Immigration reform supporters leave the Senate chamber in the Capitol after watching passage of the Senate immigration reform bill on Thursday. Photo By Bill Clark/CQ Roll Call

The next chapter in the immigration debate won't be so easy.

Senators sat in their seats on the floor Thursday, quietly one by one casting votes on a sweeping measure to overhaul the nation's immigration system. The plan includes several compromises on border security and employment practices and a pathway to citizenship for the estimated 11 million undocumented people living in the United States.

It marked the first time one chamber has passed a major change to the immigration system in nearly three decades, and a milestone in a push for reform that lost all its energy after a bipartisan plan fizzled in 2007 despite backing from then-President George W. Bush.

There was little drama, and the vote came in broad daylight, a full day before lawmakers get out of town for a holiday recess and easily meeting a deadline set by Senate Majority Leader Harry Reid.

The chamber approved the bill 68 to 32, sending a bill relatively similar to what was revealed by the bipartisan Gang of Eight 72 days ago to the House, where it faces an uncertain future. The 68 "yes" votes included all 52 Democrats, two independents and 14 Republicans.

Spectators gathered in the galleries above the floor even briefly abided by the standard warning that they aren't allowed to cause a fuss. Vice President Joe Biden read the final tally and it was silent, for a moment. Then the crowd erupted in "Yes we can!" and he had to remind them again of rules they do not demonstrate inside the chamber.

President Barack Obama hailed the legislation's passage as a "critical step" and thanked Democratic leadership and the Gang of Eight.

"The bipartisan bill that passed today was a compromise. By definition, nobody got everything they wanted. Not Democrats. Not Republicans. Not me. But the Senate bill is consistent with the key principles for commonsense reform that I - and many others - have repeatedly laid out," Mr. Obama said.

"Today, the Senate did its job. It's now up to the House to do the same."

The president predicted that opponents "will try their hardest to pull this bipartisan effort apart so they can stop commonsense reform from becoming a reality," but the reactions coming from a shrinking opposition seemed muted.

Groups from Crossroads GPS, which spent millions to try and defeat Mr. Obama last fall, to the Chamber of Commerce and the AFL-CIO issued supportive statements, with few organizations throwing down any gauntlets.

"Today's vote is an important first step toward meaningful immigration reform, but it must not be the last," Steven Law, president and CEO of Crossroads GPS, said in a statement. He said it is "up to the House to ensure the final bill takes a more balanced approach to reform," but his critique of the plan was tepid.

Politics, of course, won't be far behind. The fight in the House has many facets, and comes as people gear up for the 2014 midterm elections where Democrats will once again attempt to reclaim control of the majority.

Reid Wilson writes in the National Journal that backers of the comprehensive plan dramatically outspent opponents this spring, providing "cover to key Democrats and Republicans who voted in favor of the bill." From his story:

The five groups that spent significant amounts of money on advertising have dropped a total of $5.27 million into their television and radio campaigns since April, the data show. The four big groups opposing the bill spent a total of $1.94 million over the same timeframe.

The Democratic group American Bridge 21st Century released a snarky report through their Bridge Project that "highlights the most extreme and offensive views held by Republicans." The idea, organizers said, is to put pressure on lawmakers in the House.

And the president's Organizing for Action campaign spinoff is pulling together events across the country to call on the House "to not stand in the way of this movement."

House Speaker John Boehner, R-Ohio, has said he will meet with the GOP Conference June 10 to discuss the path forward for immigration. Top Republican aides hinted things are about to slow down, with the House setting no timeline for action on its own version of an immigration plan.

Amy Walter has the Republicans to watch in her column for the Cook Political Report.

The Hill's Alexander Bolton reported that Republicans were planning to use the support of some Democrats against them in next year's midterms. The story included a quote from National Republican Senatorial Committee spokesman Brad Dayspring, who said some Senate Democrats were putting their re-election prospects at risk by supporting the bill.

Asked about the statement following Thursday's vote, Sen. John McCain, R-Ariz., a member of the bipartisan group that crafted the legislation, warned his fellow Republicans to consider the party's electoral defeats in 2008 and 2012 and urged them to "re-evaluate what they are saying."

The NewsHour led Thursday's show with a look at the historic day.

Watch Ray Suarez's report here or below:

Ray also hosted a Google hangout with mixed-status families that Cindy Huang profiled for a multimedia project earlier this year.

Watch:

And follow developments on our immigration page. The Morning Line will keep an eye on Congress, the president and national politics Monday through Wednesday next week, and then we'll take a brief holiday of our own.

MARRIAGE CONFUSION

On the NewsHour Thursday, we examined the reverberations of Wednesday's Supreme Court decision to strike down the Defense of Marriage Act and what it means for same-sex couples going forward.

Jeffrey Brown reported on what the president had to say about marriage and the complicated next steps for a federal government looking at a patchwork of states with different laws on the books. Then he had Winnie Stachelberg of the Center for American Progress walk through the different scenarios of benefits same-sex couples can now get, and outline the continuing confusion for people living in states where gay marriage is illegal.

Jeff then turned to get two takes, from New York Attorney General Eric Schneiderman and Rep. Vicky Hartzler, R-Mo., who supports efforts in Congress to ban gay marriage at the federal level.

Schneiderman said he sees a major shift in thinking that will lead to a snowball effect of states joining his to legalize same-sex marriage.

"And I have to say that the politics were moving toward equality, the same way the politics of integration, an end to racial discrimination had been moving towards equality," he said.

Hartzler saw it differently.

"I don't think that the story is totally told on this at all," she said, calling marriage a "special institution that sets up the best place to raise children in this society."

"[T]hat's why government is in the marriage business. It's not because it cares about romance. It's because it cares about the rights of children and promoting an environment that is best for their upbringing," she said.

Watch here or below:

LINE ITEMS

A compromise to halt the rise of student loan interest rates has so far eluded the Senate: rates will double on Monday, but Sen. Tom Harkin, D-Iowa, maintained they could restore the 3.4 percent rate after the July 4th recess, while Sen. Joe Manchin, D-W.Va., circulated a competing proposal to tie rates to the markets.

Five-term Rep. John Campbell, R-Calif., announced Thursday he will retire at the end of this term. "I have decided that I will not seek re-election to represent California's 45th Congressional district in 2014," Campbell, a former state lawmaker and businessman from conservative Orange County, said in a statement. "At the end of this term, I will have spent 14 years serving in full-time, elected politics. I am not nor did I ever intend to be a career politician. I am ready to begin a new chapter in my life."

Lawmakers from both parties expressed outrage Thursday at a House Ways and Means Committee hearing looking at the targeting of political groups by the Internal Revenue Service.

The Senate confirmed now-former Charlotte mayor Anthony Foxx as Transportation Secretary with a 100-0 vote. Here's the Charlotte Observer's write-through.

Matt Cooper profiles Sen. Mark Kirk for the National Journal, looking at the Illinois Republican's stepped-up role even after surviving a stroke.

The president urged Americans to get tested for HIV as his administration backed a national effort to detect the virus early.

Democratic National Committee Executive Director Patrick Gaspard was chosen to be the new ambassador to South Africa.

Virginia Gov. Bob McDonnell declined to comment on the Rolex watch he received as a gift from a campaign donor.

The Associated Press has the latest in Texas' battle over abortion restrictions: Gov. Rick Perry on Thursday said that filibuster leader state Sen. Wendy Davis' rise from a tough upbringing to Harvard Law graduate should have taught her the value of each human life.

New York Times columnist and NewsHour regular David Brooks suggests in his latest column that immigration reform would speed us up to a New America we're already heading toward -- one that accelerates "economic dynamism" and stunts the "old ethnic-racial order."

The Hill's Eric Wasson notes that House Minority Leader Nancy Pelosi, D-Calif., moved Thursday to increase pressure on Republicans to form a budget conference by appointing 17 members to the non-existent panel.

National Review wins the day's headlines with: "Tennessee Man Accused of Trying to Blackmail Mitt Romney ... for Bitcoins."

Because you really need to know, here are all the ways to take care of a needed bathroom break when you filibuster.

NEWSHOUR: #notjustaTVshow

Christina wrote about why she played in the Congressional Women's Softball Game. Don't miss the photos by Jeff Malet.

Gwen Ifill examines equality as an evolving ideal in her blog this week, after this "head-snapping" week at the Supreme Court.

Margaret Warner spoke with Todd Moss of the Center for Global Development and Sarah Pray of the Open Society Foundation to grade the Obama administration's track record on Africa, and explore how that continent has fit into American foreign policy.

Think the economy's rough for young folks? What about for young artists? Paul Solman caught up with Julliard students trying to make it in the real world, and in the process, learned how to conduct.

And Cindy Huang examined the popularity of service organizations among young people in today's labor market.

Ray Suarez spoke with Margo Wootan from the Center for Science in the Public Interest about the USDA's regulation of snack food in schools, scheduled to take effect next year.

In the wake of the Supreme Court's ruling on DOMA, our resident Social Security expert explains how married same-sex couples can now enjoy Social Security's benefits for married folks.

TOP TWEETS

This could be interesting: Martha Coakley is now seriously considering running for Massachusetts governor. http://t.co/ukDO9u9ewj

— Matt Viser (@mviser) June 28, 2013

Photo: Guy in bee suit fillets fresh-caught salmon while moose strolls casually by in Anchorage -- http://t.co/hIJjFPlobz

— Reid Wilson (@HotlineReid) June 28, 2013

A little guy watching @AGSchneiderman promote #Marriage4ALL on @NewsHour CC: @cbellantonipic.twitter.com/r17f8ehKc1

— Damien LaVera (@DamienLaVera) June 28, 2013

Besties: Sens McCain and Schumer shake hands after the cloture vote on the immigration bill: http://t.co/h9uPZL1L5g

— Frank Thorp V (@frankthorpNBC) June 27, 2013

Ted Kennedy's widow, Vicki, called Schumer as he was celebrating today's vote w staff at The Monocle. "Teddy is smiling," she told him.

— Ashley Parker (@AshleyRParker) June 27, 2013

Incredibly rare sight: Senators voting from their desks pic.twitter.com/x3Dx3xsEeg

— Ethan Klapper (@ethanklapper) June 27, 2013

some color during the #immigration vote per @ChadPergram: laughter came as Sen. Jerry Moran (R-KS) accidentally voted yea. He is a nay.

— Bret Baier (@BretBaier) June 27, 2013

Forget White House Down -- in #mapoli's summer blockbuster, a paramilitary force has invaded Beacon Hill... it's #MAStateHouseDown

— David S. Bernstein (@dbernstein) June 27, 2013

He's really into the cow jokes RT @seungminkim: More Franken, noting that you can't milk cows seasonally: "They just get cranky, those cows"

— Elise Foley (@elisefoley) June 27, 2013

If @cbellantoni had a trading card, this would be it: http://t.co/f2IIwrz0St

— Lauren Whittington (@l_whittington) June 27, 2013

Today's @newshour viewer mail: "I saw @RaySuarezNews with a NewsHour cap. Where can i purchase one of these?" #excellentquestions

— Katelyn Polantz (@kpolantz) June 27, 2013

Meena Ganesan, Katelyn Polantz and Simone Pathe contributed to this report.

For more political coverage, visit our politics page.

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Questions or comments? Email Christina Bellantoni at cbellantoni-at-newshour-dot-org.

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Editor's Note: This article is part of a series in which the PBS NewsHour and the Organisation for Economic Co-operation and Development, or OECD, explore how health care and health policy in OECD's 34 member countries compare with the United States. Below, Christopher Prinz, a senior OECD policy analyst on employment, labour and social affairs, examines why employment policies and mental health policies should be integrated. Photo by Mark Bowden via Getty Images.

One American in two develops a mental illness at some point in their lives. At any moment in time, about 20 per cent of the population in developed countries has a mental illness.

We know surprisingly little about why so many people suffer depression, anxiety or addiction to drugs and alcohol. We do know, however, about the severe consequences on their social and economic lives.

In the U.S., people with a mental illness are two to three times more likely to be unemployed, and their employment rate is 15 percentage points lower than for those without mental health problems. They are also more likely to call-in sick, often for longer periods, and to under-perform at work. Similar patterns are found in other OECD countries.

Click on the graphic below to enlarge.

There is also a strong link between mental instability and poverty. In the U.S., the income of people with severe mental health problems is almost three times more likely than average to fall below the poverty threshold. This risk is much higher in the U.S. than in most European countries that have stronger social safety nets.

There are a number of political and social factors that contribute to the poor labor market outcomes and the high poverty risks of people with a mental illness:

The health system is poorly adapted to handle mental health problems. Because there is a stigma attached to mental illness, people often do not seek the help they need. Unlike physical health concerns, only about half of those with a severe mental disorder and less than a third of those with moderate disorders receive treatment. Even when they do seek help, treatment is often inappropriate. Doctors are more likely to prescribe medication than to offer therapy and patient compliance is low.

Job opportunities are limited. Employers cannot find the help they need to keep people with mental health problems on the job and social services don't do enough to stop the unemployed from falling into depression. Work placement services are ill-prepared to assist clients with a mental illness because their profiling tools either do not identify mental illness as a barrier to the job market or they underestimate the employment potential of those with a diagnosed mental disorder.

Employment and health systems don't complement each other. People who need assistance with both mental health issues and finding or keeping a job are rarely well-served by 'the system.' Health care services treat the illness without considering workplace-related problems, and public employment services focus on jobs without considering the necessary medical treatment.

What needs to be done? Health care systems should ensure that people have access to adequate treatment, especially for common disorders such as anxiety and depression. Too often the long waiting times and high cost of psychological therapy prohibit people with lower socioeconomic status or without medical insurance from seeking help.

Employment services should modify their profiling and assessment tools as well as their labor market policy instruments to factor in the benefits that mentally ill people can bring to the work place. For example, continuous support for both employers who hire people with mental health problems and the mentally ill themselves should be provided more widely. Hiding people with a mental disorder away on long-term benefits is not a solution.

Integrating health and employment services will be a challenge. In federal states, they are often the responsibility of different levels of government. In the U.S., employment policy is a state affair, while health policy falls largely under the national domain. Countries are trying to improve cooperation across sectors by gathering people around the table or by cross-funding of services across sectors but the administrative and procedural costs are very high and the effect often limited.

An alternative approach would be to provide integrated services within each sector. The UK's "fit-for-work services," for example, tackles health and employment issues inside the health sector. General practitioners and other agents within the health sector help provide counselling on work and workplace related issues in parallel to treatment.

Conversely, employment service providers could employ mental health specialists to provide, or refer people to, the right treatment as and when necessary. Examples of such an integrated approach are still rare but slowly rising.

Related Content

Health Costs: How the U.S. Compares With Other Countries

How U.S. Obesity Compares With Other Countries

How Growth of Elderly Population in U.S. Compares With Other Countries

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Maria Springer explains LivelyHoods' mission and work.

At age 9, when most kids are relishing the sweet pursuits of childhood, Maria Springer was trying to tackle social justice issues in her hometown of Los Angeles.

"I wrote to then President Bill Clinton about crime in my neighborhood," said Springer. "He wrote back that California's 'three strikes law' had been passed. I wasn't impressed. I thought he was going to incarcerate my neighbors instead of solving the problem."

Years later, after she graduated from UCLA, her passion for social justice led Springer to the slums of Nairobi, Kenya. Her encounters with unemployed youth living in the densely populated, extremely poor areas of the city had a profound impact on Springer.

"I didn't expect the young people to be as ambitious and talented as they are," she explained. "I saw that the only difference between them, and me and my peers, was an opportunity to make something of themselves. When I asked them what would make their life better, they said they just wanted a job."

The seemingly simple request for a job ignited a fire in Springer. In 2011, she recruited her childhood friend, Tania Laden, a Stanford University graduate and Morgan Stanley financial analyst, to help Springer found LivelyHoods, a nonprofit with a mission to create jobs for youth in urban slums.

Laden said she jumped at the opportunity to trade a comfortable job in finance for a decidedly less comfortable job running a startup in Africa. As a child growing up in Los Angeles, she traveled frequently to the Philippines, where her mother's family lives. "From an early age, I was very familiar with extreme poverty," said Laden.

Springer and Laden, now both 26, decided to base LivelyHoods in Kawangware, an impoverished Nairobi neighborhood, which has an estimated population of 250,000. With financial support from several foundations, as well as private individuals, they rented a small space in a shopping center and stocked it with consumer goods geared toward improving the quality of life for residents, such as clean burning cook stoves, solar powered lamps, and reusable sanitary products for women. They then fanned out into the community looking for potential sales agents: motivated young people with "a willingness to learn and a great attitude," according to Springer.

There were plenty of them. The LivelyHoods team put the first group of recruits through an intensive two-week training course, where they learned customer service and other professional development skills. They also were taught about finances and saving money. Those who successfully completed the course were offered a job. Over the last two years, 65 young people in Kawangware have become LivelyHoods sales agents.

"Our sales agents report to our customer service center at 8 a.m. in uniform," explained Springer. "They have a daily sales coaching meeting where they report on what they've sold the previous day, and they can figure out what they want to try to sell that day." The young reps can take up to $75 worth of goods, on consignment, when they head out on their daily door-to-door sales calls.

Their best-selling product, according to Laden, is the fuel efficient charcoal stove. "It's something that people can show off in their homes," said Laden. "Indoor cooking kills more children in Nairobi than malaria because of the smoke produced," so the fuel efficient versions were even more attractive to buyers.

The stove costs $35 -- a seemingly exorbitant price for those living in absolute poverty -- but Laden pointed out that there is an emerging "middle class" in the slums who are able to afford an increasing number of low-end consumer goods. And the stove, which saves owners half of their monthly fuel costs, pays for itself in about three years.

LivelyHoods agents earn between 15 percent and 20 percent commission on the retail sale's price of the products they successfully sell. It's modest but steady income that is rare in the slums of Nairobi.

The co-founders point to a former sales agent named Paul as one of their success stories. "He sold so many stoves in a few months that he helped his wife start a business," said Springer. "They went from being financially insecure to having two incomes. Paul's smile got bigger and he started buying himself things."

Most of the LivelyHoods agents are between the ages of 18 and 25, although the group does accept applicants up to age 35. And there is no education requirement. "One of our best-selling agents never finished primary school," said Springer.

Lisa Parrot is the director of program development and quality in Kenya for the international NGO Save the Children. She sits on the LivelyHoods board of directors and said the organization offers the youth something constructive to do. "It gives an affiliation to these young people who often don't know what to do with their time," said Parrot. "They just need to get a foot in the door. It will also provide them something to put on their resumes."

Laden now lives full-time in Nairobi, while Springer travels back and forth to Los Angeles so she can focus on fundraising. They recently raised more than $25,000 dollars on the crowdfunding website Indigogo so they could open a second retail center. Springer appears in this fundraising video:

LivelyHoods seeks donations for its projects.

They expect to hire about 50 sales agents in the coming months. And, perhaps most importantly, the operating costs for the customer center in Kawangware are now fully covered by profits from the young agents' sales. The co-founders believe they've developed a sustainable model for helping youths living in slums, not just in Kenya, but throughout the developing world.

"In five years, our vision is to be on every street corner in the Nairobi slums," said Laden. "And in that process, create a lot of jobs and change a lot of lives."

Slideshow by David Pelcyger. The NewsHour's Agents for Change series highlights individuals helping communities solve problems, build businesses and create jobs.

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By Tantum Collins

How will this week's transition of power impact Qatar's grand experiment? Photo courtesy of Tantum Collins.

Paul Solman: Tantum "Teddy" Collins was an especially stellar student in the "Grand Strategy" course I help teach at Yale. As part of the class, he spent last summer in Qatar. He's also lived and worked in Jordan, and traveled across the Middle East. Having graduated from Yale this year with a bachelor's degree in global affairs, he is now in Washington D.C., working on a book with retired Gen. Stanley McChrystal.

This week, Qatar's emir, Sheikh Hamad bin Khalifa Al Thani, passed the baton to his 33-year-old son Sheikh Tamim bin Hamad Al Thani. Since there are few people anywhere who know more about the astonishingly ambitious economics of the emirate than Teddy does, I asked him to explain what's been happening there.

Tantum Collins: By now, many in the West are somewhat familiar with Qatar -- the enigmatic emirate that was largely unknown to those outside the Middle East before it came from behind to clinch the rights to host the 2022 World Cup. The scorched, Connecticut-sized spit of land has recently made headlines for its ongoing attempts to broker peace talks between the United States and the Taliban and, just days ago, for the transition of power from the emir, Sheikh Hamad bin Khalifa Al Thani, to his heir apparent Sheikh Tamim bin Hamad Al Thani.

While the latter may seem at first glance like a mundane matter of succession, it is, in reality, anything but that. Under Hamad's rule, Qatar ascended from near-total obscurity to acquire fabulous wealth and carve out a glamorous diplomatic niche for itself.

Depending on how Tamim handles the country's assets and problems, it could continue to develop as a cultural oasis in the Gulf, a hotspot for investment and business, and a key political node linking the Arab and Western worlds, or it could tumble backwards, one more failed experiment in a region rife with them.

A Quick Background

For most of its history, this thumb-shaped peninsula jutting into the Persian Gulf was a sparsely populated, impoverished backwater. Cartographers rarely included it on maps before the 1900s; in 1940 the national population sat at 16,000, and the state ranked as one of the poorest on earth. Through the 1960s, passports were not used at the Doha airport because the community of those who came and went was so small that airline employees knew them all by name.

Then, in the mid-20th century, Qatar stumbled upon what may have been the largest natural resource jackpot per capita in history: large oil fields and a spectacular gas field. Thanks to deft negotiation (a Qatari specialty) with outside oil and gas contractors, sound investment decisions and a pinch of luck, Doha turned these finds into explosive, sustained economic growth. In 2009, when neighboring nations saw their economies shrink, Qatar enjoyed 12 percent GDP expansion. In 2011, Qatar boasted both the world's highest wealth per-capita and the highest GDP growth of any state -- an intimidating pair of economic indicators.

Today, with a GDP on the cusp of $200 billion, Qatar has more economic heft than Iraq, Jordan, Lebanon or Oman, and has surpassed Kuwait and Bahrain to become the richest small state in the region.

These gains are the product of a singular grand strategy that Hamad has pursued over the course of his 17-year rule. GDP is only part of the equation, however. His real goal has been something much more remarkable: to transform this sleepy backwater into a world player, culturally, diplomatically and economically. He has used the state's massive resource wealth on infrastructure projects designed to ensure Qatar's cultural, and thus commercial, staying power long after the oil and gas fields have dried up.

The Deal in Doha

In Western media, Qatar's strategic choices bubble up as an eclectic assortment of headline-grabbing controversies (the Taliban negotiations, the World Cup, the arming of Syrian rebels). Seen from Doha, however, these are part of a coherent whole. Since Emir Hamad came to power in 1996, ousting his father in a bloodless coup, he has aggressively sought to establish a place for Qatar at the diplomatic and cultural crossroads of the West and the Middle East.

By maintaining a list of seemingly contradictory friendships -- America and Iran, Hamas and (kind of) Israel, Saudi Arabia and the Taliban -- and by remaining largely unreadable on most policy issues, Qatar has become the arbiter-of-choice in a string of disputes. Led by its exceptional Foreign and Prime Minister Hamad bin Jassim bin Jaber Al Thani, now leaving office, Qatar helped resolve a decades-long internal Lebanese dispute, mediate a border disagreement between Djibouti and Eritrea, broker Sudanese peace talks, arrange a ceasefire between the Yemeni government and the separatist Houthi Movement, restore some semblance of calm between Hamas and Fatah, and even help Israel and Hamas reach a ceasefire after a flare-up of violence in Gaza last year.

The list goes on. Contrary to the Swiss model of small-country neutrality, Qatar has thrown itself into the diplomatic spotlight, without betraying any particular ideological alignment. (A large exception being its outspoken support of Arab Spring uprisings, representing a calculated, forward-looking bet that helped establish a progressive reputation). The West sees Qatar as level-headed and has used it as a diplomatic link to radical factions that cannot be dealt with directly, such as the ongoing efforts to host peace talks with the Taliban in Doha.

A politically-savvy investment strategy has further bolstered this image of Qatar as a cultural bridge. Its sovereign wealth fund -- the Qatar Investment Authority (QIA) -- recently made several substantial acquisitions in the United Kingdom, including Europe's tallest building, "the Shard"; the upscale department store Harrods; One Hyde Park, the world's most expensive apartment block; and sizable stakes in Camden Market, the London Stock Exchange, Sainsbury's and Barclays banks, London's Olympic Village and Heathrow airport. The U.K. has noticed: the emir found himself greeted by the queen on his last visit. The QIA also has stakes in Valentino, Tiffany, Porsche and Louis Vuitton.

It has also made less glamorous, more politically-minded purchases, such as investing $775 million in Greek gold in 2011 and launching a joint venture to inject $2.5 billion into struggling Italian industries. Icelandic economist Sigridur Benediksdottir told me that "Europe hopes Qatar will save them" from their debt crises.

At home, Qatar has embarked on a building spree designed to turn Doha, which one architect told me currently has more cranes per capita than any other city in the world, into a global destination and cultural powerhouse.

Over the past few years, ground has been broken on no fewer than a dozen new museums, many almost unthinkably extravagant. It is common for new money to turn to art -- Abu Dhabi is building a 260,000 square foot franchise of the Louvre and an even larger branch of the Guggenheim -- and Qatar's royal family has done its fair share of buying up European masterpieces such as a record-breaking $250 million Cézanne.

But Qatar is not interested in simply importing name brand Western art: its initiatives seek to reconcile Western and indigenous elements. The Museum of Modern Arab Art collects work created since 1840 that connects to Arab culture and includes artists from Marc Chagall to Cai Guoqiang. The Orientalist Museum is dedicated to outsiders' perceptions of the Middle East over time. Doha's crown jewel, the Islamic Art Museum, is an I.M. Pei masterpiece built on its own island and boasting an unparalleled collection of Islamic Art.

And then there is Al-Jazeera, the news and entertainment service that has been captivating audiences, creating controversies and winning awards since its founding in 1996. Al-Jazeera's director of development described how the network was founded by the emir to provide "accurate global news with a Middle Eastern perspective."

Before Al-Jazeera, news in the Arab world came either from Western media outlets or from local government-sponsored propaganda. Now in its 16th year, Al-Jazeera has earned a place, he says, as a "leader of news across the globe" and is one of the world's most influential brands. It provides live coverage of conflicts, such as the war in Afghanistan and the revolution in Libya, that other networks won't risk covering and has won international acclaim for journalistic integrity. In 2011, then-Secretary of State Hillary Clinton praised Al-Jazeera for providing "real news" of a caliber U.S. networks failed to offer. While it has also attracted criticism, it is arguably the modern Middle East's most important cultural emissary to the outside world.

Finally, Doha has set its sights on becoming the regional, and eventually global, leader in education -- a place where rising Arab engineers, artists and statespeople can learn their trades and find inspiration.

Education City is the product of the behemoth Qatar Foundation, run by Emir Hamad's preferred wife, Sheikha Moza. A collection of satellite campuses from prominent Western universities assembled on a 3,500-acre campus on the outskirts of Doha, it currently educates approximately 400 students. (By comparison, Harvard's 21,000 students make do with 600 acres). On the surface, Education City resembles New York University's campus in Abu Dhabi or Yale University's new joint venture with the National University of Singapore.

Each of the eight Western schools selected, however, were chosen to resonate with some strand of Qatari identity: Northwestern University's primacy in journalism is relevant to the home of Al-Jazeera; Georgetown's School of Foreign Service focuses on the kind of diplomatic agility in which Qatar excels; Texas A&M has the expertise to educate a new generation of hydrocarbon experts. The goal, according to two Education City deans, is not just to provide a better education for Qataris but to create a research hub and springboard for the region's rising leaders and scholars.

Education City aims to do for education what Al-Jazeera did for media: achieve unparalleled quality and a global brand, matching or exceeding what the West has to offer, while remaining culturally rooted in the Middle East. It is all part of what one of the deans called "the grand experiment" taking place in Doha. As he put it, Doha wants "to look to the world and influence the world." The government hopes that in doing so, Doha will rise above the ranks of sterilized trade capitals, such as Singapore and Dubai, and become a New York, London or Paris instead.

Projects such as Education City, the Museum of Islamic Art, and the expansion of Al-Jazeera demonstrate a desire to balance Arab traditions and Western modernization. Compared with peer states, Qatar is making, in the words of architecture critic Nicolai Ouroussoff, "a more calculated attempt to find a balance between modernization and Islam." Qatar's ideal, hybrid national identity would fuse elements of conservative Islamic ideology and Western thought. Much like in its shrewd diplomacy, Qatar is not picking a side; it is creating a new one.

More than one person I spoke with in Qatar compared Emir Hamad's ambitions to the "Golden Age" of Baghdad under Abbasid rule, which witnessed breakthroughs in trigonometry, optics, astronomy and philosophy. Powered by Baghdad's cosmopolitanism, the Arab world became an international cultural, economical and political force. Abbasid leadership adhered to the Quran, but emphasized passages on the importance of knowledge and tolerance, and gathered Muslims and non-Muslims together in pursuit of scientific progress. To the outside world, Abbasid rule exemplified the most appealing aspects of Islam and Arab culture.

Will It Work?

Are these goals attainable? Fueled by practically bottomless wealth, spearheaded by a visionary emir, facilitated by a political structure that grants the royal family almost unchecked authority, and with only a small and relatively complacent population to appease, Doha's odds are better than one might think. There is certainly no shortage of enthusiasts.

Obaid Younossi, director of the RAND-Qatar Policy Institute, the government's adviser-of-choice on education reform and political matters, argues for the exceptionalism of Qatar's ambitions -- not just for Education City, but its broader attempt to remake Arab culture. A native Afghan educated in America, he sees the situation as unique because of Qatar's extraordinary wealth, the emir's "long-term, top-driven visionary leadership," and the focus on programs with the potential to have "foundational impact." Qatar, he told me, is "reaching to things that haven't been done before."

Carl Bang, the chief investment officer of the Qatar Foundation Endowment, also lauded the emir's intentions and competence, saying that "he really aims to lift not just Qatar but in fact the whole region." An official at the U.S. embassy in Qatar predicted that by 2030, Qatar will be "like Jordan but better," serving as an ally of the West "while preserving their Arab core." Joining this chorus of voices was a stream of businessmen, diplomats, architects and others I met while in Doha, all equal parts astounded and exhilarated by Qatar's ascent.

Others, however, believe that the emir's "noble vision" is at odds with "Qatarization," a series of increasingly cushy benefits that native citizens have come to expect. Qatarization ensures employment, as well as providing a host of other benefits, ranging from interest-free loans to heavily subsidized education, to free healthcare and utilities. I spoke with two businessmen who had long lived in the country and who requested I not disclose their identities. "Qatarization guarantees that all companies in Doha -- foreign, local, whatever -- will be run at the highest level by Qataris," one of them explained.

Sometimes these people are talented and driven, but more often, the companies could find more qualified candidates if given the freedom to hire based solely on merit. This not only has adverse effects on business performance, he told me, but it creates a two-tier society where expats are constantly reminded of their foreignness. It is a roadblock in the way of Doha's cosmopolitan vision. For foreign nationals, acquiring Qatari citizenship is notoriously difficult if not impossible: a source close to the royal family told me that in an average year, only "12-15 friends of the emir will receive passports."

For Qatar, a country used to being able to afford to have its cake and eat it too, this is an unusual difficulty, because no amount of money can appease both factions; every step towards enriching the Qatari experience further stratifies a two-tier society that alienates the newcomers Doha so badly wants to assimilate. An employee of a British think tank operating in Doha described security asking him to leave a public park because it had been reserved "for Qataris only."

Fixing this is of great consequence for the emirate: forging a new identity would not only make Doha more pleasant, it would undergird the national character that Qatar hopes to project internationally. Without it, the country's friendships will last only as long as its gas reserves: as Ausama Monajed of the Syrian National Council (SNC) put it, "there's no special relationship [between the SNC and Qatar] ... Doha is just a good place to have a meeting."

Qatar seems to have all of the pieces in place, or at least under construction, for its caliphate makeover: the extravagant facilities and endless funding have made Doha a great setting for conferences, semesters abroad and short-term employment. But the Abbasid Golden Age vision will require a complex cultural ecosystem in which all residents contribute and benefit. Qatar needs to go beyond a compelling national brand to forge a new national identity that is accessible to foreigners. This was Hamad's greatest challenge: the fundamental contradiction between the cosmopolitanism of his fantasies and the tribal nature of his country's native culture.

Ultimately, if Doha wants to convince its talented visitors to stay, and if it intends to lay the foundation for continued growth and long-lasting "special relationships," the newly anointed Tamim will have to master the opportunity cost of politics. This will probably require a willingness to risk offending the native Qatari population.

Qatar's newfound assertiveness in the international sphere has proved that its rulers are capable of flexing muscle, but the continued indulgence of Qatarization suggests a reluctance to play hardball at home. Imbuing Hamad's urban masterpiece with life will require a tougher line from Tamim: he will have to give less to and ask more of his people, and he will need to make citizenship and its benefits more accessible. If the grand strategy works, it will ultimately redound to everyone's benefit -- native citizens and newcomers alike.

Of course, the royal family has reason to be wary of pushing its people too hard: though the emir has the constitutional authority to do almost anything he wants, the political stability that enforces that authority is tenuous. There are unconfirmed but widely believed rumors that Hamad faced multiple attempts on his life, from actors both within and outside of Qatar. The forces of conservatism and ethnic privilege represent major obstacles. At a time when unpopular hereditary leaders are finding themselves deposed across the Arab world, rulers must think twice about pushing through reforms that give foreigners, especially Westerners, a stake in defining local identity.

Hamad's decision to step down early is most likely motivated in part by this fear. Putting a younger face at the helm of the government broadcasts a progressive image to the country's population, especially the 20-somethings that have been responsible for most of the trouble in Egypt, Tunisia and Syria. But if the total quiet of Qatar's political scene over the past few years has indicated anything (Qatar is the only country in the region to emerge from the Arab Spring completely unscathed), it is that worries about unrest may be overblown.

Looking Forward

All of this means that 33-year-old Tamim has inherited a hefty set of responsibilities. The visionary Hamad has managed to avoid making a difficult decision; he retired before it became absolutely necessary to choose between Qatarization and internationalization. Tamim is tasked with blazing ahead on the road to continued Qatari economic and cultural relevance, hopefully without losing his job in the process.

If Tamim remains too cautious he will end up with, at best, a city-sized luxury hotel. At worst, the attempt to force organic growth of creative endeavor will dry up and wither away, like so much of the greenery lining Doha's Corniche. If he pushes too hard, he may find himself deposed, like several of his peers in other countries, and several of his predecessors in Qatar. If he plays his cards just right, and finds enough luck in the process, Qatar may succeed in realizing its outsized vision.

Having spent most of his time prior to this transition concealed by the opacity of Qatari governance, Tamim is something of an enigma, and only days after the transfer of power, there is no real basis to make bets on which of these paths Tamim will follow. In the end, only time will tell whether the hybridized seeds of this artificial creation will flourish in the Qatari desert. The undertaking is unprecedented, ambitious, risky, and of massive consequence. If anyone can do it, it's Qatar.

This entry is cross-posted on the Rundown -- NewsHour's blog of news and insight. Follow @paulsolman

Nearly two million Medicare beneficiaries are re-admitted to the hospital within 30 days of discharge every year. A slate of new programs is hoping to bring that number down. Photo by Christopher Furlong/Getty Images.

Two things keep retired engineer Daniel Tollins out of the hospital, despite diabetes, high blood pressure, a liver condition and cancer -- "any one of which could kill me."

The first piece of credit goes to him, he says, "Because I'm doing what I should be doing in terms of diet and exercise and it's as simple as that."

The other part isn't so simple. Tollins is part of a group called PACT at Beth Israel Deaconess Medical Center. It stands for "Post Acute Care Transitions," which in practice means that patients like Tollins who find themselves in and out of the hospital frequently are monitored closely by a team of nurses and pharmacists between visits.

The hope is that making sure these "frequent flyers" take better care of themselves -- taking the proper medication, exercising regularly and connecting with appropriate services outside of the hospital, among other steps -- will translate to better health, fewer readmissions and, ultimately, a reduction in the nation's runaway health care costs.

"It's screening, evaluation, it's a personal touch; it's coordinating resources that I need," Tollins recently told PBS NewsHour health correspondent Betty Ann Bowser. "By all means, it is not only good for me, it is good and cost effective to hospitals."

As Bowser reports on Friday's NewsHour, nearly two million Medicare beneficiaries are readmitted within 30 days of discharge every year, which costs Medicare $17.5 billion in hospital bills. And while new programs like PACT are helping to bring down those rates, government officials are hoping that a new program under the Affordable Care Act will add an extra boost to those efforts by imposing stiff financial penalties on hospitals with high readmission rates. Will the new policy instigate much-needed reforms nationwide or simply harm safety net hospitals serving a high number of low-income and elderly patients? Tune in for Bowser's full report.

In the meantime, there are specific steps you can take to avoid a readmission next time you or a loved one are transitioning home from the hospital. Below, Dr. David Goodman, co-principal investigator for the Dartmouth Atlas Project, offers his top seven tips.

Seven Tips for Staying Out of the Hospital After You Leave, According to the Dartmouth Atlas Project

1. Work with the hospital to plan ahead

Many return visits to the hospital could be avoided if doctors and nurses coordinated patients' care better and if patients, their caregivers and hospital staff did a better job of planning for the day the patient leaves.

Before leaving the hospital, make sure to ask your doctors and nurses if the hospital has special planners who can help you prepare to leave the hospital. Work with the hospital staff so they know the name of the doctor you see regularly. This is often your primary care provider. Ask if the hospital will be calling your regular provider to inform them when and why you were in the hospital. Ask them to give the results of any tests or other relevant information so your regular provider can better understand how to continue your care.

2. Understand your illness and ask questions about your health care

Being in the hospital can be overwhelming, but it's important to understand why you are in the hospital and exactly how to care for yourself after you leave. Ask your doctors or nurses to explain what they recommend, including medications and follow-up visits, after you get home. Make sure you understand the doctor's written instructions. Ask questions if you don't understand something!

Sample discharge checklists that can help you ask questions are available from the Robert Wood Johnson Foundation or the Centers for Medicare and Medicaid Services.

3. Have a written discharge plan

It is best to create a detailed, written plan, often called a discharge plan, that includes important information about your hospital stay and how to continue feeling better after you leave the hospital. The discharge plan may include:

The date you are leaving the hospital

Where you are going after you leave the hospital

How you will get there from the hospital

A schedule of follow-up appointments with primary care providers or specialists

A list of your medical problems

A list of allergies

A list of medications, including when to take them and for how long, and any possible side effects

How you will fill your prescriptions

A list of any equipment you might need, such as a cane or wheelchair

What you will do if you have a medical problem in the middle of the night.

Ask for copies of the discharge plan for yourself, your primary care provider, any specialists (such as a cardiologist), and your loved ones. Sample discharge plans are available from the Robert Wood Johnson Foundation or the Agency for Healthcare Research and Quality.

4. Understand your medications

Problems with medications are often the cause for returning to the hospital, so it is important to take extra time to talk to your doctor or other appropriate staff about your medications. It's important to understand what medicines you should take after you leave the hospital and when you should take them. If you were taking medications when you were admitted, you should work with the doctor, nurse, or pharmacist in the hospital to understand which of these medications should be continued and which should be stopped. Make sure that you have a written medication list before you go home.

5. Don't go it alone

Having a family member or loved one help you when leaving the hospital can make it easier for you to get better after leaving the hospital. By being in the hospital room when the doctor is explaining things or giving instructions, your loved one can understand how to help you get better once you are home. Make sure your loved one has a copy of your discharge plan, including a medication list, and talk about it with them.

6. Follow through with follow-up care

Follow-up appointments with a primary care provider or a specialist shortly after leaving the hospital reduce the chance that you will need to go back to the emergency room or hospital. Be sure that you have an appointment for follow-up care before you leave.

It's important to attend your follow-up appointments with your regular providers, even if you start to feel better. Bring your discharge plan to your appointment, including a list of all your medications and test results from the hospital in case your doctor does not get the information from the hospital.

7. Find out how good the care is in your community for patients leaving the hospital

The problem of repeat trips to the hospital occurs nationwide, but it happens more often in some parts of the country than in others. In a recent report, we found that in 2010, nearly one in eight Medicare patients who went home after surgery ended up back in the hospital a second time within a month. But in some areas of the country, more than one in six patients returned to the hospital within a month of surgery, while only one in 13 patients were readmitted in other areas.

To learn more about how hospitals coordinate care for patients when they leave, look at the map showing how often patients were readmitted in your area, and read the report on hospital readmissions Dartmouth Atlas released earlier this year with the Robert Wood Johnson Foundation.

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Should hospitals be held accountable for what happens to patients once they're discharged? A new policy under the Affordable Care Act says yes. Photos by Jim Petit.

The federal government began fining hospitals based on how many Medicare patients were readmitted within 30 days of discharge in October. They track three specific conditions -- heart failure, congestive heart failure and pneumonia.

The goal is to improve the quality of care for seniors by preventing return trips to the hospital -- and save the government millions (a whopping $17.5 million dollars this year alone) in the form of fines to the hospital, based on their readmission rate.

In 2010, nearly one in five Medicare patients returned to the hospital within a month of discharge. Many hospitals are now working on more aggressive ways to follow-up with seniors in the first 30 days, to avoid a readmission.

Since October, the policy has been widelystudied, reported and analyzed. And its penalties have been revised.

On Friday's PBS NewsHour, health correspondent Betty Ann Bowser examines how the policy is unfolding at a medical center in Boston. Tune in for the full report.

For a broader overview, we spoke to Kaiser Health News reporter Jordan Rau recently. He's been following the policy since the Affordable Care Act was passed in 2009.

NEWSHOUR: Jordan, thank you so much for joining us. First of all, what do readmission rates tell us about a hospital? And is it something that consumers can use as a tool?

JORDAN RAU, Reporter, Kaiser Health News: On the face of it, they tell you how a hospital and the post-acute care that a patient gets after leaving worked, how well they performed in making sure patients follow everything that they need to do to recuperate from whatever brought them into the hospital. So it gives you an overview of that "continuity of care" between the time that you leave the door and the 30 days afterwards. And it's generally a reflection of how well patients adhere to whatever medication they were supposed to take, follow-up with appointments with doctors, and follow the diet they've been instructed on in the case of something like heart disease or diabetes.

NEWSHOUR: Are these numbers something that consumers can use as a tool, or is it more complicated than that? Should they be wary of using that strictly as a tool in that sense?

RAU: You can certainly use it as a tool. It's one of many factors you should take into consideration. There are over 100 published measures out on Medicare's Hospital Compare website, including hospital readmission rates, and there's mortality rates, patient surveys, infection rates. There's a lot of information. I don't think consumers should use it as a primary tool for choosing a hospital, but if you've got a hospital that's a particular outlier, I think that's certainly something to take into consideration.

NEWSHOUR: Why are patients readmitted?

RAU: The major reasons are, one, if something went wrong with their treatment at the time. That could be anything from a misdiagnosis to a surgery where something went wrong -- a surgical implement was left in the body, for example.

Second, many are due to the natural fact that a lot of sick people, particularly older people, don't always get better immediately -- particularly for some with complex problems like congestive heart disease, pneumonia, and heart failure, the three conditions that Medicare tracks in this new policy.

After a patient is discharged, a lot of things can happen. One of the most common that experts are discovering is that doctors will often give patients new prescriptions to deal with their illnesses. And when people go home, they don't understand some of these are duplicative of what they're already taking, maybe under a different name -- you know, like a drug could be a generic, while they've been taking a brand name, and they end up taking too much of a medication, or the wrong dose, or they didn't realize they were supposed to stop taking something they had been taking. So that can bring them back into the hospital.

For individual medical conditions, there are other factors. For example, in heart failure, it's very important to maintain a pretty scrupulous diet, and if people don't follow that, they can end up back in the hospital. And then there are follow-up factors, like if you're not going to your regular doctor to check up on you, it's more likely a problem won't be caught until you end up in the hospital again.

NEWSHOUR: How many readmissions can be prevented, realistically?

RAU: That is a great question, and I don't think there's a firm answer. The most recent estimate, which comes from a commission that advises Congress, is that about one out of eight Medicare patients returned to the hospital in 2011 in a readmission that in theory might have been preventable. But even the best-performing hospitals had potentially preventable readmission rates of nearly 10 percent, and nobody believes that every such readmission can be averted. If you look at the difference between the hospitals with the highest and lowest readmission rates, you can conclude that around 20 percent of readmissions should be avoidable.

NEWSHOUR: The Medicare readmissions policy that was implemented last October -- how much of it is meant to reduce readmissions, and how much of it is aimed at saving the government money?

RAU: Well, they're one and the same -- because readmissions cost the government a lot of money. And under very few circumstances are readmissions considered an ideal outcome. But I would say the primary desire of the policy was both to improve care and force hospitals to focus on doing a better job helping patients transition out of the hospital.

Policy makers decided that hospitals are the biggest players on the block. They've got the most money and they have the most experience just in terms of all the patients coming through. This penalty was a way of forcing them to take this sort of broader overseer role, and make sure that even though they didn't benefit from it financially, they would start paying attention to patients once they left the door.

NEWSHOUR: Readmissions are down slightly, about half a percent in 2012. How much of that can be attributed to this new policy?

RAU: The Centers for Medicare and Medicaid Services (CMS) argues that in anticipation of this policy going into effect, hospitals were really getting their acts together on this. But it's impossible to tell. And there's a wide variation in there, in that some hospitals have lowered their readmission rates, but others have not. No one has done a comprehensive study to see what type of actions hospitals took led to lower readmission rates. So we just don't know.

NEWSHOUR: For hospitals, how big a deal is this one-percent penalty -- soon to be three-percent in 2015?

RAU: It depends on the hospital. For hospitals that have very tight margins -- operating with one- or two-percent profit, or at a loss -- these penalties can be very significant. That said, most of the hospitals are not getting the full 1 percent penalty. They're getting anywhere between 0.01 percent and 1 percent. Only 276 of 3500 hospitals are getting the full penalty. So for most, it's sort of a warning nudge. It's also a way to get the hospital administration and board or owners to realize this is an important quality issue.

That being said, once the penalties get up to 3 percent, it gets a lot more serious. But just to be clear, these penalties are just affecting payments for Medicare patients -- that's between a quarter to 40 percent of your patients. So the penalties don't affect payments for people who have insurance through their employer or from Medicaid.

PBS NewsHour: The hospital we profiled, Beth Israel Deaconess Medical Center in Boston, got $4.9 million to start this Post-Acute Care Transitions program, or PACT, from CMS. They've seen a significant drop in their readmission rates for Medicare patients enrolled in the program. But for hospitals that haven't gotten a grant, how hard is it to start a program like PACT?

RAU: It depends on how strong they are financially. There are hospitals that have done these types of programs, and even more aggressive programs like Banner Health system out in Arizona, without any outside money. But they have strong finances, so they can dig into their pockets and cover it. But for struggling hospitals that are already operating in the red, it's going to be a big problem. That said, even these CMS grants like the one that Beth Israel got are limited in time. They're not going to be going on forever. So after the grant ends, this sort of uncompensated work that they're doing right now won't be paid for by the government.

NEWSHOUR: Some of the experts we talked to, like Dr. Ashish Jha of the Harvard School of Public Health, have urged changes to the policy because it penalizes safety net hospitals. What are the arguments for -- and against -- revising the policy?

RAU: The overall consensus among policy makers is moving pretty quickly and fairly strongly toward the idea that the penalties should be revised to take into account the portion of patients who are low-income. MedPAC, the commission that advises Congress, has just recommended that -- and they were one of the originators of the readmission penalty. There has been some very strong academic work out of Harvard by Karen Joynt and Ashish Jha showing that this is a problem. So I think that in that case, it's pretty well-established.

Now the argument against it is two-fold. One is that some hospitals that treat a lot of poor patients do extremely well in preventing readmissions -- and therefore, all hospitals can do that. It's not a guarantee that if you have a lot of poor patients, you will have high admission rates. And conversely, there are some hospitals that have patients who are well-off financially that have high readmission rates.

And then the second argument is a more touchy one, and it has to do with the fact that the government has been understandably concerned about discounting readmissions, becoming acceptant and almost complacent about readmissions in places that treat a lot of low-income people, because they don't want to signal that those people are just going to inevitably be readmitted. And they also don't want to change the readmissions statistics to make it appear as if their readmission rates are lower than they actually are. So MedPAC came up with, I think, a pretty smart answer. It said, when reporting readmission rates, socio-economic status should not come into account. But when determining the penalties, it should.

NEWSHOUR: How likely do you think it is that CMS will actually revise the policy?

RAU: That's another good question, and it's completely unclear. One of the issues is that CMS had said in the past that it doesn't have the authority to change the penalty without Congressional action, because specifics about how the readmissions penalty works were written in some detail into the Affordable Care Act, as opposed to a lot of the other pieces, where they said "this is our intent, and we instruct the government and the Department of Health and Human Services to figure out how to do it."

So, if CMS is going to change the program, it must change its view that it doesn't have the authority to do it. Now another way, obviously, is to fix the legislation in Congress, and normally from a policy perspective, that would be very easy, because as more and more parts of the health care system are implemented, the stakeholders come into agreement on this topic. However, the fact is that no one on Capitol Hill has wanted to open up anything related to the Affordable Care Act because it's so politically controversial. It's become a Pandora's box. So because of that, the readmission penalty is one of at least 10, maybe dozens of things that are considered fairly innocuous, non-controversial fixes that don't appear anywhere on the spectrum of things that Congress is considering.

NEWSHOUR: Thanks so much, Jordan.

RAU:Thank you.

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Chimpanzees snack on fruit and vegetables at Louisiana's Chimp Haven retirement facility. Image by Cameron Hickey.

In another move toward ending invasive research on our chimpanzee cousins, the National Institute of Health announced on Wednesday that it will "substantially reduce the use of chimpanzees in NIH-funded biomedical research and designate for retirement most of the chimpanzees it currently owns or supports."

The decision was based on recommendations from an advisory group that examined all of the research projects that use chimps. The agency will keep, but not breed up to 50 chimpanzees in case there's a need for them in future research.

From a statement by NIH-director Francis Collins:

"Americans have benefitted greatly from the chimpanzees' service to biomedical research, but new scientific methods and technologies have rendered their use in research largely unnecessary," said Dr. Collins. "Their likeness to humans has made them uniquely valuable for certain types of research, but also demands greater justification for their use. After extensive consideration with the expert guidance of many, I am confident that greatly reducing their use in biomedical research is scientifically sound and the right thing to do."

Science correspondent Miles O'Brien reported on the subject in a piece that ran in May 2012. For the piece, we visited Chimp Haven, a 200-acre retirement oasis for many federally funded chimps and watched them frolic and play and fight among the sweetgum and elm forests. They are committed to developing space for more retired chimps there and expanding the facility to do so. We also visited the Texas Biomedical Research Institute, where they were doing active disease research on chimpanzees and other primates.

Miles O'Brien reported on the debate over chimpanzee research in 2012. Are there ever cases, he asked, in which the scientific value of research should offset the moral cost of working with chimps?

That institute also released a statement on Wednesday, saying that it was disappointed with the decision and calling 50 "an arbitrarily chosen number" not sufficient to maintain research for Hepatitis B and Hepatitis C, a virus that affects more than 150 million people.

QUICK BITES

Nautilus Minerals Inc. is expected to drill the world's first large scale deep sea mine in 2014. They are motivated by huge gold, copper, manganese, and cobalt reserves (among many other metals) but there is significant environmental risk. Have a look at both sides in this infographic from Wired.

Volvo claims to have developed a "self-parking car," which "relieves the driver of the time-consuming task of finding a vacant parking space." See video below.

Also from our reporting on chimpanzee research last year, we came upon this story: 'Oops Babies' Sired by Twice-Vasectomized Chimp

Plants 'do maths' to control overnight food supplies. BBC reports.

It was long thought that the mouth of the Komodo dragon contains bacteria that's used as a form of venom. Ed Yong dispels the myth in this fascinating post on his Phenomena: Not Exactly Rocket Science blog. Turns out large serrated teeth, powerful venom, and a knack for inflicting huge gaping wounds are enough.

NOT SAFE FOR LUNCH

Pee a Rainbow: Scientist Snaps Shot of Colorful Urine

Rebecca Jacobson, Patti Parson, David Pelcyger and Justin Scuiletti contributed to this report.

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MARGARET WARNER: President Obama landed in Johannesburg, South Africa, this evening, his second stop on a weeklong tour of the continent.

The president's long-planned visit, with his family, comes at a delicate moment, as South Africa's 94-year-old former President Nelson Mandela is clinging to life in a Pretoria heart clinic.

Some South Africans appreciated the timing of President Obama's arrival.

MAN: Mr. Obama's visit will seem to me some form of solidarity, although it may not necessarily be the purpose of his visit. Coming to South Africa at the time the president is ill, and a man so revered nationally and internationally, will, I think, be a very good thing.

MARGARET WARNER: It's unclear if the two men will meet. White House officials said that decision rests with the Mandela family.

Aboard Air Force One en route to Johannesburg, President Obama said he wasn't seeking a photo op, adding: "The main message we will want to deliver, if not directly to him, but to his family, is simply profound gratitude for his leadership."

Mandela remains in critical condition, but his ex-wife Winnie said today there were positive signs.

WINNIE MADIKIZELA-MANDELA, Ex-wife of Nelson Mandela: I'm not here to answer medical questions. I'm not a doctor, but I can say that from what he was a few days ago, there is great improvement, but, clinically, he is still unwell.

MARGARET WARNER: Many gathering outside the hospital appear to be preparing for the inevitable passing of their icon.

TAMMY HACK, Resident of Johannesburg, South Africa: Our hearts are breaking at the moment. He is such an inspiration and he is a true South African hero. I think he is a world hero and we all are absolutely devastated.

MARGARET WARNER: The near quarter-century since Mandela's release from prison and his 1994 election as president brought tectonic change in South Africa. The end of the racial apartheid spurred social and economic development, and catapulted the democracy to the world stage.

The country even hosted Africa's first-ever World Cup in 2010. But for many, dreams of a better life remain unrealized. Income inequality is among the greatest in the world, though some blacks have joined the elite. Crime, corruption, and high unemployment plague the country.

Frustrations boiled over last year. Strikes by platinum mine workers angry with their low wages turned deadly. In one instance, 34 people were killed when police opened fire on strikers. Still, business figures, like this bank analyst, hope the president's visit will boost economic ties between the two countries.

MOHAMMAD NALLA, Bank Analyst: And as the United States emerges from what has been a fairly difficult economic cycle, South Africa really needs to do its bit in trying to cement those relationships, expanding on those trading relationships, because right now our trading relationships with Europe still remain the dominant factor, and we need to diversify some of that over the coming years.

MARGARET WARNER: For now, South Africa continues to struggle in recovering from the global recession. First-quarter growth this year was the slowest since 2009. 

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JEFFREY BROWN: For more on South Africa and Mandela, I spoke a short time ago with former NewsHour senior correspondent and now NBC News special correspondent Charlayne Hunter-Gault.

Well, Charlayne, welcome back to the NewsHour, as always.

First, tell us a bit about Nelson Mandela, how he's seen in South Africa today. What is his role there?

CHARLAYNE HUNTER-GAULT, NBC News Special Correspondent: Well, thank you for having me, as always.

You know, Nelson Mandela remains the icon of the world and the icon-plus in South Africa. He really is the father of the nation in so many ways. I mean, he represents everything that a young democracy strives for that his own country hasn't yet come to, but they're striving for it. And so he lies in what I understand is a fairly peaceful situation.

He responds from time to time to his daughter. I spoke with Zindzi Mandela a couple -- yesterday, day before yesterday, and yesterday. And she was very excited, because he was very emotive. When she said that Barack Obama was coming to South Africa, he actually opened his eyes and smiled. I think he sleeps a lot.

I have had an elder parent and mother-in-law, and I understand that as someone who's almost 95. He will be 95 in July. So he's had some challenges and -- but he's also had probably the best medical care for a geriatric patient, if not in South Africa, if not in the world. So, you know, someone else might have succumbed to the kinds of challenges, medical challenges, he's had a while ago.

But because he has -- and I'm told he has a renowned geriatric specialist working on his case -- he continues to go up and down, but right now he's stable and even some say as of yesterday he was improving.

JEFFREY BROWN: Charlayne, you have covered this country for a long time. You have lived there. For those of us that don't follow it day by day, year by year, as this is happening, with Nelson Mandela and as President Obama is there, what is South Africa? Where is South Africa now in its evolution from apartheid days? How would you describe it?

CHARLAYNE HUNTER-GAULT: Well, I would describe the whole continent where democracy is new.

I mean, South Africa will only be 20 years old in its democracy next year, and they take baby steps. And, sometimes, as you know, with baby steps, they stumble and fall. And so, on the one hand, there has been an increase in the middle class. There's been an increase in the standard of living. There's a smaller number -- proportion of people at the bottom, in part thanks to government social grants and child care for the poor people.

There is a -- an increase in the middle class, and you can see that when you go to South Africa. When I first went there in '85 and again in '90 and '94, there weren't many apartments. Most people were wealthy enough to have houses, houses with fences, of course, but houses or nice properties. Now you see a lot of apartments, which suggest that there is a growing middle class, and these apartments are being built to accommodate them.

At the same time, you probably have read about the street demonstrations where young people and others are demonstrating because of a lack of basic services. So you do have the same thing we had in America when our riots broke out in '68, two societies, one black, middle class and starting to go up. Whites still for the most part prosper, although you do now have some on the street begging, as you have other beggars. But most of the beggars are on the streets are immigrants from other countries, particularly Zimbabwe, where they're running from a repressive government.

But you also have in the rural areas people who are still struggling to get decent water. I know of a study that they recently did on sanitation and clean water, which is just devastating. I mean, so many people in the rural areas don't have those basic amenities. So you have a country that's divided into two, and not unlike our own, you have people at the bottom who are worse off and people at the middle and upper who are better off.

JEFFREY BROWN: Well, and speaking of our own, what about relations with the U.S. or how the U.S. is seen? How is President Obama's arriving there -- has arrived. How he seen? How is the U.S. seen now these days?

CHARLAYNE HUNTER-GAULT: I think most South Africans really still love the fact that a black man is president of the most powerful country in the world.

I think they would like to see more engagement. I think you have a young group who will protest, as you probably reported, but the majority of South Africans, I think, really do respect the president and hope that he will lay out some of the things that they would like to see happen between the United States and South Africa.

They want more engagement with the country because it's falling behind in terms of investments and things of that sort. So I think that's what they're looking for. But, generally, they're going to embrace him, I think.

JEFFREY BROWN: All right, Charlayne Hunter-Gault, thanks so much.

CHARLAYNE HUNTER-GAULT: Thank you, Jeff, for having me. 

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KWAME HOLMAN: A heat wave baked a large swathe of the Western U.S. today. Temperatures hovered in the triple digits from parts of Idaho down to Arizona. Readings are expected to approach 130 degrees in Death Valley, Calif. Airlines are monitoring the heat because it's close to the limit for safe operation of some planes. And fire crews are on alert in case wildfires ignite. Forecasters expect the scorching temperatures to last through the weekend.

Dueling political rallies were held in Cairo, Egypt, today after Friday prayers. The gatherings were ahead of massive demonstrations planned for Sunday to call for President Mohammed Morsi's resignation. Thousands of Morsi's supporters waved flags and banners outside a mosque in the capital city. But in Tahrir Square, opponents demanded he leave office immediately.

MAGDY SAYED, Opposition Protester: We are here today because President Mohammed Morsi is a killer. We are here to bring back the rights of our country, because President Morsi and the Muslim Brotherhood have destroyed the country.

GAMAL AHMED, Mohammed Morsi Supporter: We are sending the opposition the message that the president possesses legitimacy and that no one could make him step down. He reached this position through democratic elections and that is the only way he is going to leave.

KWAME HOLMAN: In the coastal city of Alexandria, clashes broke out between government supporters and opponents. Two people were killed in the violence. Egyptian officials said one of them was an American citizen.

It was widely reported a retired four-star general is at the center of a Justice Department leak investigation. Retired Marine Gen. James Cartwright reportedly has been told he's a target in a probe involving a 2010 secret cyber-attack on Iran's nuclear facilities orchestrated by the U.S. and Israel. Cartwright was in charge of the cyber operation and details of it appeared in The New York Times last year.

The U.S. Senate went into recess last night without passing a bill to stop student loan interest rates from doubling beginning Monday. Last summer, lawmakers delayed the increase for a year as they searched for a bipartisan solution. But time ran out. Rates on government-backed Stafford loans will jump to 6.8 percent from 3.4 percent. Congress still could lower rates retroactively when it returns.

Police in Boston searched the home of professional football player Aaron Hernandez this morning, in connection with a double homicide last year. Earlier this week, Hernandez was arrested and charged in a separate murder that occurred earlier this month, the shooting of his friend semi-professional football player Odin Lloyd. Hernandez pleaded not guilty. The New England Patriots have since cut the 23-year old from the team. His contract was worth $40 million dollars.

Stocks on Wall Street ended the day on a down note, after a turbulent month of trading. The Dow Jones industrial average lost more than 114 points to close at 14,909. The Nasdaq edged up one point to close at 3,403. For the week, the Dow gained nearly one percent; the Nasdaq rose more than a percent.

Those are some of the day's major stories -- now back to Jeff.

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JEFFREY BROWN: And we update the story of Edward Snowden, as a family member of the former intelligence contractor defended him on national television this morning.

Ray Suarez reports.

LONNIE SNOWDEN, Father of Edward Snowden: You know, at this point I don't feel that he's committed treason.

RAY SUAREZ: The father of former CIA contractor Edward Snowden told NBC News today his son is not a traitor.

LONNIE SNOWDEN: He has, in fact, broken U.S. law, in the sense that he has released classified information. And if folks want to classify him as a traitor, in fact, he has betrayed his government, but I don't believe that he's betrayed the people of the United States.

RAY SUAREZ: Lonnie Snowden also told Attorney General Eric Holder he believes his son would voluntarily return to the U.S. to face espionage charges if the Justice Department promises not to hold him before trial or subject him to a gag order.

Snowden himself remains out of sight. His passport has been revoked by the U.S., and he's reportedly still holed up in the transit area of a Moscow airport; he arrived there six days ago after leaving Hong Kong. The U.S. has asked Russia to extradite Snowden to the U.S. for trial. On Tuesday, President Vladimir Putin said no.

PRESIDENT VLADIMIR PUTIN, Russia: We can hand over foreign citizens to countries with which we have an appropriate international agreement on the extradition of criminals. We do not have such an agreement with the United States.

PRESIDENT BARACK OBAMA: You don't have to have an extradition treaty, though, to resolve some of these issues.

RAY SUAREZ: President Obama said yesterday that Snowden and the untold amount of classified material he's yet to disclose still poses a threat.

PRESIDENT OBAMA: I continue to be concerned about the other documents that he may have. That's part of the reason why we'd like to have Mr. Snowden in custody.

RAY SUAREZ: Today, the Washington Post reported that federal investigators believe USIS, the contractor responsible for screening Snowden for his security clearance, misled the government about its background checks. Snowden has applied for asylum in Ecuador, but yesterday its president said there's a hitch.

PRESIDENT RAFAEL CORREA, Ecuador: Mr. Snowden is not on Ecuadorian territory so, technically, we cannot process his asylum request yet. If he is allowed to go to Ecuadorian territory, well, that's something that we haven't considered. We would probably evaluate it, but, right now, he's in Russia.

RAY SUAREZ: The Washington Post also reported that following the attacks of September 11, the National Security Agency cultivated relationships with phone companies and Internet providers to obtain domestic records.

And, today, 26 U.S. senators sent a letter to Director of National Intelligence James Clapper, asking him to publicly disclose information about the duration and scope of the NSA surveillance program. 

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RAY SUAREZ: For more, I'm joined by Barton Gellman, a senior fellow at The Century Foundation and Pulitzer Prize-winning reporter. Gellman was one of the first journalists to make contact with Edward Snowden.

And, Bart Gellman, we now know there was an inspector general's report inside the NSA about its activities after 9/11. What did it reveal?

BARTON GELLMAN, Senior Fellow, The Century Foundation: It revealed an immense amount. It's 50-some pages and it's a -- it's a look back on the operation that was known inside the NSA as Stellar Wind and was actually we now know four separate programs.

I mean, I spent a lot of time trying to figure out what was the Bush-era warrantless program, devoted a couple chapters to it in my book, and I could never crack the details. What exactly were they doing? And what exactly was it that led to a huge rebellion in the Justice Department in which Jim Comey, who's now President Obama's nominee for FBI director, and others threatened to resign?

RAY SUAREZ: Well, did those people go along with the programs for a time and then there was one that they just couldn't go along with?

BARTON GELLMAN: Well, the brief history of it is that it was invented largely by Vice President Dick Cheney and his lawyer David Addington, with the help of Mike Hayden, who was running the NSA.

The Justice Department had secret opinions written by John Yoo, who's the same guy who wrote the torture opinions and some others that became quite controversial later. And when Jack Goldsmith became the head of the Office of Legal Council at the Justice Department by around the end of 2003, he started to become convinced there was a big problem with this program.

In March of 2004, Comey -- sorry -- Goldsmith and Jim Comey, who's the deputy attorney general, convince Attorney General John Ashcroft that he has to say no to part of it. And then John Ashcroft becomes quite sick. Comey has the confrontation with Cheney and eventually with the president and nearly resigns.

RAY SUAREZ: Well, now that you have had a chance to look over documents that reveal things that you didn't know for years after trying to find them out, what would you say the tone of the inspector general's conclusions were?

Was he a probist? Was he judgmental and casting harsh judgment on what had happened, or generally looking at it as something that happened in the wake of a terrible tragedy in the United States?

BARTON GELLMAN: Well, this report is written really with an inside view.

It is not blaming anybody for anything. It is -- it's a kind of very dry and I would say sympathetic factual accounting of the sequence of events. What we know for the first time now -- and I wrote about this almost two weeks ago in The Washington Post -- is that there were four different programs.

There was the program that President Obama admitted, although he mischaracterized it, which was listening to some American phone calls. There was a similar program for reading e-mails and looking at other Internet content, and then there were two programs that went after records and logs of communications, call detail records that showed who was calling who and when and from what devices. And those were being collected on every single American, and the similar stuff for e-mails and Internet chats and voice-over Internet.

This isn't listening in or reading the content. This is logging everyone who talks to everyone and when, including all Americans suspected of nothing and data-mining that.

RAY SUAREZ: At this point, is there any certainty about the whereabouts and the manner of life of Edward Snowden, where he is and what he's up to?

BARTON GELLMAN: Yes, I sure wouldn't say I'm certain about it. I don't think there is.

He has disappeared into the bowels of the Moscow airport some days ago. It is said or implied that he's still in the transit area and therefore not legally on Russian territory. He could be anywhere. I don't think that the Russian government is being especially forthcoming. We don't know what the issues are, diplomatic, legal or otherwise, and he seems to be in almost a kind of twilight zone right now.

RAY SUAREZ: What about his eventual fate? His father was hinting that there are terms under which his son would surrender, while Rafael Correa, the president of Ecuador, seemed kind of uncertain about whether Snowden was headed there.

BARTON GELLMAN: Yes, I have no idea sort of whether his father is speaking for his son, in the sense of whether his son has communicating with his father. And I don't know how exactly to read the Ecuadorian president.

Ecuador has never stated flatly that it would give asylum to Edward Snowden. He had reasons that he was heading there, and I think that the -- his WikiLeaks escorts believed that they had a deal. I did detect a certain amount more hedging in the public statement of the Ecuadorian president than I had before, but I don't know what to make of that.

RAY SUAREZ: Is it possible that the Senate and the senators who've asked for more answers from James Clapper are going to find out more from the director of national intelligence than they would have known to ask if not for these leaks?

BARTON GELLMAN: Well, it is just an undeniable fact that many members of Congress are learning things that they didn't know to ask until Snowden released into the public documents describing secret programs that the Obama administration wanted to keep secret.

We have -- we have had a national debate that was enabled only because of him, and that includes most members of Congress. I believe what's happening here in the current request is that members of the Senate are asking for public accounting of things that they do know in a classified sense and that they do not believe should stay classified. For example, you had ...

RAY SUAREZ: Barton Gellman -- well, go ahead. Go ahead. Finish your thought.

BARTON GELLMAN: Sorry.

I was just going say -- I was just going say about -- Ron Wyden and Sen. Udall as well asked Clapper to correct a public statement because they knew it was false based on classified information, but they couldn't cure it themselves.

RAY SUAREZ: Barton Gellman from The Century Foundation, thanks for joining us.

BARTON GELLMAN: Thank you. 

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GWEN IFILL: We return now to the topic of immigration reform and what's next on Capitol Hill.

Ray Suarez has that.

RAY SUAREZ: As we heard earlier, House Speaker John Boehner says he prefers a step-by-step approach to the reform, rather than the comprehensive bill passed by the Senate, which includes a path to citizenship for millions of immigrants living in the U.S. illegally.

So what are the alternatives?

For more on the options being considered by the Republican-led House, we're joined by South Carolina GOP Congressman Trey Gowdy, R-S.C. He serves as chairman of the House Subcommittee on Immigration and Border Security within the House Judiciary Committee.

Congressman, welcome to the program.

You're the sponsor of the Strengthen and Fortify Enforcement Act, or SAFE Act. What does it propose and how does it differ from the Senate version?

REP. TREY GOWDY, R-S.C.: Well, if you think of security in three different components, there's border security, there's E-Verify and then there's internal security.

In other words, visa overstays or folks who may not have been detected at the border, the SAFE Act deals with the internal -- internal security component of that. And I think the part -- one of the parts that I'm proudest of is it gives state and local law enforcement, which, incidentally, have a role in all other forms of criminal justice enforcement, it gives them a role in enforcing our country's immigration laws as well.

So it's part of that tripod of security that we have to have before we get the other part of immigration reform.

RAY SUAREZ: By giving that kind of authority to state and local law enforcement, do you run up against the Supreme Court's decision last year when looking over Arizona's SB-1070?

REP. TREY GOWDY: You can if you don't do it the right way.

Of course, what the Supreme Court said is when Congress intends to fully occupy a field, and they have a constitutional basis for fully occupying that field, then states and local tease can't play in that field.

When Congress, however, evidences an intent or dual jurisdiction or to allow state and law enforcement entities to also have a role, there's nothing constitutionally infirm about that. So this doesn't disregard the Supreme Court decision. It just expresses Congress' intent and goal to have partners with state and local law enforcement, like we do, frankly, in every other category of crime, whether it be narcotics trafficking or murder.

Look what happened in Boston. You had Boston city police officers working hand in glove with ATF and FBI. And if it's good enough for terrorism cases and child pornography cases and narcotics cases, I think it ought to be good enough for immigration cases.

RAY SUAREZ: Well, your bill's intent is certainly clear when it comes to knowing who's in the country, when they got here and when they leave. Does it allow for a path to citizenship?

REP. TREY GOWDY: My bill doesn't.

However -- and I stressed to my friend Luis Gutierrez and Zoe Lofgren and others on the other side of the aisle -- you made reference in the introduction a step-by-step approach. Necessarily, you have to start with a first step. I think, because there is so much distrust, at least in my district, of government, they're going to be really reticent to want to discuss legalization and citizenship if we can't guarantee them that this is going to be the last time we're going to have this conversation.

So I think it's important to start with security, whether that's border security, internal security, employment security. Reasonable minds can differ, and some folks may want to start with legalization. But I can tell you, in my district, before I can convince folks to have a conversation about the 11 million, they want to have a conversation about the 300 million American citizens who are desirous of this being the last time we enter into the realm of immigration reform in their lifetime.

RAY SUAREZ: Before they took a vote, the Senate added a doubling of the size of the U.S. Border Patrol, significantly more money for electronic detection at the border and a significant lengthening of the fence.

Did that sweeten the pot enough to attract your attention and possibly your vote?

REP. TREY GOWDY: No, sir.

The Senate bill is not going to pass in the House. And I don't know how to say that any more plainly than that. That's not necessarily a criticism of my Republican colleagues in the Senate, who, by the way, are in the minority. But it's not going to pass in the House. And keep in mind, of the 11 million undocumented immigrants, 40 percent didn't cross any border, southern or northern. They were visa overstays.

So you can put 200 Border Patrol agents, and unless you deal with the internal security and the E-Verify, you are not going to solve the problem. So I'm fully in favor of anything that makes the border more secure for national security reasons and a host of others, but simply adding 20,000 Border Patrol agents without also adding prosecutors and probation officers and pretrial service officials is symbolic -- and symbols are important.

That's why I wear a wedding ring. They're important, but it strikes me as being something of a political remedy, as opposed to a real remedy.

RAY SUAREZ: Today, House and Senate Democrats got together, returning to town from their recess, and they announced that they wouldn't vote for any bill coming out of the House that didn't include a path to citizenship.

Does that mean that this question is basically for the moment dead?

REP. TREY GOWDY: I don't think so.

You know, I always smile when I hear, immediate citizenship for 11 million aspiring undocumented immigrants. Surely to goodness, no one, not even Chuck Schumer, thinks that all 11 million desire citizenship. Polls indicate that as many as 40 percent would prefer just to have a legal working status, as opposed to citizenship.

Surely to goodness Senator Schumer doesn't think all 11 million can pass a background check. There's not any group of 11 million in the United States, immigrant or otherwise, who can pass -- who all can pass a background check.

So what I prefer to do is look at the 11 million in natural subgroups. You have what are called the DREAM children. I would think most people would advocate for an accelerated path to citizenship for children who, through no fault of their own, were brought here at an early age. I would have a shortened path to citizenship for those who serve in our armed services.

And then you can have a sliding scale based on your years in the country and contributions you made to society. Again, I don't know anyone who would advocate that a person from Ecuador who has been here for 20 years and made serious contributions to our society should be on the same path to citizenship as someone from Ecuador who's been here for 20 days.

So this notion that it's 11 million all at once before you do anything else is so overtly political and so transparently political, surely to goodness Senator Schumer doesn't really believe that. And if he does, then he's right. There won't be a bill.

RAY SUAREZ: Congressman Trey Gowdy of South Carolina, thanks for joining us.

REP. TREY GOWDY: Thank you. Appreciate it.

GWEN IFILL: We will get a different view on immigration reform when we speak with Democratic Congressman Raul Grijalva, D-Ariz., later this week.

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JUDY WOODRUFF: Finally tonight: the stories of those at the forefront of health care, the nurses who serve as healers in communities from coast to coast.

We turn again to Hari, who recorded this conversation recently.

HARI SREENIVASAN: There are more than three million registered nurses in the U.S., and that will not be nearly enough in the coming years, as baby boomers begin to need more assistance and the Affordable Care Act kicks in.

A new book called "The American Nurse" looks behind the numbers in a very personal way, through portraits and essays of more than 75 men and women in several different caregiving capacities.

Photographer and documentarian Carolyn Jones spent the last two years chronicling the changes in the health care system and the compassion of those on the front lines. She interviews nurses who care for prisoners at Angola prison in Louisiana, the coal miners in Kentucky, to wounded soldiers in California, and hospice patients in Florida, among many others.

Carolyn Jones joins me now, along with Rhonda Collins, who is a registered nurse and vice president of Fresenius Kabi USA, the health care company that funded the project.

Thanks for being with us.

CAROLYN JONES, author, "The American Nurse": Thank you.

HARI SREENIVASAN: OK. So most of us are born with a nurse nearby and many of us may have a nurse near us at the end. Why this project?

CAROLYN JONES: Rhonda really wanted to celebrate nurses and to shine a light on a portion of the population that we really don't know very much about. So we will all need a nurse eventually in our lives and we need more of them, so we wanted to give them a voice.

HARI SREENIVASAN: So, you were a breast cancer survivor. You had a very long relationship with a nurse through a very painful portion of your life. What didn't you understand about nursing when you took on this project?

CAROLYN JONES: Well, I have to say, even though I went through breast cancer experience, I really thought a nurse was a nurse was a nurse. You know, I mean, they take your blood pressure and your temperature.

And, in my case, I had an extraordinary relationship with a woman who gave me chemotherapy. But I didn't know about all different kinds of nurses and everything that they do and how many different ways they touch our lives. I mean, they look at us really holistically.

So my experience with the chemotherapy nurse was a really personal and emotional one. She got me through because of how she made me feel during that time.

RAY SUAREZ: Did your perceptions change when you finished this book?

CAROLYN JONES: Well, yes. I saw nurses doing things I had no idea they did.

I mean, first of all, I saw nurses go into places -- in Kentucky, for example, we went to visit a gentleman named Sidney who was living in a trailer at the end of a long road. And we got to his door, and I think that the nurse that was coming to visit him had, he hadn't seen anyone for weeks, and his home hadn't been cleaned in weeks and neither had he.

I stopped at that door just thinking, oh, my gosh, I don't even think I can walk in there. And the nurse, Robin McPeek, blew by me, walked in, found a little area, moved some stuff away, put down a sterile area, and took his blood pressure and his -- took his temperature and gave him kind of the warmest hello that I had ever seen.

And I thought, you know, that's a quality I would like to get. So, I think nurses spend an enormous amount of time doing things that are outside of the box of what we think normal nursing is.

HARI SREENIVASAN: So, give me an example of care that a nurse might be providing that you might not know is coming from a nurse?

RHONDA COLLINS, vice president, Fresenius Kabi USA: You look in ICUs or trauma patients who come in, they're comatose.

Really, nursing then is caring for the family. And it's caring for those around them to help them cope with what you know is a life-changing event. Whether it's a spinal injury or neurological injury, something like that, you know that this child or this loved one will never be the same.

And, as nurses, we work very hard to educate the family, to prepare them for the future, to give them all the tools and resources that they need to take that loved one home and have a quality of life.

HARI SREENIVASAN: So let's talk a little bit about the health care system now. How is the role of nursing changing?

RHONDA COLLINS: I think that nurses are taking a more prominent role as we look at how to care for our communities and provide primary care.

There's approximately 210,000 primary care physicians in the U.S. There's over three million registered nurses. We believe that nurses should practice to the full extent of their education and their experience, and advance nurse practitioners can provide some of the primary care.

We do have a role in this changing landscape of moving us from a sick model of health and just treating the illness to focusing on growing healthy communities through education and access. That's been one of the issues that we have had in this country is just the access to care.

You get into rural areas where primary care providers are very lean and sparse, folks don't have anywhere to go. Nurses can be that gap. And we work together as a team with physicians and provide that care.

HARI SREENIVASAN: And did you see any themes emerging as you crisscrossed the country and talked to all these different types of nurses? What is it that makes someone want to do this? Is there a common thread?

CAROLYN JONES: I was looking for that.

I was looking for whatever that secret mix of ingredients is that would kind of lead someone to this profession. I want some of that. I want to know what those qualities are. So sometimes it was that they were the eldest of six kids and they took care of their younger brothers and sisters and they knew they had a capacity to care. Or maybe there was a grandparent that was in the home that they cared for at the end of life. That was a really big influence on people, I found.

But, in each instance, I think that there's this kind of personal well that they're just able to draw upon that the rest of us don't necessarily have. I told Rhonda in the beginning I was always looking for wings on the back of these -- the people that I was meeting, because I was expecting them to kind of sprout wings at some point along the way, because I thought they were saints.

But they're not. They're people just like us. But they are driven to care for other people.

HARI SREENIVASAN: All right, the book is called "American Nurse."

Carolyn Jones, Rhonda Collins, thanks so much for your time.

RHONDA COLLINS: Thank you.

CAROLYN JONES: Thank you.

JUDY WOODRUFF: We have assembled a list of eight types of nurses you have probably never heard of, roller derby nurse, for example. Find that online.

House Speaker John Boehner on Capitol Hill Tuesday. Photo by Drew Angerer/Getty Images

House Republicans will have a meeting of the minds Wednesday, but it remains unclear if the fractious group of lawmakers will be able to reach a consensus on a path forward with immigration reform.

Despite pressure from the Senate, which last month convincingly passed a bipartisan plan, and calls from the White House and advocacy groups asking for haste, there is no indication House lawmakers feel the same sense of urgency to pass legislation.

One thing House Speaker John Boehner, R-Ohio, has made clear is that his chamber will craft its own immigration bill rather than take up the Senate version.

"We all believe that if we're going to go forward on immigration reform, the first big step is you have to have serious border security because without serious border security, what you're going to end up with is the same thing we saw after the 1986 act," Boehner said Tuesday. "We believe that a commonsense, step-by-step approach is the right way. We've talked about it for months. We're going to talk to our members about it tomorrow."

Mike Allen and Jim VandeHei write in Politico that the deliberative pace in the House could cause the push to reform the immigration system to stall out:

Republicans walked away from their 2012 debacle hell-bent on fixing their problems with Hispanics. Now, they appear hell-bent on making them worse.

In private conversations, top Republicans on Capitol Hill now predict comprehensive immigration reform will die a slow, months-long death in the House. Like with background checks for gun buyers, the conventional wisdom that the party would never kill immigration reform, and risk further alienating Hispanic voters, was always wrong -- and ignored the reality that most House Republicans are white conservatives representing mostly white districts.

These members, and the vast majority of their voters, couldn't care less whether Marco Rubio, Bill O'Reilly and Karl Rove say this is smart politics and policy.

As Boehner seeks to wrangle his unruly conference, he is not getting any help from the top Democrat in the Senate. Majority Leader Harry Reid, D-Nev., charged Tuesday that the speaker was having difficulty controlling his members on a wide range of issues, including immigration.

"Speaker Boehner is trying to decide where he is. Pick an issue. How about the farm bill? Last year's farm bill, this year's farm bill. He has dissension in his own ranks. We know that," Reid told reporters at a Capitol Hill stakeout. "He is saying the bipartisan bill that we have done, he is not going to touch that. Well, we're going to continue to press. The American people, the vast majority of the American people, Democrats and Republicans, support what we did."

The Senate proposal would create a pathway to citizenship for the estimated 11 million undocumented immigrants in the country and would bolster security along the southern border through the hiring of additional border patrol agents and completing 700 miles of fencing. It passed late last month on a 68 to 32 vote, with 14 Republicans joining all 54 Senate Democrats to back the measure.

But if recent history is any guide, a strong showing in the Senate does not guarantee a similar result in the House.

The Washington Post's Sean Sullivan and Aaron Blake highlight six previous votes in the House that have seen GOP leaders struggle to keep the varying factions of the conference together and note those battles could be a preview of what is to come for Republicans on immigration reform:

The six votes that have proved most divisive for the GOP conference since the November election -- on the fiscal cliff, Hurricane Sandy relief, the debt limit, the Violence Against Women Act, the farm bill and the selection of a speaker -- each seemed to leave Boehner and his team in a weaker position for the next round of battle. And immigration may be the toughest test yet for Republicans, who will be grappling with difficult questions about border security and a pathway to citizenship for illegal immigrants.

All told, 69 of 234 House Republicans (nearly 30 percent) have voted against leadership on at least half of the six key votes, and a majority -- 134 out of 234-- has departed from the leadership on at least two of the six votes, according to the Washington Post review.

The six key votes are not a perfect predictor of how members will vote on immigration, but they show how little emphasis members place on party unity these days.

With the debate formally getting underway in the House, the Huffington Post put together an interactive whip count outlining how members are likely to vote on immigration reform, with nearly 140 lawmakers, mostly Republicans, listed as "unknown."

President Barack Obama's White House, meanwhile, Wednesday morning released a report on the economic impact of a comprehensive bill. The report focused mainly on a June Congressional Budget Office estimate that found the legislation would reduce the deficit and argued there are "high costs" to inaction.

"[I]mmigration reform will ultimately increase overall U.S. productivity, resulting in higher GDP and higher wages," the report read. "Bringing undocumented workers out of the shadows and into the legal economy also helps put a stop to practices that undercut wages and worsen working conditions for American workers. This bill also has provisions to protect U.S. workers and ensure that new worksite enforcement and border security measures deter future illegal immigration."

And former President George W. Bush, whose legacy has been burnished in recent months, will make the case for reform at a naturalization ceremony at his presidential library Wednesday. We'll have video of the 9 a.m. event.

As part of the NewsHour's ongoing look at immigration reform, Ray Suarez spoke Tuesday with Rep. Trey Gowdy, R-S.C., about his border security proposal and prospects for Congress passing a bill this year.

Watch the segment here or below:

Ray will speak with Reps. Luis Gutierrez, D-Ill. and Raul Labrador, R-Idaho, on the show Wednesday.

See our other interviews with lawmakers and track every piece of the debate on our immigration page.

LINE ITEMS

The Texas state House passed by 98-49 a measure banning abortion more than 20 weeks after fertilization, sending the controversial legislation to the state Senate.

Senate Democrats are meeting Thursday about options for filibuster reform, with Reid ready to invoke the so-called "nuclear option" to limit filibusters for executive branch nominations.

The Washington Post's Rosalind Helderman breaks more news about the relationship between Star Scientific CEO Jonnie Williams and Virginia Republican Gov. Bob McDonnell. Williams gave McDonnell's and his sister's real estate corporation -- MoBo -- $70,000 in 2012, which McDonnell didn't disclose as a loan or gift and has yet to repay. Also unknown until now, Williams wrote McDonnell's wife a $50,000 check in 2011.

And McDonnell's 21-year-old son, Sean, was arrested in Charlottesville on charges of public intoxication.

Libertarian gun rights activist Adam Kokesh was arrested at his Northern Virginia home Wednesday on drug and weapons charges. Kokesh, who had scrapped plans to lead a gun march into Washington on Independence Day, was allegedly depicted in a web video loading a shotgun in Freedom Plaza during the holiday celebration, a violation of D.C. law.

Republicans will strip food stamps from the farm bill and move that legislation for a solo vote.

"Ready for Hillary" is teaming up with 270 Strategies, founded by former Obama aides.

Vice President Joe Biden addressed the memorial service for the firefighters killed last week in Arizona.

Illinois became the last state in the country to allow residents to carry concealed firearms in public places after the state legislature voted Tuesday to override Gov. Pat Quinn's attempt to rewrite the bill.

The New York Times details House Republicans' efforts to seize on opportunity and delay the individual mandate in the health care law.

Former New York governor and current comptroller hopeful Elliot Spitzer appeared on Charlie Rose, with guest host Mark Halperin.

Former Alaska Gov. Sarah Palin told Sean Hannity she is considering a 2014 Senate bid against Democratic Sen. Mark Begich.

Politico reports that the acting head of the embattled Internal Revenue Service "is moving to halt $70 million in scheduled bonus payouts."

Nathan Gonzales of the Rothenberg Political Report details how campaign finance guidelines may apply differently to gay couples, depending on where they live.

Student loan rates: still doubled.

Public Policy Polling has the first survey ahead of a special election in North Carolina to replace Rep. Mel Watt.

Former Democratic Rep. Donald Irwin of Connecticut died Tuesday, and Lyndon Johnson's speechwriter Robert Hardesty also passed away.

The Associated Press' Charles Wilson reports that there is newly found "film footage of President Franklin Delano Roosevelt being pushed in his wheelchair, depicting a secret that was hidden from the public until after his death."

Vanity Fair gives BuzzFeed a dose of their own medicine.

On Wednesday and Thursday, Christina continues guest-hosting for Kojo Nnamdi on WAMU 88.5 in Washington D.C. Tune in. Listen to Tuesday's segments on the quantified self movement and Superman. Yes, really.

NEWSHOUR: #notjustaTVshow

Read after breakfast: Jenny Marder reports on "dog vomit" mold.

Paul Solman caught up with Julliard graduates learning to translate their "artistic magic" into means of financial support, which it turns out, is not a new phenomenon. (Check out how Rossini kept opera afloat)!

And our resident headhunter Nick Corcodilos explains how to beat age discrimination to land -- and keep -- a job as a senior.

TOP TWEETS

Suspect will see so much more of this >>> Conservative Think Tank Trolls State Agencies Looking For IRS-Like Scandal http://t.co/qBKdWvEhhS

— Josh Marshall (@joshtpm) July 10, 2013

God bless him RT @NBCNews: 12-year-old Ohio State fan nicknames his brain tumor "Michigan," beats it http://t.co/vprEc1N9Qg@cftalk

— Speaker John Boehner (@SpeakerBoehner) July 9, 2013

Yacht in Georgetown named Sea Questered. So 1% DC. pic.twitter.com/TGm7WiUdQg

— Sam Jewler (@LuddoftheFuture) July 9, 2013

What happened to Arugula? RT @steveholland1: A kid journalist asked Obama today what his favorite food is. His answer? Broccoli.

— Maeve Reston (@MaeveReston) July 9, 2013

Mine is bacon. RT @bdomenech: My favorite vegetable is guacamole.

— Chris Moody (@Chris_Moody) July 9, 2013

You'll never eat broccoli in this town again. RT @seungminkim: You are all lame RT @TrendsDC: 'broccoli' is now trending in #DC

— Nick Confessore (@nickconfessore) July 9, 2013

Reading twitter feed from afar, sure looks like a slow day for DC journos.

— Dan Balz (@danbalz) July 9, 2013

cc: @GingrichIdeas RT @bradplumer: Democrats are proposing a new national park... on the moon: http://t.co/ZcYFgdYYtg

— Matt Yglesias (@mattyglesias) July 9, 2013

This is what congressional inaction looks like http://t.co/4OofRsCGLXpic.twitter.com/7oLptNutD3

— HuffPost Politics (@HuffPostPol) July 9, 2013

Public media superheroes! @ghweldon and @cbellantoni with Superman. pic.twitter.com/4sa2cTNjLe

— Michael Martinez (@MikeMartinezDC) July 9, 2013

Simone Pathe contributed to this report.

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Questions or comments? Email Christina Bellantoni at cbellantoni-at-newshour-dot-org.

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By Michael Chwe

UCLA Professor Michael Chwe believes reading Jane Austen, as this man does in Bath, England, to celebrate the 200th anniversary of the publication of "Pride and Prejudice" in January, can inform our understanding of strategic thinking. Photo courtesy of Matt Cardy/Getty Images.

Paul Solman: Game theorist Michael Chwe made quite a splash here recently with a post encapsulating his new book "Jane Austen, Game Theorist." Freakonomics recently picked up Chwe's thesis, and we thought this was a good time to let Chwe respond to his many commenters.

Michael Chwe: Marriage came up consistently in reader comments to my first post on this page, which wasn't surprising given the plot lines of Austen's novels. But how do we explain who marries whom? Do 21st century university professors have anything to add to 19th century novelists? Or might there be a synergy between us?

Everyone, from Austen to contemporary academia, is interested in the question of marriage. Evolutionary biologists examine animal mating generally. Psychologists prefer to analyze sexual attraction. Sociologists study how singles meet others of similar socioeconomic backgrounds. Political scientists see how government policies encourage or discourage marriage. The inescapable conclusion: there is no single "best" way to explain who marries whom. So why not use more than one?

A game theorist like myself begins with the economic premise that human beings make individual choices based on their reckoning of the costs and benefits. It is a premise that, I argue, Jane Austen obviously shares.

In "Pride and Prejudice," for example, when Jane Bennet wonders whether she should marry Mr. Bingley, even though his sisters dislike Jane, her sister Elizabeth Bennet advises, "If, upon mature deliberation, you find that the misery of disobliging his two sisters is more than equivalent to the happiness of being his wife, I advise you by all means to refuse him."

For Austen, then, the choice of a spouse is a matter of tradeoffs, which can only be measured in terms of (often subtle) costs and benefits.

But choice itself is all-important. Consider another example, this one from Austen's "Sense and Sensibility." Edward Ferrars's family plans for him to marry the wealthy Miss Morton. After his family disowns Edward for his secret engagement with Lucy Steele, they plan for his brother Robert to marry Miss Morton. Elinor Dashwood remarks, caustically, "The lady, I suppose, has no choice in the affair."

In other words, the Ferrars family thinks about marriage in terms of advancing the family's wealth and social class (which is still relevant today), but Elinor Dashwood thinks that marriage should be a matter of choice -- the woman's choice.

There are, of course, other factors to consider in explaining how the human animal winds up with a mate. Sexual attraction is important and is presumably not a matter of "choice" in the sense we use the word. Many novelists analyze how sexual attraction begins and develops, but Austen does not pursue this line of inquiry. For Austen, initial attraction is not terribly interesting.

For example, in "Mansfield Park," Edmund Bertram is drawn to Mary Crawford, but it's hard to argue he has much contemplated the matter.

"A young woman, pretty, lively, with a harp as elegant as herself; and both placed near a window, cut down to the ground, and opening on a little lawn, surrounded by shrubs in the rich foliage of summer, was enough to catch any man's heart," he says. Mary Crawford's response is equally mundane: "He pleased her for the present; she liked to have him near her; it was enough."

I do not think that Austen -- or any game theorist for that matter -- would say that an analysis of marriage in terms of individual conscious choice will result in a complete, overarching, theory of marriage. But a strategic perspective on marriage, which analyzes how individuals make choices, from introduction to courtship to proposal, can be developed and refined, and I think that this is one of Austen's objectives. As a game theorist, it is certainly one of mine.

The more refined a strategic perspective, the more usefully it can be combined with other perspectives, even those that study our involuntary impulses. For example, if you think you can increase another person's sexual attraction to you, should you do so earlier or later?

This quite practical question requires both strategic and psychological perspectives. If novelty and uncertainty are important for the psychology of sexual attraction, doing too much too early could make it difficult to generate more attraction later. On the other hand, moving too slowly risks boredom and sending mixed signals. Strategic considerations also include sizing up your target's other alternatives, which depend on the target's other suitors and their actions.

Economics and the psychology of courtship can strategically intersect in interesting ways. What about, for example, people who misperceive the intentions of others in games of courtship?

In a 2000 paper with University of Texas psychologist David Buss, my UCLA colleague Martie Haselton found that in courtship situations, men tend to overestimate women's interest in sex and women tend to underestimate men's interest in commitment.

For example, in surveys, a man's understanding of a woman's interest in having sex after, for example, being kissed by her, was more optimistic than what women reported as having intended by a kiss. Women's understanding of a man's interest in a committed relationship after, for example, receiving expensive jewelry from him, was more skeptical than what men reported as having intended by giving expensive jewelry.

Haselton interprets this result in terms of the relative costs of misunderstanding: men tend to be over-optimistic because they have more to lose from underestimating a woman's sexual interest (and thus losing a possible chance to mate) than from overestimating it. For their part, women are more skeptical because they lose more from overestimating a man's commitment than from underestimating it.

But systematic misunderstanding in this game can actually have social benefits. If men overestimate women's sexual interest and women underestimate men's commitment, men might attempt more often to initiate relationships and might work extra hard to overcome women's skepticism, thus creating more stable relationships than would occur if everyone's perceptions of each other were correct.

The logic here is very similar to Milton Friedman's 1968 explanation of how inflation can increase employment. The game here is the strategic interaction between employer and employee. Under Friedman's explanation, when there is serious inflation, employers can offer employees wages which are nominally higher ($11/hour instead of $10/hour, say), but which are in real terms lower because if inflation is greater than 10 percent a year, $11 next year is worth less than $10 today.

Thus employees sign up for work thinking they are going to be paid more, but employers are happy to have them because they will be paid less in real terms. In other words, if employers are aware of inflation, but employees are not, then employment increases. Similarly, if employers overestimate inflation, then they are fooled into believing that they're paying less than they actually are, in which case -- and this is the key -- they will hire more employees than they otherwise would have. Once again, a systematic misunderstanding will lead to a beneficial social outcome.

Of course, systematic misperception can also have negative effects: for example, in the game of international grand strategy, two countries might go to war "accidentally" because they misunderstand each other's true intentions.

But Friedman's argument suggests how systematic misperception, which is not quite the same as outright bumbling, can sometimes lead to socially positive outcomes. Just as systematic misperception between men and women about sex and commitment can have social benefits in the form of more committed relationships, systematic misperception between employees and employers about the real value of wages can have social benefits in the form of increased employment.

The constant is the logical analysis of strategic thinking that we call game theory. Austen's emphasis on strategic analysis can teach us about the world today, not just the manners and mores of rural England two centuries ago.

The social sciences are increasingly defined more by methodologies -- how you approach a question -- and less by subject matter and which questions you approach. My book "Jane Austen, Game Theorist" is meant to be an example of this trend since it argues that the novelist's vision of human behavior is methodologically quite similar to that of the mathematically-driven social scientist.

This duality -- or non-duality, as I see it -- between the "intuitive" and the "formal" came up in reader comments, and so did the topic of autism spectrum disorders. These two topics are related. One reader suggested that Austen's extremely analytical bent indicates that she had Asperger's. I don't know if Austen was on the autistic spectrum, but in a recent book, Phyllis Ferguson Bottomer does indeed analyze "Pride and Prejudice" from the perspective of autism.

In "Jane Austen, Game Theorist," I suggest that social science and game theory in particular can be understood as the analytic investigation of insights that many people find obvious. But this "formal," "nonintuitive" perspective can be valuable if for no other reason than it is different and forces people to see familiar things in a new way.

George Mason University economist and New York Times columnist Tyler Cowen suggests, for example, that when Adam Smith writes that human sympathy demands the perspective of an "impartial spectator," he's really talking about an autistic outsider who must observe others in detail precisely because he does not "get it" intuitively.

One reader wrote that Austen's novels help illustrate game-theoretic concepts but asked whether understanding her as a game theorist really generates new insights about literature. In other words, does my book and those like it simply attach newfangled terms from game theory to concepts which Austen readers already know well?

All I can say is that the study of literature has for a very long time interacted with ideas from social science, such as psychoanalysis and Marxism. Literary theorists including Lisa Zunshine at the University of Kentucky and Alan Richardson at Boston College have recently used cognitive psychology in their analyses. Game theory is a short step away.

Understanding Austen as a game theorist provides new interpretations of her work. As far as I can tell, no Austen scholar has analyzed the episode mentioned in my earlier article, in which Fanny Price chooses to wear both Mary Crawford's necklace and Edmund Bertram's chain. I am not aware of any previous interpretation of Austen's many examples of how one aspect of an alternative can be a "counterpoise of good" for another.

Of course, many understandings of Austen's novels are possible, and I do not claim that my own is somehow "better" than anyone else's. Understanding Austen as a game theorist, however, adds something new.

Michael Chwe's book "Jane Austen, Game Theorist" was published this year. Video courtesy of Michael Chwe's YouTube Channel.

This entry is cross-posted on the Rundown -- NewsHour's blog of news and insight. Follow @paulsolman

TIÉBÉLÉ, Burkina Faso -- On the rocky ground outside the Kollo mining village near the border between Burkina Faso and Ghana, about 100 people are working, 30 or so of them children. They smash boulders into pebbles and pebbles into grit with primitive hammers and sticks. They haul buckets of well water up the hillside and, pouring this water into shallow pans filled with rock and dirt, they swirl the muddy mix, looking in the silt for tiny flecks of gold.

Nearby, a small hill rises from this barren gold field, and atop this hill are hand-dug shafts that plunge 150 feet into the ground. Joseph, 15, and Germain, 12, lead the way down into the mine, gripping knotted ropes, finding footholds and squeezing past support timbers in the yard-wide pits. They get to the bottom after 20 minutes and silently begin to fill buckets of ore to be hauled up by rope.

The shaft ends in a cramped, pitch-dark pit. The bottom widens a bit to reveal a tiny, wedge-shaped crevice. In the darkness, sitting cross-legged with a flashlight strapped to his head, is a small boy. He chinks at the rock walls with a handmade pickax and scoops the shards into a large green bucket. His hands never stop moving - scooping and chipping, chipping and scooping. The older boys call him Théophile. They say he is 7 years old.

The United Nations' International Labor Organization estimates that as many as a million children between ages 5 and 17 work in the small-scale gold mines of Africa for as little as $2 a day. In the African Sahel, a semiarid region that stretches from the Atlantic Ocean to the Red Sea across parts of Mali, Ghana, Burkina Faso, and Niger, 30 percent to 50 percent of small-scale mine workers are children, according to ILO estimates. Child labor is against the law in Burkina Faso, where last year the government announced a plan to significantly reduce the numbers of exploited children by 2015. But enforcement is lacking.

The U.S. Department of Labor also is funding a four-year, $5 million project in Burkina Faso, one of the world's poorest nations, to reduce child labor in cotton farming and gold mining. The grant will be used to help raise awareness about child labor laws and build government capacity to monitor and enforce the laws, said Eric Biel, acting associate deputy undersecretary for the Bureau of International Labor Affairs.

The project aims to help 1,000 households and 10,000 children avoid "exploitative child labor" by offering schooling, financing, and alternative employment.

Child labor in the gold mines here is so prevalent -- and so obvious -- that the U.S. government prohibits its agencies and contractors from buying the gold directly from Burkina Faso. The prohibition, however, does not extend to private dealers.

Observers say porous borders, which facilitate black-market trades, and the very nature of the world gold supply chain make tracking gold mined in Burkina Faso almost impossible. Furthermore, federal purchases of gold from legitimate international sellers do not necessarily preclude some of the gold originating here.

The Canada-based Artisanal Gold Council, which is working to implement tracking systems and promote fair-trade policies, says there are no hard data to pinpoint whether gold mined by children in Burkina Faso reaches the United States or ends up in jewelry purchased by Americans. Anthony Persaud, a policy and field operations coordinator for the council, says it is "unlikely" but not out of the question.

Burkina Faso does not refine its gold but sells it through exporters to refiners in Dubai and Europe, he says. From there the gold enters the world supply chain.

"The thing about gold, you can fit $50,000 of it in your pocket without anybody noticing," says Persaud. "It's quite easy to move across borders like that."

Juliane Kippenberg, a senior researcher for Human Rights Watch, said the group's 2011 report on child labor at small-scale mines persuaded one gold refiner to suspend purchases from Mali.

"We are not calling upon companies to boycott gold that has been mined by children," Kippenberg said, "but to remediate the situation if they find child labor in their supply chain -- by engaging the relevant government, their suppliers, and demanding progress to get these children out of the mines and into school."

Gold production in Burkina Faso has more than doubled in recent years, reaching 43.2 metric tons in 2012, according to the World Bank. (Unlike its neighbors Mali and Ghana, ancient gold kingdoms and major producers today, Burkina Faso is a relative newcomer to the market.) The return of international mining companies, banned for a time in the 1990s, has boosted production. Still, much of the gold comes from small-scale mines.

Small-scale gold mining began here in earnest in the 1980s as droughts and famines forced families from farms and into mines to earn a living. It remains a family affair.

"You cannot eliminate child labor in a community when the income of the family is so low," said Alexandre Soho, senior program officer for the International Program for the Elimination of Child Labor of the ILO. "You need to tackle the issue of the livelihoods for the parents."

The U.S. Labor Department and the ILO consider mining one of the worst forms of child labor because of the risks of injury and death and the long-term health consequences from constant exposure to dust, toxic chemicals, and heavy manual labor. The list of documented ills includes permanent lung damage caused by inhaling pulverized minerals, muscular and skeletal injuries, hearing loss, accidental blinding, and mercury poisoning with its attendant neurological damage. And then there is the fact that when children are working, they are not in school.

In Tiébélé, near the Kollo mine, Daouda Ganno, general secretary of the mayor's office, says local communities are trying to establish a prefect near each village to enforce school attendance. When a child is absent, he said, "the prefect will go out and find the parent and ask, 'Where is your child?' and then they will find the child and bring him to school." This is Ganno's plan, but for now, he says, it is still only a plan.

The nature of the mining makes enforcement difficult. Often the mines are illegal and hastily dug on private property. A claim is worked and then abandoned and the miners move on. The government collects taxes from miners who work or prospect on public land and has made efforts to regulate the small mines, but with an estimated 200 mining sites, most of them very remote, the task is overwhelming, authorities say.

At a new mining site in the Bilbalé region 12 miles west of Diébougou, about 200 people show up overnight, drawn by the rumor of gold. About 50 children are in the crowd and even the tiniest will work. In hours, the men and older boys have cleared the ground of scrub trees and sparse grass and the digging begins at a frantic pace.

Little children, some naked, squat on the ground to claw dirt and rocks into shallow bowls. The families fill as many vessels with raw dirt and rock as possible. This rock and dirt is weighed and becomes their share of the "take" from the mine. If gold is found, all the miners will get a little money. If there is no gold at this site, the miners move to the next place where gold is rumored to be.

Miners earn little for their work -- children even less. ILO surveys found children often were paid no more than $2 a day or only received food for filling buckets with gravel, Soho said. An entire family might make $5 at an undeveloped site. At established mines, such as Kollo, workers say they can earn about $40 a day.

If the yield at a field is good, word gets out and a boomtown springs up with shanties, supply huts, and cafes among the plastic-covered huts where miners live. Such is the case at Kollo, now home to 3,000 people.

With the established mines and villages also come the ore-processing centers where miners take large sacks or rocks and pebbles to be ground into powder. This powder will be processed, usually with mercury, and further refined into gold nuggets at another location.

The ore-crushing machines are makeshift contraptions cobbled together with pulleys, belts, grinding plates, and smoke-belching diesel engines. And while it takes the strength of a man to empty the bags of rock into the crushers, children do most of the other work. They sharpen metal grinding wheels without eye protection; scoop and bag fine powder without dust masks; and fetch and carry just inches from pulleys, belts, and spinning motors with the power to rip and shred anything caught in their works.

The pounding and clanking of the crushers are deafening. The machines spew constant clouds of dust, which coats the children from their heads to their bare feet. Water is scarce, so the children use the bilge water from the machines to wash their faces and brush their teeth. When the children are not working, they lie down near the machines and sleep, oblivious to the noise. Their coughing is constant.

At the Kouékowéra camp near Gaoua, Karim Sawadogo works with his uncle. The boy says he thinks he is nine years old, but he isn't sure. He has been to school, but only a little. Before the gold field, he was a goatherd near his home in northern Burkina Faso. In the camp, he cooks, fetches water. In the mine, Karim works barefoot and shirtless, his feet thickly callused, his muscles flexing as he chips ore and fills buckets.

Speaking in his native dialect, Karim smiles when he is asked what he wants to do with his life. "I came here to make money," he says. "My dream is to make enough money so I don't have to do this anymore."

Editor's Note: An earlier version of this story reported Burkina Faso had produced 32 metric tons of gold in 2012, according to the World Bank. Since publishing in April 2013, the World Bank has updated that number to 43.2 metric tons.

This piece was originally published in The Philadelphia Inquirer on April 28, 2013. Price received funding from the Pulitzer Center on Crisis Reporting. View more of his work on its project page, The Cost of Gold: Child Labor in Burkina Faso.