This is a rush transcript from "On the Record," December 15, 2009. This copy may not be in its final form and may be updated.

GRETA VAN SUSTEREN, FOX NEWS HOST: Well, the White House has a new message for health care: Now or never. The White House communications director tells "Politico," "For those who want to reform health care, this may be the last train leaving the station." Vice President Joe Biden says if health care doesn't pass Congress now, reform will be kicked back for a generation. So what do the Republicans say? They say the Democrats are stubborn and tone deaf.


UNIDENTIFIED MALE: Americans are standing up and speaking out, speaking out against too much taxing, too much spending, too much debt, and a job-killing health care experiment. Yet President Obama and Democrats ignore the voices of millions of Americans, still basking in the glow of an adoring media. They are tone deaf, stubborn. They refuse to listen. The stakes are too high to let this happen.


VAN SUSTEREN: Karl Rove joins us. And Karl, we've now gotten down to my favorite, this name calling -- stubborn and deaf and all the other, going back both sides. Nonetheless, this is a profoundly important issue. Is it now or never? Because Republicans have said to me they do want reform. Democrats say they want reform. Is it now or never?

KARL ROVE, FORMER GEORGE W. BUSH ADVISER, FOX CONTRIBUTOR: Well, it's not now or never. I mean, we've heard this song five times or four times earlier this year. We were told we needed to get it done and it would be done by the August 7th break. We were told it would be done by the -- it needed to be done by the end of September. We were told it would be done and needed to be done by the end of October. We were told it would be done, could be done, should be done, must be done by Thanksgiving.

I mean, these are artificial deadlines, and on something this big and this comprehensive, it is better to do it right than to do it quickly. You cannot repent at leisure if you screw up the health care system in America, which this bill in its current form in the House and the current form in the Senate would clearly do.

VAN SUSTEREN: All right, I don't mean to be flip about the -- about a memo we're going to talk about in a little while, about a secret Iranian memo, but this health care bill is beginning to feel like some sort of secret bill to me because nobody really knows what's in it, and so -- you know, which is bizarre. But if -- if -- as you understand it, if they strip away public option, if they strip away the Medicare buy-in, what is left? Can you explain this bill to me as best you understand it?

ROVE: Well, look, there are two ways to explain it. You're right, we don't know and -- we don't know what the particular form of the Medicare buy-in and what the particular form of the -- of the -- of the Office of Personnel Management private -- public option would be. But we do know a lot about the rest of the bill. And what would be left is, first of all, very big cuts in Medicare, about $450 billion worth of cuts in Medicare over the next 10 years.

There would be several hundred million dollars of tax increases, principally $80 billion more on pharmaceutical drugs and $40 billion on medical devices. But there'd also be a lot of others. For example, there's an $8 billion tax in there on people who have health savings accounts and use those health savings accounts to pay for over-the-counter drugs. Isn't that weird? We're supposed to be encouraging people to use the least expensive form of health care that they can get. Somebody says, I can deal with this by an over-the-counter medication, as opposed to -- as opposed to a prescription drug, and the government's going to tax you if you do that.

So we do know that those are in there. We also know in there that there is, at the end of the day, a thing called the exchange, where in essence, everybody will have to come with a -- their insurance policies, every company that provides them. They will have to meet certain federal standards, which will drive up costs. And then the federal government will then allow people to buy those policies through the exchange. And if you - - if you are at the bottom end of the income level, you get a subsidy that will help you buy that.

Now, this -- what we (INAUDIBLE) is that the cost of premiums are going to go up higher than what they would otherwise be. And we know that about half of the people who are going to get coverage are not going to get it through subsidies and the private insurance market. They're going to get it in Medicaid because this expands the eligibility for Medicaid. So 15 million out of the 31 million people in the Senate bill get additional health care coverage by being dumped into Medicaid, which is second-class health care.

We also know that every study shows that every version of this bill, House and Senate, raises health care costs nationally higher than they would otherwise be. Weren't we told the purpose of this was to lower premiums and lower the overall health care cost?

And finally, we know that the government will be in the middle of the patient-doctor relationship. In the Senate bill, for example, there are 70 new government bureaucracies or committees, and there are requirements -- 1,357 requirements that the secretary of Health and Human Services spell out something about health care in the form of a federal regulation.

So at the end of the day, you know, we don't know what's in there with regard to the public option and the Medicare buy-in, but everything else we know is, is that it will cut Medicare...

VAN SUSTEREN: All right...

ROVE: ... dramatically, raise taxes, raise premiums, raise the cost of health care, and most of the people or much of the people who get additional coverage will get so by being dumped into Medicaid.

VAN SUSTEREN: All right. I confess that, you know, (INAUDIBLE) and I confess that I -- you know, there's a lot to, you know, digest in terms of this bill. But I always sort of -- if -- if there are any sort of parts of it that sort of look slippery to me, it really sort of indicts the whole bill.

Let me ask you this question. Senator McCain just moments ago spoke about how the pharmaceutical industry has raised their prices 9 percent this year. In your list of things that are happening in this bill, it says that -- that the pharmaceutical companies are going to get taxed $80 billion. To what extent are they trying to beat the clock, raise the prices by 9 percent to beat that $80 billion tax?

ROVE: Absolutely, they're trying to do it. Look, every player who's looked at this...

VAN SUSTEREN: Well, so this is...

ROVE: ... is trying to figure out how they can game...

VAN SUSTEREN: So this is slippery!

ROVE: ... the system.

VAN SUSTEREN: This is -- I mean...

ROVE: Oh, it is. Absolutely.

VAN SUSTEREN: ... that to me -- that to me...

ROVE: Absolutely.

VAN SUSTEREN: That's gaming it. You know...

ROVE: Absolutely. Gaming it, absolutely. Look, they cut a deal with the administration. They said, If you don't do these things, we'll cough up a bunch of money. We will voluntarily make changes that will allow us to reduce the cost of drugs. But of course, at the end of the day, they're going to try and game the system. So you bet. The senator was absolutely right. Companies -- we're also going to see insurance companies raise their premiums, afraid of getting locked in at a lower rate. We're going to see doctors make a decision that they're going to drop out of health care, rather than stick around and be forced into a system where the government has even more control over reimbursements. We're going to see hospitals...

VAN SUSTEREN: Well, see, that's...

ROVE: ... change their -- change their...

VAN SUSTEREN: But see, that's what bothers me is that when I can find something I can really sort of sink my teeth into, something (INAUDIBLE) you know, that I can get, and this -- you know, the $80 billion -- I take it that there's nothing in this particular bill -- and I don't mean to focus on one section, but there's nothing in this bill to say, Pharmaceutical industry, you can't raise the prices 9 percent, that you already did to offset the $80 billion that you -- under this bill you're going to get hit with, the tax, right?

ROVE: No, that's -- that's right. And look, the CBO already told us this would happen. Doug Elmendorf was before the Senate Finance Committee and was asked by Senator John Cornyn of Texas, All these taxes, what's going to -- who's going to pay them? And he said people who have health insurance are going to pay them in the form of higher premiums. And this is going to be directly passed on to the patients. So you tax something, you get less of it. We're going to get less pharmaceuticals and less medical devices, and the cost of those taxes are going to be paid for by the consumers, which are the patients.

VAN SUSTEREN: I just don't like to be gamed. I like to know what it is so I can make a decision. But anyway, I got to go. I'm taking the last word on that.

ROVE: Absolutely.

VAN SUSTEREN: Karl, thank you.

Up next...

ROVE: You bet, Greta.

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