The MacNeil/Lehrer NewsHour

MR. MAC NEIL: Good evening. I'm Robert MacNeil in New York.

MS. WARNER: And I'm Margaret Warner in Washington. After the News Summary this Wednesday, we'll have a Newsmaker interview with Israeli Foreign Minister Shimon Peres, then Paul Solman explains why health care reformers want to increase the authority of nurses. Fred De Sam Lazaro reports on the AIDS epidemic in India, and essayist Paul Hoffman looks at the difference between people and chimpanzees. NEWS SUMMARY

MR. MAC NEIL: President Clinton did a high profile push for his health care plan on Capitol Hill today. He held a closed-door session late this afternoon with House Democratic leaders to discuss a strategy for moving the program to a vote. Then he went to the Senate side to talk with Democratic Leader George Mitchell, Republican Leader Bob Dole, and key Senators in the health care debate. The visit came amid reports that House Ways & Means Committee Chairman Dan Rostenkowski was facing a possible indictment for alleged financial impropriety. He's considered one of the President's most important allies in getting the health care legislation to the floor. Some reports said he might resign from Congress in a plea bargain agreement. This morning, First Lady Hillary Rodham Clinton was asked what impact that would have on the legislation. She spoke at a women's media forum in Washington.

HILLARY RODHAM CLINTON: It would be an obstacle that the Congress would have to figure out how to overcome, but I think that if you watch this administration, we have so many obstacles that we're always overcoming that from my perspective, you know, you just keep climbing and you keep trying to get the results that you need. It would be a great loss to the Congress, but health care reform and the need for it is bigger than any one person in our country.

MR. MAC NEIL: Rostenkowski was expected to attend today's health care meetings with the President. When asked by reporters, White House Spokesman Dee Dee Myers said there would be no discussion of his legal problems. Margaret.

MS. WARNER: A Senate report released today says that U.S. troops were exposed to harmful levels of chemical agents and possibly biological agents during the Persian Gulf War. But Defense Department officials say they've turned up no conclusive evidence that Iraq used chemical or biological weapons. These differences were apparent today during a Senate Banking Committee hearing on the report. EDWIN DORN, Undersecretary of Defense: We've concluded that Iraq did not use chemical or biological weapons during the war. This conclusion is based on analysis of large amounts of detailed data gathered in the theater and reviewed after the war.

SEN. DONALD RIEGLE, [D] Michigan: We have a difference of opinion on that issue, and if you talk to the sick veterans who were out there and who were in the theater of operation where the alarms were going off, the ones that are now sick are overwhelmingly convinced that there is a relationship. Now, you know, maybe you're smarter than they are; and maybe they're smarter than you are. The consequences for them are a lot higher than they are for you, because you're not sitting here sick.

MS. WARNER: Retired General Norman Schwarzkopf, who led the allied forces during the Gulf War, underwent surgery for prostate cancer today at Walter Reed Army Medical Center in Washington. The statement released by the hospital said the cancer was detected in its early stages and a full recovery was expected.

MR. MAC NEIL: President Clinton said today the United States cannot send its troops to solve everyoutburst of civil strife or militant nationalism in the post Cold War world. He said U.S. interests were not sufficiently at stake in crises like Bosnia to justify the risk of American lives. He said the U.S. must leverage its influence to work with allies who are closer to the conflict. He spoke to the graduating class at the Naval Academy in Annapolis, Maryland.

PRESIDENT CLINTON: The world's most tearing conflicts in Bosnia and elsewhere are not made in a day. And one of the most frustrating things that you may have to live with throughout your life is that many of these conflicts will rarely submit to instant solutions. But remember this, it took years after D-Day to not only end the war but to build a lasting peace. It took decades of patience and strength and resolve to prevail in the Cold War. As the generations going before, we must also be willing to pay the price of time, sometimes the most painful price of all.

MR. MAC NEIL: U.N. Secretary-General Boutros-Ghali today called the world's slow response to the crisis in Rwanda a scandal. At least 200,000 people have already died in a month of tribal warfare. Ghali called that genocide and said all of us are responsible. The FBI director, Louis Freeh, told Congress today that Russian organized crime groups had spread their activities into Europe and the United States. And he warned that they may already have the capability to steal nuclear weapons. He said there had been a significant number of cases involving the threat -- theft or smuggling of low grade nuclear materials, but so far there was no weapons grade material being stolen.

MS. WARNER: Israeli warplanes attacked a Shiite guerrilla stronghold in Southern Lebanon today. There were no reports of casualties from the raid which was the second in the area in two days. Israel is trying to keep the guerrillas from retaliating for Israel's kidnapping of a Shiite Muslim leader from Lebanon last weekend. Israeli Foreign Minister Shimon Peres was in Washington today for talks on the Mid East. He met with Vice President Gore and Secretary of State Christopher. We'll have a Newsmaker interview with Foreign Minister Peres right after the News Summary.

MS. WARNER: Federal Reserve Chairman Alan Greenspan said today there was no need to further regulate the derivatives market. Derivatives are financial instruments used by large corporations to hedge risk during market swings. They're usually based on the value of stocks, bonds, and commodities. Last week, the General Accounting Office said derivatives could pose a threat to the U.S. banking system if they weren't more tightly regulated, but Greenspan said additional regulation could itself increase the risk in the market. In other economic news, the government reported orders for durable goods rose .1 percent last month. Durable goods are items designed to last three years or more, such as cars or home appliances.

MS. WARNER: A moderate earthquake hit the Los Angeles area early this morning. Officials said it was another aftershock to the devastating earthquake that hit LA in January. There were no reports of injuries or major damage. A bomb threat forced the evacuation of an air traffic control center in Auburn, Washington, this afternoon. No bomb was found, and no one claimed responsibility for the threat, but the incident delayed all air travel in the Northwest for two hours.

MR. MAC NEIL: In Nashville today, the man convicted of murdering Martin Luther King, Jr., lost his first bid for parole. James Earle Ray claimed he was innocent of killing the civil rights leader 26years ago and said he was coerced into confessing. In 1978, a House Committee ruled that Ray was part of a conspiracy to kill Dr. King. Ray, who is now 66, will be up again for parole in five years. That's it for the News Summary. Now it's on to Israeli statesmen, a healthy rivalry, a deadly threat, and the primal parallel. NEWSMAKER

MS. WARNER: We turn first tonight to a Newsmaker interview with Israel's foreign minister, Shimon Peres. He's been in the U.S. this week to receive a world peace award for his role in negotiating the historic Israeli-PLO accord. Yeltsin met with Sec. of State Warren Christopher and Vice President Al Gore today. Welcome, Mr. Minister. Thanks for being with us. Let's turn first to this agreement that you're hear in Washington to celebrate, the Israel-PLO accord. Now, in the last couple of days, Yasser Arafat, the head of the PLO, took out an ad in Palestinian newspapers calling on the courts in Gaza and Jericho, the two areas turned over to Palestinians, to no longer enforce the Israeli rules and laws that have been in effect since '67, but to start enforcing only laws that were in effect before Israeli occupation began. Now, how do you react to that? Isn't this in complete defiance of the agreement you just signed with him?

MINISTER PERES: I regret it, but papers are papers, and realities are realities. We cannot judge the PLO and its leader just by what he is saying. Would we do so, it would be completely wrong, and we would be in trouble. But the fact is that on the ground, in real terms, the agreement is becoming a reality, and the Palestinian people for the first time in their history will taste a piece of reality, a territorial address, a real responsibility, and the real authority. And this is the real meaning of the agreement.

MS. WARNER: Then are you saying that you think this edict from Arafat is just irrelevant, it has no meaning?

MINISTER PERES: It has meaning, but it doesn't change the whole picture. I think Arafat was basically a leader in exile, and the leaders in exile, usually what they do is issue declarations here, and it's becoming the way of life. And generally, when you say, no, or when you speak, you're better off than when you say yes, and you have to create something real. You know, all "no's" are perfect and all "yeses" are imperfect.

MS. WARNER: But you seem very unconcerned by this. Do you think the courts are just going to ignore what he said?

MINISTER PERES: I am concerned. I don't believe it changes the basic situation, and I think we are now having the participation of the third party to the negotiations, and that is the people who reside in the Gaza Strip and in Jericho. And they are really concerned about the real meaning of the change. Among them, many young people, many able people, it is their dream, it is their need, and they do believe that they have the capacity to really take it and make it into a new situation.

MS. WARNER: Well, now Arafat said a couple of things at a speech in Johannesburg when he was down there for Mandela's inauguration that have also made at least skeptics in your country doubt his commitment to this agreement. And one of them was to call on Moslems who were in his audience to join a Jihad to liberate Jerusalem. Now, you met with him in Oslo last week.

MINISTER PERES: Yes.

MS. WARNER: And afterwards, you said you were satisfied with his explanation. What satisfied you? What is the explanation?

MINISTER PERES: I didn't say I was satisfied with the explanation. There were good parts to our discussion. One, it tried to explain to me in the religious and linguistic terms what he was saying. Now, I am not a great authority on the Islam religion, and neither am I a great authority on their language. What he said -- and that's what I took it as a serious commitment -- he repeated three points: [a] That there remains through the reparation of principles as the only guiding line in his relations with his; secondly, that he continues to denounce terror and violence between the Palestinians and us; and thirdly, that for the future he undertook that every dispute or disagreement will be solved peacefully and diplomatically.

MS. WARNER: And do you trust his intentions here, his good faith?

MINISTER PERES: To give you a real answer, I trust the stream of history. I believe neither him or us have another choice or a better choice. And I don't think that a person or a speech of a person can turn the world around in the wrong direction again. I believe that what we are doing is a must, that nobody can win anything anymore by war, that whatever is important in life cannot be achieved by armies, and whatever armies can achieve lost a great deal of their importance. So I rely upon realities and also I say upon our own strength. We are not a weak country. We are not a lost country. We didn't lose neither our minds nor our strength.

MS. WARNER: The comment you made a minute ago about the young people who have been on the ground there, the Palestinians, and you're talking about the stream of history. You're almost suggesting that you think Arafat may be passed over here; he may have to give way. Do you think that in the stream of history his day is over?

MINISTER PERES: Let me say the following. In this century, the Palestinians did have two leaders. One was the Grand Mufti of Jerusalem, who led the Palestinians for 43 years uninterrupted. The second was Sadat, who led the Palestinians for 28 years, together 71 years. The Mufti all his life says no and no and no to everything, and he killed a little bit of people. He was tremendously popular. Everybody applauded him, and he brought a catastrophe on the heads of the Palestinian people. I told Arafat, look, for your first twenty or twenty-three years, you were following him. You said, no. You killed a little bit. You were accepted and unanimously applauded. Now, you made a different choice. You said yes, so you created a controversy. People are against you. You have to argue. You have to fight. But you may be the first Palestinian that brings back home a piece of bread and butter, something which is really meaningful. You have to make your choice between saying no and being applauded and making a positive decision and face opposition.

MS. WARNER: Well, let's turn now to the next thing on your plate, which is trying to get a deal with Syria. There was a lot of publicity here. Sec. of State Christopher was shuttling back and forth between Damascus and Jerusalem last week. Reading it from afar, it sounds as if it's the same old dance. I mean, you want full peace. Syria wants full withdrawal. Syria is trying to figure out who goes first and who takes a bigger step. Is there anything new here? Has there been any real movement in the past month?

MINISTER PERES: The one change that one can mention is that we are going over from generalities to details, not that we have reached an agreement, but there is sort of an opening, and what Israel feels very strongly, that if President Assad wants really to normalize the relations with Israel, he has to start it by normalizing the negotiations with Israel. At the end of the 20th century, you cannot conduct a negotiation secretly in a narrow channel just by emissaries. It must be open, and each nation should see that the other nation, not just a single leader, is interested in peace.

MS. WARNER: And are you seeing that?

MINISTER PERES: We are sitting now and talking. We are being watched by many people, and they are the judges. They are the diplomats of our life. And we have to convince our own people that we are talking sense, that we are responsible, that we are sincere.

MS. WARNER: And are you seeing that yet from Hafez Assad?

MINISTER PERES: No, not yet. I think he remains the same old ruler of his country. Though he understands maybe the changes in the world, he still finds it difficult to change himself. Maybe every neighbor is very much like him in a small island not far from America, who has the intellectual capacity to understand the changes but doesn't have the mental force to change himself.

MS. WARNER: Now, the Americans starting with President Clinton are saying that Assad now accepts what your definition of full peace is, which is not just a cold cease-fire but, in fact, full diplomatic relations, open borders, and so on. Are you convinced that Hafez Assad is ready for full peace in Israel terms?

MINISTER PERES: Not yet. When he says full peace, for example, he doesn't include in it -- at least not immediately -- the exchange of embassies. How can you have peace without having embassies? He doesn't include open borders. He doesn't include security arrangements. Israel has to give up a mountain of great importance from a strategic point of view. We have to receive in return something which is not as tangible and not as permanent and not as full as that or high as that. So we would like to be sure that at least the things that we are going to have in return are a full-fledged peace, including embassies, open borders, market economy, and security arrangements, to the satisfaction of the two sides.

MS. WARNER: And you have proposed -- I gather, Israel has a phased withdrawal from the Golan?

MINISTER PERES: Yes.

MS. WARNER: A three phase over fight to eight years.

MINISTER PERES: Right.

MS. WARNER: But you want Syria to give most of the elements of peace right up front, is that right?

MINISTER PERES: No, no. We suggest that we shall make it possible. We shall make a step. He will make a step. Then we shall see what the situation is, if it is trustworthy for them and for us. We don't ask any advancement on it, as we did, by the way, with the Egyptians. We took one step, then we looked around. We saw it is successful, we made a second step, and then a final step.

MS. WARNER: If you had to bet your life on it, would you rather make a deal with Yasser Arafat? Would you trust him more to make a deal or Hafez Assad?

MINISTER PERES: They are not replaceable. I mean, each of them is running a different country. Maybe I would invite a man like Mandela. Maybe I would invite a person like Sadat. But it is not us who select the leaders of the other people. It is for the people, each people select their own leaders. And we have to negotiate with them, with their strong points, and poor points. I can say some nice things about Arafat as well, but he is not our choice. He is the Palestinian choice. And he is the person with whom we have to negotiate. And the best thing I can say about him is that he is the Palestinian leader in the last 73 years who decided to sit down and try his hands to make peace. So while I'm criticizing him, I still remember this point which is of importance.

MS. WARNER: Well, thank you, Mr. Minister, very much. Thanks for being with us.

MINISTER PERES: Thank you.

MR. MAC NEIL: Still ahead on the NewsHour, nurses doing doctors' work, AIDS in India, and an essay on creation. FOCUS - NURSES VS. DOCTORS

MR. MAC NEIL: Next tonight, one element of the Clinton health plan that has broad support on Capitol Hill but not in doctors' offices. Business Correspondent Paul Solman of public station of WGBH-Boston reports.

MR. SOLMAN: The 100th anniversary of Columbia University's School of Nursing. Entertainment by the Harlem Boys Choir. The audience is feeling the spirit of nursing as a key to health care reform.

JOSEPH CALIFANO, Former Secretary, HEW: It is time to give nurses more to do, to face the reality that the physician's monopoly over all practice of medicine, once a professional imperative to protect patients from quacks and charlatans, is now rooted as much in economic self-interest as in consumer protection.

MR. SOLMAN: According to former Health Secretary Joseph Califano, all consumers have an economic interest in more primary care nursing. It's a cornerstone of the Clinton health plan and already a reality for poorer patients like the boys of Harlem Choir who get exams from Columbia's nurses. Now, regardless of mouth type, most of us have been examined by the school nurse, at least, so what's the big deal? Well, it turns out that one of President Clinton's key ideas for cutting health care costs and getting lower cost nurses to do much of the primary medicine instead of higher priced doctors whose monopoly has supposedly been driving up the tab. In a sense, the question is whether or not to deregulate medicine, fostering competition to drive down prices, as in the case of recent years in airlines or telephone service. But deregulation brings headaches of its own, the chaos of competition, for example, or consumers overwhelmed by choice. And most important of all, perhaps will competition really bring prices down?

MR. SOLMAN: Senate Harbor, Long Island, summer homes for the rich and famous, year-round home to a medical practice backed entirely by the chief competition to primary care doctors, primary care nurses.

BETH MORAN, Nurse Practitioner: I'm Beth Moran, and I've invited you all here today because I know you all have an interest in starting your own private practices as independent nurse- practitioners.

MR. SOLMAN: This is the movement Bill Clinton wants to accelerate, partly because nurses charge significantly less than doctors do. Clinton thinks the country would save several billion dollars a year if nurses provided primary care.

ELAYNE DeSIMONE, Nurse Practitioner: I think that there's been a mystique about what is necessary to provide primary health care, and I think that that mystique has been perpetuated by the American Medical Association.

MR. SOLMAN: Doctors say they deserve far more than nurses because they provide far more care. Nurses are dubious.

NANCY BOWDEN, Nurse Practitioner: Do they know how to do primary care? How many physicians have you been to, have I been to, where I walked in the room, and they actually sit down, and you listen to me, maybe even look at me? They're too busy writing. They're very, very quick. They're there to get in there, get out, write prescriptions, and that's it.

GLENNIE METZ, Nurse Practitioner: I have been asked: Why did you find a cancer in the patient's mouth? When I examine my GYN patient who comes for her comprehensive, and it says comprehensive, annual exam, it means from head to toe. I found lesions on the gum. I send patient to dentist. Everyone, well, what is she looking in your mouth for? The patient had to have an excision. Well, that's the way nurse practitioners practice.

MR. SOLMAN: In fact, studies suggest that doctors and nurse practitioners like Beth Moran are equally good at delivering primary care perhaps because these nurses have an RN degree plus several years of additional training. But they also have an education that emphasizes the individual, wellness, prevention.

BETH MORAN: What we do when we see that patient are often things that help the patient prevent surgery or prevent a hospital admission so that we're saving the insurance companies or the patients or both money.

MR. SOLMAN: As it happens, the President is counting heavily on prevention to lower costs.

PRESIDENT CLINTON: Any family doctor will tell you that people will stay healthier, and long-term costs of the health system will be lower if we have comprehensive preventive services.

MR. SOLMAN: But there isn't enough prevention, because there weren't enough family doctors or pediatricians and internists, for that matter. These generalists make up only 30 percent of the nation's doctors and less than 15 percent of new med school grads, perhaps because primary care doctors are the lowest paid of all physicians. The Clinton plan offers incentives to boost these numbers to 50 percent or more, while encouraging nurse practitioners to give primary care as well. But Yale's Barbara Safriet, who studied the economics of nursing, wondered why we should pay to train more family doctors, period.

BARBARA SAFRIET, Yale Law School: It's easily four to five times as much, cost as much to prepare a physician as an advanced practice nurse.

MR. SOLMAN: Now is it costing me any of that money?

BARBARA SAFRIET: Sure. It's costing you because graduate medical education has been after Medicare and direct subsidies from the federal government. We pay those taxes.

MR. SOLMAN: Beth Moran has run her Sag Harbor Practice since 1986. Two years into it, Long Island doctors initiated a state investigation as to whether she was practicing medicine illegally. She wasn't, and at World Aids Day at the high school, she's clearly become part of the local health establishment, sharing the stage with one of the town's two family doctors. She also competes with them.

DR. DAN LESSNER, Internist: Nurse practitioners take a lot of the stuff that we do, and they'll do the same thing. There is a direct competition, no question.

MR. SOLMAN: Isn't it often the case that nurse practitioners can give patients more time than typical -- the typical doctor would?

DR. DAN LESSNER: Some doctors are considered very cold and rushed and unfortunately, that is part of reality. We have to see a lot of patients to meet our overhead, the malpractice expenses that we have, it's almost my rent -- almost the same as my rent every month -- just to meet my overhead for malpractice. And you have -- it's a problem --

MR. SOLMAN: Do you worry that nurse practitioners -- that they're competing with less training than you have?

DR. DAN LESSNER: No, sir. We don't really have that much doctor shortage out on Long Island. You know, we have plenty of doctors. I think that in rural areas, I think that in reservations, in reservations, I think that in methadone clinics, the nearest city, they definitely have a lot to offer, definitely a lot to offer. The doctors are just not, they're not able to deal with the load there.

BETH MORAN: So what are they saying? We're capable of seeing patients that have no money, and we're capable of making assessments for people that don't get served in any other way. What does that say about health care for people that can't afford it, or don't have access to a physician, suggesting that they are getting lesser care because they have seen nurse practitioners, because they have no money.

MR. SOLMAN: Well, yes, many doctors can see that is a problem with the economics of medicine, but to nurses, this can sound like arrogance.

SHELLY BAZES, Nurse Practitioner: What is the difference between God and a doctor? And the answer is, God knows He's not a doctor.

MR. SOLMAN: For centuries, of course, the practitioners of medicine weren't gods. Many, in fact, were quacks, like this snake oil salesman duping the public in the film "Pete's Dragon." It made sense then that at the turn of the century reputable doctors in the U.S. through the AMA began to push laws making medicine into a profession, and as it happened, a very lucrative one.

BARBARA SAFRIET: They reorganized in 1901, and they pushed for increased standardization of education, and reduced, if you want, entry into the field. So the thought was we'll have better practitioners, and as with all licensing schemes, we will also be able to fence out our competitors.

MR. SOLMAN: The doctors fenced in a sizable chunk of turf, from ear piercing to diagnosis.

BARBARA SAFRIET: It was in my lifetime that a nurse could not write on a chart, "The patient is dead," because that would be diagnosing. So the nurse had to write, "The patient appears dead," because that wasn't a diagnosis, merely it was an assessment or an observation.

MR. SOLMAN: By the 1930's, the doctor's image and income had improved dramatically.

NEWSREEL SPOKESMAN: In every city and town there is one house that everybody knows, the doctor's. Available here are the services of a man who by law is privileged to practice the most respected of all professions.

MR. SOLMAN: The licensing of medicine had two effects: It protected the patient's health and it protected the doctor's income by limiting the competition from other health providers. People like you and me call this a monopoly. Economists like Andrew Shotter put it more technically.

ANDREW SHOTTER, Economist: By definition, a monopoly is really defined as one seller of a product. So under that definition, of course, doctors don't have a monopoly, however, they do have a market which is probably characterized as one containing olgiopolistic characteristics.

MR. SOLMAN: Now, an oligopoly is simply a market dominated by a few sellers instead of just one. And in medicine, as in many industries, these dominant sellers have arguably acted in concert to control the market and keep competition at bay. Nurses complain that organized medicine has tried to block them on, one, legal authority to prescribe, two, practicing without physician supervision, and most of all, three, building insurers directly. With Medicare, for example, only 18 states will reimburse nurse practitioners, and even then, only if they work in rural areas. And what's more, Medicare will pay a nurse only 65 percent of what it pays a doctor.

MR. SOLMAN: So Medicare would save 35 percent, a third of the fee, if they allowed nurse practitioners to do it, but they don't allow them to do it?

BARBARA SAFRIET: They allow them to do it; they just won't pay them for it. And intriguingly, it gets even more complicated. But in order to get reimbursed, a nurse practitioner will bill through the physician and guess what? The physician bills at the physician's rate even though he never saw the patient, he never treated the patient, and this is acknowledged in our federal regulations, that physicians can bill for services they did not provide and bill at a higher rate.

MR. SOLMAN: The AMA, however, opposes direct reimbursement for nurses. We asked AMA Chairman, family practitioner Lonnie Bristow to explain why.

DR. LONNIE BRISTOW, Chairman, AMA: We don't believe that a nurse should practice independently because nurses aren't trained as physicians.

MR. SOLMAN: The obvious question for us, as we listened, was whether the AMA is maintaining important regulatory standards here or just protecting its own economic interests.

DR. LONNIE BRISTOW: And a physician trains for a minimum of 11 years after high school before that physician is judged to be competent and have the level of medical judgment necessary in order to practice in this country.

MR. SOLMAN: Do you really need 11 years of education to be a good diagnostician?

DR. LONNIE BRISTOW: There's a vast difference between what a physician brings to bear on what seems to be an ordinary problem and what a lesser trained individual brings to bear. And so you've had a very broad training base from which to draw upon when the undifferentiated patient comes in to see you. He says, "I've got discomfort here at the top of my belly." Well, that could be an ulcer. It could be a heart attack. It could be a flock of things.

MR. SOLMAN: Is there -- as the nurses and a lot of other people claim -- a doctor's monopoly?

DR. LONNIE BRISTOW: That's not true. Certainly I didn't come from a wealthy family. I didn't come from a privileged class. And yet, the opportunities are here in this country for those who want to discipline themselves in order to meet the standards that are required. Americans should not be receiving substandard care as some sort of social experiment. What nurses learn during their training period suits them for being excellent nurses, which is what they are. In fact, we've talked to nurses who have subsequently gone to medical school and become physicians. And interestingly, to a person, they all say, "I didn't know what I didn't know until I went to medical school."

MR. SOLMAN: That is now, however, what this former nurse, now a doctor, says. Dr. Susan Fox.

DR. SUSAN FOX, Internist: I said the opposite. I said just the opposite. I certainly knew what I didn't know, and what I feel is that they don't know what I learned as a nurse, the ease of being with patients, the empathy for patients, the kind of feeling where I knew what the patient was going to require, I knew what the nurses on the floor were going to require from me as a physician.

MR. SOLMAN: Dr. Fox says that as a nurse she learned prevention and listening skills that were never taught in medical school which she attended to get the respect and money that come with an MD degree. But if wellness care is really the coming trend in medicine, how come medical societies around the country are stepping up their opposition to nurses with this quack ad, for example?

DR. SUSAN FOX: I think now it's becoming an economic issue, because everybody's scrambling to hold on to their procedure. Everybody's scrambling to hold on to their piece of the pie, and it's kind of nauseating to me, because it's being driven by the dollar signs, i.e., who can deliver the best care most efficiently.

MR. SOLMAN: Now, from the economic perspective, there's nothing nauseating about preferring less competition and higher income. It's true of doctors and it turns out even of nurse practitioners.

MR. SOLMAN: One question that arose and I was listening to is the desire to get paid the same amount as doctors, to bill the same amount, because one of the issues here is: Does this lower the total health care bill?

NANCY BOWDEN: The problem right now is that we're not getting reimbursed at all by many of the insurance companies.

MR. SOLMAN: But suppose they would accept nurse practitioners but say, look, you have fewer years of training and, therefore, you should get paid -- I don't know -- however much less your education costs, pro rated then for the doctor, how would you feel about that?

NANCY BOWDEN: I wouldn't be comfortable with that.

JOY STEIN, Nurse Practitioner: What's relevant is, what do you provide, what is the end product, what is the end service?

MR. SOLMAN: But do you think that doctors should be paid more than nurse practitioners?

JOY STEIN: For what?

MR. SOLMAN: Just a primary care visit. Should the doctor be paid more than you?

JOY STEIN: Paid more than me -- well, no, actually what I'm saying is that I should be paid more because I'm providing more services.

NANCY BOWDEN: If we are giving primary care, better primary care, which I feel we are giving, then, yes we should be.

MR. SOLMAN: At the moment, however, the average nurse practitioner makes maybe $40,000 a year compared to the average family doctor up around $120,000. Now, maybe doctors provide three times the value. Maybe they've simply got a lock on the market, but in either cases, nurses have been complaining. They've been organizing, and they've been pushing for regulations to try to tighten their own licensing procedures. So nurse practitioners want some of the power and monetary rewards that doctors have gotten, trying to maximize their income like any other economic group. But if it's rewarding to them, it'll cost us, since we wind up with the tab, a tab that should be lower than what we're paying now if nurse practitioners do more primary care but not perhaps as low as deregulation or the Clinton administration would suggest. FOCUS - DEADLY EPICENTER

MS. WARNER: Next tonight, the AIDS epidemic. As the medical research community searches for a cure for AIDS, the disease shows no signs of abating. It rages on and is especially virulent in countries where the resources to treat and prevent it are few. One such place is India. Medical Correspondent Fred De Sam Lazaro of public station KTCA-Minneapolis-St. Paul reports from Bombay.

MR. LAZARO: It is one of the busiest red light districts in the world. About fifteen to twenty thousand prostitutes ply their trade along this stretch of Falkland Road in India's bustling commercial center of Bombay. Some are behind the curtains of storefront brothels. Others linger outside seeking attention from customers, not cameras. Most are female, although there's a sizable number of castrated males known in India as Hijiras. On this and many early evenings before business gets into full swing, Dr. Ishwar Gilada can be heard on his bull horn preaching about the dangers of AIDS.

DR. ISHWAR GILADA: [speaking through interpreter] We're not here from any condom company. We are doctors, and we are here to tell you about AIDS and why it is important to pay attention to AIDS.

MR. LAZARO: Depending on who's counting, there are between seventy and one hundred thousand prostitution workers in Bombay. Dr. Gilada has recorded only a few hundred full-blown AIDS cases. These occur five to twelve years after HIV infection. But that statistic doesn't even hint at the huge looming problem. The trade seems quite brisk on Falkland Road.

DR. ISHWAR GILADA: Our aim is to see that they perform safer sex, so our task whether they're positive or negative, whether they're AIDS patients or they're healthy, they must use condoms with all the clients.

MR. LAZARO: With a team of prostitutes or peer recruits, Gilada's Indian Health Organization distributes thousands of condoms each night. They have no problem coaxing takers, one sign they hope that condom usage is becoming more widespread.

WOMAN: [speaking through interpreter] In the beginning, they used to not treat it seriously, but now they have understood. The illness is spreading very fast. Now the girls understand that. When they see us go by, they call us back and ask us for condoms. The girls now understand about AIDS, and if the customer does not listen, they send them away. In fact, if the customer is insistent, sometimes they'll even beat him up.

MR. LAZARO: That kind of assertiveness may be the exception rather than the rule, however. Shilpa Patil, a social worker involved in AIDS education, says condom usage is far from universal.

SHILPA PATIL, Social Worker: One thing is very much clear, that awareness level within the client group has definitely gone up. It has gone up to 80 percent, but then there is no change in behavior.

MR. LAZARO: One reason could be that many prostitutes and their clients don't fully understand the nature of AIDS. Dr. Veronica Moss is a visiting London-based physician fluent in Hindi.

DR. VERONICA MOSS: Everybody always wants to know what does somebody with HIV look like, and the women were asking us, well, the men were asking me, so what do they look, what do you get if you have AIDS? And of course, if you have AIDS and you are in in end stage disease, there are things that can be seen or observed that make it obvious that you're ill. But if you're simply HIV positive, there are no signs at all, and of course this is something that they -- people often can't understand.

MR. LAZARO: The absence of overt HIV symptoms is only one factor that makes it difficult for prostitutes to press clients into wearing condoms. Surekha has worked in a Falkland Road brothel for 10 years.

"SUREKHA," Prostitute: [speaking through interpreter] They say they don't get that much pleasure if they're using a condom, and they ask, "Are you infected? Why are you insisting on condom use, because I'm not infected." So we can't say anything.

MR. LAZARO: Surekha typically sees about 50 customers each week. She estimates about 20 percent, or about 10 customers a week refuse to wear condoms. Multiply that by the number of prostitutes in Bombay and epidemiologists say each week up to one millions sexual encounters are unprotected in Bombay's Red Light District. But Dr. Gilada is quick to add it's high risk behavior over which prostitutes have little or no control since in almost all cases they are abducted into the trade, little more than slaves.

DR. ISHWAR GILADA: There are a sizable number of people who come through rape or incest where after they were incested, they don't find a safe place in society or at home, and they come to prostitution. And they come because of fake marriages, where someone marries them for dowry, and after getting that money, they disown them.

MR. LAZARO: That was the fate of Surekha, who was introduced to us by social worker Patil. Surekha was married in an arrangement by her parents to a man who left her three years later. In rural India, there are ancient social stigmas attached to that separation which often means the bride's own family will disown her, putting her out in the street. In Surekha's case, she found work as a house maid but her employer soon brought her from her village in rural Maharashata to a Bombay brothel.

"SUREKHA": [speaking through interpreter] I was told I'd have to help these women in their household chores, cook for them. Then about a month later I was told to go into the business. I asked, "Why do I have to do this business? I don't want to do this. I want to go back home." She said, "Okay, then, you pay me back the money, 2000 rupees, that I have given this friend of yours." I said, "I never asked you to give her that money." But she said, "No. She has sold you here."

SHILPA PATIL: And the other part is there is always interest increasing on that loan. It is much higher than the normal rate, so her entire life she's just repaying that loan.

MR. LAZARO: She'll never retire that debt?

SHILPA PATIL: Hardly anybody escapes that thing even if they try and escape, then there are again, pimps and police people who come and collect their [bribes] so at the end of the day, she is left with nothing.

MR. LAZARO: Sadly, even economic freedom is no ticket out of prostitution. Surekha, in fact, paid off her loan, thanks to a regular customer who married her. But six years later, he left her for another woman. A mother of two by now, Surekha says she had no choice but to return to the brothel.

"SUREKHA": I have two children, two sons, and no place to go.

MR. LAZARO: In the short-term, Dr. Gilada can only hope his message on safe sex stems the HIV infection rate, but he says in any long-term prevention effort it is hard to separate the myriad of social mores and sexual practices that allow India's sex trade to flourish. They are ticklish questions that challenge age-old productions.

DR. ISHWAR GILADA: Sexuality is such a thing that you can't discuss with your parents, you cannot discuss with your teachers. There is no sex education in this country, in the schools and colleges, not even in medical college.

MR. LAZARO: You say that there simply isn't enough space for people and time presumably to have fulfilling sex lives?

DR. ISHWAR GILADA: In some of the families there are four or five couples and there's only one bedroom. The mother-in-law decides which daughter-in-law will sleep with her husband in the bedroom.

MR. LAZARO: So which couple will have sexual relations?

DR. ISHWAR GILADA: Yes. So it is seen as a thing to be done for procreation rather than recreation. So there is no element of recreation in sexual life for them. A lot of people have not seen their wives naked because there is simply not opportunity. They have a sex life of five, ten minutes. That's it. So what they do is they see on TV, they see in their offices, in the buses and stores, and they get excited. And they come home, and the wife is tired. The wife does not have simple time to recreate her husband, so that kind of phenomenon has to be looked into, and we are doing that kind of research of women's empowerment sexuality, all this kind of recreating business about why the men are going out.

MR. LAZARO: The idea of sexual repression here is ironic to Gilada and many Indians. This is an ancient culture whose art, folklore, religion, and mythology have for centuries celebrated human sexuality. What's needed, according to many experts, is a return not to the Kamasutra, but to a healthier discussion of sexuality.

DR. ISHWAR GILADA: If we make the behavioral change right in the school-going age, where people are not established in their behavior, we have to convince parents and teachers, and we have to convince them that educating children about sexuality, about AIDS, is not making them promiscuous.

MR. LAZARO: That kind of sea change in sexual and social mores may come a generation from now. But among the generation of these children's parents, some experts are already predicting India will suffer a disaster of multiple holocaust proportion. Dr. Subhash Hira is an infectious disease specialist on loan from the University of Texas and the U.S. Agency for International Development. He previously directed the AIDS program for the government of Zambia, a nation devastated by AIDS in the 80's. India says it's going down the same path only on a larger scale and faster.

DR. SUBHASH HIRA: We have probably passed the critical level in Bombay and all it now is going to be doubling at a very fast rate. By the year 2000, India will have probably between 11 to 40 million infected people, another six years away from us.

MR. LAZARO: With all this, the Indian government, plagued by so many other pressing problems, has been slow to acknowledge the new crisis. India spends an average of 2 cents per year per capita on AIDS control and prevention. It's a fraction of what's spent by many poorer African countries. Meanwhile, Dr. Hira says India's health care system faces a massive onslaught when the HIV positive begin converting to full-blown AIDS cases. Hira predicts that in just a few years, there will be at least six AIDS patients contending for every available hospital bed in Bombay. Surekha would well be among those patients. She recently tested positive for the HI virus, a fact she did not want to discuss in our interview. She has managed to place her older, eight year old son in an orphanage and hopes to do the same with her two year old. The best Shilpa Patil's organization can do is help women like Surekha get medical help.

SHILPA PATIL: There aren't many hospitals that will take these women because they are stigmatized as sex workers going to a hospital. Nobody wants to threat them properly. And with AIDS, nobody wants to touch you, so it's a problem.

MR. LAZARO: What happens to them?

SHILPA PATIL: She may die on the roads. That's what happened with one of our cases. Her brother owner just kicked her out with her three month old child, out of the brothel. We tried to explain that she won't pass AIDS by touching or sharing any room with her, but they just refused.

MR. LAZARO: They threw her out of the brothel with a three month old child?

SHILPA PATIL: Yeah.

MR. LAZARO: What happened?

SHILPA PATIL: She's still on the roads. We can't do much about it. What we can, we can help her medically, provide a few things to her.

MR. LAZARO: Where does she live, just on the streets?

SHILPA PATIL: On the streets.

MR. LAZARO: And there are going to be thousands and thousands of these faces not very long from now?

SHILPA PATIL: Yeah, that's right.

MR. LAZARO: The clinical matter-of-fact air of a social worker, the seeming lack of urgency on the part of policy makers and many ordinary Indians about the looming AIDS crisis all tend to mask its immense scope, a scope that goes far beyond public health. A country which has managed to become self-sufficient in food, one whose economy has made impressive gains in recent years, could see all those advances wiped out by AIDS. So while reporters usually try to conclude stories on some note of hope, this is difficult with the story of AIDS in India, where under the most hopeful scenario between now and just the year 2000, as many people will become HIV infected as have been infected throughout the world since the beginning of this epidemic. ESSAY - RE-CREATION

MR. MAC NEIL: Finally tonight, essayist Paul Hoffman, editor of Discover Magazine on how close we are to monkeys.

PAUL HOFFMAN, Discover Magazine: It's been 20 years since Donald Johannsen digging at this remote site in Hadar, Ethiopia, discovered the bones of Lucy, the long sought missing link in the evolution of human beings. More than 3 million years old, Lucy is the earliest hominid that walked on two legs. As famous and monumental as Lucy's bones are, they are nonetheless bones of contention. For one thing, only 40 percent of the bones were recovered, and not much from the skull. Johannsen assumed Lucy was a female because of her petite size, three feet, six inches, but another anthropologist has questioned even that assumption. That's par for the course in the study of human origins, where everything seems up for grabs. About the only thing anthropologists agree on is that earliest hominids evolved in Africa, some 4 million years ago. Until this February, they thought they agreed on something else, that a group of Lucy's descendants, the heavy browed, hand axe-wielding, homo erectus, the first hominid that looked like us, and tamed fire, left Africa about one million years ago for Asia and Europe. But a new analysis of homo erectus skull fragments from Java shows them to be nearly two million years old. This suggests homo erectus migrated from Africa at a much earlier time, long before inventing the sophisticated hand axes that were thought to make that migration possible. The hominid fossils that anthropologists have to work with are few and fragmentary and often hard to date, but our thirst for knowledge of our origins is insatiable. Witness this new Hall of Human Evolution at the American Museum of Natural History in New York. That's why anthropologists spin out grand scenarios from the smallest sliver of bone. It's also why the discovery of a new sliver can easily overthrow a long-accepted notion. Monday, the cradle of civilization is Africa; Tuesday, it could be Java. But do not conclude that the theory of human evolution is somehow in jeopardy. While religious groups may disagree, scientists today are completely united in thinking that people and apes descended from a common ancestor. The physical evidence, of course, is suggestive. We share many features with apes. We both can grip things with our hands by opposing the thumb to the forefingers. And we both lack claws and a tail. But the most compelling evidence comes from the molecules we share. By the mid 1980's, biologists knew that we shared 98.4 percent of our DNA, our genetic material, with chimpanzees. All the observed differences between chimps and us, the differences in brain size, in body hair, our ability to talk and walk erect, our ability to make art, develop technology, and build civilizations, can be ascribed to only 1.6 percent of our DNA. Moreover, these genetic studies show that we are more closely related to chimps than chimps are to gorillas. Those two apes differ by 2.3 percent of their DNA. Look at it this way. The chimp's closest relative is not the gorilla, but us. Genes are known to change as a certain slow rate. By turning back this genetic clock, scientists have concluded that chimps and people shared a common ancestor 7 million years ago. Little can be made of the fact that the bones of this ancestor have yet to turn up. If an orphan after concerted effort could not find the identity of his parents, he wouldn't conclude that he didn't have any. No more weight should be given the failure to find our long lost ancestor. That human beings and chimpanzees are fully alike in 98.4 percent of our fundamental genetic chemistry raises the question of whether we should treat them with respect and compassion. If chimps are that much like us, it's not silly to ask whether we should accord them the rights we grant our fellow human beings. I'm Paul Hoffman. RECAP

MS. WARNER: Again, the major story of this Wednesday, President Clinton went to Capitol Hill for strategy meetings on his health care reform proposal. The meetings took place amid reports that Congressman Dan Rostenkowski, one of the Presidents key allies in the health reform battle, may be facing an indictment for alleged financial improprieties. The report said he might resign from Congress in a plea bargain agreement. Good night, Robin.

MR. MAC NEIL: Good night, Margaret. That's the NewsHour for tonight, and we'll see you again tomorrow night. I'm Robert MacNeil. Good night.