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Analysis, background reports and updates from the PBS NewsHour putting today's news in context.

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    Senator Bernie Sanders (I-VT) speaks during an event to introduce the "Medicare for All Act of 2017" on Capitol Hill in Washington, U.S., September 13, 2017. REUTERS/Yuri Gripas

    Sen. Bernie Sanders, I.Vt., speaks during an event to introduce the “Medicare for All Act of 2017” on Capitol Hill on September 13, 2017. Photo by REUTERS/Yuri Gripas

    In defending his health care plan this week, Sen. Lindsey Graham, R-S.C., called the measure “the only process left available to stop a march toward socialism.” The remark was a boiler-plate Republican critique of the Affordable Care Act. But it was also a nod to the massive political divide over health care policy on display in recent weeks.

    While Republicans built support for Graham-Cassidy, which would gut the health care law and shift federal funding to the states, Sen. Bernie Sanders, I-Vt., introduced the “Medicare for All Act” earlier this month. A growing number of Democrats signed onto the bill, which would expand Medicare and create a universal health care system.

    Obviously, Sanders’ plan stands no chance of passing right now. (It’s unclear if Republicans can pass Graham-Cassidy, especially after Sen. John McCain, R-Ariz, came out against the plan Friday). Still, it’s worth re-examining some of the fundamental flaws of United States’ current health care system — and why adopting a single-payer model makes the most sense.

    To begin with, it’s worth pointing out that the single-payer system is hardly a step towards “socialism,” as Mr. Graham claims. The United Kingdom, Canada and Germany — all countries with different forms of universal health care — are safe bastions of capitalism.

    Secondly, the U.S. has the most inefficient medical system in the world, based on health care spending and outcomes. America spends much more on health care per capita than any other nation in the world and gets less health for it.

    Source: World Health Organization.

    Source: World Health Organization.

    The differences are not trivial at all. The median per capita spending on health care in wealthy countries is $4,700 per year, according to research by the Organisation for Economic Co-operation and Development. (That means that half of the countries spent more than that and half spent less). For instance, Canada‘s spending was just at the level of the median. In contrast, the U.S. spent more than twice as much, at $9,900 for every man, woman and child.If we had Canada’s system we could save no less than $13,600 per average household. That adds up to a walloping $1.7 trillion dollars for the U.S., about as much as last year‘s after-tax profits of all U.S. corporations combined. That’s right: all the profits of J.P.Morgan Chase, Walmart, Apple, Exxon, Facebook and you name it put together. That’s tantamount to highway robbery.

    And what do we get for it? More bureaucracy, more price gouging, more uncertainty, and, most importantly, shorter lives. In 2015, average life expectancy in the United States was 79.3 years, data from the World Health Organization shows. In Canada, it was 82.2 years. That means that Canadian babies can expect to live three years longer than their counterparts born south of the 49th parallel. How much would it be worth to you if you could live three years longer? Probably a large amount. Who cares about what you call the system if it delivers a better product?

    These are not alternative facts. It’s hard evidence pointing to grave inefficiencies in the health care system. So, what causes all this?

    As a country we tend to cling to the misguided belief that all markets are always and everywhere necessarily efficient. This is patently false, however, as the Nobel Prize-winning economist Joseph Stiglitz has pointed out. In the case of the medical system, clinging to an outdated ideology is nothing less than pernicious. Why? Because the medical industry is unique, and we’ve known this for a very long time. As the economist Kenneth Arrow, another Nobel Prize winner, argued as far back as 1963, free markets in health care are inefficient because of the “existence of uncertainty in the incidence of disease and in the efficacy of treatment.”

    Source: Organisation for Economic Co-operation and Development

    Source: Organisation for Economic Co-operation and Development

    In addition, unlike in most other markets, health care lacks serious price competition (price competition being one of the ways in which markets reach efficiency). For example, hospitals do not list prices as we enter the door. When was the last time you shopped around for the lowest-priced x-ray? As a result, the current health care system runs on what’s called asymmetric information. And markets characterised by asymmetric information — where you get services first and find out the cost later — are generally inefficient.

    What’s more, there are perverse incentives built into the current health care system for providers and insurers to increase their prices, and prescribe additional, costly services — like x-rays or MRIs — when they’re not really needed. I’ve experienced that myself.

    The health insurance market has also been hampered by the problem of “adverse selection.” People with the most health care needs have a higher probability of insuring themselves than those who are healthy, which drives up the cost for everyone. (The Affordable Care Act tried to address this issue, with mixed results). For all these reasons and many more, it’s no wonder that the U.S. population has less confidence in its health-care system than people in other advanced industrialized countries.

    Which brings us back to single-payer. I experienced the difference between a single-payer system and the U.S. system when I worked in Germany. And I can tell you that the German system was much simpler, cheaper, and better. The extra insurance I purchased beyond the one provided by the government cost $500 for my family of four. But it meant that we were covered 100 percent for everything, the coverage was worldwide, and it included doctor’s visits, dental work, and hospitalization. We had no copayments or deductibles, and prescriptions cost just $10 each. I did not experience any frustrating moments in the 18 years I worked there.

    Here, in contrast, there is lot of confusion, mistakes, and I usually have to call for an invoice. So the future isn’t Trumpcare — whether it’s the current Graham-Cassidy bill or some future version of it. It’s a single-payer system. The Sanders wing of the Democratic Party is right: it’s time for Americans to repeal Obamacare and adopt a single-payer system like the ones in other developed, capitalist countries like Canada.

    The post Column: Here’s what’s wrong with the U.S. health care system appeared first on PBS NewsHour.


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    A voter casts his ballot at the Tippecanoe Library during voting for the Wisconsin U.S. presidential primary election in Milwaukee April 5, 2016. REUTERS/Kamil Krzaczynski - RTSDPOO

    The federal government is telling election officials in 21 states that hackers targeted their systems last year, although in most cases the systems were not breached. Photo by REUTERS/Kamil Krzaczynski.

    The federal government on Friday told election officials in 21 states that hackers targeted their systems last year, although in most cases the systems were not breached.

    The government told The Associated Press last year that more than 20 states were targeted by hackers believed to be Russian agents before the 2016 elections. But for many states, the calls Friday from the Department of Homeland Security were the first official confirmation of whether their states were on the list.

    The AP contacted every state election office on Friday. While not all of them responded immediately, those that said they were targeted were Alabama, Arizona, Colorado, Connecticut, Illinois, Iowa, Maryland, Minnesota, Ohio, Oklahoma, Pennsylvania, Virginia, Washington and Wisconsin.

    The government did not say who was behind the hacking attempts or provide details about what had been sought. But election officials in three states said Friday the attempts could be linked to Russia.

    The Wisconsin Election Commission, for example, said the state’s systems were targeted by “Russian government cyber actors.”

    MORE: How Russia hacked American faith in the democratic process

    Federal officials said that in most of the 21 states, the targeting was preparatory activity such as scanning computer systems. The targets included voter registration systems but not vote tallying software. Officials said there were some attempts to compromise networks but most were unsuccessful.

    Only Illinois reported that hackers had succeeded in breaching its voter systems.

    Colorado said the hacking wasn’t quite a breach.

    “It’s really reconnaissance by a bad guy to try and figure out how we would break into your computer,” said Trevor Timmons, a spokesman for the Colorado secretary of state’s office. “It’s not an attack. I wouldn’t call it a probe. It’s not a breach, it’s not a penetration.”

    Virginia U.S. Sen. Mark Warner is praising the federal government’s notification but says it should have come sooner.

    The Democrat says it’s unacceptable it took almost a year after the presidential election to notify states their elections systems were targeted. He says he’s relieved the Department of Homeland Security is finally informing the top elections officials in all 21 affected states “that Russian hackers tried to breach their systems in the run up to the 2016 election.”

    The disclosure to the states comes as a special counsel probes whether there was any coordination during the 2016 presidential campaign between Russia and associates of Donald Trump.

    Trump, a Republican who defeated Democrat Hillary Clinton in the presidential election, has called the Russia story a hoax. He says Russian President Vladimir Putin “vehemently denied” the conclusions of American intelligence agencies.

    The post Hackers targeted election systems in 21 states, federal government says appeared first on PBS NewsHour.


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    The federal government plans to shut down Healthcare.gov on all but one Sunday morning during open enrollment for the Affordable Care Act, according to Department of Health and Human Services materials first reported by Kaiser Health News.

    HHS made the announcement during a webinar training session with assisters who help enrollees sign up for individual plans, Kaiser Health News reporter Phil Galewitz Friday.

    HHS regularly schedules maintenance outages for Healthcare.gov during open enrollment period, according to a spokesperson from the Centers for Medicare & Medicaid Service. The spokesperson said the schedule was provided earlier this year “to accommodate requests from certified application assisters.”

    “System downtime is planned for the lowest-traffic time periods on HealthCare.gov including Sunday evenings and overnight,” the spokesperson said in a written statement to the NewsHour.

    The department has already planned to shorten open enrollment season by 45 days — running from Nov. 1 to Dec. 15, 2017 for 2018 coverage. During the previous enrollment period, people had twice as much time to enroll for individual health insurance.

    Linda Blumberg, a senior fellow at the Urban Institute, said this decision for reduced hours on top of that hurts people with inflexible work schedules and limited access to Internet and services.

    “That’s the height of irresponsibility,” Blumberg said. “It’s just one more thing to create difficulty for people to be able to access the insurers they need through the law as it was written.”

    As Congress continues to struggle to pass legislation that would repeal and replace the Affordable Care Act, Trump has suggested he would “let Obamacare fail.”

    “We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it,” he said after the Senate’s last failed attempt in July.

    Advocates and policy experts say the administration has since taken steps that chip away at the law. In July, the Trump administration decided to end assistance contracts with 18 cities, decreasing the amount of help available to people who may have questions while signing up for health insurance.

    Neglect — through things like shedding staff for the exchanges or stop paying for marketing billboards or radio ads to remind people to sign up before the enrollment deadline — is one of the easiest ways to do that, experts said.

    Reduced outreach could contribute to fewer new enrollees for health insurance exchanges but also a drop in beneficiaries for Medicaid, children’s health insurance programs and more because people often find out they’re eligible for multiple services when applying for one.

    Most people window shop for their individual insurance plans and don’t purchase until the last minute, said Thomas Miller, a research fellow with the American Enterprise Institute. But HHS should be transparent about why these website updates are a good thing, he said.

    “You need to go out of your way to explain how this is actually going to be helpful rather than feed into suspicions that will just derail the process” of scaling back Obamacare, Miller said.

    The post Obamacare signup site to be shut down for 12 hours nearly every Sunday of open enrollment appeared first on PBS NewsHour.


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    The plesiosaur is long extinct, but thanks to a biomechanical engineer, it has been reincarnated — as a robot. This new so-called “robosaur” reveals the secret behind the animal’s odd but powerful swimming style, which could inspire alternatives to boat and submarine propellers.

    Scientists have speculated over the swimming ability of plesiosaurs for decades. Long-necked and round-bodied, the plesiosaur lived 203 million years ago during the age of dinosaurs, but it was a marine reptile, more closely related to lizards and snakes.

    “There has been no other animal that swims like this, ever,” Luke Muscutt, a biomechanical engineer at the University of Southampton in the U.K., told NewsHour. A fish propels itself by swishing its tail side to side, while a dolphin flaps its tail up and down. But the plesiosaur is the only known animal that swam with four nearly identical flippers.

    A plesiosaur skeleton model on display in the American Museum of Natural History in New York. Photo by American Museum of Natural History/M. Shanley

    A plesiosaur skeleton model on display in the American Museum of Natural History in New York. Photo by American Museum of Natural History/M. Shanley

    Early work in the 1920s argued the plesiosaur’s four flippers moved like oars, in a simultaneous rowing motion. But other scientists posited that plesiosaurs sliced through the water like penguins, using an up-and-down flapping motion for their flippers. Sea turtles and sea lions also have four aquatic limbs, but they differ in shape and purpose. The front flippers create thrust, while the back flippers steer.

    So, after digging for clues in fossil records and X-rays of existing animals, Muscutt tried to deduce the shape and motion of the plesiosaur flipper. He used a 3D printer to create four flippers and then attached them to a mechanical body so he could fine tune their motion inside a water tank. The team programmed the robot to flap in a range of patterns, speeds and angles while using a sensor to measure thrust and efficiency.

    “They had a nice method of looking at the full shape of these flippers,” said Georgia Institute of Technology computer scientist Greg Turk, who made a computer model of plesiosaur swimming behavior in 2015. With only plesiosaur bones as a reference, Muscutt studied modern-day animals to guess the flipper’s dimensions beyond the bone, said Turk, who wasn’t involved in the study.

    Turk’s model predicted that the plesiosaur’s front flippers dominated its swimming style, but he said that Muscutt’s robotic plesiosaur outperforms their predictions. By adding colorful dyes to the water to observe the flow over the robotic flippers, Turk said Mucutt’s experiments offer a more precise picture of the plesiosaur’s fluid dynamics than a computer model.

    Colorful dyes helped the scientists observe water flow over the robotic flippers. Photo by Luke Muscutt

    Colorful dyes helped the scientists observe water flow over the robotic flippers. Photo by Luke Muscutt

    Unlike the sea turtle’s flippers, which steer or propel, Muscutt found that the plesiosaur robot uses all four flippers to power through the water. The biggest thrust didn’t come from the front or rear flippers alone, but through a harmonious combination of both, Muscutt said of his study published in Proceedings of the Royal Society B.

    The key was the front flipper’s wake. As a single plesiosaur flipper moves up and down, it creates a vortex — a mini whirlpool that moves backward behind the flipper. When timed right, the plesiosaurs’ hind limbs get a boost from the fore flippers’ wake. The process is similar to geese flying in a V pattern. The lagging birds ride the air lifts from the ones ahead of them.

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    Muscutt found the back flippers’ performance while in the wake of the front flippers increased by 60 percent in thrust and by 40 percent in efficiency

    This finding argues that the plesiosaur’s back flippers were not just for steering. By grabbing wake energy, they played a role in propulsion.

    “Engineers spend their whole life trying to increase the performance of a wing on a plane, for example, by 3 percent. But an increase of 60 percent is a huge amount in engineering,” Muscutt said. He added that today, designing an efficient flipper for an underwater vehicle from scratch would be a large undertaking. But understanding plesiosaurs’ locomotion could generate new technology that makes underwater vehicles quieter, faster and more nimble.

    Any aquatic vehicle that has a propeller is fair game for being replaced by flapping wings, Muscutt said. He is already working on a submarine that could model the plesiosaurs’ unique underwater flight.

    The post The odd swimming style of plesiosaurs decoded by a robot appeared first on PBS NewsHour.


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    JUDY WOODRUFF: Now a look at some must-reads for this fall.

    Jeffrey Brown has this special edition of the NewsHour Bookshelf.

    JEFFREY BROWN: And this time, we’re turning for recommendations to two authors with new or recent books.

    Louise Penny is the author of the popular murder mystery series featuring the Quebec chief inspector of police, Armand Gamache. The latest installment, “Glass Houses” was published earlier this month. And Pamela Paul oversees book coverage at The New York Times and is editor of its Book Review. Her latest work is “My Life With Bob,” a book about the many books in her life.

    And thank you both for joining us.

    And, actually, I want to start with a quick question about the books in your life.

    Louise, what kind of reader are you, and how do you pick what you’re going to read next?

    LOUISE PENNY, Author, “Glass Houses”: I read everything.

    But, you know, the only sadness in my life now is that I can’t read crime novels anymore, even though I love them.

    JEFFREY BROWN: Why?

    LOUISE PENNY: Because, if I read a great crime novel, that’s the only book I want to write now, is the book I have just read. If I read a really bad one, I’m just all upset.

    And part of my brain is always turned on, of course, trying to figure out how it worked.

    JEFFREY BROWN: Pamela, I know you get millions of books being sent to you every day, so how do you pick what you’re going to read?

    PAMELA PAUL, Author, “My Life With Bob”: Well, there’s work reading and there’s fun reading.

    And I’m going to focus on the fun reading. I always admire the single-minded dedication of like the hard-core detective novel reader who will just read every single novel in a series or by an author.

    But I’m like Louise. I’m really omnivorous. And, for me, deciding what book to read next is really a question of mood. It’s almost like, on a gut level, I need to read something, and I have to figure out what that book is.

    And if I try to read something that’s not, that doesn’t sort of match that mood, it doesn’t work, it doesn’t take, and I end up putting it down.

    JEFFREY BROWN: OK.

    Our category is new or soon-to-come books, fall books.

    Louise, you start.

    Let’s take a couple of nonfiction books.

    LOUISE PENNY: All right, my first choice is Toni Morrison, because I would read anything by Toni Morrison, of course. If she wrote cereal boxes, I would collect them.

    “The Origin of Others,” which is a collection of essays, and the theme is race. It’s about belonging, our yearning to belong, about community, about why race matters even, and how we came up with the concept of other, us and them, and why is it that, once we had come up with that concept are we predisposed to look at the other with suspicion.

    So, that’s my first pick.

    The second one is Daniel Mendelsohn. And his book is called “An Odyssey.” He is a critic, a reviewer, but he also teaches an undergrad course in Homer’s The Odyssey.

    JEFFREY BROWN: Right.

    LOUISE PENNY: And his father, 81-year-old mathematician, joined one of his courses. And so it’s really an odyssey into literature, but also into their relationship. So I’m dying to read that one as well.

    JEFFREY BROWN: Pamela Paul, what are you — start with nonfiction for you too.

    PAMELA PAUL: Sure.

    Well, I have spent the entire summer, really actually the entire year, doing escape reading. And I think fall is a great time to reengage. And, luckily, there are a lot of books, a number of books that really try to take on serious topics that have been in the news, the cultural news, political news, social headlines, and to delve a lot deeper than the Twitter feeds and headlines have been able to do.

    So, a couple that I’m really interested in are Franklin Foer’s new book, which is called “World Without Mind: The Existential Threat of Big Tech.”

    Frank Foer was the editor of The New Republic until shortly after it was purchased by Chris Hughes, formerly of Facebook. There was a sort of major falling out between them.

    But what he does in this book is not just write a memoir about that experience, but really takes on the issue of how technology has sort of infiltrated journalism, the media and really our daily lives, and what some of the negative impacts of that, those changes are. So I think that’s one.

    Another book I’m recommending is Mark Lilla’s “The Once and Future Liberal,” which is a controversial book. Again, you might not agree with all of it, but it’s about identity politics. And it’s interesting to read that along, I think, together with Ta-Nehisi’s forthcoming book, which is called “We Were Eight Years in Power,” which is a lot of the work that he’s done in “The Atlantic,” but it’s his first big book since “Between the World and Me.”

    And I think, together, these books take on the issues of identity, race, class, and also electoral politics.

    JEFFREY BROWN: OK. There’s four coming books in nonfiction.

    Now, Louise, a novel.

    LOUISE PENNY: All right.

    “Happiness.” This is a Canadian one. It is by Will Ferguson.

    JEFFREY BROWN: Which you couldn’t resist?

    LOUISE PENNY: I couldn’t resist. I know. And you didn’t necessarily ask. And it’s an older one, too. I have to admit that.

    JEFFREY BROWN: All right, we’re breaking the rules.

    LOUISE PENNY: We are. I’m going rogue here.

    JEFFREY BROWN: OK.

    LOUISE PENNY: I read a lot. I know how cruel the world is. And I read a lot to just — to feel good about it, as Auden said, that goodness exists.

    So, “Happiness” is a hilarious book about a self-help book that actually works.

    JEFFREY BROWN: We should say the author.

    LOUISE PENNY: Oh, I’m sorry, Will Ferguson, of course, Will Ferguson.

    JEFFREY BROWN: Yes.

    LOUISE PENNY: This book is put out there. And it works. But everybody’s emotional ills are actually healed and everyone becomes happy, except for the publisher, who’s thrilled how many books are being sold, but he’s a cynic. And he’s trying to figure out who wrote the book and why it works.

    It is — I highly recommend it.

    JEFFREY BROWN: One other quick new novel?

    LOUISE PENNY: All right.

    This is by Ayobami Adebayo. And it’s called “Stay With Me.” She’s 29 years old. It’s a debut. She’s a Nigerian. And it is big-hearted. It’s lush. It’s an exploration of a marriage that starts out loving, begins to have a problem when she can’t get pregnant. A second wife is brought in. She gets pregnant, and then all sorts of family secrets are brought out.

    But I love the fact that it is so big-hearted. So, again, it goes in with the happiness thing.

    JEFFREY BROWN: All right, Pamela Paul, for fiction, you’re going happy or tragic on us?

    PAMELA PAUL: No.

    It is another book that I think really grapples with contemporary issues. And that’s Jesmyn Ward’s “Sing, Unburied, Sing.”

    And Jesmyn, I don’t know, I feel like she can do anything. Her first novel was “Salvage the Bones.” And this is her latest novel. They all take place in a fictional town called Bois Sauvage in Mississippi, where Jesmyn Ward lives and where her family is from.

    It’s a bit timely and sort of post-Katrina novels. This is about sort of the people who are left behind and the people who stay behind and why and what their lives are like. And it’s about race. It’s about class.

    She has been compared to William Faulkner, Toni Morrison and Herman Melville in the reviews of this latest book. And while I think she is her own voice, those aren’t terrible people to be compared with.

    JEFFREY BROWN: No, they certainly are not.

    Pamela, let me give you one more, any category you want.

    PAMELA PAUL: All right.

    Well, this is — this is about fiction, but its nonfiction. And that is Bruce Handy’s book “Wild Things,” which is about the joys of reading children’s books as an adult.

    JEFFREY BROWN: Oh, yes.

    PAMELA PAUL: And I am a huge fan of children’s books. And I do think that you read them in a different way as a child, and then you read them in a different way with your children. And then, if you read them on your own, you also see in them different things.

    And I think one of the things that he makes clear in his book is that the children’s — children’s literature is really — that’s when we become readers. And those stories really stay with us. And the themes that they raise, whether it’s Maurice Sendak’s books, or “The Chronicles of Narnia,” or “Little House on the Prairie,” those are stories that really stay with us for life.

    And he explores why that is and really just the joy of reading them again.

    JEFFREY BROWN: OK, eight books to get our readers started. And we’re going to have more online.

    For now, Pamela Paul, Louise Penny, thank you both very much.

    LOUISE PENNY: Thank you.

    PAMELA PAUL: Thanks so much.

    Here’s the full list:

    The post Great books to fall for now that summer’s over appeared first on PBS NewsHour.


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    JUDY WOODRUFF: But let’s go right now to Shields and Brooks. That’s syndicated columnist Mark Shields, as you just saw, and New York Times columnist David Brooks.

    The only thing better than seeing you guys once is seeing you guys twice, three times.

    MARK SHIELDS, Syndicated Columnist: Just a great…

    (LAUGHTER)

    JUDY WOODRUFF: So, the health care story.

    David, the Senate Republicans have been trying to so hard to once again resurrect an effort to repeal Obamacare. They thought they were getting — or at least they sounded like they were getting somewhere.

    But, today, John McCain throws down the red flag, says he’s not voting for it. Where does this leave all this?

    DAVID BROOKS, The New York Times: It’s pretty grim. Francisco Franco is still dead, to quote that old “Saturday Night Live” joke.

    (LAUGHTER)

    DAVID BROOKS: It’s — I should say, first of all, there is nothing intrinsically wrong with having state flexibility and sending the health care thing back to the states. We’re a diverse country. We might profit from different systems.

    And there is nothing wrong with reducing the rate of increase in the cost, the amount we spend on health care. We would spend a lot more than other countries. Personally, I would be happy if we spend a little less on health care and a little more on education.

    But the way the Republicans have done this yet again is without a deliberate process in a way that seems to have magically offended every single person outside the U.S. Capitol Building, no matter what party, and in a way that raises anxiety on every single level.

    And so, it’s very easy for John McCain to say, you haven’t followed regular order, you haven’t worked with Democrats, you haven’t held hearings, and so I’m going to be against this thing.

    And that’s him being very consistent with the way he’s been over the past several months. And one would have to suspect that Susan Collins and Lisa Murkowski will follow suit. And, therefore, it’s down the tubes.

    JUDY WOODRUFF: What does it look like to you?

    MARK SHIELDS: I hate to say that I agree with David, but I agree with David.

    And I would just add this. It’s no accident, Judy, that the Republicans find themselves in this position. It’s really since the retirement of John Chafee of Rhode Island in 1999 or David Durenberger from Minnesota in 1995 that there’s been any Republican senator who has any earned credentials or any deserved reputation for working on health care.

    They have just been an against party. That’s all. So, who’s the sponsor of this? Lindsey Graham. I happen to like Lindsey Graham. Lindsey Graham’s credentials, military, national defense. He’s worked bipartisan on global warming, campaign finance.

    Is there a — Lindsey Graham on health care? And Bill Cassidy, who got to the Senate a year ago, not exactly a long-toothed, long-term legislator.

    I mean, all they have succeeded in doing this year is taking the Affordable, which had always been controversial and never had majority support, and now has majority support in the country. And they have convinced voters that Democrats care much more about health care than they do.

    And Democrats had an advantage. They believe in Medicare and Medicaid. They believe in federal action. There is no coherent Republican organizing principle or philosophy about health care. Everybody should have it, and it should be private.

    It’s an abstraction. It doesn’t work in the real world. And voters have concluded it doesn’t. And Pat Roberts, to his credit, the senior senator from Kansas, said, this is not the best bill possible. It’s the best possible bill. And this is the last stage out of Dodge. Because of the quirky rules of the Senate, they need 50 votes until the 30th of September, when the fiscal year ends.

    JUDY WOODRUFF: Yes.

    MARK SHIELDS: After that, it’s 60. So, they’re trying to pass something. And they won’t.

    JUDY WOODRUFF: It’s a tough moment for Republicans.

    DAVID BROOKS: They’re caught with a divide.

    I do think there is a defensible case that an intelligent market-based system could reduce — cause efficiencies. There’s models around the world that Republicans and conservative policy wonks can get to, to point to that.

    But if you are going to get people to entertain the idea of some sort of reform, you have to give them universal coverage. We’re at the point where even a lot of conservative health care economists think, if we give them universal coverage, if your get your preexisting, you’re going to have coverage, then we can work on the reforms.

    But the Republican Party and the Republican Congress — congressional party is basically out of touch with their voters. Their voters are not libertarians. Their voters are insecure economically and want some security. And Medicaid and Medicare and even now Obamacare offers some of them security. And they will not support their own Republican Party when it takes that away.

    JUDY WOODRUFF: Well, while we’re talking about Senate Republicans, President Trump, Mark, is headed to Alabama tonight to campaign for the man he endorsed in that runoff Senate election down there, Luther Strange. He’s the appointed senator.

    What’s made this race so interesting is, the man he’s running against is Roy Moore, the state chief justice, who made a name for himself by trying to get the Ten Commandments publicly displayed in the state capitol building.

    This is a race that probably otherwise wouldn’t be getting a lot of attention, but Roy Moore is now ahead in the polls. And, last night, I want to show everybody just a clip from the debate that Moore and Strange had last night, because Trump’s name was front and center.

    Let’s listen.

    SEN. LUTHER STRANGE, R-Ala.: I know you may get tired of hearing this, and you may resent that the president is my friend and is supporting me in this race.

    But I think it’s a good thing that the president of the United States has a personal relationship with the junior senator from Alabama.

    ROY MOORE, Republican Senate Candidate: The problem is, President Trump’s being cut off in his office. He’s being redirected by people like McConnell, who do not support his agenda, who will not support his agenda in the future.

    SEN. LUTHER STRANGE: And to suggest that the president of the United States, the head of the free world, a man who is changing the world, is being manipulated by Mitch McConnell is insulting to the president. That’s why he’s chosen me.

    JUDY WOODRUFF: Mark, what does this tell us about the Republican — the state of play among Republicans in the Senate right now?

    MARK SHIELDS: Well, first of all, Judy, we must understand this.

    Alabama, Donald Trump’s sixth best state in public polling. He’s the most popular there. A leading Republican campaign manager who’s deeply involved in this race on behalf of Strange, or at least on the side supporting Luther Strange, told me they will spend, they being Mitch McConnell’s Senate leadership fund, political action committee, the Chamber of Commerce of the United States and the National Rifle Association, over $12 million on behalf of Strange against Roy Moore.

    What it tells me is, Luther Strange is presenting himself as Donald Trump’s new best friend, and that Roy Moore is running as: I am the real Trump candidate. I’m going to go to Washington and let Donald Trump be Donald Trump.

    He’s trying to make it a referendum on Mitch McConnell, who this week in The Wall Street Journal/NBC poll was at his all-time low, 11 percent favorable. And so I think what Strange’s side is counting on is Donald Trump, the president, going there to Alabama and convincing Trump voters, who are more comfortable with Roy Moore, to vote for Luther Strange.

    JUDY WOODRUFF: Meanwhile, the president’s poll numbers, David, have ticked up a few points in the last week or two.

    DAVID BROOKS: Yes, because he’s done something with the Democrats, and bipartisanship is popular. So, he gets ticked up on there.

    But, in Alabama, the revolution devours its own. He ran as the anti-Washington candidate, Trump, Donald Trump did, got to Washington, and has to play a little by some Washington rules, which is supporting guys in the Senate who are supporting you. So, he’s supporting Strange.

    Roy Moore is a Trumpian before — of the letter, as they say, before Trump, and a guy who made his name on the Ten Commandments, on some gay marriage issues. It’s Alabama. And so he’s saying: I’m actually the Trumpian.

    And so what — I think what we see for the Republican Party is that this populist tide is not ebbing. If Moore wins, then there are some signs — Alabama is unique, Moore is unique — but there are some signs the party is still getting more populist.

    And that’s caused by two things. First, as Mark said, McConnell is still the enemy for a lot of Republicans. The Washington Republican establishment is still more than ever. And the things that fueled the populist rise, rise of the opioid crisis, the decimation of the economy, the white identity issues, all those things are still rising, not ebbing.

    And so the populism that Trump tapped into might be getting more extreme.

    JUDY WOODRUFF: So, turning quickly from populism to foreign policy, Mark, the president made his debut, first big speech before the United Nations General Assembly this week, and notable because he came out and said, basically, we will destroy North Korea if they make a wrong move.

    Does he come away looking more like a statesman? He’s followed that with days of squabbling, in effect, with Kim Jong-un, the leader of North Korea. How do we — how do we now look upon President Trump as somebody who’s leading foreign policy?

    MARK SHIELDS: An embarrassment.

    I mean, you compare the words of presidents in the past, measured, you know, John Kennedy in Berlin, wherever free men live, to come to Berlin, they are citizens of Berlin, ich bin ein Berliner.

    Or Donald — Ronald Reagan, Mr. Gorbachev, open this gate, tear down this wall.

    They were expressing principle. They were expressing coherently and lucidly and compellingly. And there was a sense of pride in the national direction.

    That was totally missing. I gave him a B for bombast and bullying and belligerence. You know, it was a — it wasn’t a speech in which Americans could take pride or direction or comfort.

    DAVID BROOKS: Yes, I don’t mind a little tough talk. When Reagan called the Soviet Union the evil empire, he was telling the truth, and that’s fine.

    The problem with Donald Trump’s — with the rhetoric there is that it’s self-destructive. First of all, it may put the North Koreans in a corner, where they can’t back down because of their own psychic needs. And it creates a context in which North Korea can test whatever they want to do apparently in the atmosphere, where — and then, weirdly, against North Korea, somehow, suddenly, we look like the bad guys.

    And that’s the interesting thing about the speech, was so nationalistic.

    MARK SHIELDS: Yes.

    DAVID BROOKS: If you’re the country who is the top dog in the world, which we are, you need international organizations and alliances as a way to extend your power. And if you take that away, you are diminishing your own self.

    And so his nationalistic pose makes sense if you’re Vladimir Putin, if you’re a second-rate power. But if you’re a top-rate power, it’s a self-destructive thing. And we see it here, where we actually end up having less leverage, rather than more.

    JUDY WOODRUFF: So, Mark, what do we look for in the weeks to come, because, right now, it’s just a war — it is literally a war of words.

    MARK SHIELDS: Yes.

    JUDY WOODRUFF: A lot of people are out there listening to this, thinking, are we going to go to war?

    MARK SHIELDS: I certainly pray not. I hope not.

    I take some comfort, quite frankly, as a citizen, in your interview with Tim Kaine, the senator from Virginia, who said that he, who had been — not hesitated to criticize President Trump’s policies, had great confidence in the defense team of chief of staff…

    JUDY WOODRUFF: Defense secretary.

    MARK SHIELDS: General — chief — I’m sorry — of Secretary Mattis, General Mattis, and General McMaster and General Joe Dunford, chairman of the Joint Chiefs of Staff.

    I mean, they are — they provide him direct — confidence and direction and maturity. And that’s our best hope.

    JUDY WOODRUFF: So, he’s surrounded by people who are getting some high marks, some of them, David.

    DAVID BROOKS: Yes, he’s got very good people.

    But I have been watching the Vietnam series on PBS. And countries can do really stupid things. And the veneer of civilization sometimes gets slender.

    World War I, there were a lot of very talented diplomats and world leaders at that time, but events just spun out of control. So I don’t think we’re going to go to war. I still think there’s some reason on both sides.

    But you look at the realm of history and you have a little cause for concern.

    JUDY WOODRUFF: Yes, and watching the Vietnam series, which is a superb series — for any of us who haven’t started watching, you can do that.

    All right, David Brooks, Mark Shields, thank you both.

    MARK SHIELDS: Thank you, Judy.

    SUBSCRIBE: Get the analysis of Mark Shields and David Brooks delivered to your inbox every week.

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    JUDY WOODRUFF: As we reported earlier, Senator John McCain’s announcement that he will not vote for the Graham-Cassidy Republican health care bill tosses the fate of current Obamacare repeal efforts into serious doubt.

    We look at what all this could mean, and at a couple other issues, with Senator Tim Kaine, Democrat from Virginia, who was his party’s vice presidential nominee last year.

    Senator Tim Kaine, thank you for talking with us.

    Let’s talk health care first. Senator John McCain’s announcement today that he will not vote for the latest Republican effort to overhaul Obamacare, the Graham-Cassidy bill, is this the death knell for that proposal?

    SEN. TIM KAINE, D-Va.: Judy, I wouldn’t call it that.

    Until we get to the end of next week, we have to be very diligent and defeat efforts to repeal the Affordable Care Act and, instead, force it back in to the bipartisan discussion that my committee, the Health, Education, Labor and Pension Committee, under the leadership of Senators Alexander and Senators Murray, were having.

    We owe it to the American public to improve health insurance and health care, but we have got to do it, I think, in a bipartisan way. We were doing it. We were very, very close to a bipartisan deal to stabilize the individual insurance market going forward. But the president and the speaker and Leader McConnell kind of blew that effort up, at least temporarily, this week.

    So we have to defeat Graham-Cassidy, and my hope is, as Senator McCain indicated today, then we will get back to doing it the way we should, which is, in an albeit Republican Senate, but have full discussions in committee with amendments and full debate on the floor.

    We shouldn’t jam something through on health care at the 11th hour that affects the most important expenditure of anybody’s life and one-sixth of the American economy.

    JUDY WOODRUFF: Well, two other questions on that, because one of the arguments Republicans were making to advocate for this proposal was that states need more flexibility in how they spend their health care dollars.

    And, in fact, there’s a Kaiser Foundation study out saying Virginia, your state, would have received something like $4 billion more under this proposal.

    Isn’t that — you’re a former governor. Why doesn’t that make sense?

    SEN. TIM KAINE: Well, because it’s — the reasoning is true. States need more flexibility. But the Graham-Cassidy bill is being sold as states need more flexibility, but, Judy, every one of the 50 state Medicaid directors said this would be a horrible idea.

    They said you can’t do something like this with no CBO score and people not knowing the consequences, and you shouldn’t be cutting this much out of Medicaid.

    And then, second, as for, did Virginia benefit, we didn’t benefit, if you look at the entire 141 pages of Graham-Cassidy. There is, in the early years, a slight uptick. If you block grant the Affordable Care Act money to Virginia, there is a slight uptick in that. But then the moneys go away completely.

    So we get a little bit of an uptick in the short-term.

    JUDY WOODRUFF: Right.

    SEN. TIM KAINE: Then all the money goes away.

    But the real sucker punch for Virginia is this. Separately from repealing the Affordable Care Act, Graham-Cassidy act goes into the base Medicaid program, didn’t have anything to do with Obamacare, was there before Obamacare, and they cap it and they take $120 billion out of it over the next 10 years.

    In Virginia Medicaid recipients, nearly 60 percent of them are children. And they would have been badly hurt by this piece of Medicaid. So, if you look at the whole bill, Virginia gets hurt. And that’s why our governor and our Medicaid director are against it.

    JUDY WOODRUFF: Senator, several other things I want to ask you about. So, I’m going to move through this quickly, but still on health care.

    You say what’s needed is a bipartisan approach. But Senator Bernie Sanders, a number of your Democratic colleagues this past week, came out in favor of a Medicaid — Medicare expansion bill that really didn’t have the earmarks of bipartisanship.

    Isn’t the Sanders proposal that many of your Democratic colleagues signed on to — that is not a bipartisan approach. So how does that move you in the direction of something that’s going to win approval?

    SEN. TIM KAINE: Well, let me tell you, Judy, about Bernie Sanders’ proposal. He put an idea out on the table, yes, with Democratic co-sponsors.

    He didn’t say vote on it immediately. He didn’t say, I want a vote before the CBO scores it. Bernie’s a member of the Health Committee with me. He’s putting an idea on the table.

    Graham-Cassidy’s an idea. Fine. It’s on the table. Bernie’s got one. It’s on the table. I would like there to be a publicly offered insurance policy that any individual could buy, if they chose, more choices, rather than less. That’s on the table.

    But the way to legislate is to first stabilize the market. And we can do that in a bipartisan way. And then, once we have stabilized it, we can, with care and deliberation that is warranted, given the seriousness of health and health care to regular people, we can consider the ideas and possibly find concepts from a number of proposal that we can put together to help Americans.

    So, putting ideas on the table is fine, but don’t try to jam them through and hurt people with no score, no debate, no amendment, no meaningful opportunity for the public to participate.

    JUDY WOODRUFF: Senator, just quickly now, wearing your hat as a member of both the Foreign Affairs Committee and the Armed Services Committees in the Senate, what is your assessment of the heightened tensions between the United States and North Korea this week, with President Trump calling Kim Jong-un, leader of North Korea, a madman, President Kim, the leader, Kim, in turn calling President Trump deranged?

    What is the state of these relations? How worried should Americans be?

    SEN. TIM KAINE: Well, it’s very troubling.

    I will say, I am a fairly frequent critic of President Trump, but I do think the national security team that he has, after a lot of bad people were chased out, is actually now a very solid team. There’s no good military option here, but we have got a good military team that is looking at what we need to do to keep the country safe.

    However, even the secretary of defense, Secretary Mattis, says over and over again that, we’re diplomacy first, we’re never out of diplomatic options.

    And what the president shouldn’t do is poison the diplomatic well. Big rhetoric, calling names, that starts to poison the well. And the president is even contemplating backing the United States out of a nuclear deal with Iran.

    If he does that, when the IAEA and other nations say that Iran is complying with the deal, there is no chance North Korea would do a diplomatic deal with the United States if they felt certain that the U.S. would back out of the deal and not follow it.

    JUDY WOODRUFF: Senator Tim Kaine, we thank you very much.

    SEN. TIM KAINE: Absolutely.

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    JUDY WOODRUFF: As we reported earlier, the death toll in Tuesday’s earthquake in Mexico neared 300 today, as rain hampered rescue efforts in the capital, Mexico City.

    In a moment, William Brangham will have a look at how the city has sought to harden itself since the last big quake in 1985.

    But, first, William joins me again tonight from Mexico City.

    So, William, what can you tell me about the rescue efforts of people who reportedly are supposed to be trapped in that office building behind where you are?

    WILLIAM BRANGHAM: Yes, Judy, it is a really extraordinary story that has given people here a lot of hope.

    Using a whole series of very high-tech technology, thermal cameras, motion detectors, apparently, even an Israeli piece of equipment and an Israeli team that was able to zero in on cell phones, they believe that they have found six, at least six people in that office building behind me that are trapped there. And they are all believed to still be alive.

    The family members of the missing are camped out just a few yards away from over this way. They have been told, and they are telling the press that food and water has been able to be sent to the people that are trapped there. But efforts are under way right now to try to get them out.

    JUDY WOODRUFF: Well, I know that finding out they’re there is one thing, but getting them out in time is something else altogether. What are you hearing about the prospects?

    WILLIAM BRANGHAM: Well, that’s absolutely right. It’s obviously a race against time.

    Rescuers have said that they think that they have got nine different access points that they can use to access where they are. And so they are slowly working their way into it.

    The tricky part is, is that’s a very fragile building behind me. And, as you can see, unlike a lot of the other sites that we visited here, it’s not swarming with people. It’s just a few people up there, because they’re worried about collapsing the structure.

    But the idea is, if they can get through one of these access points, they might be able to reach those people inside.

    JUDY WOODRUFF: So, William, this is still an active rescue site, but I understand, at a number of other sites, they have stopped the searching.

    WILLIAM BRANGHAM: Yes, that’s right.

    The Mexican president today said that of the 38 sites that used to be rescue operations, only 10 of them remain active rescue operations.

    And there is one other larger concern that’s been going on here, which is not just for the buildings that have been collapsed, but what to do with the thousands of other buildings across Mexico City that are damaged.

    While most of the attention remains on search-and-rescue across the city, there are an untold number of victims like Silvia Barroso.

    SILVIA BARROSO, Resident (through interpreter): I was in the house doing chores when it started shaking. It was really, really strong.

    WILLIAM BRANGHAM: Her apartment wasn’t destroyed by Tuesday’s quake, but she’s been told it’s too dangerous to go back and could crumble at any minute. So, she now lives here with what soaking belongings she could grab in this leaky shelter inside this vast makeshift community response center.

    SILVIA BARROSO (through interpreter): We’re feeling desperate. We really can’t go anywhere. We don’t have money to rent a new place. Everything has gotten wet from the rain here. There are tons of people coming and going.

    WILLIAM BRANGHAM: There are likely thousands and thousands of people like Barroso.

    The government estimates that at least 2,500 buildings were damaged on Tuesday, and they have received reports of 4,000 others. These are buildings that weren’t flattened, but will likely remain uninhabitable for the foreseeable future.

    Mexico City, of course, is no stranger to big earthquakes. The worst quake was in 1985, 32 years ago to the day of Tuesday’s quake. Mexico City was terribly damaged. Thousands of buildings, including many newer ones, collapsed fully.

    The official 5,000-person death toll is considered a gross underestimate. After the ’85 quake, government officials said reforms would come: better rescue and response, better public education, and stronger, enforceable building requirements.

    Daniel Rodriguez Velazquez has consulted the Mexican government’s disaster prevention board. He’s an expert in urban planning, and he says many of those reforms did in fact come.

    DANIEL RODRIGUEZ VELAZQUEZ, National Autonomous University, Mexico (through interpreter): Before 1985, building standards didn’t consider such large earthquakes. That’s been an important change, the stronger building standards for the city.

    WILLIAM BRANGHAM: Many point to the fact that Mexico City largely survived intact from Tuesday’s quake. Yes, 45 buildings collapsed entirely, but the vast majority of this sprawling city of over 20 million remains untouched.

    In fact, on most blocks, it’s hard to even tell there was an earthquake at all. Daniel Rodriguez agrees those post-1985 reforms did save lives and saved structures. But he worries that, in the rush to cleanup, the lessons of why some buildings failed will be lost.

    DANIEL RODRIGUEZ VELAZQUEZ (through interpreter): We need to see if the buildings that fell met construction standards. There’s suspicion that many buildings were built through corruption to bring investment and generate the image of a modern city.

    We need to have the scientific and technical information to be able to determine the causes of collapses, and, when applicable, criminal responsibility.

    WILLIAM BRANGHAM: In fact, just a few blocks away, Rodriguez showed us what he’s concerned about. Four families lived in what was a five-story apartment building here. It looked like this on Tuesday, and now it’s being completely demolished. People here said no investigation had been done.

    Javier Morales Acosta lived here with his wife, daughter, and grandson. He was at work when the quake struck.

    JAVIER MORALES ACOSTA, Resident (through interpreter): My first thought was of my wife and family. My wife was at home. I tried to call, but she didn’t answer, so I knew something had happened.

    WILLIAM BRANGHAM: His wife was injured, but got out alive. She’s at the hospital now. He says they have lost absolutely everything.

    JAVIER MORALES ACOSTA (through interpreter): We haven’t been able to recover anything. When something like this happens, the first thing people ask you for is I.D., but everything we had is buried.

    DANIEL RODRIGUEZ VELAZQUEZ (through interpreter): There is a rush to bring in heavy machinery and clean up the rubble, to demolish buildings. Just like in 1985, it’s a political move. The government is in rush because a presidential election cycle is just starting.

    WILLIAM BRANGHAM: Morales’ house and all his family’s belongings are being carted away in an afternoon, as officials here face the competing demands of trying to learn from this disaster vs. cleaning up and getting back to normal.

    In Mexico City, I’m William Brangham for the PBS NewsHour.

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    JUDY WOODRUFF: Hurricane Maria continued her march across the Caribbean, still as a powerful Category 3 storm. Puerto Rico is dealing with a dam failure in the western part of the island; 70,000 people are in the process of being evacuated.

    Damage estimates have already reached $45 billion for the Caribbean islands in the storm’s path. And all told, at least 27 have been blamed on Maria.

    John Yang has more.

    JOHN YANG: Across waterlogged Puerto Rico, many of the 3.4 million residents have been forced from their homes. Two days after Maria made landfall, knocking out power and communications, the personal stories of facing the storm’s wrath are just emerging.

    These women live in Salinas, along the southeast coast.

    WOMAN (through interpreter): A lot of trees and many, many houses destroyed and boats on the ground. The power and the water are out, everything, everything. We don’t have anything. We have got nothing and we don’t know for how long we will go without.

    DAVILA SANTANA, Salinas Resident (through interpreter): It came when my son said that we have lost everything. It took our house. It’s tough, but we’re going to start over.

    MAN: What are you going to do now?

    WOMAN (through interpreter): We’re going to the shelter.

    JOHN YANG: Governor Ricardo Rossello reports complete devastation. Damage estimates reached $30 billion on Puerto Rico alone.

    With areas submerged beneath floodwaters, the U.S. military and Federal Emergency Management Agency began airlifting aid, water, food, generators and temporary shelters.

    MAJ. GEN. DEREK RYDHOLM, Deputy Chief, Air Force Reserve: We’re able to fly on our mobility aircraft, firefighters, search-and-rescue and other civil support as well. Until probably today, there was no real understanding at all of the level, the gravity of the situation.

    JOHN YANG: Today, Maria kept churning north, lashing the Turks and Caicos. The Eastern Bahamas are next, and then is forecast to make a slight turn east into the open Atlantic.

    Damage to Saint Croix in the U.S. Virgin Islands and the tiny island of Dominica was also extensive. Both islands have no power and curfews are in place to prevent looting.

    It could take years for some of the Caribbean islands to fully recover from Hurricanes Maria and Irma. That includes nation of Antigua and Barbuda.

    Sir Rodney Williams is the governor general. A family physician, he is currently on a medical mission in the United States. He joins us from Annapolis, Maryland.

    Your Excellency, let me — can I start by asking you what conditions are like on Antigua and Barbuda?

    GOVERNOR GENERAL RODNEY WILLIAMS, Antigua and Barbuda: Well, in the phase now where we’re trying to rebuild.

    And the whole question is, how do we deal with the people from Barbuda in particular, because we are concerned about their well-being, their protection and their social needs. And the persons from — all the people from Barbuda are now in Antigua, and some living with family, some living with friends, and some living in shelters.

    I must say that the government and the various agencies did a very good job in educating the population prior to and during the hurricane. And now it’s time to rebuild. We have actually accommodated 500 schoolchildren in schools in Antigua.

    And we have also put their teachers to those schools so that they can be feeling comfortable. Presently, the government is working on some accommodation to make them more private and more comfortable by restructuring a hotel. There’s an old nurses’ hostel that is being renovated as well.

    And there’s an old Pan Am base on the island that they’re putting things in order so that the Barbuda on Antigua and Barbuda can have their own private accommodation. And things are moving along rather smoothly.

    JOHN YANG: And, as you say, all the people from Barbuda have been moved to Antigua.

    How long do you think they are going to have to stay there?

    GOVERNOR GENERAL RODNEY WILLIAMS: Well, that is a very difficult question for me to answer.

    A lot will depend on what they find on the ground. Right now, they’re cleaning up Barbuda. They have been able to bury the dead animals and they’re cleaning up the debris on the island. And persons from Barbuda have been allowed to go back on a daily basis to protect their assets and then they return at night to Antigua.

    There are teams on the ground looking at Barbuda and looking at what is needed. From my understanding, they are trying to ensure that the rebuilding of Barbuda takes into account the type of island that we want to bring back.

    We have got to develop innovative ways and ensure that we have some of the best engineers and technicians who will advise as to how we will build the country, the island, because we’re going to have to make sure that the buildings that we put up are durable and that it is sustainable in the long run.

    JOHN YANG: Sir Rodney Williams, governor general of Antigua and Barbuda, thanks so much for joining us.

    GOVERNOR GENERAL RODNEY WILLIAMS: Thank you for having me on, sir.

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    JUDY WOODRUFF: And in the day’s other news: Rescuers in and around Mexico City combed through mountains of debris, desperately searching for signs of life. The death toll from the 7.1-magnitude quake has now climbed to at least 293. More than half of those have been in the capital. We will take a closer look at the scope of the destruction later in the program.

    North Korea’s leader ratcheted up his war of words with President Trump today, warning that he would face consequences “beyond his expectations.” Kim Jong-un’s statement came days after President Trump threatened to “totally destroy North Korea” in his United Nations address.

    A newswoman read Kim’s response aloud on North Korean state TV.

    WOMAN (through interpreter): “Now that Trump has denied the existence of and insulted me and my country in front of the eyes of the world and made the most ferocious declaration of a war in history that he would destroy North Korea, we will consider with seriousness exercising of the corresponding highest level of hard-line countermeasure in history. I will surely and definitely tame the mentally deranged U.S. dotard with fire.”

    JUDY WOODRUFF: Later, North Korea’s foreign minister suggested that they would next test a hydrogen bomb in the Pacific ocean. President Trump reacted on Twitter, saying — quote — “Kim Jong-un, obviously a madman, will be tested like never before.”

    Iran’s president also had a defiant message for the West today, vowing to continue building up his country’s arsenal of weapons. At a military parade in Tehran, a new ballistic missile capable of reaching Israel was unveiled. President Hassan Rouhani spoke to the crowd, pushing back against President Trump, who had singled out Iran in his address at the U.N. Monday.

    PRESIDENT HASSAN ROUHANI, Iran (through interpreter): Whether you want it or not, we will increase our defensive and military capabilities as a deterrent, as much as we deem appropriate. We will not just strengthen our missile capabilities, but also our ground forces, air forces and naval forces. For the defense of our country and our land, we will not seek permission from anyone.

    JUDY WOODRUFF: Today marked the first time Iran had showcased the medium-range ballistic missile in public. But its military test-fired the same type of weapon back in February.

    There was word today that the U.S. Department of Homeland Security notified 21 states that Russia potentially targeted their election systems in the run-up to the 2016 election. But most were not successfully breached.

    Meanwhile, President Trump and the Kremlin are both dismissing reports that Russia planted thousands of paid advertisements on Facebook in a bid to help candidate Trump with the election. Facebook said yesterday it’s turning over copies of the ads to Congress’ Russia investigation. This morning, the president tweeted — quote — “The Russia hoax continues. Now it’s ads on Facebook.”

    The Trump administration is revoking Obama era guidelines on investigating sexual assaults on college campuses. Education Secretary Betsy DeVos had said that the previous policy was unfair to accused students. Now interim rules will permit universities themselves to choose how to handle assault complaints, until the Education Department drafts permanent rules.

    Critics fear that victims will lose protections or feel pressured to stay silent.

    Former FBI Director James Comey was heckled today while delivering a convocation address at Howard University in Washington. Protesters sang civil rights songs as he took the stage, delaying his speech. Calls of “No justice, no peace” continued as Comey began his remarks at the historically black university.

    JAMES COMEY, Former FBI Director: It’s hard sometimes to find people who will listen with an attitude that they might actually be convinced of something.

    Instead, what happens in most of the real world and about four rows of this auditorium is that people don’t listen at all. They just try to figure out what rebuttal they’re going to offer when you’re done speaking.

    JUDY WOODRUFF: It was Comey’s first public appearance since testifying before Congress about his dismissal by President Trump.

    Federal officials are investigating reports that Health and Human Services Secretary Tom Price used costly chartered jets for official business. The agency’s Office of the Inspector General said today that it’s looking into whether the flights complied with federal travel regulations that generally require officials to minimize travel expenses.

    Price’s office said that he sometimes uses chartered planes when commercial flights aren’t feasible.

    British Prime Minister Theresa May tried to revive stalled Brexit negotiations with the European Union today. She proposed a two-year transition period after Britain leaves the E.U. in March of 2019, to give both sides time to adjust to the changeover. She also indicated a willingness for Britain to pay a financial settlement, but she stopped short of specifying an amount.

    May spoke today in Florence, Italy.

    THERESA MAY, Prime Minister, United Kingdom: Let us not seek merely to adopt a model already enjoyed by other countries. Instead, let us be creative, as well as practical, in designing an ambitious economic partnership which respects the freedoms and principles of the E.U. and the wishes of the British people.

    JUDY WOODRUFF: Brexit talks are set to resume next week in Brussels. But several key sticking points remain, including how much the U.K. should pay to leave the bloc, and how to protect the rights of E.U. nationals who are living in Britain.

    London’s transportation agency is stripping Uber of its license to operate in the city, over public safety and security concerns. The ride-sharing service’s license will expire at the end of the month. The regulator specifically took issue with Uber’s approach to reporting criminal offenses, and the way in which it conducts background checks for its drivers. Uber said it plans to appeal the decision.

    On Wall Street today, stocks were searching for direction. The Dow Jones industrial average lost nine points to close at 22349. The Nasdaq rose four, and the S&P 500 added more than a point. For the week, both the Dow and the S&P 500 added a fraction of a percent. The Nasdaq fell a fraction.

    And NASA has bestowed a new honor upon Katherine Johnson, the African-American mathematician whose life inspired the hit feature film “Hidden Figures.” A ribbon-cutting ceremony officially opened a new research facility bearing her name at NASA’s Langley Research Center in Hampton, Virginia. The 99-year-old who calculated the trajectories for America’s first spaceflights in the 1960s was on hand for the festivities.

    What an inspiration.

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    JUDY WOODRUFF: Senator John McCain today dealt a serious blow to Republicans’ latest effort to dismantle the Affordable Care Act.

    In a statement, the Arizona Republican rejected a reform proposal by fellow GOP Senators Lindsey Graham and Bill Cassidy. The move leaves his party’s leaders with diminishing hope of repealing President Obama’s signature health care law.

    We get the latest from our Lisa Desjardins.

    So, Lisa, what reason did Senator McCain give?

    LISA DESJARDINS: Senator McCain said, first, in good conscience, he could not support the bill because he said it’s been rushed through. And he thinks now is the time and this issue is so large it requires bipartisanship.

    Let me read one quote from what he wrote: “The issue is too important and too many things are at risk for us to leave the American people guessing from one election to the next whether and how they will acquire health insurance. A bill of this impact requires a bipartisan approach.”

    What he’s saying here is leaving this up to states for another two years is just unacceptable. And, moreover, what he wants is a full debate through committee. He wants months and much more thought spent on this issue.

    JUDY WOODRUFF: Where does this leave Republican efforts? They have tried again and again and again to get this done.

    LISA DESJARDINS: We have so many metaphors, the zombie bill. It keeps coming to life.

    I think this Republican plan is down on the mat if this was a boxing match, and the referee is counting, because John McCain was a vote they needed. They can only lose two Republicans. He’s a hard no. Rand Paul is a hard no, his office confirmed to me today. He is still a hard no.

    Susan Collins today said she is leaning no. We’re waiting to hear from Alaska Senator Lisa Murkowski, who supported a bill that did not go as far — who voted no on a bill that wasn’t this broad in scope. So it’s very unlikely that this bill will get the support it needs in the next two days.

    JUDY WOODRUFF: So these are the key Republicans. There have been some bipartisan efforts.

    Some other Republicans, Democrats have been getting together to see if they could come up with something that could work across the aisle. Where does all that stand?

    LISA DESJARDINS: That’s right.

    When last we were talking about this on the program, we had heard from Senator Alexander, who was leading that effort, that that was frozen, the bipartisan effort was frozen.

    Well, now that might be changing. We heard from Senator — Iowa Senator Joni Ernst today, unexpected voice in this, Republican. She told her constituents at a town hall that she wants that bipartisan talk between Murray and Alexander to restart next week.

    And she said — get this, Judy — today that she doesn’t think Graham-Cassidy will come up for a vote and she doesn’t think the votes are there. And so there is now a renewed attention perhaps to the bipartisan effort.

    Democrats told me that they actually did — were ready to make some compromises in that effort. They may have to actually show those cards now if we get to that.

    JUDY WOODRUFF: And so it’s Senator Patty Murray who has been leading the charge on that, Democrat of Washington, with Senator Lamar Alexander of Tennessee.

    LISA DESJARDINS: That’s right.

    JUDY WOODRUFF: Lisa Desjardins watching it all, thank you.

    LISA DESJARDINS: Sure.

    The post What’s next for health care after McCain rejects GOP’s Graham-Cassidy plan? appeared first on PBS NewsHour.


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    Senator John McCain (R-AZ) looks on during a press conference about his resistance to the so-called "Skinny Repeal" of the Affordable Care Act on Capitol Hill in Washington, U.S., July 27, 2017. Photo by Aaron P. Bernstein and Reuters

    Senator John McCain (R-AZ) looks on during a press conference about his resistance to the so-called “Skinny Repeal” of the Affordable Care Act on Capitol Hill in Washington, D.C., on July 27, 2017. Photo by Aaron P. Bernstein and Reuters

    WASHINGTON — Sen. John McCain’s opposition to the GOP’s last-ditch effort to repeal and replace the Obama health law has dealt a likely fatal blow to the legislation — and perhaps to the Republican Party’s years of promises to kill the program.

    It was the second time in three months the 81-year-old Arizona Republican had emerged as the destroyer of his party’s signature promise to voters.

    “John McCain never had any intention of voting for this Bill, which his Governor loves. He campaigned on Repeal & Replace. Let Arizona down!” President Donald Trump said in a series of tweets Saturday that attacked GOP senators who hadn’t gotten behind the bill. The measure was co-written by South Carolina Sen. Lindsey Graham, McCain’s closest Senate ally, and Sen. Bill Cassidy, R-La.

    “McCain let his best friend L.G. down!” Trump said, adding that the health bill was “great for Arizona.”

    McCain, who is battling brain cancer in the twilight of a remarkable career, announced Friday that he could not “in good conscience” vote for the legislation.

    “I believe we could do better working together, Republicans and Democrats, and have not yet really tried,” McCain said. “Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it.”

    His opposition all but ensured a major setback for Trump and Senate Majority Leader Mitch McConnell, R-Ky. It also appeared likely to deepen rifts between congressional Republicans and a president who has begun making deals with Democrats out of frustration with his own party’s failure to turn proposals into laws.

    [Watch Video]

    During the election campaign Trump had pledged to quickly kill the Affordable Care Act — “It will be easy,” he contended — and he has publicly chided McConnell for not winning passage before now.

    McCain joined Sen. Rand Paul, R-Ky., as two declared GOP “no” votes on the repeal legislation, though Trump held out hope on Paul.

    “I know Rand Paul and I think he may find a way to get there for the good of the Party!” Trump tweeted.

    With Democrats unanimously opposed, two is the exact number of GOP votes McConnell can afford to lose.

    But Sen. Susan Collins, R-Maine, said Friday she, too, is leaning against the bill, and Sen. Lisa Murkowski, R-Alaska, was also a possible “no,” making it highly unlikely that McConnell can prevail.

    READ NEXT: What you need to know about the GOP’s Graham-Cassidy health care bill

    Trump tweeted that health premiums have risen dramatically for Alaskans under the health law, “deductibles high, people angry!”

    While Trump tries to keep up the pressure, the GOP seems destined to fail again on a campaign promise that every Republican agreed on — right up until the party obtained full control of Congress and the White House this year and was actually in position to follow through.

    Trump, at a political rally Friday night in Alabama, he said he would continue the fight to repeal the law. “You can’t quit when you have one or two votes short.”

    Graham, in a statement, said he would “press on,” and he reaffirmed his friendship with McCain.

    Up until McCain’s announcement, McConnell allies were optimistic McCain’s relationship with Graham might make the difference.

    GOP leaders hoped to bring the legislation to the full Senate this coming week. They face a Sept. 30 deadline, at which point special rules that prevent a Democratic filibuster will expire.

    Democrats hailed McCain’s announcement and pledged to commit to the bipartisan process he sought. GOP Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington have been working on a package of limited legislative fixes to the health law’s marketplaces.

    “John McCain shows the same courage in Congress that he showed when he was a naval aviator,” said Senate Minority Leader Chuck Schumer, D-N.Y. “I have assured Sen. McCain that as soon as repeal is off the table, we Democrats are intent on resuming the bipartisan process.”

    Trump charged that Schumer “sold John McCain a bill of goods. Sad.”

    The Graham-Cassidy bill would repeal major pillars of the health law and replace them with block grants to states to design their own programs.

    “Large Block Grants to States is a good thing to do. Better control & management,” Trump wrote.

    But major medical groups said millions of people would lose insurance coverage and protections. A bipartisan group of governors announced their opposition.

    Yet Republican congressional leaders, goaded by GOP voters and the president himself, were determined to give it one last try.

    Trump spent much of August needling McConnell for his failure to pass a repeal bill, and Republican lawmakers back home during Congress’ summer recess heard repeatedly from voters angered that after seven years of promises to get rid of the health law, the party had not delivered.

    The House passed its own repeal bill back in May, prompting Trump to convene a Rose Garden celebration, which soon began to look premature.

    After the Senate failed in several attempts in July, the legislation looked dead. But Cassidy kept at it with his state-focused approach, and the effort caught new life in recent weeks as the deadline neared. Trump pushed hard, hungry for a win.

    The bill would get rid of unpopular mandates for people to carry insurance or face penalties. It would repeal the financing for Obama’s health insurance expansion and create a big pot of money states could tap to set up their own programs, with less federal oversight. It would limit spending for Medicaid, the federal-state program that now covers more than 70 million low-income people. Insurance rules that protect people with pre-existing conditions could be loosened through state waivers.

    Over time, the legislation would significantly reduce federal health care dollars now flowing to the states. But McConnell had little margin for error in a Senate split 52-48 between Republicans and Democrats, and could lose only two votes, counting on Pence to break the tie.

    Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.

    The post Trump criticizes McCain over health care bill appeared first on PBS NewsHour.


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    An international passenger arrives at Washington Dulles International Airport in Virginia after the Supreme Court granted parts of the Trump administration's emergency request to put its travel ban into effect later in the week pending further judicial review. Photo by James Lawler Duggan/Reuters

    An international passenger arrives at Washington Dulles International Airport in Virginia after the Supreme Court granted parts of the Trump administration’s emergency request to put its travel ban into effect later in the week pending further judicial review. Photo by James Lawler Duggan/Reuters

    WASHINGTON — President Donald Trump is weighing the next iteration of his controversial travel ban, which could include new, more tailored restrictions on travelers from additional countries.

    The Department of Homeland Security has recommended the president impose the new, targeted restrictions on foreign nationals from countries it says refuse to share sufficient information with the U.S. or haven’t taken necessary security precautions. The restrictions could vary by country, officials said.

    Trump’s ban on visitors from six Muslim-majority nations, which sparked protests and a flurry of lawsuits, is set to expire this coming Sunday, 90 days after it took effect.

    “The acting secretary has recommended actions that are tough and that are tailored, including restrictions and enhanced screening for certain countries,” Miles Taylor, counselor to acting Homeland Security Secretary Elaine Duke, told reporters on a conference call Friday.

    But officials refused to say how many countries — and which countries — might be affected, insisting the president had yet to make a final decision on how to proceed. Trump huddled with Duke, Attorney General Jeff Sessions, Secretary of State Rex Tillerson, his director of national intelligence and his national security adviser Friday to discuss the issue, White House spokeswoman Lindsay Walters said.

    Taylor said the recommendations were based on whether countries were providing U.S. authorities with enough information to validate the identities of potential immigrants and visitors and to determine whether or not they posed a threat. The recommendations were first reported by the Wall Street Journal on Friday.

    Trump’s travel ban executive orders remain two of the most controversial actions of his administration. The ban, which went into effect in late June, barred citizens of Iran, Libya, Somalia, Sudan, Syria and Yemen who lacked a “credible claim of a bona fide relationship with a person or entity in the United States” from entering the country. The Supreme Court is scheduled to hear oral arguments on the constitutionality of the ban next month.

    READ NEXT: Trump calls for ‘larger, tougher’ travel ban after London subway attack

    Officials described the process of reaching the new recommendations as far more deliberate and systematic than Trump’s original travel ban order, which was signed just days after he took office with little consultation or input outside the White House.

    DHS said it had worked with other agencies to develop a comprehensive new baseline for foreign nationals based on factors like whether their countries issued passports with biometric information to prevent fraud and shared information about travelers’ terror-related and criminal histories.

    “Our guiding principle,” Taylor said, “was this: We need to know who is coming into our country. We should be able to validate their identities, and we should be able to confirm that our foreign partners do have information suggesting such individuals may represent a threat to the United States.”

    The U.S. then shared the new baseline requirements with every foreign government in July and gave them 50 days to comply.

    While most countries already met the standards, officials said that some that didn’t have made changes that put them in compliance. Other countries, however, were unable or “deliberately unwilling” to comply. Citizens of those countries would be denied entry or face other travel restrictions until their governments made changes.

    Trump had originally tried to ban the entry of nationals from seven Muslim-majority countries, including Iraq, in his January order, but scaled back his efforts in a more narrowly tailored version written to better withstand legal scrutiny in March. Trump later derided that second order on Twitter as “watered down” and “politically correct.”

    After a bomb partially exploded on a London subway last week, Trump once again called for a tougher ban.

    “The travel ban into the United States should be far larger, tougher and more specific — but stupidly, that would not be politically correct!” he wrote on Twitter.

    The administration has argued the ban was necessary to give it time to complete a thorough review of screening procedures and information sharing to make sure that those who enter the country don’t pose a safety risk.

    Critics accuse the president of overstepping his authority and violating the Constitution’s protections against religious bias by targeting Muslims. Trump had called for a “total and complete shutdown of Muslims entering the United States” during his campaign.

    The American Civil Liberties Union, one of the groups challenging the ban in court, described the proposed changes as “an apparent effort to paper over the original sin of the Muslim ban.”

    “This looks to be the Trump administration’s third try to make good on an unconstitutional campaign promise to ban Muslims from the United States,” ACLU Executive Director Anthony D. Romero said in a statement.

    A new travel policy could also complicate the Supreme Court’s review, scheduled for argument on Oct. 10. The court could order the parties to submit written arguments about what should happen next, and it might dismiss the case or return it to lower courts for a fresh analysis of the changed circumstances.

    Associated Press writer Mark Sherman contributed to this report.

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    NFL: 2016 NFL Draft

    NFL commissioner Roger Goodell announces the draft picks in the first round of the 2016 NFL Draft at Auditorium Theatre. Photo by Kamil Krzaczynski/USA TODAY Sports

    SOMERSET, N.J. — The National Football League and its players’ union on Saturday angrily denounced President Donald Trump for suggesting that owners fire players who kneel during the national anthem and that fans consider walking out in protest “when somebody disrespects our flag.”

    “Divisive comments like these demonstrate an unfortunate lack of respect for the NFL, our great game and all of our players,” the league commissioner, Roger Goodell, said in a statement.

    DeMaurice Smith, executive director of the NFL Players Association, tweeted: “We will never back down. We no longer can afford to stick to sports.”

    Trump, during a political rally in Alabama on Friday night, also blamed a drop in NFL ratings on the nation’s interest in “yours truly” as well as what he contended was a decline in violence in the game.

    Smith said the union won’t shy away from “protecting the constitutional rights of our players as citizens as well as their safety as men who compete in a game that exposes them to great risks.”

    Trump kept up his foray into the sports world on Saturday, when he responded to comments by Stephen Curry of the Golden State Warriors, who has made it clear that he’s not interested in a traditional White House trip for the NBA champions

    “Going to the White House is considered a great honor for a championship team. Stephen Curry is hesitating, therefore invitation is withdrawn!” Trump tweeted while spending the weekend at his golf club in New Jersey.

    It was not immediately clear whether Trump was rescinding the invitation for Curry or the entire team.

    Several athletes, including a handful of NFL players, have refused to stand during “The Star-Spangled Banner” to protest of the treatment of blacks by police. Quarterback Colin Kaepernick, who started the trend last year when he played for the San Francisco 49ers, hasn’t been signed by an NFL team for this season.

    Trump, who once owned the New Jersey Generals of the U.S. Football League, said those players are disrespecting the American flag and deserve to lose their jobs.

    “That’s a total disrespect of our heritage. That’s a total disrespect of everything that we stand for,” Trump said, encouraging owners to act.

    “Wouldn’t you love to see one of these NFL owners, when somebody disrespects our flag, you’d say, ‘Get that son of a bitch off the field right now. Out! He’s fired,” Trump said to loud applause.

    Trump also predicted that any owner who followed the presidential encouragement would become “the most popular person in this country” — at least for a week.

    The players’ union said in a statement that “no man or woman should ever have to choose a job that forces them to surrender their rights. No worker nor any athlete, professional or not, should be forced to become less than human when it comes to protecting their basic health and safety.”

    The NFLPA said “the line that marks the balance between the rights of every citizen in our great country gets crossed when someone is told to just ‘shut up and play.'”

    Buffalo Bills running back LeSean McCoy tweeted, “It’s really sad man” and then used an obscenity to describe Trump.

    On the issue of violence on the field, Trump said players are being thrown out for aggressive tackles, and it’s “not the same game.”

    Over the past several seasons, the NFL and college football have increased penalties and enforcement for illegal hits to the head and for hitting defenseless players. A July report on 202 former football players found evidence of a debilitating brain disease linked to repeated head blows in nearly all of them. The league has agreed to pay $1 billion to retired players who claimed it misled them about the concussion dangers of playing football.

    During his campaign, Trump often expressed nostalgia for the “old days” — claiming, for example, that protesters at his rallies would have been carried out on stretchers back then. He recently suggested police officers should be rougher with criminals and shouldn’t protect their heads when pushing them into squad cars.

    It’s also not the first time he’s raised the kneeling issue. Earlier this year he took credit for the fact that Kaepernick hadn’t been signed.

    Television ratings for the NFL have been slipping since the beginning of the 2016 season. The league and observers have blamed a combination of factors, including competing coverage of last year’s presidential election, more viewers dropping cable television, fans’ discomfort with the reports of head trauma and the anthem protests.

    Ratings have been down even more in the early 2017 season, though broadcasters and the league have blamed the hurricanes that hit Florida and Texas. Still, the NFL remains by far the most popular televised sport in the United States.

    Trump said the anthem protest was the top reason NFL viewership had waned.

    “You know what’s hurting the game?” he asked. “When people like yourselves turn on television and you see those people taking the knee when they’re playing our great national anthem,” he said.

    Trump encouraged his supporters to pick up and leave the stadium next time they spot a player failing to stand.

    “I guarantee things will stop,” he said.

    Associated Press writer Jill Colvin in Washington contributed to this report.

    The post NFL commissioner, players’ union angrily denounce Trump appeared first on PBS NewsHour.


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    Soldiers remove the debris of a house destroyed in an earthquake that struck off the southern coast of Mexico late on Thursday, in Juchitan

    Soldiers remove the debris of a house destroyed in an earthquake that struck off the southern coast of Mexico late on Thursday, in Juchitan, Mexico, on Sept. 8, 2017. Photo by Edgard Garrido/Reuters

    Early in the morning on Sept. 16, 1810, priest Miguel Hidalgo y Costilla rang the bell of his church in the small town of Dolores, near Guanajuato, Mexico. His parishioners gathered round, and he urged them to revolt against Spain’s two-year-old Napoleonic government.

    Hidalgo’s call to arms, which later became known later as the Grito de Dolores (Cry of Dolores), triggered the Mexican War of Independence. Every September 15, the president of Mexico takes to the balcony of the National Palace in Mexico City to reenact it.

    This year, just a week before Independence Day, a historic earthquake struck Mexico’s southern coast, killing nearly 100 people. So President Enrique Peña Nieto added a poignant element to his Grito by including in the incantation a reference to the impoverished states that were most devastated by the quake, crying “Long live the solidarity of Mexicans with Chiapas and Oaxaca!”

    It was a nice twist on tradition, but these two states will need more than expressions of solidarity to recover. The 8.2 magnitude quake is the strongest Mexico has experienced in 100 years, surpassing even the Sept. 19, 1985 earthquake that killed up to 40,000 people in and around Mexico City, according to the highest estimates.

    It was also significantly more powerful than the recent 7.1 magnitude earthquake that killed upwards of 200 people in and around Mexico’s capital on September 19.

    mexico_earthquake_reuters

    Graphic via Reuters

    Natural and man-made disasters

    This latest quake shook Mexico City 32 years to the day after the 1985 “big one.” I was 11 years old when the quake hit, and I recall the government of President Miguel de la Madrid reacting with what can only be described as criminal apathy: In the first days after the disaster, he prevented the army from rescuing victims and rejected international aid.

    The people of Mexico City, however, took to the streets, distributing food, water and blankets among those who needed them and digging neighbors free from the rubble with their bare hands.

    This time around, the death toll is significantly lower than it was in 1985: 78 fatalities in Oaxaca, 16 in Chiapas and four in Tabasco for the first earthquake, and more than 220 for the second. In part, this reflects improvements in building regulations since 1985 and the creation of both a Mexican Seismic Alert System and a National Civil Protection System.

    Still, the damages are daunting. Scores of buildings in Mexico City have suffered catastrophic damage.

    But it was Oaxaca and Chiapas – Mexico’s two poorest states – that took the harshest blow. More than 2,500 schools have been severely harmed and 85,000 houses have been affected – more than 17,000 of them beyond repair.

    Poverty makes these disaster impacts worse in the south. On average, 46 percent of Mexican households live in poverty. But 70 percent of Oaxaca’s population earns less than what’s needed to satisfy basic family needs, according to the government’s CONEVAL agency, and 77 percent of Chiapas households do.

    Soldiers remove the debris of a house destroyed in an earthquake that struck off the southern coast of Mexico late on Thursday, in Juchitan, Mexico, September 8, 2017. Photo by Edgard Garrido/Reuters

    In both states, the lowest-income families make as little as 37 pesos (US$2) per day, less than half the the Mexican minimum wage, which is 80.04 pesos, or around $4.50 a day.

    The World Bank lists Mexico as the 15th most powerful economy in the world, but its wealth has not trickled down to the southern states.

    That fact has left many on the ground wondering whether the 16 billion Mexican pesos ($901 million) in federal disaster assistance being offered to 283 municipalities in Oaxaca and 97 in Chiapas will get to where it needs to go.

    Unequal development in Mexico is an ongoing challenge. A recent report from the Bank of Mexico showed that during the second trimester of 2017, the Mexican economy grew in north (0.9 percent), center-north (1.2 percent) and central zones (0.7 percent), home to such powerhouse cities as Monterrey, Guadalajara and Mexico City, but contracted over 1 percent in the rural south.

    If there’s a silver lining to these twin earthquakes, it’s that the post-disaster recovery analyses have finally shed some light on the historical neglect of Chiapas and Oaxaca, together home to around nine million Mexicans.

    What the earthquake unearthed

    It is not incidental that many of those residents are of indigenous descent. Upwards of 40 percent of Mexico’s indigenous peoples live in the southern states of Oaxaca, Chiapas and Yucatán.

    Their economic exclusion dates back to the colonial era. In 1813, a Chiapas priest, Mariano Robles Domínguez de Mazariegos, testified in Spain to the “violent humiliations” suffered by the indigenous inhabitants of Chiapas, who, he said, lived a life of “agitation and continuous terror and distress” because they were treated with such “contempt and hatred.”

    More than 200 years later, on New Year’s Day 1994, the Zapatistas, whose ranks consist of largely of poor Mayans from Chiapas, used similar words to justify an indigenous rebellion against the North American Free Trade Agreement (NAFTA), which had just been signed.

    Condemning NAFTA as a death sentence for traditional agricultural methods still practiced on collectively owned indigenous lands, the First Declaration of the Lacandona Jungle asserted that Chiapas’ rural population had “nothing”: “no land, no work, no health care, no food nor education” – not even a roof over their heads.

    As the recent earthquake reveals, the plight of indigenous Mexicans has not improved markedly over the past 200 years. Their homes offered tenuous shelter from the quake at at best, and their food supplies, long delicate, are now running short.

    The worst and the best of Mexico

    Mexico is and always will be a land of earthquakes. Pre-Columbian records report seismic activity attributed to the wrath of gods said to be unhappy about the state of human affairs.

    Today, quakes still unearth https://theconversation.com/for-many-mexicans-this-government-spying-scandal-feels-eerily-familiar-79981scanthe best and the worst in Mexico.

    It’s not clear that Peña Nieto, whose government is dogged by scandals and wildly public corruption, can make use of this crisis to bring social change to Oaxaca and Chiapas.

    Other politicians are falling short of this high bar, too. In a Facebook video, the wife of Chiapas Governor Manuel Velasco, a member of Peña Nieto’s inner circle, toured a ruined Chiapas home to show the administration “is helping” but lamented her “tousled” hair.

    The populace, at least, is coming to its own assistance. Right after the quake in Mexico City, people formed veritable factory lines of diggers to excavate their buried neighbors and lent out bicycles so stranded colleagues could make their way home.

    Residents of Mexico’s southern region have also showed the country what resilience looks like, even in the face of overwhelming historic odds. In the town of Juchitán, Oaxaca, where the historic town hall pancaked after the earthquake, a man picked up a Mexican flag that had previously decorated its facade, shook off the dust and then, in an act that touched millions, he placed it atop the debris.

    There should be an embedded item here. Please visit the original post to view it.

    The Conversation

    Luis Gómez Romero is a Senior Lecturer in Human Rights, Constitutional Law and Legal Theory at the University of Wollongong. This article was originally published on The Conversation. Read the original article.

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    Secretary of Health and Human Services Tom Price testifies on Fiscal Year 2018 Budget Blueprint before the Committee on Appropriations at the U.S. Capitol in D.C. Photo by Joshua Roberts/Reuters

    Secretary of Health and Human Services Tom Price testifies on Fiscal Year 2018 Budget Blueprint before the Committee on Appropriations at the U.S. Capitol in Washington, D.C. Photo by Joshua Roberts/Reuters

    WASHINGTON — The Trump administration is signaling it will pursue significant changes to Medicare that could put beneficiaries on the hook for higher costs.

    In an informal proposal on Wednesday, federal health officials hinted at several new pilot programs it may implement in the months ahead. One idea would give doctors more latitude to enter into so-called private contracts to charge Medicare beneficiaries more for certain services, if the patients were willing to pay. Elsewhere in the document, officials indicated they might offer more incentives to encourage beneficiaries to join private Medicare plans, known as Medicare Advantage plans. Democrats and other experts said the language suggested interest in the controversial “premium support” model long favored by Republican policymakers.

    For now, the proposals are only hints of what the Trump administration hopes to pursue in its Medicare and, potentially, its Medicaid policy making. There are no formal rules for the new ideas, nor is there any clear timeline for when they might be detailed. The suggestions came as part of a broader request, asking doctors, hospitals, and other parties to weigh in on ways that the administration could use an Obama-era policy center to make it easier for the industry to work with Medicare.

    The policy center, known as the Centers for Medicare and Medicaid Innovation, or CMMI, has sweeping authority to steer about $1 billion annually toward almost any new program or initiative that agency officials believe will help reduce costs in Medicare and improve the quality of its services. The Obama administration deployed it for a wide array of pilot programs touching everything from hip surgery payments to cardiovascular care improvements.

    Until now, the Health and Human Services Department under Secretary Tom Price has mostly made changes to Medicare by unwinding Obama-era initiatives. It has canceled pilot programs that would have penalized some doctors and hospitals and made others voluntary, among other changes.

    Wednesday’s request includes, for the first time since Trump’s inauguration, clear signals about the conservative policies that the Republican officials want to achieve in the Medicare and Medicaid programs. Many of the changes reflect policies outlined by Speaker Paul Ryan and other Republicans in the “A Better Way” plan that, unlike efforts to repeal the Affordable Care Act, can be achieved without legislation. And Democrats caution that the proposals could have serious ramifications for patients.

    “Beginning down this treacherous path is a clear sign that Secretary Price is betraying Donald Trump’s campaign promise not to touch Medicare or Medicaid and instead pursue his ideological goals at the expense of vulnerable Americans,” said Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee, which has jurisdiction over Medicare.

    One of the policies most clearly outlined in the document is a longstanding favorite of Price’s: so-called private contracting. Price, who introduced legislation on the topic when he was a Georgia congressman, wants to let doctors who feel Medicare’s prices are too low contract directly with beneficiaries to charge them more. Now Price may be able to achieve something similar via regulation.

    The practice is actually legal right now, but any doctor who engages in it is barred from accepting some Medicare payments for two years. And beneficiaries must pay the whole price for any service a doctor provides through private contracting — Medicare doesn’t pick up its part of the tab. About 96 percent of physicians who work with Medicare avoid private contracts.

    But Price might be able to use the CMMI authority to waive the current rules, making it more attractive for doctors to try private contracting. It could also allow the doctors to start “balance billing” patients — essentially, putting them on the hook for any price they want to charge beyond what Medicare is willing to pay.

    READ NEXT: CMS moves to cancel Medicare programs overhauling some hospital payments

    “There have been all of these stories about emergency room surprise billing, out-of-network balance billing — none of that’s a problem in Medicare,” said Tim Gronniger, a nonresident fellow at the Brookings Institution and a former CMS official under President Obama. “There’s opportunities for really significant new costs for Medicare patients.”

    “I have never met a Medicare patient who wants to take on the job of contracting with his physician, as his or her own responsibility, instead of having the government or Medicare Advantage plans do it for them,” he added. “It’s obviously a situation that’s ripe for abuse, to put seniors and people with disabilities into that situation.”

    The new proposal also includes language that suggests HHS wants to help private Medicare Advantage plans “compete with traditional Medicare.” The language is vague, but it resembles Republican talking points on so-called premium support — a way to encourage Medicare beneficiaries to enroll in a private plan when that option is less expensive. On a follow-up call Wednesday about the proposal, administration officials confirmed that the language was meant to signal an interest in premium support, according to a congressional aide.

    For Republicans, premium support is a way to reduce federal spending on Medicare and encourage competition among private insurance plans. But Democrats and consumer advocates warn that major differences exist between private Medicare plans and the traditional one. For example, beneficiaries in a private plan pay higher prices when they go out of their plan network, compared to those enrolled in traditional Medicare.

    “The main intent of a lot of premium support programs is to save money,” said David Lipschutz, a senior policy attorney at the Center for Medicare Advocacy. “If you limit the payments to the plans and at the same time, make the rules more flexible for the plans, water down some of the consumer protections, you could be paying, as a beneficiary, more for less. You’d be getting fewer services but paying more money.”

    READ MORE: Mayo Clinic: Privately insured patients to get priority over Medicaid, Medicare patients

    Lipschutz also suggested that if healthy enrollees all choose the cheaper private plans, while sicker enrollees stay in traditional Medicare, it could lead to a so-called death spiral for the traditional Medicare program, further jeopardizing the federal program.

    The new HHS proposal also hints at other key Republican health policy ideas, like pushing Medicare toward “value-based purchasing” contracts for prescription drugs. Another phrase in the section on prescription drug benefits, pushing programs that would “engage beneficiaries as consumers of their care,” suggests another comparison-shopping idea that could also lead to higher costs for consumers.

    Stacy Sanders, federal policy director at the Medicare Rights Center, said she had another concern about the proposals: whether or not they fit the requirements laid out in the statute authorizing CMMI. A model has to either save money and maintain the same or better level of care quality, or keep spending neutral and improve quality, she said.

    “It’s hard for me to see how private contracting or premium support fits that,” she said. “That would obviously be something that CMS would have to prove before they could move forward with a model.”

    Right now, the proposal is just that. Much of the document seeks input from hospitals, doctors, and others in health care about exactly what kind of models might improve the way they work with the Medicare and Medicaid programs. And for the most part, those industry officials are pleased to have been asked.

    “Give credit where credit is due. [The proposal] is a fairly open-ended request for information on improving Medicare delivery models. That’s a bit of a change from the past where CMS was relatively prescriptive when requesting comments on Medicare programs and demonstrations,” said Chet Speed, vice president of public policy for the American Medical Group Association.

    The American Hospital Association, too, said it’s encouraged by the effort and eager to work with the administration to find more “flexibility” for its members. Anders Gilberg, the senior vice president of government affairs for the Medical Group Management Association, said he’s hopeful that the new administration will look to build on or try some of the new ideas industry is already implementing in the private sector, rather than developing its own from scratch.

    Industry has until Nov. 20 to submit its comments. The informal nature of the proposal, however, means that unlike other requests for industry input, HHS won’t be legally required to publicize the comments and ideas it gets in response.

    This article is reproduced with permission from STAT. It was first published on Sept. 21, 2017. Find the original story here.

    The post HHS hints at major changes to Medicare that could mean higher costs for patients appeared first on PBS NewsHour.


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    Melania Trump attends the opening ceremony of the Invictus Games in Toronto, Canada

    U.S. first lady Melania Trump arrives at Toronto Pearson International Airport to attend the opening ceremony of the Invictus Games in Toronto, Canada, on Sept. 23, 2017. Photo by Jonathan Ernst/Reuters

    WASHINGTON — U.S. first lady Melania Trump met Saturday with Britain’s Prince Harry as she led a delegation to Toronto for the opening of an Olympic-style competition for wounded service members and veterans that he founded several years ago.

    Mrs. Trump was heard telling the prince that she had just arrived on a flight from Washington, her first solo trip outside of the United States as first lady. It was also her first time meeting the prince, the White House said.

    The first lady also planned to meet Saturday with Canadian Prime Minister Justin Trudeau, address the nearly 100 U.S. athletes participating in the weeklong Invictus Games and attend the opening ceremony before returning to the White House.

    President Donald Trump was spending the weekend at his golf club in central New Jersey.

    “Nice to meet you,” Harry said as he was introduced to Mrs. Trump and they shook hands. They stood together and smiled for the British and American news media before sitting in adjoining club chairs placed in front of their countries’ respective flags.

    Harry remarked on how busy the first lady has been.

    “Yes, very busy,” she said, before offering a compliment in return. “You’re doing a fantastic job,” she said.

    [Watch Video]

    Mrs. Trump’s decision to lead the U.S. delegation, whose members include Veterans Affairs Secretary David Shulkin, professional golfer Nancy Lopez and entertainer Wayne Newton, reflects the first lady’s “utmost respect” for the hard work, courage and sacrifice of the U.S. military, said Stephanie Grisham, a spokeswoman for Mrs. Trump.

    “She feels strongly that they – and their families – should be honored every day,” Grisham said.

    Grisham said Mrs. Trump also has “great admiration for the role the games have played in empowering those who have been injured while serving.”

    At a recent event marking the 70th anniversary of the U.S. Air Force, the first lady thanked the many military members who assisted thousands of people in Texas, Louisiana, Florida and the Caribbean whose lives were upended by recent hurricanes.

    A native of Slovenia who became a U.S. citizen in 2006, Mrs. Trump also thanked service members’ families.

    “You endure time apart, are expected to move when new orders come in, and face the uncertainty that can come in times of need,” she said at Joint Base Andrews in Maryland, before introducing her husband. “This kind of lifestyle requires its own kind of courage and your sacrifices do not go unnoticed or unappreciated.”

    Mrs. Trump has been slowly warming up to her new role, waiting to move to the White House until her 11-year-old son finished the school year in New York and holding few public events of her own. She accompanied the president on his three overseas trips so far this year.

    Prince Harry, a military veteran who served two tours of duty in Afghanistan, established the Invictus Games in 2014 for sick and wounded service members and veterans from around the globe. More than 550 people from 17 countries are expected to participate in 12 sports during the coming week, ranging from cycling to wheelchair tennis to sitting volleyball.

    London was the setting for the inaugural event in 2015, followed by Orlando, Florida, last year.

    Mrs. Trump’s participation continues White House involvement with the games, which Harry launched during President Barack Obama’s tenure.

    Jill Biden, wife of then-Vice President Joe Biden, led the U.S. delegation to London as part of a military initiative undertaken with then-first lady Michelle Obama. Mrs. Obama helped open last year’s competition in Orlando.

    The post U.S. first lady, Prince Harry meet before Invictus Games appeared first on PBS NewsHour.


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    North Korean leader Kim Jong Un participates in a meeting with the Presidium of the Political Bureau of the Central Committee of the WorkersÕ Party of Korea

    North Korean leader Kim Jong Un participates in a meeting with the Presidium of the Political Bureau of the Central Committee of the WorkersÕ Party of Korea in this undated photo released by North Korea’s Korean Central News Agency (KCNA) in Pyongyang September 4, 2017. Photo by KCNA via Reuters

    WASHINGTON — In a show of American military might to North Korea, the United States on Saturday flew bombers and fighter escorts to the farthest point north of the Demilitarized Zone by any such American aircraft this century. The Pentagon said the mission showed how seriously President Donald Trump takes North Korea’s “reckless behavior.”

    “This mission is a demonstration of U.S. resolve and a clear message that the president has many military options to defeat any threat,” Defense Department spokesman Dana White said in a statement.

    “North Korea’s weapons program is a grave threat to the Asia-Pacific region and the entire international community. We are prepared to use the full range of military capabilities to defend the U.S. homeland and our allies,” White said.

    North Korea’s leader, Kim Jong Un, has said Trump would “pay dearly” for threatening to “totally destroy” North Korea if the U.S. was forced to defend itself or its allies against a North Korean attack. Kim’s foreign minister told reporters this past week that the North’s response to Trump “could be the most powerful detonation of an H-bomb in the Pacific.”

    North Korea has said it intends to build a missile capable of striking all parts of the United States with a nuclear bomb. Trump has said he won’t allow it, although the U.S. so far has not used military force to impede the North’s progress.

    The Pentagon said B-1B bombers from Guam, along with F-15C Eagle fighter escorts from Okinawa, Japan, flew in international airspace over waters east of North Korea on Saturday. The U.S. characterized the flights as extending farther north of the DMZ, which separates North and South Korea, than any U.S. fighter or bomber had gone off the North Korean coast in the 21st century.

    Trump on Friday had renewed his rhetorical offensive against Kim.

    “Kim Jong Un of North Korea, who is obviously a madman who doesn’t mind starving or killing his people, will be tested like never before!” the president tweeted.

    On Thursday, Trump announced more economic sanctions against the impoverished and isolated country, targeting foreign companies that deal with the North.

    “North Korea’s nuclear weapons and missile development is a grave threat to peace and security in our world and it is unacceptable that others financially support this criminal, rogue regime,” Trump said as he joined Japanese Prime Minister Shinzo Abe and South Korean President Moon Jae-in for a meeting in New York.

    Hours later, Kim responded by saying Trump was “deranged.”

    In a speech last week at the United Nations, Trump had issued the warning of potential obliteration and mocked the North’s young autocrat as a “Rocket Man” on a “suicide mission.”

    Trump’s executive order expanded the Treasury Department’s ability to target anyone conducting significant trade in goods, services or technology with North Korea, and to ban them from interacting with the U.S. financial system.

    Trump also said China was imposing major banking sanctions, too, but there was no immediate confirmation from the North’s most important trading partner.

    If enforced, the Chinese action Trump described could severely impede the isolated North’s ability to raise money for its missile and nuclear development. China, responsible for about 90 percent of North Korea’s trade, serves as the country’s conduit to the international banking system.

    The post U.S. flies bomber, fighter mission off North Korean coast appeared first on PBS NewsHour.


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    U.S. President Donald Trump takes the stage to deliver remarks at the American Center for Mobility, a test facility for driverless car technology for American Manufactured Vehicles in Ypsilanti Township

    U.S. President Donald Trump takes the stage to deliver remarks at the American Center for Mobility, a test facility for driverless car technology for American Manufactured Vehicles in Ypsilanti Township, Michigan, U.S., March 15, 2017. Photo by Jonathan Ernst/Reuters

    MACKINAC ISLAND, Mich. — Republicans in Michigan, where Donald Trump triumphantly stamped the election last year, are giving the president mixed reviews nine months into his term in light of the all-but-dead effort to undo the Obama-era health care law.

    While Trump still remains popular with the Michigan GOP’s base, a number of state party loyalists attending a weekend conference expressed disappointment in the president’s administration and his demeanor.

    Some who criticize Trump struggled to excuse his blustery comments and stalled legislative record, masking their disappointment by faulting leaders in the GOP-controlled Congress for stymieing the man they backed last year as a take-charge leader.

    And while Trump’s name draws applause from large audiences, some say privately his first year isn’t what they had hoped for when he rolled to victory through their state and nearby Midwestern battlegrounds in November.

    “It’s not going as well as it should,” Paul McClorey said of the Trump administration.

    McClorey, a construction company owner from near Lansing, and his wife, Alison, were among about 2,000 Michigan Republicans attending the Mackinac Leadership Conference, a biennial gathering on the scenic island off the Upper Peninsula.

    Though the two-day event’s public speakers have praised Trump from the podium in the Grand Hotel’s opulent dining room, in conversations next door in the windowed parlor overlooking Lake Huron a more nuanced theme has emerged: We like him, but not everything we’ve seen from him.

    “There are things he says that I just don’t like,” said Linda Kolich, a nurse from Kalamazoo.

    She said Trump’s vow during a speech to the United Nations this past week to “totally destroy North Korea” scared her. And his reference to North Korean Leader Kim Jong Un as “Rocket Man” she found “unbecoming to the office of the president.”

    Her husband, Greg, suggested that a better approach would be “to speak softly and carry a big stick.”

    He said Trump is engaging in “playground B.S.,” by publicly disparaging fellow Republicans such as Arizona Sen. John McCain, who again appears to have blocked the Senate’s attempt to repeal the 2010 Affordable Care Act.

    READ NEXT: John McCain a ‘no’ on Graham-Cassidy health care repeal effort

    Trump “just won’t play nice with some people,” said Greg Kolich, a machinist.

    To be sure, there was no love lost on McCain in this group of die-hard Republicans. “That bugger makes me so mad,” said Marilyn Mackie of Sault Ste. Marie.

    But it isn’t just Trump’s words that are getting to some of his supporters.

    Some, like McClorey, said it was wrong to run at health care again after it had failed during the summer. The episodes leave yet another bruise on Trump’s relationship with Congress, they said.

    For others, like Mackie, it’s the overdue promise of a major federal infrastructure program, which Trump talked up earlier in the year but has mentioned less often as the summer fight over health care has dragged into the fall.

    [Watch Video]

    Trump promised last year in Michigan, she said, to see through the decades-old reconstruction project on a Great Lakes lock system near her town.

    “We need a new lock,” she said. “He promised us a new lock.”

    Specifically, the Poe Lock, the only one capable of handling standard barges, is at a critical point in an aging shipping complex that moves cargo between lakes Superior and Huron.

    If the lock fails, the economic impact would be devastating, Gov. Rick Snyder said.

    “They haven’t come out with their infrastructure package yet,” Snyder said Saturday, though it’s on the list of projects he submitted when Trump sought input shortly after his January inauguration.

    Granted, Snyder and a number of other Republicans in the Michigan party establishment were cool to Trump as the presidential nominee. And the late-summer conference attracts those who can afford to travel to the pricey resort, not so much the blue-collar conservatives who helped Trump carry Maccomb County, a tract of suburban Detroit recovering from what was double-digit unemployment less than a decade ago.

    Former Rep. Candice Miller, from Maccomb County, was unfazed by her fellow Republicans’ critiques of Trump.

    “We are listening to him say ‘Rocket Man’ and want him to knock the guy’s block off,” Miller said. And Republicans who voted against the GOP health care bills? “They are going to be reminded of those votes,” Miller said.

    Republican National Committee Chairwoman Ronna Romney McDaniel, a former Michigan GOP chairwoman and granddaughter of a former governor, blamed Democrats for the inaction during her speech Friday evening.

    “While GOPs continue to progress and work hard for results for the American people, Dems continue to resist, obstruct and divide,” she said, praising Trump twice, for executive action on business deregulation and helping the party raise money.

    In Michigan, as elsewhere, some Republicans say hope for the “win” Trump needs rests in legislation to cut taxes.

    “I thought they would get some things done, and I’m looking forward to them completing tax reform,” said Michigan Republican Chairman Ron Weiser. “Tax reform is front and center and I think it’s vitally important it gets completed.”

    The post Some Trump supporters grumble in battleground Michigan appeared first on PBS NewsHour.


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