today on face the nation so it begins. the senate votes along party lines. the debate health care reform. what are the chances now of a bill before christmas? bill disagreements remain over taxes, abortion, and just the huge size of the bill. can majority leader reed keep the democrats in line? will a republican crossover to help? and what is going to happen with the so-called public option? we'll hear about all of these issues with republican minority whip jon kyl of arizona and senator chuck schumer, democrat of new york. then we'll talk about the uproar over new mammogram guidelines with doctor jennifer ashton of cbs news medical correspondent.

i'll have a final word on remembering when a billion here and a billion there added up to real money. but first health care reform. the debate begins. on "face the nation." captioning sponsored by cbs "face the nation" with cbs news chief washington correspondent bob schieffer. and now from cbs news in washington, bob schieffer. and good morning again. joining us now in the studio senator chuck schumer, democrat from new york. and senator jon kyl, republican of arizona. there were two key players in this leading up to the senate deciding to debate this whole health care issue. it is you too. i'd like to get your reaction on what happened last night. >> i thought last night was a very good night for us. look, there are still many bumps in the road, discussions, arguments, disagreements.

but i think now the wind is at our back. there's real momentum. the good news is we have a diverse caucus, but democrat from the most liberal to the most conservative very much wants to get a bill. >> schieffer: on the other side every republican from the most liberal to the most conservative voted against it. >> the reason is because ordinarily when you do start debate on a bill like this, it ends up passing. most of our constituents are saying you need to do everything you can to stop it. the best way to stop it is not to start it but rather to go back and start over again with more republican ideas in legislation than is currently the case. that's why you have every single republican saying no, not this. >> schieffer: orrin hatch said the republicans will launch a holy war of delay. is that going to happen? >> well, first of all, the american people by public opinion surveys have made it very clear they want this whole thing aired out. they would rather have us do it right than do it quickly. we've had so many deadlines it has to be done before august. it has to be done before

october. so on. now the president says he's got to have it by the end of the year. the reality is this is a huge issue affecting every american. we do need to do it right. the object is not to delay for delay's sake but rather to have an opportunity for everyone to see what's in it, to understand it, to know how much it costs and to know how it's going to impact their lives. >> schieffer: senator schumer, there are at least three or four democrats right now and maybe more who have real problems with this bill. senator lincoln from arkansas said yesterday don't think that i'm for this bill. as it now stands just because i'm voting to go ahead with debate. senator landrieu from louisiana, what now? $100 million in federal funds had to be channeled to louisiana. they're calling it the louisiana purchase in order to get her vote to begin debate. you've got some real problems here. >> well, look, we are a diverse caucus. when we become 60 members we get members from red states.

but what we've shown is unity throughout. every time there's a major challenge, the caucus comes together for the good of the nation. our belief is two-fold. one, we believe we have debated this a long time. it's been debated in america for the last decade-and-a-half. but in terms of legislative deliberation, the health committee began in may. the finance committee on which jon and i sit had extensive hearings all through the spring. this has been debated for a long long time. now the time is to act. frankly, you know, there are a lot of people on the other side of the aisle who don't want health care. they haven't put together an alternative proposal that's out there on the web the way our proposal is. i think what orrin hatch said is right. it's a dilatory tactic. >> schieffer: but what about this idea that it takes $100 million in federal funds channeled to one state. should that be added to the

cost of the health care bill? >> mary landrieu is a very good legislator. she does two things very well. one, she delivers the goods for louisiana. she has constantly. i think the people of louisiana respect her for it. but second she has real views on health care. those are taken into account as well. one of the issues that she's pushed very hard is foster children because she has great experience with them. health care for foster children. >> schieffer: what about that senator kyl, what about this idea of funneling all this money? how much is this going to cost in the end? do you think there are any republicans here? what would republicans charge to get.... >> well you haven't heard republicans saying here is my price. that's the problem when you have to get 60. people in your caucus have severe reservations about the bill. in order to get every single vote sometimes you do resort to things that appeal to a particular senator or in the case of the house to a particular representative. the american people don't like that when they see it. it should be on the merits.

when these senators, for example, say we'll vote to start the bill but that doesn't guarantee our vote at the end, the pressure at the end of the process is enormous. the real question ought to be are you willing representing the will of your constituents. all of the public opinion polls show the american people don't want this. gallup showed that independents oppose it by better than 2-to-1. so do you abide by the wishes of your constituents or succumb to the dictates of your leaders. >> schieffer: is that exactly right because i've seen polls that show a majority do want health care. some don't want the public option or this or that. but to say that the majority are against it. is that accurate? >> i can cite ten polls that the majority in every one of them oppose this health care legislation. of course we all support health care. the question is do you support this legislation or would you be more likely to vote against a senator who supports it than not. that was the exact question in that gallup poll. >> the polling is all over. i can cite ten polls on the other side.

we have to do what's right. what's right is this. the health care system, if left on its own is crashing. medicare will be broke in seven years. it's running out of money because it's so expensive. for those who argue, oh, that's the government at work because medicare is a government program,, i always find it an irony that my republican colleagues are against government programs but love medicare. at the same time the private sector costs double every six years. what will happen, bob, over the next five or six years tens of millions of americans will be told by their employers that they can no longer afford health care for them. so we have to get this in line. the goal of our bill above all is this: we try to get rid of the waste, the fraud, the abuse, the duplication, the inefficiency. every individual has experienced that. you get a bill back from your hospital. you say what was this? what are they charging me this much for that? i didn't even see that person there. we all know there's a ton of

that kind of waste, fraud, abuse, inefficiency in the system. we're trying to get at that so we can preserve medicare, so that we can preserve private insurance basically as it is. we know all the providers don't like it because sometimes their axs will be gored if they're doing the waste, fraud, and abuse. >> schieffer: let me ask senator kyl about the most controversial part of this. that is the so-called public option which would be a government insurance program like medicare for younger people. why are you so opposed to that? >> there are several reasons. incidentally i was going to quote from the congressional budget office letter that points out that the expenditures here are going to increase not decrease so it's not as if we're actually cutting the costs of these government programs like medicare but in any event the government-run program is objectionable for two primary reasons. first of all, a lot of people will acknowledge, even members of congress, that it is the first in a two-step process to

get to a single payor system. there are people on the left in this country who support that. most people do not. this is seen as a way to get there. how do you get there? as senator schumer just mentioned, you get a lot of people that have policies today with their employer. according to the study, 88 million of those people will drop the coverage with the employer or be dropped because the employer can't... it will be cheaper for him to dump them into the government-run program. 88 million people. that then brings up the second point. if you like your insurance you get to keep it. not true. you have your insurance with your employer. he says it's cheaper for me to send you to the government plan than it is for me to continue to provide it, you don't get to keep your policy anymore. now you're in the government-run system. that's the other objectionable feature. in addition to which there are a lot of costs associated with it and dictates from the federal government as to what is covered and what is not. >> let me answer that. first the luan study is widely

discredited for one good reason. they're fully funded by united health, the health insurer. >> doesn't mean they're wrong. >> in this case they're very wrong. c.b.o. said our plan, a more modest public option, would be 4 to 6 million people. they're not funded by anybody. they're impartial and we both go by their readings. here's the reason we need a public option. we do. we very much do. the insurance industry is about the most highly concentrated industry in the country. in many states 81% of the insurance is by one company. in 40 states, two companies dominate. when there is no competition or very little competition, every economist, left, right and center will tell you the costs go way up. that's what's happened here. so you need to inject some competition into the insurance industry. the best way to do that is a public option. and the program that we've put together is set up by the government but then it's on its own. there is no intent for it to

compete unfairly against private insurance. some of the original plans were. the house plan at the beginning i would admit it was. but i came up with the idea and the help committee adopted it as well of a level playing field public option. it gets an infusion of dollars from the federal government at first. it has to pay it back like it is a loan over a period of time. then it has to meet the statement... the same rules, requirements, regulations, reserves of any private insurer. now i believe a public option will work better. why? >> schieffer: let me ask you this. can you enough democrats, can you get 60 votes to vote for a public option because right now independent democrat joe lieberman says, look, no health care reform is better than health care reform with a public option. senator lincoln has a real problem with that. senator landrieu already has said she has a problem. ben nelson says he has a problem. i'm just talking about democrats. is it possible to find some way to get those democrats to

vote for this? >> i believe we can. here's why. two reasons. first as i said this is a modest public option. many of those folks when i spoke to them over the course of the last several months their great was jon's fear that this would become a government plan and knock out everybody else. by the people the people from... by the way, the people from private insurance are not allowed to go into the exchange where the public option is. they can't. so the bottom line is though it is not... it is a level playing field and then what we will say to the people from the more red conservative states, your state doesn't have to take it. but don't make it so that my state, which would like a public option can't take it. and the opt-out works. i think at the end of the day, everyone is going to be degree. ... together. i think the proposal that leader reed wisely put into his bill which is a moderate, modest proposal sort of in the

middle of public option land. there are some on the left who don't like it and some on the right. at the end of the it will be where we end up. >> if you want it today, do it today. maine and massachusetts has the ultimate public option. massachusetts has the second highest premiums in the country. turns out public option doesn't drive premiums down. maine is having problems as senator susan collins the former insurance commissioner from maine has pointed out f the state wants to go that route they can do it today. but it's not advisable. to think that you can be both a competitor and the umpire and you're not going to have the advantage is. >> they're not the umpire. >> the government is the umpire. >> no. >> chuck, please don't interrupt me here. i've read good portions of this bill. the government makes decisions. i think there are over 3,000 times where in the legislation it says "shall". the secretary of health and human services has tremendous power under this legislation. as a result, a lot of people fear that when the government is both the competitor and the umpire obviously they win. the final point on the the

public option. there are a lot of states where there aren't enough people either in terms of a risk pool or in terms of the network of physicians and hospitals to put together a lot of different competing plans. you don't help that by adding one more plan. >> schieffer: are people going to pay more taxes because of this. >> yes. >> no. >> schieffer: yes, no? >> let me say this first on the public option. first someone makes the rules but under our plan unlike what was feared before, the same rules apply to private insurance and to the public option. in other words, we say to private insurance, you have to have reserves in case you go bankrupt so your policy holders are still there. same with the public option. we say that you cannot cut people off when they pay too much. you know, when their health care bills go up too much. same at the other. so it's a level playing field public option. it is not... one does not have an advantage over the other. it creates good old-fashioned american competition. >> schieffer: obviously the

wealthier people are going to pay more taxes but aren't people down the line going to have to pay more taxes as well? >> no. what we have focused on particularly in the finance committee bill and then in the bill that leader reed put together, which i think has the best of the health bill and the finance bill, and that's why i believe it's going to pass the senate with 60 votes, maybe 61. 62. who knows. and the reason is we focus mainly on cutting the waste, inefficiency and the duplication, the run-away costs. >> schieffer: all right. >> are there a few taxes on botox and things like that? yes. a small increase in the medicare rate but only for people above $250,000. >> schieffer: we're out of time here. >> the average citizen, no tax. >> schieffer: i'll give you 30 seconds to response. >> if you have insurance you get taxed. if you don't have insurance you get taxed. if you need a life-saving medical device like a stent or a diabetic pump you get pump. pharmaceutical. the congressional budget office says and the joint tax committee says that these taxes imposed on others will be passed through. and why does the letter from

the c.b.o.say it will cost between 5 and 10 billion dollars for the i.r.s.? because the i.r.s. has to enforce these taxes. >> schieffer: we have to end it there. thank you all both for a veryen lieening discussion. back in one minute. for over 150 years, wells fargo has been putting our clients first. according to a leading independent research firm, in 2009 clients rated wells fargo advisors the #1 u.s investment firm for doing what's best for them.

with advisors nearby and nationwide, we're with you when you need advice and planning expertise to meet today's challenges. wells fargo advisors. together we'll go far. >> schieffer: and joining us now cbs news medical correspondent dr. jennifer ashton. i should add in the beginning unlike some doctors on tv, nothing against them, dr. ashton still sees patients. >> that's right, bob. >> schieffer: every day. she is an ob/gyn. doctor, i want to talk to you about this ruling that shocked a lot of people this week including me on mammograms and where you have a government advisory committee saying that women under 40 should no longer get regular mammograms. women 50 to 70 should get them just every other year. and to me the most shocking part of it all, telling younger women they should no

longer do breast exams themselves. you know, i'm not objective about this. i am a cancer survivor, but i want to ask you, as a doctor, what are you telling your patients about this? >> well, bob, first and foremost, as i had been telling them all along, see your own health care advocate. be informed. be educated. ask your doctor questions. always ask what the risks versus the benefits versus the options of any test or any treatment are. you talk specifically about breast cancer screening i'm telling them to continue being familiar with their own body, to continue checking their breast if that's what they have done in the past and to continue along the screening that they had been doing which, if they're 40 or over, included a yearly mammogram. >> schieffer: what about this idea of telling young women not to conduct self-examinations? >> again, you know, that is not really new. in the medical field we've known that self-breast exams or even doctor breast exams are not that accurate.

they can generate a lot of false positives, things that may feel like cancer but turn out not to be. and that then in turn generates a lot of biopsies for the patient. i think that many women, in fact, about 70% of breast cancers are initially detected by palpation. after either the doctor or the patient feels it themselves. again risk versus benefit analysis on that level when you're talking about someone with cancer, the benefits outweigh the risk. >> schieffer: so you're saying continue the examination and then go to your doctor. >> absolutely. i think to disempower a woman about her own body i think again really potentially stacks the deck against her. when you're talking about things like her health and things like cancer. >> schieffer: what do you... what is your biggest concern about this? >> well, i think after the week we had, bob, with not just the breast cancer screening but then the cervical cancer screening guidelines giving women as

well as their doctors really a 1-2 punch, so to speak, i think the risk is that if women get the message that they don't need a pap smear every year and they don't need to get a prescription for a mammogram every year that then they will say, well, why should i go to my gynecologist? i think that that would be a very unfortunate continues consequence of this week. the fact of the matter is that gynecologists, women's health specialists are the primary care physician for women in this country. >> schieffer: let me tell you what bernadine healey who used to be the former director of the national institutes of health. she said if the new guidelines are followed more women will die of breast cancer. do you agree with that? >> i do, bob. let's look at what the science said about the mammography debate because i think it was oversimplified to some degree this week. i think you had people coming down on the side of the cold facts, hard science. and then you had those talking about the raw emotion. in reality it's really somewhere in the middle. the fact is that the mammography debate in terms of

its accuracy or lack thereof especially in younger women started in the '70s. but it's really the best we have. and i think that because a certain percentage of breast cancer is diagnosed in women in their 40s to completely send the message that it really is not having any positive value is wrong. in fact, the task force has acknowledged that good scientific data has demonstrated the benefits of mammography in younger women. but what they found, bob, is that the risks or the harms in that age group outweighed them. i think when you're looking face to face at a patient, as i do, and i look them in the eye and have to hold their hand and tell them they have cancer, the patient and her doctor can decide whether those risks or those harms are too great. >> schieffer: all right. doctor, thank you so much for being with us this morning. i'll be back with my final thoughts in just a moment. tdd# 1-800-345-2550 introducing new schwab etfs,

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>> schieffer: during the johnson administration, the senate republican leader was railing one day against government spending and managed to say a billion here and a billion there and pretty soon you're talking about real money. that's almost quaint these days. i'm not even talking about the costs of health care. i used to say i had been around so long that nothing surprised me. but last week i got surprised-- no, i should say had a jaw- dropping shock-- a better way to put it every time i picked up the newspaper and read about the numbers that we're throwing around lately. like yesterday. when i picked up the "new york times" to discover we have spent more money rebuilding iraq's schools, hospitals, water treatment and electrical plants-- $54 billion-- than we have spent on any construction

project since the marshal plan. which you'll recall was to rebuild europe after world war ii. sobering but not surprising, many of those facilities may close when we leave because there are not enough trained iraqis to operate them. another number in the news last week that i found astounding. it is now costing $1 million a year to keep one u.s. soldier on the ground in afghanistan.& not to mention that for every soldier there, we have one civilian contractor. which helps explain another shocker that came out last week. that ten years ago we owed the government of spain more than we owed china. yet when president obama came calling to china, we owed the chinese more than a trillion dollars. yep. old eb was right. a billion here, a billion there and it added up to real money and a big pile of bills. but is going a trillion dollars in hock to one country made us more secure? that's our broadcast. we'll be right here next week

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