The MacNeil/Lehrer NewsHour

MR. LEHRER: Good evening. I'm Jim Lehrer in Washington.

MS. HUNTER-GAULT: And I'm Charlayne Hunter-Gault in New York. After the News Summary, we take first a look at North Korea's nuclear hard ball and the strategy of its leader Kim Il Sung. Then Fred De Sam Lazaro reports on who represents doctors in the health care debate, and Tom Bearden looks at what's holding up Denver's new airport. NEWS SUMMARY

MR. LEHRER: North Korea announced its withdrawal today from the International Atomic Energy Agency. A statement said inspectors from the U.N. agency would no longer be permitted in North Korea. Also today the government of South Korea called up more than 6 million reservists for a huge air raid drill. The action came as former U.S. President Jimmy Carter arrived in Seoul. He's visiting the two Koreas in an attempt to de-fuse tensions over the stand- off with the North. The international community suspects it is building nuclear weapons. In New York City, the U.S. Ambassador to the U.N., Madeleine Albright, spoke to reporters today about sanctions against North Korea.

MADELEINE ALBRIGHT: The resolution as it looks now will be phased so that there will be certain parts of it that will be designed to correct -- try to ensure that the North Koreans correct some of their behavior, and some of it will be designed to deter some future behavior that would be unacceptable.

MR. LEHRER: Amb. Albright said she plans to introduce the resolution in the next day or two. This afternoon, White House Spokeswoman Dee Dee Myers said President Clinton discussed sanctions with President Yeltsin. He said the two had agreed on a general approach to sanctions. Myers said Mr. Clinton also planned to contact the president of China on the issue. We'll have more on this story right after the News Summary. Charlayne.

MS. HUNTER-GAULT: Japanese Emperor Akihito and Empress Michiko made a state visit to the White House today, where they were greeted by President and Mrs. Clinton. The royal couple was accorded full Democrat honors, including a 21-gun salute. During remarks, the emperor thanked the United States for its role in rebuilding Japan after World War II. President Clinton, hosting his first official state function, expressed hope that the two countries can work together toward a common goal.

PRESIDENT CLINTON: Today we share a common vision. It is a vision of democracy and prosperity, of a world where we trade freely in ideas and goods, a vision of a world that protects and secures the rights and freedoms of all human beings, a vision of a world at peace. You have called the era of your reign pace, fulfilling peace, and nothing could be more important to our nation than working with you to achieve that goal

MS. HUNTER-GAULT: Tonight, President and Mrs Clinton will host a state dinner for the royal couple in the White House Rose Garden. Earlier this afternoon, Emperor Akihito went to Arlington National Cemetery, where he laid a wreath at the tomb of the unknown soldier. It marked the first time a Japanese emperor has visited the site. After leaving Washington, the royal couple will visit nine other U.S. cities.

MR. LEHRER: The military government of Haiti declared a state of emergency this morning on grounds the country faces the threat of invasion and occupation. The New York Times reported today the leaders of about 30 countries would back such military intervention if sanctions fail. Bill Gray, President Clinton's special adviser on Haiti, confirmed later today that a number of nations are interested in immediate action throughout the military government of Haiti.

MS. HUNTER-GAULT: A Palestinian terrorist today claimed responsibility for the 1988 bombing of Pan Am Flight 103. Youseff Shaban made the claim during his trial for the assassination of a Jordanian diplomat. Shaban is a follower of terrorist leader Abu Nidal. Two hundred and seventy people were killed when the jetliner blew up over Lockerbie, Scotland. Britain and the U.S. charged two Libyans with the attack and are demanding their extradition. Investigators and families of the victims said they doubted the confession.

MR. LEHRER: President Clinton spoke by satellite today to the U.S. Conference of Mayors Meeting in Portland, Oregon. He asked for the mayors' support for his domestic agenda. The mayors told him that they worried crime, health care, and welfare reform will be too costly to local governments. He repeated his determination to get health care reform with universal insurance coverage passed in Congress.

PRESIDENT CLINTON: Let's be clear about what we should have. I want private insurance running it. I do not want a government-run system. I do not want to take any part of the private system away from the private sector. But I do want to make sure private insurance is available to every American family.

MR. LEHRER: President and Mrs. Clinton were questioned under oath on Sunday by Whitewater Special Prosecutor Robert Fiske. A statement issued today by White House Counsel Lloyd Cutler said the interviews dealt with circumstances surrounding the death of White House Deputy Counsel Vince Foster and with contacts between Treasury and White House staff members regarding a failed Arkansas savings & loan. Cutler said the President and the First Lady agreed to the interviews voluntarily after the request was made.

MS. HUNTER-GAULT: The Supreme Court today unanimously struck down a city law banning most signs on private property. The case involved a woman in Ladue, Missouri, who was told by city officials no to place a sign on her lawn protesting the Gulf War. A jury in Alaska today found that recklessness by Exxon Corporation and Capt. Joe Hazelwood led to the nation's worst oil spill. Hazelwood was skipper of the Exxon Valdez when it ran aground in 1989. Today's ruling means thousands of plaintiffs can seek billions of dollars in additional damages. Exxon has already paid more than $3 billion from the spill.

MR. LEHRER: Retired Army Col. Charles Beckwith is dead. He led the ill-fated 1980 raid to rescue 52 Americans held hostage in Iran. Police said he apparently died of natural causes in his Austin, Texas, home. He was 65 years old. And that's it for the News Summary tonight. Now it's on to what is North Korea up to, who speaks for the doctors, and when, oh, when, will the Denver Airport open? FOCUS - DISHONORABLE INTENTIONS?

MS. HUNTER-GAULT: North Korea's high stakes nuclear strategy and its near total isolation are where we go first tonight. Today, the North Koreans said they would go ahead with their threat to drop out of the International Atomic Energy Agency. We start our look with a backgrounder on the reclusive North Korean Leader Kim Il Sung. North Korea's dictator, Kim Il Sung, has held the reins of power for 46 years, longer than any other head of state. Known as the "great leader," the 82 year old Communist rules with unchallenged authority. Over the years, North Korea's propaganda machine has built him into a powerful personality cult with myriad commemorative statues and placards everywhere. His birthday this year, as in previous years, was cause for great celebration. From the time they enter school, North Koreans are taught the whole mythology about Kim Il Sung, including stories glorifying him as a guerrilla leader while he was still a teenager. So strong is Kim Il Sung's grip on power that he had been able to designate his son, 52 year old Kim Jong Il, to be his successor. Very little is known about him. Kim Il Sung came to power after World War II, when Korea was divided into the Communist North and non-Communist South. A revolutionary, who fought against the Japanese in China, Kim Il Sung was chosen by Joseph Stalin to be his puppet ruler in the North. But in the years that followed, Kim proved himself to be just as strong willed and ruthless as his mentor. HIs surprise attack on South Korea in 1950 cost the lives of some 4 million soldiers and civilians on both sides. Kim Il Sung has a long history of resorting to violence. In 1968, North Korean commandos tried to assassinate President Park Chung Hee of South Korea. In 1983, North Korean agents bombed a funeral in Rangoon, Burma, killing 17 South Korean officials, including four cabinet ministers. In 1987, terrorists bombed a South Korean airliner, killing 115 people aboard. A North Korean agent later confessed to the bombing. In recent years, as the once dynamic North Korean economy has struggled to recover from the loss of its Communist trading partners, the country has become increasingly isolated. At the same time, Kim Il Sung, commander of a million-man army, the world's fifth largest, has become more and more unpredictable. His regime first diverted nuclear weapons grade plutonium from its nuclear reactor at Yongbyon in 1989. In March, 1993, he threatened to drop out of the nuclear non-proliferation treaty but never did. Now three views on the motives of North Korea's leadership. They come from Donald Gregg, U.S. Ambassador to South Korea from 1989 to 1993. He's now chairman of the Korea Society and has just returned from a trip to South Korea. Karen Elliott House is vice president of the international division of Dow Jones. A former journalist, she visited North Korea in 1991. And Selig Harrison is a senior associate at the Carnegie Endowment for International Peace, where he directs the program on arms control and nonproliferation in Asia. He just returned from a week's visit to North Korea, where he met with Kim Il Sung. Selig Harrison, you've just come back, and you met, as I said, with Kim Il Sung today. He proposed -- you brought back a deal or the proposal of a negotiated deal in which he would give up his plutonium processing in exchange for diplomatic recognition and economic assistance from the United States. With that floating towards the table, why do you think today North Korea said it was getting out of the International Atomic Energy Agency?

MR. HARRISON: Well, that was a response -- what they did today - - to the fact that the IAEA cut off its aid to North Korea last Friday. When you put pressure on North Korea, you can be quite sure they're going to find a way to retaliate, because they're obsessed with what they see as their self respect. They don't want to appear to be surrendering under any kind of international pressure. When I met Kim Il Sung for three hours, I found him extremely conciliatory, no threats of war, no threats of withdrawing from the non-proliferation treaty. What's important about their position so far is although they're responding to this IAEA action, they have not threatened to withdraw from the NPT yet.

MS. HUNTER-GAULT: Which is the treaty.

MR. HARRISON: The non-proliferation treaty. And it's very important that they stay in that and that we respond to the negotiating offers that they are making. What he's proposing is they will freeze their nuclear program where it is today. It won't expand. They've got about a 200-megawatt reactor under construction which if it were to be completed in 1996 under schedule could produce enough plutonium for 10 bombs a year. So it's very much in the United States' interest to respond to his offer to stop the completion of that plant, to stop the processing of plant that they already have largely in operation in return for a package deal which they've been offering for some time which would include returning to the non-proliferation treaty, as well as stopping the construction of these particular facilities. What they want the United States to do is to provide the diplomatic recognition, light water reactors, a less dangerous type of reactor that we're ready to see them have to replace the type of reactor they now have, and a pledge not to use nuclear weapons first in the Korean Peninsula.

MS. HUNTER-GAULT: It's been argued that that was the whole purpose all along of the North Koreans pursuing the development of nuclear weapons, to be able to use that pursuit as the bargaining chip for economic assistance and diplomatic recognition. Is it your view that that's why Kim Il Sung wanted a bomb?

MR. HARRISON: Yes. I think that Kim Il Sung doesn't necessarily want a bomb. He wants some plutonium with which they could make bombs. But there's no question that they're bargaining. They're still bargaining, and there's a great deal of confusion in the United States about the question of negotiations. It is an impression that we've already tried negotiations, and they haven't worked, so we've got to go to sanctions. But that's simply not true.

MS. HUNTER-GAULT: All right. Let's pursue the sanctions thing in just a minute, but let --

MR. HARRISON: It isn't sanctions. It's the fact that we have not negotiated with them yet. We haven't been willing to negotiate about the things they want to negotiate about.

MS. HUNTER-GAULT: All right. I want to pursue that track in just a moment, but let me just go to Amb. Gregg. You've just come back from South Korea, and today they called up, I think, something like 6 million reservists. What's the South Koreans' reading of North Korea's intentions? AMB. GREGG: Well, when I was there, I met an old friend, a major general, who had years of dealing with the North Koreans at Pan Win Jom, and he said to me, "They're afraid you're trying to strangle them, and what they really want is better relations with you." And he said, "Why are you only talking to them about nuclear matters?" I think the call up of the reserves is an exercise; it'll be over in a few days. But I think the South Koreans have to respond in terms of rhetorical actions when the North Korean rattles the saber. I think the North Koreans in their very inept way are trying to deal with an outside world which is very unfriendly. They've lost their allies. They feel very much --

MS. HUNTER-GAULT: Their allies being the Russian --

AMB. GREGG: The Russians and the Chinese, in particular.

MS. HUNTER-GAULT: The Chinese, and any source of economic aid from them.

AMB. GREGG: No compensatory, no concessional aid whatsoever at this point, and their economy is weak.

MS. HUNTER-GAULT: What is your sense of why North Korea wanted a bomb or plutonium?

AMB. GREGG: Well, I like to contrast Kim Il Sung with Castro. Castro has not gone for the bomb, and I would say he's drifting off into irrelevance. I think had he gone for a bomb, we probably would be engaged in the same kind of bargaining with him that we are now with Kim Il Sung. I very much agree with Selig's analysis, except for one thing. I think the North Koreans would love to have a bomb and economic assistance. I think our game plan is to make clear that they can have one or the other. But I agree that by only talking about nuclear issues, the Clinton administration has not really negotiated with the North.

MS. HUNTER-GAULT: Karen, what's your view on that, why Kim Il Sung would want to bomb?

MS. HOUSE: Well, I think he -- I mean, I have not met the man, but it seems to me that it is logical to assume after as much discussion, whether you call it negotiation or not, as much discussion has gone on, that they do want a bomb, (a) because they've seen what happened to the Soviet Union and Eastern Europe, and that the ultimate insurance policy is nuclear weapons. And if you're a country that is poor and vulnerable and your fear in life is that you'll go the way East Germany went, be absorbed by your non-Communist path, I mean, if I were Kim Il Sung, I'd probably want nuclear weapons too.

MS. HUNTER-GAULT: And your sense is that the East German experience is weighing heavily on Kim Il Sung's mind?

MS. HOUSE: I think it has to be, and I think our problem is we have not sent -- we have not found a way to communicate that these are the things that we're prepared to do for you, and these are the things we will absolutely do to you if you don't take the positive package.

MS. HUNTER-GAULT: Well, do you think that the U.S. fundamentally misjudged North Korea when it took the path of negotiations?

MS. HOUSE: We have engaged in a lot of wishful thinking that somehow, you know, if you just chat 'em up a little bit, they probably really don't want it, you know, and we haven't been very clear, and I think that's what Selig's saying too, but we haven't been very clear about what are the positive benefits of yielding up the bomb. I, for one, don't think they want to yield it up. I'm closer to Amb. Gregg on that. I think they -- they would like to have both but that if you're, if you're there and you're 82 years old and you know your son -- it's taken you years and years to prepare people to accept him, and they probably don't still accept him -- that the bomb is a nice, a very nice thing for North Korea to have because the South Koreans will have to mind their business, and no one can get too aggressive about trying to absorb North Korea and your own -- you perpetuate yourself, which I think is their No. 1 goal.

MS. HUNTER-GAULT: Do you agree with that, Selig Harrison?

MR. HARRISON: Well, she's absolutely right that the North Koreans and Kim Il Sung are deeply concerned about what happened in Germany, and they do believe that the United States and South Korea elements in the United States and South Korea want to bring down the regime, isolate it to put economic and other pressure on it so it will follow the path of Germany and be absorbed by South Korea, and they think that some elements want to drag, in South Korea, want to drag the United States into a war that would give them an opportunity to militarily conquer North Korea and absorb it into the South. But that doesn't follow for that, that they're determined to keep the plutonium that they might have accumulated, and we really don't know how much. They, the first stage they made very clear this week with Kim Il Sung, what he offered to me, and what I'm sure he'll offer to Jimmy Carter also, to freeze the program where it is, not to accumulate any more. And --

MS. HUNTER-GAULT: And do you think -- do you think that he can be believed on that?

MR. HARRISON: Well, the point is -- and I'm sorry -- we have not agreed to negotiate with North Korea about the things they want to negotiate about. We've said, you do what you want first with nuclear inspections, and then we'll talk about those things after you've behaved yourself. Mondale, Amb. Mondale said just yesterday exactly the same thing in a comment on the proposal that I reported, so that is our policy. First, they do what we want, then we negotiate. Now that's the policy we've got to change. We've got to have immediate negotiations, or things will get worse and worse. I saw signs that some of the hard-liners in North Korea, the militarists are getting stronger. The longer we put it off, negotiations on an equal basis with no pre-conditions, the worse the situation will get and pressure will just make things worse.

MS. HUNTER-GAULT: Amb. Gregg, do you agree with that?

AMB. GREGG: Yes, I basically do. I'm reminded of what Ronald Reagan used to say about the Soviet Union: Trust but verify. And I don't think you give anything away by doing what Selig suggests, and that is keep your force in place. I had a conversation with Gary Luck, our commander in Korea, who is the ideal man to have there. He's battle-hardened, rock solid, unflappable. He was the most confident man I saw in South Korea. Force and diplomacy work in tandem. We have force in place but we haven't really used diplomacy. And now it's time.

MS. HUNTER-GAULT: Selig, today Kim Il Sung reiterated his threat to -- that sanctions would be an act of war. Do you think the would use a bomb in, in response to sanctions?

MR. HARRISON: The last thing North Korea wants is a war. There are no economic conditions for a sustained war, although I'm sure their forces are in readiness for a short war. What I think is dangerous is a naval blockade. The act of imposing economic sanctions, in themselves, I don't think worries them as much as they pretend. It's, it's rhetoric, because as long as they think the Chinese will stick with them, they're not really deeply concerned. But what I think would produce a military response would be any hint of a naval blockade or what some people in Japan are calling naval interceptions. Then I think you're going to begin to see North Korean military responses. It's a very dangerous period we're going into. I think we should back off the sanctions. And if we go ahead with them, we should simultaneously move on a positive negotiating track.

MS. HUNTER-GAULT: Karen.

MS. HOUSE: But Selig, I think if you -- precisely as you say war is the one thing they're not prepared for and couldn't survive. And to me that is why we should make it very clear to them that that's exactly what they may confront if they don't accept the positive package, because to negotiate for many more months while the plutonium builds up and while no one knows really what's going on there, it seems to me to be playing their game, that, of course, they're not worried about economic sanctions, because economic sanctions won't work unless you do have a naval blockade, and you do tell the Chinese that anything that crosses from your border will bomb it on the North Korean side of the border. Otherwise, the Chinese don't care either. I mean, the status quo is preferred, I think, by North Korea, because they figure eventually, (a) they'll have a bomb, and then they'll be able to blackmail the South Koreans, and to me, the one thing that is most disturbing about all this is when, whether you believe they have it now or it'll take a year or two or three, when they do have nuclear weapons, American troops, I believe, will not be allowed by the American people and U.S. Congress to stay in South Korea, and then I think you can be sure that the Japanese do feel that it's necessary to go nuclear, and then you have a total mess, as far as I'm concerned, in Asia.

MR. HARRISON: They aren't getting any Iranian oil at the present time. There's no reason for a naval blockade really. Sanctions, in general, are not going to work. The only way to deal with this problem is diplomatically, and we simply have to be prepared to spend about what we're happening at Kazakhstan, in the Ukraine, 2 to 3 billion dollars, and work with the Japanese and South Koreans. One suggestion that was made to me was that this freeze could take place; if we give the Russians enough aid to help them to provide North Korea with the light water reactors, which are not as dangerous, and which we've indicated we would prefer, that would be the best way to do that. And I really think it all boils down to whether we're willing to face the fact that you don't get countries to give up their nuclear option for nothing.

MS. HUNTER-GAULT: Let me just -- we may have really covered this -- but let me just see if I can get you to say this. You talked about meeting with Kim Il Sung for three hours and all the reports are that he's -- you know -- that he's very enigmatic and unpredictable. What was your sense of his state of mind, and did you see any real signs of a siege mentality there?

MR. HARRISON: Well, I think there is a siege mentality in the sense that they suspect our intentions. They think we want to bring them down and make what happened in Germany happen in Korea, but he was very relaxed. There were no threats. Everything was conciliatory. He's kind of like Lyndon Johnson, you know. He puts his arm around you, and he's a very warm man, and he's kind of like your uncle, you know. He's not a forbidding figure at all.

MS. HUNTER-GAULT: We're about to run out of time, but, Karen, you alluded to his son. They call him the dear one, I believe, "dear leader."

MS. HOUSE: "Dear Leader."

MS. HUNTER-GAULT: How is he involved in this crisis right now, and what influence is he likely to have over all of this? Is he any -- because there are rumors that he is not the most stable and potential successor as a successor might be a problem, just briefly.

MS. HOUSE: That's one of the problems of their having nuclear weapons. I have no idea what role he plays. What one hears from those who claim they do is that Dad is in control here, the great leader. The dear leader is out driving fast cars and chasing women, or whatever he does, you know, during this -- but he's not running this crisis.

MS. HUNTER-GAULT: And what about Jimmy Carter's mission there, Ambassador, how successful do you think that can be? I mean, he's already -- Kim Il Sung has already told Selig Harrison what he wants. What can Carter do?

AMB. GREGG: I think he can be helpful. I think he's done a lot of international negotiations. I think the South Koreans would prefer that it be George Bush, but I think that the North Koreans weren't about to invite George Bush, because they remember Desert Storm and Panama, and that's part of the reason they are concerned about our military force. But I think President Carter can be helpful.

MS. HUNTER-GAULT: Karen, what do you think?

MS. HOUSE: I think he's the wrong person for the assignment.

MS. HUNTER-GAULT: Why?

MS. HOUSE: Well, because he's the man who wanted to pull troops out of South Korea, and even though he shifted that position in his presidency, I think they will see him as another sign that the U.S. is short on resolve on this issue, and so unless he's really empowered to negotiate as both the ambassador and Mr. Harrison are advocating -- and I would say negotiate tough -- which I doubt that he is -- then I think it's -- it confuses the picture to send him.

MS. HUNTER-GAULT: All right. Well, we're going to have to leave it there. Ambassador, Karen, and Selig Harrison, thank you for joining us.

MR. LEHRER: Still to come on the NewsHour tonight, who speaks for the doctors, and will the Denver Airport ever open? FOCUS - WHO SPEAKS FOR DOCTORS?

MR. LEHRER: Now, speaking for the doctors on health care reform and other issues. Most assume it is the American Medical Association who does the talking. The AMA is holding its annual meeting this week in Chicago.Some doctors say not so on the AMA. Our medical correspondent, Fred De Sam Lazaro of public station KTCA-Minneapolis-St. Paul reports.

MR. LAZARO: The American Medical Association has a wide ranging mission. It supports research and establishes standards and protocols in medicine. But the group is perhaps best known for its lobbying powers which have long been acknowledged in Washington's political establishment.

VICE PRESIDENT GORE: (March, 1993) This administration knows that we cannot and do not want to build a better health care system without the cooperation and leadership of the AMA.

MR. LAZARO: The AMA first established its formidable reputation during the Truman administration, when it used its deep pockets to derail a health care reform proposal. It's been an active voice for positions ever since. Dr. James Todd is the group's executive vice president.

DR. JAMES TODD, American Medical Association: The AMA is the only organization that is able to assimilate and act as a final common pathway for the thinking of the doctors in this country.

MR. LAZARO: However, whether the AMA has a good pulse on the thinking of American doctors is open to question. Dr. Arnold Relman is editor emeritus of the New England Journal of Medicine.

DR. ARNOLD RELMAN: American medicine has splintered into many organizations, not only provided by professional specialties, special interests, but also ethnically and by gender too. There is a National Women's Medical Association. There is an Association for Black Physicians. And more and more, medicine is being splintered into special groups.

MR. LAZARO: In fact, only about 43 percent of the 650,000 American physicians are members of the AMA, and Relman says few among them are actively involved. Dr. Darracott Vaughan leads the Department of Neurology at New York Cornell Medical Center. He still pays his AMA dues, but as a specialist and an academic physician, he feels far better represented by other lobby groups.

DR. DARRACOTT VAUGHAN, Urologist: Our specialty group, the American Neurologic Association, that will speak for us on the Hill looking at our specific areas of interest. From an academic point of view, there will tend to be the AAMC, American Association of Medical Colleges, the Deans' Group, who have a great deal of access to the government.

MR. LAZARO: As a large organization, Vaughan says the AMA must respond far more to the interests of primary care doctors. They stand to do well under managed care, which is the hallmark of most reform plans, including the President's. These general physicians would serve as gatekeepers. They would decide when it's appropriate for a patient to see specialists like Vaughan.

DR. DARRACOTT VAUGHAN: As a specialist, as a specialist like urology, where much of what we do is cognitive as well as procedure-oriented. He would like to have the patient, if they so choose, to be able to see us on first visit, rather than have to be referred, so that would be an area that we would feel very strongly about which might be at odds with a group which is primarily represented by primary care physicians.

MR. LAZARO: But primary care physicians come in various stripes. Dr. Dena McFadden is a pediatrician who works on salary for Harvard Community Health Plan, a Boston HMO. Dr. McFadden has spent her entire career in managed care plans. She does not belong to the AMA, and she, like Vaughan, says other groups far better represent her priorities.

DR. DENA McFADDEN, Pediatrician: The American Academy of Pediatrics is a wonderful advocate for children's health care. I think in terms of getting the ability to truly deliver cost effective, high quality universal health care in this country in my mind is the most important is probably the GHAA, the voice of managed care. I do strongly believe in managed care. The AMA has not historically been a strong voice for managed care or for the kind of care that I've chosen to deliver.

MR. LAZARO: Denver Emergency Room Physician Rick Bieser also does not belong to the AMA. His dues go to the American College of Emergency Physicians. That group has endorsed the President's health care plan. However, Bieser, himself, is a leading campaigner for the Canadian style, government-financed, single-payer system.

DR. RICK BIESER, Emergency Room Physician: I think vast numbers of front line emergency physicians who are practicing would prefer to be dealing with a single payer, to no longer have to ask patients: "Who is your doctor, and what kind of insurance do you have, and which hospital are you supposed to be at, and where do I need to transfer you, and how am I going to get paid for what I'm doing," and instead get back to just asking: "What's wrong, and how can I help," because that's what we really went into the business for in the first place.

MR. LAZARO: Bieser feels this caring ideal is best championed by Physicians for a National Health Program, a growing organization that now has about 6,000 members. On the other hand, the primary concerns of insurers, who predominate under the President's reform plan, is economic according to Bieser. He levels the same criticism at the American Medical Association.

DR. RICK BIESER: There are disturbing examples of progressive physicians that the AMA takes with regard to public health policy, tobacco policy, gun reform, things like that where political contributions by the AMA are exactly contrary to their publicly stated position, i.e., that they give more money to candidates who oppose them than they give to candidates who support them. I think that may be because the AMA is more concerned with the economic interests of physicians than they are sometimes with patient care.

(DOCTOR TALKING TO PATIENT)

MR. LAZARO: California family practitioner Ronald Bangasser belongs to the American Association of Family Physicians, but he's also an active member and a delegate at the AMA. Bangasser has reconciled the apparent contradiction of what he calls the political realities in Washington.

DR. RONALD BANGASSER, Family Practitioner: I had difficulty when I started working and organized medicine with understanding why you would contribute to a politician who takes a particular issue, say not in favor of quitting tobacco for everybody. But I understand that there's other issues that they might deal with in health that have to do with AMA, and that they need to have access to those people.

MR. LAZARO: Bangasser says the American Medical Association has a broad agenda that has served his entire profession on various issues, malpractice, quality standards, antitrust legislation, and economics. Economics, he adds, is important in the big picture.

MR. LAZARO: What you're saying is the AMA looking out for your pocket book is not entirely a bad thing?

DR. RONALD BANGASSER: No. It's not entirely a bad thing. If we can't be able to operate the offices and operate the hospitals, and hospitals the income has gone down so low that most of them are not making money, we'll never be able to keep up with new equipment and new innovations and new technology and new research. It's just not going to happen.

MR. LAZARO: With a mean annual salary now $177,000, Bangasser admits doctors have no real fear of economic hardship, whatever the eventual reform. But the prospect of stagnating incomes is one of several physician worries according to Harvard University Public Health Professor Robert Blendon. He's currently conducting a poll of American doctors.

ROBERT BLENDON, Public Health Professor: Physicians are losing their ability to choose how they practice, their environment, the hours they work, where they get referrals from, and their income. They also feel they're no longer in control of their professional lives. Organizations, insurance companies, government and hospitals, HMO's, they'll really shape a lot of what a doctor's life will be about.

MR. LAZARO: Amid all the change, Dr. Todd says the AMA remains the most effective voice to represent doctors from all walks of the profession.

DR. JAMES TODD: We firmly believe at the AMA there is room for HMO's, PPO's, fee for service. There's room for everybody out there. There is no one best way of satisfying every individual need to be gratified by their work. But I think it's important to realize that pluralism is what made the profession great, what made the country great.

MR. LAZARO: It also makes the AMA less effective politically, according to many analysts. The group has vacillated in recent months on several key aspects of health care reform. For example, long before it became part of President Clinton's reform plan, the AMA supported the so-called employer mandate, the requirement that employers, no matter how small, pay for the insurance coverage of all workers. But more recently, the AMA weakened its support to exempt employers of fewer than 100 people from the mandate, an employer category in which critics note most doctor offices fit.

DR. ARNOLD RELMAN: They try to be all things to all people, and sometimes they take a position on principle, a strong position, and then they hear it from a lot of doctors whom they haven't heard from before, and they back off and they recommend something else. And that's been characteristic of the AMA. Its great strength is that it's democratic. Its great weakness is that it is trying to keep a large group of very heterogenous, independent-minded practitioners happy.

MR. LAZARO: While it sorts out its own positions, the AMA has spent some $1.6 million in an ad campaign for the status quo.

ROBERT BLENDON: Most Americans think that the health care system is broken and things really need to be fixed. At the same time, the care they got in the last few months from a doctor or a hospital was real good, and so most people start out by thinking we can help the health care system, and I could still have good medical care. And what the political advertising wants to say to you, if you're trying to fix the health care system, the care won't be very good in the future, and so it's better to stay with what you have, even though the system's broken, then to take a chance that the reform could be worse for you.

MR. LAZARO: And Blendon's own polls show most American doctors, whether they are members of the AMA or not, are united in their fear that any reform will not be favorable to them. FOCUS - DIA

MR. LEHRER: Finally tonight, the coming some day of a new airport for Denver. Tom Bearden reports.

AIRPORT ANNOUNCER: Attention, passengers and visitors, certain individuals and organizations have requested to solicit contributions for various causes.

MR. BEARDEN: The inevitable disclaimer falls on few ears at this terminal. Denver International Airport sits on the empty prairie like a giant birthday present, undelivered, pristine, almost untouched, waiting for someone to come along and try it out. Some day these empty approach ramps will be filled with cars, the taxi ways filled with planes, the wide, sun-filled concourses teeming with travelers hurrying to change planes, some day, when the baggage system works. Then and only then will the people of Denver finally begin to get answers to 20 year old questions. Is this airport the key to Colorado's future, or an over-priced white elephant? Was the first big new U.S. airport in a generation worth building at all? Those are questions that concern not just Denver but anyone who builds something big.

CARY GRANT: (movie segment) Anybody who builds a house today is crazy! The minute you start, they put you on the list, the all American sucker list!

MR. BEARDEN: Years ago, Cary Grant played opposite Myrna Loy and Melvin Douglas as a kind of cinematic every man who learned firsthand about the excitement and frustration of building a big project. It was only a fable. It is also a surprisingly accurate guide to what Mr. Pena and the city of Denver went through trying to build a dream airport. That's Federico Pena, now Secretary of Transportation. But back in 1983, he was mayor of Denver and the driving force behind the new airport.

FEDERICO PENA: I am relieved now that I know this airport will be added to the system. Unfortunately, in many communities we have to wait till we have a crisis. In Denver, we got very close to that crisis, and people recognized the opportunity and were able to demonstrate the political will and the vision to get this project done, but they are very complicated.

MR. BEARDEN: The complications started right at the beginning, deciding whether Denver needed a new airport at all. Every homeowner knows the classic ways the problems first appear, those small but growing hints that the old place is running out of room. Stapleton Airport opened in 1929. By the early 80's it was swamped in a sea of connecting passengers, the sixth busiest in the nation thanks to airline deregulation. Three airlines had hubs here. Stapleton kept up with the traffic until the weather turned bad. Because the runways were too close together, controllers had to shut down half the airport's capacity when visibility dropped. That backed up traffic all over the country. What to do? Years of community meetings had narrowed the possibilities down to the usual homeowner's choice, renovate the old place and save money, or spend more money and move someplace else.

CARY GRANT: (movie segment) Would you spend $7,000 to tear out someone else's walls, when for a few thousand more you could find a nice old place in Connecticut, fix it up, and have the kind of dream house you've always wanted?

MR. BEARDEN: For Stapleton, renovation meant building new runways on the nearby Rocky Mountain arsenal, saving money, and keeping the airport close to downtown. But the arsenal is one of the most polluted places on earth thanks to 50 years of chemical weapons production. The cleanup would have taken years and billions of dollars and only if the federal government had agreed to turn over the land. It meant political problems too. The people who lived around Stapleton weren't thrilled at the idea of even more jet noise.

MAN: I moved out of East Denver to get away from this, and now all of a sudden, I'm getting it again.

MR. BEARDEN: The incumbent mayor, Bill McNichols, favored expansion, so did Pena, his opponent, when he ran against McNichols in 1983.

FEDERICO PENA, Secretary of Transportation: Then I got elected, and then we studied it. We found out that there were significant pollution contamination problems on the Rocky Mountain arsenal. The mayors from the two cities to the north of Denver, Commerce City and Briton, and the county commissioners of Adams County made it very clear that they would sue the city if we built the airport on the Rocky Mountain arsenal because, they argued, their cities were built first, and they would not be bombarded with noise and potential safety problems, and they said, we'll take you to court, and you'll never build the airport.

MR. BEARDEN: The commitment to a new airport created a new set of political problems. Moving meant bargaining with officials from neighboring Adams County, where the undeveloped land was. The city wanted to build a huge airport with enough room to place the runways far apart, allowing simultaneous parallel landings even in bad weather. That would eliminate the national backups, a key point in winning support from the Federal Aviation Administration, and 1/2 billion dollars in federal money. It took years to strike a deal.

UNIDENTIFIED MAN: I don't care how long you give us, that decision is not going to get me, because politically it's not makable.

MR. BEARDEN: Ultimately, it was makable, but only after Gov. Roy Romer spent endless mornings at breakfast meetings arguing that the dealt was a good one, trying to talk Adams County voters into passing a referendum to let Denver annex the land. That was in 1988. Then Denver voters demanded their say too, even though it wasn't legally required. A special election was held in May of 1989, and the electorate okayed the new airport two to one. That was five years after Mr. Pena got that gleam in his eye.

ACTOR: (movie segment) Something like this -- first floor, living room, dining room, study, kitchen.

MR. BEARDEN: Now the city began drawing up detailed plans of the terminals and concourses. That turned out to be the hardest part of all. When discussions began in 1984, United, Continental, and Frontier all had hubs at Stapleton. The FAA projected quantum leaps in passenger traffic. By 1989, Frontier was out of business. Traffic was down. United and Continental were loudly proclaiming they wanted to stay at Stapleton. Deregulation had turned the corner, and the opposition of airlines made the planning of DIA unique, according to two University of Denver professors who have studied the project.

ANDREW R. GOETZ, University of Denver: Prior to 1978, when airline deregulation took place, the airlines really did not have a major role in airport planning. After 1978, with deregulation, with the airlines' abilities to alter their schedules, to alter their fares, to decide whether or not to serve a market, the airlines played a much bigger role. They essentially held the trump card regarding whether or not this new airport was going to be utilized or not. And eventually, that card proved to be very important to the airlines and very costly to the city.

MR. BEARDEN: But Mr. Pena did not shy away. He decided to start building the airport in 1989, without commitments from either United or Continental.

FEDERICO PENA: I think essentially the airlines never believed it could happen. They looked at the project and said it is too complicated, the people of Denver and Colorado don't have the political will to do this, they don't have the ability to do it, they'll never get federal support, they won't be able to go to the bond markets. And, of course, we proved them wrong every step of the way.

MR. BEARDEN: But others say the city paid a high price for its stubbornness. The original plans called for a $2.1 billion airport with all the trimmings. When the airlines refused to sign lease agreements, that was scaled down to a smaller, plain vanilla $1.9 billion airport. Meanwhile, the contractors moved thousands of tons of dirt, poured millions of cubic yards of concrete. As DIA began to take shape, the airlines came back to the bargaining table. The price of bringing the airlines on board was bigtime changes. Continental wanted a pedestrian bridge to its concourse. United wanted a lot more. Its concourse grew from 30 gates to 44, a full kilometer long. Even more ambitious, it wanted the biggest, fastest, most hi-tech baggage system in the world. Gennifer Sussman was the airport's finance director then.

MR. BEARDEN: The city had to know that there were going to be big changes when the airlines finally did sign on. In that sense, were those original budget projections a bit illusory?

GENNIFER SUSSMAN, Former Airport Finance Director: They really weren't. We were not sure what the airlines would do. We really were very much focused on the Denver market and the need to have a project that could demonstrably be built and opened. And I don't think we anticipated the amount of changes or the size of the facility that United decided it wanted when it did sign on.

MR. BEARDEN: It was the classic moment when costs start to escalate, when the customers decide to scrap the original blueprints and go for something bigger.

CARY GRANT: (movie segment) Now here, for instance, in the study if we could just push out this wall a little bit and put in a built-in bar.

MR. BEARDEN: Now, DIA was no longer plain vanilla. It was chocolate amaretto cheesecake. The price approached $4 billion. United Airlines declined our request for an interview to talk about its role in the changes.

(MOVIE SEGMENT)

MR. BEARDEN: All the revisions literally drove the city's airport director, George Doughty, right out of town. Today he runs little Allentown Bethlehem Easton Airport in Pennsylvania, where construction problems are mercifully small. Doughty believes the present mayor, Wellington Webb, who took office shortly before United signed on, shouldn't have given in to the airline's demands.

GEORGE F. DOUGHTY, Former Denver Aviation Director: Once that was recognized, that the city was going to grant all of these changes, and that's fine, if they wanted to do that. I think it's perfectly legitimate to have their largest tenant make these changes. I think at some point they should have said, okay, give us all of them, this is the cutoff date, and then from that point on say the airport will open 18 months later, whatever that date would have been. The other approach would have been simply to say to United, look, we're not going to make these changes now, we're going to open the airport on schedule, as we've planned, and then we'll come back to you and make the modifications that you still need. The trouble with airlines is they'll change three times in the same, in the same month.

MAYOR WELLINGTON WEBB, Denver: The previous aviation director and myself had a different, somewhat of a different philosophical view in terms of you don't change anything, you build a semi-generic airport, you bring and then make the airlines land there and then go back and do the renovations. I thought it was more cost efficient to do that in the beginning, as opposed to do thing that after the fact, after the airport's open.

MR. BEARDEN: Out on the job site where foundations had been laid, tunnels dug, the abstract debate meant concrete changes. Things had to be ripped out and replaced. The biggest change was to the baggage system: One hundred ninety-three million dollars' worth of tracks, belts, pulleys, cars, lifts, and motors all controlled by computers; the biggest, fastest, most complex system ever built, bags from ticket counter to airplane untouched by human hands. But because it was a late addition, it required extensive rebuilding. It was the moment every builder dreads, when the client asks for changes after construction is underway. Nobody knows about that better than Ginger Evans, the chief engineer.

GINGER EVANS, Deputy Director for Engineering: What we didn't contemplate was with this particular baggage system that's very sophisticated and very complicated and has a lot of movements, that the location of the structural framing as an example, that the system, itself, was fairly unforgiving in terms of, of tolerances and radiuses and slopes, and so we had to move structural framing or frame penetrations through the floor to allow that system to be accommodated within the system.

ACTOR: (movie segment) Well, I think I can tell you what happened. First, the carpenters had to rip out the floor, and it was already laid. Those planks run under the entire width of the pantry, so Rex had to knock out the bottom of the pantry wall to get at them. Then --

GINGER EVANS: It doubled our connected electrical load, so that meant that all our switch gears and panel and metering devices were all undersized, and we had to add a parallel circuitry system to accommodate that load. That was a huge impact.

ACTOR: (movie segment) Well, I guess that's about the size of it, except that Rex had to repair the pantry wall. That meant getting a plaster -- and he couldn't possibly have broken through that wall without --

CARY GRANT: (movie segment) All right, Henry, we'll take care of it.

MR. BEARDEN: It got worse. The baggage system contractor, BAE Automated Systems, tried desperately to meet the original October 1993 deadline. By then, the original design had been dramatically expanded to serve not just United but the whole airport. The contractor set about trying to kill computer bugs while the system shredded test bags. And time ran out. DIA's opening was delayed to December, then March. TV comedians began making jokes. It was an embarrassment for a politician who billed himself as a manager, even more so when Webb had to announce a further delay until May 15th. Three days before that date, the system was still losing track of bags. The airport couldn't work without the baggage system, so Webb's latest announcement was no surprise.

MAYOR WELLINGTON WEBB: (May) Now let's begin with the obvious. The opening at Denver International Airport will be delayed.

ACTOR: (segment) Well, there she is, bright and shiny, and just about complete.

MR. BEARDEN: Just about complete, but over budget and past four deadlines, not unlike Mr. Blanding's little project. But do the delays and increases mean it was badly managed?

JOSEPH S. SZYLIOWICZ, University of Denver: This is a very typical project because large technological projects tend to encounter unexpected difficulties. They tend to run over budget, and they tend to end up costing more than anticipated. All one has to do is to just look at the case of the Chunnel this week, which is one year late and cost double what was originally projected.

MR. BEARDEN: Denver University's Szyliowicz believes the beginning of wisdom about projects this week is to recognize that the changes are inevitable.

JOSEPH S. SZYLIOWICZ: It's illusory for planners and technical experts to assume. We'll let the political decision makers tell us that we want -- that they want an airport built and then they'll leave us alone to do it our way. That -- it simply doesn't happen, and it's never going to happen, happen that way. But that doesn't mean that the planners are rational and the politicians are irrational. What you have at work are very different kinds of rationalities.

FEDERICO PENA: Wow! Look at this!

MR. BEARDEN: Part of the political rationality is to sometimes gamble on a future payoff before the true costs of that gamble can be known. The total price of this airport won't be known for years, and it continues to mount. The bonds issued to finance construction began accruing interest in January. If the airport had opened on schedule, rent and landing fees would have paid that interest. With no revenue coming in, the interest continues to mount at a million dollars a day. Yet, even its critics say that if the airport helps the economy in decades to come, it may still wind up being a long-term bargain, amply justifying Mr. Pena's original vision. RECAP

MS. HUNTER-GAULT: Again, the major stories of this Monday, North Korea announced its withdrawal from the International Atomic Energy Agency. It said inspectors from the U.N. agency would no longer be permitted into the country. And a jury in Alaska found that Exxon Corporation was negligent in the 1989 Valdez oil spill. The ruling could mean billions of dollars in additional damages for the company. Good night, Jim.

MR. LEHRER: Good night, Charlayne. We'll see you tomorrow night. I'm Jim Lehrer. Thank you, and good night.