The MacNeil/Lehrer NewsHour

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

MR. MAC NEIL: And I'm Robert MacNeil in New York. After our summary of the top stories, we focus on Rwanda [Focus - Growing Crisis], first an update report on the plight of the refugees, then a Newsmaker report [Newsmaker] with the chairman of the Joint Chiefs of Staff, Gen. John Shalikashvili, then a [Focus - Evolving Policy] two-part look at the health care debate first a report on one Maryland Congressman's debate back home, then political analysts Mark Shields and Paul Gigot with [Focus - Political Wrap] health reporter Julie Kosterlitz look at the latest political dynamics in Washington. NEWS SUMMARY

MR. LEHRER: President Clinton today ordered a round-the-clock airlift to help the Rwandan refugees. They were said to be dying of cholera at a rate of one thousand a day in the border town of Goma in neighboring Zaire. Mr. Clinton spoke at the White House this morning.

PRESIDENT CLINTON: The flow of refugees across Rwanda's borders has now created what could be the world's worst humanitarian crisis in a generation. It is a disaster born of brutal violence and according to experts now on site it is now claiming one life every minute. Today I am announcing an immediate and massive increase in our response. I have directed the Defense Department to assist in expanding airlift operations near the refugee camps in Goma and Bukavu. We will provide personnel and equipment to enable these air fields to operate on a 24-hour basis. I've ordered our military to increase the capacity to receive, transfer, and distribute goods at these air fields. Our aim is to move food, medicine, and other supplies to those in need as quickly as possible.

MR. LEHRER: The President said the expanded relief effort will cost more than $100 million. The airlift will be based in Entebbe, Uganda. Several thousand U.S. military personnel will be involved in the operation. We have more on the crisis in this report by Robert Moore of Independent Television News.

ROBERT MOORE, ITN: The scale of the crisis would be daunting for the most energetic and dynamic of relief efforts, and yet, the refugees are largely on their own. It is an environment desperately short of water. What little there is is badly contaminated. The cholera is killing many, severe dehydration visible in the people all along the road out of Goma. Fifteen miles out of the town children are digging in the mud to find tiny quantities of water so polluted so diseased it has led directly to the epidemic of cholera that is now out of control in several of the major camps. Worst of all, most harrowing are the scenes at Magigi, where hundreds are dying every day. No one is in any doubt about what is the key to survival out here.

JODY KASPROW, Aid Worker: Unless we have water, the people can't have adequate hygiene, and we have cholera. With no water, we have no sanitation, we have nothing.

ROBERT MOORE: This is the very front line of the battle to save refugees from the epidemic. The desperation for water cannot be met. The dreadful thirst cannot be relieved, for the humanitarian effort is failing and failing badly. So where is the aid, and what has gone so catastrophically wrong here? Behind me there are a few French medical tents but elsewhere all I can see are people collapsing, and there is no one, absolutely no one, here to help them. Recognizing this, the first Americans have arrived this morning, a team of logisticians assessing the humanitarian needs. They will find horrifying images and will realize that for many refugees they have simply come too late.

MR. LEHRER: We'll have much more on this story right after the News Summary. Robin.

MR. MAC NEIL: President Clinton's health care reform proposal will be rewritten by the Democratic Congressional leadership and reintroduced next week. That decision was made last night at a White House meeting between President and Mrs. Clinton and the Democratic leaders. But Mr. Clinton said today that the new version would not compromise the principles he enunciated when he made his original proposal last September.

PRESIDENT CLINTON: Our goals is the same. We reaffirm them. The leaders reaffirm them, universal coverage, quality and choice, an emphasis on preventive and primary care, and discipline in constraining costs not only for the government so that we don't increase the deficit but also for people in their private insurance plans.

MR. MAC NEIL: Mrs. Clinton launched a cross country campaign today aimed at rallying popular support for a Clinton style health care reform plan. The starting point was Portland, Oregon. The First Lady was there to encourage supporters who will travel in a four-bus caravan, ending two weeks from now in Washington, D.C. We'll have more on the health care issue later in the program.

MR. LEHRER: O.J. Simpson entered official pleas of "not guilty" today to charges of murdering his ex-wife and a friend of hers. It happened at his arraignment in Los Angeles Superior Court before Judge Cecil Mills.

JUDGE CECIL MILLS: Do you understand the charges against you, sir?

O.J. SIMPSON: Yes, Your Honor.

JUDGE CECIL MILLS: You've had an opportunity to discuss those charges with your attorneys?

O.J. SIMPSON: Yes, Your Honor.

JUDGE CECIL MILLS: And are you ready to enter a plea at this time?

O.J. SIMPSON: Yes, Your Honor.

JUDGE CECIL MILLS: How do you plead to counts one and two?

O.J. SIMPSON: Absolutely 100 percent not guilty.

JUDGE CECIL MILLS: And do you deny each of the special allegations and the special circumstance that is alleged?

O.J. SIMPSON: Yes.

JUDGE CECIL MILLS: Thank you.

MR. LEHRER: A hearing on pre-trial motions will be held next week. A date for the trial could be set at that time. A federal judge today ordered the Citadel to admit its first woman; 19-year- old Shannon Faulkner was initially accepted by the state-funded military college but was later rejected after it was learned she was a woman. The judge also ordered the 151-year-old South Carolina school to develop an admissions plan for other women.

MR. MAC NEIL: There was more violence today in the West Bank and Gaza Strip. The unrest occurred after Israel reopened the border with Gaza which had been shut by earlier rioting. We have this report narrated by Louise Bates of Worldwide Television News.

LOUISE BATES, WTN: The main border crossing was reopened in the early hours, letting through local farm produce for sale in Israel and Palestinian workers for their day jobs. The morning passed without incident. The Palestinian police said little more than 3,000 of the 22,000 Palestinians with work permits turned up. The number should decrease in the coming months as international aid helped to set up a viable economy in Gaza and the Jericho enclaves. That's something both sides will be happy with. Elsewhere in Gaza, a young Israeli soldier, a Betowin scout, was shot in the arm and leg in an ambush near one of the Israeli settlements started across the strip. A leaflet at the scene indicated the militant Islamic Jihad group, which opposes the Israel-PLO accord, was responsible. And more blood was spilled on the West Bank. One Palestinian was shot dead during riots in Nablus, while here in Hebron, stone throwing youths clashed again on the streets with Israeli army patrols.

MR. MAC NEIL: Sec. of State Christopher wrapped up his latest round of Middle East shuttle diplomacy today. He met for the second time with Syrian President Hafez Assad in Damascus but failed to resolve the stalemate with Israel over the Golan Heights. North Korea announced today it will resume talks with the United States in Geneva on August 5th. The talks are aimed at ending the stand- off over the North's suspected nuclear weapons program.

MR. LEHRER: The space shuttle Columbia astronauts set a new shuttle endurance record today because bad weather delayed their return to Earth. They passed the previous flight record of fourteen days, twelve and a half hours at mid day today. The landing at Cape Canaveral, Florida, has been rescheduled for tomorrow morning. The astronauts have been conducting experiments involving insects and sea creatures. The comet Shoemaker-Levy 9 is no more. The final fragments smashed into Jupiter early this morning. Most of them were not as spectacular as some of the earlier and larger ones but the final piece called Fragment W was said to be significant with pictures to come later. NASA released photos today of the explosion caused by Fragment R yesterday. And astronomers said today they observed evidence that the comet may have introduced water to Jupiter.

MR. MAC NEIL: Former Republican lawmaker Hugh Scott has died. Scott represented the state of Pennsylvania for 36 years in the House and the Senate. He rose to Republican leader during the Watergate years and urged Richard Nixon to release all documents and tapes to save his presidency. Scott died of cardiac arrest in a retirement home in Falls Church, Virginia. He was 93. That's our summary of the day's top stories. Now it's on to Rwanda's refugees, Gen. Shalikashvili on the U.S. response, a Congressman's health care dilemma, and Shields and Gigot. FOCUS - GROWING CRISIS

MR. LEHRER: The tragedy of Rwanda is once again our lead story. We'll talk to the chairman of the Joint Chiefs of Staff about U.S. relief efforts right after a report on a refugee camp on the Rwanda-Zaire border. Alex Thompson of Independent Television News accompanied a relief flight from Kenya to Zaire. His report contains some graphic pictures.

ALEX THOMPSON, ITN: Nairobi Airport and Hercules transport takes on a payload of sorghum and a truck trailer desperately needed to distribute the food at the other end. It is agonizingly slow. This plane fell behind schedule and was unable to leave until the next morning. And all around at Nairobi Airport food aid bound for the Sudan, a reminder perhaps that Rwanda and Zaire are far from the only crises in subsaharan Africa. Coming in over the volcanoes on the Rwanda/Zaire border and the size of this catastrophe is spread before you. Katumba Refugee Camp, about 10 miles from Goma, one of four such camps around this once small town. About a dozen flights a day are getting into the airport here with a large road convoy expected from Kampala tomorrow. Willing hands though can only do so much. The Goma Airport is simply not equipped to unload aid in the amounts which are needed. As yet, people are not starving here but the shortage of clean water is acute. Agencies appealed for 50 water tanks last week. Not one has yet arrived.

NINA WINQUIST, International Red Cross: The No. 1 priority without any question is the question of water, and the ICRC actually appeals for some kind of other means of transport to get the water to the people than by road. It's quite clear that the road transport does not work.

ALEX THOMPSON: Cholera killed 400 people two days ago, 800 yesterday, and tonight they have not yet finished counting. The water problem can be seen everywhere. Lake Kevu, near Goma, and families take their cooking and drinking water within feet of a decomposing body. We saw over a hundred and seventy bodies tipped or flung into a burial pit in the space of half an hour. Children were among them, most killed by the dehydrating effects of dysentery, cholera, or simple diarrhea. Teams of trucks work every daylight hour to collect the dead people and bring them to the pits. It was the fear of massacre which drove people here in their millions but now the fear of disease and the effects of it may perhaps start forcing people back over the frontier. But even here at the burial pits among the grave diggers themselves there is the feeling and among many the hope that the war is not over and that it will continue. Some who declined to be filmed felt that the defeated Hutu forces should fight on, but all say a return to Rwanda is a return to certain death at the hands of the RPF, though there's little evidence for RPF atrocities.

MAN: [speaking through interpreter] Yes, if we go back, we'll certainly be killed automatically.

ALEX THOMPSON: Yet today we saw the first signs of people trying at least to go home. About 800 gathered at the frontier post only to be turned back by Zairian troops after a gun was fired. This is one of the immediate frontier problems, piles of guns, rockets, bullets, grenades, spears, mortars, and the favor weapon of the Hutu death squads, machetes, stripped from the defeated army as they came back through to Zaire. Soldiers say they fear injuries by letting the crowds through. As we filmed, the Rwandan and Zairian United Nations groups met at the border posts to try and open it. The U.N. knows they have to persuade people to go back to harvest their crops and to plant for the coming season.

MAJOR JEAN PLANTE, UN Rwanda Mission: Nothing will be planted in the next two months because the whole place is empty. So we need those people to get back as soon as possible. We particularly can see what can be saved so that in six months from now they've got something to eat, otherwise there will be nothing left to eat in this country, and there are still over seven million people there.

ALEX THOMPSON: And late this afternoon the UNHCR announced it'll set up camps in Rwanda to try and encourage people to stop leaving and persuade some to return. But almost as they did so, a minister in the former Hutu government said the new Rwandan government would murder anybody returning who could read or write.

JEAN DE DIEU HABIMANEZA, Former Government Minister: I am sure that Hutus who know how to read and to write if they come to the country they will be killed.

ALEX THOMPSON: Why?

JEAN DE DIEU HABIMANEZA: It's a declaration of RPF and all these people who left the country.

ALEX THOMPSON: Declared to who?

JEAN DE DIEU HABIMANEZA: To who?

ALEX THOMPSON: Who was this declared to?

JEAN DE DIEU HABIMANEZA: On radio.

ALEX THOMPSON: And a warning, a comprehensive settlement for Hutus too, or the war goes on.

JEAN DE DIEU HABIMANEZA: If the international community doesn't help to, to find this kind of solution, this army, we organize it to try to fight and take power.

ALEX THOMPSON: Tonight the frontier remains shut, and the few who want to go home wait.

MR. LEHRER: Now to the chairman of the U.S. Joint Chiefs of Staff, Army Gen. John Shalikashvili who is with us now for a Newsmaker interview. NEWSMAKER

MR. LEHRER: General, welcome.

GEN. SHALIKASHVILI: Thank you, Jim.

MR. LEHRER: What are your orders from the President? What is it you are to do for those folks in Rwanda?

GEN. SHALIKASHVILI: Well, first and foremost, we are to go into the region and make a difference, difference the way we did when we went into Northern Iraq and Eastern Turkey, when we had hundreds of thousands of Kurds who fled ahead of the cruelty of Saddam Hussein. We then went in and did make a difference. It is the President's direction that we do the same thing here. Specifically, he directed us to concentrate on those things we know make a difference. First of all, it's to provide a measure of command and control and direction to the effort. Secondly, to make certain that the distribution system on which all of this depends starting from, from the kind of hubs in Europe to a central hub that we are to establish in Entebbe.

MR. LEHRER: And Entebbe's what, about 300 miles --

GEN. SHALIKASHVILI: Three hundred miles from Goma. And then from Entebbe, then serve the smaller air fields and that can take the larger aircraft, and so that I think is critical. The next thing he charged us to do is to get on top that which is now causing the greatest problem, i.e., the lack of good water.

MR. LEHRER: Well, let's talk about that a minute. There are what? You have to provide water. I mean, is it -- are you going to try to provide water to a couple of million people?

GEN. SHALIKASHVILI: Well, we're not going to be deterred by the fact that the problem is so large. Otherwise, you freeze yourself into inaction. We recognize how long it will take before we're able to solve the totality of the problem, but we need to start now, we need to start right away to bring in purification equipment that can get to those waters, polluted water sources that we just saw on the tape.

MR. LEHRER: Is it possible to clean that water?

GEN. SHALIKASHVILI: Absolutely, yes.

MR. LEHRER: And the United States military has the equipment to do that?

GEN. SHALIKASHVILI: We do, and we need to rush it down as quickly as possible, and begin that effort and not be deterred because we cannot on the first day or even in the first week provide sufficient water to everyone. We need to start that effort, and we will.

MR. LEHRER: Where is that equipment now?

GEN. SHALIKASHVILI: The equipment is being assembled now in Europe, moving to Rhine Mine, which is the hub.

MR. LEHRER: It's in Germany.

GEN. SHALIKASHVILI: In Germany, our transportation hub from which we will move very quickly into Nairobi, and then onward to Goma, where it's needed the most right now.

MR. LEHRER: And you think within how long will this equipment be functioning?

GEN. SHALIKASHVILI: I'm very hopeful that the first pieces of this equipment, the first purification systems will be in place within a very few days.

MR. LEHRER: In the meantime, there are these packets of water that are aimed at helping stop the diarrhea and the cholera, is that right?

GEN. SHALIKASHVILI: Right.

MR. LEHRER: Now, how are you getting them in there, and how many of those and what's the process?

GEN. SHALIKASHVILI: There are some 10 million packets or so that will be arriving on one of our aircraft tomorrow, and then will be distributed to those who are suffering from dehydration due to cholera. I again -- I must tell you when I was in Northern Iraq, and when we were facing the same sort of an epidemic of cholera, those dehydration packets can, can perform miracles, so we need to get 'em to the people as quickly as possible to replace the fluids that they're losing.

MR. LEHRER: But those packets already exist and are on the way?

GEN. SHALIKASHVILI: On the way.

MR. LEHRER: Enough to stop it, do you think?

GEN. SHALIKASHVILI: Well, I think it depends on at what stage of the illness that you get to an individual person, but they are, they are absolutely essential to replace the fluids and to replace the chemicals that a person loses as a result of the diarrhea that is the outgrowth of the disease.

MR. LEHRER: How many U.S. planes are going to be involved in this operation overall?

GEN. SHALIKASHVILI: Oh, I don't think we can put a number on it. I hope that we'll be able to have a fairly steady stream. Right now we have scheduled ahead some 42 airplanes, probably 50 by now, but this is just to get the stream going, and I --

MR. LEHRER: These are big transport planes?

GEN. SHALIKASHVILI: Big transport planes.

MR. LEHRER: And they'll land in Entebbe, and then smaller planes will take them to --

GEN. SHALIKASHVILI: That's right, until this whole hub is established, we will have to take larger planes into Goma, but I hope we'll be able to stop that very soon so we can bring the larger planes into Entebbe, have all the equipment there to quickly unload and trans-load the equipment and move it on to the smaller air fields so we can get it close to the people that need medical care, that need to have the food, the water.

MR. LEHRER: And you're bringing in U.S. military personnel to operate these small air fields as well on the ground in Zaire?

GEN. SHALIKASHVILI: Right now, the French are doing a super human effort in operating those air fields. However, they don't have the equipment to operate them 24 hours a day so we're losing 12 hours each day of production capacity out of those air fields. We're going to as quickly as we can turn them into 24 hour air fields and help them not only operate the air fields but also flying in forklifts and other stuff to quickly unload these airplanes. We are bringing in trucks as quickly as we can so we can then have a distribution system away from the air field to places where we need to bring the equipment.

MR. LEHRER: Now, for instance, one of those aid workers said that -- she said that the road system doesn't work, there's got to be some other way. Have you all figured out another way besides the roads?

GEN. SHALIKASHVILI: Well, starting on Sunday, we are also going to airdrop humanitarian assistance to those people we cannot reach by road. It's a system that has worked for us very well in Bosnia, in Eastern Bosnia particularly, when we, when we have pockets of people that we couldn't reach, we developed some very good methods of air dropping food and other humanitarian assistance. We're going to do that starting on Sunday in and around Goma, where we cannot reach people by truck. Again, I don't want to imply that everything's going to be well because it is a long-term effort, but we're going to try to have no stone unturned to get this started and get it moving.

MR. LEHRER: General, give us a feel for what that means by leaving no stone unturned. How big an effort is this? Give us -- compare it with something so those of us who are not pros as you are know what you're talking about.

GEN. SHALIKASHVILI: I think when you have a calamity of this proportion, you have to recognize that no one has all the expertise and no one organization has the capability to deal with it. You are, you are all of a sudden faced with a city of over a million people and you have to provide overnight to that city safe water, enough food, sanitation, food distribution, and you have to provide them some shelter.

MR. LEHRER: So you could take the area, the Washington area where we're sitting now and imagine it --

GEN. SHALIKASHVILI: That's right.

MR. LEHRER: -- with no shelter, no running water --

GEN. SHALIKASHVILI: No sanitation.

MR. LEHRER: -- no sanitation, no food, no security even, right?

GEN. SHALIKASHVILI: It is an absolutely unbelievable task. The dilemma is this, that some look at this and freeze because it's so big.

MR. LEHRER: So big.

GEN. SHALIKASHVILI: I think what you must do is discipline yourself not to freeze but get on and do the job, and there's countless of these private organizations, humanitarian organizations, that are doing absolutely heroic things out there. We need to get there as quickly as possible and join them and give them all the help we can give them, and that's what we'll do.

MR. LEHRER: What about the second part of this, General, which is to encourage those refugees who have gone over the border into these awful places, these awful non-places in Zaire, to go back home, as the French officers said in that piece, we need these people to come back and cultivate the crops and all of that. What can the U.S. do about that? What is your mission there?

GEN. SHALIKASHVILI: I think that we all as a community of nations have to ensure that as rapidly as possible the conditions inside Rwanda are such that it's safe for these people to return. There have been some good beginnings in the formation of this new government, but we have to make certain that we are satisfied that the conditions are such that people can return some relative safety and then we have to do everything we can to de-magnetize places like Goma, and give them an incentive to return home --

MR. LEHRER: In other words, make the alternative better than -- right now there is no alternative?

GEN. SHALIKASHVILI: Again, I fall back on my very limited experience, command of Operation Provide Comfort in Northern Iraq, where we were successful only because in the final analysis we brought everyone back to the, to their village and town, and it is only there that they have the hope for lasting peace. And to return to a degree of normality you can't do that in a refugee camp.

MR. LEHRER: Are you prepared -- I mean, do your orders include sending in U.S. troops, if it means that, to maintain order and to make it safe for these people to go back?

GEN. SHALIKASHVILI: No. I think we have a United Nations peacekeeping operation now that is hopefully being beefed up as we speak. Our task is going to be to have security only to the degree that we need to protect the humanitarian effort that's ongoing. I think that we, the United Nations forces there between the government of Rwanda, they're going to have to create the conditions and we're going to give them the help that we can to make it attractive for the people of Rwanda that now have fled to return back to their homeland.

MR. LEHRER: General, are you and your military colleagues comfortable with this kind of assignment, this general assignment in Rwanda?

GEN. SHALIKASHVILI: Well, I think that it's very difficult to be an American and look yourself in a mirror and not try to do everything that you possibly can about a human tragedy like this. And I think while we often think that the military is really there to fight our nation's wars, we have seen in the past what a great capacity young men and women in uniform have to do enormous good. And so if we can do good there, and we are determined to do so, I think it's something that's, that's very worthwhile, and we should do it.

MR. LEHRER: Are you the least bit concerned about the Somalia analogy? It began this way as well, a humanitarian mission, and then they started shooting at, at the Americans and the thing deteriorated to their differences of opinion to what it deteriorated into. Are you worried about that?

GEN. SHALIKASHVILI: Well, let me tell you first of all that I think that the young men and women who went into Somalia did an extraordinary, noble thing. There are thousands upon thousands of people who are alive today because they went in and did what they did. I am much more encouraged by the fact that we went into Northern Iraq and saved hundreds of thousands of people who surely would not have survived those days in the mountains because of what America's young men and women did. We made a difference. There are no guarantees, but we're determined to make a difference here.

MR. LEHRER: General, thank you very much.

GEN. SHALIKASHVILI: Thank you very much.

MR. MAC NEIL: Still ahead on the NewsHour, how one Congressman's district sees the health care debate and analysis by Shields and Gigot. FOCUS - EVOLVING POLICY

MR. MAC NEIL: Now, at the end of this week, a two-part look at health care reform. The view from Washington and from just outside the beltway. We start with a debate in one Congressman's district. Kwame Holman has our report.

REP. BENJAMIN CARDIN, [D] Maryland: It will be a tragedy if we fail. I have yet to meet a person who believes that we don't need health care reform at the national level.

MR. HOLMAN: For Democratic Congressman Benjamin Cardin, the passage of a health care reform bill would bring an end to three years of intense study, debate, and compromise on the issue.

REP. BENJAMIN CARDIN: It's been a long process. I think we started with the American people wanting health care reform. They wanted major changes in the health care system but they didn't know how to get there.

MR. HOLMAN: Figuring out how to get there has been in part Cardin's job. He's a member of the House Ways & Means Subcommittee on Health. The committee is responsible for financing health care reform.

REP. BENJAMIN CARDIN: The funding sources have always been within the jurisdiction of this committee. That's nothing new.

MR. HOLMAN: Over the course of the Ways & Means debate, Cardin introduced dozens of proposals and amendments. Some were accepted, others rejected, but almost all of Cardin's ideas originated here, 60 miles from Capitol Hill, in his home district in Baltimore.

REP. BENJAMIN CARDIN: I am extremely fortunate -- I've said this before but it's worth repeating -- to be first, to live so close to be able to get back to my district but secondly to have such experts in the various areas. We have in this room some of the best talent in this nation on health care.

MR. HOLMAN: Baltimore is home to some of the most respected medical, academic, and research centers in the country. The city is a leader in public health and is headquarters to several top insurance companies and managed care groups. Three years ago, Cardin decided to tap into Baltimore's wealth of knowledge and experience. He formed a health care advisory group, bringing together health care providers and administrators, business and labor representatives for an occasional exchange of views and concerns on health care reform.

MARCIA PINES, Alliance for the Mentally Ill: I have to -- one is to acknowledge you and your committee for what you have done, including persons with mental illness, and a package that I think is very, very commendable, and probably a landmark decision. I hope it will not be removed in any compromise.

DR. GARY GOLDSTEIN, Pediatric Neurologist: It seemed as it was initially written that children born with a disability like cerebral palsy might not be -- might not have available for him through this act rehabilitation services. Has that been straightened out, or where does it stand for the disability community?

DR. PETER STAMAS, Internist: For every time somebody saw a physician they had to pay 20 to 25 percent of that fee, whether it be a surgery, whether it be an office visit, and in the marketplace, then the consumer would be able to exert some influence. As soon as -- I see it every day in my practice -- as soon as the patient has supplemental insurance covering everything, they don't care what's charged.

REP. BENJAMIN CARDIN: That's a separate issue, and I'm in agreement with you there. Individual responsibility is very important.

DR. PETER STAMAS: Well, then why do we still have supplemental insurance in here?

REP. BENJAMIN CARDIN: Well, the question would be is whether we should be providing any tax advantages for supplemental insurance or not. That's an issue that is still somewhat open. About a year and a half ago, I filed a bill as a result of working with that advisory group. I changed that bill, and it sort of evolved as we've gotten more information and more and more health from the different experts in Baltimore, so they've been part of the process, and the bill that moved through the Ways & Means Committee has the fingerprints of many people from this health advisory group in helping me work on the bill.

REP. BENJAMIN CARDIN: [addressing group] Now what's going to happen from this day forward no one can predict. The only thing certain is that there will be more changes, that we haven't seen yet the final version of health care reform.

MR. HOLMAN: During their most recent meeting, members of the group examined details of the House Ways & Means Committee bill and Cardin continued to defend his support of its controversial employer mandate provision as a way of achieving universal coverage.

REP. BENJAMIN CARDIN: If you believe in universal coverage -- and I believe the American people want universal coverage and most people in Congress want to support universal coverage -- you have a choice. You have a choice between more individual responsibility which means more taxpayer support, higher taxes, versus requiring employers to help pay towards the cost of health care. Our current system is based upon an employer-based health care system. It's unfair for some employers to pay and others not to pay.

MR. HOLMAN: But just as it has Congress the plan to force employers to pay for their employees' health care split the Baltimore group.

FRANK KOSMAKOS, Maryland Restaurant Association: Sec. of Labor Reich wants to increase the minimum wage. Mr. Rostenkowski, before he had problems, wanted to increase Social Security contributions. Every aspect of the government is contributing to my payroll figures and the way I figure them out, they're in the range of 20 to 16 percent increase at my end just in payroll. Also, one of my questions is losing money. I cannot take a tax credit so that when I'm hurting the most is when the government is stepping on me the hardest.

REP. BENJAMIN CARDIN: The tax credit is not on your income; it's on your payroll taxes, so you would get the credit, just to answer that question. We are not, not going to increase the payroll tax here. Our bill doesn't do that, okay? I understand what some people might have said over this debate, but this Congressman told you we weren't going to do it, and we're not going to do it. It's not in there.

MR. HOLMAN: Listening intently to the discussion was Thomas Saquella, who also opposes employer mandates. Saquella is head of the Maryland Retail Merchants Association, and he took us to Finkelstein's Clothing Store, a Baltimore landmark that opened in 1922, to demonstrate the impact mandates would have on this kind of business.

THOMAS SAQUELLA, Maryland Retail Merchants Association: We're a very labor intensive industry. Our job is to serve our customers. The stores are open six to seven days a week, ten to twelve, sometimes fourteen hours a day. As you see here today, very few customers, but you've got to have people on the sales floor, so we're very labor intensive, low wage, and to suddenly put a requirement on to provide health care insurance at the contribution rate of 80 percent by employer is a dramatic impact in real dollars to especially small, independent merchants.

MR. HOLMAN: But Saquella says through the health care advisory group, Congressman Cardin has come to understand his concerns better.

THOMAS SAQUELLA: I think he's distinguishing the impact on our types of small business as to other types of small business and realizing that we may need some specific assistance.

GERALD GEFFEIN, Furniture Store Owner: Is there any maximum that the government is going to say to me, you're not going to pay any more than this? And the other problem we have is we have no faith in what the government says.

REP. BENJAMIN CARDIN: Maybe there should be a cap on the total exposure. That's not an unreasonable suggestion. I would make this prediction. The provisions concerning small business will change as it goes through the process. We're not finished. It's not the last chapter yet. We're going to make some additional modifications.

REP. BENJAMIN CARDIN: I've met with many small business people, and I don't think they'll support any legislation that requires employers to make a contribution. They're opposed to that. But as a result of our meetings, I think there's a better understanding of what we're trying to achieve.

MR. HOLMAN: Other members of the group had more specific concerns like Everard Rutledge, president of Liberty Medical Center.

EVERARD RUTLEDGE, President, Liberty Medical Center: What are going to be doing to deal with those traditional providers who have been in the community providing care?

MR. HOLMAN: Liberty is an urban community hospital where 17 percent of the patients don't pay their bills. Universal coverage would solve that problem. But Rutledge is concerned that some of the new HMO's and managed care networks moving into the community might exclude Liberty Medical Center and its physicians from their lists of approved health care providers.

EVERARD RUTLEDGE: I welcome from a health perspective more providers coming into the community but at the same time I have to be -- I would be less than candid if I said I wasn't a bit suspicious about what the true motives are with regard to the new entrance into various communities.

REP. BENJAMIN CARDIN: A provision that you actually brought to our attention on providing capital assistance to facilities located in hard to serve areas is in this bill. In addition, we have what's known as essential community providers, that if you're a facility that's essential to a particular neighborhood, that that facility must be included in all health care plans, so that -- at full reimbursement.

MR. HOLMAN: Another member of Cardin's advisory group, Dr. Dan Morhaim, says the problems of health care reform extend far beyond the dilemma of how to pay for it.

DR. DAN MORHAIM, Emergency Room Physician: It doesn't matter how you do the financial fixes as long as that demand is there, that's goingto continue to be a rising health care cost.

MR. HOLMAN: Morhaim is an emergency room physician, the front line shock troops of health care, as he puts it. Here at Franklin Square Hospital in Baltimore, Morhaim and his colleagues treat anyone who walks or is wheeled in.

DR. DAN MORHAIM: Old, young, trauma, medical problems, overdoses, accidents, injuries, sports, heart attacks, appendicitis, asthma, I could go on.

MR. HOLMAN: And people are treated regardless of their ability to pay, even though emergency room services are among the most expensive in the health care field.

MR. HOLMAN: To what extent do you find that people come here to the emergency room at the -- as the last resort rather than because they didn't have access to preventive care?

DR. DAN MORHAIM: That certainly happens, and I think that's a very good point. I would agree with it. People do that all the time, and they do need to access other kinds of services before this, and if they did, sometimes they wouldn't need to be here at all.

MR. HOLMAN: But Morhaim says the road to more efficient, more affordable health care service begins with solving the kinds of problems that are not drawing much attention in the health care debate.

DR. DAN MORHAIM: Violence in America costs $20 billion a year of health care costs. Homelessness, teen pregnancy, a lack of a lot of prevention programs, alcoholism, drug addiction, just the huge number of social problems that end up getting tallied on the health care side of the ledger.

REP. BENJAMIN CARDIN: They're excellent questions. Understand that there are not going to be national solutions to these problems. They're going to be developed in our state capitals and in our private sector working together to come up with a system that is the most cost effective.

MR. HOLMAN: Congressman Cardin admitted that he didn't have all the answers, and not everyone was satisfied with the answers he gave. But everyone we talked to, including the Congressman, said they had a better understanding of all the issues and concerns that make up the health care debate.

REP. BENJAMIN CARDIN: People do come to the table with a very narrow focus, people representing the doctors for the insurance companies, or the drug companies, or the elderly consumer groups. They come with a narrow view, but when we sit around a table, you realize you can't get the answer to your question unless you understand the other person's concerns, and you can reconcile these views. That's what happened during this process, including in the public. We've had -- we've gone through some of these battles now, and the people are now ready for action, and I really believe that the legislation in Washington is going to be better because of your participation in these meetings, and for that, I'm very grateful, so thank you all very much. FOCUS - POLITICAL WRAP

MR. MAC NEIL: Now the Washington perspective on the battle over health care reform. Reporters asked the President today about the latest developments at a press briefing this morning.

ANDREA MITCHELL, NBC News: The leadership came here last night and told you that your health care plan for all intents and purposes is dead and that they're going to start over with something very different from what you had proposed. How do you feel about that? Are you willing to accept this turn of events?

PRESIDENT CLINTON: First of all, I want to tell you I had a prediction last night. I said to the leadership, they said, what shall we say, I said, well, I have been saying for four weeks we have agreed to dramatically change this plan, we're willing to string it out, we have to have a longer phase-in, we have to have less bureaucracy, we have totally voluntary small business alliances, and we have to give a bigger break to small businesses to get them to buy into it. I'll bet if you go out there and say it, it will be treated as news, and that is exactly what happened. That is exactly what I said to the governors. That is exactly what I've been saying for the last three or four weeks. And I'm glad that it finally is going out to the American people. We listened to the American people, all of us did, so we said when I sent my plan to Congress I implored the Congress to go out and offer suggestions for changing it, for improving it, for making it better. I did that from day one. I have, I am still waiting for someone else to produce a bill who believes there's another way to achieve universal coverage. I thought it was a very good meeting because the leaders reaffirmed their belief that our objectives should stay the same, universal coverage, so that we can provide security to those who have health insurance and cover those who don't. Now one-sixth of our people -- remember, America is going in the wrong direction; only the United States is reducing the number of people with health coverage every year.

MR. MAC NEIL: Now to sort through the health care developments of the week, we turn to our regular political team of Shields and Gigot, Mark Shields is a syndicated columnist, Paul Gigot is a columnist with the Wall Street Journal. Tonight they're joined by Julie Kosterlitz, health correspondent for the National Journal. Starting with you, Julie Kosterlitz, there were two health developments this week. One we've just seen. I'd like to come back to that, but first go to the President giving the governors in his talk earlier this week and some people in the press an impression that he had greatly modified his proposal and then had to deny it. Take us through what happened there.

MS. KOSTERLITZ: This was the week that was, Robin. This was to be the week that both the President and to some degree the Senate Minority Leader, Robert Dole, were to launch their opening plays in this political end game of health care reform, and they started it off with a visit to the governors which is an inescapably bipartisan sort of gathering. Both men made a point of trying to show themselves to be operating in a bipartisan spirit. It just seems as though the President might have gone a little bit overboard in his effort to persuade people that he was open to change, that he was truly a bipartisan sort of guy. He actually managed to panic the liberals in his own party. Now if you look closely at what both men said, you will see that neither one, in effect, budged a whit from what they've been saying over the past few weeks. Neither one seems very much prepared to give much ground at all, but the way it was phrased rather clumsily by Clinton in a couple of cases, he managed to convey an impression that, indeed, he had moved and was willing to sacrifice some of his bedrock principles.

MR. MAC NEIL: Mark, what is the political fallout from Clinton at the governors?

MR. SHIELDS: It's not fatal, Robin, but it certainly wasn't helpful. It interrupted the effort being made by those in Congress, supporters of the President, to put together a plan, because they then had to stop and start to reassure their colleagues, many of whom are skittish and skeptical based upon earlier caves on the President's part, on the BTU issue, where the House Democrats stood up strong and true, voted for a BTU tax, only to see it wiped out in the Senate in 12 hours' time, a new NCAA indoor record, and having earlier voted for grazing fees to be raised in western states, western Democratic House members, only then to have that pulled out from under them. So they're skeptical, they're skittish, and the President's remarks up in Boston left, as one Democrat put it to me, Bill Clinton is the type of fellah who is actually persuaded that his own charm and his own intellect are so immense that he can persuade anybody to his point of view. And oftentimes he can but not before C-Span cameras and a bipartisan audience of, of Republican and Democratic governors.

MR. MAC NEIL: Paul, what did you think is the political fallout? The issue was the President seemed to be or sounded at least to some in the press as though he was backtracking on the universal question, and saying, well, in Social Security it's not 100 percent and so on.

MR. GIGOT: Well, that's right, and certainly the moderates who do want him to move to the center were welcoming that, meanwhile, the liberals in his own party for whom universal coverage is really their bottom line were appalled, and they were saying, where does this President stand. And I think Mark is exactly right in that the problem for the President is that he, he really doesn't have a lot of negotiating room because neither side really trusts his core of convictions. They're not sure where he stands. To go back to a comment by one of his friends, one of his supporters, James Carvill, as quoted in Bob Woodward's book, at one point during the economic debate he asked himself and said to other advisers, where is the hollowed ground, where does this President draw the line? And that's what a lot of the liberals are worried about. You know, I know Mark, one of Mark's favorite presidents, Ronald Reagan, whatever you thought about Ronald Reagan and his views, he had those core convictions, so his core supporters were willing to give him some leeway. Bill Clinton doesn't have that leeway.

MR. MAC NEIL: Now, Julie Kosterlitz, let's go back to the event we just saw, the meeting of the Democratic leaders last night, and coming out and saying that they've dropped the Clinton plan as such but Clinton saying, the President saying, but all his principles are still there. Take us through what that means.

MS. KOSTERLITZ: Well, Robin, this strikes many of us who've been covering this for quite a while as another non-news event in some respects. I don't think anybody really thought that the -- that the leadership in either the Senate or the House was going to introduce the Clinton bill as delivered to the Hill last year. None of the committees thus far have passed the Clinton bill per se, although some come closer than others, so the notion of the leadership of both Houses coming to the White House and announcing that they intended not to introduce the Clinton bill was really at best anti-climactic. I think that what it is in some ways is helpful to Clinton because they are retaining many of his principles, or they intend to, or at least they've announced they intend to, and yet they are able to distance themselves from a plan that people like the components of but have come to dislike at least in name.

MR. MAC NEIL: Paul, is it helpful to President Clinton?

MR. GIGOT: I think it is helpful. Certainly it's helpful because if he doesn't do that, anything with the name Clinton on it and followed by health care is going nowhere. I mean, these are the new scarlet letters of his health care debate. So what they're trying to do is they're trying to take some of the Clinton program, repackage it, modify it in some respects, come back and say this is more or less a new plan, we've listened to you, the voters, and but we're not giving up on universal coverage. And that's the problem. I mean, some of these things can't be parsed. Some of these differences can't be split. It's either going to have an employer mandate or it's not. It's either going to have bureaucratic alliances or it's not, and that's where the crux is going to come, and House leadership and the Senate leadership has to make very tough decisions about how many of these core principles they're going to have to throw over the side to get to 218 and 51.

MR. MAC NEIL: Mark, how do you read this latest maneuver?

MR. SHIELDS: Well, I think that there is less there than meets the eye. I do think that one MacNeil-Lehrer viewer with a long memory reminded me after last week's show that an unpopular Harry Truman when he wanted to launch his bold initiative to save Western Europe after World War II had the political astuteness to call it the Marshall Plan after George Marshall, his popular and respected secretary of state. Following that lead, it might be a good idea for Bill Clinton -- I mean not to call it the Clinton plan but to call it the Chafee plan, after John Chafee, the Republican Senator from Rhode Island.

MR. MAC NEIL: Or the Lincoln plan, I thought of it in the Lincoln bedroom.

MR. SHIELDS: Or the Lincoln plan or the Fred Grandy plan, Republican House member from Iowa who's shown some willingness to cooperate, but I think it does give a sense of freshness to it and a little distance from what had become clearly unpopular.

MR. MAC NEIL: Julie Kosterlitz, is it now your reading that the Democratic bills to be introduced next week or the week after will have the White House blessing, will be called -- will have universal coverage, and will have an employer mandate of some kind in there?

MS. KOSTERLITZ: Well, Robin, I think that the House Majority Leader has made it pretty clear that he intends to bring to the floor a bill that looks very much like what emerged already from the Ways & Means Committee which does, indeed, have an employer mandate and in addition has a Medicare Part C, a public program for individuals and small businesses who are not otherwise insured and some others as well. So I think it's fairly clear that the House will be deliberating on at least an employer mandate bill. The Senate, I think it's -- it is assumed that there will be an employer mandate of some sort because basically for the reason it's almost impossible to get to universal coverage in a way that most liberals would find palatable without relying on an employer mandate, but the House -- the Senate Majority Leader, George Mitchell -- has been a little cagey about just exactly what he's going to bring. There are a lot of efforts to persuade him. One popular candidate now is being pushed forward by Sen. Kennedy which would involve a 50/50 split, asking employers to pick up 50 percent of the tab and employees to pick up 50 percent of the tab. That would be a rollback from asking employers to pay 80 percent of the tab and employees 20 percent of the tab.

MR. MAC NEIL: Mark, do you have a sense of what is going to go to the floor?

MR. SHIELDS: I have a -- I have a general sense. I think that Julie's absolutely right, that the House bill will contain an employer mandate. But the House is going to wait in a tactical sense this time. The bill will be unveiled first, probably early, middle of next week, and Sen. Mitchell will not unveil his probably until the end of the week. The Senate will then take it up, and I think the House will hold its breath and view very carefully what the Senate does do on the employer mandate or whatever form it does take, what's called a hard trigger, which may be one of the proposals. It was interesting to me that the whole --

MR. MAC NEIL: Hard trigger meaning they have to do it at some point?

MR. SHIELDS: That's right, if, in fact, the initiatives taken, the changes made do not lead to a certain percentage of coverage that, in fact, employer mandates or something quite similar to them would set in, so I think -- you know, I don't think there's any question that we're talking about probably at minimum of two weeks in the Senate, the House taking up its bill probably a week after the Senate's taken up its.

MR. MAC NEIL: I'll come back to the dynamics of the debate in a moment but Paul, where does this, all this leave the Republican alternatives?

MR. GIGOT: Well, when you have as few votes in the Senate and the House as the Republican s do, you're always going to be a counter puncher. You've got to wait and see the whites of their eyes really, what they produce before you can build a coalition to defeat it. But one thing's going on in the House that is very, very interesting, and that is Newt Gingrich, the normally quite partisan No. 2 leader for House Republicans, is working with an awful lot of Democrats right now, Jim Cooper of Tennessee, Mike Parker of Mississippi, Roy Rowland of Georgia, on an alternative that would be somewhere between what the Republicans have proposed in the past and what Jim Cooper proposed earlier this year and got a little ballast, if you recall, a few months ago. They're trying to put together an alternative that would be able to beat whatever the Majority Leader, Dick Gephardt, puts together that is offered to the floor. They have a chance to do that, I think, especially if, and I think Julie is right, they propose what Julie suggests they're going to do.

MR. MAC NEIL: Mark, obviously, we're approaching a historic debate. I don't know how you describe it, but it's obviously got to be one of the big debates of this generation. How do you see it shaping up? How long will it take? Is there going to be a filibuster in the Senate? What's your sense of this debate coming up?

MR. SHIELDS: I think that the debate coming up, the longer it goes, the more attention it gets, the greater press and media scrutiny that attaches to it, the better the chances are. I think it is -- I think it is a debate where the advocates of change have an enormous rhetorical and historical advantage on this side. For example, they held hearings today on, on the question of employer mandates, and the chief executive officer of Pizza Hut, a courageous gentleman, came up to defend the practice of his company paying 50 percent of the insurance premium to workers in Japan and Germany, though it didn't insure its workers in this country, of course, because those countries have employer mandates and had to acknowledge that yes, he had gone in and yes, the country -- the company was doing okay over in those respective socialist paradises, and I think -- I think quite frankly we're going to get into a discussion that I, I think the advantage is on the side of those who are advocating change.

MR. MAC NEIL: And, Paul, do you see the advantage on their side, and how does it shape up in terms of historic importance, this debate?

MR. GIGOT: Well, I think this is of historic importance. This is really an expansion, a proposal to expand government much bigger than Medicare in 1965, even bigger than Social Security of 1935, and so the stakes are enormous. I don't know who really has the advantage now. I'd say if you look at the poll numbers, the Clinton plan supporters do not have an advantage, and I think the problem that the Democrats are going to have to overcome is they're going to have to persuade the middle class that there is something in health care reform for them because right now they believe if you look at all the polls, they believe that what health reform really means is they are going to be taxed, or their employers are going to be taxed, which ultimately means they will be in order to redistribute money for the poor. That is not a winning argument for Democrats. They have to make -- they have to convince the middle class.

MR. MAC NEIL: I'm sorry to interrupt but they tell me we've got to go. Thank you both, and Julie Kosterlitz, thank you. RECAP

MR. LEHRER: Again, the major story of this Friday, President Clinton announced a 24-hour a day airlift of relief supplies as part of a new effort to help the Rwanda refugees. On the NewsHour tonight, Joint Chiefs of Staff General Shalikashvili said U.S. forces would deliver 10 million rehydration packets by tomorrow. Water purification equipment within a few days and start air drops Sunday for people who cannot be reached by road. He said the United States was determined to make a difference. Good night, Robin.

MR. MAC NEIL: Good night, Jim. That's the NewsHour for tonight. We'll see you again on Monday night. I'm Robert MacNeil. Good night.