The NewsHour with Jim Lehrer

JIM LEHRER: Good evening. I'm Jim Lehrer. On the NewsHour tonight some perspective on the standoff in Northern Ireland; a look at the growing debate over regulating managed care that includes the debut of our new health care policy correspondent, Susan Dentzer; a report from Seattle on the business of on-line publishing; and a sampling of new television commercials aimed at curbing drug abuse. It all follows our summary of the news this Thursday.% ? NEWS SUMMARY

JIM LEHRER: President Clinton consoled victims and thanked firefighters today in Florida. He flew to Daytona Beach to inspect homes and businesses burned by weeks of wildfires that swept the state. He was flanked by emergency workers and Governor Lawton Chiles at the Daytona Speedway. He told the group the federal government is developing a long-term recovery plan. It will offer loans, jobs, and temporary housing to victims. Before his Florida visit, the president stopped in Atlanta to launch a $2 billion anti-drug advertising campaign. He was joined by House Speaker Gingrich. The ads are meant to target children. Seventy-five newspapers and four major television networks will carry them. Gingrich said Congress was committed to funding them for five years. Mr. Clinton talked about his brother's past drug addiction.

PRESIDENT CLINTON: There's somebody like my brother back atyour school who's a good kid, just a little lost, somebody told him something all right that wasn't, and the family members were just a little out of it and couldn't believe it was going on. You can save 'em. What these ads are all about. These ads are designed to knock American up side the head and get America's attention and to empower all of you who are trying to do the right thing.

JIM LEHRER: We'll show some of those ads at the end of the program tonight. The Senate passed the IRS reform bill today by an overwhelming ninety-six to two vote. It would give taxpayers more rights, including moving the burden of proof in tax court cases to the IRS. And it would create an oversight board with members from the private sector. The House has already passed the bill. President Clinton has said he would sign it into law. A powerful earthquake struck Alaska today. It measured 6.4 on the Richter Scale. It was centered about 125 miles southwest of Anchorage in a remote mountain area. The tremors caused only minor damage and no injuries, according to early reports. Overseas today talks between British Prime Minister Tony Blair and Northern Ireland Protestant leaders failed to break the parade standoff. It started Sunday when security forces turned back Protestant marchers as they approached the Catholic enclave near Belfast. Blair does not have the power to lift the police blockade, because it was imposed by an independent Irish commission his spokesman said. We'll have more on the standoff right after this News Summary. Secretary of State Albright today urged Congress not to change US trade treatment of China. She asked the Senate Finance Committee to renew so-called Most Favored Nation status for China. Most US trading partners have such MFN consideration. By law, China's must be renewed every year because of its Communist government and human rights record. President Clinton just returned from China. Albright said revoking its trade status now would be embarrassing and harmful.

MADELEINE ALBRIGHT: MFN revocation could come back to haunt us even more substantially by de-stabilizing currency markets in the Asia Pacific. China has played a constructive role in promoting financial stability in the region through direct assistance, multilateral cooperation, and participation in the international financial institutions. MFN revocation would set back China's own daunting program of market reforms and, thus, make it harder for China to maintain its contribution to Asian stability.

JIM LEHRER: Police in Puerto Rico today arrested five people for planting bombs at the headquarters of the state-run telephone company. It followed a two-day labor protest against the sale of the company to a private buyer. The 48-hour general strike ended with a few rallies last night, but 6400 phone workers were still refusing to return to work. The protest was the largest in Puerto Rico's history. Strikers said the island's voters may decide whether the sale should be allowed. And that's it for the News Summary tonight. Now it's on to a Northern Ireland update, a managed care debate, publishing in cyberspace, and some new anti-drug commercials.% ? UPDATE - NEW TROUBLES

JIM LEHRER: Kwame Holman begins our coverage of those new troubles in Northern Ireland.

KWAME HOLMAN: Early today, a delegation of Protestant Orangemen arrived at London's Number 10 Downing Street to meet with Britain's prime minister--drawing Tony Blair directly into the latest crisis in Northern Ireland. The meeting was aimed at ending the four-day stand-off that has prevented Protestant Orangemen from completing their annual parade through a Catholic neighborhood in Belfast, Northern Ireland.

TONY BLAIR: We had full and frank meeting with the prime minister, and we will be reporting back on the contents of that with the Belair and Portadown district in due course. Thank you very much.

KWAME HOLMAN: But the prime minister reportedly will not try to overrule the local commission that banned the Protestants from their annual parade down the Gavaghy Road in the predominantly Catholic town of Portadown. As the stand-off entered its fourth day, Protestant leaders warned it easily could escalate into a general shutdown of Northern Ireland if the marchers aren't allowed to proceed. Robert Sawlters is grand master of the Orange Order.

ROBERT SAWLTERS, Orange Order: This protest is not party political. This protest is about stopping the cultural apartheid in Northern Ireland. It is about ensuring civil rights for all and special privileges for none. It is about securing a just, equitable, and tolerant society.

KWAME HOLMAN: There has been violence in the province each of the last four nights. Protestants have clashed with police and British Soldiers who began enforcing the parades committee decision to halt the marchers last Sunday. Fifty officers have been injured and one hundred twenty-five people arrested. Meanwhile, camped out in a field near the barricades are hundreds of Orangemen. The Orange name goes back to King William of Orange's victory over Catholic King James II 400 years ago. Having formed a fraternal organization about 200 years ago, the Orangemen have been marching through Portadown every July since. The July parades have been a flashpoint for violence in the last 30 years of Irish troubles. This latest outbreak comes just two weeks after the province entereda new era of self government and, it was hoped, peace. The new government was a result of the Good Friday peace accords overseen by former US Senator George Mitchell. The historic agreement was aimed at bridging the gap between Protestants--called Unionists--who favor continued union with Great Britain and Catholic Nationalists who favored joining the Republic of Ireland. Unionist David Trimble, elected to head the assembly and barely sworninto office when the violence hit, has been appealing for calm.

DAVID TRIMBLE: We are all very conscious of the fact that time is running out and that the weekend carries with it very grave risks for society in Northern Ireland. We do know that there are elements within the society here who will take advantage of the quite understandable protests that the Orange Order have organized in order to create mayhem either because they have a political motive, or because they intend to enrich themselves as a result of it, or just simply out of politicism at large.

KWAME HOLMAN: However, the Orangemen say they plan to go ahead with another parade set for Monday, on Belfast's predominantly Catholic Ormeau Road. That march already has been approved by the parades commission.

JIM LEHRER: Margaret Warner takes the story from there.

MARGARET WARNER: For more now we turn to Paul Arthur, a professor of politics at the University of Ulster, one of Northern Ireland's two universities. He's spending the year in Washington as a senior fellow at the United States Institute of Peace. And James Mates, Washington bureau chief of the London-based Independent Television News. He covered events in Northern Ireland from 1984 to 1987. Welcome both.Mr. Arthur, why are we seeing this flare-up now after months of real progress on the peace front?

PAUL ARTHUR, University of Ulster: Well, you have to remember this is an annual phenomenon. There is what is known as the marching season, when the Orange Order have up to 3,000 marches over a short summer season. So it has been going on for centuries, as your news clipping showed. And the fact that it's going on simply means it proceeds from previous year all the way back to the 1800's. But the significance of what's happening now is simply because we've had a peace agreement and this has got the potential to wreck peace agreement. And that gives it another dynamic.

MARGARET WARNER: Why do you think we're seeing this flare-up?

JAMES MATES, Independent Television News: I think it's exactly as Paul says. Partly, the unbreakable cycle, it seems, in Northern Ireland politics. A lot of what's been going on in terms of the peace agreement and the referendum and the new assembly is aimed at trying to break that cycle, but it hasn't broken this one. This comes round every year. Every year you can write it in your calendar-there's going to be trouble in July and early August, because of the Orange parades and because of Catholic opposition to them.

MARGARET WARNER: Why are parades-you mentioned that the Orangemen hold some 3,000 a summer-why are they such a big deal in Northern Ireland and such a big deal politically?

PAUL ARTHUR: I think parades are a way of staking out your territory. Here are a people here-the majority of the population that behave as if they're a minority, because on the island of Ireland they are a minority and have never trusted the British government. Parades are a way of saying this is our territory, this is the only way we can assert ourselves.

MARGARET WARNER: And why this particular parade, because a lot of them do go on peacefully, relatively peacefully, why did this particular one become such a flashpoint?

JAMES MATES: It's been a flashpoint really since 1985, and it's gotten worse and worse every time. And it's now become symbolic. Many of these parades have been re-routed or even canceled. There has been compromise on both sides over other parades. But this is one of the ones on which-which has taken on a symbolic importance because of the battles that have been fought-they're literally pitched battles between Orangemen not allowed to go through and policemen and then when the police tried to force them through, it did force them through between the Catholics-residents and the police, we've seen horrendous scenes in the past. Both sides have absolutely staked the parade battle drum-we saw it coming, because we know it's happened in previous years.

MARGARET WARNER: You said, Mr. Arthur, that you thought this could really derail the peace agreement. How so? I mean, give us a brief bad scenario.

PAUL ARTHUR: Well, the bad scenario is that as a result of this parade being blocked Orangemen in other parts of Northern Ireland are already on the streets. They're stretching security forces to their limits. So that that creates a climate of violence which just takes on a life of its own. Once that happens, those who happen to support the peace agreement, they begin to have second thoughts about it. For example, in your news footage a number of people I could see are members of David Trimble's own party.

MARGARET WARNER: David Trimble being-

PAUL ARTHUR: Being the leader of the Ulster Unionist Party and being the first minister in this new peace agreement assembly. So he has even members of his own party, elected members of parliament of his own party opposed to this, and they carry a good degree of moral authority. Once that spreads throughout a community, people may begin to have second thoughts. And against that I think that the peace agreement has set up a new political architecture which it will be very difficult to knock down. In the short term, yes, it might succeed in causing a lot of damage, but in the long-term I think we're into a period of sustained peace once we get over this marching season.

MARGARET WARNER: How big do you see the threat here?

JAMES MATES: As Paul said, it's a very real threat, and I think one of the reasons that it can undermine things is how David Trimble's authority will come out of this. Remember what he's achieved in the last year. He's managed to sign the agreement against the opposition.

MARGARET WARNER: Let me interrupt you a minute. Explain a little bit about his background just that he came from the different side of things on the Protestant camp. I mean, he used to be quite militant, did he not?

JAMES MATES: Absolutely. And one of the ways that he managed to take Unionists with him-Unionism with him through the referendum and through these elections is by standing at the head of the marches at Drum Creek-in previous years with his orange sash on to convince those of his own supporters that he is a man who is not about to sell out the union even if he is trying to persuade them to make the compromises, to make peace possible. Now, that puts him now in a very difficult position. He is the first minister of Northern Ireland. On the other hand, his own constituency is not likely to stand behind him, as it would have done, if he compromised or backing down or Drum Creek, which is where lots of the authority of his leadership came from in the first place.

MARGARET WARNER: But has this really epitomized the split that existed in the Protestant community even over the vote?

PAUL ARTHUR: I think it does precisely that. We have to remember that Protestantism, unlike Catholicism, isn't monolithic. There are several different fragments. And as you said, Margaret, David Trimble has moved from one tendency to another, and people like certainties. They don't like the leaders to move in a place like Northern Ireland, and that makes his life-political life very, very precarious at the moment. What he has done is he showed a huge amount of moral courage. He's shown vision inside a community which hasn't shown much vision in the past. And that has been, for many of them, a bridge too far, and they're not prepared to go along with them on that.

MARGARET WARNER: Pick up on this split in the Protestant community. How representative would you say the Orangemen are in what they're doing of the Protestant community in the North?

JAMES MATES: I wouldn't have said they were unrepresentative in their views. They backed the peace agreement. The Protestant community, of course, support it, a majority of them supported the peace deal, but didn't get much over the 50 percent. So many members of David Trimble's own party and the official Unionists were not prepared to go along with the agreement, and, of course, the more radical party, the Democratic Unionists, were utterly opposed to it. So the Protestant community overall is split, but the Orangemen, I would not have said, and Paul may disagree with me on this, I would not have said are out of step with the Protestant community in general in their demand to be able to march down the Gavaghy Road.

PAUL ARTHUR: It's a highly emotional thing. I mean, as I said, they-

MARGARET WARNER: You could support the peace agreement, as some of these Orangemen did, and still believe you have the right to march down the-

PAUL ARTHUR: Absolutely. Absolutely. What you have to remember is, in fact, that a decision to oppose the agreement was taken by the leadership of the Orange Order. The Orange Order has 80,000 members. We don't know absolutely because people would have voted. Many of them would have voted against it. They are a microcosm of the white Protestant community, and just as the whiter Protestant community split, so are they.

MARGARET WARNER: And what about the Catholic side now? They've been pretty quiet. Is that because right now the status quo is essentially favoring them.

PAUL ARTHUR: The Catholic community has been pretty quiet because it's to their advantage that the damage is being done by the so-called Loyalists, those who seem to be loyal to the crown, who are attacking the forces of law and order of the crown. They can afford to sit back and they believe if the peace agreement unwinds, they won't be held responsible. It will be the Protestants. They also know that in Tony Blair there is a prime minister with a huge majority who is probably here for the next eight or ten years in power, and they know that he will not be pleased with the actions of Orangemen, and he will become more sympathetic to their particular stance.

JAMES MATES: It's going to be very interesting to see what happens, picking up on the point about the Catholic community, what happens on Monday, when, of course, the parades commission, which banned this march down the Gavaghy Road has allowed a march through a Catholic area in Belfast, and now they're fighting that in the court. We'll expect a decision on that tomorrow, but if the courts give that march the go-ahead, it'll be very interesting to see whether the-why the Catholic community is prepared, themselves, to accept a parades commission decision.

MARGARET WARNER: Now, the voters of Northern Ireland just six weeks ago elected this new assembly. 70 percent or so are moderate centrists drawn from both communities. Do they have any power here, any sway, any authority, any ability to control this, or handle this situation?

JAMES MATES: I think in terms of an overall breakdown of the whole peace process, yes, they have. The weight of opinion is such, I suspect, that however bad things get in the next few weeks and-don't forget-things were just as bad last year-and yet within months people were still talking and still doing bills and still passing referenda. I suspect at this stage the weight of opinion in favor of peace and opposed to letting this whole thing collapsed will be strong enough, I hope, to see it through.

MARGARET WARNER: Do you think-

PAUL ARTHUR: I would agree absolutely with that. As I say, short-term, the prospects don't look very good. Let's get over the marching season, and I do believe that there is a drive there on the ground by ordinary people to say we want peace, and we're going to insist that our political leaders push towards peace. 72 percent of us voted for peace; we voted overwhelmingly in a referendum for a peace agreement. Admittedly, the Protestant community was much more divided, but still there's a great majority inside Northern Ireland.

MARGARET WARNER: But you said let this marching season end this summer season, but can this-I mean, we saw the kind of violence-no one's died yet-but can that just continue for the next seven or eight weeks and sort of just frozen like this, without spinning out of control?

PAUL ARTHUR: Someone once described the politics of Northern Ireland as the politics of the last atrocity. And so as a secretary of state once said, that there was an acceptable level of violence. Cynically, I think that that's what politicians do believe, that there is an acceptable level of violence, and if you can keep it at that level, that's a victory of some sort.

JAMES MATES: I agree with that. I think one of the difficulties, of course, is the violence between the police and the Loyalists. The Protestant community is always slightly different than between the police and the Catholic community because it is an almost entirely Protestant force that has to live amongst Protestants, and, therefore, reprisals against a policeman and their families. They know who they are. They know where they live, and they're living right amongst them. So it's always rather more dangerous if Protestants and police are fighting from that point of view. But, as Paul says, it's containable at the moment, and is by a very long way not the worst that's been seen there.

MARGARET WARNER: And, briefly, do you think Tony Blair can have an impact here?

JAMES MATES: Certainly. He put his personal authority behind this from the very beginning. He went there and sat through the talks to drive it personally. And I think the reason he's meeting Orangemen today is to do the same thing.

MARGARET WARNER: Do you think he can have an influence?

PAUL ARTHUR: I think he can have. I think he is having an influence over it. I think matters could have been much worse, and, at the very least, people realize he's around for a long time, they're going to have to deal with him, so they may try and get him on their side. And to get him on their side, they have to show restraint.

MARGARET WARNER: All right. Well, thank you both very much.

JIM LEHRER: Still to come on the NewsHour tonight, the managed care debate, on-line publishing, and some new anti-drug ads.% ? FOCUS - MANAGED CARE

JIM LEHRER: Tonight we inaugurate a new venture for the NewsHour. It's a partnership with the Henry J. Kaiser Family Foundation to expand our ongoing coverage of health care issues. Susan Dentzer, most recently with US News & World Report and a frequent reporting guest on our program, will be the correspondent. She will do regular reports on the full range of issues that fall under the broad heading "health care." Here's her first on proposed managed care legislation.

SUSAN DENTZER: At least 160 million Americans are now in HMOs or some form of managed care, up from 92 million just six years ago. That means that a majority of Americans have now experienced some of the cost-saving techniques of these plans, such as restricting patients' choice of physicians. A backlash to these measures is growing - and in an election season where there isn't much else to talk about, politicians have noticed.

PRESIDENT CLINTON: Millions of Americans are looking to us for the right kind of action. They want us to pass a strong bipartisan Patients Bill of Rights, they want us to put progress over partisanship. They want us to leave our country stronger for the century just ahead.

REP. DENNIS HASTERT, [R] Illinois: Let's face it when folks are sick, they should be able to see a doctor. Unfortunately, many are afraid that they will not receive the care they need, and I'm proud to say that our plan provides patients with the necessary protections to get them well without new taxes, without more bureaucracy, or the heavy hand of government.

SUSAN DENTZER: Even Hollywood has picked up on the public's growing concern that managed care could translate into poor care--or no care--just when patients really need it.

SPOKESPERSON: How about skin testing for allergies?

WOMAN: No.

SPOKESPERSON: Standard scratch test, they poke 'em with a needle?

WOMAN: No. I asked. They said my plan didn't cover it and it wasn't necessary anyways. Why? Should they have?

SPOKESPERSON: Well-

WOMAN: [Expletive deleted] HMO [expletive deleted] pieces of [expletive deleted]--I'm sorry.

SPOKESPERSON: It's OK. Actually, I think that's their technical name.

BOB BLENDON: When they saw it on the movie, they could say this could happen to me and this is a phenomena going on in America. That's what makes this such a powerful political issue.

SUSAN DENTZER: Robert Blendon is a public opinion expert at Harvard. He says people tell pollsters they are most concerned about these core issues.

BOB BLENDON: People absolutely feel in the emergency room if they have pains in the chest they don't want to deal with an 800 number nor be second guessed later on. The second has to do with appealing if you are very very ill and you feel that you are being denied access to a medical specialist or an advanced drug, that you appeal to someone who has no financial stake and your decision is professionally responsible. That's overwhelmingly popular. The issue about whether or not people--even if they pay more--should be able to go out of the plan and seek care from another specialist--even though they would pay more, that that is entitled in the plan-that's unbelievably popular.

SUSAN DENTZER: Support for many of these protections cuts across party lines. Polls show that almost as many Republican voters want to see them enacted as Democrats. Roughly 40 states have already put some of these protections on the books. Now, in Congress, many Democrats and Republicans want to broaden these safeguards, and the parties are jockeying to take the lead on the issue. Senate Democrats tried in vain this week to force a vote on their Patients Bill of Rights Act, which would tackle many of these consumer concerns. Senate Minority Leader Tom Daschle says they'll try again.

SEN. TOM DASCHLE: If our Republican colleagues won't agree voluntarily to allow a full land fair debate on this issue, we will force them to address it.

SUSAN DENTZER: A House majority task force is preparing a Republican consumer protection bill, and Senate Republicans are developing their own plan to head off the Democratic alternative. A fight looms over parts of the bills that the managed care industry insists will only drive up health insurance costs and prompt employers to drop health coverage for their workers. A coalition of health insurers and employers is mounting a big-ticket ad campaign to make the point.

SPOKESMAN: Some politicians are bashing HMO's and adding expensive new regulations. That scheme could increase costs even more and that hurts everyone.

SUSAN DENTZER: Congress has no more than 45 legislative days to act before it adjourns for the November election, resolving the bitter dispute and getting a bill out that the president would sign could be a tall order.

JIM LEHRER: And Susan Dentzer is here now. First, welcome to the NewsHour team, Susan.

SUSAN DENTZER: Thanks, Jim. It's a delight to be here.

JIM LEHRER: Okay. Now, as you just said on the tape, both the Democrats and the Republicans want to do something about managed care, correct?

SUSAN DENTZER: Well, in principle. The Democrats almost certainly want to do something about it. They certainly want to have the issue to use in the elections against the Republicans, and there's some debate within the party about whether it's better to pass a bill, or whether it's better to have a bill that goes down or doesn't get passed because the Republicans vote against it, and then the party can say-the Democratic Party-

JIM LEHRER: Use it as a hammer.

SUSAN DENTZER: Exactly.

JIM LEHRER: Use it as a hammer.

SUSAN DENTZER: Republicans, for their part, many of them are actually philosophically opposed to, as they were a few years ago in the Clinton health care reform debate, greater government intrusion into health care and into private health insurance. And many of them still have reservations about greater regulation of health plans. On the other hand, there are many Republicans who do recognize this is a very potent issue that needs to be dealt with.

JIM LEHRER: Well, let's go through the differences. First of all, there are some common points. There are some things that both Republicans and the Democrats generally agree on, correct?

SUSAN DENTZER: Yes, in principle, although, as with all these pieces of legislation, the devil is in the details and the details mean a great deal, but, in general terms, they both tend to agree that as Bob Blendon said at the top of our piece, greater access to specialists for individuals who think they need to be seen by medical specialists is important. That is to say if you're in a plan that has a so-called primary care physician as a gatekeeper who has to refer you on to see, for example, a cardiologist or somebody else, that that referral should be pretty much automatic, and that's a very important principle. In addition, there's a desire to have access to physicians outside your plan if you want to pay extra for it, and in principle the legislation now being discussed on the Republican side, as well as the legislation proposed on the Democratic side, would allow people to purchase what's known as point of service coverage that would allow you to do that.

JIM LEHRER: Now, this independent review of appeals, what does that mean?

SUSAN DENTZER: Well, in fact, most health plans have some kind of internal appeals process, as well as in theory an external appeals process so that if you feel you are denied care that is due you, you can appeal inside the plan to have that decision reversed. There is a lot of dispute about how independent this decision really is. Is it the five friends of the insurance company executive who are going to make that decision, or is it a legitimate outside provider without a financial stake in the outcome?

JIM LEHRER: And both sides want emergency room coverage, right? It's automatic?

SUSAN DENTZER: Basically with varying degrees. In fact, the Republicans want to adopt a standard that many of the states have used called the prudent lay person standard. It means that if a prudent lay person in your position would have gone to an emergency room out of a concern that they might be having some serious medical episodes, then that coverage should be automatic. The Democrats want to go even a bit farther and say virtually anybody who walks into an emergency room without prior approval from the plan should have that care covered.

JIM LEHRER: Now the gag rule on doctors, what's that about?

SUSAN DENTZER: This one is really kind of a throwaway, Jim. A couple of years ago there was a big dispute. Physicians were very worried that there were rules in the contract language that they had with insurance companies, that seemed to suggest that if the doctors talked about treatment options with patients, that the plans would not pay for, that they would somehow be kicked out of the plan, that they couldn't talk about things that weren't covered. In fact, the General Accounting Office-the auditing office of Congress looked into this, found really no instances where plans were really doing this. It seemed to be really a question of the confusion on the part of the doctors, so it's an easy one now to pay your bill-

JIM LEHRER: Just sounds good-

SUSAN DENTZER: --because it doesn't cost much.

JIM LEHRER: I got you. Sounds good. Now, confidential information. Everybody agrees, that should be safeguarded, right?

SUSAN DENTZER: Yes. Although, again, that's an extremely contentious issue, and the devil was in the details, and as many people in Congress have made the point, you don't want to safeguard information so much that you can't use it first of all to improve the health care delivery system, or certainly also to improve medical care and medical research, so that's a difficult one. It's easy again to say it should be confidential. It's hard to figure out precisely how to do it.

JIM LEHRER: All right. Now let's go through the major differences now between the Democratic plan and the Republican plan. Quickly, the Democratic differences allow patients to use health plans and recover damages.

SUSAN DENTZER: This is really where the biggest battle is going to be fought if, in fact, these bills really do come to the floor. In fact, under a federal law that is elegantly known by the acronym ERISA, if you are in an employer-sponsored health plan, your ability to sue the plan, if you are injured because of care you receive or if you die, is very much constrained under state law, and, in fact, you cannot recover damages beyond the cost of your care. So let's say if you had some care denied to you, you became disabled, the most you could get out of the plan was the cost of the care, not for example the compensatory damages that you might get in some other form of lawsuit. Democrats propose basically to get rid of this so-called ERISA pre-emption and basically allow you to go into state court, sue your planner, recover compensatory damages. This is extremely worrisome not only to health plans but also to employers, because they believe that they are the next step, they are the next ones who are going to be able to be sued.

JIM LEHRER: And the Republicans don't support that. Now, moving ahead quickly to what the major Republican difference is-the cap on medical malpractice, right?

SUSAN DENTZER: Yes. In fact, the Democrats charge that what the Republicans have planned to do, and of course we don't have Republican bills yet, we have a Republican press release in effect in the House, and we are soon to have, we think, a plan in the Senate, so we don't quite know, but basically, what the Republicans in the House have said they want to do is attach some provisions that they've attached in prior years to their legislation, which would restrict the liability of doctors and medical malpractice suits. This has been popular in the past with groups like the American Medical Association. Interestingly enough, this year the AMA says they're really not that interested in it, they really want to see the overall patient protection put in place, and they would forego this one, if they had to.

JIM LEHRER: Finally, Susan, is it too early to say that HMO regulation of some kind is the hot issue right now, I mean, replacing tobacco with campaign finance reform and all those other things that were going to get done but didn't quite get done, is this one the new one?

SUSAN DENTZER: I think many politicians hope it will become a hot issue, and others of course fear that it will becomethe hot issue. It certainly is playing very actively in a lot of state races, a lot of gubernatorial races around the country. Governor-candidates for governor coming out and saying they're in favor of these kinds of protections at the state level. Already, of course, some of these protections have been adopted at the federal level with respect to the Medicare and Medicaid programs. So I think that people want to fight the battle over it with these few legislative days left, to get this kind of conflict legislation through I think as we said would be a tall order, and maybe that we'll be back fighting it again next year.

JIM LEHRER: We'll we look forward to your many reports from the battlefield on this and other things in health care reform. And, again-on health care generally-and again welcome to the NewsHour.

SUSAN DENTZER: Thanks, Jim.

JIM LEHRER: And more on the debate on health care reform and to Phil Ponce.

PHIL PONCE: We get two views now on what Congress should do about managed care. Ron Pollack is director of Families USA, a health care advocacy group. He served on the President's advisory commission on health care quality, which made recommendations about managed care last year. And Bill Gradison is president of the Health Insurance Association of America. Its member companies provide health coverage for 65 million people. He's a former Republican congressman from Ohio. And gentlemen, welcome both.Mr. Pollack, what is your best argument for federal legislation of the kind that Susan was talking about?

RON POLLACK, Families USA: I think there are a variety of reasons. First of all the American public I think is feeling very worried that-you know, we've had a real revolution in our health care system. Before in the old fee-for-service system there was every incentive to provide more and more care. And doctors made money and everyone made money that way. Now we've got a system where you make your money by withholding care, so a lot of people are terribly concerned that they're not getting the care they should be receiving, so I think we need to restore the public's confidence. Secondly, if we're going to drive quality, the only alternative that I know to driving quality is let the marketplace work, and that's what the insurance industry thinks we should do. Unfortunately, we don't have a marketplace for most people to get health coverage. Most of us get our health coverage from an employer, and our employers increasingly are saying here's one plan and it's the only plan and you don't have a choice, so you can't, in effect, vote with your feet and thereby drive quality. Thirdly, it-right now we've got a crazy quilt pattern. We've got some states doing one thing, other states doing another thing. Nobody understands what rules they're supposed to be functioning under, whether it's the consumer's or whether it's the health plan's. The only way we can rectify that is if we have one federal law which makes sure nobody can fall under a floor of very important standards.

PHIL PONCE: Mr. Gradison, issues of confidence, of quality, of equality?

BILL GRADISON, Health Insurance Association of America: Well, frankly, we're in a market today where the consumer is king. Consumers four or five years ago said health care is too expensive. And you know they were right, and what happened was that health plans and health insurers developed a system called managed care, which has brought health care and inflation down more or less in line with the general inflation rate, which is a remarkable accomplishment. Now, obviously in the process there were a lot of disruptions and there were a lot of changes made that people didn't like. And, as a result, the plans are making very dramatic changes. Much of what Ron talked about isn't the case today. Two thirds of Americans on the job get a choice of two or more plans. 92 percent of Americans on the job have an option to go outside of the network provided by let's say their HMO and pick a provider of their own. 83 percent of Americans who have an option to change plans, say they're going to stay with the plan that they have, people are overwhelmingly satisfied with their specific plan, however much they may raise questions in very broad terms about managed care, about HMO's, or about health insurance in general. My basic concern on behalf of consumers is that these very well-intentioned consumer protections, many of which are being put into effect anyway, if done through regulation, will drive up the cost of health insurance, make it less affordable, and result in fewer people having health insurance than have it today. That's not in the best interests of America's consumers.

PHIL PONCE: So, Mr. Gradison, are you saying that you oppose any federal legislation trying to "ensure these rights?"

BILL GRADISON: I think the consumer would be better served if they followed the recommendations of the president's quality commission on which Ron sat which recommended these protections but did not recommend that they be put into federal laws and a federally enforceable right. That's precisely what they did.

PHIL PONCE: Mr. Pollack is the market responding? Do consumers have a choice?

RON POLLACK: No. Of course they're not. Today most of us get our coverage through an employer and half of us who get our coverage from an employer have no choice of plans. So we cannot walk with our feet, and we found that very clearly on the president's commission. I've got to say that the American public is terribly worried. They're worried that if they're experiencing an emergency, that they won't be able to go to an emergency room because a health plan says you need to have prior authorization before you go to an emergency room. They're worried if they need a really basic health service, being referred to a specialist or get a test, when they fear they may have cancer, they're being told that they can't get that test or they can't get referred to a specialist, so what a Patients Bill of Rights is about is to try to make sure that people have recourse when they're denied the benefits that were promised to them by their insurance companies. And the only way you can have a right is ultimately if you have a remedy. So if we just say to the insurance companies go do it and if you choose to do it, terrific, but there's no right there, so that's why we need federal legislation.

PHIL PONCE: Mr. Gradison, how do you respond to the polls? How do you respond to the reaction in movie theaters to that scene that we saw in the clip? Why is the public so concerned and hostile in some cases?

BILL GRADISON: Well, I think, in general, the public is being influenced by anecdotes that are not borne out by actual experience. There have been a whole series of studies which have compared what really counts, which is medical outcomes. Does somebody get well? Do they get home quickly? Do they survive a serious illness? Compare those with managed care versus more traditional insurance, and every single study that I've ever seen indicates that the quality of care is at least equal, if not superior in managed care as in comparison with the kind of plans, which it took the place of. You know, there's a mythology out here that the federal government knows best, that only if big daddy in Washington sets up a bureaucracy and puts out a lot of regulations can people be protected. What we're not told is the fact that in the government's own programs these things are not available. For example, the Veterans Administration does not have the kind of emergency room provision that this legislation suggests. No federal employee is entitled to an objective external review of a denial of care by a federal employee plan. The Indian Health Service has practically none of these protections. I think the federal government has got a role. The federal government, the state governments, local governments pay for almost half of all health care in America, and what I think they ought to do is to influence the way this develops by example. Let them get it right, and then compete in the sense with the private market, the private sector, private plans, which are doing the very same thing, and let's see what works. If it's done through regulation, there will be a single approach. You're going to have to do it by the rule book. It will take longer to get these plans in effect, because companies which may not have the provisions today are going to have to wait till a law is passed, regulations are written, and maybe even there are some court decisions before they find out what's expected of them.

PHIL PONCE: Mr. Pollack, may I ask you a question?

RON POLLACK: Sure.

PHIL PONCE: Is it possible-because this ties into something he was just alluding to-and that is, is it possible to have a system where costs are maintained and people still have a lot of freedom?

RON POLLACK: Of course. And when we're talking about a Patients Bill of Rights, we're talking about something that is extremely inexpensive. Every independent survey-the only exceptions are those that have been commissioned by the insurance industry-every independent survey says this costs virtually nothing. For example, the president's commission's proposals, the Congressional Budget Office tells us, will cost 0.3 percent of premiums.

PHIL PONCE: Let's get a quick response from Mr. Gradison.

RON POLLACK: Let me just-give you the list. The Kaiser Family Foundation hired Coopers & Lybrand. They told us also it was under 1 percent.

PHIL PONCE: All right. I do need to get Mr. Gradison on that point.

BILL GRADISON: I just want to say that's not so. Many of these studies recognize how difficult it is to estimate the cost. And for example, with regard to the question of exposing health plans, employer provided health plans to state liability, the reports that come back say, well, we haven't taken into account defensive medicine. We haven't-because we don't have estimates. We haven't taken into account the changes that might take effect with regard to utilization review. The fact of the matter is that this is a serious concern. We represent consumers because they're our customers. We've got to meet their needs every day, not just in an election. And we're absolutely convinced that we're doing what is best for consumers in pointing out the unacceptably high premium increases, which we would be forced to pass on if this ill-advised legislation is passed.

PHIL PONCE: A quick response from Mr. Pollack.

RON POLLACK: I find it astounding to hear the insurance companies saying they're worried about costs. At the same time that they are pulling out of the Medicare and Medicaid programs so that they're not serving the people who need care the most, they're providing compensation to theirhighest level executives, which is extraordinary. For example, the head of Oxford Health Care was given $29 million a year and $83 million in unexercised stock options. It's clear we've got a double standard when it comes to cost. Millions of dollars that get paid to HMO and insurance company executives, that seems to be all right, but the pennies that it cost to provide basic rights for patients, that's where the insurance industry goes ballistic. And I think it's very unfortunate. One other point I just want to make-

PHIL PONCE: Excuse me. I'd like to get Mr. Gradison in. Mr. Gradison.

BILL GRADISON: I'm glad you brought up Oxford. They're not a member of my association. But I do follow what they do. What happened to Oxford is that they had so underpriced the benefit package that they made available that they would be broke today if they hadn't been able to go out and raise almost $3/4 billion to say that because an executive got a high salary, that that is the reason that Oxford had difficulties is simply not the fact at all, not at all.

PHIL PONCE: Gentlemen, I'm afraid that's where we'll have to leave it. Mr. Pollack, Mr. Gradison, I thank you both.% ? FOCUS - ONLINE PUBLISHING

JIM LEHRER: Publishing in cyberspace. Rod Minott of KCTS-Seattle reports.

MICHAEL KINSLEY, Editor, "Slate:" [speaking to staff] We can keep those templates-not forever, but we don't have to hold up--

ROD MINOTT: The deadlines never stop at "Slate," the on-line magazine of news, politics, and culture. Each day staffers scramble to update and fine tune content before launching it in cyberspace. Until recently, the magazine had cost nothing for readers to access. Then in March of this year, "Slate," itself, made headlines when it started charging $19.95 for a one-year subscription. Michael Kinsley is "Slate's" creator and editor.

MICHAEL KINSLEY, Editor, "Slate:" It's our estimation that in order to be self-supporting we have to ask the subscribers, the readers, to pay something. There are many economies to publishing on the web. You have no paper; you have no printing; you have no postage. But it's not free, and publications like this can't make it on advertising, in our estimation.

ROD MINOTT: So far, "Slate" has survived off the deep pockets of its owner, software giant, Microsoft. This pioneering move to charge will be a test of whether Internet users are ready to pay to read serious journalism. Prior to its subscription fee, "Slate" estimated its readership at more than 200,000 a month. Kinsley concedes that figure has dropped by as much as 90 percent since the magazine fee went into effect but insists "Slate" has exceeded early goals for signing up customers.

MICHAEL KINSLEY: It's going very well. We have a long way to go, but we were planning to hit 20,000 paid subscribers within six months, and we hit it within six weeks. And that's obviously not enough, but it's a very good start.

ANNOUNCER: Live from Washington, "Crossfire."

ROD MINOTT: Before coming to Microsoft, Kinsley was best known for his appearances on CNN's "Crossfire" as the show's liberal voice.

MICHAEL KINSLEY: From the left, I'm Mike Kinsley, sitting in for Bill Press. Good night for "Crossfire."

ROD MINOTT: A former editor of the print magazine "New Republic," Kinsley was hired by Microsoft two years ago to start up "Slate." Many media analysts remain skeptical that "Slate" or any other general interest on-line magazine can succeed at charging for its content. The Internet remains a place where many users believe they shouldn't have to pay for information, beyond the $240 a year they already pay, on average, for Internet access. Stephen Manes is a columnist for the "New York Times" who writes about the computer industry.

STEPHEN MANES, Columnist, "New York Times:" I suspect on the web short term it's going to be very tough to build a franchise. For most people if you have to pay money to get past the door, unless there is something incredibly valuable, be it timeliness, be it specialized knowledge--but for general magazines, you know, your competitors are one click away, and that makes it tough, and they're free.

ROD MINOTT: Manes points out another key hurdle on-line magazines face in attracting paid subscribers--the lack of portability.

STEPHEN MANES: It's not at all clear that people really, you know, are going to want to read magazines on the web anyway. I certainly--at the end of a long day--the last thing I want to do is spend more time in front of a computer screen.

ROD MINOTT: Michael Kinsley acknowledges portability is a problem for "Slate" but believes that will change when screens get lighter and smaller. He suggests time and demographics will also help.

MICHAEL KINSLEY: I was on a panel and this subject came up. And I was giving a rather mournful answer about how hard it is to get people to read things on a screen, and this computer science professor who was on the panel interrupted me and said, "Your problem will be solved actuarially," meaning that the people who have a hang-up about reading on the screen will die off and the younger generation, which reads on screens and doesn't even know from paper, will take over. We can't wait that long. So we're trying to offer features which compensate for the disadvantage.

ROD MINOTT: For now, Kinsley says he's happy to keep on experimenting with his magazine, which he calls a weekly, even though its content is updated every day.

MICHAEL KINSLEY: In fact, I've come back to the view that the really coolest thing is the immediacy and the fact that now you can go to the site at any hour and there will be new stuff, and-because it's live. It's a live thing. It's not a dead magazine. So we're evolving towards more and more features where the writer actually sits wherever she or he might be with their laptop computer and posts directly to our site. And the editorial process is curtailed or even eliminated, or, interestingly enough, conducted after publication. And there is something inherently less polished about the web. And I like it. I like it very much. It's more like a conversation. It's--the voice of E-mail, I think, is a really good thing.

ROD MINOTT: But with no profit and an annual operating budget reportedly as high as $5 million, Stephen Manes wonders how long Microsoft will continue to fund "Slate."

STEPHEN MANES: Their record hasn't been very good in this when it's come to content. They had a magazine called "Mungo Park," which was a sort of adventure or travel magazine, and that has bit the dust. They also had a magazine for women called "Underwire," which I think is long gone. They had one for kids called "Mint," which is long gone. They've had a pretty lousy record.

ROD MINOTT: But Kinsley says Microsoft shows no sign of pulling the plug on his magazine.MICHAEL KINSLEY: I have made clear all along that the typical successful magazine takes six, seven, eight years to become successful and that we face the additional challenge of helping to develop a medium, as well as developing a product within that medium, and that, you know, a six, seven, eight-year time horizon is not unrealistic. And they've never blinked.

ROD MINOTT: Whether Microsoft blinks eventually or not, the outcome is expected to have a huge impact on publishing in cyberspace.% ? FINALLY - AD WAR ON DRUGS

JIM LEHRER: Finally tonight, a new anti-drug. Today in Atlanta President Clinton and Speaker Gingrich launched a $2 billion radio, television, and newspaper advertising blitz. The five-year campaign is designed to discourage children from taking drugs. Here's a sampling of the new ads.

ANTI-DRUG AD SPOKESPERSON: [holding egg] This is your brain. This is heroin. This is what happens to your brain after snorting heroin. [smashing egg with frying pan] This is what your body goes through. It's not over yet. This is what your family goes through and your friends-[smashing up kitchen]-and your money and your job and your self-respect and your future! Any questions?

ANTI-DRUG AD SPOKESPERSON: What would you do if a stranger talked to you?

CHILD IN AD: I wouldn't talk because he might be bad.

ANTI-DRUG AD SPOKESPERSON: Very good. And what would you tell someone playing with matches?

CHILD IN AD: I'd tell them not to play with them because they might start a fire.

ANTI-DRUG AD SPOKESPERSON: Wow. How come you know so much?

CHILD IN AD: My mommy told me.

ANTI-DRUG AD SPOKESPERSON: Oh, and what did your mommy tell you about drugs?

CHILD IN AD: [blank look - no response]

MAN'S VOICE IN AD: Your children are listening. Are you talking?

ANTI-DRUG AD: [father and son at breakfast table not speaking to each other] MESSAGE ON SCREEN: Another missed opportunity to talk with your child about marijuana. We'll tell you what to say.

MAN IN ANTI-DRUG AD: I am not a purple dinosaur. I'm not 64 bits. I don't play pro ball. What I am is a mentor. I'm not a psychologist. But I'm a listener-unleash hopes-create self-esteem. I don't have all the answers. But I'm a mentor. I make a difference. This is my reward. [walking with little boy]

SPOKESPERSON IN AD: Kids who have mentors are less likely to do drugs. Be a mentor.

JIM LEHRER: As I said, those are among the ads that are part of the new national television anti-drug campaign launched today by President Clinton and Speaker Gingrich. % ? RECAP

JIM LEHRER: Again, the major stories of this Thursday, President Clinton consoled victims in fires of the wildfires that swept Florida, and the US Senate passed the IRS reform bill to give more taxpayers more rights. The vote was an overwhelming ninety-six to two. A reminder before we go that our race conversation with President Clinton will be broadcast later tonight on most PBS stations. It includes exchanges such as this.% ? EDITOR'S NOTE - DIALOGUE ON RACE

JIM LEHRER: Sherman, does a poor Native American starting out face more hurdles than a poor white American starting out?

SHERMAN ALEXIE, Author/Screenwriter: A poor Native American faces more hurdles than a poor anybody.

JIM LEHRER: Anybody?

SHERMAN ALEXIE: Anybody. In this country, certainly, we're talking about third world conditions, fourth world conditions on Indian reservations. I didn't have running water until I was seven years old. I still remember when the toilet came. So-and there are no models of any success in any sort of field for Indians. We don't have any of that, so there's no idea of a role model existing. You know, an Indian has not sat on this kind of panel before, so me being here for the first time is something amazing.

PRESIDENT CLINTON: Let me ask you something. When I was running for president in 1992, I didn't know much about the American Indian condition, except that we had a significant but very small population of Indians in my home state, and that my grandmother was one quarter Cherokee. That's all I knew. And I spent a lot of time going around to these-to the reservations and to meet with leaders. I concluded that the American Indians had gotten the worst of both worlds, that they had not been given enough empowerment or responsibility or tools to make the most of their own lives, and the sort of paternalistic relationship the US Government had kept them in was pathetic and inadequate. So they literally got the worst of both worlds. They weren't getting enough help, and they certainly didn't have enough responsibility and power, in my view, to build the future. So what do you think the most important thing is for Americans to know about American Indians?

SHERMAN ALEXIE: I think the primary thing that people need to know about Indians is that our identity is much less cultural now and much more political, that we really do exist as political entities and sovereign political nations, and that's the most important thing for people to understand is that we are separate politically and economically and should be. For Indians, themselves, I think we have to recognize the value of education, which is something culturally we have not done. And with the establishment of the American Indian College fund and the 29 American Indian colleges on reservations and in Indian communities throughout the country, I think we've begun that process of understanding that education can be just as traditional, just as tribal as a pow-wow or any other ceremony; that education should become sacred.

JIM LEHRER: Please check with your public television station for the exact time of the broadcast of the entire conversation. And we'll see you online and again here tomorrow evening with Shields & Gigot, among others. I'm Jim Lehrer. Thank you and good night.