The MacNeil/Lehrer NewsHour

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

MS. WARNER: And I'm Margaret Warner in Washington. After our summary of the news we go first tonight to the health care reform debate that began today in the Senate. Then Time Magazine's Richard Ostling reports on the religious controversy over whether abortion should be covered under health care reform, and finally Charlayne Hunter-Gault has another in her series of conversations about stopping violence among young people. NEWS SUMMARY

MR. MAC NEIL: After months of political wrangling and millions spent on trying to win public opinion, the debate over health care reform moved to the Senate today, and depending on the final outcome, both sides agree that changes could be historic. Proponents liken the measure being considered to the start of Social Security, while critics say it smacks of socialized medicine. At issue is a bill offered by Majority Leader George Mitchell. It would seek to cover 95 percent of the population by the year 2000 largely by subsidizing the poor. If universal coverage were not finally achieved, employers could be forced to pay half of their employees' insurance. President Clinton supports the bill. Opponents have threatened a filibuster. Late this afternoon, Sen. Mitchell welcomed the upcoming debate and said it was time for action.

SEN. GEORGE MITCHELL, Majority Leader: Health care reform is a matter of simple justice. Human beings are born unequal in ability and strength. None of us chooses our family's circumstances. None of us is immune to bad luck. We're all susceptible to accident and illness. We all grow old.

MR. MAC NEIL: Senate Republican Leader Robert Dole is expected soon to offer a competing bill. The House begins its own debate next week. We'll have more of the story right after the News Summary. Margaret.

MS. WARNER: The Clinton administration today again urged Congress to pass the crime bill which is being blocked by an unusual coalition. The National Rifle Association and its congressional allies opposed the bill because it banned certain assault weapons. Members of the Congressional Black Caucus also opposed the bill because it does not include a provision that would help track racial bias in death penalty cases. This afternoon, White House Chief of Staff Leon Panetta talked to reporters about the bill's prospects.

LEON PANETTA, White House Chief of Staff: This looks like the same kind of tough vote we've faced time and time again. I think we'll get there because it's the right issue and because it's the right vote. But very frankly, it is really going to take both Republicans and Democrats alike. This is not a partisan issue at this stage of the game.

MS. WARNER: House Speaker Tom Foley said the bill is picking up support, and he expects the measure to come to the floor this week. The $33 billion bill would pay for 100,000 more police as well as crime prevention programs. President Clinton today ordered an investigation into the building of a $310 million spy satellite complex near Washington, D.C. Construction on the CIA project began in 1990 and is more than half complete. The Senate Intelligence Committee said this week it was not properly informed about the size or the cost of the project. Attorney General Janet Reno today asked for the appointment of an independent counsel to investigate Agriculture Sec. Mike Espy. The counsel will examine whether Espy illegally accepted gifts from Tyson Foods, an Arkansas poultry company. Espy says he has reimbursed Tyson for those gifts.

MR. MAC NEIL: In economic news, the productivity of U.S. business fell 1.2 percent in the second quarter. It was the first decline in five quarters. Seven people were injured after an explosion at an Exxon chemical plant in Baton Rouge, Louisiana, last night. Officials said fumes from the ensuing blaze were not toxic but warned nearby residents to close their windows as a precaution. Police closed two miles of a nearby interstate.

MS. WARNER: A relief official said today that medical evacuations from Bosnia have been suspended for lack of funds. The International Organization of Migration is making an urgent appeal for donations to continue the evacuations. Meanwhile, food airlifts into Sarajevo resumed today. They were suspended two and a half weeks ago after snipers fired on relief planes. Negotiators from Israel and Jordan began talks today on a full peace treaty between the two countries. At a meeting near the Dead Sea they discussed security, trade, and tourism. They also focused on water sharing and other environmental issues.

MR. MAC NEIL: In the Rwanda story, aid workers are now worried that typhus may be breaking out among the refugees in Zaire. At least 30 people have died in refugee camps from the suspected disease. Mark Austin of Independent Television News has the latest from Zaire.

DR. JOHN PARKER: This baby is dehydrated, starving.

MARK AUSTIN, ITN: In the disease-ridden camps of Goma another child on the brink of death, the sort of challenge British GP John Parker is getting used to.

DR. JOHN PARKER: Every day's a very long day.

MARK AUSTIN: From dawn to dusk, they're carried into this makeshift Red Cross clinic as a lethal strain of dysentery called shigella now spreads through the hundreds of thousands of refugees here.

DR. JOHN PARKER: Today I've seen five cases of cholera and probably fifty, sixty cases of dysentery, and it's only 10 o'clock in the morning.

MARK AUSTIN: The camp he works in has 300,000 refugees. Two thousand five hundred pass through his clinic every day. Some can't be saved. Trying to dig latrines in this terrain of volcanic rock is proving almost futile. The sanitation remains appalling. Terrain, says Dr. Parker, will turn these camps into a cesspool.

DR. JOHN PARKER: I see another huge epidemic of cholera and dysentery, an outbreak of pneumonia, meningitis. Just the infectious diseases will become rife.

MARK AUSTIN: Twelve hours a day Dr. Parker works here, but at dusk he has to leave the clinic for his own security, and the people who depend on him have to fend for themselves.

DR. JOHN PARKER: The terrible thing is that at 5 o'clock we take all the drips out and go home. We give them a bottle of water to drink, we cover them up with a blanket, and we go home. And in the morning we come back and if they're alive, they're alive, and if they're dead, we carry their bodies out, and we start again.

MR. MAC NEIL: U.N. officials have begun scouting sites for another large refugee camp in Zaire. They're expecting another exodus of refugees when French troops leave Rwanda in the coming weeks.

MS. WARNER: That's our News Summary. Now it's on to opening arguments in the Senate health care debate, religious differences over abortion and health reform, and preventing teen violence. FOCUS - HEALTH DEBATE

MR. MAC NEIL: The health reform debate is our lead. Today the full Senate took up the centerpiece of the Clinton administration's domestic agenda. The Democratic health care reform bill is one of the most sweeping pieces of social legislation in decades. It attempts to bring health insurance to tens of millions of Americans who don't have it and to guarantee that once insured people will not be at risk of losing their health care. With the threat of a Republican filibuster in the air, the debate began this afternoon. Correspondent Kwame Holman begins our coverage.

SEN. DALE BUMPERS, [D] Arkansas: We're getting ready to take up health care this very evening, probably the most defining moment in the history of the Congress.

MR. HOLMAN: After a day of partisan haggling over the debate schedule, action on health care reform legislation finally moved to the floor of the Senate late this afternoon. The plan the Senate will debate first is one proposed by Senate Majority Leader George Mitchell.

SEN. GEORGE MITCHELL, Majority Leader: Everyone engaged in the health care reform effort has heard firsthand the stories of people, ordinary working people, middle class professionals, high school football stars whose health bills are ruining their lives and limiting their futures. Sen. Reed told us of a man in Nevada who is able and is willing to pay for insurance for his college student daughter. But he can't, because there isn't an insurance company in the country that will insure is daughter. She was born with a malfunctioning adrenal gland and is a victim of juvenile diabetes. She takes medication every day to control her symptoms, and sometimes she needs hospitalization. Her father wants to pay for insurance coverage. He can afford to pay for insurance coverage, but he can't find anyone willing to sell it to her. He told Sen. Reed, Neither Laura or I are looking for a government handout. We are willing to pay, even at a premium price." Isn't it ironic that we mandate automobile insurance companies to pool their assets and provide automobile insurance to high risk drivers, but we do not require the same for health insurance companies? Health is far more important than driving, so said a man from Nevada, and he was right. If the states can demand that auto insurers cover the risk resulting from bad driving behavior, behavior that can be controlled and influenced and prevented, it is not beyond our ability to require health insurers to cover those whose conditions don't arise from behavior but from circumstances and bad luck. My bill will do this.

MR. HOLMAN: Unlike the original Clinton plan, which called for universal coverage, the Mitchell plan settles for covering 95 percent of all Americans by the year 2000. To achieve that, the plan provides subsidies to buy health coverage for uninsured, low income workers, children, and pregnant women. The plan also provides subsidies for up to five years to employers who expand coverage to insure all of their workers. If by the year 2000 the 95 percent target is not meant, Congress would impose an employer mandate, requiring employers with 25 or more workers to pay for at least 50 percent of their health coverage. The standard benefits package offered by the Mitchell plan includes hospital care, doctor visits, prescription drugs, and pregnancy-related services. The plan would be financed through a 45 cent per pack increase in the cigarette tax as well as increased taxes on some handgun ammunition, and a new 25 percent tax on the most expensive health care plan. Hanging over the Senate is the threat of filibuster by Texas Republican Phil Gramm.

SEN. PHIL GRAMM, [R] Texas: I want to work out an agreement. I'd like to pass a bill this year. We can make insurance better. We can buildon the strengths of the current system. But if I believe the final bill is a bad bill for America, for the people of my state and for the whole country, I'm going to do everything I can to stop it.

MR. HOLMAN: But West Virginia Democrat Jay Rockefeller says the Republicans would be the big losers if a filibuster goes forward.

SEN. JAY ROCKEFELLER, [D] West Virginia: I don't know if we face a filibuster or not. I think it would be a tragic mistake on the part of the Republicans if they were to do that. It would only be them who do that. If they do that, I think it'll fly back in their face, it'll show the American people where they stand on health care. They have, you know -- they don't have a bill. They have no bill. They have no alternative. They only have rhetoric. They only have delay. They only have complaints. They only have procedural moves. And I for one am sick of them.

MR. HOLMAN: Some Senators still are working toward a bipartisan agreement. A group made up mostly of members from the Senate Finance Committee met throughout the afternoon in the office of Rhode Island Republican John Chafee. The Finance Committee's bill was the only health care measure in Congress that attracted both Democratic and Republican support. And these Senators hope to achieve that same kind of support on the Senate floor. Senate leaders have set aside four hours each day this week for debate on health care, with amendments to be offered on Friday. No one is predicting how long debate in the Senate will last. Debate in the House is scheduled to begin next Monday.

MR. MAC NEIL: We're joined now by to health care policy advisers who've helped shape the Democratic and Republican health reform proposals. Gail Wilensky was a health reform adviser in the Bush administration where she served as administrator of the Health Care Financing Administration which runs Medicare and Medicaid. She has advised House and Senate Republicans on health reform legislation this year. Paul Starr helped write the original health care proposal President Clinton sent to Congress last year. He's a professor of sociology at Princeton University and the author of the Pulitzer Prize winning book The Social Transformation of American Medicine. Ms. Wilensky, let's begin with you. What do you see as the choice now before the American people?

MS. WILENSKY: The choice is really the appropriate role for government and whether we're at a stage where we're ready to do those things that we agree on to try to fix problems in health care, make sure people don't get shut out of health insurance because they've been sick, break down barriers that have kept people because they're too poor from buying insurance. Whether we do what we agree on or whether we insist that if we can't do a complete redo of health care, then we do nothing at all. They are the most fundamental issues of the proper role for government containing spending on health care, breaking down barriers, versus guaranteeing coverage. They're very serious issues, and they're unfortunately wrapped in incredibly complex legislation, much of which hasn't been finalized, and is going to make it very difficult now I think to pass major legislation this year, not impossible but very difficult.

MR. MAC NEIL: Do you -- Mr. Starr, do you see, do you define it that way, as the proper role for government?

MR. STARR: You know, Robin, for 50 years, Republicans have been trying to turn the issue of health insurance into an abstract question about socialized medicine, about government. There's a practical issue here about whether people are going to have access to health care, whether they're going to have protection from financial ruin in the event of illness, and we have some very practical and sensible legislation on the table from the Majority Leader of the Senate. I think of all the proposals that we've seen the Majority Leader's are the least susceptible to these charges about the great and expanding role of government.

MR. MAC NEIL: Ms. Wilensky, Mr. Starr just used the phrase socialized medicine. Mrs. Clinton came out -- as you probably read -- came out very strongly today saying that Republicans and opponents of the bill are using the phrase socialized medicine to scare Americans. Is your phrase the proper role for government, a kind of code to evoke that, that idea?

MS. WILENSKY: I find it kind of amusing that I wasn't the one that used it. And I wouldn't use it for this bill, the Majority Leader's bill, or the Gephardt bill, or the Clinton bill. It is a massive increase, however, in the power and role of government, in the organization, financing, and delivery of health care. And that's a very serious issue. We are proposing in these bills government defining what benefits people must have, the kinds of prices that they will face, the definition of where they can purchase their health insurance, major changes. Now perhaps that is what the American people. That's the kind of debate that we need to be having, but I think that these are very serious issues. There are, however, places where we agree, like making sure people don't get shut out because they've had an illness. We all agree, Republicans and Democrats, that should be changed.

MR. MAC NEIL: Well, I'll come back to the substance of the bills in a moment. I just want to pursue this point for a second. You would agree with Ms. Wilensky it is a large increase in the role of government in this area as being proposed?

MR. STARR: It is some increase in the role of government but not nearly as much as many people are saying. You know, it used to be said that it would take the equivalent of Nixon going to China, a Republican, to get national health insurance adopted in the United States. And, in fact, of course, Nixon did support an employer mandate. Ironically, I think it may take a Democratic President and a Democratic Majority Leader in the Senate to pass a bill that I think of as being fundamentally conservative and Republican in its frame work. This is a bill that relies on a voluntary structure, voluntary contributions. A few weeks ago the Republicans were saying we can't live with these mandatory alliances. Well, the purchasing alliances in the Mitchell bill are now voluntary. A few weeks ago they were saying we can't live with these price controls, these premium caps. Well, there are no price controls in the Mitchell bill. A few weeks ago they were saying, this rush to an employer mandate isn't justified. Well, Sen. Mitchell has said, let's work on voluntary measures, and let's give the Congress every opportunity in the future to come back and enact other voluntary measures before we go to the extreme, which isn't really so extreme, of shared responsibility by employers for health insurance.

MR. MAC NEIL: So not nearly as much an increase in the role of government Mr. Starr says than its critics are saying, Ms. Wilensky?

MS. WILENSKY: Well, I think the fact is if the Democrats had been as supportive as Mr. Starr suggests, then there wouldn't have been the problem that we now see. In fact, the administration clearly realized that large numbers of Democrats were against the kind of government intrusion that was being proposed under the Clinton administration, including the mandatory monopoly health alliances that they proposed. What they've been trying to do is to find whether there isn't a way to at least get through the Senate something that the moderate Democrats will support, hoping that when they get into a conference committee, they can move the bill left. Leon Panetta, the chief of staff, made that very clear in his statements. They just want to get something into conference, where there is much more control, and they see this as the most -- least obvious role for government. But, in fact, it's there, hidden in the wings, ready to jump out, fast tracking to employer mandates, fast tracking to price controls, the kinds of things that if you're against, you're going to continue to be against in the Mitchell bill.

MR. MAC NEIL: Okay. I really am going to move on to the contents of these bills in a moment. I just want to clear a couple of other ideas out of the way. Ms. Wilensky, Sen. Mitchell said today that those who want to stop the momentum right now, those who are saying, for instance, do it next year or whatever, or let's not move too fast, don't -- in his words -- don't want anything to happen. Is that the motivation of the Republicans you were advising, not to have anything to happen?

MS. WILENSKY: No, it isn't. And I think it's very clear by the active work that has been done in the Senate with the Dole-Packwood bill, the attempt to bring on a very diverse group of Republicans into a single bill, the intensive work that's been going on in the House with their bipartisan bill, of trying to bring the Roland and the Bill Arachus group of Republicans and conservative Democrats, there is a lot of serious interest in trying to get a good health care bill, but I think we ought to take what Sen. Gramm and also Sen. Shelby have said seriously, i.e., there are people who believe that a bad bill is worse than no bill and will do what they can to stop a bad bill.

MR. MAC NEIL: How do you read that rhetoric? What do you believe the Republicans who are in the Senate almost unanimous, with the exception of four, I believe, Senators, how do you read their motivation, or do they want nothing to happen, or are they out to get some health reform?

MR. STARR: I think that there is a real question here of bad faith, because several weeks ago many Republicans were still supporting the bill that Sen. Chafee had introduced which was a universal coverage bill with an individual mandate. And they were saying the choice was between an employer mandate and an individual mandate. And they've now walked away from the individual mandate. Earlier in this debate they were also supporting a revenue measure, a tax cap, i.e., a cap on the tax deductibility of health benefits. They've walked away from that as well. It has happened repeatedly that as the Democrats have moved toward the center -- and I think Sen. Mitchell's bill is very much in the center -- the Republicans have moved away. And that does raise a question as to whether they are really interested in striking a compromise, or whether or not this is a bait and switch meant to hold out an agreement but to prevent it in the end and then to blame it on President Clinton in time for the November election.

MR. MAC NEIL: Ms. Wilensky.

MS. WILENSKY: Well, I think that if, again, if the Democrats were as united as the administration sometimes likes to make it sound, they do hold the numbers in the House and the Senate. They can get their bill through. I think that the work that was done to try to set up a bill that had wide support among the Republicans ought to be taken very seriously.

MR. MAC NEIL: Okay. One other question before we move on, if this bill is stopped now, how long will health care reform be stopped for?

MR. STARR: Well, I think there is a very great likelihood of deterioration in the health insurance market in the rest of the decade without action at the federal level. People have been losing health insurance, and I think there is nothing currently happening in the market place to correct that. So the problem is going to look bigger and bigger if we don't do anything about it.

MR. MAC NEIL: And what about the political situation? If it doesn't happen now, when will it happen again?

MR. STARR: You know, we have had windows of opportunity every generation, but there's no guarantee that we'll have another window soon. It could, in fact, be put off for quite a while.

MR. MAC NEIL: What do you think of that, Ms. Wilensky?

MS. WILENSKY: Well, I think the actual biggest window of opportunity has come and went, and that was in the summer of 1993, bad strategy decision on the part of the Clinton administration. The fact is there are some problems that even an aggressive private sector is not going to help, i.e., who pays for poor people, who fixes some of these insurance rules. I think you'll see it taken up in 1995, if it doesn't happen in 1994. I haven't given up hope that we'll see something in 1994 yet though.

MR. MAC NEIL: Okay. Let's turn to the bills, themselves, Ms. Wilensky. I mean, you've started a little bit, but just in brief terms evaluate the Mitchell bill for us.

MS. WILENSKY: Well, I think the Mitchell bill looks less intrusive than, in fact, it is. And the reason is because it starts out with a voluntary program in terms of the role of employers and the role of government. But what it does by the end of the decade is fast track some very powerful roles for government. It sets up some twenty or twenty-two government commissions. It has 17 taxes is the count that I've heard. But it mainly sets up the ability to put into place those elements that have been fought against in terms of the Clinton bill like employer mandates, like price controls, fast tracking that if recommended by the cost commission, and, therefore, I think people have to be very careful because it really is a major expansion of government roles but in a way that makes it look through stealth, i.e., it's not obvious in the way that Mr. Gephardt's bill is. That's government in your face. You know what you've got.

MR. MAC NEIL: How do you evaluate the Mitchell bill?

MR. STARR: I don't think that's really fair at all. For example, the commissions that Gail Wilensky is talking about report back to Congress. It will be up to Congress to decide what to do about their recommendations. It's true also, by the way, there was a mistake in the earlier reporting about the Mitchell plan in this regard, the employer mandate does not go automatically into effect if we haven't achieved 95 percent coverage by the year 2000. There will be recommendations from the commission about further voluntary measures to raise the number of people insured. Congress can do other things at that point. The small mandate that Sen. Mitchell has proposed is an if all else fails measure. It is a last resort. And let me just say this about it. It may concentrate the mind wonderfully of both Democrats and Republicans to get the voluntary measures to work if there is a threat of an employer mandate. It may get them to be partners in making this work instead of working at each other's throats.

MR. MAC NEIL: What do you say to that, Ms. Wilensky?

MS. WILENSKY: Well, I think if you believe employer mandates are a bad idea because you think it makes it look free to the employee when we're trying to get people to be more cost conscious. If you think that price controls are a bad strategy setting up a way to fast track these, to have them be in a abeyance in case that you want them and to come in unless something else comes in its place is bad policy. It's bad policy now. It will be bad policy then.

MR. MAC NEIL: Evaluate the Dole bill.

MR. STARR: Well, the Dole bill does not do much for people who are above the poverty level. It is primarily a support. It does include subsidies for people below the poverty line. But for people between let's say about 15,000 and 30,000 dollar family income, it doesn't do very much at all. And when you consider a family that's earning maybe $20,000 a year that may face a premium of $5,000, it's really a very considerable burden to impose on them to ask them to pay that full premium without any help. So I think that's really one of the key differences. There are also lots of other aspects. The Dole bill really perpetuates a problem that we've seen from the beginning with the Republican proposals. The bill that President Bush proposed, which Gail Wilensky worked on back in February 1992, when they brought it to Congress, they didn't have any financing. Sen. Chafee's bill relied for a lot of its financing on the tax cut which they've now walked away from, and Sen. Dole's bill, the financing depends entirely on controls in Medicare and Medicaid. The Medicaid cuts have got the governors screaming. It's very unlikely that will stand up. The bottom line is this: The Republicans have not been willing to finance the subsidies which their own approach calls for, and that has been the key problem that they have never been able to face up to.

MR. MAC NEIL: Let's hear your evaluation of the Dole bill, Ms. Wilensky.

MS. WILENSKY: I think the Dole bill takes the power of government and uses it to break down the barriers that have kept people from being able to get insurance. For poor people that means having the economic wherewithal. For those who are the lower middle class and the middle class it means some additional subsidies, making sure that you get a subsidy if you're self-employed that's just like the government tax subsidy you now get if you're an employee, making sure you have access to group insurance, making sure you don't get shut out because you've had a pre-existing condition, if you're a small employer making sure that you can buy into the federal health employees benefits program, which is a good way to access the power that the federal government has been able to use as its employer status, and a lot of other reforms as well, making sure information is available. It really gets down to this issue of do you use the role of government to break down barriers, help poor people, knock away the barriers that have kept the middle class and others from being able to buy insurance, and making sure that markets can work to try to get value for your money, or do you use a much more aggressive, direct role for government, guaranteeing, forcing people to buy a specified package of benefits, having this more aggressive role on the part of employers, mandates if need be and mandates soon in some of the bills. It's a very different role for government, and that's why I come back. It's a very serious issue. It will have major repercussions. It's something the country needs to think hard about.

MR. MAC NEIL: This point was raised on our program by Sen. Mitchell when he was here last week. Why is it different in role for government than from Medicare, for example?

MS. WILENSKY: Well, I think it's a very different example. Let me give you the reasons for that. When it came to Medicare, we were trying to fix a very narrow problem, helping elderly people who hadn't been able to buy insurance get insurance and have that insurance look just like what the middle class was buying, the Blue Cross and Blue Shield plans. Here what we're trying to do is to reconfigure how health insurance is organized, financed, and delivered for the 85 percent of the people who have health insurance as well as the 15 percent who don't, and to do changes that will do much more than try to make sure people have access to a very comparable insurance package like the one that others have, very different activity together.

MR. MAC NEIL: How different do you see it?

MR. STARR: Well, I think there's a fundamental continuity between Medicare and these proposals. They are aimed at making available to millions of Americans who can't buy insurance today a good insurance package. I think in that sense it's very comparable to Medicare. I think what's different is that we face much more serious problems of cost containment today than we did back in the 1960's, and so we do need to do exactly what Gail was referring to, i.e. to reconfigure the marketplace and to create incentives, to build in cost consciousness, and I think that is what the Mitchell bill does, and I think it's very important that that part of it be preserved.

MR. MAC NEIL: We have to leave it there. Ms. Wilensky, thank you, and Mr. Starr. Margaret.

MS. WARNER: Still ahead, abortion and health reform, and ways to end youth violence. FOCUS - ABORTION - COVERAGE CONTROVERSY

MS. WARNER: Next tonight, the debate over abortion and health care reform. When Congress votes on health reform in the coming weeks, it will have to decide whether to include abortion in the basic benefits package mandated by the government. Both House and Senate Democratic leaders included abortion coverage in their bills, but the Catholic Church and others are lobbying members of Congress to vote against the bills if they include abortion coverage. Richard Ostling, religion correspondent for Time Magazine, has this report.

MR. OSTLING: The sermon was highly political during Sunday Mass at St. Rose of Lima, a conservative Catholic parish in Providence, Rhode Island.

FATHER ROBERT MARCIANO: Those who have painted themselves with the conveniently moral neutral brush of pro-choice and scream that women have the right to choose now say that you and I citizens, men and women, who believe in God and virtuous living and religious freedom, must abdicate our right to choose. For with this law we will have no choice but to be mandated by federal law to do what is wrong, like it or not, as we become part of the abortion industry.

MR. OSTLING: Father Robert Marciano was responding to a call from the nation's bishops for all Catholics to oppose health reform if abortion is included, a difficult decision for the bishops because they've wanted universal health coverage since 1919. During Mass, Father Marciano asked parishioners to sign protest letters to Congress, as did most of the priests across the state. The parishioners' letters were delivered to state Catholic headquarters, 28,000 of them in the first week. This was only part of a coordinated statewide campaign. Rhode Island's Catholic weekly issued a special edition devoted entirely to the issue, and the state's Catholic leader, Bishop Louis Gelineau, sent strong letters of his own to Rhode Island's congressional delegation, which is united in supporting abortion coverage. The most pointed went to the only Catholic, Rep. John Reed. Though Rhode Island is 2/3 Catholic, the Church stand has met some resistance.

RADIO ANNOUNCER: This is WPRO.

ANNOUNCEMENT: Mary Ann Sorrentino, WPRO.

MARY ANN SORRENTINO: [radio show] Looking for your calls this morning --

MR. OSTLING: one prominent dissenter is radio talk show host Mary Ann Sorrentino, who was excommunicated by the Church for heading Planned Parenthood, which performs abortions.

MARY ANN SORRENTINO, WPRO-AM Radio: If you know your Catholic dogma, then you know that the Church is its people. It isn't a few guys in dresses telling us what to do. Pablo Rodriguez, I assume a Catholic, medical director of Planned Parenthood, Rhode Island, some would say there's a contradiction. Pablo, welcome to WPRO again.

PABLO RODRIGUEZ: It's always a pleasure to be with you, Mary. When you look at the research done on all health care plans in this country, you find that 2/3, 66 percent, already cover abortion. So any kind of change of that standard practice in this country would represent a step backwards for women, and not just for women.

MARY ANN SORRENTINO: One of the compromises, of course, that's been suggested is that abortion would become a separate rider under the national health plan, and those people who would wish to buy abortion coverage would buy it separately. That's not only a step - - not only a step -- it's like on a giant express train backwards - - it's insulting because, for example, I have no need -- please God -- at this point in my life for maternity coverage. Non-smokers don't want to pay for somebody else's lung cancer. I mean, we can't start having selective insurance coverage where you only pay for the things you think you're going to need. That's not how any pool works.

MR. OSTLING: But parishioners who signed letters at St. Rose insist abortion is unlike any other medical treatment.

UNIDENTIFIED MALE PARISHIONER: Any universal health program is going to have certain mandated benefits, and you look at 'em. Are we going to include acupuncture or not? Are we going to include chiropractic services or not? When you look at other things, such as abortion, and you see this terrific division in the country and you see millions and millions of Americans morally opposed, strongly morally opposed to it, it should not be a mandated benefit in a representative democracy.

MR. OSTLING: Nurse Jan Perreault fears abortion coverage will undermine protection of life elsewhere.

JAN PERREAULT: Any government program, it never gets smaller, it only enlarges. So first we'll start with abortion, and then next thing you know it'll be premature babies who won't get care, we'll go into rationing health care for the elderly, and I think that's a terrible thing. We have to stop it now.

MR. OSTLING: The local campaigns are aimed at changing opinion here in Washington, where most of the nation's major religious groups are lobbying. Full abortion funding is promoted by a coalition, including liberal Protestants, Jews, and Unitarians. But the conservative Southern Baptist Convention and National Association of Evangelicals, among others, unite with the Catholic Church in opposing abortion as part of health reform. A Time Magazine-CNN poll asks: If the government were to guarantee health insurance for all Americans, should the plan pay for abortion? Last year, 50 percent of Americans said yes, and 44 percent no. But a repeat poll in July showed only 41 percent in favor and 52 percent opposed. Helen Alvare is the Church's public spokeswoman on abortion. She's been lobbying members of Congress, advising local campaigns, and making media appearances.

HELEN ALVARE, National Conference of Catholic Bishops: Abortion is sui generis. It's unlike any other thing. It is an operation in which technically speaking a developing human life is ended.

SPOKESMAN: But there have been Americans who oppose various expenditures of the federal government with the same vehemence that a faithful Catholic may oppose abortion and yet, they are not allowed that, that way of working their will into both the funding or the spending of the funds in the United States government.

HELEN ALVARE: Well, there are a lot of -- just let me -- one sentence here, that one thing is that, you know, there are a lot of things we don't like that we contribute to as a people, but why add another one? I mean, things are offensive enough. Why add another one that we object to in the majority?

MR. OSTLING: Alvare is worried about several future possibilities.

HELEN ALVARE: Much more than individual tax money is going to abortion. We have some other personal intrusions of abortion into our lives. I have to buy abortion insurance for myself and my daughter. My employer, the Bishops Council, has to subsidize abortion insurance for its employee community which have rejected the presence of abortion clinics, will have to have abortionists available because every basic benefit has to be available regionally to every purchaser.

MR. OSTLING: Frances Kissling runs a small organization of Catholics who oppose the bishops on the abortion issue.

FRANCES KISSLING, Catholics for a Free Choice: You have to respect the consciences of those who feel that for them abortion is the most moral decision that they can make in a given set of circumstances.

MR. OSTLING: Like Alvare, she lobbies on Capitol Hill.

FRANCES KISSLING: The best policy is one that basically says here's a range of reproductive health care services, you make the decision about what fits within your moral frame work and what meets the circumstances you have at this time, and we will fund that decision, whether it's child bearing and rearing or abortion. I think that there is widespread belief that abortion should be legal, and in this context, I think it is important not to send a message to women in America that abortion is so odious that they, themselves, will be stigmatized as human beings if, indeed, they make that decision.

MR. OSTLING: Catholic hospitals have a major stake in the debate as well. There's general agreement that hospitals and individual health workers shouldn't be forced to provide abortions. But under a new nationwide system of health networks Catholic hospitals which admit 50 million patients a year might be required to refer patients for abortions. Sister Carol Keehan is president of Providence Hospital in Washington, D.C.

SISTER CAROL KEEHAN, President, Providence Hospital: If those new methods of the delivery of health care are formed, then either we will have to provide the service or join plans and jointly sponsor the funding of it in another facility, both of which we're opposed to. We don't think we should be required to buy it or do it.

MR. OSTLING: Kissling is worried that under a unified health system a broad conscience clause for Catholic hospitals would prevent somewomen from getting other services that violate Church teaching.

FRANCES KISSLING: So we do run the risk that something that almost everyone in this -- things that almost everyone in this country find morally unobjectionable, contraception, you know, the fertility treatment, morning after pills for rape victims, condoms in the case of AIDS, that these things are going to become unavailable I would estimate to up to approximately 20 percent of the population.

MR. OSTLING: A generation ago it would have been nearly unthinkable for Catholics to disagree in public over something as fundamental as the Church's long opposition to abortion. But the debate on this and many other issues has raised important questions about the nature of Catholic conscience.

FRANCES KISSLING: The Church, itself, holds that conscience is primary. Conscience, however, is not a whimsical kind of thing. It is to some extent an intuitive but educated evaluation, personal evaluation of what is a morally correct action to take in any given circumstance. And it involves, I would say, in a Catholic sense, an attempt to try to try to understand what would God want of me in this circumstance.

HELEN ALVARE: If in the end they really have informed their conscience and say I find myself in a completely different position from you, we would still say your position is not a position that respects human life. They know whether they have truly tried hard to inform themselves of what we teach and why we teach, and they know whether they have made their peace with God. I can't say that person is or is not definitely a Catholic. I can say that the position that they hold is not a Catholic position.

MR. OSTLING: No matter what their views, Catholics on all sides agree on the right of citizens, religious voices included, to campaign for their moral beliefs. Whatever happens on health reform, the Catholic crusaders are participating in a tradition of religious activism that's as old as the United States, itself.

MR. MAC NEIL: Despite the bishops' refusal to support any bill with Catholic coverage, yesterday the Catholic Health Association, which represents 1200 Catholic hospitals, urged Congress to pass the Democratic bills. In a press release, the association said that if the bills are defeated, meaningful health care reform is dead for the foreseeable future. The Catholic Health Association says it will continue to urge that abortion coverage be dropped from the final bill. SERIES - BREAKING THE CYCLE

MS. WARNER: Next, we continue our series of conversations on breaking the cycle of violence among young people. With adolescent homicide rates reaching the highest levels in history and many cities and towns across the country wrestling with the increased violence levels among the young, Charlayne Hunter-Gault has been talking to people with solutions.

MS. HUNTER-GAULT: It's never too early to start trying to break the cycle of violence among the young, the experts say.

[CLASS]

MS. HUNTER-GAULT: This is a class in conflict resolution and mediation. Teachers are applying skills they've learned in a national program called Resolving Conflicts Creatively. While it is a school-based program, it's not just for tots.

MALE TEACHER: We have rules for mediation, first of all. There's no name calling. If you're talking, Wanda cannot interrupt you at any time. She has to wait till you finish, and she can give us her story. Okay? Do you understand that? That's either a yes or a no.

GIRL: Yes.

MALE TEACHER: We're here to solve the problem. We don't need that. Okay,so --

GIRL: I understand it.

MALE TEACHER: I'm saying to both of you --

GIRL: I've been mediated before because of conflicts that I've had with people. It's helped. You get -- you say what you want to say to that person, and there are certain boundaries that you cannot pass.

MALE TEACHER: We want win/win situations. What we mean by win/win situations is we want both persons to come out and say this really works, I feel good. If one person doesn't feel good, and the other person thinks they got the best of you we didn't do anything.

MS. HUNTER-GAULT: No one is more committed to win/win situations than Linda Lantieri, a former school teacher and principal in New York's East Harlem. Lantieri is the coordinator of the New York- based National Resolving Conflicts Creatively Program. In 300 schools nationwide from New York to Alaska, the RCCP, as it is called, is the largest school-based violence program in the country. We talked with Lantieri about the program and about youth violence in general.

MS. HUNTER-GAULT: Linda Lantieri, thank you for joining us. What can you tell us about the reasons behind the up surge in violence among young people?

LINDA LANTIERI, Resolving Conflict Creatively Program: Many of us at this point know that the United States is No. 1 in terms of homicide in the industrialized world and that that rate really is true of all races, of all backgrounds. I mean, we're seeing violence erupting in rural and suburbia, as well as we are in the urban areas. What we do know is that often kids who have experienced or witnessed violence themselves is, is probably the strongest variable that moves young people without any kind of intervention to being violent to others or themselves.

MS. HUNTER-GAULT: What is the premise of your program?

LINDA LANTIERI: I think what we're saying in the Resolving Conflict Creatively Program is that violence is preventable. It's not inevitable. Kids can learn concrete skills at a very early age -- we begin in kindergarten -- to begin to deal with conflict in a very different way, one that does not escalate into violence. But I think we're also useful to the young people who don't know how to say what it is they need and feel. We have as many parents come to us who are happy that their kids are able to tell what it is they want and need as we are about parents who are happy that their aggressive kids have become more assertive. To me, again, I go back to the concept of emotional literacy.

MS. HUNTER-GAULT: Emotional literacy?

LINDA LANTIERI: Yes.

MS. HUNTER-GAULT: That's a good term.

LINDA LANTIERI: Yes. We don't know how to tell each other what we need and feel. We do it in very destructive ways very often, and to me, these are lifelong skills. We've been around for 10 years now, well before the epidemic of violence began to frame us as a violence prevention program. We felt that these emotional and social skills should be a basic of kids' education in general.

MS. HUNTER-GAULT: How does it work?

LINDA LANTIERI: Well, we work with the adults in kids' lives first. We work with administrators of a school, teachers, parents, who then learn these skills and learn how to, in fact, begin to teach these skills to young people.

MS. HUNTER-GAULT: Like, for example --

LINDA LANTIERI: For example, what might they learn? One of the - - some of the skills involved, how to listen better, we call it active listening, where we really are able to hear each other's point of view and be able to say back what we have heard someone say. So often, conflict starts very early on with misunderstandings simply in communication. We learn how to negotiate what's called the win/win solution, where we understand that people have needs and wants and we move beyond positions to what it is they need and want, get those things on the table and begin to come to a solution we both could feel good about. Very often we look at conflict as a win/lose situation. But I think what we're really saying is that conflict is a natural, normal part of life.

MS. HUNTER-GAULT: But what kind of conflict are you talking about? Because in my reading of the literature of youth violence, it happens when, I hear this all the time now, some kid disses another kid, disrespects him, and that could be just in passing in the street. He could bump him or accidentally rub up against him at a dance.

LINDA LANTIERI: Any conflict escalates quite quickly. It could de-escalate that quickly. To me, we have the potential always of, you know, I always think of having the Mother Theresa and the Hitler in each of us. But for a stroke of a coin we are often presented with bringing hope and positive situation to the other. And often what happens with conflict is somebody disses somebody else and if the next act is one of violence, whether it's verbal violence or whatever, we could be pretty assured that that conflict is going to escalate. What we are hoping kids learn is that very thing, that conflict can escalate with one remark after another and as a result, we could take control and begin to de-escalate that conflict in some of the very same ways. So, again, it's that kind of first interaction which is crucial, by the way, because if words are exchanged and it's not changed right there, then immediately the escalation happens for lots of reasons, availability of the weapon but also the escalation happens because that young person is touching in that moment of time that free floating bank of anger that he or she carries around with him or her all the time.

MS. HUNTER-GAULT: Yeah. That was the point I was just going to ask you. What about this --

LINDA LANTIERI: It's not about that present situation.

MS. HUNTER-GAULT: Exactly.

LINDA LANTIERI: It's not about that. So to also help kids realize that about their own unspent anger that has been unexpressed and knowing that we often touch that in others and to sometimes not take some interaction like that so personally -- I mean, I could give you an actual example -- there was a time a couple of years ago where many kids in New York City were getting killed for their sheepskin coats, and at that very time one of our young people from one of our local high schools got off a subway stop in East Harlem -- he was a mediator -- and in seconds surrounding by three other guys who basically did the same -- said the same line that had been said all week and kids had lost their lives. Instead, this young man looked at these three boys and said, "This is amazing. I was just getting ready to do that," as he unzipped his coat and handed it and even asked who he should hand it to, by the way, said, you know, "Who should I hand this to," gave it over. Well, what happened is that the three young people were so almost disturbed because the script wasn't going the way it should go they took the coat by the way, but they began to run themselves because they felt like what's happening here, the script has changed. Now, if it ended there, it would be a problem for me, because what happens to the justness in the world. What that young man was able to do was go back to that Resolving Conflict Creatively School, have the foresight of a teacher to call a group of kids together where he began to tell about what had happened and express the anger, and in moments, one of the kids said, "How much was that coat?" One kid said, you know, he said $119. He said, "Aren't there 92 seniors here? That's a little over $1.50 each." And in about three days' time they collected the money. Now that's the kind of thing that we talk about when we talk about a village, because, you know, if he were left with, isn't that wonderful, he used his conflict resolution skills on the corner, but he used them in a very important way and was able to hold his anger to express it in a more appropriate place.

MS. HUNTER-GAULT: But what about the kids who took the coat? I mean, there's three of them for the one that you reclaimed.

LINDA LANTIERI: Right. You know, you just keep doing what you do and you hope to get to as many young people as possible and we're finding our work that, that it's best to be as preventive as possible, meaning to get to kids before there are great, great risks of violence. On the other hand --

MS. HUNTER-GAULT: And when is that?

TLINDA LANTIERI: Well, for us, it's pre-kindergarten. It's in Head Start. But on the other hand, I have seen time and time again that even when kids are at risk of violence and have been violent, themselves, there's still always hope. Young people really don't want to be doing what they're doing sometimes around this issue of violence. In this very room, for example, there were 11 young people that had put each other in a hospital over a gang fight and wanted to sit around a table and begin to talk out their differences in another way. Previous to that, no one had afforded them the opportunity to do it in that way.

MS. HUNTER-GAULT: So are you working to, to engage the critical mass of kids who are young and in school and is that --

LINDA LANTIERI: That's where we're beginning. I mean, I think we're really saying eventually this work in conflict resolution and multicultural understanding needs to be a basic of every kid's curriculum, you know, needs to be a very fabric of schools, that to be educated, one needs the emotional and the social domain as much as we need the academic domain. So I think that's the first thing we're saying, and if we're saying that, then we would love the Resolving Conflict Creatively Program to be in every school in America as Marian Wright Edelman keeps hoping.

MS. HUNTER-GAULT: Who's the head of the Children's Defense Fund.

LINDA LANTIERI: Yes. But again, I feel that in getting to the critical mass, we're hopefully also going to get to the kids who are very at need, who have seen violence, who have experienced violence, who see no other way of being. And I speak to many young people in that category too, and when they're presented with another way of doing things, they too have some real openness to doing it another way.

MS. HUNTER-GAULT: Well, Linda Lantieri, let's hope you're right.

LINDA LANTIERI: Thank you.

MS. HUNTER-GAULT: All the best.

LINDA LANTIERI: Thank you.

MS. HUNTER-GAULT: Thank you.

MR. MAC NEIL: That program, Resolving Conflict Creatively, is an initiative of Educators for Social Responsibility, a non-profit organization that raises donations to run the program. The cost is $33 a student per year. Full implementation at an average size school would cost about $30,000 a year. Tomorrow night, Charlayne will be talking to an Atlanta juvenile court judge named Glenda Johnson whose solution to teen violence is a program to fight teen truancy. RECAP

MS. WARNER: Again, themajor story of this Tuesday was reforming the nation's health care system. The Senate opened debate on a Democratic proposal that would try to cover 95 percent of all Americans by the year 2000. President Clinton backs the measure but some Republicans have threatened to block it with a filibuster. Good night, Robin.

MR. MAC NEIL: Good night, Margaret. That's the NewsHour for tonight. We'll be back tomorrow night. I'm Robert MacNeil. Good night.