tv Charlie Rose Bloomberg May 26, 2017 6:00pm-7:01pm EDT
♪ from our studios in new york city, this is "charlie rose." evening we begin this the fourth leg of president trump's first trip overseas. the president was in brussels today. in a speech at the new nato headquarters, he criticized members of the alliance for failing to contribute enough to collective defense. president trump: i have been very direct secretary stoltenberg and members of the alliance in saying nato members must finally contribute their fair share and meet their financial obligations.
member-nations8 are still not paying what they should be paying and what they are supposed to be paying for their defense. charlie: against expectations, president trump declined to explicitly endorse article five. that clause hold an attack on any one member is an attack on all. joining me from chicago is ivo daalder, a former ambassador to nato and currently president of the chicago council on global affairs. with me at the table, john micklethwait, the former editor of "the economist." i'm pleased to have both on this program. tell me what you thought of the president's speech. >> thought it was disappointing, to be frank. i think there is nothing wrong for theprogram. president of the united states to come to europe and remind europeans they need to spend more on defense. every president from truman on has been doing that and doing it in the forceful way he did is perfectly fine, although perhaps
you get more results if you do it privately. but you also need to tie it into a commitment of the united states to the essence of the alliance which is article five, this notion the united states stands foursquare with our allies when it comes to their security and defense. it was particularly important for donald trump to do this since during the campaign he had called nato into question. he called it obsolete. the allies were sitting there waiting for reaffirmation of what is a treaty commitment of a treaty signed 68 years ago. and they did not get it. charlie: john? he knows a lot about this and i think he is right to point out he failed in that respect. but against that, you have to take all the things he said on the campaign. implicitly, there wa trump standing beside the head of nato. i agree it would be better if he had said something specific
about article five. to defend him, i think people think it is wrong these allies sit there and do not spend their 2%. some people say there might be better ways of measuring it than the 2%. but the 2% of gdp is not a large amount to us. charlie: president obama called for it to. >> he was not being outrageous by those standards. it has been a relatively disciplined trump approach so far. charlie: what about article five? >> article five is crucial. without article five, there is no alliance. it would have been better if he had said it. against economically of all the things -- the pen utley of things donald trump has said before, -- he came in saying nato was a disgrace and obsolete. he is there no doing things with them. charlie: why would he do this? why wouldn't he endorse article five? ivo?
>> i don't know. i had expected him to do that. his aides indicated he would do it. the fact he is not able to say this publicly is concerning. it was particularly concerning at this particular moment. i think i disagree with john. this is the first visit by the president to nato headquarters. it was -- his speech with an unveiling of a memorial to 9/11. what is important about 9/11 is not only did the united states was attacked that day but the very alliance where he was standing in the headquarters, the next day invoked for the first and only time article five . as a result of that invocation, nato and europeans, hundreds and thousands of the past 16 years, have been deployed to afghanistan. they fought and died alongside americans for what is in essence the protection of the united states. that is what the alliance is all about.
when it comes to whether you care, yes, dollars matter and euros count. but it is really about the solidarity underscored by the afghanistan mission. >> i absolutely totally agree with everything ivo said. i wish trump had done that. relative toaying the more up calling he said about nature before, he could have been cross about macron's firm handshake or any of the things that might have irritated him. charlie: i missed that. what did macron do? >> macron delivered a particularly firm handshake which seemed to shake trump. charlie: a firm handshake shook the president of the united states? >> it has been reported. charlie: it seems especially timely, article five, at this moment because of whatever
threat there might be by russia to some of its neighbors in the balkan states. >> i think that is the second piece. to only is it a failure reaffirm commitment to article five, it is the other piece which is the failure to recognize the degree to which russia is a true threat to nato in a way that was not the case a few years ago. but with the invasion of ukraine, with the annexation of crimea, nato has responded quite forcefully to try to protect its new members in eastern europe. it has deployed troops there, including the united states. but so has germany, canada, great britain. all three are leading the diplomas into the balkan states. in order to demonstrate the reality of what article five is. the rush of threat was barely mentioned in the statement the president made. it is that combination, and
unwillingness to recognize the unwillingness to recognize the degree to which russia does pose a danger to nato and combined with an unwillingness to declare article five as a solemn treaty commitment of the united states. charlie: you used to be there. you know what member states and the nato representatives think. what would you say about the reception today to the president's speech? >> i think there is a great deal of anxiety. this is an alliance that works in one way and one way only, which is when the united states leads. to get 28 countries to agree on requires somebody like the united states, a major power, to bring these countries along, to be a leader. it does not help to be a scold er when you are not willing at the same time to be leading. you are more likely to get
results when you demonstrate you are committed to get people to follow you rather than telling them in the way the president did, scolding them almost like schoolchildren, that they were not doing their part. they are not doing their part and they should be doing their part. it is something presidents have said all along. i spent a good amount of my time hanging the table saying we need to do more on defense. but it has to be part of a holistic package. it is the lack of the other parts, the recognition of russia as a threat, article five is a fundamental treaty commitment, that undermines the message about burden sharing. >> two things. one part, he was exactly right. for many of these countries, article five is binary. you are either fully behind you or not. any kind of weakness on that has always been a problem. if you are one of the 40 countries, you have russia as a neighbor. the idea america would not come to help matters.
this trip as a whole began in saudi arabia in the middle east. there seem to go better than most people expected. the reaction in europe has been more frosty. people are less keen to be seen standing beside trump. there are fewer relocations happening. --relocations happening. -- royal occasions happening. charlie: what did you think of his trip to the middle east aligning against iran? >> he has done one thing which is interesting. historically, american presidents in the middle east have had this awkward thing with saudi arabia and israel as the principal allies in the region that do not agree on many things. the one thing pulling them together is the iranians. trump by making a lot of noise is helping. a lot of people think the iran deal is good and he should take it. there are other people worried about it. ingeneral with the mess
washington he left behind, you have to say it went relatively well for him. he signed business meals -- deals. the choreography suited him. they gave him a lot to do. he did not have as much time to tweet. the way it was organized by the saudis and israelis worked in his favor. now he has arrived in europe. it is a harder audience. it is less about commercial deals and more about him scolding them about direct -- defense spending. they're are also saying it is not in our interest to be seen standing beside you. you have merkel facing election. may is in an election. none of them are rushing to be seen hugging donald trump. charlie: angela merkel is hugging barack obama because he happened to be there accepting an award. >> yes, he remains a more popular figure. charlie: does it in any way -- can you imagine these kinds of
circumstances in this iconoclastic president can somehow do something that previously was not able to do in terms of aligning forces so some kind of israeli/palestinian deal is possible? have you seen too many failures to even raise hope? >> one always hopes because clearly peace in the middle east is something both parties deserve and need to get behind. it would certainly change the character and nature of the middle east itself. if donald trump is able in some ways to rearrange the forces in a way that gets us to an agreement where others have failed, all the more power to him. in that sense, i think his commitment to this, the willingness to meet with both bring the attempt to arabs along as part of that, are all to be welcomed and
encouraged. clearly, he was coming to the middle east with a lot less baggage than he may have had in other places. particularly once he gave the speech on the importance of the muslim world coming together to stand up against terrorism. >> he is in the position of having the trust of the israelis, which is something if obama ever had he lost quite quickly. that is a useful thing in his pocket. the one thing donald trump has her us is he is a dealmaker. in a sense, this is the hardest in international politics and has been for a long time. most people think there are elements of a deal if somebody really wants to push for it. charlie: in the speech, in the meeting with the leaders in terms of the politics we are talking about, did he somehow overcome the reputation he
withd ring the campaign banning muslim injury to the united states? >> i think he certainly softened his own rhetoric and maybe crucial distinction between ,errorists and the religion which during the campaign he seemed to merge with a blanket ban on muslims. i think he made progress on that and clearly was embraced by a large number of leaders from us in countries. that is to be encouraged. we want the president to learn over time where he may have been wrong and adapt to the circumstances. turning back to europe, i had expected, and i think many people were expecting him, to reflect that learning in the conversations he would have with european leaders. i think john is right. there was a higher bar here. the europeans were not
particularly anxious to be closely associated with him, particularly those facing elections. he did come with a lot of baggage. it looks like he has taken that baggage with him to his next top. charlie: let me talk about a new leader on the world stage, theresa may, the british prime minister. everybody i know is impressed by the way she stood in front of 10 downing and said what she said with the presence she said it. crisis, it is the always crew to think about these things in terms of politics, and it has helped her. her appeal to the british people is to say trust me, in a somewhat angela merkel way, i am the only person who can take us through this negotiation which most people would imagine is a a slightly bad outcome and a really bad outcome, the brexit negotiation. it played into that. the stuff she said about terrorism has been very direct. charlie: where was the secretary of state in the strip?
>> he has a company the president throughout the trip. iswas with him in brussels sitting behind him at the nato meeting when they were showing the pictures. on article five, just yesterday he said of course we support article five. if that is the case, it should be easy for the president of the united states to say so. >> this is a trip which in some ways reflects quite well in him. tillerson, mattis, mcmaster, the grown-ups in the trump aganization have pulled off relative success against a picture of utter carnage on the domestic policy side. and yet they are doing this with virtually no staff at all. the trump administration has been incredibly inefficient getting anybody through. they are working on a shoestring. i think tillerson has some
welcome. how do you measure the success of the first foreign trip of president trump? expectations, pretty high. every step of the trip, it gets harder. the saudis, there is no domestic dissent. they are enormously happy trump is there. everything went according to plan. did not have to deal with questions from the media. also, the whole region came to riyadh to see the american president. that made him look residential -- presidential. israel, netanyahu had to corral his cabinet to actually show up to see trump on the tarmac. you had a little dissent. the personal relationship is very warm. trump had a couple of gaffes. israel at the end of the day is
a strong ally of the united states. then he goes to the vatican and it is more formal, or stilted, more awkward. the fact pope francis gave him ed copy on climate change is about as big of a date as you would get from the pope. clearly, there was a strong message there. now we are on to brussels and nato. a lot tougher. you have a lot of allies that do not feel like trump is on the same page as them. he is pushing them on spending more on nato. you have mr. tusk saying they are not on the same page as russia, not clear how committed trump is to the alliance even though he is more committed than before. he is going to the g-7. it is clear trump is no supporter of the multilateral organization. charlie: who will he see their? >> at the end of the day, the
canadians will be tough to i think the italians will be tough. we have already seen macron at the meeting. at that meeting, he was not easy on climate change, europe. he said i was behind you but that was not the case. the hardest part of all is the trip back to the united states where he has to deal with enormous scandals and crisis and divisiveness. i think the trip on a whole, trump could have done a lot worse. he is meeting allies. many of those allies have better relations with him than they did obama. this is a very challenging global environment for any more so president and by trump, much of which is self-inflicted. charlie: self-inflicted and because the perception of him is unpredictable? >> incapable. charlie: incapable? >> that he is not aware of a lot
of the issues. you saw when he went to the thatli holocaust memorial what he wrote in the visitors book implied he had no idea what the holocaust really was. the single part of the trip i found painful. yes, israel is a strong ally. we were there for them. the personal relationship is fine. nothing is going to unravel this. and yet, the american president is so far from being able to show empathy and understanding for historical context for things that matter to a lot of people around the world. so yes, they will go and give us a big show and treat as well because they feel like they have to and they should and because the relationship is more than about just one president. but these things, they are not just symbolic. they hurt.
you have a president that is not able, willing to stand up to what american values in history actually mean. around theer nations world are not just embarrassed by that, they are profoundly troubled by it. charlie: the was a story this week about how much debt there is in china. growing issue? >> the fact they got a downgrade is quite significant. there is a question about how acrosshese bad loans are the chinese state corporate space as well as the banking space. nobody really believes chinese growth numbers. charlie: nobody believes 6%? >> no. i would say the economist you talk to think it is closer to 3% to 5%. they are still showing good employment. charlie: half of what they say. >> generally speaking, the
economic consensus from people who seem to know, 4%. i am not inside the numbers. i will say irrespective of what the debt looks like, i am a political scientist, the ability of the chinese to forestall challenges, runs on their market -- charlie: president xi jinping wants to focus on all the things coming up so he goes into that congress in october in a strong position so he can get the people he wants understanding. >> he does not want problems. but i would not think he wants a quiet year. if you look around the world now, there are two big things happening. phenomenon andp how it plays out. but the second is china's role in the world. the one built/one road summit they hosted a week ago. they had 29 heads of state show
up. charlie: how much attention to do given the west? >> very little. charlie: i was surprised by that. >> i think it is the biggest thing happening geopolitically in the world, the fact that the chinese are methodically building long-term a strategic infrastructure architecture that competes with the united states. it is not as big as what the united states did after world war ii, but it is enormously meaningful. it is definitive in asia. the countries that are not in it, it is going to be a problem for them. charlie: expansive in africa? >> not all of africa. i was in nigeria last week. west africans like the chinese writing checks, but they do not understand what is happening in terms of infrastructure strategy on the part of china. charlie: the fact that they do not understand it does not mean it is not working. >> i would say for them, the one belt, one road summit, they like
the idea -- they still see china as they saw china 10 years ago. they are growing, writing big checks -- ideaelt/one road is this the chinese are building out infrastructure and spending an enormous amount of money to do so. roads,orts, train rail, i.t. architecture. behind that, it is standards. in return for giving that money, you get things like cultural exchanges. the chinese expect a level of political alignment and support and economic alignment as well. it is mostly bilateral. it is not multilateral the way americans set up institutions. this is the single biggest new geopolitical thing in the world. xi jinping is not only rolling it out and not stopping it when he is about to have his big leadership transition in the fall, he is actually rolling out
the red carpet having the first summit right now. charlie: what is going to happen in brazil? >> i think you're going to have another impeachment. i really did. charlie: second impeachment in a row? >> with south korea in between. my goodness. the scandal is extraordinary. of thee this tape brazilian president with the head of the largest meat producer in the world. the tape said he was bribing him. it turned out the tape was fellowd and that the that was having the conversation with the president had $1 billion of insider trading knowing the story was going to drop. the guy doing the investigation all -- also had his own insider trade going on. it is an incredible mess. but the president cannot explain why this corporate leader who
was under investigation at the time, what he was doing in his private residence late at night without any security checks were being written down about it. he has not been able to explain any of the discussions of $500,000 in a bag that went from one of his top five advisors to this fellow. none of this is explainable. there have been big demonstrations in brazil over the past 24 hours. he called the military out to crack some heads. it feels like a desperation move. he might not be out in a week, but he will lose an immense amount of support from his coalition. and eventually, you will probably see -- charlie: will the president go to jail? >> i don't think lulu will go to jail. charlie: why is he immune because he has been linked to it? >> he has been linked to it.
actually bringing him to jail implies they will be able to bring the cases to indictment. it is not clear they rise to that level. the amount of opposition, strong opposition to him from 80% of the population from being caught up in the corruption is immense. i think the next president of brazil when we get to have real elections as opposed to another acting president is an outsider we don't know right now. it can be someone who served under previous presidents, but this is just a mess. there are over 100 ministers and former ministers that have been caught up in the investigation. the brazilian scandals make american, washington politics look benign, look mild. and there is no end in sight. the good thing is brazil is showing, as the united states is
showing this, that these institutions ultimately work. you have an independent judiciary that cannot be bought off and ultimately the law is supreme in the united states with trump and the investigations. i think we are finding out the same thing. charlie: when you travel around the world and people say, what will happen? will there be impeachment? asking about president trump. ian: they are asking about how much they should be taken seriously what they are hearing out of washington. they know that in the united states these are just polarization and discontent and scandal after scandal. you can go on a plane for three hours and there is a whole new news story when you get off. they want to know how much of this is the united states going
nuts over something that does not matter to them, or is this something to really worry about. charlie: instability here? >> the thing that starts to worry me from the international community is a perspective is right now we have people that both you and i respect a lot better making some important decisions around donald trump. that syria bombing went well because you have people like mattis and mcmaster. if you ask me in a years time, how confident in my that those people will still be serving in the administration, they will not to say, we had it. when i sought mcmaster with stephanopoulos this past weekend, he looked uncomfortable. charlie: he dodged the question four times. ian: if they cannot get donald trump to a more normal place. charlie: this trip has been
pretty good for the most part. he has been close to the prompter. ian: that is right. that speech he gave in red, he yadh,ot -- reality -- ri he did not stray. he has been much better betagement i would dollars to donuts that will not continue. people like mcmaster and mattis, they don't need this job. they believe they are doing the right thing. if suddenly it looks like their values have to be thrown under a truck, i think they will leave. if that happens and we have a crisis over north korea, over iran, russia, china, all of which is possible, i worry that in insecure donald trump who does not have people like that,
the house earlier this month. the project it will leave 23 million more people uninsured. it will also reduce the deficit by $119 billion. it could destabilize individual insurance markets in some states. it is expected that the senate will make major changes before moving forward. , headg me is ezra klein and peter or zach of lazard group. let me start with you, ezra. what are the implications? ezra: calamitous. ensure about 23 million people. y is this would allow states to waiver out of the
obamacare regulations. republicans said this had no downside. they promised that it would continue to protect people with existing conditions and keep insurance markets stable. the ceo said no. they think about one out of six states will use this waiver ability, and people will find insurance becomes too high-priced or not available to them. they find about 1/6 of americans will live in places where the insurance market will destabilize completely. the number of people losing insurance compared to what we would expect otherwise went from 23 million from 24 million. from 24to 23 million million. the senate is taking up basically a new bill. it isn't clear what the relevance of this is except to allow the senate to pivot away from the house bill. the more they pivot away from
the house, it makes a secondary problem if the senate ever gets a bill that the house does not want to accept. -- lie: ezra: it is very slim in the senate. there is a much larger republican majority in the house. people what you might call the coverage copies. the house had the freedom caucus that once more people uninsured. the senate has people who are concerned about medicaid and overall coverage levels. these are powerful senators. it also has people like senator ted cruz who want a very conservative bill. the range of opinion is extremely wide. a number of votes they can afford to lose is extremely narrow. it is considered harder to get anything through the senate than the house. the senate is taking it a bit
more seriously. the house voted on this bill before they had the score. they voted -- they voted on a bill that they did not know, they do not want to know. ae senate is creating significant working group and trying to craft something. when you do that, you are faced with very difficult trade-offs, and it is hard to get something right. taking it more seriously makes for a difficult process. charlie: how many hours do you think you have spent on health care legislation? dr. orszag: i don't want to think about that. too many. administrations first full that for years -- first four years. this shows how hard it is -- it is easy to talk at a bumper
sticker level. when you get into details, there are unexpected surprises. one of them was you think you are creating a high-risk pool for unhealthy people. you are actually creating an incentive for healthy people to go into that pool and destabilize the rest of what you're trying to do. a lot of unintended consequences, a lot of complexity. this is not an easy topic. that is what the house legislation has demonstrated. charlie: the senate will do what? dr. orszag: the problem is there is no magic here. if you start with the thought that it is not just that pre-existing conditions are governed but that premiums should not be dramatically higher if you're sick and if you are healthy, if you start with that principle, you have to avoid people waiting until they are sick and buying in.
you need some kind of incentive or mandate. as and as you do that, you need subsidies for low and moderate income people because they cannot afford coverage otherwise. there is no magic here. that is a box that both house and senate republicans find themselves in. they know they don't like obamacare. obamacare reflects those basic principles. they have no intellectual place to go. au wind up with either somewhat incoherent plan at the house approach or what i suspect will come out of the senate, a much lighter touch like what senator cassidy and senator collins have a -- proposed. much more power to the states. charlie: obamacare got a lot of things right, several important things wrong, including the launch of it. dr. orszag: everyone agrees on that. charlie: there were certain
essential elements that it said, if you like your insurance from you could keep your insurance. buzzwords like that were not true. premiums did rise. dr. orszag: here is the interesting thing. the national budget office took a lot of heat for supposedly getting obamacare wrong. the fact of the matter is they got it basically right. premiums in 2017 are within 1% of what the cbo initially estimated when the affordable care act was passed. therage, people say congressional budget office blew it in terms of how many people would be on the exchanges. that is right. cdl overestimated how many people would end up on exchanges. that is because there were fewer employers that dropped coverage. it was expected that firms would
drop coverage. what matters is the net number of people without insurance. bo after the 2011 supreme court ruling said it would be 30 million people uninsured in 2016, the actual number is 27 million. that is pretty good. ezra: i'm going to say what obamacare did well. among other things, the subsidies are too small. there are more radical reforms i would prefer. within the structure of the affordable care act, you needed higher subsidies to make insurance affordable, make unions in horrible -- premiums affordable. that is not a hard thing to fix. you can add more money to the system, and the system does not come in over cost if you are worried as democrats said they are about deductibles being too high. if you look at the american health care act, the republican
alternative, you can get into the weeds. simple, it takes $600 billion of money that currently subsidizes insurance for poor people and gives tax cuts to rich people. that is a literal statement of what it does. there is no magic to this. if you take money out. health care is expensive. there are ways to make it cheaper. it is hard. it takes time. if you want to make it affordable, you have to give people the money to buy insurance. if you take that money away, there is no fancy footwork you can do. the republican plan is taking $600 billion away and trying to figure out some way to keep people covered. you cannot square that circle. there are trade-offs in life. if you want to give that my in tax cuts, people are going to lose their health insurance in large numbers. that is where this will is going. the great betrayal is donald
trump ran for president saying he is a different type of republican. he said everybody would be covered, insurance would be better, deductibles would be lower, pre-existing conditions would be protected. every single one of these, this bill is breaking his promise. not arguable, just breaking a promise. not going to cover everybody, deductibles are going to go up. there is a real betrayal that people thought they were voting for an economic populist. the more this gets obscured, i think it is bad. i think it is important to get clear about what is happening. charlie: at the same time, the polls show that up until this time that those people who supported him and will be damaged by this will lose insurance and lots of other things are still supporting him at the same level. it may change over months and months when the impact of things are felt, what am i right or wrong? at 38%.re or less he is
that is not great. has lost some support among those folks, too. he is losing some of his core supporters. when you see these special elections in montana and georgia, they are not talking about russia. they are talking about health care. that is pulling high. it is hitting the republicans hard. dr. orszag: don't forget, this is a proposal. it has not become reality. if this were to become reality, and you are talking about a 64-year-old with $27,000 in income, a $12,000 increase on premiums, their political reaction would be different. it is one thing when it is a piece of paper. it is a different thing if it is happening to you or you live in a high cost state like alaska where premiums will skyrocket. the reality is different.
charlie: could we have a political revolution? dr. orszag: i don't think there is going to be a law. charlie: will there be political repercussions because the republican party promised there would be a replacement of obamacare. dr. orszag: that is right. i think that brings you back to this point, which is obamacare sort of is the republican plan. it involves ride that -- private insurance companies and tax credits and exchanges, all of that. they have no place to go substantively to back that up because this plan sort of is their plan. they just don't want to admit it. there a place where they have affected health insurance? ezra: you could almost not do it
worse than we do it. i will start there. there are a lot of interesting models out there. people like different ones. the highest performing model is france where you get a basic level of insurance, and the state gives some people supplementary insurance, and other people by themselves. conservatives like singapore. it is interesting. they had a supercharged visual mandate where they force you to save a large percentage of your paycheck to cover health bills. then they have a universal catastrophic plan that most people buy into. the one thing all these countries have in common is that they set prices centrally. every single developed country except for the united states. the government says here is how much an mri is going to cost, how much xanax is going to cost. that is the key thing that makes all of them cheaper.
when it is cheaper, you have a lot more room to design insurance. charlie: we had been assessed saying that republicans are horrified about the government setting the price. dr. orszag: right. ezra is right. the reason u.s. health care costs more is not because we do more, it is because the prices are much higher. take for granted that we are not going to intervene directly in some way to set the prices because we have a different history, there is still so much we can do to try to get more efficiency of health care that we are not doing. ultimately, if you want to focus on driving premiums to reasonable levels, you have to focus not on mixing up who is in the pool and the subsidies, but on the underlying cost of care. we can do a lot more on the price of it and the efficiency
of it. absolutely. we have been making some progress. the untold story of obamacare is that -- when i was in office, it was widely said obamacare fixes coverage but doesn't do anything on cost. the fact of the matter is we did everything we could think of -- ezra: except regulate prices. dr. orszag: except regulate prices. it has turned out better than i could hope for. medicare costs continue to grow much less rapidly than they have in the past. this year they are up 3% in nominal terms. the result is a much better debt trajectory for the whole country. there is a whole agenda that this debate misses. there are 10 times as many americans with coverage through their employer down on the exchanges. for them what will matter is
whether we are attacking the problem. ezra: the only thing i was going to say in response to senator sass, republicans are repelled by the idea of price setting. charlie: mandating insurance, too. ezra: yes. there is a more honest debate we could be heading. there is a consistent, coherent, in some ways persuasive conservative case. if you regulate prices in america where we are the single largest market for health services that you would hurt innovation badly. if it would be cheaper, it is not worth hurting innovations. what it implies is that the direction you are going is more expensive health care. in order for america to have this world leading innovation and for the rest of the world to free write off of her innovation, then we need to be willing to put more money into
our health care system to keep this going. liberals believe you should have single-payer, and medicare negotiates prices somewhat. medicaid negotiates prices somewhat. that is the debate we should be having between the liberal vision of price regulation through the government, which is cheaper, and the republican version of health care which is maybe you need to spend more, but you have more innovation and more consumer choice. but we don't have that. charlie: have we seen whether the republican model of more innovation works? dr. orszag: we do subsidize medical innovation the rest of the world. the question is how. we have historically just paid for whatever comes along. we paid for very minor improvements. there is one gets the that is high cost -- plenty of stuff that is high cost that doesn't do much. how to remove to where we are
not just paying for more, but we are paying for better. we have been going down this path. the big risk is that path has been led by the government, by medicare and medicaid, they have been moving the system away from paying for quantity piecemeal and towards paying for value. we conducted a survey of 300 investors and executives in which they expect, 55% expect payments in the u.s. to be these value-based versions by 2020. the key question is that requires continued government effort to push in that direction. the current secretary of health and human services has been quite agnostic about whether he would put any weight behind continuing down that path. it is essential, even in their vision of health care. if you don't do this, nothing else you do will be affordable.
this,e: can you imagine looking at the principles of how lookinga free society, at the principles of how you feel about a civil society and the society that is humane, that these reconciliations will take place, so we will have a health ae plan that works in both tax access and cost? ezra: i would like to believe on the 15 to 20 year timeframe. obamacare put us on this path. if hillary had one, we would be continuing on this path more or less steadily. we are going towards access and coverage being more or less completely solved if not much improved. i don't think health care will be as cheap as in our competitor nations in any near-term timeframe. because of the absence of
regulation, but even past dependence is a powerful thing. you would have a huge disruption. i think we could get it down, and we are doing a better job -- we could be doing a better job. if there is anything you are saying that gives me a little hope, there is a different baseline in this country now. you're supposed to protect people with pre-existing conditions. questionhe fundamental of what is the government's responsibility to its citizens and our responsibility to each other has moved towards being a little more salt. you see folks like senator cassidy and senator snowe taking this more seriously. i think compared to where we were 15 years ago before the affordable care act and some of
these understandings were built into law, we are at a better baseline. dr. orszag: i am an optimist. i think in 10 years we will have a health care system that is much more digitized and much more personalized in the sense of not just something works on average, but it works for you in which scheduling and billing is not as annoying. the good part of all the inefficiency that exists in health care today is that we can slow the growth rate and maybe even reduce costs without harming the quality of health care that people get. i am an optimist. charlie: thank you. think you very much. thank you for joining us. ♪