The NewsHour with Jim Lehrer

GWEN IFILL: Good evening. I'm Gwen Ifill. Jim Lehrer is off. On the NewsHour tonight: Our summary of the news; then, a Newsmaker interview with Britain's Prime Minister Tony Blair; clearing bottlenecks in hospital emergency rooms; pension plans in the red; and Clarence Page on what defines a journalist.

NEWS SUMMARY

GWEN IFILL: The U.S. and Great Britain announced efforts today to eliminate the debt of developing nations in Africa. President Bush and British Prime Minister Tony Blair discussed the matter at the White House. Later, they said African nations that commit to reforms should get help.

PRESIDENT GEORGE W. BUSH: I see we've got a fantastic opportunity presuming that the countries in Africa make the right decisions. Nobody wants to give money to a country that's corrupt. Where leaders take money and put it in their pocket. No developed nation is going to want to support a government that doesn't take an interest in their people, that doesn't focus on education and healthcare. We're really not interested in supporting a government that doesn't have open economies and open markets.

TONY BLAIR: We're well on the way to agreement in that but it's important to realize we need obviously America and the UK to be in agreement. Then we need to get the agreement of the others so we have to watch how we manage that process and bring everyone into it. But, yes, i think there is a real desire to make sure that we cancel the debt and cancel the debt in such a way that it doesn't inhibit or disadvantage the international institutions.

GWEN IFILL: The president also pledged another $674 million in famine aid, mostly for Eritrea and Ethiopia. Prime Minister Blair has called for wealthy nations to double aid to Africa. The U.S. currently gives more than $3 billion a year. We'll have an interview with the prime minister right after the News Summary. A series of bombings in northern Iraq killed at least 18 people today. The attacks, apparently coordinated, were centered around Hawija, 40 miles south of Kirkuk. In addition to the dead, 39 people were hurt. We have a report narrated by Alex Thomson of Independent Television News.

ALEX THOMSON: It is a form of attack, the suicide bomb, which is a daily occurrence in northern and central Iraq. And as the insurgents know well, it's virtually impossible to protect against. Coordinated this certainly was. All these car bombs delivered and detonated in this small town in a seven-minute period. As ever, security checkpoints were the chief targets. More than 860 people have been killed now in the six weeks since Iraq's Shia-led government was sworn in. In the capital, Baghdad, a further 27 civilians were wounded in another car bomb blast as well as one policeman. The bomb detonated in the north of the city. In Baghdad, Iraqi and American forces have continued with what they call "operation lightning." Designed to round up suspected insurgents, 800 checkpoints, nearly 900 suspects taken so far. And today, that word again-- Fallujah-- occupied by force by the U.S. Marine Corps but never pacified. Three people killed by a gunman today who attacked their convoy for supplying the U.S. forces in the city with food.

GWEN IFILL: U.S. and iraqi troops struck back today near the Syrian border. Hundreds of troops launched a new offensive around Tal Afar. They were backed up by U.S. tanks and armored vehicles. Also today, the U.S. Military announced two Marines were killed monday outside Fallujah. Back in this country, General Motors announced it will cut 25,000 jobs by 2008. GM's work force now totals 111,000. The company also plans to shut down more manufacturing plants. It said those steps will save $2.5 billion a year. GM President Rick Wagoner told shareholders meeting in Wilmington, Delaware, the company must rein in medical costs, as well.

RICK WAGONER: Our $1500 per unit health care cost expense represents a significant disadvantage versus our foreign-based competitors. Left unaddressed, this will make a big difference in our ability to compete in investment, technology and other key contributors to our future success.

GWEN IFILL: GM sales are down 5 percent just this year, and the company reported a loss of $1.1 billion in the first quarter. Two major airlines, Delta and Northwest, warned today they could default on their pension obligations. They asked a Senate committee for flexibility in funding the plans. Just last month, United Airlines terminated its benefits. But today, Republican Charles Grassley of Iowa complained many companies conceal under funding of pensions. We'll have more on this story later in the program. A canceled Pentagon contract with Boeing drew new criticism today. The $23 billion deal to convert passenger planes into refueling tankers was killed by Congress after an air force arms buyer admitted inflating the price to help Boeing. At a Senate hearing today, the Pentagon inspector general said former Air Force Secretary James Roche and others share the blame for rushing the deal.

JOSEPH SCHMITZ: I don't think in a real sense it was free and open competition. I think that this was simply a result-oriented, you know, effort to lease 100 of the Boeing tankers as quickly as they could as was authorized but not required in the Appropriations Act.

GWEN IFILL: The inspector general said one Pentagon e-mail even called the deal "a bailout for Boeing". At least one other criminal investigation in the scandal is also under way. The Senate today moved closer to confirming another disputed judicial nominee, voting to end debate on federal appeals court pick Janice Rogers Brown. She was one of three nominees included in a deal last month to avoid a fight over the rules on filibusters. Brown's confirmation vote is expected tomorrow. Citigroup said today it's notifying nearly four million customers of a new security breach. Computer tapes containing information on their accounts got lost in a shipment through United Parcel Service. The missing data included Social Security numbers and payment histories. The bank said there is no evidence anyone has misused the information. On Wall Street today, the Dow Jones Industrial Average gained 16 points to close at 10,483. The nasdaq fell more than eight points to close at 2,067. Actress Anne Bancroft has died in New York. A spokesman said today she had cancer. In 1962 Bancroft won the oscar for best actress as Helen Keller's teacher in the miracle worker. In 1967 she starred as the seductive Mrs. Robinson in "The Graduate." In real life she was married to actor/director Mel Brooks. Anne Bancroft was 73 years old. That's it for the News Summary tonight. Now it's on to: Prime Minister Blair; juggling patients in the ER; troubled pension plans, and who is and who is not a journalist?

NEWSMAKER

GWEN IFILL: Now our Newsmaker interview with British Prime Minister Tony Blair. I talked with him at the British embassy earlier today before his White House meeting with President Bush.

GWEN IFILL: Mr. Prime Minister, welcome. You're here in Washington to meet with the president at the White House and to ask for an aid package for Africa, yet the White House has already announced it's talking about $647 million for humanitarian aid only. That's far less than we're prepared to ask for.

PRIME MINISTER TONY BLAIR: Well, there's still obviously a lot of negotiation to do before we get to the summit that's in Scotland in a month's time.

But it's not just about aid, incidentally. It's very important we emphasize this. It's a comprehensive package for Africa that deals not just with aid but with debt, with trade, with peacekeeping and peace enforcement and conflict resolution, with the killer diseases, and with corruption, with bad governance, with proper systems of governance which are necessary to make any of the aid work. So there's a lot more to this than just discussing money.

GWEN IFILL: Does that mean that you've given up on your more ambitious plan to get countries like the United States to give more?

PRIME MINISTER TONY BLAIR: We've always had in the international community this target of naught point seven percent of the national income of a country every year going to aid.

But actually what's important for the purposes of the G8 summit is to get additional commitments that allow us to fund the things that Africa urgently needs.

If you take something like malaria or polio or TB or HIV/AIDS, there are literally thousands -- thousands and thousands of people dying every day, preventably.

Now we need money in order to be able to get the drugs and the right healthcare systems to help countries that are faced with this terrible problem. But it's not--I don't think we should get fixated on the percentage of GDP every year that goes to aid. I think what we need is the money for the specific programs we're requesting.

GWEN IFILL: You don't want to get fixated on the money but we're talking about money here. Can you achieve this ambitious goal you have for helping Africa help itself without a greater support from the United States?

PRIME MINISTER TONY BLAIR: I think you certainly need more money from the U.S., from Europe, everywhere. But my point is, it's best, instead of plucking a figure out of the air, to start, as we did in our Commission for Africa Report, to start with what does Africa need? What are the things that you could actually spend the money on that would make a difference for Africa? And then out of that you build your figure. Now the European Union's already agreed to double its aid over the next few years.

America, to be fair, this administration has trebled its aid for Africa over the past few years and rather than, as I say, just take a figure out of the air, what I'd like to do is to sit down and work out what are the specific programs that are going to help people in Africa and make sure also that money goes to the people that really need the money, not just unconditional aid given to governments to spend how they want.

GWEN IFILL: One of the things that Africa needs, everybody seems to agree, is some measure of debt relief. Do you expect to get any help from that from President Bush?

PRIME MINISTER TONY BLAIR: Yes. I think we're making progress on that, and, you know, I think we're significant way down the line to try and get that cancellation for the most heavily-indebted countries.

Now if we could achieve that by the time of the summit, in a month's time, that would be a great advance.

GWEN IFILL: What does that mean, "significantly down the line"?

PRIME MINISTER TONY BLAIR: Well, it means that we're discussing whether we can do something as ambitious as actually canceling the debt. If so, how is it funded? What are the terms upon which it's done, and so on? I mean, there are a whole set of technical details. But I think there is a--I don't want to put words in the administration's mouth--but I think there is a willingness to deal with these issues.

GWEN IFILL: When you talk about the G8, you're talking about the meeting which is going to happen next month in Scotland--

PRIME MINISTER TONY BLAIR: Yes.

GWEN IFILL: -- that you'll be leading, and one of your other goals, in addition to bringing Africa front and center, is also climate change. What kind of help do you expect from the United States on that?

PRIME MINISTER TONY BLAIR: Well, again, I think the issue is how do we -- because I've chosen two tough issues for the G8 summit, Africa and climate change -- but the issue is can we get to a sufficient international consensus on it? That it is important to take urgent action on this issue of greenhouse gas emissions and global warming and see if we can devise a way forward that brings the international community back together again on it, because if the U.S. isn't part of this deal overall, then it's very difficult to tackle the problem.

GWEN IFILL: The U.S. is pretty far away from the rest of the international community on that, wouldn't you agree?

PRIME MINISTER TONY BLAIR: Well, the U.S. is not prepared to sign Kyoto; we know that, which is the treaty that was about climate change; however, on the other hand, the U.S. is probably investing more money into research and development, into clean technology, than any other country in the world, and recently, I think it's been very clear, the administration, as much for reasons of energy, security and supply as climate change, are prepared to take bold action in this area.

Now the question is: Can we find a way in which not just the U.S. but Europe, Japan, and then crucially, the big countries, China and India, who are already of course growing massively and are big consumers of energy -- can we find a process that brings all of us together and try and find a way of growing and consuming energy in a more environmentally sustainable way?

GWEN IFILL: You may have heard that today, a group of academic scientists from the Big G8 countries denounced the Bush administration policy on this as misguided.

What would be a concession, in your mind, on this while you're here meeting with the president. or even at the G8 meeting? Would he -- just acknowledging maybe that global warming is a problem?

PRIME MINISTER TONY BLAIR: I don't think the administration do take the view, actually, that there's not an issue here. I think there is a disagreement about how certain the science is. But I think what is interesting is that whether people are coming at this from the climate change angle or whether they're coming on the other hand, from the angle of energy, security and supply, and the worry that, you know, how are we going to make sure that countries like America but also countries like my own--how are we going to be able to secure our energy supplies for the future; whether you come at it from either of these two angles, you get to the same place, which is that we need an urgent, an assertive way forward on this, so that we're developing the technologies and we're making sure that we are creating the circumstances in which we can move beyond this very heavy dependence on carbon emissions and greenhouse gas emissions which are going to do so much damage to not just the environment but over a long time, the whole stewardship of the planet.

GWEN IFILL: The European Union Constitution. Within the last 24 hours Britain decided to delay the parliamentary ratification of the constitution. This is following what happened in France, no, what happened in The Netherlands, no. Where does that leave the state of the European Union and its constitution?

PRIME MINISTER TONY BLAIR: Well, it leaves us with a problem obviously because the constitution is the rules that we agreed that we're going to regulate the enlarged Europe. Europe was fifteen countries; it's now twenty-five; it's going to grow even further. So we've put together a new set of rules to govern this situation in the constitution for Europe.

Now you've had two referendums in two countries that rejected it. We can't ignore that, so we've now got to sit down and work out the way forward, and I think the way forward is first of all to work out the political direction for Europe.

You know, what do we--how is Europe going to respond to the big issues to do with globalization in the economy and the different type of economy that we're expected to have today and with all the insecurity there is in that? How do we deal with the big tides of migration across Europe and elsewhere? These are the major issues our citizens want us to deal with.

I think the problem with the constitution in a way was that they just didn't think it dealt with those issues. It may have been a better set of rules for an enlarged Europe but it wasn't answering those questions.

GWEN IFILL: Was it a political defeat in a Europe --throughout Europe or was it a defeat to the whole idea of unification?

PRIME MINISTER TONY BLAIR: I don't think so; no. I don't think it was a defeat for the whole idea of unification. I think that in the end people do accept that enlargement's got to happen, though you're right--there are underlying worries and concerns, because what's happened is you've brought in countries, the ten new countries coming into Europe, by and large, have got cheaper labor, you know, they're countries that have often emerged from the old communist regimes, and some of the countries who are the existing members of the European Union, wonder that--worry about cheap labor coming in and can we cope with this competition, and so on.

So there are worries there but no, I think ultimately, it was a signal from the people of Europe that the political leadership's got to offer better and clearer leadership on the big issues facing Europe.

GWEN IFILL: How do you get it back on track?

PRIME MINISTER TONY BLAIR: I think getting the constitution back on track requires us really to sit down, as we will do in ten days time or so, and try and consider, you know, now what do we do, because unless you get all the countries in Europe agreeing to the constitution, and two have now said no in a referendum, the thing can't go forward. So we're just going to have to reflect on that for the moment.

GWEN IFILL: And you don't think it was throwing in the towel to cancel the parliamentary ratification?

PRIME MINISTER TONY BLAIR: No, because I think the trouble is, until you get a clarification of what happens, given the French and Dutch no, then it's very difficult to see how you can -- you know -- other countries can make progress very easily.

Now I'm not saying, incidentally, that we don't have to return to this issue because I think it's important we have a proper set of rules for Europe for the future, and neither am I saying in Britain we can tell anyone else what to do. But we didn't feel it right to proceed with our referendum whilst this uncertainty is there.

GWEN IFILL: I have to ask you about something which is finally, belatedly, getting some attention here, and got a great deal of attention in Britain and that's the so-called Downing Street memo, which surfaced as a memo that was very critical of the Iraq War.

In fact, I'll read part of it, where it says that Bush had made up his mind to take military action even if the timing was not yet decided but the case was thin, that is, the case for war in Iraq, which of course you were one of the president's staunchest supporters on this. What do you make of that memo? Did you know about it?

PRIME MINISTER TONY BLAIR: Basically the case that people are making that somehow we'd taken the decision to invade, you know, irrespective of what Iraq did, it's simply not correct. The whole reason we went to the United Nations back in, originally in September 2002, then with the resolution in November 2002, was precisely in order to see if there was a way of giving Iraq a last chance to come into compliance with the United Nations resolutions and avoid conflict. But they didn't.

And so when people -- you know, they take bits out here of this memo or that memo, or something someone's supposed to have said at the time, and what people ignore is we went through a very open, obvious process through the United Nations and the issue was how did you -- because the view I took, as the president did, was we had to enforce United Nations resolutions against countries that were developing and proliferating WMD, that after Sept. 11, the world had changed, we had to take a definitive stance. The place to start was Iraq because it was a breach of U.N. resolutions and instead of doing straight to conflict, which we would have done, had this been the done deal everyone accuses us of, we went through the United Nations to give it a last chance. But it didn't work, unfortunately.

GWEN IFILL: Given what you now know about the intransigence of the insurgency in Iraq and the lives which are continuing to be lost and the build-up which has never died down, do you -- would you make the same decisions based on what you knew then?

PRIME MINISTER TONY BLAIR: Yes, I would because in the end, the reason for it was the breach of the United Nations resolutions, and you're right, it is very difficult, although I believe we--

GWEN IFILL: More so than you expected?

PRIME MINISTER TONY BLAIR: Yes. I think it's been more difficult than we expected because I think what has happened in Iraq is the will of the Iraqi people incidentally is clear. Millions of them went and voted. They want a democratic government. They want a decent future for their country.

But what's happened is that those who are opposed to us, the terrorist groups that want to start this sort of Jihad between the Muslim world and the Christian world, between Arabs and the Western world, those people have gone into Iraq, linked up with some of the people who are insurgents there, and what they're trying to do is to destabilize that democracy in order to defeat not just the Iraqi people and their will but also our ability to show the world that what we actually want is democratic freedom for people, not occupation, not making satellite states of these countries.

And so that what's at stake is very, very big indeed; if we stabilize Iraq and deliver democracy, as I believe we will, the benefits will be felt, you know, not just in the region but right round the world. And so what is at stake here is huge for us.

GWEN IFILL: But how much longer?

PRIME MINISTER TONY BLAIR: I don't know.

GWEN IFILL: I guess I should ask: How much patience do the British people have for us to stay in an open-ended conflict?

PRIME MINISTER TONY BLAIR: Well, the British people aren't quitters. You know. They don't walk away from something that they have started and something they know they need to see through. Whatever people thought about the original decision to go to war -- and I know there's passionate debate about that here as in Britain -- there's only one side to be on this struggle, because we're on the same side as the United Nations, the Iraqi people, you know, not just the countries who are in favor of the war but the countries who are against the war, and who are helping us train the Iraqis, you know, build their capability for government.

It's us versus a group of people that want to subvert that democratic possibility. So, you know, what I say to people is even if you were against the war, even passionately against the war, this struggle is one in which there's only one decent side to be on.

GWEN IFILL: And finally, Mr. Prime Minister, as you know, there is a popular notion that the United States -- it owes you something in exchange for the kind of support that you gave them, and that you suffered for it politically at home by the loss of seats, the Labour Party, and that now when you come here asking for support on Africa, you're being essentially turned away, on global warming perhaps turned away as well.

What does the United States owe you for your loyalty? Or is there anything owed?

PRIME MINISTER TONY BLAIR: Whenever I'm asked this question, I say I don't look at it as sort of payback. If I hadn't thought it was right to do what we did, to stand by America after Sept. 11, to take the action in Afghanistan, to take the action in Iraq -- if I hadn't thought that was right for my own country and in our national interest, I wouldn't have done it. And now I believe we will make progress, incidentally, on climate change and on Africa.

But it's not a--there's no point in America taking this action unless it believes in the action that it's taking in climate change for Africa. So it's not -- this isn't a payback; it's notsomething, a favor I get in return for my support. That's now I look at it.

I'm proud of what we've done in the past few years in the world. I think eventually it will make the world a safer and a better place, and I think what is important is to try then and add to those things that have been tough measures, the necessary action on Africa and climate change that requires a different type of politics but actually has just as much determination.

GWEN IFILL: Mr. Prime Minister, thank you very much.

PRIME MINISTER TONY BLAIR: Thank you.

FOCUS - OVERCROWDED ER

GWEN IFILL: Still to come on the NewsHour tonight: efficiency in the ER, red ink in pension plans and a Clarence Page essay on journalists.

Susan Dentzer of our health unit has the emergency room story. The unit is a partnership with the Robert Wood Johnson Foundation.

SUSAN DENTZER: Boston, Massachusetts -- famous for that long ago tea party in this harbor, for those champion Red Sox. Less well known to the general public -- but a fact-of-life in health care circles -- are the city's overcrowded hospital emergency departments.

This one, at Boston Medical Center, is the busiest emergency department in New England, with 128,000 patients s a year.

DR. NIELS RATHLEV: I think what we're going to do is look at your EKG.

SUSAN DENTZER: Dr. Niels Rathlev, vice chair of the emergency department, or ED, says it's one of many Boston emergency rooms that frequently go on "diversion."

DR. NIELDS RATHLEV: Well, diversion means that all of our acute car bays are full and at that point we make a decision that we're unable to care for yet another sick patient that's brought in by the ambulance services. We then notify the City of Boston Emergency Medical Services and inform them that we cannot accept any more ambulances.

SUSAN DENTZER: The diversion problem is pervasive here in Massachusetts -- and it's getting worse. State figures show that the number of hours Massachusetts hospitals go on diversion has risen about 50 percent in the past two years. There have been no studies to demonstrate the effects. But officials think the problem is almost certainly bad for patients -- and could be causing avoidable deaths.

VOICE ON LOUDSPEAKER FROM ED: Could I have a medical worker to the trauma room?

SPOKESPERSON: I need a bed for this young lady over there...

SUSAN DENTZER: Diversion isn't just a local problem, either. Studies show that three in five of the nation's emergency departments, or ED's, are full or over capacity -- and more than a third regularly go on diversion.

The problem stems in part from a growing chronically ill population -- and rising numbers of uninsured patients crowding the ED. But some critics say hospital practices are also to blame.

So Boston Medical Center called on this man, Eugene Litvak:

EUGENE LITVAK: Now, you manage to have a high sense of some yet significant increase in patient volume.

SUSAN DENTZER: Litvak is an industrial efficiency expert from, of all places, the former Soviet Union. Before emigrating to the U.S. in 1988, he worked at the then-Soviet Ministry of Transportation. There, he helped to streamline building of the nation's railroads.

When Litvak came to the U.S., he turned his sights on health care -- against the advice of his American scientist friends.

EUGENE LITVAK: People suggested the airline industry, transportation, banking, many, many other industries. They were uniform, however, in suggesting that I never go to the healthcare because they said that the healthcare system is not interested in improving efficiency. So I was very much surprised that probably the biggest industry in the world does not apply the operation management tools that every single other industry is applying.

SUSAN DENTZER: But Litvak was eager for a challenge, so he became director of a program in healthcare management at Boston University. After consulting with a number of U.S. hospitals, he concluded his friends had been right.

EUGENE LITVAK: I was extremely impressed with the level of clinical knowledge and the clinical level of the healthcare delivery here, and even more surprising was the fact that it has been accompanied with an absolutely inefficient system.

SUSAN DENTZER: At Boston Medical Center, Litvak set to work figuring out the causes of the diversion problem. His work there was funded through a grant by the Robert Wood Johnson Foundation, which also provides financial support to the NewsHour's health unit.

Litvak first looked at all the ways patients were flowing into and through Boston Medical Center. As is typical in hospitals, many seriously ill patients came in through the emergency department. Once treated and stabilized, many would then be transferred to a bed on the general floor. Other patients would come into the hospital's operating rooms for scheduled or elective surgeries, such as heart bypass operations. If they needed to recover afterward, they'd be transferred to beds on the floor too.

Based on the data he reviewed, Litvak quickly rejected one hypothesis: That the emergency department was being flooded with unpredictable surges of seriously ill patients. In fact, says Litvak, those numbers were steady.

SUSAN DENTZER: So the flow into the emergency department of accident victims, people with gunshot wounds, people with heart attacks, all of that was predictable?

EUGENE LITVAK: That's correct. Surprisingly, our Mother Nature is more predictable than our actions.

SUSAN DENTZER: Instead, Litvak's analysis showed that the ED bottleneck started here in the hospital's operating rooms. Those scheduled surgeries, were mostly being done on Tuesdays, Wednesdays and Thursdays. That was so surgeons could devote other weekdays to scientific conferences or to seeing patients in their offices.

Litvak says a basic principle of industrial engineering is that bunching up anything this way -- including surgeries -- is inefficient. A better way is to smooth out the flow. He demonstrated that by an analogy to Boston area traffic.

EUGENE LITVAK: Let's look at those cars across the river on Memorial Drive. You can see that those cars are driving more or less smoothly, with a similar speed. So when your cars are distributed more or less evenly, then you can get more cars through the road.

But the surgery patients at Boston Medical clearly weren't flowing smoothly -- they were being bunched up on just a few weekdays. That led to choke points on those days throughout the hospital.

One was here in the so-called step-down unit, where patients are brought after surgery if they need extensive monitoring.

Janet Gorman was the unit's nurse manager.

JANET GORMAN: Certain days of the week there would be a bottleneck. There would be patients in the surgical intensive care as well as the recovery room, fighting for the same beds, because it is such a small unit and they were doing so many hearts a day and so many cases that needed the step-down unit, they were both fighting for the same beds. So on those days of the week it was chaotic here.

SUSAN DENTZER: And on those chaotic days, nurses like Gorman racked up dozens of stressful hours of overtime. What's more, amid the scramble for available beds, Emergency Department patients who also needed to be admitted to a bed usually lost out.

EUGENE LITVAK: There is no bed, and the patient in the Emergency Department became what we call a border. She is sitting in the ED, waiting for a bed upstairs on the floor or in the ICU. In the meantime, this patient is occupying the bed in the ED, so other patients who come into the ED, they cannot get in.

SUSAN DENTZER: That's what led to diversions. And at the other extreme, when patients coming into the Emergency Department needed immediate surgery, scheduled surgeries on other patients were frequently cancelled.

Heart Surgeon Dr. Oz Shapira says these so-called "surgical bumps" made for hundreds of unhappy elective surgery patients.

DR. OZ SHAPIRA: Just imagine you are a patient, you're scheduled to have an open heart surgery or a vascular procedure on your leg on or your blood vessel in your belly. And you're waiting for this operation for a month, finally, or even just a week. Finally your day has come, you're coming into the hospital, change to your gown, and then all of a sudden you're being told, 'Sorry, we can't do your operation. You're being bumped for an emergency case, for an urgent case'.

SUSAN DENTZER: Fixing these problems meant eliminating the causes of the bottlenecks. So for starters, scheduled surgeries were spread out over the week.

Heart surgeon Shapira shifted his office hours by one day, to Thursday, to free up Fridays for operations.

Among other changes, nurse Janet Gorman was put in charge of a new system of coordinating patient flow through the entire hospital.

JANET GORMAN: The surgical intensive care unit, there's two patients//ready to go in, so I'm making sure they have their beds.

SUSAN DENTZER: The results were dramatic. In the ED, average waiting time and diversion hours fell.

DR. NEILS RATHLEV: In 2001, we had over 700 hours a year of ambulance diversion. We dramatically decreased this number by about 40 percent. This year we project that we'll have about 250 hours of diversion, which is down about 12 percent since last year.

SUSAN DENTZER: Surgical bumps also plummeted, falling from three hundred thirty-four in one period of 2003 to just three in a comparable period the following year. The changes also saved money -- and improved nursing morale -- by sharply reducing costly nursing overtime in the beleaguered step-down unit.

JANET GORMAN: You look back and say, 'Why did we ever live with it?' I mean it was such an easy thing to fix, why didn't we think of fixing it before? I think in medicine we don't look at the obvious, and Dr. Litvak made us look at the obvious, and it's much better.

SUSAN DENTZER: Given the results in Boston, and at other hospitals Litvak has advised, his approach is now catching on. The national hospital oversight body, the Joint Commission on Accreditation of Health Care Organizations, now recommends that hospitals use scientific management principles to help address ED overcrowding.

Meanwhile, Litvak and his Boston colleagues now plan to conduct further research. They hope it will show that making hospitals more efficient will produce fewer medical errors and better outcomes for patients.

FOCUS - PENSION PROBLEMS

GWEN IFILL: Now, growing concerns over pension obligations and the government's role in protecting them. Ray Suarez has the story.

RAY SUAREZ: As the nations' planes take to the air this summer, some of the employees keeping them aloft face uncertain futures. Many of their companies' pension plans are in jeopardy. One of those companies, United Airlines, terminated its pension plans after a bankruptcy judge gave it the green light last month. Under funded by $9.8 billion, the United default is the largest in U.S. History. Now, the carrier's retirees get their benefit checks from the Pension Benefit Guaranty Corporation, or PBGC, a federal body now running in the red by some $23 billion. Today, the Senate Finance Committee brought federal pension insurers, airline industry executives and employee representatives to Washington for a hearing designed to help prevent the next pension collapse. The chairman, Sen. Charles Grassley from Iowa, was critical of loopholes in the law that allowed United to portray its pension fund as solid when it was in fact weakening.

SEN. CHARLES GRASSLEY: In addition to allowing plans to book phantom investment gains United was able to use stale, non-market interest rates to value pension liabilities, thereby further disguising funding deficits. In other words, our pension laws tell these companies, "take off the green eye shades and put on rose-colored glasses."

RAY SUAREZ: The executive director of the PBGC, Bradley Belt, said United had operated within the law.

BRADLEY BELT: The fact of the matter is that under current law, companies have legal right to pursue distress compensation, to seek to shed their pension liabilities on to the government. That's the law the structured framework that Congress has put in place. United was taking advantage of that as, in my view, far too many companies have done in recent years.

RAY SUAREZ: Though the hearing focused mainly on the airline industry, more than half of the nation's 100 largest pension plans have less than the promised benefits on deposit. Some 34 million people, or 20 percent of the nation's work force, expect to get payments from their employers' benefit plans. Captain Duane Woerth, the head of the Airline Pilots Association, warned other airlines would follow United's path.

CAPT. DUANE WOERTH: All these legacy carriers are on the same path. U.S. Airways and United got there first, but I can tell you with absolute certainty Delta Airlines, Continental Airlines, Northwest Airlines and eventually American Airlines are on that same path.

RAY SUAREZ: Delta's CEO, Gerald Grinstein, said other airlines were headed toward bankruptcy unless reforms were made.

GERALD GRINSTEIN: Airlines are at a crossroads. Without changes, they will almost certainly be forced into bankruptcy in the transfer of additional pension liabilities to the PBGC.

RAY SUAREZ: But Republican Sen. Jim Bunning of kentucky took airline executives to task.

SEN. JIM BUNNING: Sir, in the last two and a half years, how many dollars has Delta Airlines lost?

GERALD GRINSTEIN: Well, we lost $5 billion last year.

SEN. JIM BUNNING: You're going to listen how bad management at Delta Airlines has cost the employees of Delta not only their pensions, but reduced pensions, reduced pay and reduced everything, and you blame it on everybody but your own management group.

RAY SUAREZ: The president of the Flight Attendants Association, Patricia Friend, gave the problem a human face.

PATRICIA FRIEND: These are not careless people who failed to plan for their retirement. They did everything right-- worked hard, saved as much as they could and invested when possible. Their only mistake was one of trust.

RAY SUAREZ: Congress is now beginning to draft legislation to strengthen the future finances of the Pension Benefit Guaranty Corporation. No timetable has been set for the debate or the vote.

RAY SUAREZ: A closer look now at the pension system and the challenges it faces. For that, we are joined by Bradley Belt, executive director of the Pension Benefit Guaranty Corporation, the federal institution that backs-up private pensions-- as we just saw, he spoke at today's hearing; and Karen Friedman, director of policy for the Pension Rights Center, an organization that seeks to protect the pensions of workers and retirees.

And, Karen Friedman, given what was said at today's hearing, given the very high profile failures of the recent past, should a portion of those 34 million workers who are in defined benefit plans now be skeptical, be worried that they're going to get the check they think they have coming to them?

KAREN FRIEDMAN: Well, I want to talk about this in a couple different ways, Ray. First, just because a company has an under funded pension plan is not immediate cause for concern. How a pension plan is funded is cyclical. It's done over the long-term just like the economy. So a pension plan that may be under funded today may not be under funded tomorrow. In fact, in the 1990s a lot of the companies that have under funded plans now had over funded plans in the 1990s just as an example. The issue is, if a company is troubled and has an under funded plan, then there may be cause for concern. And that company may terminate the plan. But even then, i want to point out-- and this is where, you know, Brad is here-- the Pension Benefit Guaranty Corporation is there as a back-up system to ensure that people in defined benefit plans will be able to get their benefits paid by the PBGC, if a company can't meet all of the benefit obligations. And in a majority of cases it does pay most of the benefits. The United case, however, have devastating consequences because in that situation the company was able to go into a bankruptcy court and dump its liabilities on to the PBGC, which led to $4 billion in losses for workers. That's a tragedy.

RAY SUAREZ: How did all these companies, Bradley Belt, get into trouble at the same time?

BRADLEY BELT: It was a combination of factors, Ray, perhaps most attributable to the funded status of the pension plans themselves, what was happening in the pension plans and beginning in 2000 you saw the market, equity markets turn against them. Many of them were heavily invested equities taking on significant equity risk. The markets went south for a period of about three years. At the same time, interest rates also fell. That's how they discounter their liabilities. When interest rates fall the value of those liabilities goes up. So you're moving in opposite directions. The problems that under current law much of that movement, that funding gap that was building fairly substantially for that three- year period of time was hidden from view because of some flaws in the current funding rules. That's why the Bush administration and the president is so committed to changing those rules, strengthening them so that we understand the true financial status of the pension plan at any point in time and we can move quickly to restore those plans to healthy funded status.

RAY SUAREZ: What about these changes in the rules? Will they be at least part of the answer that you're looking for?

KAREN FRIEDMAN: Well, certainly we think that the administration has presented some strong and thoughtful proposals. However, we think in a lot of situations the administration's proposals actually may have the opposite effect. That instead of strengthening defined benefit plan it may undermine the defined benefit plan because some of what their proposing is on onerous that companies may exit the system. In some cases their solutions rely on benefit cuts for workers which we disagree with.

RAY SUAREZ: Now you just heard Bradley Belt talk about interest rates, about the decline in the markets. You yourself called the problem cyclical. But the market has clawed back a lot of its post 2000 losses. Interest rates have risen gradually but eight straight quarters. Job creation has been robust. How come a lot of these pension plan balance sheets aren't in better shape as a result?

KAREN FRIEDMAN: Well, again i mean we saw a situation in the 1970s where there were under funded pension plans. There may be other, you know, factors. Brad is absolutely right that some of the funding rules do need to be strengthened, Ray. I mean there's no question on that. The funding rules allow for companies often to promise benefits way into the future and not fund them, so we agree that there has to be some funding reform. However, we think that there has to be a balance struck between the kinds of reforms that will strengthen funding for pension plans and not lead to companies just dropping those plans.

RAY SUAREZ: Well, if there are more United Airlines in the pipeline, is your agency ready to back up those pensions? Can you handle many more of them?

BRADLEY BELT: We have the ability to do so in the near term but clearly not over the long term without a change in law, Ray. That's why it's so critically important to put in a place appropriate policy changes now. Karen is right. There does need to be a balancing of interest. But the balancing cannot tip on the side of continuing the status quo set of rules that got us into this problem in the first instance.

RAY SUAREZ: Well, tick off what some of those changes would be.

BRADLEY BELT: Strengthen the funding rule s so that companies have meaningful measures of assets and liabilities, market-based measures, not some phantom measures of assets and liabilities based upon market conditions two, three, four and five years ago.

RAY SUAREZ: So right now i have this much money.

BRADLEY BELT: That's exactly what participants, retirees, workers, shareholders and even regulators need to know to make informed life and policy and business decisions. We need to make sure that we have an appropriate funding target so that companies are always moving in the right direction to make sure that if there is a funding gap that develops, they're quickly moving in the direction of closing that funding gap. We need to make sure that there is a premium structure in place that recognizes that different companies pose different levels of risk to the insurance program, just as the case with homeowners insurance, life insurance or auto insurance. Most importantly we really do need much greater transparency into the system. There's far too little information. We need to shed a little sunlight on pension finances. It's been an area that's really been cloaked in darkness for far too long. Workers and retirees have a right to know the president believes very strongly that companies that make pension promises to their workers should honor those promises and critical to having that happen is allow them to be able to post some discipline on the companies themselves by understanding what the funded status of the pension plan is at any given point in time.

RAY SUAREZ: Karen Friedman.

KAREN FRIEDMAN: What I would say to that we certainly agree that premiums should be increased and in fact if premiums had been doubled since the time that the Pension Benefit Guaranty Corporation was created, we probably wouldn't even have a deficit right now in the PBGC. We agree with that. We certainly agree that there should be some changes in the funding rule but they have to be done slowly because their aim... most of the administration's proposals are aimed at the very troubled industries that have defined benefit plans. We don't want to push those companies out of the pension business. The point here for the American public is that this is not just an academic exercise. We're talking about defined benefit plans are the most efficient way of providing benefits to workers of all different income levels. And what is worrisome is that the administration's proposals in some cases may push employers out of the system. And then who is going to win in that situation? We're going to move into a society which we're moving into anyway, where there's not going to be good defined benefit plans and we're moving into a do it yourself savings society where people are going to have to save on their own. We need to find plans in this country so we can provide adequate income to people in the future. One of the questions that i have, i want to go back to United for a minute --

RAY SUAREZ: Quickly.

KAREN FRIEDMAN: United was able to use the bankruptcy courts to dump their liabilities on to the PBGC, and we have to do something now and i think Brad would agree with me on this to ensure that companies can't use bankruptcy courts in that way.

RAY SUAREZ: Well, let's take on just that. Does this create an incentive for companies that may have other options to declare bankruptcy because they know they can take that pension load off their back?

BRADLEY BELT: That's certainly a legitimate concern. We saw a come knee effect in steel industry. We've seen the beginnings of that certainly in the airline industry. Understand that not only U.S. Airways and United Airlines we've previously taken over and assumed responsibility for the pension plans in Braniff, TWA, Eastern and Pan Am. That's the important point to note. In the last three there have been 23 corporate pension defaults in excess of $100 million. United is simply the largest of those with a pension shortfall of almost $10 billion and as Karen noted tragically a loss of over $3 billion in benefits for retirees and workers. That's unacceptable. That's why we need to strengthen the pension rules. It's not acceptable to allow the status quo framework to stay in place where we've run into this situation where workers and retirees are losing benefits that they earn that were promised to them by the corporate plan sponsor and not only do they lose it's the other responsible premium payers that have acted prudently to fund their pension plans that also have to face the prospect of higher premiums and ultimately the taxpayer may be at risk.

RAY SUAREZ: Bradley Belt, Karen Friedman, thank you both.

BRADLEY BELT: Thank you, Ray.

KAREN FRIEDMAN: Thanks.

ESSAY - WHO'S A JOURNALIST?

GWEN IFILL: Now, essayist Clarence Page of the Chicago Tribune asks who is a journalist?

CLARENCE PAGE: As you may have noticed, I'm a member of a vastly misunderstood minority group. I am a journalist. So many people are running around calling themselves journalists these days, claiming journalist access, privilege and protections, that a lot of other people are asking who is a journalist and who isn't?

REPORTER: Senate Democratic leaders have painted a very bleak picture...

CLARENCE PAGE: The question loomed large as a banner headline after a White House reporter named Jeff Gannon-- and also James Guckert-- was found to be reporting not for a conventional newspaper or broadcaster but for a partisan Republican web site. Journalist or propagandist? Such questions loom large again after Apple Computer sent subpoenas to the authors of online web sites that allegedly had published trade secrets about a new Apple product. Apple wants to know who the leakers are. The web loggers, or "bloggers," claim they have a right to protect confidential sources, as journalists do.

SPOKESMAN: Like, I upgraded to "blogger pro," which is...

CLARENCE PAGE: But bloggers may be shocked as some journalists have been to learn that shield law protections depend on the state in which they are subpoenaed. The Constitution does not differentiate between the New York Times or the National Enquirer, nor do the rules for who covers the president. The Secret Service determines who is a security risk but not who qualifies as a journalist. Are bloggers journalists? The question presumes journalists are more special than we are. The founders might never have forecast the Internet, but they would easily have understood its purpose. We have bloggers, they had pamphleteers. Were pamphleteers journalists? It didn't matter. They were protected by the very first amendment, because freedoms of political expression, like the freedoms of assembly and religion, were the freedoms from which all others grew. Today, we have the Internet, a great leveler. "The Drudge Report," a one-man web page, broke the monica lewinsky scandal story. It also produced the john kerry sex scandal scoop that proved to be false. Bloggers exposed flaws in Dan Rather's story about President Bush's National Guard Service. And the bloggers won't let us old school journos forget it.

SPOKESMAN: Had it been left to the major media, the Trent Lott affair would have come and gone and just zipped right off the landscape.

CLARENCE PAGE: Like unleashed adolescents, they do get a bit full of themselves sometimes, crowing about their independence and their uncensored cleverness, taunting us old school mainstream media types-- or "MSM" in blogspeak. That's okay. Reality, like the aging process, awaits the blogosphere and its webhead inhabitants. The new wave media face the same workaday challenges and obligations as their "MSM" brethren. Ultimately, you must feed the beast, the bottomless appetites of an audience always hungry for something new. Get your facts straight or lose credibility and possibly your house. After all, lawyers say, bloggers can be liable for defamation or for spilling trade secrets just as journalists can. Live like a journo, suffer like a journo. The Internet is empowering, but journalism is humbling. Once the new toy thrill has wafted away, the new journalism will look increasingly like the old, only faster, more interactive and infinitely more abundant. Who is a journalist? Anyone who wants to be. The audience decides who among us is credible and who's a crackpot. Journalist sometimes judge others, but always we are judged. I'm Clarence Page.

FINALLY - ANNE BANCROFT - 1931-2005

GWEN IFILL: Finally tonight remember be Anne Bancroft who died yesterday at age 73. For many movie viewers she'll always be Mrs. Robinson the 1967 film "The Graduate." Here she is with Dustin Hoffman in a clip from that movie.

ANNE BANCROFT AS MRS. ROBINSON: May i ask you a question? What do you think of me?

ACTOR: What do you mean?

ANNE BANCROFT AS MRS. ROBINSON: You've known me nearly all your life. You must have formed some opinion of me.

ACTOR: Well, i always thought that you were a very nice person.

ANNE BANCROFT AS MRS. ROBINSON: Did you know i was an alcoholic?

ACTOR: What?

ANNE BANCROFT AS MRS. ROBINSON: Did you know that?

ACTOR: Look, i think I should be going.

ANNE BANCROFT AS MRS. ROBINSON: Sit down, Benjamin.

ACTOR: Mrs. Robinson, if you don't mind my saying so, this conversation is getting a little strange. I'm sure that Mr. Robinson will be here any minute now.

ANNE BANCROFT AS MRS. ROBINSON: No.

ACTOR: What?

ANNE BANCROFT AS MRS. ROBINSON: My husband will be back quite late. He should be gone for several hours.

ACTOR: Oh, my God.

ANNE BANCROFT AS MRS. ROBINSON: Pardon?

ACTOR: Oh, no, Mrs. Robinson. Oh, no.

ANNE BANCROFT AS MRS. ROBINSON: What's wrong?

ACTOR: Mrs. Robinson, i mean you don't expect....

ANNE BANCROFT AS MRS. ROBINSON: What?

ACTOR: I mean you didn't really think I'd do something like that.

ANNE BANCROFT AS MRS. ROBINSON: Like what?

ACTOR: What do you think?

ANNE BANCROFT AS MRS. ROBINSON: Well, I don't know.

ACTOR: For God's sake. Mrs. Robinson. Here we are. You got me into your house. You give me a drink. You put on music. Now you start opening up your personal life to me and tell me your husband won't be home for hours.

ANNE BANCROFT AS MRS. ROBINSON: So?

ACTOR: Mrs. Robinson you're trying to seduce me.

RECAP

GWEN IFILL: Again, the major developments of the day: President Bush and British Prime Minister Tony Blair announced efforts to eliminate the debt of developing nations in Africa; a series of bombings in Northern Iraq killed at least 18 people; and General Motors announced it will cut 25,000 jobs by 2008. We'll see you online and again here tomorrow evening. I'm Gwen Ifill. Thank you and good night.