The MacNeil/Lehrer NewsHour

MS. HUNTER-GAULT: Good evening. I'm Charlayne Hunter-Gault in New York.

MR. MacNeil: And I'm Robert MacNeil in Washington. After tonight's News Summary we examine the new violence in Northern Ireland with the ambassadors of Britain and the Irish Republic. We continue our series of Presidential campaign speeches with Sen. Bob Kerrey. That's followed by another in our conversations with doctors on solving the health care crisis. We close with a documentary report on locating toxic waste dumps in minority communities. NEWS SUMMARY

MR. MacNeil: The Supreme Court today refused to halt the enforced repatriation of Haitian boat people, but the Justices gave the Bush administration until Friday to answer new charges by lawyers representing the Haitians. They claim U.S. officials had evidence that refugees who were returned last fall had been tortured, killed, or persecuted by the Haitian government. So far, more than 2,000 have been sent home by the Bush administration. Some 15,000 have fled the country since the overthrow of Haiti's elected president in September. The U.S. government claims they are economic refugees and do not qualify for political asylum. State Department Spokesman Richard Boucher responded to the court challenge in Washington.

RICHARD BOUCHER: What we're doing is we're continuing the process of repatriation. We're continuing to monitor the situation in Haiti with regard to the people who were sent back. Our view has been and continues to be that we had no documented reports or evidence that people who have been repatriated and subject to persecution.

MR. MacNeil: Most of the Haitian refugees are being housed in a tent encampment of the U.S. Naval Base at Guantanamo Bay in Cuba. On January 31st, the Supreme Court voted six to three to allow their deportation. Charlayne.

MS. HUNTER-GAULT: President Bush called on Congress again today to pass his economic growth package. The House Ways & Means Committee will discuss the plan tomorrow. Mr. Bush met with Republican members of the committee at the White House this afternoon. Reporters asked about his mood as he prepares for his formal re-election announcement tomorrow.

PRES. BUSH: Hey, look, Terry. I want to get this economic growth package passed. What I really feel like is we want to try to help the country and get some people back to work here and stimulate this economy. And that's exactly what this proposal is about. And that's the best thing for all people involved in politics no matter what side of the aisle they're on right now. Put America's interest first, and that's what I'm trying to do here, and then we'll have plenty of time for politics after that.

MS. HUNTER-GAULT: President Bush also today announced a speed up in a phasing out of ozone destroying chemicals. He said the U.S. would end production of chlorofluorocarbons known as CFC's by 1995 instead of the year 2000, as earlier agreed to. In announcing the move, the President cited new forecasts of a growing ozone hole over the Northern Hemisphere.

MR. MacNeil: A suspected Irish Republican Army bomb was found in London today. It was discovered near Prime Minister John Major's office and defused just hours before he held talks on security with Northern Ireland's political leaders. Major spoke to reporters after the meeting.

JOHN MAJOR, Prime Minister, Britain: In our meeting this afternoon everyone present was unanimous in condemning terrorist attacks whatever their source may be. Terrorists who claim to be acting on behalf of one community or the other were, in fact, acting against the interests of all the people in Northern Ireland. That was the unanimous view of everyone attending this meeting.

MR. MacNeil: We'll have more on that story after the News Summary. Vice President Dan Quayle was also in London today. He met with British Foreign Secretary Douglas Hurd just yards away from where the bomb was found earlier in the day.

MS. HUNTER-GAULT: Humanitarian aid from the U.S. airlift began reaching former Soviet citizens today. In Moscow, it went to some 30 hospitals, orphanages and soup kitchens. It included food such as fish sticks, pork chops, and vanilla pudding, enough for 100,000 meals. Most of it was rations left over from the Gulf War. Secretary of State Baker was in two other former Soviet republics today, Moldova and Armenia. Baker met with Moldova's president and said he won assurances on human rights. Baker predicted the U.S. would soon recognize the republics. This evening he arrived in Armenia where officials appealed for U.S. help in resolving a bloody ethnic feud with neighboring Azerbaijan.

MR. MacNeil: The Red Cross today announced a new effort to help families of Holocaust victims learn the fate of their loved ones. Thousands of Nazi documents seized by U.S. forces at the end of World War II are being catalogued on microfilm. They include death logs from the Auschwitz and Gugenvalt Concentration Camps and lists the Protestant majority, mostly eager to keep links to Britain, and the Catholic minority, many of whom favor a union with the republic of Ireland. We begin with this report on today's London meeting from Joan Bennett Powell of Independent Television News.

MS. POWELL: Expectations of what the meeting could achieve were deliberately played down by Downing Street. His aim was to get all the party leaders together and hear what they have to say. the Prime Minister was to stress the need for an unequivocal condemnation of terrorism, whichever side it came from. The talks lasted for over an hour and a half. There was a brief announcement by Mr. Major alone summarizing the session.

PRIME MINISTER MAJOR: We've had an excellent meeting. It was held in an extremely good spirit, and I believe everyone who took part in it regarded it as thoroughly worthwhile. The discussions we've had were frank and they were wide ranging. Points of agreement were aired and so were points of disagreement by all the four party leaders. We have discussed all these and we will return to those matters later. As a result of the excellent dialogue we've had this afternoon, I've indicated to the four party leaders that I'm prepared to hold further meetings with them in order that we can discuss the matters of relevance to Northern Ireland and, in particular, to the security situation that prevails within Northern Ireland.

MS. POWELL: The parties agreed to a request to extend the existing informal talks to cover political issues and agreed as well to further talks with Mr. Major. In addition, Mr. Major said he intended to meet the new Irish Prime Minister in the near future. The unionist leaders said later at a joint news conference in Westminster they were pleased with the outcome.

JAMES MOLYNEAUX, MP, Leader, Official Unionists: Well, for the first time that I can remember in 16 years that I have notcame to the meeting to deal with Northern Ireland.

REVEREND IAN PAISLEY MP, Leader, Democratic Unionists: I think too that the Prime Minister has now got to deliver and if he delivers, there will be a Northern Ireland. And I said we're not in a situation of begging. We are agreed what he would say and he said what he said and I can't find any fault with it, but I mean now we have to see activity, real activity.

MS. POWELL: However, change is signaled with the new prime minister in Dublin, Albert Reynolds, and the cabinet he announced from the doyle today, almost a clean sweep from the old regime and describd by one observer as enlightened, liberal, and moderate, and leaving the unionists less room to hail Dublin as an intransigent obstacle.

MR. MacNeil: We now get the views of the British and Irish governments. The Irish Republic and Britain have pledged to work together to resolve the Northern Ireland problem. Sir Robin Renwick is Britain's ambassador to the United States. Previously, he was British ambassador to South Africa. Dermot Gallagher is Ireland's ambassador to Washington. Before this, he was responsible for Anglo-Irish issues with the Irish Department of Foreign Affairs. Amb. Renwick, what was the most important result of the talks held in London today?

AMB. RENWICK: The two most important results were the denunciation by all four constitutional parties of terrorism and the expression of their support for the security forces, and the agreement to get together to try to resolve between them the obstacles to getting into serious discussions about the future.

MR. MacNeil: What are those obstacles?

AMB. RENWICK: Well, the, in the past, the unionists have raised difficulties over --

MR. MacNeil: Unionists for the American audience are Protestants who want to stay united with Britain.

AMB. RENWICK: Protestant leaders have raised difficulties over aspects of the anglo-Irish agreement to which they are opposed but to which the British government is firmly committed. There are other problems which have to be dealt with as well. Nevertheless, we believe that it will be possible to find a way forward. The hold up has been because both parties on both sides have wanted to wait until after the general election in Britain. Mr. Major was trying today to say this issue is too urgent and too important to wait until after the elections. We want you to get together and sit down and discuss it now.

MR. MacNeil: In other words, the recent up surge of violence on both sides, Protestant and IRA, has forced this, Mr. Major to deal with it before the election?

AMB. RENWICK: It has helped to concentrate everybody's minds even more. I'd just like to put the violence in some sort of perspective if I may. Last year in Northern Ireland, 94 people were killed. Now, that's a terrible figure. It is 94 people too many. Compared with the death rate in many American cities it gives a lie I think to the illusion that some sort of civil war exists there or anarchy. We have to get on top of the violence, which is why we are sending more troops and increasing the peace presence. But at the same time, we have to look for political ways.

MR. MacNeil: Some in Prime Minister Major's own party, the Tory party in Britain, see the situation as on the verge of civil war, open civil war. Does your government see it that way?

AMB. GALLAGHER: My government sees it as extremely serious, extremely worrying, as requiring the highest priority to be given to it by both governments. Both governments work together very closely and my colleague mentioned the Anglo-Irish agreement, which dates from 1985, which is a formal international agreement between the two governments and within the frame work of which they meet on a daily basis at an official level in Belfast and on a monthly basis at ministerial level and they're committed to operating that agreement fully and under that agreement, a range of reforms have been introduced in Northern Ireland. Yes, it's a very serious situation.It's a situation that requires a response across a number of fronts. It requires a response at the security level. It requires a response at the political level. It requires a response at the reform level in the area of human rights, in the area of building confidence in the security forces, et cetera. The two governments are working closely together to bring that, those reforms about. We are working very closely to get all party, round table talks underway because at the end of the day all people who believe in the constitutional way forward have to get around the one table. The two governments and the constitution of political parties in Northern Ireland have to get around the one table.

MR. MacNeil: All parties, the Shin Fein, the party that supports the IRA and won't renounce violence, excluded from these talks today for that reason, I know your government's position, but in many rebellions, a time comes when a government is forced for pragmatic reasons to turn its back on whatever resolutions it's held in the past and include those who refuse to renounce violence. The South African government, you've just come from South Africa, has just done that with the ANC, which persists in refusing to renounce violence.

AMB. RENWICK: Could I just interrupt you.

MR. MacNeil: Let me ask my question. With this endless, bloody stalemate, although of a scale in death smaller than perhaps many American cities, is there any reconsideration of including the Shin Fein?

AMB. RENWICK: No, there isn't. And I was partly instrumental in helping to persuade the South African government to talk to the ANC, who represent probably the majority of black South Africans. The IRA has a basic problem and its basic problem is that it cannot win election. It has never been able to win more than 10 percent of the votes in Northern Ireland. Consistently, John Hume and the Social Democratic Labor Party win twice as many Catholic votes in the elections as the IRA do. We are not prepared to let anarchy prevail in Northern Ireland and we're not prepared to let the government have their way in Northern Ireland. What we are prepared to do is to work with all the constitutional parties who represent 90 percent of the population of Northern Ireland to try to bridge the differences between the two and to find a way forward. Now, we have had very solid support from the Irish government in trying to do just that.

MR. MacNeil: Does your government support that position of not admitting the Shin Fein and describing it as unconstitutional?

AMB. GALLAGHER: We support it fully.

MR. MacNeil: You do?

AMB. GALLAGHER: Violence is an obstacle to people coming to the table. If violence were to be set aside, then I think there would be changed circumstances and both governments accept that and would have to look imaginatively at those changed circumstances, but at the moment, what we are talking about is getting everybody, all parties who believe in the constitutional way forward, around the table. And I think as John Hume said, to have their cards on the table and with nothing under the table, so it is the men of violence, it is the IRA and the paramilitaries on all sides who by their own actions are excluding themselves. It's not the governments who are excluding them.

MR. MacNeil: The prime minister agreed today, Mr. Major agreed to meet with your new prime minister, Albert Reynolds, who took office today. You heard the ITN reporter say that some people thought that it opened new hopes of some progress. What can your prime minister do to help the situation?

AMB. GALLAGHER: Well, the two governments --

MR. MacNeil: That Mr. Hawhay hasn't been doing.

AMB. GALLAGHER: The two governments, as I said, have been working very closely together since 1985. We have a formal international agreement between us which institutionalizes and gives the Irish government a formal role in the development of policy in Northern Ireland. The new prime minister has been a member of the government for five years in Dublin, which has operated that agreement, Anglo- Irish agreement, imaginatively and effectively and skillfully. He's a very experienced politician. He was minister for industry and commerce and minister for finance. And he was the member of the government, which together with the British government last April crafted a frame work that enabled all party talks to get underway. Now, we weren't able to sustain those talks last year. We do hope that they will start again, but that was a crucial breakthrough. If we had been able to sustain those talks, we may even at this stage have been talking about historic developments in Northern Ireland and in relations between the North and South and between Britain and Ireland.

MR. MacNeil: Is there any justification in believing, as that ITN reporter suggested, that the new prime minister in Ireland will be perceived by the Protestant extremists in the North as not as sympathetic to the IRA as some of them thought Mr. Hawhay was? In other words, does Britain, does London see, does your prime minister see this as a good sign and that it may in the chemistry of the North help things along?

AMB. RENWICK: I can't answer for their views, but I can answer for their views. We expect to have very good relations with Mr. Reynolds. We know him well already and what he has just said on this subject might be of some interest to you. What he said was a dwarfed and twisted patriotism sees death as an instrument of change. We must put no limits on what we must do to change all that. And we expect to be able to work very closely with Mr. Reynolds, as we've been doing for several months.

MR. MacNeil: After all this new outburst of violence, what evidence do you see that there is the spirit in Northern Ireland, what fresh evidence, to tackle the fundamental problems that just perpetuate the deadlock?

AMB. RENWICK: On a program like this, we discuss nothing but bomb attacks and the problems. Any visitor to Northern Ireland, and I know that you've been there, comes away enormously impressed by the resilience of the people, by the remarkable leadership of many people, some of them in politics, the religious leaders, the community leaders, by the fact that the great majority of the population of Northern Ireland on both sides want to have normal lives to educate their children, to better themselves economically and to live in peace. And there is plenty of hope in Northern Ireland. I think that the Anglo-Irish agreement has helped to create more hope.

MR. MacNeil: But if the talks got deadlocked last year, what's different this year that would give people some new impetus to break these very, very fundamental differences between the majority and the minority?

AMB. RENWICK: It can only be done gradually. You have to build confidence between the communities. Every single sectarian killing is designed to destroy confidence between the communities and to trigger counter violence by the other side.

MR. MacNeil: Do you see some --

AMB. GALLAGHER: I could perhaps be helpful there. But before doing so, I just, if I may put a gloss on your use of minority and majority, the problem on the island of Ireland is that there are really two minorities and two majorities. There's a nationalist or Catholic minority within Northern Ireland, but part of the majority on the Island as a whole, there's a unionist majority within Northern Ireland within that artificial area, but part of the minority sees itself very much as a minority on the island as a whole. Now, what is different and what gives me hope is that for 60 years the situation was bottled up within the narrow ground of Northern Ireland. Since '85, it is seen within the totality of relationships between the two islands. The two governments are critically involved in finding the way forward and crafting a frame work that will enable us to move forward. Secondly, the British and Irish governments are now sharing sovereignty in Brussels. There's a European dimension to the problem which gives it a scope and a pace which wasn't there previously. We, as I said, crafted, the two governments, London and Dublin, crafted a frame work together last April that got all the parties round the table. Those -- we weren't able to sustain those talks at the time, but they didn't break down in recriminations and the parameters, the frame work for those talks, is still there, still accepted by all the parties, and we hope, we fervently hope, as our new foreign minister said today, we very much hope that the parties will return to the table in the very near future.

MR. MacNeil: Well, Amb. Gallagher and Amb. Renwick, thank you both for joining us.

AMB. RENWICK: Thank you.

MS. HUNTER-GAULT: Still ahead on the NewsHour, Sen. Kerrey campaigns, a doctor talks about the health care crisis and Californians debate toxic waste dumps. FOCUS - '92 ELECTION - MAKING HIS CASE

MS. HUNTER-GAULT: Now we continue our series of extended excerpts from candidates' stock campaign speeches. Tonight, we hear from Democratic Senator Bob Kerrey of Nebraska. He spoke yesterday at Daniel Webster College in Nashua, New Hampshire.

SEN. BOB KERREY, Democratic Presidential Candidate: I'm running for President of the United States because I am concerned about the direction in which we are going and I'm running for President because I believe America is ready for challenge, not just a list of new programs but, indeed, a challenge to rise to our full greatness. And there is a challenge that lies before us, a rather substantial one. The bad news is that we've accumulated a substantial amount of debt in the 1980s, almost $4 trillion for the total debt, a $400 billion annual deficit this year. The bad news is we had 16,000 drug murders in 1991. There's a lot of violence in our streets. The bad news is we've got higher than we should dropout rates. We've got relatively high unemployment and families in America, working families in particular, find themselves with a great deal of stress and not surprisingly, sort of giving up in many cases on the political process. The good news is that we have a tremendous opportunity, and I believe we as Americans have typically defied the odds and have risen to the opportunity when it's presented to us. This, unlike many opportunities that we've hadin the past, where we have been challenged by a war or we've been challenged by a depression, this is a challenge of a much different nature. At the end of the cold war, we now see that the Soviet Union has completely collapsed. They're reaching out to try to get our help. Perhaps the most dramatic example of that is when President Yeltsin of the republic of Russia comes to the United States of America, Camp David, and said nicer things about our President than the chairman of the Republican Party has said about our President lately. Now, he's asking for our help. There's a tremendous opportunity for us in the post cold war era. And the vision that I have is that the United States of America will join with Japan and the European community and that the three strongest economic powers, rather than isolating themselves and restricting opportunity, that we will use this historic moment to create opportunity for the rest of the world, that there is a connection between our desire for a higher standard of living and the prosperity of the world at large. The three large economic centers, the United States, Europe, and Japan, represent less than a billion people of 5 1/2 billion people on this planet. I should not have to tell you to tell you but I'll try to deal with an elemental level. We cannot have a strong economy here unless we have something to sell and we can sell nothing unless there's somebody out there that's ready to make the purchase. It's a relatively simple proposition. We, first of all, have to produce goods and services, and then we have to have somebody out there to make the purchase. And there's a tremendous opportunity for us in the post cold war era to convert old enemies into new customers. We are going to have to make the effort to get that done. And my vision is that instead of having two nuclear powers going head to head, we should have three large economic powers, and I must tell you we're drifting in the opposite direction today, the three economic powers working in a cooperative fashion to advance prosperity to the rest of the people on this earth. In order to do that, I believe very strongly that Americans in the 1990s are going to have to rise to the economic challenge at home. And we do need an industrial policy that puts us in a position to be competitive with the rest of the world, to organize our government so that it can make the investments necessary to win economic battles in semiconductors, consumer electronics, machine tools, aerospace, automobiles, those things that will producer higher income, produce those things that the world, indeed, wants to purchase. And we've got a massive amount of shifting to do. The end of the cold war was a very precipitous, calamitous event. No one expected it to happen this fast. No one predicted that it was going to happen so suddenly. Thus, we've got to shift our government resources in a very rapid way, and as I indicated at the beginning, we've got some damage control to do prior to being able to reach our full strength. And I'm campaigning for President of the United States because I'm committed to the American people and challenge you and America to make the investments in plant and equipment, to make the investments in our people, to make the investments in our infrastructure and organize our government so it can get the job done. I'm secondly fighting in this campaign because I believe it's time for national health insurance, not just because I see it as a means to make certain that long-term care is there for our parents, that continuous health care is there for our children, but because I believe it's a powerful economic necessity if we are going to be competitive. And once again, the national health insurance proposal that I have will remove the uncertainty that is growing in far too many American families. I was -- we did a little five kilometer road race yesterday and after the race, a woman came up to me and said, I want to know that when you're talking about national health insurance, you're fighting for me. I had a radical mastectomy, she said, a couple of years ago, and now neither one of my two daughters or I are able to purchase health insurance because we're considered high risk. I've met with pregnant women with preexisting medical conditions who told me that they and their husbands pray every night that no complication will occur. I've met with people who've lost their jobs and lost their health care. I've met with elderly people who are terrified of what might happen if they fall down and break a hip or something happens to them in their home. Yes, we'll end the uncertainty with national health insurance. But the most important thing that I'm trying to argue with this proposal is that we will establish ourselves as being able to control the cost and reach a competitive position with Japan and with the Europeans, not, as I said at the beginning, for the sake of merely competing, but for the sake of building our economy from the inside so that we've got the capacity to lead in this world. I did at one point in my life fight in a war, the war in Vietnam, not an altogether popular war, but, nonetheless, we put ourselves on the line for freedom. Nonetheless, I still believe that the fight for freedom is not over. The United States of America is going to need to maintain a strong military, but the United States of America is going to have to make a concerted effort to build our economic strength in order to advance to peace on this earth. We have a tremendous opportunity in America today. And I'm running for President of the United States because I want to seize it. And I'm running for President of the United States because I intend to come to the American people and challenge them to save more, to invest more, to make a stronger effort in school, to make a stronger effort in the workplace, to make a stronger effort not just to build this great country of ours, to build it for the purpose of raising our standard of living and our income, and build it for the purpose still of leading on this planet towards peace on earth. I appreciate very much what you're doing in the school. I mention aerospace on my list of things not because I'm attempting to pander to you, although I'm capable of it. I'm doing it because it is, indeed, one of the most critical parts of our industrial policy. We still lead the world in aerospace and if I'm elected President of the United States we'll continue to lead the world in aerospace because it is one of the best and brightest hopes for us as Americans.

MR. MacNeil: That was Sen. Bob Kerrey of Nebraska. Tomorrow our campaign series continues with the Republican candidates. We'll start with President Bush, who will be in New Hampshire to formally open his reelection campaign. CONVERSATION - PRESCRIPTION FOR CHANGE

MS. HUNTER-GAULT: Next, our series of conversations on what is ailing the American health care system. After a heavy dose of proposals from the political arena in recent weeks, we turn this week to the medical profession for their ideas. Last night we heard from an emergency room doctor from Tennessee. Tonight's guest is Dr. Mary Jane England, the president of the Washington Business Group on Health. I spoke with Dr. England earlier this afternoon.

MS. HUNTER-GAULT: Dr. England, thank you for joining us. What in your view is wrong with the nation's health care system?

DR. MARY JANE ENGLAND, Business Group on Health: Health care costs have been escalating at a very fast pace. We're now at about 14 percent of the Gross National Product and we're not getting our money's worth. We have an infant mortality rate in this country that places us 23rd out of 38 developing countries, developed countries. And it's, we are not getting our money's worth. We have increasing problems with the uninsured, 34 million people uninsured, and also we have a problem with cost shifting, that is, about a fourth of what private payers pay for in health care is cost shifted from the public sector. We also have --

MS. HUNTER-GAULT: Meaning --

DR. ENGLAND: Well, the public sector, particularly Medicaid programs, don't pay the full cost of care for their patients and so the hospitals and doctors hope to make it up and shift back costs on to the private sector.

MS. HUNTER-GAULT: To people who they feel can afford to pay.

DR. ENGLAND: That's correct. And we also have a fragmented delivery system, a delivery system that is really very difficult for people to understand the maze through which they have to kind of wend their way when they need health care. And that delivery system isn't held accountable. We currently have a system that just isn't held accountable to the kind of quality health care we need for all Americans.

MS. HUNTER-GAULT: When you say they have to make their way through a maze, what exactly do you mean?

DR. ENGLAND: Well, right now people in the fee for service medicine, if people go to see a physician, they have to fill out a lot of forms, a lot of claims forms. They're referred to another physician. They have to kind of make their way to the next doctor and they're never really sure who's quality. They oftentimes, people get referrals about who to go to see, a doctor, from their neighbor, rather than from -- they're really never sure it's a quality provider.

MS. HUNTER-GAULT: So is there any -- so you see a multiplicity of problems as opposed to any one thing that you can point to?

DR. ENGLAND: Absolutely. I think that initially the whole cost issue has been a major issue for employers, but as they look more and more at how to solve this problem, they realize that we have serious quality problems as well. There's inappropriate and unnecessary care in this country where we have inappropriate rates of caesarian sections, for instance, much higher than any of the other countries where many of our women have to have caesarian sections where it really isn't necessary so there's a lot of unnecessary care in this country which really contributes a low quality.

MS. HUNTER-GAULT: How do you see fixing this? I mean, is there any one way to do it?

DR. ENGLAND: Well, I think we have to recognize that there are a lot of flaws in our current delivery system and we have to also address the financing issues. In particular, business and employers are increasingly convinced that we need to move to organized systems of care, organized systems of care that will provide a continuing of care for the patients so that when they come to a physician, the primary care physician, which would be an internist or a pediatrician, or obstetrician, would actually help them negotiate to find the best quality health care for them and help them to find the best specialist. They'd be responsible for them from prevention, early intervention, and when they have a medical problem, right straight through the whole process. Employers are, in fact, increasingly concerned that they should provide health promotion at the work site and ensure that people get adequate care right through when they're ill, when they're on disability, and right through to retiree health.

MS. HUNTER-GAULT: So you're talking about a particular kind of system. Is this the managed care, organized care, that's the same thing?

DR. ENGLAND: Well, the system we're talking about has developed from managed care. The initial generations of managed care were where the doctors would be reviewed from a distant physician or a nurse saying you can or can't deliver that particular care, and the employers in trying to control cost moved from that to actually developing what we call provider networks, that is, they went and contracted with physicians or hospitals for lower costs. That is not found -- has not been found to be quite as helpful as really is needed to control costs and ensure quality so the next generation we're talking about now are organized systems of care that will be held accountable. They'll be physicians and hospitals, health care providers working together to provide the whole continuum of care that patients need, and they'll be held accountable by a number of things. One would be outcomes measures, that is, is what they're doing effective, are all of the services that they're providing effective for the patient, and also we'll judge it by patient satisfaction or customer satisfaction. Do the patients understand what they're getting and is it working for them?

MS. HUNTER-GAULT: And let me just be clear on what it is that they would be getting. In other words, if I were -- is this something I'd get into or I mean, take me through it.

DR. ENGLAND: Well, there are a number of different ways. Employers today, in fact, over the last five years, employers have been building these systems. One system would be the one that has been developed by Southwestern Bell called Custom Care. They provide a whole range of services, health care services available to their employees. If an employee needs to have a routine physical, they would actually go to a -- Prudential actually covers the Custom Care employees -- they would go into the doctor's office, a primary care physician, and he would know them, he would have a uniform record, he'd have their past history, he'd know what had happened to them in the past and be able to see whether they needed a specialist, he would actually know who the best specialists were for the particular area that needed -- he would be responsible -- he or she would be responsible for providing them with immunizations, adult immunizations, mammography, pap smears, whatever was necessary for that particular patient, the primary care physician would be responsible for providing it.

MS. HUNTER-GAULT: And how would this bring down costs?

DR. ENGLAND: It would be one system of care, that is, the, there would be one record, hopefully we can do away with a lot of the administrative costs we have today of multiple claims forms, as people go to different doctors. There'd be one kind of electronic claims form so that people would not have to worry about that and the doctor's office could actually do it for them. And he would be able to know what is most effective for that particular patient.

MS. HUNTER-GAULT: Is there anything like that working now that has demonstrated that it is more cost effective?

DR. ENGLAND: Well, many of the HMOs are moving in that direction.

MS. HUNTER-GAULT: Health Maintenance Organizations.

DR. ENGLAND: The Health Maintenance Organizations like Kaiser have a community health plan. We also have a program in Southern California Edison, a utility company in Southern California that actually has built their own health care delivery system where they have in-house physicians, in-house pharmacy, and they provide care not only to their employees, but to their dependents, the spouses, the children, and then as people move into retirement, they also can come back and receive their health care through Southern California Edison's own health care system. Now, if they need to go into a hospital or in to a, a specific specialist, Southern California Edison has developed quality standards against which they know the different hospitals and the different specialists and have made contracts with those who they feel are the highest quality and most effective.

MS. HUNTER-GAULT: Who would be eligible to participate with it? Would it just be people who are attached to jobs, I mean, employees?

DR. ENGLAND: No. We feel very strongly in the employer community that the public sector should also be using organized systems of care, that we really should move the Medicare and Medicaid programs into managed care and into organized systems so that the, particularly for the elderly where they have, they need so much health care, this kind of what we call a case management approach where the patient feels comfortable with their physician and the physician helps manage the physical therapy they might need or the hospice care for later on, or whatever kind of care would actually be managed by the health care system.

MS. HUNTER-GAULT: But if they're not attached to a job site or whatever, I mean, how do they get into it?

DR. ENGLAND: They can be enrolled through the Medicaid program or through the Medicare program.

MS. HUNTER-GAULT: How do you respond to critics who say that this approach is one that stresses cost over care, that for example they rush people out of the hospital because hospitals stays cost a lot of money and that the, you know, that the emphasis is on the bottom line and so quality care is, is sacrificed at the expense of trying to get to a bottom line?

DR. ENGLAND: Well, I think the early generations of managed care were very much focused on controlling costs. The employers were seeing costs go up 20 percent a year and the initial approach was just to control the costs but they realized that they needed to focus on quality, that it wasn't just simply the cost but they needed to make sure they got the best possible care because good quality care can actually help reduce costs. So they actually went and developed these systems that were lower cost but also measured by quality and they do -- you can do that a number of ways. You can ensure that the physicians all are credentialed, licensed, as well as you can begin to compare one managed care company against another by actually looking at outcomes, and this is the kind of competitive notion that you would look at different HMOs in the community and see which of them did better as far as effectiveness goes. It's really important today that people realize that a lot of the care they receive is unnecessary. It's done oftentimes because physicians fear that if they don't do another particular study, they might be sued. So there's a fear of a malpractice suit.

MS. HUNTER-GAULT: Well, how does this take care of that?

DR. ENGLAND: Because this particular, we will be looking at effectiveness, thatis, outcomes, not, so that if people provide adequate care, we'll now actually be able to measure them against what we call practice parameters, that is, physicians will practice against certain kinds of practice guidelines that have been developed by their professional groups. There will be data systems that are common across all HMOs and they'll be able to be compared one against the other.

MS. HUNTER-GAULT: How does what you're proposing compare with the President's plan and particularly his proposal to use tax credits to help the poor purchase medical care?

DR. ENGLAND: Well, I think the important part of what the President's plan is that the administration is now a player in this debate and the, certainly the business community is very concerned that we have universal access to health care. They feel that is the way that we'll be able to control costs and I'm particularly pleased that the President has recognized the need of poor people, that this plan clearly covers those that are poor and not currently covered by Medicaid, up to 100 to 150 percent of poverty. He also addresses some of the cost issues by saying that we should have small market reform, that is, we should redesign the way that small businesses and individuals can actually purchase health insurance, so that they don't, if they have a preexisting condition, or a serious illness, they can be able to find good health insurance at a reasonable cost.

MS. HUNTER-GAULT: And just very briefly, are you hearing good things, in your view, from his Democratic opposition, or how have you assessed what you've heard, just briefly?

DR. ENGLAND: Well, I think there's support of this notion around community health centers and a national health service corps and the malpractice reform, and the small market reform, but I think both sides, both the Democrats and the Republicans, need to look much more closely at the way that health care is delivered. We cannot focus on financing alone because if we only finance the way that health care is delivered in this country today, we will not control costs.

MS. HUNTER-GAULT: Well, Dr. England, thank you for joining us.

DR. ENGLAND: Thank you. FOCUS - ENVIRONMENTAL RACISM

MR. MacNeil: Finally tonight, placing hazardous industries and toxic waste dumps near minority communities. Ecologists and civil rights activists say it amounts to environmental racism because it takes advantage of the poor and disenfranchised. Spencer Michels of public station KQED-San Francisco reports from California's Central Valley.

MR. MICHELS: About halfway between San Francisco and Los Angeles, along a desolate and arrid stretch of Interstate 5, sits the tiny, mostly Hispanic community of Kettleman City, population not quite 1200. Four miles away is California's biggest toxic waste landfill. They'll dispose of practically anything other than nuclear waste at this spot. Trucks loaded with oil impregnated soil, pesticides, household poisons and other toxins dump their hazardous cargos here.

JOE MAYA, Rancher: Now we get the smell from the dump, we get the dust. It has to be contaminated.

MR. MICHELS: Rancher Joe Maya, who lives in Kettleman City, charges that county officials and operators of the dump have been indifferent to the health concerns of his neighbors.

JOE MAYA: They're most migrant workers and they're people that are not, have the voting power, they're not the U.S. citizens.

MR. MICHELS: Now, Chemical Waste Management, Incorporated, the dump owner, has proposed building a huge state of the art incinerator on its property. That hasoutraged Kettleman City residents. It's not just a question of pollution, says Maya and others who are raising the cry of environmental racism.

MR. MAYA: We feel that all these incinerators and toxic waste dumps, that every one of them has been built by cities or towns that are predominantly Hispanic or colored or Anglos of low economic and social economic levels. So they won't site one of these dumps in a predominantly affluent area like, let's say close to Los Angeles or close to Santa Barbara or any of those places.

MR. MICHELS: The fight over environmental racism in Kettleman City is the most current of many such battles nationwide. The issue gained credence after a 1987 study by the United Church of Christ, which concluded that hazardous waste sites are most often placed in minority communities. In San Francisco, for example, activists are concerned about Hunter's Point, a predominantly black and poor area. Here, city officials have built a large sewage treatment plant which emits odors the residents complain of and a power company has constructed a generating plant. Both facilities are close to low income housing projects.

ROBERT BULLARD, University of California, Riverside: Hunter's Point has been black a long time. It's the dirtiest zip code in San Francisco. I mean, we can look at the dirtiest zip code in Los Angeles. It's basically the zip code in South Central LA, mostly black and Latino.

MR. MICHELS: Robert Bullard is professor of sociology at the University of California at Riverside. He is acknowledged as a leader in fighting environmental racism nationwide.

ROBERT BULLARD, University of California, Riverside: If you look at the communities that have been selected for hazardous incinerators, for example. These communities oftentimes, they are poor, they are communities of color, and oftentimes they are powerless. Kettleman City is a classic example that is not only, it has been impacted by an operating hazardous waste landfill, but it's now being proposed for an incinerator. You are basically compounding the problem. It doesn't matter whether or not Chem Waste or BFI, or any of these big disposal companies pick sites, somebody is picking these sites. It just so happens that four of the five Chem Waste sites that are under development or operating today happen to be located in Latino or African- American communities.

MR. MICHELS: Chem Waste, the nation's largest hazardous waste company, is expanding its toxic waste landfill near Kettleman City. It says its entire operation is safe, carefully monitored, and in a nearly ideal location geologically. Sylvia Vickers is the local spokesperson.

SYLVIA VICKERS, Chemical Waste Management Inc.: Chem Waste has not sited one facility from scratch. It's all been acquisitions of previously owned businesses, operated landfills, et cetera, that we acquired and upgraded and brought them to the standards that they're at today.

MR. MICHELS: Now the issue that gets brought up a lot is that you're going to put this incinerator in an area near a town that is 95 percent Hispanic. That amounts to so-called environmental racism. What do you say to that?

SYLVIA VICKERS: Well, speaking for this facility, it's absurd. This facility was sited here not based on the social factors, but because of the environmental soundness of the property, because there's no groundwater under this facility and it was sited at a time when disposal was the primary method of managing these types of waste.

MR. MICHELS: The people of Kettleman City doubt the toxic waste dump is as safe as the company says it is. But they have little hard evidence of its effects. Housewife Mary Lou Mares complains of health problems resulting from the dump and she fears that the incinerator will make matters worse.

MARY LOU MARES, Kettleman City Resident: They don't know what kind of pollution an incinerator will make and incineration is a new technology that hasn't been around that long to be tested. How do they know 20 years from now what's going to happen to our area?

MS. VICKERS: Well, the requirement by federal and state standards is that an incinerator operate at what we call Four Nines efficiencies. That means that 99.99 percent of what's fed into the incinerator must be destroyed and removed.

MR. MICHELS: Meaning in terms of safey.

MS. VICKERS: In terms of safety, the environmental impact report was very favorable.

JOE MAYA, Rancher: Even at the maximum amount of efficiency of the Four Nines that incinerator be operating at it will drop over 150 tons of contaminants a year, with the amount of, of toxic waste they're going to burn.

MR. MICHELS: Maya says that some contaminants will pollute the nearby California acqueduct. It carries water from the North to Central California farmlands and South to the populated Los Angeles Basin. For her part, Mary Lou Mares is more concerned about the people in the town she lives in.

MS. MARES: What will happen to the people of Kettleman City? That's not right. And they say they put it there because it's not populated. What are we, chopped liver? I mean, we're here and we care about our town.

MR. MICHELS: Kettleman City residents charge their elected officials ignore townspeople's interest because Chem Waste is politically powerful and its facility is a major source of tax revenue and jobs. Last fall, environmentalists and activists, including the Rev. Jesse Jackson, staged a rally in this remote town to publicize the environmental racism issue.

JESSE JACKSON: If a community is poor, or black, or brown, they put these agents of death in our community.

MR. MICHELS: Greenpeace activist Bradley Angel was among those organizing the rally.

BRADLEY ANGEL, Greenpeace: If you live near an incinerator, you will be breathing literally hundreds of highly toxic chemicals, heavy metals and dioxins, that are often persistent in the environment, are bio-accumulative, they say it's acceptable, but acceptable to whom?

MR. MICHELS: Thirty-five miles from Kettleman City is Hanford, the county seat. Officials here have approved the incinerator though their action is not final. Many of them believe Greenpeace is orchestrating the protest as part of its nationwide campaign against incinerators. Kings County Supervisor Joe Hammond claims local residents were unconcerned with the toxic dump until recnetly.

JOE HAMMOND, Kings County Supervisor: They were not aware the site was even there until a request for the incinerator and the Greenpeace people came in and made an issue out of it. So if they were having headaches and concerns before, they should have been talking about those headaches and concerns long before this.

MR. MICHELS: It sounds like you think they're being manipulated to some extent.

JOE HAMMOND: They're certainly being manipulated. There's no doubt.

MARY LOU MARES: Thank God for Greenpeace. If they hadn't come and told us, we wouldn't have known about it, about the incinerator, and I would have never found out that I was living near a toxic landfill.

MR. MICHELS: It's four miles away and you didn't know you were living near it?

MARY LOU MARES: No, I didn't. You know, you --

MR. MICHELS: Some of the people of this community work over there.

MARY LOU MARES: Right, right. You just take everything for granted sometimes, you know, you just live in, you know, blissfully ignorant to what is around you.

MR. MICHELS: Mares became an activist. She and others joined with California rural legal assistance, filing suit to stop the incinerator. It was one of her first political acts.

MS. MARES: If you would have known me three years ago, I never went out of my house, but as soon as this thing came out, you know, I saw how horrific, how dare you do this not just to my family but to the whole town, this little town that I was banking on so much to living so happily ever after in, you know. It was just a myth, it wasn't true, and it made me angry and that's, you know, what makes an activist, people that get angry.

MR. MICHELS: Her anger paid off. In late December, a judge ruled against Chem Waste and the county, declaring that data on air pollution effects of the proposed incinerator were inadequate. That ruling could delay the project for a year. The judge also agreed with residents who want county officials to translate the text of the environmental impact report into Spanish, a move that deputy planning director Bill Zumwalt sees as unnecessary.

BILL ZUMWALT, Kings County Planner: Kings County has conducted its business in English since it was formed in 1893. We have never prepared an environmental impact report or any other staff reports in any language other than English, ever.

MR. MICHELS: Zumwalt insists that studies prove the site is safe and racism is irrelevant to the debate.

MR. ZUMWALT: This place is remote. It is not in their backyard. They may be the closest communities, but they're not in their backyard.

MR. MICHELS: Do you think the county would have behaved the same way if Kettleman City was an upper class, white community?

MR. ZUMWALT: The fact that Kettleman City is 95 percent Hispanic had nothing to do w ith the decision making process.

MR. MICHELS: In the fields around Kettleman City, just as in minority urban areas, toxic waste disposal has polarized residents and officials. People who live here, worried about their children and themselves, point to studies they claim prove minority communities bear the brunt of such waste. But government and industry counter that the health of these children is unaffected by dumps that have operated for years without protest. Whether the new incinerator is built near Kettleman City will turn not just on the evidence of how much pollution is in the air and water but on the political and legal power the residents can garner in their fight. RECAP

MS. HUNTER-GAULT: Again the main stories of this Tuesday, in a change of policy. President Bush announced a five year speed up in the phasing out of ozone destroying chemicals. The Supreme Court refused a request to halt the forced return of Haitian refugees, but it gave the Bush administration until Friday to respond to the charges the returnees are being persecuted. Good night, Robin.

MR. MacNeil: Good night, Charlayne. That's the NewsHour tonight. We'll be back tomorrow night with a NewsMaker interview with the new Turkish prime minister and another doctor gives a prescription for health care reform. I'm Robert MacNeil. Good night.