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 News Summary, we get a status report on the health care battle in Congress. Next, political analysis from Mark Shields and Paul Gigot, then an update on treatment for heart disease, and we end with a look at Aleksandr Solzhenitsyn's return to Russia. NEWS SUMMARY

MR. MAC NEIL: The chairman of the Federal Reserve was put on the defensive today over raising interest rates. Since February, the Central Bank has boosted short-term rates four times to keep inflation in check. That policy was challenged this morning at a hearing on Capitol Hill.

SEN. PAUL SARBANES, [D] Maryland: The costs that we're paying on the growth front and the jobs front, the costs that ordinary people are paying in terms of trying to advance their standard of living -- and, you know, I have these young couples coming to me. They can't buy a house now. They were about to buy a house. Now they can't do it. The rates have gone up a point and a half, maybe two points, and they're priced out of the market.

ALAN GREENSPAN, Chairman, Federal Reserve Board: I would say the evidence is increasingly that slow inflation means higher economic activity, greater growth and standards of living, greater real wages, not lower.

MR. MAC NEIL: Greenspan's testimony came as the government reported that the nation's economy expanded at an annual rate of 3 percent in the first quarter. That was better than originally forecast at well below the 7 percent rate posted in the final three months of last year. Today's report does not reflect the recent run-up in interest rates. Margaret.

MS. WARNER: Chinese officials today applauded President Clinton's decision to extend them most favored nation trade status and to de- link trade from human rights concerns. But Beijing rejected the President's charges that China still violates human rights and said China won't tolerate interference in its internal affairs. Meanwhile, White House officials spent much of the day disputing charges that the President had caved in to big business in renewing MFN for China. The administration's UN ambassador had this to say after a morning meeting with the President.

MADELEINE ALBRIGHT, UN Ambassador: I think that this is a policy that shows strength, that shows the ability to know what is important for the United States and to know the importance of how to pursue a policy of human rights as well as a policy of engagement with China. On the contrary. I think it is a very important step in showing American resolve.

MS. WARNER: Sec. of State Christopher later said that the U.S. planned to intensify its discussion of human rights with China. Senate Majority Leader George Mitchell, who criticized the President's decision, said he would introduce legislation to impose sanctions on targeted Chinese products.

MR. MAC NEIL: The Clinton administration hinted today it was considering pressing for additional sanctions on Haiti if the present embargo fails to force the military to step down. President Clinton's adviser on Haiti, Bill Gray, spoke with reporters at the State Department this afternoon.

WILLIAM GRAY, Presidential Adviser: There is a very good possibility that the nations may look at ways to bring pressure that they have available where they can bring pressure to the military elite and those who support them. There are a variety of ways that you can do that, from financial restrictions such as third country transfers, remittances, commercial airline flights, a whole list of items that can be done that have been exercised by the United States government before and other places and by other countries. Will that perhaps be done unilaterally? Perhaps, it could be done by the United States unilaterally.

MR. MAC NEIL: Today the Dominican Republic announced it is sending troops to its border with Haiti to enforce the new sanctions. A Dominican military spokesman said the United Nations has agreed to send helicopters, planes, and motor boats to help in the effort. Mr. Gray added that the United States will offer technical assistance to the Dominican Republic to enforce the trade embargo.

MS. WARNER: A hostage drama in Southern Russia ended today with just one casualty. Yesterday, four gunmen seized a school bus filled with students, teachers, and parents. The gunmen traded most of their 29 hostages for a helicopter and several million dollars in ransom. But when the fleeing helicopter landed some 150 miles away, commandos quickly captured three of the kidnappers and rescued the remaining hostages. The commandos killed the fourth kidnapper in a shootout. Aleksandr Solzhenitsyn returned to his native Russia today after 20 years of exile in the United States. The 75-year-old writer who won a Nobel Prize for literature said he won't write anymore but will work, instead, on helping to rebuild Russia. Before his exile, Solzhenitsyn spent eight years in a labor camp for his criticism of Soviet communism. We'll have more on this story later in the program.

MR. MAC NEIL: George Ball, Undersecretary of State in the Kennedy and Johnson administrations, died yesterday in New York. Ball was the only senior U.S. official who argued against the escalation of the Vietnam War. Ball was also the U.S. Ambassador to the United Nations and the author of several books about world affairs. He was 84.

MS. WARNER: That ends our summary of the day's top events. Ahead on the NewsHour, health care on Capitol Hill, Shields & Gigot, new treatment for heart disease, and Solzhenitsyn's homecoming. FOCUS - PULSE CHECK

MR. MAC NEIL: First tonight, we take the pulse of health reform in Congress. It's been a pivotal two weeks for the overhaul of the nation's health care system. The first congressional committees began working on their visions of how Americans will get health care. We begin with this backgrounder from Correspondent Kwame Holman.

MR. HOLMAN: President Clinton went to Capitol Hill this week to deliver a pep talk to leaders of both parties. The President hopes to restore flagging momentum for health care reform legislation before members go home for the Memorial Day recess and face constituents whose support for broad reform may have plateaued.

PRESIDENT CLINTON: I got a very heartening progress report about the efforts being made in the committees and subcommittees and in reaching out to the Republicans.

MR. HOLMAN: But, in fact, the pace of health care legislation in Congress has been slow. Two major committees responsible for crafting bills now are working through the specifics of the Clinton plan, but it's proven a formidable task for Clinton plan supporters, Edward Kennedy, chairman of the Senate Labor and Human Resources Committee, and House Ways & Means Chairman Dan Rostenkowski.

REP. DAN ROSTENKOWSKI: If we can be bipartisan and achieve universal coverage, great. If not, I will do whatever I need to to get at least 20 votes in this committee.

SEN. EDWARD KENNEDY: There is a time to discuss and debate, and there is a time to decide. On the challenge of health care and health reform, we have reached a time to decide. Every member of this committee knows it and the American people know it too.

MR. HOLMAN: Since it began action last week, Sen. Kennedy's committee has met daily, beginning at the very un-Senate-like hour of 8 AM.

SPOKESMAN: I want to thank our colleagues who are good enough to be here.

MR. HOLMAN: The mark-up, as it's called, the actual writing of the bill, is a slow, tedious process. Members and staff read through each provision of their committee's version of health care reform line by line, and those provisions are either approved or amended.

UNIDENTIFIED PERSON: The academic health center's account, Senator, under the bill we authorize a total of $41.8 billion to be expended through the Alton-Newall-Pare Fund.

UNIDENTIFIED WOMAN: And by a later date determined to be feasible for the uniform transmission of information for other services --

MR. HOLMAN: In the House Ways & Means Committee, where mark-up also drags on, Chairman Rostenkowski says he doesn't yet have the 20 votes needed to pass key elements of the President's health care package. Even though the committee continued to move along through the process, attention has been diverted by Rostenkowski's looming legal troubles over possible misuse of office funds. On Wednesday, First Lady Hillary Clinton said Rostenkowski's legal problems would not derail chances for a health care bill this year.

HILLARY RODHAM CLINTON: It would be a great loss to the Congress, but health care reform and the need for it is bigger than any one person in our country.

MR. HOLMAN: The Ways & Means Committee won't begin voting on any health care provisions until the second week of June, after the Memorial Day recess. Meanwhile, the three other committees working on health care reform, Energy & Commerce, and Education & Labor in the House, and the Finance Committee in the Senate, have yet to begin marking up their versions of health care reform. The committees seem deadlocked on one major issue, the so-called employer mandate, requiring employers to pay a major percentage of an employee's health care premium. Republicans generally are opposed to that provision, and they've gone on television to make their position clear.

SEN. ROBERT DOLE: [commercial] Yes, we could make health insurance portable now without the Clinton government-run health care system. Congress simply needs to change the law so you can change jobs and keep continuous coverage.

MR. HOLMAN: The ads, released by the Republican National Committee, will continue to air in major cities during the two-week congressional recess, but viewers won't be seeing the insurance industry's Harry and Louise ads, the ones that invited the wrath of the Republican and the First Lady. Rostenkowski apparently has convinced the Health Insurance Association of America to suspend the ads until the committee completes its work in exchange for letting the industry present its views to the committee next month. But signs the health care debate is growing more politically partisan drew this appeal from the President yesterday.

PRESIDENT CLINTON: I still think this town is way too partisan. I think that there's too much bomb lobbing and rhetoric, you know. I just believe there's got to be a way to work through this and to do it in a way that is kind of less partisan in tone than a lot of what we've heard.

MR. HOLMAN: Congressional leaders once hoped to have a health care reform bill to take home to constituents over the recess. Now they hope the dwindling number of legislative days left in this year's session will force action when Congress returns.

MR. MAC NEIL: We're joined by three people who've been watching the health care debate closely. Julie Kosterlitz is a correspondent for the National Journal, a weekly publication on politics and public policy. She's been covering health policy in Washington for nine years. Norman Ornstein is a congressional analyst and a resident scholar at the American Enterprise Institute, a Washington think tank. AndKathleen Hall Jamieson is the dean of the Annenberg School for Communications at the University of Pennsylvania. She's an analyst of political advertising and communications. Since the administration's push on health reform, she's been studying TV ads, public opinion, and the communications strategies in the health debate Ms. Kosterlitz, does the progress made before Memorial Day, the Memorial Day adjournment, give you confidence that there is going to be health care reform legislation this year?

MS. KOSTERLITZ: I wouldn't say that what's happened in the past couple of weeks is necessarily confidence inspiring, but I, nevertheless, think that there is a reasonable chance that they will succeed in passing something that meets the President's requirements before the end of the session. And I guess the things that encourage me or send encouraging signals in that direction are what's been happening in the Senate, for starters, a place where people thought progress was going to be a lot slower than it was in the House, and, in fact, the tables have turned in the last couple of weeks where we see more bipartisanship and more progress in the Senate than in the House. It's an encouraging sign, if that's where the problem was going to be. Now, clearly, there's some very formidable obstacles and new ones cropping up seemingly daily in the House. I guess my feeling is that this is still an issue of great importance. Albeit eroding popularity for the President's proposal, it's still an important issue to the American electorate, and it's an important issue to the Democratic Party and to the President. I think there is too much riding on this for most of the key actors to let this go without a good fight.

MR. MAC NEIL: Norm Ornstein, where we stand now, are you confident we're going to have legislation this year?

MR. ORNSTEIN: I think there is at least a 70 percent chance, Robin, which for anything in the legislative process is pretty good. Ironically, all of the adversity here, both Chairman Rostenkowski's troubles, the headaches that President Clinton has had in foreign policy and here at home probably drive the process a little bit closer to getting something done, because the last thing members of Congress want to do -- they're the ones judged in November -- is to go home empty-handed. And this is still the issue in which they will be judged, the No. 1 issue for the year. So there's a real chance of getting something done. Where I might disagree slightly with Julie is she said something that meets the President's requirements. And one of the things that the President may have to decide is whether 91 percent is universal coverage, whether covering less than everybody without a firm commitment to go further is going to be enough. And that may be where we're heading.

MR. MAC NEIL: Kathleen Hall Jamieson, do you think we're going to have legislation by the time the Congress goes home for the mid- term elections?

MS. JAMIESON: Yes. And it's going to look like this. There's going to be a guaranteed set of benefits. The National Health Board will be able to scale them back or make other adjustments but doesn't think the money is there, and Congress can override it. There will be a pledge to get universal coverage, but the understanding that first we'll try voluntary measures, we'll try incentives. That's what the Republicans want. And if that doesn't work, then we'll either come back to discuss it again, or we'll automatically require employers to come in place with coverage for their employees.

MR. MAC NEIL: So you're saying you don't think President Clinton's going to get employer mandates?

MS. JAMIESON: I don't think he's going to get employer mandates. I think he's going to get an agreement that we'll get to universal coverage but through voluntary means first, if that fails, then through a mandate.

MR. MAC NEIL: Julie Kosterlitz, what do you think of that?

MS. KOSTERLITZ: Well, I'm told that the President has made it fairly clear that there is some room for negotiation and that when he went up to Congress this week, and in the -- I guess -- recent weeks he has made it clear that he's willing to talk about different ways of getting the universal coverage, but I think he's going to draw some lines on that. I think a proposal in which you would have to have the Congress come back and act again at some future point if voluntary measures fail will be unlikely to be acceptable to the majority of Democrats. I think that it will be a lot of parsing of clauses and phrases at the last minute about just how firm the guarantee is, and you could see people on either side walk over that issue.

MR. ORNSTEIN: Robin, let me just add a couple of things.

MR. MAC NEIL: Yeah.

MR. ORNSTEIN: There are a couple of terms here. Kathleen, I think, has got it pretty close, a couple of terms of jargon that all of the viewers are going to become familiar with before we're done. One is the hard trigger. The other is the soft trigger. And the question is whether when we get this plan we have the hard trigger, which would mandate, would say at a certain point along the way, if we haven't achieved universal coverage, we will force it by mandating people to provide it, or a soft trigger, whether we reach a certain point and then if we've achieved a certain amount in savings, or we haven't done it, we'll come back and redo it, or we'll have a series of levels where until you can reach the savings, we'll get there. That's going to be a key here. And we're not just talking employer mandates. There is a mix here, possibly including an individual mandate that's also under discussion.

MS. JAMIESON: There's one more element in this, and that's what do they mean by universal coverage, and the analogy is going to be full employment. Full employment doesn't mean a hundred percent employed. At one point we agreed full employment was 4 percent unemployed, and so at some point we're going to acknowledge that there's no way in a fallible system to get to a hundred percent, and someone's going to set a target point that everyone is moving toward. We're going to call it universal but it won't be.

MR. MAC NEIL: Julie Kosterlitz, it's been a very partisan struggle until now. Do you see signs of real bipartisanship, bipartisan cooperation beginning to emerge?

MS. KOSTERLITZ: I think you have to distinguish between the Senate and the House. They're two very different creatures. They are anyway but they are particularly in this debate. In the Senate, we're seeing far greater at least beginnings towards bipartisanship than people might have expected. Some of that is due to the fact that there is a hard core of liberal Republicans or moderate Republicans and Democrats who have been at this issue for a good deal of time and have a chance to work through the issues and have ended up with a narrow range of issues between them that are yet to be resolved. They're not easy issues, but they are doable, and there's a commitment there. I think it's worth pointing out that there a number of members of the key committee, the Senate Finance Committee, a number of Republicans and some conservative Democrats retiring this year from the Senate who feel some obligation to go out with that, leaving a legacy. These include people like Sen. Durenberger, who has made much of his career out of working on health care reform, Sen. Danforth. We have Sen. Boren leaving. He's tried to play a constructive role as a conservative Democrat in this issue. We have Sen. Packwood, who as a Republican has some reasons to want to redeem his reputation in the Senate and to leave something of a legacy whenever he should choose to leave as well. So there is some impetus on the Senate side which we are not seeing in the House. Very briefly, in the House, it's been much more fractious, and, if anything, some of the early returns from some of the early mid-term special elections I think have emboldened the leadership in the House, the Republican leadership, to think that we're already disinclined to cut deals and are now even less disinclined seeing that they might, indeed, gain more seats next year and have -- erode the Democrats' working majority. So there is different dynamics, very different dynamics going on in both Houses.

MR. MAC NEIL: And Norm Ornstein, there's also been some movement, has there not, by Democrats? I mean, Sen. Breaux, who was lined up with Congressman Cooper in the so-called "slimmed down" version, Clinton lite, a version of Clinton's thing, has he not made some movement towards the President?

MR. ORNSTEIN: Exactly so, Robin. It was the Cooper-Breaux bill, and now you have to draw a distinction between the two. There were reports that last week there was a particularly fractious meeting between the House leadership and Rep. Cooper where they wanted him to try and move, because as Julie said, it's drawn strictly on partisan lines in the House. And the Energy & Commerce Committee and the Ways & Means Committee can't come up with a majority among their own Democrats. Rep. Cooper is on the Energy & Commerce Committee, and his vote matters, but he doesn't want to budge right now. Sen. Breaux is willing to budge. The issue right now is, it's moved from a hope and a belief that the House would act first and force the Senate. But now the expectation is that you'll develop a coalition in the middle in the Senate. And the question is whether the President and some of the Democrats in the Senate -- Sen. Rockefeller, who wants to hold firm and try and build a majority that moves more towards the President with fifty-one or fifty-two votes, maybe even Sen. Mitchell, who also is leaving and who sees this as his last best hope will hold firm, or whether Sen. Moynihan, who'd prefer to broaden that coalition and get sixty or seventy votes, using all the Senators that Julie has mentioned, along with Sen. Breaux, and more broadly will prevail. But that means moving quite a bit away from the President's plan. How quickly do we get there? That's where we're going to end up, Robin, is much closer to where Sen. Breaux has started where Senators Durenberger and Danforth and Packwood and Chafee have been. But do we move relatively quickly, i.e., before the July 4th recess, or do the Democrats who want to take a harder line hold out longer? They don't have much time though, frankly.

MR. MAC NEIL: Let's turn to outside the Congress for a moment, Kathleen Hall Jamieson. How has the pressure of special interests on the public and on congressional opinion been unusual in this battle compared to other big battles on legislation?

MS. JAMIESON: The first thing that is unusual about this is the dollar amount that's been spent on both sides arguing for and against the public policy position. We've seen this before on abortion and on NAFTA, but we haven't seen this number of players or this dollar amount spent. Secondly, we haven't seen the level of sophistication and targeting that's happening here. In this 11 day Memorial Day break, you're going to see extensive amounts of television and primarily radio advertising not nationally aired but aired in the districts of the players who are going to come back after Memorial Day to forge the consensus. That kind of high level of targeting policy --

MR. MAC NEIL: So somebody like Sen. Breaux, we've just been talking about, back in Louisiana, his constituents are really going to hear about it over the Memorial Day?

MS. JAMIESON: Yes. And part of the reason that there was a tacit agreement between Rostenkowski and the HIAA, the Health Insurance Association of America, to take Harry and Louise off the air during the mark up period was that Rostenkowski was worried about HIAA going into the districts of two of his key players and influencing their votes, because, they, in fact, have a lot of leverage there. And so you're seeing Congress now being influenced by a mass media that's highly targeted into congressional districts. That's new, and it's important.

MR. MAC NEIL: And what, what has it achieved so far, do you think?

MS. JAMIESON: The main arguments against the Clinton position have been that their health care is going to cost more, that the quality is going to be lower, that they're going to lose choice of plan and doctor, and a big, awful bureaucracy is going to be put in place. The advertising and aggregate have made those four points. And you've seen heavy erosion in the polls on those dimensions of the Clinton plan. Now, it's not the advertising alone, but the advertising has reinforced the public dialogue on those issues. That clearly has hurt Clinton.

MR. MAC NEIL: What kind of impact, Julie Kosterlitz, do you think that's had on the key members of Congress who are making these early decisions?

MS. KOSTERLITZ: Well, I just wanted to point out before directly answering that that what's ironic about some of this is the areas in which the ads have been successful in eroding support are not primarily the areas in which Congress is hung up. There's an irony here that while support for the Clinton plan has been dropping steadily, when you take focus groups of individuals or polls of individuals and you take key elements of the Clinton plan but you do not identify them as such, they receive a great deal of support. There was about 75 percent for the employer mandate. Now, you want to be careful with these kinds of polls. Clearly, if you raise the issue of job loss, will an employer mandate cause job loss, you find some of that support tapering off. Nevertheless, the issues where public support has eroded are not primarily the issues that are holding up passage right now in the Congress. But I think there's a more general malaise that doesn't get necessarily translated one for one necessarily about broad public support, translating into Congressional action. In the case of the key swing districts and the key swing votes, I think that some of these campaigns have been very successful. You look, for example, at the two key members we're talking about on the Energy & Commerce Committee, Congressman Slattery of Kansas and Congressman Cooper of Tennessee, both are running for statewide office, a fact that may not be widely appreciated, but these two are sort of the two key holdouts that is to some degree blocking a vote getting out of that committee. They are both running for statewide office in states that are more conservative than their districts are in particular, and it has given interest groups, particularly small business, a great deal of leverage over these people where the battle for the hearts and souls of Slattery and Cooper has been fought to a dead standstill.

MR. MAC NEIL: Can I just go -- we're just about at the end of our time -- can I just go to Norm. I'd just like to know how you see the impact of all this extraordinary advertising on the Congress.

MR. ORNSTEIN: It started broadly to take public opinion, which was not all that desirous of radical change, and firm it up into a skepticism. Now it's targeting individual members and having some impact. There's something else going on here that has to be pointed out, Robin. We're starting to target groups out in the country not so much through television advertising. Another element of this is direct mail, and watch the seniors, because they are the most skittish in general, and we've seen them erupt before into an opposition to health care with the catastrophic plan in 1986 and '87. We have a massive direct mail campaign going on now by a lot of groups out there that don't want a Clinton plan or a plan that comes close to it trying to make the seniors, of course, and we're going to see a lot of direct mail and targeting of different groups in the society besides the individual members. It's going to be a real battleground, and, of course, the administration and its allies, including labor, fighting back on the air waves and through their own direct mail campaign. It's a fascinating and unusual campaign.

MR. MAC NEIL: Well, Norman Ornstein, Julie Kosterlitz, and Kathleen Hall Jamieson, thank you all. Margaret.

MS. WARNER: Still ahead on the NewsHour, our Friday look at the week's politics, rethinking treatment for heart disease, and Aleksandr Solzhenitsyn returns to Russia. FOCUS - POLITICAL WRAP

MS. WARNER: Now, political analysis with our own Shields and Gigot, syndicated columnist Mark Shields and Wall Street Journal columnist Paul Gigot. Good evening, gentlemen.

MR. SHIELDS: Good evening, Margaret.

MS. WARNER: Let's look at the political atmosphere on the Hill in which this debate and others are taking place. When the President went up there this week, he sounded very open and flexible, as we just saw on the tape, in public. But when he went behind closed doors with the Democrats, he blasted the Republicans and said, they're determined not to cooperate on anything before the election and that we're going to elect a bunch of right wing fanatics to the House. Mark, are we seeing a return to kind of hyper partisanship on the Hill?

MR. SHIELDS: Well, I think partisanship has been there. I don't think it's ever really gone away, I mean, at a low level fever, but I mean it's tough to look at the Clinton record since he's been President, only 18 months, and to make the case that there's been much bipartisanship. He got his entire economic package through without any support. He got his entire budget through without any support from the Republicans. So yes, on NAFTA, they were helpful. That was a position which had been that of a Republican President as well, and which did the same thing on health care. I mean, I think there's one Republican Senator, Jim Jeffers of Vermont, who endorsed the Clinton plan, and so I think partisanship is there, and it's heightened obviously by the fact that the Democrats have had a string of unsuccessful congressional, special congressional elections which I think have increased the partisan level.

MR. GIGOT: Well, I agree with much of what Mark says, but right now the problem isn't the Republicans. I mean, they are opposed to the health care plan. The real problem is the Democrats. I mean, they have 256 seats in the House, and they can't put together a 218 vote majority for something resembling the President's bill? I mean, he went there and he talked to the Democrats, and I know one or two Democratic members, Roy Roehn of Georgia, for example, Tim Penny of Minnesota, who wanted to get a word in edge wise with him. They wanted to say, look, Mr. President, your strategy isn't working, you've got to pare back a lot of this program, let's sit down and do a deal that's bipartisan. Instead, he got in and he gave a pep rally, and -- and the only way that they got a word in was going afterwards up to shake his hand and said, Mr. President, despite this little show here, it's not working. You're going to have to try something else. And he said, well, look, maybe over in the Senate. But he's got a real problem with moderate Democrats.

MR. SHIELDS: If we accepted Paul's premise and which, you know, some listeners might do. If we accepted that, there would never have been a Reagan revolution, all right, because Ronald Reagan never had more than 190 votes in the House, therefore, he couldn't have passed anything. I mean, there was a time there were boll weevil Democrats, all right, who supported Ronald Reagan. There are no boll weevil Republicans. I mean, you know, so Bill Clinton had to deal with this of trying to get it through solely with the support of a Democratic Congress and Democrats in the Congress. I mean, we've never had that kind of party discipline in this country in the past where the President -- or it's not a parliamentary system where you rise and fall on a cohesive, unanimous vote of your own, your own caucus.

MS. WARNER: But, of course, if the conventional wisdom is right, we're looking ahead at a November election that's going to rob him of a lot of these Democratic seats. Now, tell me, Mark, what do you think is the meaning behind the Kentucky race this week, the special election in which Democrats lost the seat they've held for 100 years?

MR. SHIELDS: The -- there's a meaning -- there's a cumulative meaning. The meaning began in 1993. Actually, it began in November of 1992 when Weich Fowler, the Democratic Senator of Georgia, was defeated by Paul Koverdale. Then it was continued by Kay Bailey Hutchison in Texas. It was continued further by the Republican wins in the New Jersey Gubernatorial race and the Virginia Gubernatorial race, and then New York and Los Angeles city hall. When the Democrats lose New York and Los Angeles city halls, it's the political equivalent of losing a PTA election to Woody Allen. I mean, it is really a stinging rebuke, and the -- you add to that a string of these House races, Oklahoma and Kentucky, and the perception becomes reality. I mean, there's a sense of what they did in Kentucky was they made the President the issue.

MS. WARNER: The Republicans did.

MR. SHIELDS: The Republicans did, and they won on it, and so they made a referendum on Bill Clinton. So if you're a Democrat and you're a little skittish, and you're one of those 256 that say, gee, wow, add to that the fact the Democrats have not for 14 years run with a President in the White House. Dr. Vin Weber today, former Republican Congressman of Minnesota, said Democrats are going to find out in the 90's what Republicans found out in the 80's, it's no fun to run in non-presidential years with your guy in the White House.

MS. WARNER: But, Paul, now David Wilhelm, the head of the DNC, said that the reason the Democrat Prather lost is that he tried to run away from Bill Clinton and that's a no win. Does he have a point?

MR. GIGOT: Well, he might have a point, except the Democrats last year who ran with Bill Clinton, I mean, Jim Florio, and David Dinkins, and the mayoral candidate, also lost. So you get 'em coming; you get 'em going. That -- certainly turnout was bad in Kentucky, there's no question about it, but this issue of accountability, which I know Mark has brought up many times, is that this time Democrats run everything. There's no muddle with George Bush in the White House, so there's no muddle about accountability. And I think one of the reasons that the Democrats have been able to retain their majorities in Congress through the 70's and the 80's is that they have Republican Presidents to run against most of the time. So they could -- they could differentiate themselves. Now these people have to differentiate themselves from a Democratic President who's got the bully pulpit, who's on the air all the time. It's very difficult to do.

MS. WARNER: So it's really impossible -- what you're both saying -- is for Democrats to run as outsiders anymore.

MR. SHIELDS: I don't think they can.

MS. WARNER: Even if they're not incumbents?

MR. SHIELDS: That's right. I think this, Margaret. That's the most imitative art form in Western civilization, with the exception of political journalism is political campaigning. I mean people do what's worked in the past. And it's a hard habit to break when you've been running and winning as a House Democrat by distancing yourself from the White House, pointing out the criticism. I do think that voters understand that the Democrats are responsible and there is an accountability. I think it is suicidal in large numbers in the long run to try and distance yourself as a Democrat on the conservative side of the President and run away from the President of your own party. I just think in the final analysis people say, wait a minute, if I want a conservative, I might as well choose the real thing and go with a Republican. I think that is -- it's fine to establish differences between yourself, but when you spend the entire campaign emphasizing how different you are from everything Bill Clinton's about, I think you just sign your own political death warrant.

MS. WARNER: But now, why is Clinton so unpopular? I mean, whatever happened to pocket book issues? Why, Paul, isn't the improving economy helping Democrats?

MR. GIGOT: It's something of a mystery I know to Democrats because that's what they expected. I've been hearing for months that they were going to run on the economy. We took a very tough tax vote. Remember, the Republicans said it was going to be awful; it's not. But it doesn't seem to be doing anything about the sour mood. I think part of the problem is that there is still a great anti-Washington sentiment out there. There's still a distaste for politicians generally. And in the South, in particular, where Bill Clinton is particularly weak, I mean, the Kentucky district has re- elect numbers with 30 percent. 30 percent of the people in the district said I would vote for Bill Clinton now, a Democratic district.

MS. WARNER: Had they voted for him in the election?

MR. GIGOT: They'd gone narrowly for Bush.

MR. SHIELDS: Bush carried twice.

MS. WARNER: But he's worse off.

MR. GIGOT: But he's much worse off, and I think the problem is in the South part is that there is a deeper anti-government sentiment there than there is in a lot of the rest of the country. Character resonates more in the South for some reason according to all the pollsters I talked to than say in California. I don't know why. But --

MR. SHIELDS: Richard Nixon --

MR. GIGOT: But you -- so these things have worked against the President there, and it's making it much more difficult for these swing and southern members to hold on.

MR. SHIELDS: One of the great problems that the Democrats have is that they've consistently won districts that Republicans have carried at the presidential level. For example, in 1984, Ronald Reagan carried 378 congressional districts. Democrats carried 57. And yet, the Democrats had a solid majority in the House of Representatives. That meant they were carrying districts that a Republican presidential candidate was carrying at the same time. That's what the case was in both Oklahoma, where Frank Wilkus defeat Dan Weber for Glenn English's seat in Oklahoma City two weeks ago --

MS. WARNER: Last week, yes.

MR. SHIELDS: And then again this week with Bill Natcher's seat, which the Democrats held for 129 years but which George Bush twice and which Ronald Reagan won twice. The key is if the Democrats start to at least become federalized races, in other words, in both cases the Republicans tried to make it a national referendum. They brought in Newt Gingrich; they brought in Jack Kemp; they brought in Bob Dole. I was in Oklahoma City and the Democrat Dan Weber brought in David Boren and Charlie Stenholm, Congressman from West Texas, leader of the boll weevils, but there was no George Mitchell, there was no Tom Foley, there was no Dick Gephardt, there was nobody from the administration. So I think this is really the test. I mean, if you get into a situation where Democrats start to lose districts that they've been losing at the presidential level, then you're really talking about big problems in November.

MS. WARNER: Are you saying the fact that they were always losing these at the presidential level meant there was this underlying weakness there and that the local Congressmen could carry the Democrat but philosophically --

MR. SHIELDS: I think ---

MS. WARNER: -- voters were moving away.

MR. SHIELDS: I think obviously they were moving away on a national referendum question. I mean, the presidential race obviously is the dominant race. But if good old Congressman Gilch was great to the junior high class when they came down to the Capitol for the tour, made everybody's bar mitzvah and confirmation and attended wakes and weddings and funerals and was just a wonderful person and was always available and was a smoker, then you voted for Congressman Gilch probably irrespective of whether he was a right wing nut bag or a left wing loony.

MS. WARNER: Well, Paul, do you think the Republicans could actually this November take enough seats in the South to come to parity with the Democrats?

MR. GIGOT: In the entire Congress?

MS. WARNER: In the entire Congress, in the House.

MR. GIGOT: Well, dreams keep recurring. I don't -- it's -- for the first time I think Republicans can actually talk -- in maybe a decade -- they can talk about ideological control certainly. It will no longer be a liberal Congress if they gain fifteen or twenty seats. Total control they have to get 40 seats. That's still a very long shot, particularly in this era when incumbency matters so much. But I'll tell you one thing that gives them at least an opening. Sixteen of the twenty-seven Democrats who are retiring, sixteen of them, one last year was under 56 percent of the vote. So that means they're swing districts, they're marginal districts. It gives Republicans a chance.

MR. SHIELDS: Newt Gingrich, the Republican leader to be and now the Republican whip in the House, says up to seventy seats, if things really go well, is what he --

MR. GIGOT: He's already -- Speaker Gingrich [laughing] --

MS. WARNER: So the headline --

MR. SHIELDS: That's right -- Speaker Gingrich --

MS. WARNER: Before we go, very quickly, should Dan Rostenkowski accept indictments so he can fight these charges against him, or should he accept resignation to avoid a battle? I notice the Wall Street Journal called on him to stay and fight. I'm not sure the Journal has his deepest interests at heart, Paul, but what do you think he should do?

MR. GIGOT: Something amazing happened this week. A week ago, the Democrats were saying he's vital to health care, we can't see him going -- now, this week, they're saying, please, quietly, cop a plea, get out of town, fade away, get it all behind us, we don't want a trial moving on to November, we don't want this going on, please, Dan, do the right thing for your party. Whatever happened to presumption of innocence? I mean, if -- if he's innocent, why not fight it and save his reputation?

MR. SHIELDS: Dan Rostenkowski is the --

MS. WARNER: Quickly --

MR. SHIELDS: -- strongest argument both for and against term limits, for term limits because the allegations, if they're true, showed him out of touch, absolutely out of touch, but against term limits in the sense that this was a guy for 22 years, an ordinary Chicago Paul, until he took over the House Ways & Means Committee, and become an effective, dominant, influential, and I think very positive force for the country.

MS. WARNER: Well, I'm sure we'll get to discuss this again next week. Mark, thank you. Paul, have a nice weekend.

MR. GIGOT: You too. UPDATE - VITAL SIGNS

MR. MAC NEIL: Next tonight, an update on heart disease. Nearly 60 million Americans have heart disease, but bypass surgery and various other procedures have cut the death rate by 50 percent. Now, many doctors are re-thinking these aggressive interventions. Correspondent Tony Burden of public station KUHT- Houston reports.

DR. TIM HAGEMANN, Cardiovascular Specialist: Are you feeling okay?

VIVIAN CARTER: No, I have a pain in my chest.

DR. TIM HAGEMANN: A pain in your chest. Could we have a sublingual nitro, please.

MR. BURDEN: Fifty-year-old Vivian Carter of Richmond, Virginia, has been having chest pains for two weeks.

DR. TIM HAGEMANN: How's that feeling?

MR. BURDEN: The night before they were so severe she came to the emergency room. This morning, she's in the cardiac catheterization lab at Richmond's Retreat Hospital. With fluoroscopic imaging devices guiding him, Cardiologist Tim Hagemann is threading a small plastic catheter from the large artery in Mrs. Carter's leg through the aorta and into heart.

DR. TIM HAGEMANN: Okay. Take a nice breath in for me and hold it. Inject. Breathe normally.

MR. BURDEN: Cardiac catheterizations have been a major breakthrough in the diagnosis and treatment of heart disease. More than a million catheterization procedures were done in the U.S. last year, a tenfold increase in the past decade, striking evidence of an increasingly aggressive approach to cardiovascular disease in this country.

DR. TIM HAGEMANN: And again a breath in for me.

MR. BURDEN: Coronary artery bypass surgery was the only treatment for a blockage this severe. And it was major surgery, requiring a lengthy period of hospitalization and recovery. Today more and more cases like this are being treated without surgery, using specially designed catheters.

DR. TIM HAGEMANN: I think we can take care of that, but we need to take a look at the film and then we'll talk with you about what the different approaches might be. Okay?

MR. BURDEN: Last year, the number of catheter-based procedures performed in the U.S. far exceeded the number of bypass surgeries which reveals a dramatic shift in the treatment of heart disease from the surgeons to the cardiologists.

DR. TIM HAGEMANN, Cardiovascular Specialist: In someone who is her age we would like to not have them have to go through bypass surgery, although she would have an excellent result with bypass surgery -- but -- and I'll talk with her about the different options and let her make a decision.

MR. BURDEN: After reviewing the treatment options, Vivian Carter has decided on a catheter approach, rather than bypass surgery.

DR. TIM HAGEMANN: We're going to go in with a balloon and take care of --

MR. BURDEN: In addition to the major blockage, Dr. Hagemann found a smaller obstruction in one of the other coronary arteries. For this lesion, he uses a procedure called a PTCA, or balloon angioplasty. A sausage-shaped balloon with a small, round X-ray marker is positioned across the blockage.

DR. TIM HAGEMANN: Inflating.

MR. BURDEN: Inflating the balloon pushes the lesion aside, restoring the pathway. PTCA is the most widely used catheter-based procedure. It's estimated that close to half a million angioplasties will be performed this year at a cost of twenty-five to thirty-five thousand dollars each.

DR. SAMUEL CASSCELLS, University of Texas Health Science Center: It's been a time of tremendous excitement for cardiologists.

MR. BURDEN: Samuel Casscells is director of cardiology research at the Texas Heart Institute in Houston.

DR. SAMUEL CASSCELLS: Heart disease death rates are falling dramatically. They have dropped 40 percent in the last 10 years, and the survival, if you are diagnosed with heart disease, has increased twofold in the last 30 years, the number of years of survival.

MR. BURDEN: Since we've also seen an extraordinary increase in catheter-based treatment during the same 10-year period, it's tempting to give much of the cardiologists and their new interventional technique. But there are several factors that need to be considered. First, the current system of reimbursement encourages aggressive treatment.

DR. HOWARD FRAZIER, Texas Heart Institute: The inclination is to act.

MR. BURDEN: Howard Frazier is a heart surgeon at Houston's St. Luke's Hospital, which leads the world in the number of bypass surgeries.

DR. HOWARD FRAZIER: And I think that the emphasis, of course, in America is for you to do something, and I'm not saying that's wrong. I think in a way it's one of the reasons why we've really impacted the deaths, because we aggressively treat these patients.

MR. BURDEN: Bypass surgery is an expensive proposition. The average cost for a procedure is just over $50,000. Many surgeons complain that even when bypass is indicated, current medical economics will encourage a less expensive catheter-based approach. Cost per PTCA is about half that of surgery. But recent studies are revealing a major problem with catheter-based treatments.

DR. HOWARD FRAZIER: I'm going to operate on a man tomorrow that's had four PTCA's, and now he's going to surgery. So the cost effectiveness of that patient, even though if you compare the surgery to one of the PTCA'sit's more effective, but if you take it into reality, which is the whole course of the treatment of his affliction, then obviously the cost effective thing would have been to have gone on and bypassed the vessel at the time of the first PTCA.

MR. BURDEN: Emory University just completed a lengthy comparison of bypass surgery versus angioplasty. It concluded that in just the first three years of the study, repeat angioplasties had already made the catheter-based approach just as costly as the surgical approach. Even though it's considered the more dependable treatment, 20 percent of all bypasses need to be repeated. But the 20 percent is spread over more than 20 years. Researchers like James Willerson have found that the problem is that catheter procedures injure the coronary arteries in the process of attacking the plaque.

DR. JAMES WILLERSON, University of Texas Health Science Center: Somewhere between 25 and 50 percent of patients after angioplasty or arthrectomy develop the so-called "re-stenosis lesion," and that typically occurs in the weeks after the procedure and generally within the first three months. This is new scar formation basically. This is a wound healing response. It is exuberant, and is not what one wants, because it recreates the same narrowing or a worse narrowing than the patient had to start with.

MR. BURDEN: Whether it's bypass surgery or catheters, the disease continues to progress, and the same patients are requiring repeated procedures. Many in the field say that the current aggressiveness is misplaced; rather than exotic treatment, the focus should be on controlling the underlying disease.

DR. SAMUEL CASSCELLS: There is a consensus among cardiologists that few too many angioplasties are being performed, that maybe we're doing maybe 10 percent of the bypass surgeries are unnecessary. And we are as a group trying to get together and go back to some of these lifestyle modification therapies that Lance Gould and others have been urging for years. So I think, I think that only when we begin to study these things carefully with exact statistics and what they call clinical epidemiology, we realize that we were a bit too enamored of some of our, some of our devices and gadgets.

MR. BURDEN: Lance Gould, director of cardiology at the University of Texas Medical School, is considered the pioneer of a growing back-to-basics approach among cardiologists. To support a non- invasive approach, Dr. Gould has developed an alternative to cardiac catheterization. His positron emission heart scan produces three-dimensional pictures of the heart with the degree of blood supply indicated by different colors. The dark colors indicate occlusions in the coronary arteries. Gould treats the blockage with a low fat diet and cholesterol-lowering drugs. The biggest obstacle Gould sees is an economic and medical tradition that encourages intervention.

DR. LANCE GOULD, University of Texas Health Science Center: The old American way, can do, get in and fix the thing. And it happens to coincide with good reimbursement incentives. But having the luxury of having done it this way, we now have to wrestle with the cost. Is it just as effective to do it an alternative way with medical treatment in reversal, or should we continue? And that's what we're starting to wrestle with. And the literature is beginning to suggest that if you use reversal treatment, one can decrease the incidence of death, heart attacks, bypass surgery, and balloon angioplasty quite dramatically, even in current literature, 75 to 80 percent decreases in these kindof treatments, versus the standard control. Now, that's impressive data. It says that we may have the choice as well as the economic necessity of reducing our invasive rates and taking a more non-invasive reversal approach.

MR. BURDEN: Over the past 30 years, there have been dramatic changes in the practice of cardiology, and the payoff has been a 50 percent decline in the death rate from heart disease, but the cost has been astronomical. Americans spent an estimated $60 billion for treatment last year alone. The current preoccupation with health care cost may force even more dramatic changes in the practice of cardiology in the future. FOCUS - NATIVE SON

MS. WARNER: Finally tonight, the end of a 20-year exile. Aleksandr Solzhenitsyn, whose chronicle of life in Soviet prison camps won him the Nobel prize, returned to Russia today We have a report from Ian Williams of Independent Television News.

IAN WILLIAMS: Back on Russian soil after 20 years in exile, Aleksandr Solzhenitsyn, greeted with bread and salt, a traditional Russian welcome as he arrived in the Far Eastern city of Vladivostok. He'd left Vermont 36 hours earlier, stopping en route in Magadan, which was once the administrative center of Stalin's notorious system of prison camps, the gulag. After landing, he immediately urged his fellow Russians not to forget the millions who died in the camps. He said he had never doubted Communism would collapse but that Russia today is tortured and stunned, with no clear future. Solzhenitsyn was banished from the Soviet Union in February, 1974, after publication in the West of the book The Gulag Archipelago, a horrifying exposer of the camp system in which he was incarcerated for eight years. He settled in Vermont in the United States, where he lived as a recluse for most of his time in exile. During his few public appearances, he was a virulent critic of Communism and detente. He's also grown increasingly critical of what he sees as the corrosive influence of Western values in the new Russia. From Vladivostok, he will begin a journey across Russia to reacquaint himself with the condition of the country and meet former camp inmates. One place Solzhenitsyn may choose to stop on his journey to Moscow is in Northern Kazakhstan. He spent three years in camps here close to the regional center of Karaganda. An old barracks and rusting barbed wire are all that's left of one of the camps today, while close by, a field, beneath which thousands are said to be buried, victims of the gulag. Joe Glazier was in those camps at the same time as Aleksandr Solzhenitsyn. His family had come to the Soviet Union in 1931 from South Africa in order to help build Communism. But Stalin turned against foreigners. Joe's father was arrested and died in the camps. Then Joe, himself, spent seven years inside. Though he never met Solzhenitsyn, he regards the writer as a hero.

JOE GLAZIER, Labor Camp Survivor: He wrote a book called One Day of Ivan Denisovich. I read that book. To tell you the truth, I read that book three times. Never did I ever read a book three times, but this book I read three times. And each time I read it, it brings tears to my eyes, because I went through exactly what that hero of that book went through. People shouldn't forget those years of Stalin's rule. They should never forget it.

MR. WILLIAMS: Joe, along with other survivors of the camps, hope the return of Solzhenitsyn will ensure that Stalin's crimes are not forgotten. The Moscow he will return to after his journey across the country has changed almost beyond recognition since he was exiled. The morale decay he has so bitterly attacked is here in abundance, but there may be few people prepared to listen to that criticism. When he first arrives in the city, Solzhenitsyn will stay in an apartment on the 12th floor of this block overlooking the Moscow River. If he looks out across the river, he'll get a glimpse of one aspect of Moscow that so upsets him, a luxury hotel for Western businessmen and the new Russian rich. Beside it, Kiev Railway Station, one of the gathering points for Moscow's homeless and destitute. Newspapers have carried a lively debate among intellectuals, once Solzhenitsyn's natural allies. Some welcome the return of a man of such moral stature. Others question his relevance.

YURI SHEKOCHIKHIN, Liternaturnaya Gazetta: I only know if he begins now political life in Russia. Nobody, nobody will listen him, his words.

MR. BURDEN: It is a view reflected among the young. At Russia's most prestigious language institute in Moscow, students take a break between exams. All have heard of Solzhenitsyn. All respect him, but few have read his books or see a role for him in modern Russia.

MALE STUDENT: I think he's out of date actually. He's not a relevant person for Russia. He used to be, he used to be popular maybe in the 70's but not anymore.

SECOND MALE STUDENT: His returning is not so important as if, as if it could be some years ago.

MR. BURDEN: Solzhenitsyn's eventual home will be this dacha being built for him in a village on the outskirts of the city. It's within a compound surrounded by high walls and barbed wire inside which many top Communist Party officials once lived, including Stalin's top henchmen. But Solzhenitsyn insists he will not hide himself away. RECAP

MR. MAC NEIL: Again, the major stories of this Friday, Federal Reserve Chairman Alan Greenspan defended the recent interest rate increases by the Central Bank, and China welcomed President Clinton's decision to extended trading privileges but rejected his criticism that it violates human rights. Good night, Margaret.

MS. WARNER: Good night, Robin. That's it for the NewsHour tonight. We'll see you on Monday night with a special Memorial Day discussion with World War II veterans. I'm Margaret Warner. Good night.