Evening Exchange; 2209; Unfinished Business (book), Weekly News Analysis, Health Care Disparities

[bars and tones] [bars and tones] [bars and tones] (no sound?) An election campaign that's too close to call, an odd couple of political authors and the quietest kept secret about racial disparities in medical care, race, all next on Evening Exchange. [music] Hi, I'm Kojo Nnamdi. The late Republican Senator Barry Goldwater liked to

reminisce about how he campaigned in the old days. He and his Democratic opponent would get into the same car, drive to a rally, proceed to verbally beat the heck out of each other, get back into the car, share a swig or two of whiskey, and proceed to the next rally. Well, we don't know if our two guests left a flask of whiskey in the car outside, but they probably did arrive in the same car. Hopefully, Julianne Malveaux was not the one driving it. They'll proceed to verbally beat the heck out of each other since they agree on virtually nothing, but you think they'd at least go their separate ways after that, but no. Conservative political commentator Deborah Perry and liberal political commentator and syndicated columnist Julianne Malveaux decide to collaborate both on a television show and a book. The book is called "Unfinished Business," a Democrat and a Republican take on the 10 most important issues women face. You've argued on radio, you've argued on television. Why did you decide to

argue in a book? So people could contemplate the argument a bit more. I mean, when we argue on television, we generally have six minutes, five minutes, and because we're both very passionate, people we occasionally talk over each other, people can't hear everything. We may get a little more time on radio, but we thought that by putting it down, we would do a couple of things, and one was really give women both sides of the issue, give people both sides of the issue, and also Kojo, you know that people have become so much more politically iconoclastic in the 21st century. There was a piece in USA today yesterday that said that about 35% of all Americans are calling themselves Independent. They're the majority that neither Democrat nor Republican. So we frequently find we're on the road that people say I agree with Deborah on education, but I agree with you on the economy and they go back and forth. We're giving people that opportunity and resources to follow up their interest into action. I mentioned a television program, that really was the first collaboration between you two. Tell our viewers a little bit about that. Well, it's an interesting story because we were doing political commentating for MSNBC and Fox News and producers just thought we

were so great together during the Clinton impeachment. They kept booking us over and over to the point that we're just like, oh, not her again. But then we actually the Clinton impeachment died down and then about a year later I actually picked up the phone to call Julianne and invited her to lunch because I wanted to pitch an idea to our USA today column. And we realized over this lunch that we actually had more in common than we ever anticipated and that was that neither one of our respected political parties were doing enough to ingratiate women in the political and the electoral process. So we decided at that point that something needed to be done around the 2000 conventions. And Julianne had this idea to develop a room full of women where we actually brought together high-profile women like representative Juanita Millender-McDonald, Prime Minister Kim Campbell, Lisa Ling from The View. And then women who are not so high-profiled and all of a sudden this old girls network begin to coalesce. And we knew from that point we needed to do more. Well, it's ironic that it coalesced around the 2000 election because here we are two years later and we are on the verge of another election. This one a midterm election and one cannot help but

remember in 1994 and what Julianne used to call the contract against America. Yeah, contract on America. Yeah. I'm sorry, that pushed the Republicans into control of the Congress of the United States. Now it seems we face an eerily comparable situation in which nobody knows for sure how it's going to turn out in the Senate and the House. But what's known for sure is that women are likely to play a role. What role is that likely to be? Well, it could be a deciding role, Kojo, I mean, you're absolutely right about the parallels. One of the things that Deborah and I both want to see happen in this election is for there to be maximum political participation. And what we know about midterm elections is that people tend to stay away. Women about 54% of those registered are voting and only half of all women are registered, same is true of African-Americans, virtually every other group. People are not fully participating in the process. But women can be the swing vote. We've got lots of elections, gubernatorial elections right here in Maryland where women are the candidate. We have very exciting congressional elections, and then of course we have incumbency and there are two

scenarios. Bush gets a trifecta. You know, he gets the Senate and the House and the presidency, of course, which he didn't get, he took. But that's another story. So he could end up with a trifecta or the Democrats could end up controlling the two houses of Congress, leaving Mr. Bush, you know, to flail, or we could end up with the status quo. The usual orthodox thinking is that if women participate in this election in more than their normal numbers, if they're somehow motivated to participate, then it's probably going to be on the Democratic side of the agenda and therefore it is not necessarily in the Republican interest to pursue women votes in this campaign. You beg to differ? I beg to differ. I really do because that's the point is that we wanted to show that women are not a monolithic voting block. We wanted to dispel the myth that women don't care about issues such as foreign policy and globalization and taxes in the economy. I am obviously a Republican woman so I see the galvanizing that's taken place among the spread of Republican women across the board. I think we've always been out there. It's just, I think, in terms of

media time, it's always the liberal women who've really been able to dominate that force. And so I know from our perspective on the Republican side, we're really working together and create organizations and having the infrastructure at the local level. So we're just that much more effective. It seems to me that in this election, there are two major issues that people will be looking at. The one we cannot help looking at because we have been so immersed by it during the course of the past few months, national security, the implication of the war with Iraq, the other the economy, which obviously the Democrats wanted to focus on much earlier, but which in the late stages of the campaign seems to be emerging as a major issue. As a Republican woman, what is there for Republicans in the economy issue? Well, I think the, first of all is, that we want to make sure in terms of Bush's tax cut that was implemented in 2001, we want to continue and make some of those tax cuts permanent because as we know, they eventually escalate back into the system around 2010. I think overall just that there has been so much talk around the economy and while people are very concerned about those kitchen

table issues, I think things are not as bad on in terms of the economy itself versus a lot of corporate governance issues and people concerned about the loss of their job because impart, because the war on terrors and the war in Iraq, I mean there's so many other factors to it than just focusing on the economy itself. Women and the economy, what do the Democrats have to offer? Or what would Julianne Malveaux have the Democrats offer? Well, I would have the Democrats quite frankly, return to our roots and be far more populous. I mean, the Democrats have not voted, for example, or very few have even articulated the need to repeal George W. Bush's tax cut, that $1.3 trillion, primarily went to the wealthy. There is absolutely no stimulus effect in giving money to the wealthy where the stimulus should come as giving money to people who are moderate and lower income levels because they will spend the money. ?Dick Gephardt? is now talking about the possibility if the Democrats take the house to do that, but I'm afraid that at this moment I'm a little frustrated and thinking too little too late, this should have been spoken about early. Of course, their political realities with the Iraq situation, but

stimulus, increase in the minimum wage, some more attention given to the terms and conditions of work for people, some attention given to the layoff situation. The unemployment rate ticked up just a 10th of a percentage point, Kojo to 5.7%. That's not a whole lot, and I was with someone as earlier they said, well, so that means 94% of all Americans are working, but the fact is that we're recording really large layoffs and also people dropping out of the labor market. So we saw economic growth in the third quarter of about 3%. That was a good thing. I mean, so that does give some weight to Debra's notion that maybe things aren't so bad, but that growth was what we call a jobless recovery. We didn't see that growth trickling into jobs. How do you pitch the tax cut to women? You pitch it on the basis of this late growth in the economy that we're seeing. Do you pitch it on the basis of the fact that the tax cut in the view of Republicans helps families? How do you pitch the tax cut to women to make this a good election issue for the Republicans? Well, first of all, it's about education, because we got to remember the tax code was actually put in place when men were head of

household back in the 50s. And so there's a lot of areas that is not widely discussed that women are actually discriminated against. When you look at the marriage penalty tax and the social security tax, so many women don't realize that you actually have to be married for 10 years to be able to recoup any of the taxes from social security from your ex-husband. And so there's just a lot of issues revolved around the tax code where so many women can actually galvanize together to make a difference like we've done in history. Actually, single women came together because there was a point they felt they were being discriminated against and that's actually why the marriage penalty tax came into play is because there was a discrepancy in that tax code. Kojo, they're very honest differences of opinion here in terms of whether or not women are discriminated against and I would say that they aren't. And I think it depends on what you think about progressive taxation and a progressive tax system. The fact is that the Democrats have been the ones who've improved the social security situation for women. 20 years ago was that you had to have 20 years of marriage before you got

part of your ex-husband's social security, so it's be reduced to 10 and it could be reduced even further. I don't think these systems are unfair. National Security, how does this play for the Republicans? How is there any kind of gender gap in the view of the United States going to war against Iraq with or without the United Nations or without any international coalition support? Well, that's an interesting question because we've been canvassing the country on book tour and talking to a lot of women and it seems that this is one of the more popular issues women want to discuss as the war on terrorism, the war on Iraq. I actually come from a biased. I started my career in foreign policy and went over to the State Department during the first Bush administration. So we were concentrating even back then in 92 and 93 just on the spread of Islamic fundamentalism overall and turning into terrorism cells. So I think from a woman's perspective overall on a Republican woman's perspective which is certainly not limited to Republicans, women just want to know that we can live in the safest environment possible and that a 9-1-1 never happens again. And so we want to be able to travel freely

in this country and travel abroad and not worry for our safety and this random terrorism world [that we are living in during this time]. In other words, you have to make the case to women that Saddam, Iraq's Saddam Hussein is a threat to the security of the United States that he is likely to do something to whimp to families here that can raise the issue among women of safety and protection. Absolutely. I mean, I think even just the local sniper attacks that we've been through, I would be very surprised if there wasn't a link to terrorism. I think we'll find out a lot more overall and that's part of al-Qaeda's plan is you have the air war and then you have the ground war and that's part of the ground war. The general perception is that women are generally opposed to war and have to be kind of dragged kicking and screaming into support of it. I'm not sure. Well, we haven't done very much gender polling in the last month or so around the sniper but you know and I think that one of the things that's good about the work we do is that we do model women's diversity. The fact is that women are not monolithic but at the same time let's be clear that this is a fishing expedition that my colleague is on

when she says that there's a connection between the sniper and al-Qaeda. American women, American people are smart enough to know the difference between Saddam Hussein, Osama bin Laden and some random brothers who were crazy. I mean that's literally you can't connect the dots between those things. When we talk about what's happening with Iraq, what you're finding, Kojo, is that the American people have been very sympathetic to George W. Bush and wanting to support him until the issue of the cost of war and the casualties of war are brought home. So when you poll the American people after Mr. Bush's last big speech on Iraq, about 60 percent would support him in attacking Saddam Hussein. However, when you say what if this cost put in the dollar amount, what if it brings back 5,000 body bags, the numbers flip. So the fact is that people are interested in a quote "terror-free" world but they don't understand what a "terror-free" world costs. And I'm gonna say something else here. I mean women of color in the United States are clear that there has been random violence and terrorism as a part of our lives as long as we've been here. And not only in the United

States but in the African continent and Palestine and other places so for someone to just willy-nilly think that they can click their heels three times attack people to have a safe world, that is just ultimately naive. Well, first of all, let me clarify for the record. I didn't say that the recent sniper attacks necessarily had ties to al-Qaeda. I said there were ties to terrorism. There's lots of other terrorist cells out there that we have a lot to be concerned with. I think a lot of women can connect the dots. The fact that we know that Saddam Hussein has been providing chemical training for al-Qaeda, we know that he is the nucleus. We know that he is the primary financier. Deborah, that's been on the surface, that hasn't been proven. No, that's not true. That has not been proven. That is something we do know about it. And I've got to believe that the intelligence there is that he is further along in his nuclear capability. And we want to make sure that we.. In the past of the election campaigns, we have heard a lot of issues, a lot of talk about reproductive rights whether we heard it from people who call themselves pro-life, pro-choice, anti-abortion, pro-abortion, and whatever. That does not somehow seem to be a major issue in this election campaign. Why not? Well, I think that this election, this 2002 election is very strange to me. I mean, one question you have to ask

is where is the energy? What you really do see what I've seen in editorial comment around the country in the past couple of months is are we even going to get turn out? And I think that's going to be the real story. So you don't see a lot of energy. The war is causing both energy and anxiety. So it can go either way. There's been insufficient attention to the economy, also to the whole issue of corporate governance. And certain that hot button abortion issue has been one that has very much been back, back drop issue. And that's one of the issues that you can find in "Unfinished business," a Democrat and a Republican take on the 10 most important issues women face along with equal pay, working family education, the economy and taxes, the economic safety net, climate violence, race matters, foreign policy and globalization, and the environment. The co-authors of this book, Deborah Perry. Thank you for joining. Thank you very much. And Julianne Malveaux, stick around. Okay. Who will control the Senate? Who will control the House? Those predictions from our news analysts when we come back. [music] Do you remember the midterm election of 1994, the one that swept the

Republicans into full control of the U.S. Congress, the contract with America? Well, this is a midterm election that could result in one party controlling both houses of Congress, but do the voters really care? joining us to look at the upcoming election and more Henry Campbell, the Canadian Broadcasting Corporation, Noluthando Crockett-Ntonga of WHUT's Africa Initiative, Clarence Page of Chicago Tribune's Washington Bureau, and Julianne Melville, who simply refused to leave after the last day. Simply, you can say. Oh, yeah. One of the things we've been hearing and reading a great deal about is that turnout is going to be key in this election because midterm elections usually have low turnout. And in this case, it seems as if constituencies are having a very difficult time becoming enthused. What constituencies you think on the Republican and the Democratic side are ultimately going to decide this election?

Oh, I think it's going to come down in the Senate side to Arkansas, where Tim Hutchison is in serious trouble because of a marital problem. Colorado, where Wayne Allard is in real difficulty holding on there, and Minnesota, because I don't think it's necessarily a given that Monday will take a Wellstone's place successfully, particularly since there's that little bit of a squabble about the event at the memorial for Wellstone. And then, I think you look at New Hampshire, and you say that can Jeanne Shaheen actually win there for the Democrats? I think those, and then I would put New Jersey, Texas, Missouri, of course, which looks like a Republican pick-up in South Dakota, and you've got the race for the Senate. New Jersey? Frank Lautenberg is not going to win? Oh, he will win. I think he will win, but all of these are so close that it's very difficult to say. Most of the ones that I've just mentioned are within the statistical margin of it. I thought that Lautenberg and New Jersey and Mondale in Minnesota were comparable. You've got high-name recognition,

you've got people who've held the office before. I thought they would be both shoe-ins. Yes, you would have thought, but I think I'm not so certain in Minnesota that you can give this one to Mondale as easily as people think. Because there's an absentee ballot issue in Minnesota that could be very important. I mean, about 100,000 absentee ballots have already been cast. You cannot cast a ballot legally in Minnesota for a dead person. Therefore, ballots cast for Wellstone will be invalid, but his opponent, if there are ballots cast for him, will pick those up. So, just assume a 50-50 split, which is what the numbers are looking like anyway. This gives him, suppose, a 50,000 vote bump. So, there's a possibility of challenging New Jersey also on the absentee ballot front because you already had mailed out ballots with the scoundrel's name on them, Torricelli's name on them. So, people who have voted have a legitimate claim. So, you know, and in at least a couple of states, we can look at possible challenges if the margin is so small that people think that the absentee ballots would make a difference. What are you looking at, Clarence?

Well, I'm looking at, besides the states have been mentioned, Louisiana, where the incumbent senator has to get over 50 percent on Tuesday. Otherwise, it goes to a run-off, and we may be in December if I figure out who has the majority in the Senate. Also, I'm looking at North Carolina with Liddy Dole and Erskine Bowles. I personally expect Dole to pull it out, but Bowles is showing remarkable strength in the late days and the turnout, then, Kojo, Black turnout is going to be key in this and many other races of that are close because, in my experience, I've been covering politics since the Jurassic period. [laughter] Black voters, Democrats, working-class, low-income voters, oftentimes tend to be the last ones to get excited about a race. This next few days are going to be critical. Democrats are putting a lot of money in to get out the vote drives. What do black voters have to get excited about in this race? Well, that's the big question for me. I've only been back

in the country now for a few months, and I've basically been looking at what's going on in Maryland, which is where I've been living. And I just don't see people getting all that excited. You know, I had one friend who said the only thing that she can think of is you have to go out and vote like a Democrat in order to live like a Republican. You know, I just don't see the excitement. That's pretty important. Well, but I think the negative ads, even though, you know, research shows that negative ads do get people fired up. I just sense some malaise that people just really don't care. Well, you caused us to digress, but it's a great digression, because that's a very interesting race that we're talking about, in Maryland, between Kathleen Kennedy Townsend and Robert Ehrlich, Robert Ehrlich choosing to have a Black running mate, Michael Steele of the Republicans, who is not particularly disparaged in the Black community in the state of Maryland. Andm, she started out way ahead in this race. Ehrlich has caught up, and it looks as if she might still be losing ground, but the Kennedy name had a thought that she would bring out Black votes. She's a Democrat in a predominantly Democratic state

and Black voters still don't seem to be too enthused. Well, she's an indifferent campaigner. She's not a campaigner. If you see her in person, I mean, she, I've appeared with her on television programs in the past, and like her personally, think that in a setting like this, she really does shine. But when you get her in front of a couple of thousand people, it's just extraordinarily awkward. None of that Kennedy magic has really translated with her. That's number one. Number two, that she took that lead, and she squandered it. She had that lead, and she basically played it lightly. And Ehrlich has been very condescending and effective in his condescension. I mean, one might look at the role of gender here, and the way that he probably would not be able to condescend in the same way with the constant use of the word, "ma'am," and all of that, you know, with the male candidate. Well, I'm not sure a lot of our male viewers get that. Why was it condescending for Ehrlich to consistently refer to Kathleen Kennedy Townsend as a "ma'am?" It was almost, it was scolding, it was distancing. You know, you're not in the fray with me.

You know, I'm Mr. Ehrlich in your "ma'am." If it was a male, I would've probably referred to him right away by his first name, or as "Mr." Well, you know, if you want to play a political correctness game, which is what politics is about, a man has to be careful not to do what the young man, the nice young man who ran against Senator Clinton. "Nice young man?" Well, in the end of New York, whose name name I suddenly forget. Rick Lazio. Rick Lazio, thank you very much. You remember Rick Lazio played it like he was having a saloon argument with another guy, and he was viewed as bullying and being ungentlemanly. But you know, the thing about, you're absolutely right about about Kathleen Kennedy Townsend. She's a marvelous lady, very smart, but up against a beige wall, she disappears. She's not the kind of charismatic, political figure who excites people. And, she offended a number of Black folks in the Democratic Party in Maryland. because she didn't pick a Black running mate, and this is where the Republicans were very clever. Michael Steele is inoffensive. I don't know what he stands for, particularly, but he certainly doesn't seem to be threatening.

And there was a full page ad in The Washington Post, which I think was going to be very.. Everybody saw it this past week. People were talking about it. A lot of folks didn't know that there was a possibility of a Black elected governor in Maryland, and Prince George's County, and places like that, and Baltimore and all of them. And, people can't, but people can't get too happy about that. I mean, we have to look at a couple of other things here. I mean, Maryland, like many other states where the gubernatorial races has a deficit. The deficit is a function of the national economy. Everybody's got one. Yeah, but everyone's got one. and it's going to hit your taxes. The question is, when you look at Kennedy Townsend, and you look at Erlich, and you look at their plans for dealing with this deficit, frankly, hers is a better plan. It's more focused and it's more doable. Well, you're right under the race, though, you know? Most people aren't paying attention to the race. Most folks are dealing with the gut. And when she is at Bowie State University saying, "I'm so happy to be at" and then gets the, I mean, would she be at Harvard and saying, I'm happy to be at Yale? Probably. [laughter] Yes, but there's something else in the whole national campaign that I think is that we're overlooking here, too. And that is that the Democrats, universally,

in all races have come up with a very, very poor posture for the voters. I think if you look at the races, as it stands right now, the man who really likely will steal this whole thing as we see the figures right now, is the president, because it's entirely possible that at his weakest, as you look at the polls now, he'll get a status call. What happens if he gets those few votes that'll give him the Senate, he could turn out to be one of the great vote getters of our time? Oh. Well, you may not like it, but quite frankly, he's raised the money, he's been up there and done the job. For the past two weeks, he has not been the president, he has been the chief campaigner. I mean, he probably has spent less than 48 hours in the White House in the past two weeks. He has used our tax dollars to crisscross the country. But, well, be that, be that, be that as it may. No, but be that, Julianne, be that as it may, the fact of the matter is he stands that close to an enormous achievement, which would be, to at the minimum, hold a status quo, in and off your list. Is Bill Clinton's presidence

in several races at the last minute, likely to increase the turnout of African-American voters? That seems to be the assumption. Oh, absolutely, I think so. Yes. I think that he has been, for whatever reasons, and people debate those very effective with the African-American community about a week and a half ago, the Democratic Party puts some money into some ads that Bill Clinton did that were encouraging turnout. The other thing I think that we're ignoring is that while I think Democrats have been weak, extremely weak, [Right across the board] the other thing that has happened is that both the national party and the AFL have put some money into GOTV, and this may be the sort of secret under, GOTV meaning "get out the vote." "Get out the vote," yes, the undercurrent that pulls some people out, and it's been interesting that it has at some level escaped the radar screen, so it's happening, it's door to door, it's money that have been placed in a certain communities, and that may well make the difference. Democrats seeking to hold onto the Senate any likelihood that they can take over the House? Yes, small. Small. They got to win what? Well, they have it. 16. 16. Yes, but of the close seats, I think they have to win something like 16 out of 17 or 18

of the ones, the seats that are close, which does seem hard to do. However, always difficult to predict House seats because it's a district. You're not absolutely certain what the issues are. They don't necessarily translate to the national and they get the vote issue, which I agree with. Julianne will be profound. If you go back in the last election, you can see that in tight seats, that the Democrats targeted and sent in the union organizers and sent in the foot troops, they were able to gain three and four points per district. Maybe they do that. It is possible. That can make a difference, yeah. Iraq, the UN, and the United States, the ongoing discussion about whether or not a US resolution will be ultimately accepted or whether or not a French alternative will come forth. Secretary Powell, this week, insisting that a strong message needed to be sent to Saddam, who's saying, is this going any place? I predict that after the election, this whole issue will disappear. And I think it's interesting with this latest compromise or change in the language or so forth and so on, puts off even a further debate until after the election.

I mean, please, how many people... maybe I've been out of the group, [Oh she took her glasses off, this is serious!] [Awh yeah] maybe I've been out of the country too long... How many countries sit around and talk about having war with somebody for months? I mean, if you're going to do something, you go do it. Do you sit around and talk about, oh, we got to do this, we got to do that and so forth? It just seems weird and bazarre. I'm sorry. You have been out of the country too long, because what you have missed is that we have an IQ-less president who had a flagging presidency until September 11, 2001. He eagerly has attempted to connect the dots between Saddam Hussein and Al-Qaeda. But here's a bottom line, I mean, but I don't think it will go away. I don't think it will go. I think this president gains by all this happy war talk. I think that.. But that's my point; It's talk. But no, but I think he's prepared. I think he is prepared to invade. I think that he's drawing this hard line in the sand because war is good for Republicans.

I hate to be cynical, but that's what I think. [I think you're both right] The election probably strengthens, the election if it is possibly that it holds as it is, he'll be using that as a mandate for war more than not going to war. I mean, if he comes up with a status quo vote, or let's say he takes over the Senate, which isn't that far away, then I think military action against Iraq is inevitable. And we're trying to be clear about how he... And what the UN does won't really matter? Well, let me back up a second. There's a couple of pieces of unfinished business. For one, I'm not nearly as sank what about the great victorious George W. House presidency. Neither am I. I'm just saying it. That you portray. I think, quite the opposite. The more it sinks in with Americans that Republicans control all three with George W. Bush at the helm, the more people start becoming braced with their attention. It's not going to, there's not enough time for this to make a difference between now and Tuesday. But, I think it's going to start to sink in on people what it's going to mean fiscally, what it's going to mean with judicial appointments, what's going to mean in the long run to social security,

and other bread and butter issues. And number two, I think you're right in the sense that, yeah, it is just talk right now. You've got to talk tough with Saddam Hussein, or he doesn't move. And now he wants to allow inspectors in. But I predict, once we do allow, once inspectors do go in, he's going to start playing games again. This issue will be revived. And the UN still has to face up to whether it wants to be another League of Nations or a real world force that it should be. And that means they got to step up to the plate. And that includes France. Now, how they call on Powell with the behind-the-scenes deals, Chicago City Hall style, as well as the front of the TV camera diplomacy. I think the US is going to get what they want out of the UN much like what Bush got out of the country. And it would appear that what the US wants is not to have a second resolution to authorize war, to have this first resolution basically give it the authority to go to war. And I still cannot see ultimately the US overcoming the hurdle of, what's wrong with the second resolution? Well, I think that, you know, Russia is already begun to come around, though.

I mean, they've begun to talk, you know, compromise talks. Money talks. And France is going to be the lone holdout. What Mr. Bush wants is the ability to have some kind of an October surprise. I mean, he wants the ability not to do this in the daylight, [Well, what is the surprise?] [October's over...] Well, OK, A December surprise... But he wants the ability to do this in the dark. And he wants the UN to give him the equivalent of what the Senate has. How can you be doing something in the dark? I mean, is everybody brain dead? I mean, can't we connect to dust? Does this thing make any sense at all? Well, you know, you've got to remember that war is also a thing that is often formally declared. People often know when they are likely to be going to war with somebody. That does not mean that they're still considered as a surprise to them. But to declare there hasn't been that there's this World War 2. What I see happening, though, is something like this. I see him doing something like what Clinton did in Afghanistan in 1997. I see that a weapon... I mean, I hate to say about it. I mean, the weapons inspector comes in, they come back and say they move the stuff around. Rather than go back to the UN, there's a little more happy talk.

And in the middle of the night, there is some kind of military action. That's why I think he wants to have the ability to do. And you're right. It's wrong. And you're right is everybody brain dead? Why did 20-some Democrats vote for this stuff? People like Diane Feinstein and Hillary Rodham Clinton, good pacifists, many because they felt that they needed to support this president. I've been like traveling like crazy in the last six weeks, and what amazes me is how you go to someplace like Denver and you see a picture of Saddam Hussein in a campaign ad. It's like, why is this in this campaign ad? And that's implicitly what's being said. It's an implicit litmus test on patriotism and there are too many people don't want to say it. This is why people have to think. Now, we can be clear that Saddam Hussein is bad news. But I think we also have to look at our own government and it's moral bankruptcy and it's hypocritical approach to everything. Tell us what you really think though. I mean, why are you holding back? Yes, yes, well, it may very well be that you believe those things and they may be sound judgments,

but this is a White House that's bent on military action against Iraq. The resolution of the White House at the United Nations, I think, is arguable that they'll get a strong resolution, or it may be watered down. It really won't matter, because the first time that there's the slightest indication that the UN inspectors are faced with deception or deceit. That will be the consequence that this White House will acquire. And Clarence, I agree with a lot of what you're saying but, I think a strong vote gives the President the credibility that he wants. And, he will use that as credibility. [Well, a certain measure of credibility. But what does he want?] [No, no, no, no.] It's not clear what he wants, though. I think we're giving President Bush too much credit in even drawing up [?] It's possible that what he wants is the credibility that tight. Well, what he wants he wants something between what Rumsfeld and Colin Powell want. A tight race will be enough for this president to claim that -he had a mandate. He's already claimed it because of the Senate vote, frankly. Yeah, frankly, yes. The competition to try the sniper suspects, even as we get new details about where

the rifle that was allegedly used in the snipings in this area, was also used. We now know about Alabama. We now know about Louisiana. But it seems to me that there was this cooperation among all of these jurisdictions during the investigation phase. It all disappeared in a scramble to see who could impose the harshest penalty with the Justice Department ultimately jumping in and saying, we can do it. But it doesn't seem to me as if the public has been particularly turned off by this competition or [potentially] lack of cooperation among the various jurisdictions. What's the difference between the police and the prosecutors now. you see? The police found the bad guys, or the suspects, excuse me. and the prosecutors now step in, and whoever tries the case first gets most of the attention as we've seen in previous high profile trials. And so the question arises, who is going to be first? So they're all finding different reasons to be first. Maryland wants to be first because they had the most victims.

Virginia wants to be first because they've got the most severe capital punishment prosecution record and they also will execute juveniles. Alabama now steps in because they were probably first as it turns out. And now, I guess, Louisiana has much right to step in. But, this is the dispute there. I think it has more to do with which prosecutors going to get the most TV time out of this. Why is it that the prosecutors can't cooperate in the same way that the investigators did? And why is it that the public does not frown on this prosecutorial bickering? Well, I think you're looking at different goals. They cooperated to catch these guys. I mean, they wanted to get these folks in custody. Because when it comes to fame and fortune, we don't need to call them. Well, it's not necessarily even fame and fortune? I mean, I think Clarence has laid out pretty clearly what the competing interests are. I mean, you have a state like Maryland who's had about six of the victims came from Maryland. The little boy was in Maryland. I mean, you have Virginia who's saying, "we can fry him first." I mean, I object to that. I don't like the death penalty at all. But I think you have a different situation.

Now, what the solution it seems to me is for the feds to step in and really talk about a coordinated trial. And, I don't know that there's precedent for that. But, there ought to be a way to sort of rank order people's claims. But unless you do that, it's not just about the fame and fortune. I think you've got people, victims who have legitimate reasons to say, we want these people taking care of. Well they're all going to be taking care of eventually, you know. And that is precisely my point. I could be wrong, but I get the impression that what we're seeing is a whole bunch of extremely ambitious prosecutors who are looking at the next step on the political ladder if they happen to be the first one to prosecute what appears to be at this point, an open-shot case wherever it's prosecuted. That may well be. Yes, ma'am. But most people, I think, are just simply relieved [exactly] that the so-called suspect, [and don't really care] And they don't care. Their guys are locked up and folks can go to Home Depot now without and pump gas, without being worried about it. In your own conversations, Kojo, do people talk about the sniper anymore to as anywhere near the same degree as they did before the snipers were caught? No, no.

Just about the new revelation... Kids are back in school and the tension is out of family life. However, echoing back to politics, this has become a political issue in Maryland. It is a political issue. Of course. Yes. It may seem, like ballistic fingerprinting, love it or hate it, issues like gun control, issues like capital punishment itself. It's interesting to me, you know, for all of the hang-em-high fervor that we had initially, people are relieved just to have them locked up. They're just relieved. Right. And polls will show that if you can guarantee a lifetime imprisonment, support for capital punishment drops way down. What concerns people is the idea of them getting out if you guarantee it. But, you know, what's interesting, there was a case in Arizona this week where a man who shot three nursing instructors, you and... and also ex-military, John Muhammad also ex-military... People were looking for, you know, the profilers had no clue that John Muhammad was African-American and of course, many of us threw our hands up and said, "oh my goodness." But the link here is not necessarily the African-American or White link. It's a military link. Now, wait a minute. I was, I'm an ex-military, too.

Well, it's okay. It's not my AK-47, you know. Well, just don't point it over here! [laughter] But, no, I think we have to raise some questions about some of the things that are happening. We've had all those cases in Fayetteville where the men have come back from Afghanistan killing their spouses. And I think we really have to... And I think, you know... Well, I think those questions... These are legitimate questions but just remember, though, compare the... Not to get into the elevator with you, yes, Clarence. No, just compare the... compare the misbehavior of military people with non-military people. Okay, that's fair, that's a fair... question. And it's not much different in fact, they're actually better among military... I've got to get to some military people, but these military people happen to be in Africa because we would like an update on what's been going on in the Ivory Coast and what has suddenly mushroomed in the Central African Republic. Noluthando(?) I know you've been away for five months, but you're getting ready to go back in about a week or so. What is your understanding of what's going on in the Central African Republic? Well, Kojo, first of all, I have to start, and I know this is not popular, but I just have to start by saying, it grieves me that whenever we have to talk about Africa, it's always the latest coup or the starvation,

and it's always we have to talk about the train wrecks. Not that the train wrecks and the coups and things are not interesting and tragic and important but the problem for our viewers, and indeed many of us who are in the media, is that most people have no context, no background, no understanding. And so to try to put a little two-minute spin on what's happened and what is happening becomes very, very difficult. Never the less... Never the less, and whatever time I have, I want to say that people have to have an understanding of the background. The Central African Republic, which most people couldn't even find on a map if you gave them a map of Africa, but it's not too far from Cameroon where I live, has for years, during colonialism, the French basically were renting out the whole country to French companies. Now I know people get tired of hearing this. And let me tell you, until I lived in Africa, I got tired of hearing it too. But once you understand how these kinds of historical realities have shaped things, it really makes an impossible.. Nothing else makes sense.

It really doesn't. But as I understand it, things are more or less calm now. There are some reports of casualties of Chadians who were in the country up in the North claim that they had been pursued by government forces and so forth. I believe, I saw a BBC report and I'm sure we'll be hearing more in the news as we go on. But as I understand it, things have calmed down for now. The general is back in France, in exile, and things seem to be more or less. In the Ivory Coast, who's in charge? Is the situation calm or are their negotiations over? I don't think anybody quite knows what's going on right now. In the Ivory Coast, you still have the situation with the rebels and the government troops and so forth. The last report I saw indicated that things were more or less under control. But, just like the situation... When you get back there, please make sure you stay in touch because we need updates. Alright.

These situations, I mean, [inaudible] I apologize [no problem] who's used to you at another iteration... But has really made an important point about the knowledge piece because these situations are likely to constantly be unstable because of infrastructure issues and the inability to basically generate, basically a solid... that continues. And the West, the main interest in the West, is still getting out the natural resources [exactly] and extracting money from Africa, as opposed to helping. I'm afraid we're out of time not to give the impression that the women on the panel are the only ones who know anything about Africa. [laughter] If we happen to be out of time. Thank you all for joining us. What would you say if I told you that doctors are less likely to order sophisticated cardiac tests for Black patients who complain of chest pains than they are for White patients who make the same complaint? More about that when we come back. [music] [no audio]

[no audio] Racism and medicine, it's well known that African Americans are disproportionately affected by illnesses such as heart disease, diabetes and high blood pressure. Although new data indicate African Americans tend to receive poorer care for these and other diseases, then Whites. Poverty and lack of access are only part of the answer, as health correspondent George Straighten(?) discovered, too often it's a matter of race. [music] Late night in New Orleans, Otis Jenkins is just warming up. [music]

He's a blue singer, for 37 years his art has imitated his life. [music] You got to live it, if I've been there, everything I got, I got it the whole all the way. [music] Nothing has come easy, especially good health. Otis has been battling diabetes for 12 years. Two years ago he noticed his big toe was turning purple. They told me the gang green needed to be amputated, so I told him no, I can't do that, it's like, you know, I never had nothing missing on me. Government surveys show Blacks with circulatory problems are twice as likely as Whites to have a leg amputated. Harvard researchers say a major reason is Blacks are less likely to be offered an operation

to save the limb. [music] Otis says his doctor never told him he had any other option. I know that on a whole, Black people don't get treated the same as White people in hospital systems throughout the United States, I know this. If he had a little bit more information, a little bit more support he may have saved his leg if he was offered some alternative treatment. Phyllis Landry works in public health in New Orleans. For some reason, I don't know why African American life is devalued at some point. And it doesn't matter what the illness is, three dozen surveys over the last decade show the disparity in care is pervasive. Black babies are two and a half times more likely to die before their first birthday as White babies. Blacks are 34% more likely to die from cancer and twice as likely to die from heart disease. Blacks are 50% less likely to get heart bypass surgery and the problem is not just with high tech care. Blacks are 25% less likely to get pain medication.

Some of the disparities in care can be explained by the fact that as a group, Blacks tend to be poorer, sicker, and have less health insurance. But 10 different studies done around the country which controlled for these factors show the disparity still exists. [Deep breath, in and out] So what role if any doctor's play? This experiment done two years ago has some answers. Dr. Kevin Schulman designed a simple but elegant way of answering the question no one had ever asked. To what extent are physicians responsible for the differences in care that have caused so much suffering among African Americans? We thought the only way to ever address this question was to have physicians see identical patients. So that they'd have the same clinical characteristics, they'd have the same type of chest pain, they be the same age, they'd be dressed the same way. And then see whether or not given all that, given everything else being equal, whether or not people were treated differently based on their race or gender.

We tried to make this as realistic as possible. Dr. Schulman created video discs using actors. White. 'It starts about here, right in the middle and it kind of moves toward my left arm.' Black. 'It starts in the middle here and then it kinda moves into the left arm.' Each reading identical scripts describing heart pain. We tried to make the gestures the same and the gestures went along with the type of chest pain they presented in the cases. Dr. Schulman took the discs and computers to various medical meetings. More than 700 doctors took part in what was described as a government study on clinical decision making. This is the key question. At the end of the examination, the doctors were asked which patient actors needed further advanced treatment. In our main analysis, we found that Blacks were 40% less likely to be referred to cardiac catheterization compared to Whites. Cardiac catheterization is our major diagnostic test to see whether or not people have heart disease, see whether or not they need further treatment or operations or procedures.

In our study, the clinical characteristics were identical and yet physicians treated patients differently. So why the difference? Researchers say it's bias. We think it's subconscious. We think it's not something that physicians are actively doing. It's just an effect of how they automatically characterize people who come in to their office or to their emergency room. The experiment was so well controlled, most say doctors can no longer ignore the subconscious bias many harbor. Researchers do not conclude that doctors are racist, just human. This fall, this website became part of a million-dollar systematic outreach campaign to cardiologists on this issue. Cardiologists were chosen because the disparity data is strongest in heart disease. This and an ad campaign in leading medical journals will show doctors the evidence on disparities and care. This effort is sponsored by two leading health care foundations and 10 medical and public health organizations. We are not saying in this initiative and I certainly am not saying that physicians are

the problem, we are saying that physicians can play a leadership role in addressing this issue. George Strait is here with us. George, what about this new initiative to engage doctors in this problem? As we said in the piece, it's more than a million dollars and it's supposed to go on for a number of years. But just a few minutes ago, before the program, I had a chance to talk to the new head of the Robert Wood Johnson Foundation, Dr. Risa Lavizzo-Mourey, and she told me that when it comes to health disparities, really, doctors may be the key. Dr. Lavizzo-Mourey, thank you very much for being with us. So good to be here, George. I guess the first question is, how important was it for the Institute of Medicine to report on disparities to be so strong and actually declaring that there are racial and ethnic disparities in health in this country? Well, I think it was critical for at least two decades that people have been doing research on the existence of racial and ethnic disparities. But there had never been a time when all of the information was pulled together in one

source, analyzed by credible experts in the field. And that's what the Institute of Medicine did. It brought it all together and said, in a very definitive way, we do have a problem with racial and ethnic disparities and laid out some solutions. I know a number of the people who have read the report come away saying, maybe in America there are two kinds of health care, one for Blacks, one for Whites, is that what we have? Well, we do have very substantial disparities that cannot be accounted for based on clinical differences, cannot be accounted for based on other things that we think should explain those differences like whether a patient wanted a particular kind of treatment. So it does seem as if we have a health care system that needs to deliver the same quality of care to everyone who comes to get care from that system. But is it frank discrimination? We examined 400 studies and then categorized those studies according to ones that really

addressed this issue and had all the information that we really addressed this issue and had [repeat audio] all the information that we would need to try to understand that. And we came away as a committee saying, there's not evidence of frank discrimination. There is evidence that there is bias, that there's stereotyping, and that these can lead to differences in the kind of care that people get, and that there are remedies that we could use to fix these problems. Why is it important for the Robert Wood Johnson Foundation to be involved in this new initiative that frankly engages physicians in this issue? Well I believe it's important for us to partner with others to address this because one of the recommendations at the IOM, Institute of Medicine, report called for was getting the word out, having people understand that this is an issue that can be corrected if we all take ownership and begin to change the health care system, change the way there

might be biases in the system, have better language facilities for people who are not able to speak English with their providers. So we see this as an opportunity to get that word out and begin the process of taking ownership. This isn't an initiative that blames doctors, but yet it's an initiative directed at physicians. So what does that imply that physicians are unaware or are in denial about this problem? I think physicians are very much unaware, whether they're in denial is something I can't say, but I think that we saw in the committee's activities that many physicians came to this and said, I went into medicine to help people, I'm not prejudice, I don't discriminate. And yet when they were presented with the data and saw a study after study after study that showed that there were differences in the care that different ethnic groups received,

they came to understand that they had a role to play. Now that's not to say that it's only physicians or it's only nurses, it's the health care system, it's the leadership of the health care system, it's frankly the way we pay for services many times, but there's a role that physicians will play in correcting this because they are often the leaders and the respected leaders within the health care system. Very quickly, how do you define success? Elimination of racial and ethnic disparities, quite simply. Thank you very much, Dr. Risa Mourey. Thank you. My pleasure to be here. Joining us now is Marsha Lillie Blanton, Vice President of the Henry J. Kaiser Family Foundation. Good to have you here. Thank you for inviting me. Tell us about the initiative to reach doctors on this issue, who are the partners? Well, we have several key partners because this part of the initiative focuses on cardiac care.

We have the American College of Cardiology Foundation, the Association of Black Cardiologists, and also the Association, the American Heart Association. There are also ten other partnering organizations that include other physician groups, the American Medical Association, the National Medical Association, the National Hispanic Medical Association. So we have brought together the professional associations that physicians in practice and in training respect and look to for their knowledge. It's a website. There are ads in journals, but what is it? What is this outreach? Well, there are at least three major components of this. The main one is an advertising campaign that will run in major medical journals between March and between October and March of 2003. And that ad campaign has a headline that says these patients have the same condition, but their treatment may be different. And the intent of that ad is to provoke dialogue and discussion.

It's not to accuse, it's not to blame, but it is to get physicians to start to think about the problem, to seek information and evidence, to become engaged in this. So that's one major part of it. Another part of it has been our review of the evidence. What we realized from our focus groups and our discussions with physicians is that there was a lot of distrust or disbelief in the evidence. And some physicians, frankly, who were just unaware, as you've heard before. And so what we have done is summarized the evidence, first beginning with an assessment of the quality of the evidence. And so while we have identified some 81 studies with a focus on cardiac care that looked at disparities, our first cut at that of saying, how good is this evidence? And through an advisory committee, two independent teams of researchers, we first started to focus on those studies that had controlled well for those factors, particularly clinical

and socioeconomic factors, that are assumed to account for the disparities. So you can't look at the evidence and say it's not good when we've actually done an assessment of the quality of it. So that was another major part of it. And we've produced a summary report and a fact sheet, and that information is available for physicians. Why focus on cardiologists, why not other specialties? We're beginning with cardiology. And we're beginning with cardiology because, first of all, heart disease is a leading cause of death across racial and ethnic groups. But also the evidence, the research, was considerable in that arena. In other words, a part of what we needed to do was have a base of evidence that doctors could look at and draw their conclusions from. And because heart disease is so prevalent, and because research has been done, there is, there was a considerable base of evidence. So for us, the task was summarizing that and synthesizing it and then getting that information

to physicians. And that's the third part of it, the outreach. And our partner organizations are key to that outreach. What about outreach to medical students? One thing to go after doctors, what about doctors and training as it were? Well, one of our partners is the Association of American Medical Colleges. And so while our initial focus really is on physicians in practice, physicians in training are a part of the new group who will be in the field. And so while some of our efforts will focus in that group, that is not at this point a major part of the effort. And this is all be accomplished without federal help? For us to really make a change, it's going to require a concerted effort on the part of both the private and the public sector. And by the public sector, I certainly mean government. But some of those efforts are already underway. When Dr. Satcher was a part of HHS, he put in place efforts which are changing the way

we finance care, are changing the way we engage in research, are helping to change the system. And it is a small process. [But David Satcher is no longer Surgeon General] Put in place systems that are now continuing. We have a new center for research on minority health that can change the way research is done. Our systems for collecting data and analyzing data, particularly in public programs, are now being changed. It's a slow process. It's not going to happen overnight. But I do think we have that. Absolutely. Marsha Lillie Blanton, thank you very much for joining us. George, always good to see you. You know, when I'm out on about people always ask, how can I reach you? Well, now you can. With our new email address, eveningexchangeathoward.edu. That's eveningexchange. One word at howard.edu. I would thanks to all of our panelists for joining us.

Most of all, thanks to you for watching. Stay well. Bye.