checks. "consider this". could the affordable care act drive up er visits nationwide? >> plus, conventional wisdom from gun control advocates, fewer firearms mean less gun

violence, shoot holes in that theory. also, question why long term partisan beliefs be off the mark. could homophobic, locker room controversy which could be a kick to the lgbt community. hello, i'm sheila macvicar, sitting in for antonio mora. welcome to "consider this". we begin with a groundbreaking study, published in the journal of science. that cast doubt of patient protection and affordable care act. the white house and its allies have often said that expanding hearing coverage to the uninsured will lower health care cost. but might the opposite be the case? we're joined from philadelphia

by katherine backer, professor of meat economics at the time at the harvard school of public health and one of the studies of oregon's public health education, and from san francisco we're joined by james prob innson, professor of health economics university of california at berkeley. thank you very much for joining us. professor, in 2008 they expanded medicaid through a lottery given a rare chance to observe the effects of the expansion alongside a controlled group of people who did not receive coverage. what did you find when you started looking at what expanded medicaid coverage did for people? >> we looked at the multifaceted effects of medicare, benefits of financial protection and potentially improved physical and mental health and we found that expanding medicaid to low income adults dramatically

increased their health care utilization, including not just the emergency department but also hospital use doctor's office viforts and prescription visits and prescription drugs. comes along with benefits for beneficiaries. >> in fact you found that emergency room visits increased by 40% which was a pretty big number. >> yes, it's a substantial increase. you can imagine a beneficiary sitting home with a set of symptoms perhaps a sprained ankle that might be broken or a cough that's persisted a little too long, might hesitate to go to the emergency, uninsured, but would choose to be checked out if he or she had the protections of medicaid, which is what we see. >> dr. robinson, is that enough time to draw conclusions? is it enough time to know what

happens when obamacare comes into being and there are more people on medicaid? >> well hopefully, over time, the newly insured patients will develop relationships with community based primary care doctors and will not rely as much on the emergency room. but i think that what the study does show and is consistent with whatever else we know is that just giving people insurance in itself is pouring oil on a fire of a very inefficient health care system. we need more than giving people insurance, it is going be to cost more rather than less. >> they have taken steps since 2008 to reduce those costs and that they have been able able to drive that number down. does your study take that into account and what kinds of changes do you think need to happen for in to be a real

reduction in emergency room use? >> it is definitely important to be cawshz in generalize -- cautious in generalizing. you're raising the important point that our study focuson oregon's medicaid program as it existed from 2008 to 2010. that's the period we studied. and during that period we saw the increase in utilization of emergency departments and other care. ever since then, oregon has had a different effect on utilization and time will tell. our study can't speak to the change in the program that was recently enacted. >> are the kinds of changes that oregon has made, the kinds of changes that are going to have to be made in other states in order for there to be more efficient use of hearing resources? we know those resources are scarce and we know there's going to be a big demand on them. >> i think oregon is in some way

a leader in the industry and i admire oregon's health care quite a bit. one thing that's going to have to change, one is on the doctor side and the other is on the side of patients. the reality is the medical profession in the hospitals need to create more primariary care primary care practices, so they don't have to go to an emergency room. so that's a responsibility on the doctor hospital site. but there's also responsibilities in my view on the patient's side. access to health insurance is not an entitlement to go out and spend the taxpayer's money on high priced health care when you could get more cost effective and cheaper occasion in the community. the patients need to face some consumer cost sharings if they go to some emergency care, rather than primary care

practices. what they're doing is clogging up the emergency rooms, if the people who really had a heart attack, car crash, they are the ones that need to go to the emergency room, or those who have a sore throat or pain in their shoulder should wait and get care at primary care the next day. >> more accustomed to seeing primary care, we could see the number of er visits decrease. as james said this could be a question of education as well as access. >> the long run might be quite different from what you see in the short run. i think it's quite possible that patients would change their behavior. that said, 18 months in this emergency department study did not see a particular waning of the effect over that window. so the longer run has to be longer than that.

it is important to balance with any benefits the beneficiaries might have accrued in terms of mental health and increased exposure to financial distress. >> james we know going forward, as obamacare, the signup has been fraught with its own problems. but as obamacare comes into being we know that there will be people who will seize on studies like this and point to increased cost and use of e ers, if you believe health care should be more universally available, what do you say to push back when there's an inevitable cost centers? >> i think that the inefficiencies of the health care system that have been documented in the study, which i mean lack of primary care, and patients who abuse the emergency room when they don't need to be there, is not specific to people

on medicaid, or people on obamacare, it runs across the board. medically insured people do this, medicare people do this. we need to have the consumers take more responsibility for their own health and for their own health care and don't expect insurance companies or the government to pay for anything that they might want. >> katherine robinson. thank you both for joining us. we turn from health care now to another contentious topic in why american politics: gun control. our next guest has produced a study that fewer guns equals less gun violence. after 30 years of looking at gun violence statistics he found that not only do assault weapons bans have a negative

rate, but concealed carry laws may end up in lower rates of homicides. mark gates authored the study, an examination of assault weapons bans on state level murder rates. it was published in the journal of applied statistics. >> thank you for having me. >> conventional wisdom from gun control advocates. tell me what you found as it related to concealed carry permits. >> regarding concealed carry weapons laws, essentially when i found is those states that had more restrictive concealed carry weapons laws had on average gun related murder rates that were approximately 10% higher. and that is on average, over the

29-year period from 1980 to 2009, that i was looking at. >> now, your studies are consistent with the 1997 study which you also cite. but ther there are a number of studies out there that argue the opposite of what your study has found. a study published last mar and one published in november found that higher rates of gun ownership led to higher number of gun homicides. is there any way you can reconcile your data with these studies? >> my data looked at murder rates which is different than homicide rates. homicide rates are justified killings and state sanctioned killings. that's a little bit different. my study looked at gun control laws which is very different than gun ownership rates. essentially they were looking at something different than i was. >> why did you choose to examine

the question of concealed carry laws and assault weapons bans as a benchmark for your study? >> actually when i first started doing this study i was concentrating solely on assault weapons bans because i did this solely in the wake of the sandy hook shooting. and more than one gun control law, the one law that kind of leapt out at me was concealed carry laws. they had changed quite a bit over the last 30 years. if you look at the state-level laws in the 1980s very few states actually had unrestricted concealed carry laws. most -- a lot of states actually banned the concealed carry of handguns. and over the years since the mid to late 1980s more and more states have adopted more lax laws regarding exon sealed carry weapons.

i thought that would be an excellent gun control law to look at given the changes, the dramatic shifts since the mid 1980s. >> we're in a situation now where 42 state's in fact have either unrestricted concealed carry law or shall issue, in other words it's very easy to get a permit. and eight states have a may standard, but there are no carry. do you think that there is a correlation between declining crime rates, which have been sort of going down since the early 1990s , and increasing gun carry rates? >> my study definitely saw a correlation. however, there are a lot of other things going on during that time period. and i tried to capture some of those effects through the use of some control variables which i

included in my study. but obviously there areful things that you cannot quantify, better policing techniques, being crime enforcement technology, the crack down of the late 1980s, early 1990s is somewhat over. there are other factors in play that could have had an effect on the gun-related murder rates which were not quantifiable and i couldn't quantify in my study. i did make that clear in my guarded conclusion that although we see statistically, this effect that state with more restrictive gun carry laws had higher murder rates on average. it could be other factors that my study and many other studies weren't able to capture. >> i think in your conclusion one of the questions you asked

is that -- is whether one of the most violent states have the toughettes gun control measures. >> correct. >> you suggested that is something for further study. in the wake of sandy hook, the battle over gun control has in fact intensified. do you think your study will be used by advocates of lesser gun control? >> i'm not really sure. that's up to the readers of my journal article. i'm an economist, a social scientist. i thought this was an interes interesting science question, seeing if certain laws had the desired effect and in this case i found that two gun control laws actually did not have the desired effect that the legislators thought they would. the assault weapons bans had no statistically significant effect and the concealed weapons laws had exactly

the opposite effect that was intended. i'm neutral in this position. all i did was conduct a study in order to determine the efficacy if you will of these two gun control measures. >> mark gace, food for thought. thank you for joining us. coming up. has al qaeda taken control of a major region in iraq? we'll see who they are, what they want and how it got this bad. american decline, is the bipartisan beating up of u.s. actually wrong? the battle over whether homophobia put a pro-equality player out of work? contact us

@ajconsiderthis.

>> u.s. troops fought twice in 2004 to control the iraqi city of fallujah. on the other side, iraqi insurgent, some of them from al qaeda, the u.s. and its allies won that fight. but fighters were back in fallujah friday . sunni muslims have been fighting fallujah, ramady, but with sectarian violence growing, al al qaeda's islamic state sees an opportunity to carve outs a state for itself. hezbollah may be creating new regional tensions, from syria to lebanon.

for more, i'm joined by skype by danielle serwar, a former state department official. also with me from washington stephen mackerny, executive director of the project for middle east democracy, dedicated to examining how democracies can grow. >> islamic state of iraq in syria, who are they and do we know what they want? >> sure, they are a collection that has been established during the last couple of years the of fighting in syria. they are largely al qaeda and former al qaeda fighters. combination of iraqis, syrians and fighters with experience fighting in afghanistan, pakistan and some in yemen. what they want is the end to the modern nation states in iraq and

syria and want the establishment of islamic state in syria. >> 60 miles from baghdad, and fallujah and re mskseny are cities that americans fought and died for. in a powerful enough position to open up a third front in iraq. how did we get to this point? >> i think a major factor in the current situation is the war in syria. which is exporting militants into iraq and providing them syria. at the same time, you've got a prime minister in baghdad who has bee

been alienating, he faces two problems. he faces a militant extremist problem, a military challenge but he also faces a political challenge from a alienated population, and if those two come together they could create a much bigger problem. >> i'm wondering, steven, obviously we talked about the price of american price that americans paid for fallujah in 2004 during the surge, that big influx of troops that was meant to quell basically sunni insurrection in anbar province. could be brought on side to begin to have some support for the central

government of al maliki. has all the work that was done in anbar basically fallen apart? has it all been for nothing? >> i think that's basically the case. the biggest problem internally in iraq last been that al maliki and his government has not retained the confidence of the sunnies. iraqi military has largely perceived as a militia, sunni tribal leaders to work with the iraqi central government but i think al maliki and his government squandered that so

now we're in a difficult spot. >> to go to the questions daniel of the power of al qaeda, how is it that al qaeda has grown, is it simply the syria effect that is at work here, where we're seeing the spread of conflict throughout the region, the destabilization throughout the region and how did al qaeda become such a powerful force in such a relatively short period of time? >> well i think the syria effect is all very important but i don't think all is lost. levels of violence in iraq in recent months are much more serious than they've been for several years but they are nowhere near the levels of 2006, 2008. those levels of violence were on the order of five, six times higher than recent levels of violence in iraq . in addition, from the point of view of the military contest is

whether the tribal chieftains in anbar would do, fight al qaeda or whether they will go to al qaeda and fight with al qaeda against the government. i think there's a pretty good bet still that they haven't forgotten the harm al qaeda did in 2005-2006, and that they will stay against al qaeda, even if they're not overly enthusiastic about the maliki government. maliki is a clever politician and he is no doubt putting some money and other propositions on the table to try to make sure that the tribal leaders on anbar staw on his side. >> well, steven, one of the motion effective weapons the americans had in 2004 was cash. is a similarly large application of cash called for again? >> well, i think it's probably not realistic for the u.s. to

play the same role that it did in 2004. obviously the u.s. does not have the extensive military presence it had at that time, doesn't have the investment in resources that it did at that time. there's no doubt that cash and payments can play a role. i think it would be more likely the need to come from the central government of iraq. i think it would also be important that any cash payments be accompanied by a sort of confidence but building measures that can regain the confidence of sunni tribal leaders and the sunni population in anbar. >> to turn the question to what hezbollah has been up to, daniel, a security analyst has made the claim that israel has attacked what is called syrian military deliveries. the question here is this latest move by syrian president assad

to safeguard or is this the preliminary move to another round of fighting between israel and hezbollah? >> i frankly don't know. i find the whole report puzzling. because the israelis in the past have declined to talk about this but to act, these transfers to large missiles to hezbollah, rather than talking about it rather than doing something me. >> thank you, very much, daniel, steven. for being with us. >> it's a pleasure. >> thank you for having me. switching topic. staple of pundits, politicians and economists for decades. the launch of sputnik sparked fears america had fallen to second place as a global power in the late 1950s. in the

1980s japan's growing power triggered more fears of america's decline. fears that grew in the last decade with the rise of china's powerful manufacturing base and american unemployment that followed the worldwide recession. but now, is american decline really a myth? for more i'm joined afrom munich jerm mi by are joseph zofi, the author of america's decline. welcome mr. yofi. why has predicting america's decline been in effect a growth industry over the past 50 years? >> i think because the united states among the western nations is a pecularly introspective country. it's probably more willing to criticize itself than other societies are, and that's one reason.

but don't forget that declinism always comes with a purpose. the purpose is in the ways of the biblical profits. the world is going ohell but if you make amends, if you turn around, if you change your ways, you will rise again. and so all these waves of american declinism have in fact that purpose. and also helped to you gain the white house the way john f. kennedy did, when he said that the soviet union would in short order overtake the united states. >> and that missile crisis didn't exist. the americans had vastly more missiles than the soviet union did. >> it did. it played greatly to reagan's advantage in the 1980s. >> many write that china's economy will overtake america

and one are prediction to cebr pushed that back to 2028, but china becoming the world's economic power. is that how you see it? >> i certainly don't because i've seen these predictions come and go. they refer to the soviet union, to europe for a while, to japan and they are now referring to china. what this report that you just quoted is you know run of the mill, declinism, let me put it this way: it is not a very very sophisticated economic analysis. they say the japanese, chinese growth rate is higher than american one and the it will inevitably over take america. but look at japan, japan was growing at 12, 14%, it is now growing at

0%. the european union was growing faster than the united states, it is now growing at 0%. we are now watching china which has come down from double digit to 7%, we are watching this same mistake north only the same mistake being made over again but we are seeing how an economic model that generates enormous growth in the beginning, comes down to normal. and that is already happening to china. but that's not even the most important point. the most important point is the curse of demography, that none of these models like the one you quoted ever looks it. so your report -- cebr report, claims that china will overtake the u.s., in 2028. now, i look at my demographic

currents here, and i see that by 2030, the chinese dependent, welfare, pensioners, retired people, population, will overtake the american one. and an old population means slow growth. china will become old before it becomes rich. point 2 on this stop with this statistics is even closer, 2015. the supposedly endless chinese research army of labor coming in from the country side will start to decline. in 2015 the number of workers will start to decline because of the demographic curves. >> what you're saying about china and the obstacles to its growth, but in the united states there are major obstacles here. there's record income disparity that is disturbing a great many

people. unemployment. there are disturbing statistics that have to do with test scores for u.s. high school students versus their compatriots in other countries of the world. i wonder when you do look at those thaings do suggest there is trouble here, how can you truly say that the united states is not losing its position, it's not -- or sit nor that the united states is not losing its position, that other countries are just not going to catch up? >> okay. could i bother you with more numbers? >> okay, briefly. >> okay. test scores. done by the oacd, the 30 industrialized countries. united states shows up in the middle. with the french, with the germans, with the other west europeans. who shows up on top? shanghai, not china. why shanghai? well, this is the most highly

selected sample of talent and ambition that lives there. now, if we compared, say, cambridge, mass and palo alto versus shanghai, i think we'll do better. we are always mesmerized by our high schoolers in the united states. look at the distribution of the top universities in the world. 17 out of the top 20 are american. you know who came up with that lead table? shanghai university. final point, inequality. you want to talk inequality, go to china. the so-called genius quotient is a whole hell of a lot worse than the united states. >> thank you for the interesting conversation. an nfl player says he was fired because of his outspoken lgbt views. is this a step back for gay rights?

>> and >> scholars and writers, policy makers and cultural icons >> don't miss the best of "talk to al jazeera" revealing... >> he said he was gonna fight for the public option, he didn't do it... >> personal.... >> from the time i was about nine, i knew i was different in ways other than just my face... >> shocking... >> being babtist...they always talk about don't judge other people.. but they judge everybody... >> the conversations people are talking about >> forget the democrat party and forget the reublican party, they're all one party... >> talk to al jazeea on al jazeera america.

>> every sunday night, al jazeera america presents extraordinary films from the worlds top documentary directors this week: is love enough? >> that was a dream of ours... four children.... >> a little girl, removed from everything she's ever known... >> she's gone through a ton of orphan stuff... >> if their hopes don't turn out to be the reality...are they gonna crash? >> an unflinching look at a

family learning to love >> i think she could have used a hug... >> dark matter of love on al jazeera america

>> an exclusive "america tonight" investigative series >> we traveled here to japan to find out what's really happening at fukushima daiich >> three years after the nucular disaster, the hidden truth about the ongoing cleanup efforts and how the fallout could effect the safety of americans >> are dangerous amounts of radioactive water, leaking into the pacific eververyday? >> join america tonight's michael okwu for an exclusive four part series, as we return to fukushima only on al jazeera america

this is the 900 page document we

>> whais what's the science behind love? more than a century of research shows the more a child has close relationships with parents and loved ones, the better they are at navigating life. a documentary, the dark matter of love which airs right here on al jazeera america on sunday at 9:00 p.m. eastern, follows one family as they adopt three children from russia. they are helped with a team of physicians and therapists. >> we all develop patterns of relationship and that offers us a lot of stability and comfort. then you adopt somebody and the family's job of course is to help this child move into the set of patterns that we expect

has. in other words, the family's job is to teach the child in a sense to dance this new dance. and basically, the message that these parents send is, i want to take down your protective wall. i want you to dance with me. and the child is like, whoa! that's scary! >> claudio and cheryl diaz are the couple who are profiled in the film. they join me from wisconsin. claudia is the therapist that helps them, joins us by skype. claudia, starting with you. >> as human beings we are relying on each other for survival.

babies have an innate ability to tell their parents they have a need. and once that need is met the child and the parents are able to move on through the development. the research shows us that right from birth children are able to tell their caregivers that they have a need and hopefully their caregiver then can meet that need. >> claudio, you and cheryl were filmed for documentary, your children, your daughter and the three children you adopted, you were filmed not only for documentary but also working with doctors playing with your children for therapist to review. how did the therapist help you with the process of have integrating these children into your lives? >> i think enlightenment that happened for us is when we saw those snippets in slow motion of their responses that are basically giving us the cues that they wants our assistance or they may need us more than we think, it became enlightening because in a new relationship, you're looking for those accuse

and you may not -- cues but you may not see them and they do come in shorter snippets than we had been expecting. >> cheryl, you had the added advantage of your children were reiteration speaking and yet you did not speak russian. the kinds of accuse you had would be innately difficult. >> we tend to use a lot of sign language. it helped out a lot. >> did you find cheryl that you were at cross purposes, when you looked at what the trangz laition said you realized what the children were trying to communicate, something that had not occurred to you at that time? >> well, actually, claudio actually gave a sign like, to stop something. but to them, they were thinking, he's going to killer us. >> not a good thing! >> so some of our sign language

wasn't quite what their sign language was. >> well, nicole, that's a really interesting point. obviously, diazs are a very loving family, it comes very, very clear in the film but they didn't speak the same language as their adopted children, and the children went from culture slok, a pretty grim orphanage that you are introduced in the film to a lovely home in wisconsin. wouldn't they have these kinds of issues anyway? >> the language barrier definitely is a difficulty. however, as human beings we certainly have the ability to matter what our language is, to bring needs to our caregivers. and we can do that in a lot of nonverbal ways. however, with the language barriers, and the difficulty in their relationship patterns, the children definitely had more of a struggle in being able to use any kind of language, both

verbal or nonverbal. >> cheryl, did the filming of the documentary further complicate that whole adoption and integration process? and i have to say why at such a sensitive moment for your family did you say yes? >> well, we thought about it. it was having a camera follow you around when you were trying to bond with your children, that was difficult. it's lard to bond with your children anyway, let alone the camera following you into your, you know, areas of life that are more private many. but we thought if there is a way that it could help other people, to see that it's a little bit of a struggle, maybe even a lot of a struggle. but in the end you have this blessing. and help them to see that adoption is a good thing, and it is a good choice.

then it was all worth it. >> claudio yoa you've also got another child who was a young teenager when the adoption took place. how did the adoption and the science around the adoption affect the connections to you? >> well, she was my only child and she had both of us as parents. now she had to dwight the time appropriately not poanl between she and us but she and then and she knew we had to divide the time appropriately between the four children. i think the timing in her teenage cycle was almost appropriate. because she's starting to think of her world and question her world and see her world from only her lens as opposed to the unit, the three of us. so it hopefully gave her some insight as to how her place in society is going oimpact other people who are around her. so we considered it a benefit.

and that may be a glass-half-full approach at looking at it. there were moments when obviously she was frustrated by two boys, two twins who were a little louder than she was used to expel but at the end of the day i knew she wanted siblings and she was linger through the process how to become a better sibling. >> cheryl in the few seconds we have left, how is your family doing now? >> they are doing great. it's amazing that in two years, what the change has taken place, from being in russia, climbing on walls, like little wild people, out of jungle or something to -- >> we must leave it there cheryl and claudio, nicole, the dark matter of love, airs here on al jazeera america, sunday, 9 p.m.

>> hello, welcome to the news hour. these are our top global news stories. taking on al-qaeda, rebel forces drive them out to syria. in bangladesh on the eve of the election. we'll have the latest. and a half meter of snow faults on the state of massachusetts. >> reporter: with the headlines from europe including seeking a new life in pca