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AMANPOUR:
Hello everyone and welcome to “Amanpour and Company.” Here’s what’s coming up. Democrats should unify behind whoever this is the candidate. They shouldn’t be worried amid the noise about electability. Nobel economist Paul Krugman tells me why it doesn’t matter which top Democrat wins the nomination. Then Trump’s middle East peace plan falls flat. So what next for us foreign policy. Kim Ghattas, author of “Black Wave” on the ongoing Iran Saudi battle to dominate the region. Plus, I don’t ultimately see a situation where you have any kind of seismic shift in the insurance programs that are available to Americans. Healthcare is the number one election issue for voters, but the Washington Post’s Paige Winfield Cunningham tells our Hari Sreenivasan, neither party will make major changes.
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AMANPOUR:
Welcome to the program. Everyone. I’m Christiane Amanpour in New York and the 2020 election season is off to the races with its first major contest in Iowa. Wrapping up, voters are revealing which topics they care about most and who they think can address them. Among the top concerns is as always the economy under president Trump, wages are up, unemployment is down and the stock market is booming, which he’s banking on to win reelection. And while all campaigns harken back to the famous Clinton adage that, “it’s the economy, stupid.” Democrats have a wide choice of candidate from center left to further left. I made all the asked over that choice and who can be Trump. My first guest tonight has a surprising new insight. Nobel Laureate and New York times columnist Paul Krugman tells me that when it comes to actual economic policy, it won’t matter much which Democrat wins the nomination.
AMANPOUR:
Paul Krugman, welcome back to the program.
PAUL KRUGMAN:
Good to be on.
AMANPOUR:
So you wrote a very surprising op-ed. Your most recent one in the New York times was about, in a sense it doesn’t matter which Democrat wins or which front runner wins the caucus because the policies necessarily won’t, won’t change. You said in terms of actual policy, it probably doesn’t matter who the Democrats nominate. If you’re a centrist worried about the gigantic spending increases, Sanders has proposed calm because they won’t happen. If you’re a progressive word that Barden might govern like a Republican, you should also calm down because he wouldn’t that is that cynical, pragmatic, hopeful, what?
PAUL KRUGMAN:
I think it’s pragmatic and hopeful. I mean, the democratic party these days is solidly progressive. It’s a, what Europeans would call a social democratic party. And that’s true even of the people we call centrists. They are in fact, uh, prepared to move policy significantly towards more inclusion, expanded healthcare and so on. Um, and on the other hand, there is a left wing of the democratic party that would like to follow more radical policies and we can argue about whether or not those would be a good thing, but the, the country won’t back those. There, there isn’t a, uh, a president Sanders would not be able to get the really expensive items in his agenda through the Senate, even if Democrats take the Senate. So even if Democrats take the set, even if Democrats take the Senate, there are enough Democrats, uh, democratic senators, you know, think of Joe mansion at one end, but there sure enough democratic senators that, that something that called for really massive increases in spending and large middle-class tax cuts, sorry, large middle class tax increases, uh, is not going to happen. Uh, so I think that if you’re worried about it, I mean, I’m, I’m trying to talk to both sides here. I’m telling you, I think the people who, who are, you know, alarmed by Sanders, all right? I am actually don’t think his policies with you that terrible, even if he could implement that, but he can’t. So it, that, that’s not gonna happen. And yeah, and uh, and anybody who thinks that the democratic party is going to, uh, be, you know, Paul Ryan in, in disguise, it’s not gonna happen.
AMANPOUR:
So let me ask you this, because are you being political or rather, are you trying to address this big conundrum that Democrats around the country seem to have and that is who is electable? Are you basically saying, if you guys are trying to make a con a calculation about who’s electable don’t because they’re all electable and their policies economically are pretty much we’ll end up,
PAUL KRUGMAN:
I actually know electability as is something I worry about quite a lot though. I don’t know the answer, but I actually, I’m much more worried about the, the hay that Republicans might make over Sander’s proposals than about his program itself. The, the, the Sanders agenda in its full form is not going to happen, but it might, he hasn’t really been, uh, you’ve edited on it by his fellow Democrats. And so, uh, what, what happened during the campaign if Sanders is the candidate worries me quite a lot. Uh, there, you know, we don’t know this. The polling right now really doesn’t show anything very strong, but I have to say, I have some anxiety that the Republicans accuse any, anyone who wants to make life better of being a socialist. Uh, but in Sanders you would have somebody who actually says, I am a socialist. Although he, it’s not true. He’s in fact just a social Democrat. So the, I think it’s, it’s not an electability argument. It’s my argument is that Democrats should unify behind whoever this is the candidate. They shouldn’t be worried. And why do you think they might not unify behind what, what worries you about that? Surely they would, they want to beat Trump. Well, there are, there is one wing of the party, uh, of people who are, you know, uh, very, uh, are relatively conservative. Uh, if you like, it’s a sort of a Bloomberg wing or whatever, or the party. I don’t think it’s that many people, but it’s a significant part of the donor base. Um, that is a large, by a highly progressive policies. They might sit on their hands and then there’s a, the Bernie people who are sort of perfection or nothing, it’s gotta be our guy and who might be tempted to, I mean, we have seen some, some Bernie surrogates, you know, claiming that, that Joe Biden has endorsed Paul Ryan’s budget policies, which is not true. Um, but I worry that they might, uh, that we might have some opting out on, on that side of the Democrats. And the fact of the matter is everybody, every one who’s a Democrat should understand that what you’re going to get is a significant but not huge progressive shift in us policies if a Democrat, any Democrat wins.
AMANPOUR:
And just quickly outline what that looks like. A significant but not huge progressive shift.
PAUL KRUGMAN:
Uh, it means for sure greatly enhanced Obamacare maybe with a buy into Medicare as part of it, but certainly something that would get another 15, 20 million people insured. Uh, it means increased taxes on the rich, whether it’s a full, you know, Elizabeth Warren wealth tax or something more modest, but certainly increased taxes on the rich. It means increased spending on families. We’re going to see a lot of movement towards childcare and, and a relatively cheap but hugely important policies that are, that, that affect children.
PAUL KRUGMAN:
So those are the things that are going to happen. Whoever wins, I think yourself and many others in, in your field of economics predicted that a Trump economy would not be good for the country. Actually, no, I made a bad call on election night, but I retracted that call three days later. Okay. Hold on. The retraction call was, I said, we’re gonna have a recession because we have terrible group of people and markets are going to lose confidence. And then three days later I said, you know, I let my, I let myself fall into motivated reasoning. And the reality is that what Trump is likely to do is run bigger budget deficits and that bigger budget deficits are going to provide some economic stimulus, which is what it has. In fact happened. I mean, the budget deficit now is, uh, uh, is about $300 billion a year bigger than it would have been if we hadn’t had the Trump policies enacted. So, and the corporate tax cuts, corporate tax cuts about half of that. And then the individual tax cuts on a little bit of extra spending to, uh, but mostly a corporate and wealthy tax cuts. It’s lousy stimulus, but it’s stimulus.
AMANPOUR:
Okay. So with that being the point, and president Trump going around the world is Davos and around the country in his rallies, basically talking up the great American economy, people believe it. I’ve heard many people in Davos love his economy. Many people around the country love his economy. Isn’t it going to be very hard to argue come the general election that the economy is not better?
PAUL KRUGMAN:
Oh, the economy is better. The question is whether it’s enough. I mean, Trump’s approval is way lower than you might expect given the state of the economy. Uh, and I mean, there’s a lesson here, Democrats, uh, you know, Obama tried to be fiscally responsible and no, no good deed goes unpunished. He was, he was, uh, uh, it was also true that he was constrained by a Republican Congress. But all of that fiscal austerity, uh, that was the consensus of that we have to do during the Obama years, uh, turns out to have done nothing but harm it. It just, uh, restrained the economy. And now, uh, we’re having a deficit deficit Palooza under Trump and it’s all, you know, it boosts the economy. Now, I think Democrats shouldn’t try to argue that the economy is lousy. They should try to argue that, look, if we’re gonna run a deficit, this, if we’re going to run $1 trillion deficit, maybe we should do it for something useful. Actually be repairing the country’s infrastructure to do. Yes, but, but he was never going to do it. That was, uh, one of the columns I wrote right after the election, uh, was saying that there, there will never be a Trump infrastructure plan and there hasn’t.
AMANPOUR:
Is James Carville’s famous three word, four word slogan, “it’s the economy stupid” still relevant today?
PAUL KRUGMAN:
Probably not. If we look at actual politics, uh, there’s some evidence, even from the statistics I talked to political scientists, that the, uh, that the relationship between the economy and the vote is weaker than it used to be and it was never as strong as legend has it. And also it’s really, yeah, I mean that it’s real, but it’s not, it’s not everything wisdom. Yeah. But it’s, it’s, it’s exaggerated. There’s actually a lot of other stuff that goes in and also it’s the rate of change of the economy, uh, in the, in the year or so before the election that matters. So, uh, tell me what’s going to happen over the next few quarters and I’ll have a better idea that the growth that we saw most recently to 2.1%, that is not the kind of growth that it leads to a massive, a license for.
AMANPOUR:
It’s also not what the president promised as a campaigner, he promised 4 to 6% growth.
PAUL KRUGMAN:
Yeah, yeah. Right. Yeah. And what we actually got was one year of 2.9 a second year of 2.3 and a that’s not a whole lot really when all of a sudden done for all of that deficit spending.
AMANPOUR:
What about the actual people? It says in your own newspaper, the New York time, the Iowa population aptly reflects the graying of the American economy. Metropolitan areas are prospering rural ones are not so much like in agriculture and all the rest of it. And that’s not just in Iowa, it’s around the country apparently. What does that mean for people, particularly in rural States who we were told in 2016 election were being left behind and Trump was going to rescue them. But it says here that they’re not prospering.
PAUL KRUGMAN:
No, it’s actually what’s really striking about the Trump economy is that, uh, while overall performance has been pretty good, um, the parts that are performing badly are exactly the parts that Trump said he was going to boost. So farmers are hurting badly from his trade policies. Uh, manufacturing is actually in a recession. Uh, he promised to revive manufacturing. We had this massive corporate tax cut and business investment is down and it’s all being powered by deficit spending and consumer spending. So you would think that they would do some significant defections. It’s not clear because there’s a lot of other things that are going on that are motivating people.
AMANPOUR:
Your new book is called arguing with zombies. What specifically do you mean about that?
PAUL KRUGMAN:
A zombie idea is any idea that should have been killed by evidence but keeps on shambling along eating people’s brains. And so the, the biggest zombie in American politics is the idea that tax cuts pay for themselves. But the second biggest and ultimately the much more important is climate denial. And, uh, we know we have a majority of Republicans in Congress simply deny that climate change is happening. Of those who admit that maybe something is happening, uh, essentially all of them oppose any significant action to do something about it. The IMF and many others talk about how the fossil fuel industry might not even exist if it wasn’t for the enormous amount of tax benefits out in out cash, injections, tax, you know, incentives and subsidies. And not being required to pay the cost of the damage that flux, even if you leave aside climate change, uh, the, the health costs and the economic costs of air pollution created by burning fossil fuels is enormous. It’s really, um, the, if you take the U S fossil fuel sector, it basically, uh, once you take account of these things, it basically destroys about twice as much value added as, as, as the, as the value of the industry. So, uh, it is a, it’s a zombie industry with, if we had appropriate pricing and didn’t have these subsidies, most of the fossil fuel sector, which is go away.
AMANPOUR:
So what do you say, obviously you afford the greening of the economy and globally, you know, it looks like that’s what should happen. What do you say though, to voters in Pennsylvania? Key swing state where fracking exists and even the Lieutenant governor who’s a Democrat, has said a Democrat who comes in like Bernie or Elizabeth Warren who says, we’re going to ban fracking overnight, is basically saying, we’re going to ban your jobs overnight. And somebody like Biden who comes in and says, yes, it’s, it needs to be changed, but it has to be done, you know, carefully. And, and, and with, with the, you know, the correct view of people’s jobs and livelihood. What do you say about that?
PAUL KRUGMAN:
I would say that it’s climate change is a massive cumulative problem, so you don’t have to fix everything on, on day one. So it’s okay to have a transition. And it’s also really important to package, um, the climate change, you know, client package, uh, restrictions on fossil fuels with job, creating programs. A agreeing new deal is a great idea, not just because there’s a pretty good economic case for a lot of investment, but also, uh, because it means that it’s not just eat your spinach, it’s also, here’s, here’s some, here’s some, you know, people say a little bit of Christmas tree with something for everybody. Well, yes, it would, and that’s a good thing. So I’m, I’m, uh, I’m for a, uh, a sort of broad based, uh, and, and somewhat gradualist approach just because that’s the only way we’re going to get this done.
AMANPOUR:
So that’s, that’s really interesting cause it’s not what the very far left of the party is saying. And obviously young people like Gretta Thunberg and young people in this country and in many others want a right now approach to it.
PAUL KRUGMAN:
I mean they’re right on the substance if there every year that we don’t stop, uh, greenhouse gas emissions is contributing significantly to the future. But um, on the other hand, uh, one more year is not going to be make or break for the planet and it’s, it’s much more important that we get moving on addressing climate change then that we do at the perfectly right way.
AMANPOUR:
Now you have basically written a lot in your book and elsewhere in your columns and in interviews about the Republican’s bad faith on, on this issue. Um, you’ve obviously probably read the article that Sebastian Mallaby in economics correspondent has written for the Atlantic Coolit Krugman. He says, he basically says, and he takes issue with what you say. Republicans don’t just have bad ideas at this point. They are unnecessarily bad people. He’s basically saying if you sweep everybody into that one basket, you are forfeiting the ability to influence even the Republicans. And you’re not making a distinction between Republican rank and file people or you know, the, the vested interests, the leadership who are climate deniers.
PAUL KRUGMAN:
I think Matt Mallaby actually is the one who failed to meet the distinction. I thought I was pretty clear in saying that it’s a, that we’re talking, I’m talking about the professional politicians and basically anybody with any principles has been driven out of the Republican party as a professional politician. Now, if we look at all of the people in America who say that there are Republicans, there are, is a lot of flexibility. They’re there. They’re quite a few people who don’t adhere to the party line. One of the funny things is actually that less informed Republican voters often have more sensible views than well-informed Republican voters because they don’t know what the party line is supposed to be. So, um, the, I think the chance of reaching out to a number of people who think that they are Republicans, uh, is, is real.
PAUL KRUGMAN:
And I, I wouldn’t be insulting them. Uh, but the, the chance of reaching out to any Republican member of the house, any Republican member of the Senate is minimal. It’s, you’re just not going to get, so that’s the distinction you need to make.
AMANPOUR:
But what about the numbers in terms of voters? I mean, we see the number of Republicans, let’s say on campus and elsewhere who believe in manmade climate change and that something needs to be done about is increasing. We see what voters are, you know, saying about this issue. It is a voting issue for young people, both on both sides. What will make you know, the people who you despair of the leaders change?
PAUL KRUGMAN:
Oh, I think nothing short of repeated massive electoral defeat. Uh, they, they are, they’re just very, very powerful incentives. Uh, it’s, uh, anyone who breaks ranks is going to see his or her political career destroyed and her post political career destroyed as well because, uh, you know, all of the consulting opportunities will go away.
PAUL KRUGMAN:
So it, it’s going to have to come. And what’s really comes down is you have to convince these relatively conservative voters, uh, who have, however ever do care about climate change, that voting Republican is ensuring that nothing will be done. And we’ve seen, I mean, it was interesting, Greg Mankoo center, right to economist, a former chairman of, of bushes, council of economic advisors recently declared that he, he can no longer call himself a Republican because of climate change. And that’s that good for him. He’s, he’s, he’s at least acknowledging reality there.
AMANPOUR:
I want to ask you this because again, one of the items in this, I find it fascinating reading, um, the research, I find it fascinating that you yourself came out of university talking about being a technocrat. And in fact, I never knew that you worked in the Reagan white house trying to, uh, you know, bring fags, I think by 10 o’clock you meant facts and evidence, uh, in the economy rather than, than politics.
PAUL KRUGMAN:
Yes. I was the senior international economist and the Reagan council of economic advisors, sublingual level. The senior domestic economist was a guy named, I was named Larry Summers. Don’t know what happened to him. So, but that’s interesting. Yeah. But that was so what happened? What happened? Because you have become much more political, you occupy a very important place in not only in the New York times, obviously as economist, but in, in progressive politics. Well, partly it is that, uh, I’m have a different job now. No writing now reports inside the government and writing newspaper columns is a very different, uh, a very different thing. But it’s also the Republican party itself has changed. I mean the, uh, the, even on the Reagan years there was a lot more flexibility, a lot more openness to ideas. The, the process of zombie effication uh, the, the zombie idea is taking over. The party was already underway, but it had not gotten as far as it has now. So there were still a lot of reasonable Republicans in the Senate and house in the 1980s. There aren’t any now.
AMANPOUR:
Well on that categoric statement, Paul Krugman, thank you very much indeed for joining us.
PAUL KRUGMAN:
Thank you.
AMANPOUR:
Now the democratic candidates are United on a major foreign policy issue. Rejecting the recently revealed Trump middle East peace plan. Some even writing a letter to the white house demanding the U S does nothing to jeopardize a two state solution preventing any unilateral moves by either side there I Arab leaders including key Trump allies have also unanimously rejected it with a sharp statement from the Arab league this weekend. Let’s get straight to what comes next with journalists. Kim Ghattas has been covering the middle East for the past 20 years and her new book is called black wave, about the enduring 40 year rivalry between Iran and Saudi Arabia and America’s place in the region. She’s joining me now from Washington. Kim, welcome to the program.
KIM GHATTAS:
Thank you so much for having me, Christiane.
AMANPOUR:
So Kim, it’s great to be able to talk to you particularly with this, you know, sort of primmer if you like, um, with the, your book that it’s come out of this very important time because this weekend in the region, the foreign ministers from the Arab league got together and unanimously rejected the peace plan. What does that mean for, I guess the U S influence over that region? And the ability to finally get some kind of end to this enduring, um, really problem but huge problem between the Israelis and the Palestinians.
KIM GHATTAS:
Well, it’s more than a problem. Of course, Palestinians continue to live under occupation for the most part. Um, what it says about, um, you know, the U S foreign policy in the region is that I think president Trump chose his time very well to put this peace plan forward because although the Arab league put out this very sharp statement, uh, stating that they rejected this middle East plan, um, I would think that it’s really mostly lip service because a, they know that their own people are not only tired of the fact that nothing ever seems to go right with the Arabs really conflict in favor of the Arabs and the Palestinians, but they’re also too consumed by the upheaval and oppression in their own countries.
KIM GHATTAS:
Whether you live under the dictatorship of [inaudible] or whether you live in the Syrian civil war or whether you live in Yemen or in Baghdad. So Arab leaders know that they can pay lip service to the cause, but in private where they’re mostly concerned about, particularly in the case of soldier Abia is the role of Iran in the region and they need the Trump administration to help them continue to curb and contain Iran. So in private, I suspect the conversations are very different between Arab leaders and the Trump administration. What is interesting is that although, um, countries like Saudi Arabia are focused on keeping or on staying on Trump’s good side because they’re concerned about Iran, this Trump peace plan provides an opportunity for the Iranians because everyone pays lip service to the Pontius Palestinian cause, including the Iranians. And they’ve been doing that ever since. I’ll throw out a Hala Khomeini in the 70s, uh, came back to Iran, became the Supreme leader and tried to use the Palestinian cause to pose as the leader who could reach beyond the borders of Iran and the Shia community and succeed where Arab leaders had failed.
AMANPOUR:
Yeah, I mean that’s really interesting. And I wonder, I mean, what Iranian leaders might do given this, and I’m going to ask you that for a second, but I’m really fascinated by by what you say, uh, that Arab leaders are quote unquote paying lip service to the Palestinians with their unanimous declaration from, um, from the Arab league meeting and the U S Democrats are also criticizing it. As I said, let me just read a little bit of this, the statement letter to the white house: “Unilateral U S endorsement of Israeli sovereignty throughout Jerusalem over all Israeli settlements in the West bank and the Jordan Valley guarantees Palestinian rejection and paves the way for full or partial Israeli annexation of the West bank. Such a development would disregard international law ingender opposition from our allies and undermine existing U S policy. So very quickly, do you agree that this plan undermines existing U.S. Policy and you know, to an extent, international UN law on the issue,
KIM GHATTAS:
There are two ways of looking at it. Yes, it, it undermines international law because annexation of occupied territory is illegal under international law. But a lot of people in the Arab world will tell you that although it looks as though and Democrats say that this undermines U S policy, the reality on the ground as Palestinians feel it and as a lot of Arabs feel it, is that the U S has never really stood up for Palestinian rights, has never been a, a, a fair arbiter in this mediation. And that what president Trump is doing is simply removing the fig leaf and weighing all, all on the side of the Israelis.
AMANPOUR:
Well to that point then, I’m going to play you a little bit of an influence, a little bit of an interview that I had with Jared Kushner who is the architect, uh, along with some other close Trump allies of this plan. And interesting that he also talks about Arab reaction to this. Just take a listen.
JARED KUSHNER:
When I was with the Sultan of Oman, he said something to me that really resignated where he said, I feel bad for the Palestinian people, that they carry the burden with them of the entire Muslim world. And it made me really understand that this is two different conflicts that have been conflated, that people have used for their own different purposes over the years. Never for good. You have a territorial dispute between the Israelis and the Palestinians in a security dispute. There’s a very prescriptive, uh, outcome that we propose for that. If the Palestinians have issues with that, they should try to come and negotiate it.
AMANPOUR:
So is he correct, um, in the analysis of what the Arabs thing in the prescription that they have offered. And to your point about how the Arab nations are fed up with all of this, what happens next? I mean, they may be fed up, they may be paying lip service to their street, but what exactly does that mean for the future of this conflict?
KIM GHATTAS:
Well, the Palestinians have said that they’re going to cut security cooperation with the Israelis that has consequences. Um, Israelis who oppose this Trump, uh, plan are concerned about the future of their country as a democracy. They don’t seem to think that this is a peace plan. They sink. You know, Israeli commentators have said that this is a surrender. These are surrender terms for the Palestinians, but we’ll have to see how things unfold. But as I said, I do think that Arab countries like Saudi Arabia are mostly concerned about staying on the good side of president Trump because their foremost concern at the moment is their enmity with Iran and trying to contain, uh, Iran’s regional, um, ambitions. And as you, as we’ve been saying, you know, everyone uses that conflict to their advantage. Remember that Iran as part of its Islamic revolutionary guards has an outfit, a regional paramilitary force called a klutz force named after Jerusalem in Arabic Al quotes. And the head of that para military force was until very recently costume Sulaymani who somehow thought that the road to Jerusalem had to go through Beirut, Baghdad and Aleppo in Syria.
AMANPOUR:
I get the, uh, irony in your voice right there. But so with the assassination of awesome Soleimani, does that make Iran’s position stronger or weaker in the region? And given the fact that yes, Saudi Arabia and the Gulf nations and others are battling for dominance and influence in there. And believe that Trump is the person to be on side for that. Where is that really headed in this post Soleimani reality?
KIM GHATTAS:
You know, I would say that the Iranians are very good at capitalizing on moments of weakness and vulnerability and turning it to their advantage. If you’ll remember that after the 2003 U S invasion of Iraq, there was a lot of fear into Heran that they could be next. And they use that moment to really go into Iraq and flooded with their allies, their proxy militias. And here we are today where, uh, Iran really has the ultimate say in many ways in the politics of Iraq, which is why people are also protesting in Baghdad against Iran stranglehold on the country and the country’s politics. And they’re doing the same across the region. Now after the assassination of costume Sulaymani, they’re really trying to capitalize on this moment and turn a moment of weakness and vulnerability into a moment of strength in particular because to some extent the U S has moved on. Uh, president Trump ordered the strike and then, you know, the administration to some extent has taken its eyes off the ball.
AMANPOUR:
So let me ask you this, and you can imagine that I assume within the Trump administration and certainly amongst the, um, uh, the analysts of all of this people, some of them are saying, well, this encounter has revealed Iran to be a paper tiger. That it talks a tough game that everybody thought there was going to be some massive outbreak of hostilities in the region, but off to the Soleimani assassination, um, that nothing has happened. And Iran is essentially, you know, quiet. What do you think you, Iran’s next move is and what do you think of that analysis?
KIM GHATTAS:
I would disagree with that. I would say that Iran continues to do what it’s always done is move very strategically and very quietly. It is trying to put down the protests in, um, Iraq. You know, more than 500 people have died in the crackdown on these protests. It is hard to face, um, protests in Iran itself and has been using violence against protesters there and in Lebanon in my own country. It has, as I said, capitalized on this moment of weakness to try to, um, not only solidify its position in the country through the work of its ally, uh, Hezbollah militant group, but also a political movement, but push even further and have a real say in the government there. So I think we’ll continue to see very strategic political moves and more, uh, more, uh, um, uh, moves through its proxy militias in the region, including in Iraq.
AMANPOUR:
Now your book is called “Black Wave” and its subtitle is about the 40 year rivalry that I unraveled the middle East and between Iran and, um, uh, and Saudi Arabia as we’ve established Saudi Arabia enjoys the support of, uh, the Trump administration and many others who believe that the ultimate aim in the region is to confront Iran given the fact that nobody came to Saudi Arabia aid after the, uh, Iranians we believe attacked the, uh, the oil facility and the infrastructure so dramatically last year. Uh, where does this, where do you think, so how much can Saudi Arabia rely on the United States? And particularly as you hear president Trump not really wanting to go to full scale war and, and not having, you know, come to Saudis rescue really.
KIM GHATTAS:
I would say two things here. Cause Chan, first of all, yes, I think the Saudis were worried after the attack on Saudi old facilities in September because there was a lot of, uh, heat, but no fire from the Trump administration. But the Trump administration did then beef up the numbers of us troops in, in the region. And that’s why the Saudis tried to see whether they could engage in, in direct talks with the Iranians through countries like Pakistan and Iran. And that is a pattern. So drew Arabia wants Iran, um, contained and maybe even beaten up, but they don’t want to go through an escalation. And after the costume Sulaymani assassination, it was the same thing. The Saudis rushed to try to move towards the deescalation because they don’t want an all out war. They want to stay on Trump’s good side. They want more actions to contain Iran, but they do not want to fight a full on a war. What I would say is that it’s important to look not only at Iran’s actions or soldier abs actions, but to really look at the rivalry between them and how that dynamic over the last 40 years has become part of a triangle with the us. You cannot only look at one or the other. You have to look at this triangle, this dynamic that includes, um, the United States. And that’s what I try to explore, um, in, in “Black Wave,” in my book. Because I do think that the rivalry between surgery and Iran is also very damaging to the region. And we have a tendency, and particularly American foreign policy makers, have a tendency of looking at the two countries separately and they need to look at them together.
AMANPOUR:
So finally, I want you to ask you, because you know, one of the questions you ask in your book is what happened to us?
KIM GHATTAS:
In other words, Arab States, out of people, what happened to us? And you talk about a lot of young people or civilians who have made it their business, whether it’s in Saudi Arabia or in Iraq or other places, as you call it, the silent majority, the more progressive the people who want to promote democracy and presumably felt that the Arab spring might do that. But then as analysts and and reviewers are pointed out, you know, the people know you profile for instance, yamaka Shogi a good friend of yours, they’re no longer around. So what happened to us is a question that many, many people are trying to have answered. Why is the Arab nation, the people, the street unable to get beyond a very, very a authoritarian system? Well, part of the reason as I point out, as I pointed out just now in in my previous answer, is this rivalry between surgery via and Iran, they’re sort of all consuming a fight for a dominance of the region in which the U S plays often an aggravating a role. But the rivalry which started in 1979, um, has gone on for four decades. It’s a rivalry in which both countries use all tools at their disposal including cultural, religious and social, and it has transformed the region to the extent that we don’t even recognize ourselves because I know the question has been asked before what went wrong. I try to answer it from our perspective in the region, looking at how things have have changed and why and what role each one of these two countries, Iran and Saudi Arabia have played in the unraveling. But you’re right that a lot of the people who have tried to fight back against this black wave of intolerance and the rise of militancy have either gone into exile or have paid with their lives luxury [inaudible], but there are more than 350 million people in the region because I explore also actually there are more because I go from Egypt all the way to Pakistan and I think that when you look at the protests in Iraq today in Lebanon and in Iran, you can see very clearly that people do not want be hostages anymore to the ghosts of 1979 a year. That has changed everything in the region with the rise of political Islam.
AMANPOUR:
Kim Ghattas, thank you so much indeed. Thank you very much. Thanks for her. Now when it comes to the November election in the United States, healthcare is the number one issue for voters in both parties. Paige Winfield Cunningham is a national reporter at the Washington post and she focuses specifically on healthcare policy and despite the healthcare Wars within the democratic party and also between Democrats and the GOP, Cunningham tells our Hari Sreenivasan and that neither party will make major changes to insurance policies.
SREENIVASAN:
Since we’re thinking about Iowa tonight, does someone in say Dubuque have the same access to healthcare as someone in DC?
PAIGE W. CUNNINGHAM:
It’s been almost 10 years since the affordable care act was passed that landmark health care reform law. But there have been some things along the way which is which have actually hindered the law and so we haven’t reached the uninsured rate that we had hoped or that the insured rate that we had hoped for when Congress was passing the law. Um, and so it sort of varies by state. Some States accepted the laws, Medicaid expansion. And so we have a lot of wide variation in terms of health insurance, public health insurance programs that are available for people state by state. Um, certainly the issue has a, uh, is a, is a really important one for Iowa voters. I think it ranks above even removing Trump from office, um, or climate change in terms of what Iowa voters are worried about. Um, and you really have seen that in a lot of the conversations on the campaign trail that the candidates are having,
SREENIVASAN:
That healthcare, healthcare, healthcare, it’s still matters to them. Um, is there, you know, there’s also been a number of stories including from the Washington post on how rural hospitals are suffering in a, in a different way that there’s basically, obviously geography is a problem for if you’re in rural Kansas or rural Iowa, you have to drive farther. But then now if those few hospitals start to close down, you’re really going pretty far if you’re not going across state lines. And that could actually just affect something as simple as an ambulance getting to you.
PAIGE W. CUNNINGHAM:
Absolutely. So that question of healthcare access has really come to the forefront as the candidates have talked about Medicare for all. Yeah, because you’re right, right now in a lot of rural communities, we do have provider shortages. That’s been a problem we’ve had for a long time. Um, but you’ve really seen hospitals mobilize with a lot of other providers against this idea of Medicare for all. And what they’re saying is that because Medicare pays at so much of a lower rate than what the private insurers reimburse for, that if you go to a single payer system where all of a sudden all of their patients are covered under a single government plan, they’re going to be facing big payment cuts. I mean, I think studies have shown Medicare often pays only 50% or even less than what private plans do for inpatient and outpatient procedures. Um, so, but then at the same time, um, our reporters have looked at healthcare systems in other countries that do have more of a single payer type of a system and found that they don’t have those shortages necessarily. If you go to Canada, um, they have a much more expansive system where people have a basic coverage and then they can buy private coverage for supplemental things. Uh, prescription drug coverage and dental, but they sort of have this basic guaranteed coverage. Um, and you know, those reimbursement rates are certainly lower for providers and yet we don’t see those shortages necessarily.
SREENIVASAN:
But where do the candidates now the, the, this at least the top tier candidates stand on this because early on in the campaigns it seemed like everyone was for Medicare for all. Now Bernie Sanders seems to be the only ones still sticking to it because he’s been talking about it for a long, long time.
PAIGE W. CUNNINGHAM:
Right. It was so buzzy last year. I mean, even as a health policy reporter even, I was surprised at how excited and the candidate seemed to be about it. I think a big reason though was because, you know, it was early on in their, in their campaigns, they hadn’t really taken the time to look closely at what do they mean by Medicare for all. So, you know, on one hand, yes you have Bernie, he’s been thinking about this for a really long time. He had initially proposed his Medicare for all bill several years ago and then came out with a second edition, additional version of it. And he’s really spent the time to think about, you know, what services should be covered. You know, should we have copays or deductibles? He’s come out proposing a very, very generous plan. Um, and I think that Democrats really liked his plan initially because it kind of goes to that idea they all embrace, which is universal coverage, bringing the country to a place where everybody has covered. You know, we’re still kind of stuck in this place where 27 million Americans still lack health insurance even after the affordable care act. Right? So how do you get there? And you know, the thing that all these DMS share in common is the idea that everybody should have coverage. But what you saw last year is as the candidates start thinking about what it would look like as they started looking at how the issue pulls among voters and the tough questions that really come up when you talk about a single payer system, a lot of them kind of started softening their approach. Kind of walking it back a little bit, um, to where you’re right now, I think Sanders would be the only candidate who is still really promising that this is something he would try to really accomplish immediately upon becoming president.
SREENIVASAN:
And was what happened to Elizabeth Warren, kind of a cautionary tale for them to say, okay, well here she is. She’s for this idea. Now when she’s pressed on it, she’s not as stridently in support of it as she used to be.
PAIGE W. CUNNINGHAM:
Yeah, I would say I think the candidate that was the more, the most forward thinking or the most, um, foresightful on this was probably, um, mayor P Buddha judge. Um, you know, he had said things very much in favor of Medicare for all, just as mayor before he ever launched his presidential candidacy. But then, you know, last spring you could almost see the wheels turning and he kind of realized that it wasn’t going to be a very tenable position to be in favor of eliminating most people’s coverage. And so he came out with this Medicare for all who wanted option, which is sort of a very clever way of saying let’s have a government plan available to everybody, but the voter gets to choose what they want. Um, Elizabeth Warren has gone a similar direction but in a little bit of a different way and a way that I think is actually you could argue was politically smart where you know, she says she still wants Medicare for all as envisioned by Sanders. This very generous plan. That’s her ultimate goal. But she kind of walked, softened her position a little bit last fall by saying, I’m not going to push for this right out of the gate. What I’m going to try to do initially is just make Medicare available for more people. So people down to age 50 actually, and then introduce a public option plan that people could also buy into. And then once I hit the third year of my presidency, then I’m going to try to go for Medicare for all. So I think she’s, she’s kind of trying to like walk both sides of that, but by positioning herself as not quite as revolutionary as someone like Sanders, but also someone who’s progressive enough that this is where she wants to ultimately go.
HARI SREENIVASAN:
You can promise anything you want when you’re on the campaign trail, but if you don’t have, well if you don’t run the board, if you don’t take the white house, you don’t take the hold the house and you don’t take the Senate, what is the likelihood even of a president Sanders getting this through a Republican controlled Senate?
PAIGE W. CUNNINGHAM:
Yeah. Well, you know, I’ve been covering all of the battles over the affordable care act now for almost a decade and 10 years out. We are, Congress is still not at a point where it can even agree enough to fix things in the ACA or improve the ACA. Of course, it’s looking like Republicans are going to retain control of the Senate and if they do that, I’m a democratic president. Whether it’s Sanders or Biden, um, is probably going to be largely stuck with trying to undo a lot of the policies that the Trump administration has rolled out in terms of Medicaid and different rules around the affordable care act. Um, democratic administration could also work on drug pricing and tried to advance some of those things, but I don’t ultimately see a situation where you have any kind of seismic shift in the insurance programs that are available to Americans or any big shift didn’t really who’s insured or how many people are insured or where their insurance comes from. No, Congress did try to take on a surprise medical billing, drug pricing. What happened to that? Oh, that is a real story. I think of industry influence. Um, you know, last year there was a lot of optimism at the beginning of the year that we were, that was sort of one area of bipartisanship and you saw leaders in both the house and Senate saying, we want to make this happen. We saw a big, you know, a bipartisan, um, drug pricing bill out of the finance committee. We’ve seen a lot of bipartisan work on the surprise billing issue in house committees and there was a lot of talk that some of these provisions would get tacked onto the year end spending bill in December. But there was a huge, huge opposition of course from pharma, which everyone expected to the drug pricing measures. But what was really surprising is on the surprise medical billing issue, um, which everyone thought was going to happen. Um, you saw a lot of these doctors groups, uh, a lot of hospitals actually kind of take sides with insurers over how you would fix this problem and they’re sort of different ways to um, calculate how surprise medical bills would be paid. And the doctors and the hospitals were afraid they were going to get the short end of the stick and the insurers were afraid they were going to get the short end of the stick. And so at the end of the day when the lawmakers were trying to sort of hammer out these specific approaches, there was so much advertising and so much pressure from the industry groups that it all seemed to kind of collapse at the end of the year.
SREENIVASAN:
One of the images that struck me in the past year and a half for the busloads of people going across to Canada to get their medications just because the prices were so different. Right. And that was one of the things that the president said he was going to do is make it possible for you to buy drugs from Canada. Where, where’s that at now?
PAIGE W. CUNNINGHAM:
Yeah. So, um, this is become a real sore point for health and human services. Secretary Alex ASR, he had really wanted to sort of put his Mark on the drug pricing issue, um, and they have just kind of run up against wall after wall. Um, and you know, they came out with several policy proposals that were considered very aggressive, especially for a Republican administration. Um, they were going to try to crack down on these, um, drug rebates that are paid, that sort of convolute the whole system and push list prices up. Uh, they issued a rule requiring drug makers to display the list prices of drugs and television ads. Um, in December, they proposed a rule to allow the importation of some cheaper drugs from Canada. Um, but in many of the cases, not the Canada case, but in many of the other cases, they either had to walk back because of sort of side effects or industry pressures.
They’ve seen some of the things blocked by the courts. And then some other, uh, policies that they had promised haven’t actually come to fruition yet. And so now we’re at a point where, you know, there’s been reports recently that Trump has been really frustrated about the state of affairs and he spent a lot of the last two years promising that drug prices would go down promising to make his Mark on this. And now he’s going into this election year with honestly not very much to show for it. And we saw a lot of drug makers hike prices once again this year. Something they typically do at the beginning of the year. We saw the house Democrats pass a drug pricing bill in December. Uh, but they only got the support of two Republicans for that. And that would have been pretty revolutionary. And allowing the federal government to start directly negotiating prices, much like what happens in other countries. Um, but of course that’s a nonstarter in the Republican led Senate. So it’s a little bit difficult at this point to see where we go from here.
HARI SREENIVASAN:
When we talk about healthcare reformers really kind of seems like two fronts. One is the expansion to cover more people than have it today. And then the other is to really fix the problems with the system that hundreds of millions of people are on. Right. I mean, what’s the administration up to, uh, in terms of either expanding the roles or perhaps even doing the opposite.
PAIGE W. CUNNINGHAM:
Yeah. So, um, what the administration has done and of course they, you know, it should be noted, they very much wanted the affordable care act to be repealed and replaced. Back in 2017 the president had, had talked about promises and even exactly, and even hammered on it last year, even though Congress had really moved on past that and Republicans had indicated they were tired of that effort. Um, so, you know, I, I think the administration has tried to carve out a niche for itself on expanding alternate forms of coverage. So one of their arguments against the affordable care act has been okay, more people have health coverage but it’s not affordable coverage, which there is some truth to that certainly. And so what they’ve done is they have issued regulations expanding access to some of these short term limited duration plans. Um, and also, um, association health plans. Um, Democrats have sort of taken that and run with them and kind of pointed the, pointed the finger and tried to argue that the administration is trying to expand junk plans and all this. So sort of turned into a political issue. But you see president Trump out there sort of making these big bold claims saying that we’ve suddenly fixed Obamacare and made insurance so much more affordable.
PAIGE W. CUNNINGHAM:
And it’s important to keep in mind that while they have made sort of these minor changes, they haven’t made any major changes to sort of the insurance coverage offerings available to people and the cost of that insurance.
HARI SREENIVASAN:
What about the efforts to tie work requirements into Medicaid? That happened kind of on a state by state level in a couple of different places. Where’s the administration on that?
PAIGE W. CUNNINGHAM:
So that’s another big way that the administration is kind of looking to put a more conservative Mark on health insurance. You know, Republicans have been frustrated by the Medicaid program for a long time. They’ve always argued that this is way too expensive for States. And so Sima Varma who’s the head of the centers for Medicare Medicaid services, she actually comes from Indiana where she worked a lot on their program. So two years ago she extended a letter to States inviting them to apply. So the States have to go to the federal government and say, Hey, could we have permission to implement these work requirements? About 10 States have done. So CMS has given permission to all of them to go forward with this. Um, but at this point it’s really turned into a big legal battle because courts have blocked these work requirements in almost every state. You know that the heart of the question here is whether, um, what are the key objectives of the Medicaid program? Um, the obviously the, the fundamental point of Medicaid is to make sure that people who are low income have access to health insurance. What SEMA Verna likes to argue is it should also have the purpose of incentivizing people to find work to get job training to volunteer in their communities. Exactly. So it, she, she sees it as a program that is supposed to help give people a hand up. And so this is so, so this is sort of the fundamental dispute about what is the nature of the Medicaid program and that’s what the courts are considering right now.
HARI SREENIVASAN:
So how does president Trump deal with healthcare on the campaign trail going forward this year? Considering that there are a couple of key things that he promised that he hasn’t been able to do. And there were a couple of things that he kind of has underway.
PAIGE W. CUNNINGHAM:
I can’t overstate how tricky this is for him. Um, you know, when you look back at his campaign in 2016, um, he was writing off of those wins of Obamacare repeal and, and, and this was an issue that voters still believed Republicans would repeal, replace Obamacare and it played really well for Republicans at the time. Now four years later, obviously he hasn’t been able to do that and he hasn’t been able to implement any big changes on drug pricing so far.
PAIGE W. CUNNINGHAM:
And his parties tired of that fight and his party. Yeah. And so Democrats really probably had the upper hand on healthcare issues back in 2018 because they talked about this issue of preexisting condition protections and this lawsuit against the affordable care act. And so the challenge for Trump is going to be to try to flip that script and make sure that he’s not one the one on the defense about healthcare the whole time. So far, I haven’t really seen what his line is gonna be or how he is going to be talking about that. That’s probably partly because the democratic candidates have mostly been going after each other at this point, talking about and arguing about their differences over public auction versus Medicare for all. But I think once we have a democratic nominee, then those, those discussions between him and whoever the nominee is, uh, will probably become clearer and he’ll really have to figure out what is his healthcare message going to be.
HARI SREENIVASAN:
Paige Winfield Cunningham, thanks so much.
PAIGE W. CUNNINGHAM:
Thank you.
AMANPOUR:
And finally, we talked earlier about the middle East where the Syrian war is still raging with more than 3 million civilians trapped on the bombardment in ad-lib the last opposition hold out against the Assad regime. And that is why documentaries like for summer are so important to bring this brutal war back into the public spotlight. It’s an amazing story of love and suffering in war torn Aleppo. Waad Al-Kateab was an ordinary resident there when she picked up her camera as the Arab spring turned her Homeland into rubble. And last night she and her family took home a BAFTA award. That’s the British Academy film award for best documentary. Here’s a clip from the trailer. It is an amazing film and Waad told me this, she made it so that her daughter summer would know that her parents had stayed and hope and fought for a different democratic future in Syria.
WAAD AL-KATEAB:
Every parent’s in Syria and everyone who lived through the first year and two years of the peaceful demonstration we have. That fear is that maybe this is one not to be really reached to the next generation. So in one part of this, I really wanted to tell her about like what we went through, how we started this revolution and why. And it’s not just for a summer for some or for all the other children of Syria, for all the world outside. Really to understand like what we went through as Syrian people. Dream of freedom.
AMANPOUR:
This is incredible storytelling, which has taken everybody who seen it by storm. And we’ll probably go on to win a huge number of awards and we’ll put Syria in everybody’s face again in a very different way. But Assad has won.
WAAD AL-KATEAB:
This is one of the things, I’m sorry for this, but I would like, I would love when someone said like Assad won like he will never ever won. Like if he won, this is Syria now. It’s all like destroyed. Thousands of people are being killed. Thousands of people in there, in this, in his presence. And then now 6 million refugee around the world. Like if I said one, these people all should be back.
AMANPOUR:
You can watch that full interview on our website and “For Sama” is also nominated for an Oscar. And that’s it for our program tonight. Remember, you can follow me and the show on Twitter. Thanks for watching. “Amanpour and Company” on PBS and join us again tomorrow night.