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tv   PBS News Hour  PBS  November 13, 2013 7:00pm-8:00pm EST

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captioning sponsored by macneil/lehrer productions >> wooduff: dwindling stocks of food, water and other aid are stoking fear and chaos in the philippines, adding to despair in the aftermath of the typhoon. good evening, i'm judy woodruff. >> ifill: and i'm gwen ifill. also ahead this wednesday, the first official numbers are out; roughly 100,000 people have signed up for health insurance in the new state and federal marketplaces, well short of initial expectations. >> wooduff: and we close with another personal take on the setbacks and successes of health-care reform. tonight, a cancer patient shares her story.
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>> the affordable healthcare act means that i have a chance, that i don't have to stop treatment >> wooduff: those are just some of the stories we're covering on tonight's "pbs newshour." >> major funding for the pbs newshour has been provided by: >> my customers can shop around; see who does good work and compare costs. it can also work that way with healthcare. with united healthcare, i get information on quality ratings of doctors, treatment options and estimates for how much i'll pay. that helps me and my guys make informed decisions. i don't like guesses with my business and definitely not with our health. that's health in numbers. united healthcare.
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>> supported by the john d. and catherine t. macarthur foundation. committed to building a more just, verdant and peaceful world. more information at macfound.org >> and with the ongoing support of these institutions and foundations. and... >> this program was made possible by the corporation for public broadcasting. and by contributions to your pbs station from viewers like you. thank you. >> ifill: six days of misery and desperation bred anarchy today in the philippines, where the typhoon death toll rose again to near 2,350. survivors looted whole warehouses and even dug up water pipes around tacloban on hard- hit leyte island. we begin our coverage with john irvine of "independent television news." he spent the day on the island's easternmost tip. >> reporter: it's the last
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place outsiders have reached, the eastern edge of this country, where the philippines meet the pacific. we headed into what's left. the soldier with us was a guide, not a guard. the people here could not have been more welcoming as they showed us the horrendous destruction. this location, normally a blessing, was on friday a terrible curse. there's nothing to the east of this town, other than thousands of miles of pacific ocean, and it was from there that the typhoon came. the most powerful storm ever recorded by man first encountered mankind right here and dealt a terrible blow. several people were killed here in a sports center designated as a shelter, a refuge that became a death trap as the typhoon blew the roof in. the monster storm killed at
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least 85 people. and the survivors still can't quite believe that they lived through it. vincent, what was it like? >> it was like-- it was like eye don't know. it was like sunawmy and earthquake at the same time. it shook all our walls. it took all our roof. it took everything out. we-- we were all wet. we were-- some were dead, because of the walls-- the walls crumbled down. i thought i was never going to see the morning. i thought i was really not going to make it. >> reporter: the u.s. marines came here to carry out an assessment of need, and their conclusion can only have been the same as ours-- send help, fast. >> ifill: our second report comes from john sparks, also of "independent television news." he spent the day in ormoc, where things seem calmer, despite the need for outside aid.
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>> reporter: the city of ormoc has been devastated. but the people who live here have one thing going for them-- water. clean, fresh water. a number of public pumps are still working. and that's something to smile about. >> how are you doing today? >> we're okay. we've got no food. no electricity. but you know what? we're still happy. >> reporter: this community was torn apart by the typhoon and many here are hungry. but there's no sign of panic or looting that's afflicted other cities in the region. outside ormoc's main hotel, one of a small number of spots with a generator, people came to charge their phones and share stories of survival. this video was shot on a mobile by a 20-year-old just before the store removed the second floor of his house. he said he was terrified.
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we also met a woman in the queue for a soact. she's a single mother of two and pregnant, and she's now homeless. >> ( translated ): everything was destroyed. the only thing i could do was watch it happen. >> reporter: she took these pictures from her neighbor's house. she told us the storm had left her with nothing. >> ( translated ): we have nowhere to live. there's no food, and i really need help. please, end us food. i'm appealing to you. >> reporter: later, we headed towards the destructive epicenter of this storm, the city of tacloban. it's not an easy drive, however. the highway, a fearsome obstacle course of debris and downed power lines. we pulled off the highway in a town which has really been wiped out by the storm.
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and we're told that there are more than 1,000 local people now living in the elementary school, so we're going to go and see how they're doing. hello. the school is now home to half of the community's population, and there's certainly no space for lessons here. we went to meet the new occupants of the grade five classroom. >> and asked one woman how many people lived inside. >> we have six families from inside. >> reporter: six families inside the classroom? >> yeah. >> reporter: there can't be much space. >> we stand or -- >> reporter: "well, we have room to stand," she said. how long do you think you're going to be here? >> we're going to stay here maybe almost four months. we don't know exactly. >> reporter: and there is great uncertainty on the road to tacloban. people in these devastated communities told us they were hungry and thirsty, and they told us they have been overlooked as the government tend to other things.
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>> ( translated ): the relief convoy just pass us by. they don't stop. there's nothing to do but look at them. i guess i can't get mad about it. >> reporter: we reached tacloban shortly before nightfall, a city of twisted steel, and shattered glass, a city of death, the smell of decomposing bodies lingers everywhere. the military were out in force after looting and mob violence, but people here have other concerns. >> the biggest problem here is that there is no food, no medicine. water is very hard to come by. there is just only one source of water, and that is there at the city hall. and that leaves no food. >> reporter: unlike the public pumps of ormoc, this is the only place to find water in tacloban, a solitary filter station. there's not enough to go around, and it is fueling a state of desperation here.
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>> ifill: and for more on that growing state of desperation in the wake of haiyan, we turn to richard gordon, the chairman of the red cross in the philippines. i spoke to him a short while ago by telephone. richard gordon, welcome, and thank you for joining us. you are now in manila, but we're hearing reports about chaos breaking out in the hardest hit regions of the philippines. is the desire for relief now turpg into desperation? >> well, yes, a certain amount of desperation is going on because of the slowness of the relief effort, especially because of the difficulties in access, the fallen debris, trees. and then we have security issues. there has been a breakdown of peace and order, and stores are being looted.
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and there are difficult issues. you know, communications are down up to now. so there's great difficulty. people are getting very anxious because, you know, you see your homes totally demolished, and your children are hungry or dead, certainly people turn to desperation. >> ifill: how has the government response been. >> unfortunately, the language element came in, and there wasn't very much explained to the public that there were going to be storm surges, and storm surges have been unknown. they might have been better if they described it as minitidal waves caused by the wind. so many people have suffered because of that and died. but the government is exacerbating the problem by not speeding up the efforts, and
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allowing more flights and ships to get in. the army and police would be able to have a very good grip and strong enforcement of peace and order. >> ifill: how is jur staff doing? how where they coping with the water, the food, the shelter, getting them to where they need to go? >> we have three containers of trucks, 25,000 liters of water. we have food we're going to dring bring in. and also we have tents and provide hospitals for pregnant mothers or some privacy. and certainly, medicines, and we're also helping out clearing,
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people clearing streets and going to towns with chain saws and concrete saws. hopefully with about 65 people in place, we can be a lot better and more secure. >> ifill: richard gordon, chairman of the philippine red cross, thank you so much for joining us on the phone. >> thank you very much. >> ifill: overall, it turns out, this has been just an average year for tropical storms. the u.n. weather agency reported today there have been 86 storms worldwide-- three short of the annual average since 1981. the atlantic hurricane season was the quietest since 1994. but northwestern regions of the pacific ocean, have had more storms than usual, including typhoon "haiyan". the first official numbers on sign-ups under the new health care law are out and they're far below the original targets. the department of health and human services reported today that fewer than 27,000 people enrolled on the federal exchange in october. it serves 36 states. nearly 80,000 others signed up on state exchanges.
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we'll have more on this, right after the news summary. the odds against congress acting on immigration reform this year, grew longer today. house speaker john boehner said the house will not act on the sweeping bill the senate passed in june. it provides a path to citizenship for the 11 million people living here illegally. >> the idea that we're going to take up a 1,300 page bill that no one had ever read, which is what senate did, is not going to happen in the house. and frankly i'll make clear we have no intention of ever going to conference on the senate bill. >> ifill: meanwhile, president obama met with religious leaders to talk about immigration. the white house says they agreed there's a moral imperative to overhaul existing law. secretary of state john kerry appealed to congress today to postpone action on new sanctions against iran. he spoke before joining vice president biden in private meetings with the senate banking committee and democratic leaders.
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kerry said sanctions won't help efforts to get iran to freeze its nuclear program. >> we now are negotiating, and the risk is that if congress were to unilaterally move to raise sanctions, it could break faith with those negotiations and actually stop them and break them apart. >> ifill: those nuclear talks between iran and six world powers are set to resume next week. opium production in afghanistan has surged to record levels this year. the u.n. drug control agency reported today it's up nearly 50% since 2012. the poppy harvest produced more than 6,000 tons of opium, more than the rest of the world, combined. in kabul, a u.n. official warned the huge supply is fueling the use of opium among afghans. >> ( translated ): afghanistan is confronted with an enormous addiction problem. they are hurting themselves. one million addicts and a growing population.
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we have the biggest opium cultivation witnessed ever and this in a consecutive three years time. >> ifill: cultivation of opium poppies in afghanistan has spread despite billions of dollars in international aid to try to eradicate the crop. in iraq, a wave of new attacks marred the muslim holy day of ashura. at least 22 people died in bombings and shootings. many were shi-ites commemorating the death of the prophet muhammad's grandson in the seventh century. militants also assassinated the mayor of fallujah, in western iraq. president obama's nominee to run the homeland security department told senators today it's essential to fix the agency's internal problems. at his confirmation hearing, jeh johnson said filling personnel openings and boosting morale are even higher priorities than the core mission of fighting terrorism. >> morale is driven in large part by just basic, economic issues.
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when somebody hasn't had a pay raise in a long time. and they're threatened with sequestration or government shutdown that takes its toll. so i expect to address morale, but there are limits to what you can do without giving people some basic relief. >> ifill: most senators say they support johnson. republicans lindsey graham and john mccain say they'll stall the nomination until they get more answers on border security and the attack on the u.s. consulate in benghazi, libya. 21 nations in the middle east and nearby regions declared today that eradicating polio is an emergency priority. the virus recently paralyzed more than a dozen children in syria, and triggered mass vaccination campaigns in surrounding countries. the strain originated in pakistan, where militants have attacked polio workers, claiming they're trying to sterilize muslim children. in economic news, the united states produced more oil than it imported last month for the first time since 1995.
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it follows several years of steadily rising domestic production. and on wall street today, the dow jones industrial average gained nearly 71 points to close above 15,821. the nasdaq rose 45 points to close at 3,965. still to come on the "newshour": the technology chiefs behind healthcare.gov get grilled on capitol hill; another personal story of health reform; new guidelines in the fight against heart disease and stroke and the latest complications in the effort to bring all sides to the table in the middle east. >> wooduff: the rollout of the healthcare law took several hits today. most significantly: those low enrollment numbers of the 100,000-plus people who enrolled in the new federal and state
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exchanges. a big part of the problem, of course, has been the plagued launch of the federal website, where at one point people could not even navigate healthcare.gov. we'll take a closer look at those figures in a minute. republicans on capitol hill pressed the obama administration today on whether other motives played a role beyond the technical problems. "newshour" congressional correspondent kwame holman has our report. >> this wasn't a small mistake. this was a monumental mistake to go live and effectively explode on the launch pad. >> reporter: and according to republican darrell issa-- chairing today's hearing-- the blame goes straight to mission control: the white house. ranking democrat elijah cummings fired back. >> nobody in this room, nobody in this country believes that republicans want to fix the website. for the past three years, the
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number one priority of congressional republicans has been to bring down this law. >> reporter: still, republicans argued the website's woes are partially political. they suggested the reason people had to create accounts before they could shop for coverage was the administration feared sticker shock when they saw the cost. a top technology officer at medicare, henry chao, insisted the white house had no role in that decision. >> absolutely not. it was a decision made on the results of testing. it would be pretty egregious and i understand that a lot of folks are wondering why the website is functioning the way it is, but to consciously know that it failed testing and to then put into production for people to use is not what we do. >> reporter: and the white house chief technology officer todd park, who appeared under subpoena, insisted they're slowly getting the problems fixed. >> the website is getting better
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each week, as we work to improve its performance, its stability, and its functionality. as a result, more and more individuals are successfully creating accounts, logging in, and moving on to apply for coverage and shop for plans. >> reporter: park said the site now processes 1,700 new accounts an hour and handles 20,000 to 25,000 users at any given time, still less than half the original target. in fact, "the washington post" reported officials working on the troubled website now believe it is unlikely to be fully operational by the administration's november 30 deadline. still, park maintained at the hearing they will meet the deadline. >> the team set a goal of having healthcare.gov function smoothly for the vast majority of americans. the team is working incredibly hard to meet that goal. >> i thank the gentleman... >> with secure information? >> with secure information. >> reporter: that point will be crucial. a separate house committee heard today that healthcare.gov already has been targeted
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unsuccessfully, at least once, by a denial of service attack. the days hearings came as republicans and some democrats ratcheted up pressure on the administration over the cancellations of millions of existing policies. president obama promised repeatedly people who like their coverage could keep it. and just yesterday, former president clinton urged him to make good on the pledge. on the senate side, democrats diane feinstein and mary landrieu are co-sponsoring legislation to guarantee that happens. still, at the white house, press secretary jay carney cautioned today against legislative action. >> again we don't believe that proposed legislation that actually causes more problems than it fixes is the right way to go. the president tasked his team as he mentioned last week to come up with proposed solutions and you can expect us to be announcing something sooner rather than later. >> reporter: and senate majority harry reid announced his
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democratic caucus will meet with white house officials tomorrow. meanwhile, the house plans to vote friday on a bill letting people keep their existing coverage. >> wooduff: beyond the issue of cancellations, the question of expanded coverage looms large. the obama administration had hoped to get seven million more people enrolled in the first year of the new exchanges. many experts are asking whether that's still doable. but during a conference call today, health and human services secretary kathleen sebelius told reporters that when the state of massachusetts passed its own law, enrollment there started very slowly, just 123 people in the first month. >> we know experience in the bay
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>> wooduff: mary agnes carey of kaiser health news is with us again tonight. it's an editorially independent news organization. mary agnes, welcome back to the program. so what did we learn today from the administration's official release of these numbers? >> well, they're lower than expected. administration officials for days, for weeks, have been trying to dampen expectations. these numbers would be great, and they certainly were not. of the 10 6,000 people that have enrolled, you have about a quarter of those through the federal exchanges, and those are in 36 states. that's really a big chunk of states that are being run by the federal government, the exchanges, and then the remaining three-fourths were three the state exchanges set up in about 15 states and the district of column ja. >> woodruff: three to one that number reflects the state exchanges. to what extension is this consistent with what the administration has been saying? >> they have been saying publicly they did not expect to
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have, allw all the problems noted on healthcare.gov, they didn't expect great enrollment numbers. last month at a house waims and means committee hearing, dave camp, who chairs the committee, hadhad released the centers for medicare and medicaid services estimate that they expected by the end of october, around 494,000 people would have enrolled. this is way below expectations. >> woodruff: what are they saying about the progress they expect to make? they have this november 30 deadline to get it up are & running. >> they were saying they continue to make fixes, they are confident the web site will work for the majority of users. they caution this is a six-month ren olement period so let's not make too much of the fact of the numbers that were announced today, and they talk about early enrollment for programs that are popular-- medicare prescription drug programs for example. those were pretty low in the early days. so this is more of a marathon
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than a sprint. >> woodruff: did we learn much more today about what the obstacles are? what's holding this back? or do we just assume it's computer problems? >> it was very interesting, on the call itself, one of the reporters said he had just tried to create an account and couldn't do it, and one of the officials of the administration said that's an anomaly. you're an outlier. most people can get on to create an account. it's clear from the hearings on capitol hill and people's experiences they still have a lot of problems with the web site that they have to correct and smooth out. i think when people are frustrated they don't necessarily go back. >> woodruff: but they also eye mean, i did listen to part of the call, and you heard them talking about the-- they gave some larger numbers for people who have begun the process of signing up. >> right, exactly. >> woodruff: who were looking, exploring. does that tell us something about the interest in this or did they have any speculation did bthat? >> there are about one million folks who signed up and created accounts and got eligibility determination. they haven't yet made up their mind, and as the secretary was saying, people are look, they're
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shopping, they're looking at their options, trying to figure out if they qualify for a subsidy. that does provide? comfort for the administration and they talk about all the interest, all the people coming to the site, the medicine checking it out, kind of kicking the tires to see if it works for them. >> woodruff: and they're saying, again, this is what happened in massachusetts. >> right, exactly, and they're a little farther along than massachusetts was at this point. >> woodruff: mary agnes, stay with us. >> ifill: this brings us to another chapter in our series featuring reactions to the affordable care act, as more people become aware of the details. yesterday we aired the story of a washington, d.c. lawyer who was angry that her current insurance policy had been cancelled. tonight we hear from a colorado woman who was diagnosed with cancer just before her husband lost his job and his health care plan. here's some of what she told us: >> i am martha monsson. i'm 59 years old. i was diagnosed when i was 54,
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january of 2008, with multiple myeloma, which is a bone marrow cancer. the treatments for that mainly are chemotherapy, both oral and what the chemois for essentially, is reduce the number of cancer cells. this treatment is life saving. i would have died probably in february 2008 without it. when i was diagnosed, my husband was the county attorney in morgan county, and we had insurance through them. his job was eliminated, so since then he has been doing contract work which has kept income coming in, but for insurance, all we've had is through cobra,
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and that expires at the end of february. if he does not have another job by the end of february, which would give him insurance, we would have to apply for private insurance, we would get turned down because of my preexisting condition. even if they were going to take me because of the preexisting condition, it would be hugely expensive. the affordable healthcare act means that i have a chance, that i don't have to stop treatment once the insurance runs out, >> we will be able to get something. >> yeah, yeah. >> but we'll have to pay more. >> it's huge, and i think particularly to my family, because they would not like to have to pull the plug.
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this law is very much a game changer for us. i am hoping that in january, when this comes into effect, that it will give me more of a chance, that i will not have to worry about the insurance we have not ending in february, that i will be able to keep getting treatment. there's methadone, which is a pain pill for my spinal degeneration. when i was first diagnosed when i was first diagnosed-- well obviously the first reaction was to wish it hadn't happened-- but the second reaction was to wish it had happened someplace civilized, like france, or canada, where you get healthcare kind of as a matter of course, and it isn't as expensive as it is here. the problem, i think, is and frankly i was a little bit like
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that if they're healthy, they're going to say healthy forever, and even though i had insurance, i thought i was going to stay healthy forever. people who oppose it, i think very definitely don't have the bigger picture, they don't see that it can happen to them, and either they don't care, or they don't see what it does to other people. people are one diagnoses away, and they don't realize it to a large degree, but it's very true. what i tell people who oppose the affordable care act is fine. if you want to abolish it, you can pay my medical bills. that would be wonderful. give me a mailing address, and i will forward my bills to you. >> wooduff: mary agnes carey of
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kaiser health news is still with us, to help put ms. masson's story in perspective. i want to say, our heart go out to her. >> absolutely. >> woodruff: is and we appreciate her talking to us. tell us, why is the affordable care act a welcome thing for someone like her? >> because in the individual market before the affordable care act she would most likely be rejected for coverage, because she has cancer and her medical expenses are so high. this is a problem about 20% or so of people in the individual market applying for coverage get these rejection, based on medical status. that is no longer allowed. you can't be rejected because of medical condition. >> woodruff: this is a story that hasn't been told i think in many respects. people are aware of it, i think, but we don't hear about it that often. >> she put it out very well. we're all one diagnosis away from this sort of thing, and unless you've experienced it directly in your fleam or personally you may not think about the hardship that comes from this kind of diagnosis, and the fact that you can exawcht your limits pretty quickly on coverage and if you had to go
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out and buy it yourself you can't get it. >> woodruff: literally, mary agnes, what would someone's option be in her situation if it had not been for the affordable care act? what could she have done? >> she talked about cobra, which is coverage you can buy from an employer. once that ran out, she could go to an insurance agent to try to buy coverage in the individual market. she might have been denied. she might have gone into something called a hive risk pool. they're state run in many cases and they are there to help handle the high risk but that would also be an extremely expensive option for her. depending on her family income, they may or may not have qualified for medicaid. again, all of these are really tough choices. >> woodruff: and she mentioned her husband's situation. so much depends on where you live, your spouse or your family's situation. >> right. >> woodruff: it's not a cookie cutter one size fits all. >> it's very much geared towards your circumstances. that is the million underwriting going away with the affordable care act. >> woodruff: talk, mary agnes,
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about how big a part of the entire market of people, number of people looking for coverage are people like mismonson. >> you have about 14 million people on the individual market. that represents about 5% of everyone who is insured. of the 14 million, of those who apply, about 20% would be rejected based on their health care status. so it's a small group, but a very powerful group because of the dhaj this does if you don't have health coverage and what it does for your medical treatment, what it does for your personal finances. what's interestings to me is is this provision, even people who dislike the affordable care act, they like the idea that someone cannot be rejected on the basis of a medical condition for health insurance. it's a provision of the law that polls very well. >> woodruff: so is it literally the case that you are accepted under the affordable care act, no matter what your health condition is? >> right. >> woodruff: no matter how far along an illness may be? >> that's correct. they may have some adjustments based on your age or whether or not you smoke or live in the
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country, but are you allowed to have coverage in the affordable care act. an important think to know, as we talked about last night of niesht the whole stirk shock idea, this i this is one of the provisions driving up the cost for health premiums. it's an expensive provision but this plus the essential health benefits are two of the factors behind the sticker shock we're hearing about. >> woodruff: part of the larger picture here, though swe know for this new law to work, not everyone can have-- can be sick. there have to be healthy people signing up, too. >> right. >> woodruff: explain how that works and that balance works. >> it's a balance of risk. the healthier individuals get into the same risk pool as the sicker individuals and help balance the risk out over time. that's why you need someone like martha who is really circ who may or may not have problems signing up with healthcare.gov, they're going to hang in there to get coverage. the folks they also need to come into the risk people are people who currently have coverage and are healthier, may have had fewer medical problems, but stay in health coverage to help balance that risk. >> woodruff: but, of course,
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for those who are healthy, it's harder to-- as you've just been saying-- it's harder for them tond why it is something for them to seriously consider signing up. >> right, and if they've done well in the individual market as a healthier person, their premiums may increase. that was the woman we talked about last night. her premiums are increasing. she had a few medical issues this year but overall had been a healthy person. if you had lower premiums in the individual market and you have been healthier, you may pay more under the affordable care act. >> woodruff: pulling back again, and thinking about what we talked about a foot of few minutes ago about what we learned today about the enrollment numbers, as the insurance companies watch all this that is happening, where the enrollment numbers, with the stories we're telling about the individuals, like the woman we heard from last night and mismonson, how does it affect the behavior of these companies and their ability to take on new insurance policies? >> they've based their premiums for 2014, when the exchanges begin and the medicaid expansion begins and so on, based on an assumption that sick people
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would come in and health people would come in, that people currently in plans that are not deemed to be up to snuff with the affordable care act, that they'll transition to new plans. so all this conversation we heard about, for example, letting people stay on their current health insurance plans, that is going to undermine the risk pool, and could affect premiums in 2015 and beyond. so insurers are very closely watching this. >> woodruff: as are we all and i know are you. >> absolutely. >> woodruff: mary agnes carey, thank you very much. >> sure, thank you. >> ifill: now, what people need to know about new guidelines concerning cholesterol-lowering drugs. hari sreenivasan has the story. >> sreenivasan: the recommendations-- by the nation's leading heart organizations-- are the first new cholesterol guidelines released since 2004. for decades, doctors have prescribed cholestrol-lowering statins to their patients, based on their laboratory numbers. but the new recommendations focus on risk factors, including whether individuals
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have diabetes or heart disease, or if they have a level of so- called bad cholesterol, known as l.d.l.-- that's 190 or higher. dr. harlan krumholz is a cardiologist and a professor of medicine at the yale school of medicine who has long studied this issue. dr. krumholz, how significant are these new guidelines? >> these guidelines are profound. they're a marked difference from the prior guidelines. again, the ones we're talking about are ones about decision about the use of medications. and we really have changed from a singular focus on targets, pushing people to get their cholesterol levels to a certain point, to thinking more holistically about the patient, their risk and what they stand to benefit from the use of drug therapy. >> suarez: when it doms l.d.l., is that a bad measure? should we not be keeping that in control? >> first i want to say the guideline getting all the attention is the one about drugs. we remain steadfast in our advocacy for people who fur sue healthy lifestyles and we prefer
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not to use medications at all. we like the population to lower their risk just by being healthier, by being more active and achieving the right weights and not smoke. but with regard to these drugs and thinking about cholesterol, the cholesterol hypothesis, the idea that cholesterol is important in heart disease remains. in cholesterol, the bad cholesterol and the good cholesterol turn out to be predictors of heart disease. but what we've recognized is maybe we've been treating some of the wrong people. because by a singular focus on your lab test, we have perhaps often been treating people with mild elevations of bad cholesterol who were otherwise at low risk. and had relatively little to gain. and there have been others with low cholesterol who could have benefitted from some of these medications but who we may have neglectd not recognizing they had a lot to gain. >> let's talk a little bit about those congratulations. who now qualifies under the new risk calculator? >> so, the way that this works-- and there is a calculation, but i think it's good to think about
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this as a general for instance pel, trying toidentify people wt to gain-- that is, those people for whom medication is likely to lower the risk so it's worth taking the medication every day, worth exposing yourself to some of adverse effects. they said, look, if your cholesterol is markedly elevated, that should probably qualify you. by definition, you're at high risk if your bad cholesterol, the l.d.l. cholesterol is markedly rel elevated. although not everyone with diabetes is at high risk, if general we tend to think of it as elevating your risk, and we think people with diabetes would be best served by also being on these drugs. by the way "on these drugs" means statins. another piece of the guidelines was de-emphasize the drugs we have that lower l.d.l. cholesterol but are unknown with respect to their benefit, like zetia, or some of the other drugs, the nonstatin derision
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drugz. they said if you have diabetes, that's another group that might be more likely to benefit. and after that, they said if you don't have diabetes or markedly elevated cholesterol, let's take a look at all of your risk factors and figure out if you're in a range where it might be worth it for to you take a statin. and then they have introduced a calculator that's online that people can use. but the general principle is trying to figure out am i someone who is likely to have a big benefit from taking these drugs. because if you're not, and especially if the benefit's really small, it may not be worth it to you. >> sreenivasan: how significant is the population size that may not be prescribed statins anymore-- or i should say the additional medications? >> i think there's some controversy right now. my own view is that the guidelines are just guidelines. they're helping us to think about what these experts when they sat in the room felt were the right thresholds for treatment-- where is my risk high enough to treat? the truth is we should be personalizing those decision. that takes place between a patient and their doctor.
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and it-- each person may have a different perception on whether it's worth it to be treated. my sense of what's high risk that would make it worth it for me to take a medication may be very different than yours. for this guideline, they settled on a number. they said if your risk over 10 years of heart attacks and strokes was 7.5% or greater-- about one in 12, one in 13-- they thought it was probably worth it for to you take a statin. and they recommended it. my own view is that depend. i mean tfendz on you, and it should be personalized. i don't know at the end of the day whether more people or fewer people are going to be take statins, but i do know we'll be make wiser choices if we're tailoring our treatments to what you stand to gain. and if you're making an informed choice base ode whether it's really worth it to you, whether you're likely to benefit. that's really where we're turning from a singular emphasis on the lab test to trying to look ought as a whole about whether or not you're going to be able to avoid a heart attack or stroke and how big is the
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benefit for you? how likely is it you're going to be the one who will avoid prathat problem? >> sreenivasan: if we increase the pool of people who might qualify for statins, is there a chance that we'll have increased numbers of adverse side effects? >> well, these drugs are fairly safe. look, any drug we take has the potential for adverse effects, and staints, like all drugs, do have some rare adverse effects and they have some others that may cause problems. we know they can sometimes raise sugar levels, glucose levels. but the trials are fairly unequivocal. these drugs, by and larm, lower risk, and they lower risk by about 20%. they are tried and true. they're among the best drugs that we have. that being said, for someone who has got little to gain, i don't eye don't think that they should take them. these aren't for everyone. i don't think they should go in the water. and it really is a personal choice, whether you think the potential benefit is big enough. but you're right-- if we treat lower people-- and in the past i
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think we've done that by focusing on the lab test-- those people may have more harm than good. that's why we have to focus on those most likely to of benefit. >> sreenivasan: all right, harlan krumholz, thank you so much for your time. >> thank you. >> wooduff: tensions have been mounting between the u.s. and israel, over the iran nuclear talks and recent stumbling blocks in peace negotiations with the palestinians. jeffrey brown has the story. >> while i understand the skepticism, i don't share it and i don't think we have time for it. >> brown: that was secretary of state john kerry in july, announcing the restart of israeli-palestinian talks, aimed at reaching a two-state solution by next may. >> i'm convinced from my conversations today with prime minister netanyahu as well as with president abbas that this is not mission impossible. this can happen.
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>> brown: and that was kerry in bethlehem last week, pressing for progress despite rising tensions. only two days earlier, israel had announced plans to construct 1,700 new homes for jewish settlers in the west bank. palestinians angrily accused the israelis of not negotiating in good faith. >> ( translated ): we want peace and we want negotiations but peace should be fair, and guarantee the right of return, self-determination, a palestinian state, the release of all prisoners, and settlement expansion should stop. >> brown: after meeting with kerry, israeli prime minister benjamin netanyahu charged it's the palestinians who've failed to live up to their promises. >> i'm concerned about the progress because i see that the palestinians continuing with incitement, continuing to create artificial crisis, continuing to avoid and run away from the historic decisions that are
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needed to make a genuine peace. >> brown: but on israeli television, kerry bluntly warned of what might happen if there is no progress. >> the alternative to getting back to the talks is the potential of chaos. i mean, does israel want a third intifada? >> brown: then, yesterday, the housing ministry announced plans to build another 24,000 homes in disputed territory. but within hours, netanyahu halted the move, saying it would create unnecessary confrontation with the international community. today, palestine's chief negotiatior said the damage has been done and that his team is resigning. hanging over all this are the ongoing talks with iran about its nuclear program, watched warily by the israelis and other key regional players. so where does the peace process stand, and what is the state of u.s.-israeli relations? we're joined by robert satloff, executive director of the washington institute for near east policy.
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and hussein ibish, senior fellow at the american task force on palestine. welcome to both of you. >> thank you. >> brown: robert satloff, let's pick up on that last part, the iranian element. how large a shadow does that cast over any potential peace talks between israel and the palestinians? >> it castaise very, very broad shadow. we are in unchartered waters in the u.s.-israel relationship today. >> brown: unchartered waters. after all these years? >> after all these years, after all the different ups and downs, this is a new scenario in which the united states and israel are at loggerheads over an immediate national security initiative of the united states-- namely, the negotiation of a first step agreement with iran. the prime minister of israel says it's dangerous-- not just for american interest but for his interest. the united states president and the spokesman for the white house has said that if you are opposed to what is being put on the table, are you a warmonger.
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and so this is a clash unlike any i've seen in 30 years in washington. >> brown: and your sense is that holds00, in a sense, any peace talks with the palestinians? >> to be precise, israel's confidence in america as a mediator in the israeli-palestinian negotiations is totally derivative of its confidence in the iran talks. >> brown: let's get hussein ibish's assessment of that. >> i think that's a very good summation of what the prime minister of israel's office thinks and says. they have, i think, framed everything to do with the israeli-palestinian negotiations, including the cancellation of this extraordinary 24,000-unit plan, including this very sensitive e-1 construction area, which would be a strategic game changer on the ground, in terms of their confidence in the united states deriving from-- in other words, everything gets refracted through iran.
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but that is not the american perspective. that is the israeli perspective, and it might be an understandable one, but the american perspective, which has been articulated by president obama many times and by secretary of state kerry, is that if the two issues are linked, they're actually linked the other way around. in other words, that making progress between israel and the palestinians helps the international community deal more robustly with iran. i actually think that everything is linked together. but such a straightforward binary linkage, as was described by mr. satloff, and as is being provided by prime minister netanyahu, is the kind of crude linkage that we've been trying to get away from for the past 20 years. >> brown: go ahead. >> it's not that the israeli-palestinian issue is in any way linked to the iran issue. that's not it. what is the connection is that any confidence that israel will have in an american mediation, any ideas that the united states will put on the table to solve, say, the security challenges,
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which america's been looked to, to provide answers will be totally dependent that america is looking out for the best security interests in the biggest issue facing world today, which is the iran negotiations. >> brown: bring the palestinian side into this. where does that leave them and what role are they playing at this point? >> there's not much they can do vis-a-vis iran. they really are not part of the equation, and that sort of underscores the except to which while you're absolutely right, there's a question of confidence in not only that israel has, saudi arabia has, and other regional allies have in the united states has been somewhat disrupted by various different policy scenarios over recent months. it's still the case that the israeli-palestinian conflict is a pressing need that exists in a regional context, needs to be resolved in a regional context, but that also cannot be shelved.
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it can't be said by anyone seriously, that palestinians just have to wait until the nuclear issue with iran is resolved, or that somehow that's a key. and even if it were a question of, say, bringing the sowdez into the mix through the arab peace initiatives or bringing egypt into the mix because of their relative importance in the arab world and their control over the gaza crossing, it would still be an issue that has to be dealt with. there are really important things that need doing here on their own. >> brown: bring the u.s. back into the mix. because we saw secretary of state kerry with some pretty hard language, harsh language, referring to a potential third intifada. how much lonch does he have in this case? >> i think it's quite regrettable what happened over the last 10 days as we saw a u.s.-israel breach on both israeli-palestinian issues and the iran negotiations. it really didn't have to be this
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way. i think in retrospect, the secretary probably regrets suggesting the bona fidies of israel, the israeli-- >> brown: that's how it was taken. >> when you want a third intfeuda you're not serious. when you took the settlement issue-- i'm not going to defend israeli settlement policy, but what the secretary did is he took the announcement of 1900 departments, only 200 of which are east of the security fence, east of the barrier, and turned this into the greatest attack on the potential for peace ever. it's-- it was-- it wasn't wise at a moment when he needed israel's understanding from what was about to happen with iran? and now israel thinks, my gosh oiran, they're going in a different direction. on the peace process they're in a different direction. maybe they're really not the strategic partnership that we thought we had. >> well, that's got to cut both ways.
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obviously, if israel's disappointed in the united states, it's very likely the united states is disappointed with israel. look, our regional allies-- israel, saudi arabia, egypt-- these are regional powers with regional interests. we are a global power with global interests. it's understandable if israel is obsessed with iran, and thinks only in terms of iranian issues. the united states can't do that. we have to deal with multiple issues. we have to deal with syria. we have to deal with the israeli-palestinian crisis. we have to deal with repairing our relations with saudi arabia and egypt. and many other things, all over the world. so you've got to come back to the israeli-palestinian file as one that the united states takes seriously on its own. it cannot be held hostage. >> brown: very briefly, do you think that will happen? >> i do, actually. i think there is an ability that the united states has to make this issue-- to bring this issue to the fore. if the united states wants to focus on it, the parties will
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focus on it. and i think clearly the intervention to stop this settlement expansion is inspired by washington in one way or another. >> brown: okay, we are going to have to leave it there, but we'll keep watching, robert satloff, and hussein ibish, thank you very much. >> thank you. >> thank you. >> wooduff: again, the major developments of the day: the typhoon death toll in the philippines neared 2,350, and survivors ransacked whole warehouses for food. the obama administration reported fewer than 27,000 people enrolled for health insurance, during october, on the problem-plagued federal website. nearly 80,000 others signed up on state exchanges. and secretary of state kerry urged congress not to impose new sanctions on iran for now. he said any such move would damage negotiations to freeze iran's nuclear program.
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>> ifill: on the "newshour" online right now, nearly half of boomers don't have enough savings to cover basic expenses in retirement. what can be done to make up the difference? one of our "making sense" regular columnists has some ideas. all that and more is on our website newshour.pbs.org. >> woodruff: this week and next, pbs is airing many special programs to mark the 50th anniversary of president john f. kennedy's assassination. tonight, two of them feature "newshour" alumni, jim lehrer and robert macneil. they were both in dallas covering the events of november 22, 1963. jim appears on "nova", as it searches for fresh clues to the assassination. >> ifill: and robin recalls details about how carefully the news media handled the announcement of the president's death on "secrets of the dead". food for thought in this age of twitter. check your local listings for the times. >> woodruff: and that's the
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"newshour" for tonight. on thursday, we'll have an exclusive. the first t.v. interview with the new head of the a.t.f. plus, robert macneil is with us to talk about his latest book. i'm judy woodruff. >> ifill: and i'm gwen ifill. we'll see you online and again here tomorrow evening. for all of us here at the "pbs newshour," thank you and good night. >> major funding for the pbs newshour has been provided by: ♪ ♪ moving our economy for 160 years. bnsf, the engine that connects us.
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>> and with the ongoing support of these institutions and foundations. and... >> this program was made possible by the corporation for public broadcasting. and by contributions to your pbs station from viewers like you. thank you. captioning sponsored by macneil/lehrer productions captioned by media access group at wgbh access.wgbh.org
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