Question: do you think this dynamic where if you reform the health care system, you own it, goes the other way? republicans are beginning with the repeal-and-delay strategy. president-elect trump has said that he does want to repeal obamacare, but he also wants to replace it with something that covers as many people — or at least he’s said that at certain points. do you think the dynamic in which you became responsible for what people didn’t like will hamper republican efforts to change a system that maybe they don’t like?
Answer: let me start from a very simple premise: if it works, i’m for it. if something can cover all americans and make sure if they have a preexisting condition, they can still get coverage. make sure prescription drugs are affordable. encourage preventive measures to keep people healthy. make sure that in rural communities, people have access to substance abuse care, or mental health care. that medicare and medicaid continue to function effectively. if you can do all of that cheaper than we talked about, cheaper than obamacare achieves, and with better quality and it’s just terrific — i’m for it. part of the challenge in this whole debate — and this is true dating back to 2009 and back to 2010 — is this idea that somehow we had a fixed way of trying to fix the health care system, and we were rigid and stubborn and wouldn’t welcome republican ideas, and if we only had, they had all these great solutions. in fact, if you look at how this law evolved — and i’ve said this publicly before, if i was starting from scratch i would have supported a single-payer system, because it’s easier for people to understand and manage. and that’s essentially what medicare is — a single-payer system for people of a certain age — and people are very satisfied with it, and it’s not that complicated to understand how to access services. but that wasn’t available. we weren’t starting from scratch. so what did i then do? we said, “what’s a system out there that seems to be providing coverage for everybody that politically we could get through a congress which we can get republican support?” and lo and behold, there had been a plan in massachusetts that had been designed on a bipartisan basis, including by a republican governor who ultimately became the nominee for the republican party, that came close to providing universal coverage. i would have thought — since this was an idea that had previously gotten a lot of republican support — it would continue to get a lot of republican support. and yet magically, the minute we said, “this is a great idea and it’s working,” the republicans said, “this is terrible, and we don’t want to do this.” i say this, ezra, to make something very clear. from the earliest negotiations in 2009 and 2010, i made it clear to republicans that if they had ideas that they could show would work better than the ideas we had thought of, i would be happy to incorporate them into the law. and rather than offer ideas, what we got was a big “no, we just don’t want to do this.” after the law passed, for the last six to seven years, there was an argument that “we can provide a replacement that will be much better for everyone than what the affordable care act is providing.” and yet over the last six to seven years, there’s been no actual replacement law that any credible health care policy experts have said in fact would work better. in fact, many of them would result in millions of people losing coverage — and the coverage being worse for those who kept it. and now is the time when republicans have to go ahead and show their cards. if in fact they have a program that would genuinely work better, and they want to call it whatever they want — they can call it trumpcare or mcconnellcare or ryancare — if it actually works, i will be the first one to say, “great; you should have told me that in 2009. i asked.” i suspect that will not happen. and the reason it will not happen is because if you want to provide coverage to people, there are certain baseline things you’ve got to do. number one: health care is not cheap. and for those who can’t afford it or can’t get it through the job, that means the government has got to pay some money. number two: all those provisions that the republicans say they want to keep and that they like — for example, making sure people can get health insurance even if they have a preexisting condition — it turns out the only way to meet that guarantee is to either make sure everyone has some modest obligation to get health care, so they’re not gaming the system, or you’ve got to provide huge subsidies to the insurance companies so they’re taking in people who are already sick. and i think what you’re going to see now that we have a republican president-elect, you have republicans control both chambers in congress — that all of the promises they made about how they can do it better, cheaper, and that everyone is going to be satisfied are going to be really hard to meet. this is why this strategy of “repeal first and replace later” is just a huge disservice to the american people and is something that i think, whether you're a republican or a democrat, you should be opposed to. these are real lives at stake. i’m getting letters from people who say, “i’m terrified, because my son’s or daughter’s insurance, their ability to get life-saving drugs, their ability to get drug treatment, their ability to get mental health services are entirely dependent on us being able to afford and keep our insurance.” and if, in fact, there's going to be a massive undoing of what's one-sixth of our economy, the republicans need to put forward very specific ideas of how they’re going to do it. people need to be able to debate it, they need to be able to study it, the same way they did when we passed the affordable care act. and let the american people gauge: is this going to result in something better than what obamacare has produced? and if they’re so convinced they can do it better, they shouldn’t be afraid to make that presentation. it is really interesting to figure out why they are trying to rush the repeal so quickly. what is it that they’re afraid of? why wouldn’t they want to say, “here’s our plan,” and show, side by side, here’s why our plan is better than what obamacare has produced. they have said absolutely, adamantly, that they can do it better. i am saying to every republican right now: “if you can in fact put a plan together that is demonstrably better than what obamacare is doing, i will publicly support repealing obamacare and replacing it with your plan.” but i want to see it first. i want to see it first. and i want third-party, objective people — whether it’s the congressional budget office, or health care experts across the ideological spectrum, or vox, or —
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  ### Input: 
  do you think this dynamic where if you reform the health care system, you own it, goes the other way? republicans are beginning with the repeal-and-delay strategy. president-elect trump has said that he does want to repeal obamacare, but he also wants to replace it with something that covers as many people — or at least he’s said that at certain points. do you think the dynamic in which you became responsible for what people didn’t like will hamper republican efforts to change a system that maybe they don’t like?
  ### Response: 
  let me start from a very simple premise: if it works, i’m for it. if something can cover all americans and make sure if they have a preexisting condition, they can still get coverage. make sure prescription drugs are affordable. encourage preventive measures to keep people healthy. make sure that in rural communities, people have access to substance abuse care, or mental health care. that medicare and medicaid continue to function effectively. if you can do all of that cheaper than we talked about, cheaper than obamacare achieves, and with better quality and it’s just terrific — i’m for it. part of the challenge in this whole debate — and this is true dating back to 2009 and back to 2010 — is this idea that somehow we had a fixed way of trying to fix the health care system, and we were rigid and stubborn and wouldn’t welcome republican ideas, and if we only had, they had all these great solutions. in fact, if you look at how this law evolved — and i’ve said this publicly before, if i was starting from scratch i would have supported a single-payer system, because it’s easier for people to understand and manage. and that’s essentially what medicare is — a single-payer system for people of a certain age — and people are very satisfied with it, and it’s not that complicated to understand how to access services. but that wasn’t available. we weren’t starting from scratch. so what did i then do? we said, “what’s a system out there that seems to be providing coverage for everybody that politically we could get through a congress which we can get republican support?” and lo and behold, there had been a plan in massachusetts that had been designed on a bipartisan basis, including by a republican governor who ultimately became the nominee for the republican party, that came close to providing universal coverage. i would have thought — since this was an idea that had previously gotten a lot of republican support — it would continue to get a lot of republican support. and yet magically, the minute we said, “this is a great idea and it’s working,” the republicans said, “this is terrible, and we don’t want to do this.” i say this, ezra, to make something very clear. from the earliest negotiations in 2009 and 2010, i made it clear to republicans that if they had ideas that they could show would work better than the ideas we had thought of, i would be happy to incorporate them into the law. and rather than offer ideas, what we got was a big “no, we just don’t want to do this.” after the law passed, for the last six to seven years, there was an argument that “we can provide a replacement that will be much better for everyone than what the affordable care act is providing.” and yet over the last six to seven years, there’s been no actual replacement law that any credible health care policy experts have said in fact would work better. in fact, many of them would result in millions of people losing coverage — and the coverage being worse for those who kept it. and now is the time when republicans have to go ahead and show their cards. if in fact they have a program that would genuinely work better, and they want to call it whatever they want — they can call it trumpcare or mcconnellcare or ryancare — if it actually works, i will be the first one to say, “great; you should have told me that in 2009. i asked.” i suspect that will not happen. and the reason it will not happen is because if you want to provide coverage to people, there are certain baseline things you’ve got to do. number one: health care is not cheap. and for those who can’t afford it or can’t get it through the job, that means the government has got to pay some money. number two: all those provisions that the republicans say they want to keep and that they like — for example, making sure people can get health insurance even if they have a preexisting condition — it turns out the only way to meet that guarantee is to either make sure everyone has some modest obligation to get health care, so they’re not gaming the system, or you’ve got to provide huge subsidies to the insurance companies so they’re taking in people who are already sick. and i think what you’re going to see now that we have a republican president-elect, you have republicans control both chambers in congress — that all of the promises they made about how they can do it better, cheaper, and that everyone is going to be satisfied are going to be really hard to meet. this is why this strategy of “repeal first and replace later” is just a huge disservice to the american people and is something that i think, whether you're a republican or a democrat, you should be opposed to. these are real lives at stake. i’m getting letters from people who say, “i’m terrified, because my son’s or daughter’s insurance, their ability to get life-saving drugs, their ability to get drug treatment, their ability to get mental health services are entirely dependent on us being able to afford and keep our insurance.” and if, in fact, there's going to be a massive undoing of what's one-sixth of our economy, the republicans need to put forward very specific ideas of how they’re going to do it. people need to be able to debate it, they need to be able to study it, the same way they did when we passed the affordable care act. and let the american people gauge: is this going to result in something better than what obamacare has produced? and if they’re so convinced they can do it better, they shouldn’t be afraid to make that presentation. it is really interesting to figure out why they are trying to rush the repeal so quickly. what is it that they’re afraid of? why wouldn’t they want to say, “here’s our plan,” and show, side by side, here’s why our plan is better than what obamacare has produced. they have said absolutely, adamantly, that they can do it better. i am saying to every republican right now: “if you can in fact put a plan together that is demonstrably better than what obamacare is doing, i will publicly support repealing obamacare and replacing it with your plan.” but i want to see it first. i want to see it first. and i want third-party, objective people — whether it’s the congressional budget office, or health care experts across the ideological spectrum, or vox, or —