective and whether we have "a smn effective government." guest: he is still struggling about how to put that into place. given the additiambition he weno do in light of problems, one of the things he said he did not think the election brought an end to all of reaganism. he did not think there would now be an era of big government. he thought there would be less of a knee-jerk reaction, but the challenge for him and his administration would be how the show strong, effective, smart government? that is the test and i think that is still his test. guest: talk about that interview -- it was the most remarkable thing. he talks in the way i do remember any president -- full, historical context, modest, but also very deeply about the problems. he does not claim that he will solve them. he wanted to learn the lessons of leadership. that is what he was all about, trying to bring together the country if he could. he recognized that the conservative era was still there. i hope that people will look back and i think they will on it. i think it will lease look that to say there was obama as he was about to enter the white house and here he is facing these problems. guest: at the end of the interview he talked about lincoln. the question put to him was, lincoln has been a touchstone for you in the campaign. he announced his candidacy at the old statehouse in springfield, ill.. his blast train trip was a repeat of what lincoln had done in philadelphia down to washington. "in what ways does lincoln and loan issue is our -- does the ln influenced you?" he went on to talk about lincoln and the style of leadership he employed. basically he said, some presidents then othepresident bo there will -- lincoln was not like that. he said you have your view and i have mine, somewhere out there is the truth. through listening and guidance you can try to get people to that point. he said i have not gotten to that in terms of my own style of leadership, but that is the model i look to. guest: the problem is, can he bring people together? host: we will take the audience to some of the points that you outlined in your book. we will get to calls, also. guest: he was an ambitious man from the beginning. he wanted to be president. he was not sure whether he would run in 2006, but was looking at. his strategist wrote him a remarkable memo saying you will never be hotter than you are now. it cannot wait too long. but he was also warned in the same memo, saying i worry about whether you can take a punch. you do not like criticism. are you up to the rigors of the campaign? i think people will study the memo for years to come and get it set the stage of why he should run. the time was right, the country was right. he was a new generation. but also, could you take the stresses, was the up to it? was his own character such that he could sustain it? -- was he up to it? host: here is a speech from when he and senator enter the race. >> at the old state capital where lincoln once called on the house divided to stand together for common hopes and dreams -- where, hopes and dreams to live, i stand before you today to announce my candidacy for president of united states of america. [applause] host: you were there. guest: i was there and it was so cold. that is the first thing everyone remembers. a cold saturday morning. i remembered that setting. the second thing a remember -- we got there early, all the press, and were inside a building for about an hour. as we arrived one of the things that struck us was the size of the crowd. you could see the crowd building. it was 5 degrees. people had come from hundreds of miles away. people have come from kansas city, missouri, downstate in illinois, the chicago area. their sense was that they were witnessing a moment in history. no one knew whether it would be a successful campaign, are not. but there was an aura around barack obama the day that everyone recognized. caller: good morning. the reason barack obama is president is because the republicans were caucusing to kill the clintons off the top of the ticket. they never did like the clintons. whoever was put on top of the democratic ticket would be president simply because they were tired of george bush and the deception. guest: i think he is right that the country wanted change and obama became president because he understood better than any of the candidates how hungry america was for something different. change is the oldest cliche in american politics, but he captured where the country was. the politics were so riven with the scent and hatred. he says we can do better than that. -- with dissent and hatred -- and obama's of we can do better than that. host: tickets back to the summer with john mccain where he holds an effort to win the candidacy. he won new hampshire. guest: the characters are so fascinated me go he was the preeminent guy of the republican party. then his campaign collapsed and he had to fire people. he goes to new hampshire. the crowd are angry and booing him. he cannot handle it well. his family asked, will be the republican nominee? he said may be, and who knows. then he goes out and he was written off as the republican nominee. the next time he is traveling alone with only one of aide, on a commercial flight. his ability to return to new hampshire is extraordinary. it is not remembered much now in retrospect host: you write that mitt romney came out of central casting in terms of presidential timbre. guest: yes, i don't think and look more like a president of an romney with his dubuffets, great family, a lovely wife, a great kids, remarkably effective business leader, having turned around the winter olympics in utah -- and get there was this question about him because he is mormon. would the republican party dominated by evangelicals christians ever alleged a mormon as its nominee? he struggled with out throughout. this was something they knew was a problem, yet they did not know how to or whether to address it. he ultimately did in december 2007 in a speech in texas. but the point i think it was too late to deal with it. it is a question that will continue to follow him as he looks toward another run in 2012. host: tenn., next. good morning, anne. caller: i think you who campaigned for a nominee to get over it and look what he's doing too american. his stimulus package is the worst thing he could do. you look at the self-proclaimed communist, marxist radical he is. they are trying to take down free-speech. the people need to pay attention. he is a man that has never been proud of america. in his book he surrounded himself with the most radical communists. his attorney general is not going to prosecute the black panthers to threaten white voters. host: how do you respond to that? guest: i disagree that he surrounded himself with communists and radicals. there is no evidence of that. certainly there are differences of opinion about the agenda he is pushing. there are many people, goods are republicans especially, who think it is way too much government. in some ways some of what he has done is an extension of what george w. bush was doing. the bank bailouts were started under the bush administration and everyone agreed with the stimulus package. there arare disagreements about the size and composition, but there's no question that the combination of dealing with issues he inherited and pushing a big agenda has put forward the idea that there is a lot more government in people's lives in this administration, more than people anticipated. host: he brought in his poll ratings and to the debate this summer. guest: yes, i'm glad that woman said what she had to say because reflects that there is a deep anger in the country. the attacks on obama are extreme. the question will be whether he can overcome that. the question is whether that is the majority. host: we will go to matt in lancaster, pa. caller: in classified as an independent and i left the republican party because they are in my view no other conservative. -- no longer conservative. i will not even get into my concern with the democratic party, but my concern is that we have left a constitutional form of government and have been for a long time. is there any way possible to eventually return to that and eliminate all these un constitutional laws that we have in place? we have many laws that do not stick with in the free market. this health-care bill is beyond the pale. i have been tried to understand why we abandoned the constitution. if you guys could help me to understand, i would be most grateful. host: even when president bush was in the white house it drew the ire of democrats. guest: here is the congress across the street. they pass laws illegally. that is the constitutional system we have. we elect representatives and senators, and debate, decide who will be present. we have checks and balances and out of that, a series of laws. you may not like them, but whether or not they are unconstitutional is something entirely else. the laws are passed illegally. you can take it to the supreme court if they're not constitutional, but they have not yet been rendered that way. host: from a book in the campaign, a speech obama delivered in 2007 at the auditorium in iowa. set the stage. guest: this was the turnaround on it for barack obama in fall 2007. one of the things not so well understood in retrospect is that he had a very difficult start up period. each of the great moment of the announcement with a lot of energy. after that, he was not particularly effective as a candidate. he did call himself a slow starter. there's a wonderful moment in late spring 2007 where robert gibbs flies to iowa with obama. the staff is word because they know that obama is down, and happy with the campaign, and happy with himself. gibbs had the kind of relationship with obama that they could talk openly and freely. he knew he could get obama to vent. he basically said to obama that day, look, we know you are unhappy and everything is not perfect, but just find something positive about the campaign and focus on that. do not worry about everything else. obama's said, frankly, there's nothing i feel positive about right now richard obama said. the other person in the room is reggie love, his personal assistant with whom he played basketball act duke. reggie is working as blackberry at that time and he said boss, if it is any consolation, i'm having the time of my life. obama looks at him giving him a withering look, and says well, reggie, it is not any consolation. fast forward to fall 2007 when hillary clinton is running 30 points ahead of obama in some national polls, way ahead in new hampshire. obama is struggling with his message and there is a debate of how hard to go after her, how sharply to draw a contrast. at this moment is when obama is beginning to turn around his message. they put all their efforts toward the jefferson/jackson dinner in des moines. host: from november 10, 2007. >> it is because of these failures that america is listening intently to what we say here today. not just democrats, the republicans and independents who have lost trust in their government but one to believe again. it is because of these failures that we not only have a moment of great challenge, but also of great opportunity. we have a chance to bring the country together in a new majority that finally tackle problems that george bush made far worse, but that had festered long before george bush ever took office, problems that we talked about year after year after year after year. and that is why the same old washington text of the campaigns just want to do in this election. [applause] host: haynes johnson, what was going on in the room. guest: they had packed the house with both hillary and obama supporters and you do not see that on that clip. the hillary people or older. they finally began to leave. the hillary people were outraged. bring them back, hold the doors. but that was part of the campaign problems. host: the next call is from iowa, ames. caller: morning, -- good morning, there's something about the constitution that i want to respond to been a first off, i do not rely on the supreme court to rely on what the constitution tells me. i read it myself and that makes me a citizen. almost nothing the u.s. does is legal. the constitution is very explicit. allow me, something the irks me is something he said about holding back -- it is the s cam that romney put out. he campaigned as a conservative, family guy. the guy is a liar. he gave money to planned parenthood, told boys scouts they should have gay scout leaders. he bankrupt massachusetts and signed into law a healthcare plan with $50 co-pay for abortion. what did rush limbaugh and others from fox news let this guy go by? why did christian leadership endorsed this guy? guest: it is a great country. you can say anything you want if you do not believe in the laws. the supreme court does not tell me what to do, i believe in it, it is not legal. fine, make a choice. run for yourself, become president -- we will debated. that is part of the backdrop, anger and frustration that people have, that is the backdrop for the next campaign. host: here, a reporter spending new year's eve in iowa. the following tuesday was in new hampshire. it was an extraordinary five-day window that shaped the race. guest: no question, that was one the most intense periods in the campaign. january 3, barack obama wins iowa, and it easily in the three-way race. host: what about john edwards? what if he had guest: won iowa it is one of the great if's. even if john edwards had one eye when he could not have been the nominee -- even if he hadwon iowa. if obama one had finished third in iowa i think his chances would have been damaged. but we will never. never -- we will never know. the clinton campaign thought they might lose iowa, as it was always her most difficult state, but they're not prepared to finish third. they have a long meeting that night in the hotel suite. there is anger, frustration. " clinton is looking for good advice. they go off to annew hampshire and arrive. it is only two degrees. she wakes up and there is the daily conference call on the clinton campaign. her top advisers -- she is again looking for advice -- her advisers are tongue tied. someone on the call said that it was negligence on the part of the campaign. they did not have answers in the plan for her. essentially, from bad day forward through the rest of the new hampshire primary, hillary and bill and the local campaign took the campaign on their shoulders and carried it to victory. obama's came on a wave of support out of iowa and or coasting. hillary became the real hillary at the moment, dogged, determined, more effective. she turned it around and was able to win. host: 1 moment, portsmouth, new hampshire -- what happened? did she cry, tear up? guest: she actually was losing, her whole campaign was messed up, and she interviewed and talk about how difficult. she goes through a very emotional thing, speaking more candidly and personally than ever. she did not cry, but she tears up. that went over the whole state and katrina the test was that she has lost, she is taking -- but particularly women were very sympathetic of the real hillary clinton. they thought for the first time they saw the a crack from the icy hillary clinton, something human, very personal and able to express her emotions and with it was powerful. it changed. the women in new hampshire supported her and came to her. they had not been up to that point. host: someone else was sympathetic? guest: yes, barack obama was on the bus and they heard about this. they look on the internet because it was available then. the campaign staff began to debate if it was real or not. obama's reaction was look, give her a break. this is tough. things happen. this is a verye hard process aase off her, guys. that moment happened two days after they had debated in new hampshire. that was the debate and which john edwards and obama essentially ganged up on hillary clinton. there was a question put to her from one reporter which was some people just do not think you're very likable. and she said well, that makes me feel bad. obama thinking he was been sympathetic, said helleri, you are likable enough. he told us later that he realized it had come out badly. what was intended as a show of support and sympathy look like you're rude, and. i think that it played into what happened then in portsmouth. -- it cannot like are rude -- came out like a rude comment. guest: what if john edwards' affair had been reported? it turned out to be a backdrop. he was living with this lie whole time, but it never surfaced. host: we are joined from east chicago, indiana. caller: you are speaking on two levels. one on the issues they presented an the other on the human aspects. hillary clinton is a woman and barack obama as a minority, and my question is, the obama brought to the campaign and under current, the voice of the people and what they were really looking for. frankly, he moved me many times in his speeches, but in real life and got into the office not only did he realize what the real president had to do, but he went with many of the choices that bush did prior to him. we can analyze effectively how these campaigns are run, but what the american people see is that it is just a bunch of rhetoric. host: the me take your question, rosa. if obama had onwon new hampshire, it would have ended easily. did that help obama to have a long battle? guest: yes, i think it helped him. he became a stronger, more effective, tougher, and more resilient candidate because of the competition that hillary clinton provided. that is one. he began the campaign as a novice. he had very little experience. he had been in the senate for two years. he was not accustomed to the rigors of a presidential campaign. part of the process for president, like it or not, is a rigorous campaign. if you talk to him about it there's no question he thinks that he was helped in that thing up that hillary clinton's competition made him more effective. the second factor is that that campaign had to organize every state in the country before it june 2008. they were worn out, no question. john mccain wrapped up his nomination earlier and had the luxury of thinking about a general alexian campaign. but the mccain campaign had not organized the states, did not know them politically as well -- about a general election campaign, they have the luxury to prepare. barack obama campaign was more prepared concerning the state. host: what was idaho symbolic of the obama strategy? guest: it demonstrated their brilliance in understanding the difference between caucus and primary states. they had enormous volunteers and turned out enormous numbers of voters that showed he could win caucus states and did not even have to win primary state. it was incredible. political scientists will study the operation of the bombing campaign for years. the way that they use caucus states rather than primary states. host: charlotte, n.c., todd, go ahead, please. caller: hello, it is more of a comment then question. obama clearly has raised the bar and terms of running a campaign. he was brilliant and he had an incredible team put together. more importantly than that, this message, he stayed on point. it drove home to many americans. i like for it to be pointed out -- fast forward to the present day, he took over the presidency. he has only been in there for six months. the conservative republicans -- i mean, they are just giving him the hardest way to go. they just want to dismiss the eight years of george bush. guest: it is a fascinating question. he is a republican caller. it captures the problems of campaign promises and performance as president. we began three years ago with this book. the idea that it would be the most important collection perhaps in our lifetime because of all the problems, the war's committee,. what ever happened and would be a test not only of the political system but of us as a people and whether we can make changes. then you get obama coming forward and he does have a message in the campaign. now it is only six, seven months later and he is all the setting getting this battery. but it was true no matter who would be president right now would have one of the most difficult times since franklin roosevelt in the depression. the collapse of the markets is not entirely solve. you have the wars, now afghanistan islam. people are talking about it being another vietnam. you have all this discontent in the country, health care. so, how obama comes out we cannot predict right now. but we do know that no matter who was in the office it would be to. of host: john edwards, ted kennedy, john edwards, bill clinton -- and barack obama and ted kennedy -- can you eliminate the conversations? guest: this is one of the most fascinating chapters in the book, and one of the most fascinating episodes in the campaign. we knew there was something going on at the time. here was the situation. ted kennedy was looking for a candidate. he was drawn to barack obama for a number of reasons. obama had sought out his advice when he came into the senate and particularly when he thought of running in the fall 2006. senator kennedy said he should run now and the longer he stayed in the senate the more difficult it would be to be a national candidate. ted kennedy also had good relationships with bill and hillary clinton, particularly with a build. there is a real admiration for one another. -- particularly in withbil bill clinton. he believe that hillary clinton was a very effective senator. he was torn. everyone wanted his endorsement. so, they began to try to lure him. the clintons and a bonus called, but particularly the clintons called. there was one day after iowa were they, generally, and it was cordial. but after the speech obama had given the night before, kennedy was very impressed am leaning towards obama. something was said in a conversation which we have not been able to unearth, something that bill clinton said that deeply offended kennedy. that set off 10-12 days and which other things happen. that summit bill had deliberately or inadvertently injecting race into the campaign that kennedy bullyboys district. -- believed was destructive. kennedy urged him to get off of it. bill clinton was furious to b-2s that he was injecting race into the campaign. if you look at bill clinton's history, you can see that he has always tried to bring together the races, but ted kennedy was convinced that it was destructive. he kept asking clinton to stop this topic and they even argue about the war and other things. ultimately, the clintons apparently concluded that hillary was not going to get the endorsement. then they tried to convince kennedy to stay neutral. in the end, kennedy decided he went to endorse obama. in the final scene of this episode, the day after the south carolina primary obama has won a huge victory after a nasty contest. it is beginning to leak that kennedy is endorsing obama. bill clinton calls and wants to know why. kennedy briefly explains. clinton hangs up and calls that minutes later -- i want to know exactly, give me details. as kennedy is on the phone he can hear bill clinton making notes on exactly what he said. he was concerned at that time that the clinton campaign would cast it simply as racial politics on, kennedy's part. kennedy was concerned about that. both sides of a difference of opinion about what happened in those conversations. they're not wanting now especially in light of kennedy's to re-air this conversation. host: let's share the moment at the arena at american university in which kennedy endorsed a bomb. >> but i believe there is one candidate who has extraordinary gifts of leadership and character matched to the extraordinary demands of this moment in history. he understands what dr. martin luther king jr. called the "the fierce urgency of now." [applause] he will be a president who refuses to be trapped in the patterns of the past. he is a leader who sees the world clearly without being cynical. he is a fighter who cares passionately about the causes he believe in without demonizing those who hold a different view. [applause] his tough-minded, but also has an uncommon capacity to appeal to the back angels of our nature. i'm proud to stand with him here today and offer my help, voice, energy, a commitment to make barack obama the next president of the united states. [applause] host: haynes johnson, did this change the primary? guest: yes, it did. after that there was no question that obama would be the nominee. the people believe this was the moment of the passing of the torch. the ken the endorsement was so important because mccain -- after that clinton loses 11 straight contests. it meant that the liberals in the democratic party who supported previous kennedy'ys hd passed the torch to obama. many african-americans who started out in hillary's court switched now back to obama. host: we will go trevor from ohio next. caller: good morning, i have a question. we can all agree that barack obama is candidacy was definitely transformation. it was my first presidential election which was really exciting. it was exciting to see the youth on the campus more involved in national politics than before. i was wondering if some states in the general blushes, specifically virginia and north carolina -- obama under- performed in appalachia -- will it be something that we can see or more related to obama's ability to turn now young and a minority voters? guest: we don't know the answer at this point, but clearly what has happened so far is that there is a demographic change in this country that is not working to the republicans' advantage. but whether that plays out in the issues now confronting the president -- will he be able to follow through to carry those states? i do not know the answer. what do you think, dan? guest: it is a great question and we will get a clue with a gubernatorial race in virginia. there are a couple of quick questions. was the 2008 campaign simply, moment in history, or was it the beginning of a different era? the question obama was able to generate enormous enthusiasm, particularly among young people, african-americans, latinos. it is not clear that that is transferable to democratic candidates in 2012, or that obama will be able to re-kindle that in the second campaign for 2012. the states he mentioned along with some western states obama carried are the ones to look back. we will have to see how begins to play. guest: the democrats still have the advantage over republicans. so, we will see what happened. host: pam joins us from baltimore. caller: i was going to comment on something else, but i would like to clarify in reference to the friction between ted kennedy and bill clinton. first of all, from the description your guests gave, ted kennedy was absolutely right. the african-american community was already in hillary clinton's hip pocket grandfathered from bill clinton because the black community loved bill clinton, but they patronize us. barack obama it did not assume our good. i do not believe that bill clinton is a racist, but he used it to perpetuate the difference between his wife and above. when i first saw barack obama before he ran for president i knew there was something different with him. he is a spiritually very motivated and inspiration. even though the clinton had done some good things in our committee he had no right to assume we would back him no matter who was run. black people are not monolithic. we have had other black candidates. no one has been on the scene there brought anything near what barack obama abroad. another thing, what you seek in town halls today is motivated by hate and fear. those people do not even realize hannity and rush limbaugh, and special interests are using them. they will not even benefit from it. we're looking at democratic candidates and will not just vote for them because they are democrat. blue dogs are missing everything up. host: here is a message from twitter. let me use two of those points to return to a moment you,. -- to a moment you chronicle from philadelphia in spring 2008. >> william faulkner once for the past is not dead and buried, and fact, it is not even past. we do not need to recite the history of racial injustice in this country, but we need to remind ourselves that so many disparities that exist between the african-american committee and the larger american community today can be traced directly to inequalities passed on from an earlier generation who suffered undersal slavery ad jim crow. guest: it came about when abc unearthed the videos of jeremiah rwright. very inflammatory. obama recognized this was a moment a breakperil for his candidacy. all the division is,rawness were suddenly laid bare. he had been running as oppose a- ratio candidate. he said to his staff as this, broke i need to give a speech about. they had talked earlier and there had never been the right moment. he said this is. it they asked john, and now chief speechwriter at the white house who was on the campaign to give a draft and he said this is way too personal and i need to speak with obama for. he had a long conversation with obama and then obama took over the draft and ready wrote it himself. he believed had he not handled the moment effectively he would have lost the campaign. host: we're joined from louisiana on the republican line. caller: there is a andold cajun saying that my grandfather used to say -- "it makes me mad, ?" and that is what i would like to say now. because rick warren in the 2008 campaign inserted himself because he has an agenda. host: let me use that point because in the campaign obama was asked about abortion and he said that is above mypay grade and he got flak for that. guest: yes, obama tried to stay away from hot button issues. no matter, obama will always be remembered. for all love our history of race relations, it is it allo -- all of hour history, that will be remembered. the emblem of 2008 is that the americans are really ready to turn the page and take a chance on an african-american kennedy. that is the real story. host: here is one of the moments from the vice-presidential campaign. >> nice to me. can i call your "joe?" guest: it is a wonderful clips and captures sarah palin so marvelously. host: why did john mccain select sarah palin and what led to that announcement? guest: it is another great story. when they really had to make the decision, the leadership of the john mccain campaign believed given everything else happening there were on a trajectory to lose. the country was aligned because of problems and the unpopularity of george w. bush, because of what was beginning to happen with the economy that they needed to do something dramatic. if they ran the best campaign possible with the traditional approach they would lose. why sarah palin? in retrospect there are a couple of reasons. one was the element of surprise, two but that she was a female when there were deeply concerned there were losing women voters. they thought there ought to be some way to bring back some clinton supporters who might be disaffected. the third reason was that they convinced themselves sarah palin could help john mccain put back on the jacket of being the reformer and a maverick. she ran as a reformer as governor. they thought it would send a signal that john mccain was the person to shake up washington and bring real change. they knew there was risk and were prepared to take. host: was there ever a moment without the could win? guest: you know, i guess the two weeks after the republican convention when all of a sudden he was soaring in the polls, by mid-september he was ahead of obama. that was after sarah palin was nominated. then her interviews went down. then the economy began to crash. they knew they would lose and there comes sarah palin who energized the republican base. all of a sudden, the polls went up. by mid-september the economy is collapsing, her interviews were bad, and she goes down. host: tulsa, okla.. this book is called "battle for america 2008, the story of an extraordinary collection." caller: mr. johnson, i read your book sleepwalking through the republicans kept invoking the name of ronald burke reagan. you expect the truth of the reagan administration, something like134 officials resigned over crimes and reagan sold weapons to terrorists. why'd you what this guy get away with it? guest: i am glad that you read the book and got the title right. we're not letting anyone get away with anything. ronald reagan remains a powerful factor. the question for obama's presidency is whether this will be the end of the reagan era. host: how did you two calabria? guest: it is a wonderful story. we have worked together for many years at the post. haynes johnson called me and asked me to breakfast to talk about some. think i agreed and went home to say to my wife, well, haynes called and once to talk about something tomorrow. she said if it is about a book, just sayingyes. so, we went to breakfast and he did have a big book, a book about the campaign, state of the country, moment in history, a campaign of is there. but i told him it was really interesting because in two- thirds through a proposal of my own. -- a campaign of history. as a result, we decided to join forces. he had written 14 books and i had co-authored one. he knew how to do books. i would be on the campaign for two years. i was mr. inside. haynes johnson was taked with the state of the country, mood of the voters, historical sweep, context of the great story and. american that was the way we did the reporting.

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