The MacNeil/Lehrer NewsHour (PBS) - 1993-04-14 (partial)

Channel: malgent

Transcript

Language: English (original, YouTube automatic captions)

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[0:08] [music]

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[0:30] Broadcasting and viewers like you.

[0:34] >> A protest strike in South Africa turned

[0:36] violent today. It was called because of

[0:39] the weekend assassination of Communist

[0:41] Party and African National Congress

[0:43] figure Chris Hani. Black leaders had

[0:45] urged the strikers to keep their

[0:47] protests peaceful, but it did not work.

[0:49] Jeremy Thompson of Independent

[0:51] Television News reports.

[0:59] This was everyone's worst nightmare.

[1:03] Chaos in the heart of Cape Town.

[1:06] Fires burnt outside the city hall.

[1:09] Crowds of youths went on the rampage,

[1:11] looting shops,

[1:14] smashing windows, torching property.

[1:18] Vehicles were set alike.

[1:20] Security forces struggling to maintain

[1:22] control fired volleys of warning shots.

[1:30] Several people were in policemen. Even a

[1:34] peace monitor was hurt led away after

[1:36] being stabbed. The men of peace tried

[1:40] their best to hold the line. A

[1:42] distressed Archbishop Tutu blamed

[1:44] militant elements for trying to ruin

[1:47] Han's memorial day.

[1:48] >> That there are elements who are

[1:51] undisiplined and used have used this

[1:54] occasion or abused the occasion. The

[1:57] biggest labor stayaway in the country's

[1:59] history had started calmly in most

[2:01] towns, but later deteriorated into

[2:04] several angry confrontations with the

[2:06] police. Before a huge crowd in Suetto,

[2:09] Nelson Mandela had repeated his call for

[2:12] restraint.

[2:13] >> As members of a government in waiting,

[2:16] you have the responsibility

[2:19] to behave orderly and with dignity. But

[2:23] the greatest test of the ANC's

[2:25] credibility was being undermined as

[2:27] youths mobbed a Suetto police station.

[2:31] Suddenly the police opened fire. Live

[2:34] round scattered the demonstrators.

[2:37] The police who'd been told to act with

[2:39] restraint claimed they were just

[2:40] enforcing order. The result, three dead,

[2:43] five critically wounded, and scores more

[2:46] injured. Among them a BBC camera crew.

[2:49] The day of mourning for Chris Harney

[2:51] turned into mayhem.

[2:53] >> President Clerk ordered 3,000 more

[2:56] troops and police onto the streets. He

[2:58] said what happened in South Africa today

[3:00] cannot be tolerated in any civilized

[3:03] country. Robin US special envoy Reginald

[3:06] Bartholomew stepped up the pressure on

[3:08] Bosnia's Serbs today. He said if they

[3:10] did not sign a peace plan, the US would

[3:13] back lifting the arms embargo on

[3:15] Bosnia's Muslims. Bartholomew met with

[3:17] the Bosnian Serb leader in Belgrade and

[3:19] afterward told reporters what he'd said.

[3:22] >> Military and humanitarian powers have to

[3:24] stop now and that the Bosnian Serbs have

[3:28] to come to an agreement in the Vance

[3:31] process now. But does that involve

[3:33] >> and that this involves this involves in

[3:36] the first instance the line of march

[3:38] that we are on to impose tougher

[3:41] sanctions and you're all aware of this

[3:44] and it does involve the prospect of

[3:47] pursuing a lifting of the arms embargo

[3:49] should that prove necessary if in fact

[3:51] the Bosnian search do not come to terms

[3:54] come to a settlement in the Vansorn

[3:56] process quickly. Victims of Monday's

[3:59] Serb shelling of the besieged town of

[4:01] Sreanita were in the relative safety of

[4:03] a north Bosnian hospital in Tusla today.

[4:06] They were evacuated by a UN convoy

[4:08] yesterday. Many of the evacuees were

[4:10] children suffering from shrapnel wounds.

[4:13] According to UN officials, the Serbs

[4:14] unleashed another artillery barrage on

[4:16] Straitsa after the convoy left. It

[4:19] brought the two-day death toll to at

[4:20] least 64. Bosnia's Serb leader today

[4:24] denied his forces were responsible for

[4:26] the attacks. We'll have more on Bosnia

[4:28] later in the program.

[4:29] >> President Clinton continued the campaign

[4:31] for his economic stimulus package today.

[4:34] He said it would create 700,000 summer

[4:36] jobs and help cut the nation's

[4:38] unemployment rate by half a percentage

[4:40] point. He spoke to business leaders at a

[4:43] conference on summer jobs put together

[4:45] by the departments of commerce and labor

[4:47] in Arlington, Virginia.

[4:49] the jobs program that I have presented

[4:51] to Congress with the summer jobs, with

[4:54] the money for the cities and the

[4:55] counties through the community

[4:57] development program, with the

[4:58] infrastructure money

[5:01] is a small part of a big budget.

[5:05] It is an attempt to engage in an

[5:07] experiment to see whether or not

[5:10] with the economy recovering in terms of

[5:13] corporate profit. We can give a little

[5:16] goose to it, give opportunities to young

[5:20] people, create a half a million jobs,

[5:22] and maybe get the engine going again.

[5:26] House Republicans rejoined the attack on

[5:28] the stimulus package today. It passed

[5:30] the House, but was stalled by a

[5:32] Republican filibuster in the Senate.

[5:34] House Minority Leader Bob Michael said

[5:36] House Republicans would hold town

[5:37] meetings around the country this

[5:39] Saturday.

[5:41] >> Our role and responsibility is educating

[5:44] the American public to what really is in

[5:46] these specific proposals. And when they

[5:49] get to understanding it, reading the

[5:50] fine print like you have to do in an

[5:52] insurance policy, you get a a very

[5:54] different view. When you get beyond

[5:57] simply accelerating public works as an

[6:00] item or summer jobs, beyond that, you

[6:02] tell me where there's one additional job

[6:05] created, but additional spending. And

[6:07] that's the difference that has to be

[6:09] pointed out to the American people. What

[6:11] really is a job creator? White House

[6:14] officials said today a national sales

[6:16] tax was being considered as a way to pay

[6:18] for health care reform. Spokesman George

[6:21] Stephanopoulos said the idea had not yet

[6:23] been presented to President Clinton, but

[6:25] his healthc care task force was

[6:27] considering a wide range of options,

[6:30] including a so-called value added tax.

[6:33] There was still no verdict today in the

[6:35] federal trial of four Los Angeles police

[6:37] officers accused of violating Rodney

[6:39] King's civil rights. Deliberations ended

[6:42] early after the judge called all parties

[6:43] to the courthouse to announce that one

[6:45] juror was sick and being taken to a

[6:47] doctor. Deliberations are expected to

[6:49] resume tomorrow morning. The governor of

[6:52] Ohio deployed 500 National Guard troops

[6:54] to the Lucasfil prison today. Rioting

[6:57] prisoners there have been holding eight

[6:58] guards hostage since Sunday. The move

[7:01] came hours after inmates hung a banner

[7:03] out a window threatening to kill one of

[7:05] the hostages unless their demands were

[7:07] met. Seven inmates have been killed by

[7:09] other prisoners since the uprising

[7:11] began. Officials of the seven largest

[7:13] industrial nations met in Tokyo today on

[7:16] aid to Russia. The United States wants

[7:19] the group to put together a $4 billion

[7:21] fund to privatize Russia state-run

[7:24] factories. An overall package of about

[7:26] $30 billion is expected to be worked out

[7:29] during the two-day meeting. That's our

[7:31] summary of the news. Now, it's on to

[7:33] Bosnia. Managed competition in

[7:36] healthcare, Labor Secretary Rush, and

[7:38] the women of Somalia.

[7:49] First tonight, an update on the Bosnia

[7:51] story. Serb shelling of the eastern

[7:53] Bosnian town of Straanita continued

[7:56] today and so did international

[7:57] diplomatic efforts to stop the fighting.

[8:00] Yesterday, a United Nations convoy

[8:02] managed to evacuate nearly 700 Muslim

[8:05] women and children from Sra Bernita to

[8:07] Trusla. Jane Bennett Powell of

[8:09] Independent Television News has a

[8:11] report. We caution that it includes

[8:13] strong material.

[8:15] >> Last night's convoy brought civilians,

[8:18] women, and children with the kind of

[8:19] wounds soldiers get in battle.

[8:24] >> Of the 700 people evacuated from Sonita

[8:26] yesterday, 27 were brought to Tuslas

[8:29] Hospital.

[8:32] >> Surgeons operated through the night and

[8:35] were still in the operating theater this

[8:36] afternoon.

[8:43] These were the first eyewitness accounts

[8:45] of the intense shelling Serban has been

[8:47] subjected to over the last few days.

[8:53] By today, the medical staff were better

[8:56] able to assess the scale of the

[8:57] injuries, though some children like

[8:59] Essad still bore the number of his place

[9:02] in the truck on his unwashed face. He's

[9:05] in intensive care with internal bleeding

[9:07] from a shattered breast bone and a deep

[9:09] skin wound from shrapnel. He's six.

[9:13] Sadat, who's 16, was playing football on

[9:16] Monday when he was hurt. He came out

[9:18] with his mother, but his father and

[9:20] brother are still in Sonita. He has

[9:22] broken ribs and internal bleeding.

[9:28] >> I was in the school playground playing

[9:30] with the ball. One shell landed.

[9:35] There was a huge bombardment from the

[9:37] direction of Serbia and Bratina.

[9:48] >> Sead was also playing football when the

[9:51] first shells fell.

[9:54] >> Overnight surgery failed to save his

[9:56] sight. He'll never play football again.

[9:59] As the nurse explained,

[10:04] Shells hit the school. We heard 50

[10:06] people were killed there. He came alone.

[10:09] The doctor who had examined him said

[10:11] that these are serious eye wounds. There

[10:14] was more shelling last night and today.

[10:16] Eight more people died and three times

[10:18] that number were hurt.

[10:22] A UN aid worker described Monday's

[10:25] bombardment as intensive and systematic

[10:27] in its targets with bursts of three or

[10:30] five shells at a time.

[10:32] Radavan Carajic, the Bosnian Serb

[10:34] leader, said that after inquiries, there

[10:36] was no evidence it came from Bosnian

[10:38] Serb positions.

[10:41] In Europe, both proximity and heavy news

[10:43] coverage have produced political debates

[10:45] over Bosnia more passionate than those

[10:47] in the United States. And in Britain,

[10:49] some of the strongest language has come

[10:51] from Lady Thatcher, the former prime

[10:53] minister. Yesterday on British

[10:54] television, Margaret Thatcher said that

[10:56] Europe has become an accessory to

[10:58] massacres. Today there was an angry

[11:00] response from the government of her

[11:02] successor, Prime Minister John Major. We

[11:04] have a report from Ellaner Goodman of

[11:06] Independent Television News.

[11:08] >> Lady Satcha today went on the American

[11:10] breakfast shows to make the case for

[11:12] greater Western intervention in Bosnia.

[11:15] We can't pass by on the other side and

[11:17] see those terrible things going on to

[11:19] innocent people. I suggest therefore

[11:22] that we revive what was a previous

[11:25] policy talked about but not implemented

[11:28] of arming the Bosnian Muslims who have

[11:31] been prevented from getting arms to

[11:33] defend themselves by a United Nations

[11:36] resolution. The British government is

[11:38] firmly opposed to lifting that embargo

[11:41] but that opposition could lead to a rip

[11:43] with the new American administration.

[11:45] Today, Reginald Bartholomew, President

[11:47] Clinton's special envoy to former

[11:49] Yugoslavia, said on a trip to the region

[11:51] that the US would back the lifting of

[11:53] the UN embargo against Bosnia unless the

[11:56] Serbs signed a peace agreement soon. And

[11:58] he made it clear that American patience

[12:00] with the diplomatic route was running

[12:02] out given the atrocities being committed

[12:04] on the ground. In Britain, where MPs

[12:07] returned to Westminster after the Easter

[12:08] recess, Lady Thatch's intervention

[12:10] infuriated ministers. Some loyal Tory

[12:13] backbentures were privately going round

[12:15] saying that their former leader had

[12:17] flipped her lid. But other MPs on both

[12:20] sides of the house clearly shared her

[12:21] frustration at the impotence of the West

[12:23] to stop the killing. In an attempt to

[12:26] counter her arguments, the government

[12:27] agreed to make a statement. Using rather

[12:30] more measured tones than yesterday, the

[12:32] defense secretary said the government

[12:33] shared the sense of outrage about the

[12:36] attack on Sebranit. Madam Speaker, the

[12:38] government fully shares the widespread

[12:40] frustration that diplomacy and military

[12:43] pressure have not yet succeeded and that

[12:45] the suffering still continues.

[12:47] >> He stressed the sanctions noose was

[12:49] being drawn tighter. Then, without

[12:51] mentioning Lady Thatcher by name, he

[12:53] rejected her call to lift the arms

[12:55] embargo on Bosnia.

[12:57] >> Removal of the United Nations arms

[12:59] embargo would certainly result in the

[13:01] Bosnian Muslims being free to acquire

[13:04] all the weapons that they needed.

[13:06] Presumably the Botney and Serbs for

[13:08] their part would also seek more arms

[13:10] from other countries. The result would

[13:12] be to prolong the conflict and to make

[13:14] it even bloodier and more vicious than

[13:17] it is today.

[13:18] >> Turning to the calls for air strikes

[13:19] against Serbian positions, he did leave

[13:21] open the possibility that at some future

[13:24] point they might be justified, but he

[13:26] warned that they would fundamentally

[13:28] change the role of the UN. The clear

[13:30] military advice received by the

[13:31] government is that air strikes

[13:33] unsupported by substantial numbers of

[13:36] troops on the ground would be unlikely

[13:38] to be effective given the nature of the

[13:40] conflict, the weapons deployed and the

[13:43] terrain.

[13:43] >> Mr. Rifken was broadly supported by the

[13:46] opposition front benches.

[13:47] >> Madam Speaker, the Secretary of State is

[13:51] right when he says that we cannot lift

[13:54] the arms embargo to the Muslims. It has

[13:57] always seemed to us rather crazy to try

[14:00] and douse a fire with petrol. It never

[14:03] worked.

[14:04] >> Although the right honorable gentleman,

[14:05] I disagree about a number of elements of

[14:07] this matter. May I say to him that I

[14:09] believe him to be fundamentally right in

[14:11] resisting calls for the relaxation of

[14:13] the arms embargo.

[14:15] >> Mr. Rifkin was also backed by a majority

[14:17] of Toryback ventures. Would my right

[14:19] honorable friend not agree with me that

[14:21] the quickest available shortcut to a

[14:24] general Balkan war and an escalation of

[14:26] the conflict far beyond the borders of

[14:28] Yugoslavia would be to bomb Serbian

[14:31] positions?

[14:32] >> But Lady Thatcher's frustration was

[14:34] shared by a significant minority on both

[14:36] the Labor and Tory backbenches.

[14:38] Does the government not see that it is

[14:41] the inevitable consequence of the

[14:43] present policy that ethnic cleansing uh

[14:47] will continue its course and genocide

[14:51] will continue because there is nothing

[14:55] whatsoever being done by the

[14:56] international community to stop it. How

[14:58] many more millions of people must be

[15:01] driven from their homes

[15:02] >> and tens of thousands of people killed

[15:06] before the government before the

[15:07] government uh comes before that dispatch

[15:10] box with a policy commenurate with the

[15:13] genocide which we're witness

[15:15] >> and in the Lords this evening Lady

[15:17] Thatcher showed that the government's

[15:18] attempts to counter her arguments had in

[15:20] no way changed her mind

[15:22] >> the government have left the people

[15:27] although they have a right to

[15:28] self-defense without the means of

[15:32] implementing that right against a

[15:35] vicious aggressive.

[15:38] On the diplomatic front today, Russian

[15:40] officials proposed a meeting of foreign

[15:42] ministers of the five permanent members

[15:44] of the UN Security Council to discuss

[15:46] Yugoslavia. The Russians suggested the

[15:48] meeting take place after their president

[15:50] presidential referendum on April 25th.

[15:54] Still ahead, managed competition in

[15:56] healthcare. Labor Secretary Rush and

[15:58] Charlene in Somalia.

[16:02] [music]

[16:08] Now, another in our series on options

[16:10] for healthc care reform. A new survey of

[16:13] medical doctors found that twothirds of

[16:16] them favor a fundamental overhaul of the

[16:18] current medical system. And 58% of them

[16:21] in that Times Mirror survey said they

[16:24] support a so-called managed competition

[16:27] approach. President Clinton's task force

[16:29] on health reform may include that in its

[16:32] recommendations. So what exactly is

[16:35] managed competition? They already have

[16:37] such a system in California and Spencer

[16:39] Michaels of public station KQED San

[16:42] Francisco tells us all about it. Okay,

[16:46] open your mouth real wide. Real wide.

[16:48] Say ah. Ah. Ah. Good. Good.

[16:53] >> Fouryear-old Lisa Jackson and her baby

[16:55] sister Michelle are showing signs of

[16:58] retardation.

[16:59] Dr. Ronald Bachmann, a pediatrician and

[17:02] geneticist at Kaiser Hospital in

[17:04] Oakland, California, suspects that these

[17:06] young patients may have a complicated

[17:09] hereditary disorder.

[17:11] >> One of them has already had chromosome

[17:13] studies, cytogenetic studies. That

[17:14] that's a test that's close to $1,000.

[17:17] And then we'll do molecular testing, DNA

[17:19] testing for something called Pragillex,

[17:21] which is uh one of the newer diagnosed

[17:26] uh retardation syndromes as well as

[17:28] doing some other chemical testing or

[17:29] metabolic testing as they're called.

[17:32] Such state-of-the-art procedures like

[17:34] most new medical technologies are

[17:36] expensive and their increased use is one

[17:39] reason healthcare costs are spiraling

[17:41] out of control. They currently make up

[17:44] nearly 15% of gross national products.

[17:48] In California, even Kaiser, the nation's

[17:50] largest health maintenance organization,

[17:52] which prides itself on quality, lowcost

[17:55] care, is now being pressured to hold the

[17:58] line. Some health care planners believe

[18:01] that cutting cost is a simple matter of

[18:04] market economics, where price is king.

[18:10] Welcome to Price Club, one of a growing

[18:12] number of discount warehouse stores.

[18:15] True, the frills are few, selection is

[18:17] limited, and the packages give the term

[18:20] economy size new meaning, but shoppers

[18:23] are lured by bargain prices kept low by

[18:26] the outlet's enormous buying power. That

[18:29] principle may work elsewhere.

[18:32] health care, physical examinations,

[18:34] vaccinations, operations, they don't

[18:37] bear much resemblance to the products on

[18:39] these shelves. But in California, the

[18:42] people who manage a health care system

[18:44] for public employees have figured out

[18:46] that they can buy health care the same

[18:48] way that Price Club buys toilet paper or

[18:51] dog food. And then they can pass the

[18:54] savings along to their members. Volume

[18:56] purchasing is an excellent idea. It's

[18:58] been used throughout the American

[18:59] economy and every other sector that I

[19:01] can think of. and it's about time we

[19:03] start using it in the healthcare

[19:04] business.

[19:05] >> Tom Elen buys health insurance for

[19:07] nearly 900,000 government workers in

[19:10] California. They are members of

[19:12] Sacramentobased Calpers, the public

[19:15] employee retirement system, which

[19:17] manages health benefits for active as

[19:19] well as retired employees of hundreds of

[19:22] public agencies throughout the state. In

[19:25] 1991, fed up with ever escalating

[19:28] premiums and constrained by a tightening

[19:30] state budget, Elen got tough with

[19:33] insurers, Kalpers sought volume

[19:36] discounts from about 20 companies and

[19:39] then let its members choose their

[19:41] coverage from among those competing

[19:43] plans. This system is as close to a

[19:46] model of what President Clinton calls

[19:48] managed competition as exists in the

[19:51] nation. The idea of getting hundreds of

[19:54] employers together to purchase health

[19:56] care using purchasing power and

[19:58] spreading the cost administration over

[20:00] lots of employers uh from our experience

[20:02] is a pretty good idea.

[20:05] Benefiting from Kalpers's clout of the

[20:07] seven employees of the Castro Valley

[20:09] Sanitary District who clean and maintain

[20:12] the sewers near Oakland. Average health

[20:15] insurance premiums for Kalpers members

[20:17] will go up just 1.5% this year.

[20:21] far below the national average of 10 to

[20:24] 15%.

[20:25] That's why district manager Mary

[20:27] Fredette recommended a change from the

[20:29] county insurance plan.

[20:32] >> The last year that we were with the

[20:34] county, our fee for service plan, which

[20:35] was Blue Cross, had increased or was

[20:38] projected to increase 44%.

[20:40] >> What kind of savings did you get under

[20:42] the CalPERS plan? The first year that we

[20:45] were there, our our fee for service

[20:47] plan, which was roughly comparable to

[20:50] the Blue Cross that we had had under

[20:52] Alama County, decreased

[20:55] between 22 and 33%.

[20:57] >> You mean the amount you were paying that

[20:58] the district had to pay went down that

[21:00] much?

[21:01] >> The amount that the district had to pay

[21:02] went down that much.

[21:04] Such savings convinced Stanford Business

[21:06] School professor Alan Endhovven, one of

[21:09] the originators of the managed

[21:10] competition theory that Calpers is on

[21:14] the right track.

[21:15] >> I think as a model of a purchasing

[21:17] cooperative, it is excellent. It works

[21:20] very well.

[21:20] >> Does that make it manage competition?

[21:23] >> Uh, not yet.

[21:25] And Hovind believes that health care

[21:27] costs will come down only if individuals

[21:30] who want more than minimum care have to

[21:33] pay for additional insurance themselves.

[21:36] Kalpers has taken a first step in this

[21:38] direction. Realizing that its members

[21:41] had trouble comparing various health

[21:43] plans, Kalpers required all providers to

[21:46] come up with a standard benefit package.

[21:50] Here at Kaiser, I learned that the

[21:52] Kalpers plan was a little more generous

[21:54] than my own.

[21:56] >> You have V coverage, which means that

[21:57] you pay $5 for your visit when you see

[21:59] the doctor. Um, also, if you need an

[22:02] X-ray or a lab test, there's no charge

[22:04] for that. For your prescriptions, um,

[22:07] you pay $1 in the pharmacy from a Kaiser

[22:09] pharmacy. Um, and basically that's what

[22:12] you're covered for.

[22:13] >> What What kind of benefits do Kalper uh

[22:15] members get? Um, they have the S

[22:18] coverage plan and they I can look it up

[22:20] exactly and tell you

[22:22] the S coverage which is no charge for

[22:24] visits. Um, they pay a dollar for

[22:26] prescriptions as on your plan. They

[22:28] charge for X-ray or for lab tests or for

[22:30] allergy testing.

[22:32] >> Those benefits have proven too expensive

[22:34] and last year they provoked a major

[22:36] battle between Kaiser and Cal perks. In

[22:40] 1991 and '92, Kaiser's premiums jumped a

[22:43] total of nearly 30%. And Kalpers

[22:47] demanded a better price or else. We

[22:50] spent many hundreds of hours trying to

[22:52] convince the Kaiser management to reduce

[22:53] their premium increases, they never

[22:56] reduced them at all. And in return for

[22:58] that, the PERS board, since Kaiser has

[23:01] 40% of our members, uh, decided they

[23:04] would increase their enrollments for a

[23:06] year as a sanction for them not

[23:08] complying with the request. I have to

[23:10] say this is probably the most aggressive

[23:12] thing I ever went through. Jerry Fleming

[23:14] and Dr. Francis Crossen represented

[23:17] Kaiser in the negotiations.

[23:19] Fleming says Kalper's strategy of

[23:21] blocking new enrollments in Kaiser sent

[23:24] a strong message. Clearly, your second

[23:28] largest customer comes to you and say

[23:30] says, "We're very dissatisfied with your

[23:32] rates and and we we go through a process

[23:34] and they decide to punish us by freezing

[23:36] us." Okay, we can't help but notice

[23:38] that. At the same time, we knew we

[23:40] needed to get our cost down and so uh uh

[23:43] we just redoubled our efforts in some

[23:45] sense. This year, Kaiser got reinstated

[23:48] by Kalpers when it came in with a 2%

[23:51] drop in premiums. That was achieved in

[23:54] part by charging patients $5 a visit and

[23:58] raising the co-ayment for drugs from $1

[24:00] to $5. An unpleasant surprise for

[24:03] Kalpers members who had joined Kaiser

[24:06] before the enrollment freeze.

[24:08] >> You know that on August 1st you're going

[24:10] to start paying $5 every time you go for

[24:12] an office visit. That's the new Kalpers

[24:14] contract.

[24:16] >> No, you didn't know that. You didn't

[24:18] know that? Know that

[24:19] >> does that say? That's new to us.

[24:23] >> Is that going to bother you?

[24:25] >> Well, anytime anything goes up in price,

[24:27] it bothers us.

[24:28] >> Yeah, especially if you got families and

[24:30] stuff.

[24:30] >> Kaiser expects the co-ayments to

[24:32] discourage unnecessary visits and

[24:34] therefore cut costs. In addition, Kaiser

[24:37] says Kalpers forced it to become more

[24:40] efficient. For instance, finding new

[24:42] ways to reduce hospital stays. There's a

[24:45] new technique now for taking out your

[24:48] gallbladder

[24:50] which is uh done instead of with a large

[24:53] incision across your abdomen, a very

[24:55] small incision and a and a special uh

[24:58] tube with a laser on it which allows the

[25:01] gallbladder to be taken out um with a

[25:04] smaller incision um and um with a lot

[25:08] less pain. As a consequence, also

[25:11] patients get to go home much more

[25:13] quickly.

[25:14] >> Were you telling me you weren't able to

[25:16] get verbal authorization for this?

[25:18] >> But some costcutting measures draw the

[25:20] eye of physicians who resent it when

[25:22] they feel insurers and bureaucrats are

[25:25] interfering with their medical judgment.

[25:28] >> I mean, this woman has flagrant

[25:30] hypothyroidism and she's got to get this

[25:33] uh iodine treatment.

[25:35] >> Dr. Barbara Newman practices family

[25:37] medicine with a small group in San

[25:39] Francisco. She believes all this

[25:41] emphasis on cost cutting can reduce the

[25:43] quality of care.

[25:45] >> I think you're perverting the whole idea

[25:48] of of healing. A marketplace system

[25:51] would have me trying to do the least I

[25:53] can for this patient and get the most

[25:55] money I can from that patient. Number

[25:58] one, that's not rewarding. It's very

[26:00] alienating. I mean, I'd be terminally

[26:02] depressed if that's how I had to

[26:03] practice medicine. and it just doesn't

[26:05] fit. We're not selling shoes.

[26:07] >> Professor Endho encounters that cost

[26:09] cutting doesn't hurt medicine, it helps.

[26:12] >> I think people should understand when

[26:14] you talk about the lowpric plan. That's

[26:16] not a put down. That's not elipo. That's

[26:19] often the best quality care. Doctors who

[26:22] do it right the first time and don't

[26:23] make mistakes cost a lot less than

[26:26] doctors who are not very good. Enhovven

[26:28] believes that large HMOs like Kaiser,

[26:30] where patients pay a flat yearly rate,

[26:33] encourage efficient care. His theory of

[26:36] managed competition promotes HMOs over

[26:39] the old system, where the more visits

[26:41] the patient makes, the more money the

[26:43] doctor gets.

[26:45] Critics have long contended that HMOs

[26:48] skimp on tests and procedures to stay in

[26:50] the black. But Dr. Bachmann says that's

[26:53] just not so.

[26:54] >> There's no Mr. Kaiser watching over me

[26:57] uh four geneticists that actually make

[26:59] the decision as to what testing is

[27:01] medically appropriate. Uh and then we

[27:03] have to go to our administration and

[27:05] show them why we think that and then if

[27:07] we're able to show them that that it's a

[27:10] test that should be done, no one stops

[27:12] us from doing it.

[27:13] >> There are other objections to the

[27:14] CalPERS model. Author and health

[27:17] consultant Peter Boland alleges that

[27:19] managed competition isn't fair to those

[27:22] not enrolled

[27:23] >> because what we're doing on squeezing

[27:25] price, somebody else is going to get

[27:26] caught with the rest of the bubble. Who?

[27:29] Those who don't have access to these

[27:31] large purchasing groups.

[27:33] >> Is that in fact happening? If Kalpers is

[27:35] bringing down the prices, are other

[27:37] people paying more?

[27:39] >> You and me and everybody else doesn't

[27:40] have access to Kalpers. The only thing I

[27:42] could suggest is that you need to join a

[27:44] purchasing cooperative as well and use

[27:47] that power like we have to hold down

[27:49] prices.

[27:50] >> Professor Enthovven is emphatic. For

[27:52] managed competition to work, everyone

[27:55] should be in a purchasing pool like

[27:57] CalPERS, including the 37 million

[28:00] Americans now uninsured.

[28:03] >> For those people who can afford it, they

[28:05] have to be required to participate to

[28:07] buy coverage. Those people who can't

[28:09] afford it, they have to be subsidized by

[28:11] government so that we get everybody in.

[28:14] >> But Dr. Newman, an activist who favors a

[28:16] Canadian style national health system

[28:19] where the government pays all the bills,

[28:21] thinks that managed competition

[28:23] perpetuates waste. Why do I have to go

[28:26] through an intermediary HMO or Blue

[28:29] Cross with all the administrative

[28:31] expense? I mean, these places employ

[28:33] huge numbers of people. There's a lot of

[28:35] salaries, a lot of paperwork, um a lot

[28:38] of marketing. All that money is wasted

[28:40] that could go just to patient care.

[28:42] >> Unfortunately for advocates of Canadian

[28:45] style health reform, managed competition

[28:48] seems to be winning politically. In

[28:50] California, the Kalpers model is already

[28:53] being copied. The state is bringing

[28:55] together small businesses to bargain

[28:58] collectively for employee health

[29:00] benefits. You know, price and service

[29:03] are the competitive part factors. And

[29:05] >> one recent morning, this new state

[29:07] agency was negotiating with Kaiser in

[29:10] one room. While down the hall, Blue

[29:12] Shield executives were arguing that

[29:15] their health plan should also be offered

[29:17] to employees, the small businesses in

[29:19] the pool.

[29:20] >> Are there other specific diagnostic

[29:22] categories that you try to target for

[29:25] cost management and risk assessment

[29:26] besides pregnant women?

[29:28] >> We think we're the wave of the future.

[29:30] As agency chief, John Remy is the key

[29:33] negotiator for the pool of small

[29:35] businesses. He thinks the concept of

[29:38] purchasing cooperatives like his and

[29:40] Kalpers will fly nationally.

[29:43] >> It has uh the components of a possible

[29:48] political solution. It retains

[29:51] traditional relationships between uh

[29:54] patients and providers. It retains the

[29:57] function of the health benefits

[30:00] industry. Uh it retains free choice

[30:03] which is really critical to uh the

[30:07] electorate and for those reasons I think

[30:09] that it's going to be tried.

[30:11] >> The rising costs of modern medicine make

[30:14] major change inevitable. Managed

[30:16] competition appears to be the reform of

[30:18] choice today. But while various parts of

[30:21] that concept like the purchasing pools

[30:24] have been implemented, no one has ever

[30:26] put all the elements together to find

[30:28] out if the theory works. The test may be

[30:31] soon at hand.

[30:35] [music]

[30:42] We go now to a newsmaker interview with

[30:44] the Secretary of Labor, Robert Reich. He

[30:46] took part today with President Clinton

[30:48] in a special conference on summer jobs.

[30:50] Mr. Secretary, welcome. In the $16

[30:53] billion economic stimulus package that

[30:55] has now stalled in the Senate, how much

[30:57] of that would go to summer jobs?

[30:59] >> Uh, only about a billion dollars. Jim,

[31:03] we're talking about uh a $16 billion

[31:05] stimulus package that has $4 billion of

[31:07] extended unemployment insurance, a lot

[31:10] of uh roads and bridges, child

[31:12] immunization, summer jobs, a variety of

[31:15] things that have to do with uh both

[31:17] rebuilding the foundations of the

[31:18] country, but also in the short term

[31:20] stimulating the economy, uh getting jobs

[31:23] back.

[31:23] >> Now, the summer jobs part of that is how

[31:25] many? 700,000 jobs. 700,000 jobs in

[31:28] addition to 600,000 jobs that the

[31:30] government was planning to support and

[31:33] in addition to a lot of jobs that

[31:36] hopefully the private sector is going to

[31:37] come up with this summer. Uh the

[31:39] government is asking the private sector

[31:41] to uh to come up with an equal number of

[31:43] jobs because it's it's not just a public

[31:46] sector responsibility. Getting those

[31:47] kids uh into structured work

[31:50] environments, giving them some u some

[31:52] pride in what they're doing, getting

[31:53] some some work habits is something that

[31:55] both the public sector and also the

[31:57] private sector need to do.

[31:58] >> The government approach, yours and

[32:00] President Clinton's approach, is it

[32:01] based on the idea that there's a lot of

[32:03] work out there that needs to be done or

[32:05] is it there there are a lot of young

[32:07] people out there who need jobs?

[32:09] >> Well, it's it it's both. uh look at any

[32:11] major city and you look around the city

[32:14] in terms of parks and playgrounds and

[32:16] and uh places for for people to stay uh

[32:20] who uh who have no place to sleep. Uh

[32:22] there's a lot of work to be done.

[32:24] There's no question about that. Uh child

[32:26] care facilities and so on. Uh but a big

[32:29] part of the goal obviously is to give

[32:31] young kids, teenagers who are in urban

[32:34] areas uh who are in deprived areas a

[32:37] structured work environment. get them

[32:38] off the streets, give them a a sense of

[32:40] pride in getting a paycheck. Uh make

[32:42] sure that they show up for work in t

[32:44] time. Uh that there's a little

[32:46] discipline and order in their lives, but

[32:47] also this summer uh give them an

[32:50] educational enrichment, a little uh

[32:52] extra tutoring during the summer so they

[32:54] don't fall back uh and they don't forget

[32:57] by September a lot of what they learned

[32:59] by June. This is a problem particularly

[33:02] in uh some of our urban areas where a

[33:04] lot of kids just simply don't are not

[33:06] exposed to any stimulating environment

[33:08] during the during the summer and they do

[33:10] forget uh during the summer what a lot

[33:12] of what they learned.

[33:13] >> House Minority Leader Michael said today

[33:15] the same thing that many critics of the

[33:17] stimulus package have said before which

[33:19] is okay fine no problem. You want the

[33:21] summer jobs program you have the summer

[33:23] jobs program. It's all that other stuff

[33:25] that is not needed. Is the president uh

[33:28] so anxious to get this summer jobs

[33:31] program that he will make a deal along

[33:32] those lines?

[33:33] >> Uh I remember there there two purposes

[33:37] being served here with regard to the

[33:39] this uh the jobs program. Not only

[33:41] summer jobs but but all the things uh

[33:43] one is to have a down payment on the the

[33:45] long-term investments we have to make as

[33:47] a society. U roads and bridges and all

[33:50] kinds of things that have to be done

[33:51] anyway. we are want to do them a little

[33:53] bit earlier so that number two we can

[33:56] get the economy back on track. Now

[33:57] granted $16 billion is not very much.

[34:00] It's a drop in the bucket in a in a huge

[34:02] economy like ours. But it is at least a

[34:05] small kick in the right direction and uh

[34:07] it's our judgment that the economy is

[34:09] not yet picking up speed. In fact, even

[34:11] in yesterday's news, we saw a drop in in

[34:14] uh consumer spending. Uh and uh we have

[34:17] a a problem with unemployment. are still

[34:19] stuck at 7% or more unemployment for the

[34:22] 16th month in a row.

[34:23] >> But if this program is so small compared

[34:26] to the overall thing, why has it then

[34:27] been so necess why has it become such a

[34:29] huge thing to uh to the president?

[34:32] >> Well, again, it's it's small, but it's

[34:36] it's it's it's necessary. I think that

[34:37] there's there's almost a a psychological

[34:41] gridlock out there right now, Jim. It's

[34:43] not just a political gridlock. It's also

[34:44] you see firms are not hiring. uh they're

[34:48] going on overtime, but they're not

[34:49] actually bringing on new workers.

[34:51] Consumer spending, as I said, is down.

[34:53] Uh there's a there's a fear out there

[34:54] that uh this economy will not really

[34:57] recover in terms of jobs. And if you

[34:59] don't have jobs coming back, you don't

[35:01] really have a long-term recovery. Uh so

[35:03] granted, there is a psychological

[35:05] element. The government is going to do

[35:06] everything it possibly can do to get us

[35:08] back on track. Um if it takes more than

[35:10] $16 billion, uh well, it takes more than

[35:12] 16 billion. But the notion is we've got

[35:14] to at least move forward. We've got to

[35:16] try. And this is what what I find uh and

[35:19] I think other members of the

[35:20] administration find a little bit

[35:21] frustrating because uh Bill Clinton was

[35:23] elected for change to get things moving.

[35:25] Let's experiment. Let's try something.

[35:27] If it not if it's not exactly the right

[35:28] thing, let's try something else. But

[35:30] here we have a situation in which the

[35:32] economy is flat on the jobs front. We've

[35:34] got to at least begin. But even using

[35:37] your term the psychological thing here,

[35:39] uh the critics of this say, well, if

[35:42] that's what you really want to do, if

[35:44] you want to give the economy a kick,

[35:46] then you want to give it a real kick. In

[35:48] other words, with permanent jobs, help

[35:50] the help the private sector and not just

[35:52] go create a bunch of government jobs

[35:54] that are going to eventually run out and

[35:55] not going to do that much. Well,

[35:57] remember part of the simulation program

[35:59] or the jobs recovery program is an

[36:01] investment tax credit uh that would be

[36:04] retroactive right uh right through uh

[36:07] right right now. Uh now again there are

[36:10] opponents who are saying we don't want

[36:11] the investment tax credit. We won't

[36:13] don't want those business incentives.

[36:15] But uh the administration's point of

[36:17] view is that you want to stimulate both

[36:19] public and private investment after all

[36:21] not only in the short term to stimulate

[36:23] the economy but also in the long term. I

[36:25] mean, one of the big problems we've had

[36:27] in this country, if you look at uh

[36:28] whether you're looking at the debts, or

[36:30] you're looking at the disintegration of

[36:31] roads and bridges or our schools, is

[36:33] that we simply are not investing in the

[36:36] future. And uh this is sort of a down

[36:38] payment immediately on a long-term

[36:40] investment. Some people have noticed

[36:42] this appeared in print in fact that uh

[36:45] the president's rhetoric about the

[36:46] economic stimulus uh uh uh uh stifling

[36:51] in the Senate thus far uh has become he

[36:54] his rhetoric is is getting tougher and

[36:56] tougher. Is this about the the Congress

[36:59] comes back on Monday? Do you expect this

[37:01] thing to become a really bloody fight

[37:03] before it's over with? Is it that

[37:04] important to to the president? It it's

[37:07] certainly important to the American

[37:09] public that jobs come back and and I

[37:11] think the president is going to do

[37:12] everything he possibly can do to make

[37:14] sure I mean he he was elected because

[37:16] the economy was so bad. Now we are there

[37:18] are some indicator indicators Jim that

[37:20] the economy is bouncing back in terms of

[37:23] in terms of profits a little bit in

[37:24] terms of productivity but again let me

[37:26] come back to this jobs issue. We are not

[37:29] yet out of the woods on jobs and unless

[37:31] people feel uh more secure. Uh we are

[37:35] not going to be out of the woods on

[37:36] jobs. In fact, large firms are now

[37:38] continuing to slim down. We have 10

[37:40] million people who are unemployed, a

[37:42] couple more million people who are uh

[37:45] working part-time rather be working

[37:46] full-time. We have discouraged workers,

[37:49] another million or more who are too

[37:50] discouraged even to look for work. Uh

[37:53] this is not what the Clinton

[37:55] administration was elected to do.

[37:58] Let's go on to some other things uh that

[38:00] are related to your job as uh secretary

[38:02] of labor. You've said that labor should

[38:04] have a louder voice in government policy

[38:07] on economy.