afterwards, sharyl atkisson reports on how scare tactics are used to influence public opinion in her book "the smear." by ericnterviewed wemple. >> you hammered the washington post to you see is not properly reported on this incident as opposed to -- >> know also -- no offense to two, i am not going to defend john mccain or donald trump. when i criticize behavior at it does not mean i am supporting him or cheering him on.

it has nothing to do it that, when i see their smear i have spoken up about that including the washington post coverage. watch this on c-span twos book tv. >> a discussion on health care in girl areas. this is about 25 minutes. dr. helen -- is with us now. she is an emergency room doctor. thank you for being with us. guest: thank you for having me on the show. spotlight week focused on that rest belt and

the black belt. tell us what that is. guest: the black belt in 17 counties throughout alabama and mississippi. it was named after the soil originally. it has come to have a political music -- meaning. it expanded to include several other states throughout the south that are predominantly african-american population. may health care such a struggle in this part of the country. you focus on marion alabama. guest: before we talk about don't --his area doesn't have enough hospitals or doctors. there is a primary care doctor

for every 10,000 feet which is half of what you have in an urban population. of 3500 and the county seat. there's really only one doctor in town. no hospital at all, it has been closed since the 1990's. the narrative hospital is 30 darkes away, dangerous, roads to get there and even that hospital just has the bare minimum. of mistrustistory in this area. 1930's there was a study african-american sharecroppers were recruited to

be part of the study, many who had syphilis, and they found theypenicillin cure it but did not give it to these people because i wanted to see what the long-term outcome was. there are more stories like this throughout the south. women were given hysterectomies and tubal ligation's without their consent in north carolina. there is a great deal of mistrust here. you write about a tuberculosis crisis. you wrote marion, the seat of the county has been grappling with an open of a disease that vanished from much of the u.s.. 34 active cases has been found. it's almost 100 times the national average higher than the

rates in india. now in happening right perry county? we won't know for a couple of years out. they have had active cases. what happened here you can have small pockets of tb outbreaks in the u.s.. areajail populations or an where there is a high number of immigrants. but to have the whole neighborhood or town infected is rare. in 2013 they had a couple of cases and in 2000 13 they started to add up to. the health department realize they had a big problem on their hands. they tried to set up testing. in any other area when people hear there is a tb out the rack -- outbreak people show up to be

tested. in this neighborhood it is different. many of them did not have primary care doctors, they didn't show up for the testing. the outbreak just grew and grew. host: how do public health officials deal with that? what did they do? contract --ould do contact tracing. you would go to their house and tests everybody. tb affects people who live in close quarters. they wanted to do that and do a health fair to test people. localhough they got theye evolved -- involved

they-- when they set up had beer bottles thrown at them and they had to call the police. host: you profile. it is emblematic about what happens across rural america. int sort of solutions are place to address that? problemhis is a big throughout. did and said it was the department of health almost moved to marion and had to contact each person individually and had to be very discreet about it. they had to change the way they would normally operate. usually you don't have to do that in other parts. you write that medicaid

has a role to play here. how does medicaid manifest itself in a place like marion county? guest: alabama is one of the states that have expanded medicaid. medicaid have expanded . alabama chose not to. the previous governor felt strongly against medicaid. he believed it was a broken system. he left all those federal dollars on the table. as a result marion has 20% uninsured. medicaid expansion gives to a little bit over $16,000 for 2017. is underunty average

$16,000. we are talking about this piece in harper's magazine. ron calling from west texas. caller: good morning. wonderful washington journal. just awesome show. i have a couple of questions for the guest. ifh the aca have worked implemented if design -- as designed with all the states , if allanded medicare

the states had set up the exchanges? would the aca -- would it be running strong right now? million of new10 people who have been insured under the aca what is an approximate amount of those who are african-american? margin betweener african-americans? just 50/50.ically 50% weight folks in 50% folks of color. or is it 90% african-american that was recently insured under the aca? guest: thank you for your

question. aca wasthe way that the intended to work and medicaid expansion was a huge part of it would have been a saving grace for a world area. 50% drop in the uninsured which is huge. kentucky has had a two third drop in uncompensated cost of hospital. get writtensts that off as charity care. it's a huge deal. rural hospitals are closing it since 2010 80 world hospitals have closed and another 700 that are at risk of closing. 2010 almoste since 20 hospitals have closed. acard to expansion for the 20 million more got insurance, 14 million got it through the

fromsion host: patrick louisiana. caller: good morning. i want to know why is there such a doctor shortage is because we don't have enough training and medical schools or is the american medical association limiting the number of doctors, or do we not given of these is a -- visas? guest: thank you for your question. areasg problem in these are that doctors don't want to work there. profilede doctors i started with the world helped leaders pipeline. since 1993, he has been recruiting students from rural alabama interest program, they

get in earlier they have a lower cut off in scores than other students. they rotate with other world doctors. out there 120 doctors and half have gone on to work and started in the world alabama. that is compared to 7% of their cost base. in the black belt he has not been able to give any students in the future has gotten have not returned there. they don't have enough support. when you are a doctor in a world area hewed out have resources. you are out there by yourself and nobody else to talk to or consult. away soitals are far you have to think about that.

good,mpensation is not as a lot of physicians don't have insurance. -- dr.mary care doc to will not turn you away. so a lot of it is not compensated care. and they want to go into specialties which pay much better. the training and being in debt a lot of students and up going that route. there is no equipment around, you need specialties safed -- staff. they don't have those recesses. host: a call from south carolina. caller: good morning. you talked about the hospitals that were closed because they didn't have the money. , the illegals when

they go to the hospital in rural areas? the tremendous amount of unfunded care. i was a corpsman in the navy, what about nurse practitioners and physicians assistants in that area. if you have a sinus infection you really don't need a phd to diagnose it. guest: thank you for your question. these world areas at least in aretown of marion, there in a lot of cases, it is compensated for by the hospital. where i live in new york city, they will try to get people here through patient advocates, and i will cover some of it. host: could it be a essential national crisis stemming from some of the health issues in some of the underserved areas? l

national crisis stemming from some of the health issues in some of the underserved areas? guest: that is the fear, right? what happened in marion, alabama is the extreme of what can go on if this continues and other parts of the country, places where people do not trust the health-care system because they have been neglected for so long, where there is not enough to marry care doctors -- primary care doctors, where hospitals are closing, and in marion, there are only two ambulances for the whole town, and one is for the nursing home. i have heard horror stories of people having a heart attack who had to wait an hour or more for the ambulance to come pick up. i think we will enter a situation -- not tomorrow, but years from now -- where it will make a huge difference where you live what kind of health care you get. arepeople like john wei trying to prevent that from happening. but it is a slow go. art is calling from

washington, d.c. good morning, art. caller: good morning, everyone. thank you for taking my call. i think we briefly touched on the topic of some of the students coming out of medical school or graduate school, health sciences. i know the public health o corp. has programs for that. -- publicgress service, loan forgiveness. i know some people use it in respect to you get loan forgiveness with all the student loan debt, serving some of the medically underserved areas, but ont statement do you make the threats from the hill that they may not be there in the future? thank you. guest: that is definitely a big problem, the national health service corps, usually they do an exchange, so you go work and underserved area for four years,

and that is four years of medical school. phones are forgiven, and if you that, they have to be paid back. but they do not always work in places like the black belt because people are not trusted .hen they do show up this is a community that has gone through 28 different doctors over the last several decades, so there is a huge trust issue of people who come from the outside. at the end of the day, people do not state or even doctors from the black belt in that seeking opportunities elsewhere because of the opportunities. host: part of sabotage obamacare but republicans has been to dry up the funds for rural hospitals, then point fingers. next is justin in california. caller: good morning. i have got to questions and it,,

hoping you can address during i was wondering, in the black belt area, what is the quality of education that they offer the people? saint k-12. just wondering if we're talking about an area that has very poor education and then there are things that develop from that. i'm a little nervous, sorry. , as far aswondered the doctors who, until, i live in the area of -- who come and go, i live in the area where a friend had a knee replacement. movednd fantastic doctors to the area because it is so desirable. i just wondered if, even if you get a doctor to move to the black belt, if they find out this is not where they want to raise their family, and eventually they go. guest: right. so education is a massive issue in the black belt.

in marion, alabama, and the 99% of the towns, private schools are white, and poor,st of the black students go to public school. once go in tuskegee, they were doing a recruiting program, and when i spoke to the principal about with her problems were, she very quickly said 90% of our students are on reduced or free lunch. so that is the answer to your question. even when i went there, the school was freezing cold, the auditorium was not working, the projector was broken, so it is pretty poor education that the students are getting. that is a huge problem. we see in california registry, places like northern california, as doctors,k city, and at places like the black belt, even someone from outside

who spent 4, 5 years there and puts down some roots, it is usually not to keep them there for the long haul, which is why we really want to recruit doctors from the area who have back go all the way back and know the area well and are trusted by the community. host: let's speak with tom lewis calling in from michigan. good morning, tom. caller: good morning. thank you for this segment. i am a physician in the short area. i would like to say this applies in the lower areas but in general, the concept that we it self-induced diabetes, metabolic epidemic, in which staffn medicaid will have to cover and allow the purchase that we knowrink promote diabetes, whether it be sugary drinks, fruits and vegetables are not subsidized.

private funding allows augmented amount of money for fruits and vegetables purchased. and the second issue, the aca, which is still in effect in this regard, is supposed to cover anything that the united states ive services task b level,ades an a or and several ourselves, whether hypertension, diabetes, cholesterol issues, it is supposed to be covered through behavior modification programs. we have not really seen that manifests itself. but this combination of medicare coverage that we are also subsidizing foods that are aggravating metabolic problems and causing increased cost seems to be a very sad irony in an area where i'm sure the program we run here is already rare enough in this area. in a rural area, i imagine it is even less common. guest: you are right, tom.

definitely health counseling and diet counseling needs to be every part of the program. the ngo that helps with the tuberculosis health therapy definitely does a lot that. but you also need primary care doctors who can help with that. they are not in the area. host: our final call for this half-hour construct oklahoma. we have bob. good morning, bob. caller: good morning. thanks for covering this topic. it is very important. i'm glad you are on the air, d . octor, thank you. to the kobani last caller, -- to pick up on the last caller, he was talking about is that irony. i would like to flip that on its head and talk about a happy irony. do are talking about the black soil, that is good for growing food, but about the bad diet of poor people, or people can grow their own food and get together

cooperatively and get support from programs that have been in place. we need to start realizing the wisdom for nutrition, lifestyle, and health, so that health care does not become crisis intervention and catastrophic as we need toch identify the pollutants in the environments that is giving people cancer, too. thank you, doctor. guest: that is absolutely correct, and that is really where the primary care physician comes in, repeated health care. if you had one more primary care doctor for every 10,000 people, you can save 160,000 lives in the country. that is not compared to what a specialist can do. it really comes down to the primary care physicians. dr. helen ouyang is an emergency room doctor and "harper's magazine" contributor.

we have been speaking above her piece for >> if you missed our live coverage earlier today, we will show you president trump speaking at the uss gerald r ford aircraft carrier at 8:00 eastern on c-span. >> sunday on "q&a." >> when we look at president obama's domestic legacy, i think there are two things that are very important. long-lasting good consequences for the united states that can be summarized in four words. kagan,otomayor and elena his two nominees to the supreme court. >> the second of a two-part interview with david gero. he talks about his book "rising star," the making of barack

obama, which covers president obama's life up to winning the presidency. >> the point emphasize here is over the course of his presidency, there were scores and scores of people in illinois who had known him in years earlier who were deeply disappointed with the trajectory of the obama presidency. and disappointed in two ways. number one, disappointed with forgot manyck obama of the people who were central to his political rise. dated black :00 eastern on c-span's "q&a." collects a look at some of this week's developments concerning senate action on the health care lot replacement. on wednesday, president trump posted republican senators at the white house to discuss their strategy for repealing and replacing the federal health care law.