captioning sponsored by macneil/lehrer productions >> brown: authorities warned the death toll could climb in joplin, missouri, as they searched for survivors of the massive tornado that ripped through the city. good evening. i'm jeffrey brown. >> ifill: and i'm gwen ifill. on the newshour tonight, we have an on-the-ground account of the devastation. plus, we examine the power of the twisters that have ravaged the south and midwest this spring. >> brown: then, ray suarez talks to marcia coyle about today's supreme court ruling, ordering california to slash its overcrowded prison population. >> ifill: kwame holman looks at fractures within the g.o.p. over the future of medicare. >> reporter: one republican proposal would remake the federal health care program completely, but the discord is

the plan is causing is reverberating at the national and local levels. >> brown: special correspondent saima mohsin reports on a program to provide affordable health care to pakistan's urban poor. >> reporter: the 40 million low-income families here, 99.3% of them don't have health insurance. >> ifill: and we update europe's economic woes, as president obama kicks off a six-day trip to the continent. >> brown: that's all ahead, on tonight's newshour. major funding for the pbs newshour has been provided by: in 1968, as whaling continued worldwide, the first recordings of humpback songs were released. ( whale singing ) public reaction led to international bans. whale populations began to recover. at pacific life, the whale symbolizes what is possible if people stop and think about the future. help protect your future with pacific life-- the power to help

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and with the ongoing support of these institutions and foundations. and... this program was made possible by the corporation for public broadcasting. and by contributions to your pbs station from viewers like you. thank you. >> ifill: workers continued search and rescue efforts in joplin, missouri, tonight, after a tornado tore through the heart of the city with winds in excess of 190 miles per hour. at least 116 people were killed, making it the single deadliest tornado this season. more than 2,000 buildings were destroyed. the devastating tornado carved a path six miles long and more than half a mile wide straight through the center of joplin. the scope of the damage was staggering. the twister decimated entire neighborhoods, splintered huge trees and tossed cars atop one another in a metal jumble.

>> one minute, it was just barely sprinkling. the next minute the whole world was upsidedown. >> i was actually planning on where it was really torn up but there's nothing really to help. it's just flattened. i don't know. it's probably three quarters of a mile of nothing. >> ifill: according to local officials more than a quarter of the city, home to 50,000 residents, was damaged. mark ward is joplin's city manager. >> this tornado went through a major residential part of our city and damaged a large commercial district before it moved out of joplin. we are pulling together in our emergency operations center to ensure that our citizens are safe and informed as we go through this tragedy. >> ifill: many of the storm's victims would normally have been taken to st. john's regional medical center. but the hospital took a direct hit in the storm. hundreds of windows in the nine-story building were simply blown out. forcing more than 300 patients to be evacuated to other

facilities. the destruction also spawned gas leaks that triggered a number of fires. missouri governor jane nixon has declared a state of emergency. search-and-rescue crews fanned out across joplin today, combing the rubble for survivors who might still be trapped. fire chief mitch randall was among those whose home was destroyed. >> it's very important that we get them out of there entrapments as quick as we can. and, you know, we've got to worry about getting them the basics, the food and water, and getting them out of those areas where they're trapped in. >> ifill: but their efforts were hampered by a new storm battering the region today. bringing with it strong winds, downpours and hail the size of quarters. this spring has seen one of the deadliest tornado outbreaks in decades, claiming the lives of hundreds of people across the south in the last two months alone. including more than 30 in tuscaloosa, alabama.

the tornado that ripped through joplin was one of 68 reported twisters over the weekend. funnel clouds also touched down in seven other mid western states from oklahoma to wisconsin. the small eastern kansas town of reading was one of those hit. >> there is no power and there's no power in the town. so it just makes conditions really difficult and especially at night with the safety hazards that we might have in the area. it was a devastating day for many of them. they came and saw that their homes had been ripped apart. in some cases the home is completely gone. in other cases it's just a mess. they have a lot to do to clean it up. >> ifill: at least two people died in northern minneapolis where the force of the tornado even blew railroad cars off their tracks but local officials there warned the death toll could still rise. >> we're still going house to house and checking. we have a lot of large trees on top of houses. it's quite a mess. >> ifill: more violent weather is expected across the

nation's mid second now, for more on the view from the ground in joplin, i spoke a ... section through the middle of this week. now, for more on the view from the ground in joplin, i spoke a short time ago to tim metcalf, program director for krps public radio, which serves parts of missouri, kansas, oklahoma, and arkansas. he lives in joplin. tim, thanks for joining us. can you start by telling us where you were when the storms hit. >> i was at home which is about three blocks southeast of the the southern most devastated line of the city of joplin. my home is relatively unscathed. >> ifill: tell us how you knew what was happening and what you had to do. >> i had been following weather reports on tv and on the radio. the sireens had been going off for quite some time. i had been walking around my home looking out the windows. i noticed the patio doors in my house, the glass patio doors were starting to bow. i decided it was time to take

shelter. i did so in a closet with one of my dogs. it was quite a harrowing experience. a lot of noise. a lot of rain. a lot of hail. it lasted maybe five minutes, maybe 10 minutes. >> ifill: so by the time you came out of that closet and you emerged and walked around or drove around if you were able, your neighborhood, what did you see? i'm seeing what's behind you. it's kind of amazing. >> it's extremely amazing. well, when i walked outside of my neighborhood, i saw some trees down, the minimal damage to my neighborhood. but soon thereafter a family member came and picked me up after he heard that it... the storm was pretty much centered near my neighborhood. he was worried about me. he picked me up. we drove back through joplin north. that's when three blocks into the drive we saw this. it left me speechless. we didn't really talk to each other all the way to our destination because we were just speechless.

>> ifill: and tell us what you saw. the pictures we've seen, we use the word devastation but it sounds like on the ground it's even worse. >> it is. it looks like an artillery barrage perhaps. we were driving down the street. it had the smell of natural gas. we saw folks wandering aimlessly, you know, a lot of times. some folks bleeding. others looking for a loved one, family and friends. cars turned over. apartment buildings completely leveled. houses and businesses just flatteneded. >> ifill: is there power? are there utilities? are there city services? >> there are a few city services. there's power in some parts of the city. the water service is diminished. they've lost a good deal of pressure at the water plant so there's a boil-water order right now. other than that, there aren't many services.

>> ifill: in the wake of this as you walked around yesterday and drove around and as you've been there today, is it chaotic or is it quiet? how are people reacting? >> maybe a little bit of both. i think there are folks who are in shock of what has happened. you drive down the street and normally where you would see a landmark where you might want to turn somewhere you don't see that landmark anymore. you might have to ask the person with you, where are we? that happened with my wife today as we drove around the city. she asked me several times where were we? we had been to those places numerous times. >> ifill: have people ever seen anything like this before? have there been tornadoes even nearby that have been of this magnitude in joplin? >> 2003 i believe there was a series of tornadoes just a little bit north of joplin that did a good deal of devastation. i have recently learned that the tornado that was nearest this one magnitude was i think

in the early to mid 50s. it's been a good deal of time. >> ifill: today there was another line of storms and more hail. it doesn't look like the sun was shining where you were. how unnerving was this second round of storms? >> it was unnerving and it continues to be unnerving because there's a good deal of lightning and thunder and rain right now. i think folks understandably are gun shy when they hear that thunder and the clouds, the sky goes dark. i think people are skittish right now. >> ifill: tim metcalfe, thank you so much for joining us. >> thank you for having me. >> ifill: in just a few weeks, this tornado season has become the deadliest in more than five decades. we look at this intense storm season with greg carbin, meteorologist in charge of warning coordination for the national weather service. thank you for joining us from oklahoma city. how would you characterize,ckñ' mr. carbin, the intensity of

this latest tornado some. >> well, the damage we're seeing this spring is just really unfortunate. it's really discouraging to see this day after day as we go through the month of may and into late april. last month alabama and mississippi. these are violent, rare and violent tornadoes. thank goodness they're rare although you will have argument on that from a few folks in the south and midwest this year. but they are very uncommon for the most part. this is the extreme, the most extreme that we know of as far as atmospheric violence goes. >> ifill: but is it unusual? are we seeing more than we would normally see in an april and may? it seems that way. >> it seems that way only because these events are not that common to begin with. so we can go many many years without seeing the level of activity we've seen. whether there's actually an increase in this activity or its intensity, we just don't know that yet. we don't have a long enough record really. the record is pretty short when it comes to atmospheric

data on tornadoes. >> ifill: it seems also to be more deadly. we're hearing 116 which is a number that they just told us this afternoon in joplin but also hundreds we saw in alabama and a few weeks ago and we've seen in st. louis. we've seen them touch down all over the place. the question i guess is whether there is a population density correlation here, whether we're seeing these tornadoes hit in more populated areas. >> clearly there's a correlation between population density and the damage we're seeing. in fact the damage scale for tornado intensity or the scale that is used is based on the damage that occurs. so the higher the rating, the more likely it is you've had a tornado in a significantly populated area, built-up area. that's a trait we see with increasing population. increasing vulnerability to these types of storms. >> ifill: do we know how they rate this storm? we've heard an e-4 talked around. what does that mean and does this make that that level?

>> well, meteorologists and engineers will look over this devastating damage we see in the joplin area and determine the wind speeds sort of from a reverse engineering perspective. they're going to look at the damage and then determine based on that damage what type of wind speed would be required to produce the level of damage we see. an ef-4 tornado were to move there, we're looking at wind speed levels estimated at 150 to maybe as much as 200 miles an hour. excess of 200 miles an hour would get an enhanced rating of a 5. >> ifill: we always hear about this happening in the south and the midwest. those of us on the east coast and people on the west coast very rare to hear about tornadoes touching down. what is it about that region of the country that... is it humid air? is is the gulf of mexico coming up the mississippi river? what is it that draws the tornadoes to those areas? >> the central united states is unique with respect to topography. the rocky mountains to the west and the gulf of mexico to

the south set up this zone of potential that is especially prime for tornadoes during the springtime months of the year when we're transitioning from the cool season, from winter weather systems into the spring and summer season where we have warm, moist air coming from the gulf of mexico. it's the topography that is established across the middle of the continent that really sets the stage for these types of weather events. again quite unusual, quite rare. but not something we're not used to seeing in this part of the country during the spring. >> ifill: mr. carbin, when we see that kind of devastation we wonder whether it was possible to predict. have we gotten any better at being able to tell when this kind of violent storm is coming? >> we have. and the national weather service and its offices in the field, there's an office in springfield, missouri, that was monitoring this situation days out. the storm prediction center. we are to tornadoes here like the national hurricane center is to hurricanes in miami. we're watching the atmosphere day in and day out for the patterns to peculiar established and get the word

out ahead of these dangerous storms. that was done in this case with the forecast models about three days out. as the actual storms formed, the offices in springfield and wichita went into active warning mode providing tornado warnings with lead time sometimes upwards of half an hour ahead of the most devastating storms. >> ifill: even with that lead time sometimes there's only so much you can do to prevent this kind of damage? >> exactly. when you're dealing with a wind speed perhaps as high as 150 miles an hour, there are very few places to hide. but underground, basements and storm shelters certainly provide that protection. but that doesn't give you a lot of time. 15, 20 minutes to get to that location is not a lot of time to get to safety. unfortunately some people are caught off guard and unprepared. >> ifill: even if you're prepared sometimes when a building falls down around you there's not very much you can do about it. >> unless you've got a shelter. >> ifill: greg carbin of the national weather service, thank you so much. >> thank you, gwen. >> brown: still to come on the newshour: a ruling on

california's crowded prisons, the politics of medicare, health care for pakistan's poor, and europe's economic troubles. but first, the other news of the day. here's hari sreenivasan. >> reporter: debt troubles in europe shook up wall street and other world markets today. the dow jones industrial average lost 131 points to close at 12,381. the nasdaq fell 44 points to close at 2,759. oil prices also continued their retreat, dropping more than 2% to settle at nearly $98 a barrel in new york trading. five nato soldiers were killed today in afghanistan-- four in a roadside bombing in the east, and one in an explosion in the south. alliance officials gave no details on the nationalities, but the majority of forces in the east are american. meanwhile, the taliban denied reports that its leader, mullah omar, had been killed in pakistan. an afghan tv news channel reported omar was shot dead while being moved from quetta to north waziristan. afghan officials said they are not sure what happened to the taliban leader.

>> so far we cannot confirm that this was official. but we can confirm that he has been disappeared from his hideout. we hope he's dead but we cannot confirm it yet. >> reporter: the afghan tv report said omar had been helped by general hamid gul, the former chief of pakistani intelligence. gul denied it. the pakistani taliban claimed today it was responsible for an 18-hour attack on a military base in karachi that killed ten people. the group said it was revenge for the killing of osama bin laden. we have a report narrated by john sparks of international television news. >> reporter: burnt out and worthless, several military aircraft left to smolder on the tarmac. this, the headquarters of paks naval air unit. it was protected by troops and rung with barbed wire, but no match it seems for a small group of militants bent on martyrdom. they were dressed in black-- like characters from a "star wars" film, said one official--

and they were heavily armed with machine guns and rocket launchers. six members of the pakistani taliban blew up two aircraft: a helicopter and a jet-fuel tanker. the mehran naval base is located in karachi, pakistan's biggest city and commercial hub. the attacks began at 11:00 p.m., and were reportedly launched simultaneously- on the main entrance, at the museum gate at the rear, and from the shah faisal neighborhood on the east side. >> the terrorists have taken over the building within the complex. we are going to launch an operation. >> reporter: this, another embarrassment for the military, after it failed to detect or stop the u.s. raid against osama bin laden three weeks ago. the pakistani media provided blanket coverage as the battle on the base lasted 17 hours. ten soldiers were killed in the fighting. by late afternoon, the base was

back in the military's hands, but few celebrated the fact. two militants had got away. >> reporter: pakistani authorities said four attackers were killed in addition to the two who escaped. the president of syria, bashar al-assad, is now facing additional sanctions from the european union. the e.u. announced today it is freezing assets and imposing a visa ban on assad and nine other syrian government figures. it cited the syrian crackdown on protesters. human rights activists say more than 900 people have been killed by security forces since the uprising began, two months ago. republican tim pawlenty has formally announced he is running for his party's nomination for resident in 2012. the former governor of minnesota put out an internet video laying out plans for his campaign last night. and today, he spoke in des moines, iowa, site of next year's lead-off presidential caucuses. >> if we want a new and better direction, we're going to need a new and better president. president obama's policies have failed. but more than that, he won't

even tell us the truth about what it's really going to take to get out of this mess that we're in. >> reporter: pawlenty's official entry into the race came hours after fellow republican mitch daniels decided not to run. the two-term governor of indiana took his name out of consideration on sunday. he cited the wishes of his wife and daughters. an erupting volcano in iceland threatened air traffic in the united kingdom and ireland today. the grimsvotn volcano began spewing dense ash on saturday. it reached 33,000 feet, the altitude where passenger jets fly. british airways and k.l.m. were among airlines that canceled tuesday morning flights to and from scotland, ahead of the ash cloud's arrival there. another icelandic volcano erupted last year, grounding thousands of flights and stranding millions of travelers across northern europe. those are some of the day's major stories. now, back to jeff. >> brown: a divided supreme court today ordered california to release thousands of inmates from its overcrowded prisons. ray suarez has the story. >> suarez: the justices ruled five-to-four that the packed living conditions threatened

inmates' health, and violated constitutional rights against cruel and unusual punishment. california has two years to cut its inmate population from 143,000 to 110,000-- still well over capacity for facilities designed to house 80,000. in a rare move, justice anthony kennedy incorporated black-and- white photographs into his written opinion. the images of crammed sleeping quarters and walkways depicted what he referred to as "violent, unsanitary, and chaotic conditions" in california prisons. marcia coyle of the "national law journal" was in the courtroom, and joins us now. marcia, this is an old case. what was the original complaint and what were the petitioners asking of the state of california? >> well, ray, this case stems from two class action lawsuits. one filed in 1990 involving substandard care for prisoners suffering from serious mental illnesses.

the second lawsuit filed in 2001 generally for deficient medical care for prisoners. the lawsuits claim that these conditions in the prisons violated the 8th amendment's prohibition on cruel and unusual punishment. >> suarez: justice anthony kennedy was the lead writer on the majority opinion. what did he and the other justices conclude? >> well, the issue before the court was whether a special three-judge court, lower court here, correctly applied the federal prison reform litigation act. the three-judge court here issued an order after finding that the unconstitutional conditions in the prison were the result primarily of overcrowding. justice kennedy in his opinion walked through the analysis that the three-judge court applied to see if it followed the requirements of that federal law. he found that the court, the lower court, had carefully documented and persuasively

documented that overcrowding was the primary cause of the unconstitutional conditions and that the only way to solve these problems was to reduce the pris ob population. ... prison population. >> suarez: there were four defenders. they were the conservative core of the court. what did they have to say in opposition to that ruling? >> there were actually two separate dissents. justice scalia wrote one dissent that was joined by justice thomas. he said that this order by this lower court was perhaps the most radical injunction issued by a court in the nation's history. he felt that this type of order allows judges to indulge policy preferences and that they exceeded their authority under the constitution and under federal law. justice alito also wrote a dissent that was joined by chief justice john roberts. he agreed that the lower court

here exceeded its authority. u=w÷ itsd that the lower court ordered on outdated evidence of what the conditions were presently in the prisons and also that it didn't give adequate weight to public safety. he ended his defense by saying he feared that this order would lead to a grim roster of victims. >> suarez: in other words, that once they let these people out of california prisons that they'll go on to commit new crimes in the streets of the state. >> that's correct. justice kennedy refuted that. he said that the lower court here had taken testimony and had statistical evidence from expert witnesses that showed that prison... the reduction of prison populations in at least a half dozen other states had not put the public safety at risk. he felt that the lower court here did give adequate weight to public safety concerns. >> suarez: were the dissenters, well, at least have a bit of a point when they say that through this ruling the federal courts have a big say over what happens in state

prisons? doesn't this ruling do that? >> ray, to be honest, i think this court does not want federal judges running prisons or any other kind of institution. they have felt that way for many years. but this was a case, an unusual case, where the complaint and the court proceedings had lasted for almost 20 years. it was clear from the oral arguments in the case that a number of the justices felt very frustrated by the delays and the inability of california to follow the various court orders. there were at least 70 lower court orders here in the last 20 years to address the medical conditions in the prisons. >> suarez: did the original three-judge ruling or today's opinion talk about a plan? who do you release? when do you do it? how do you do it? >> no. in fact, justice kennedy pointed out that the lower court here did not say to california you must release

43,000 prisoners within two years. it said you must reduce the prison population. it left to california to come up with a plan that would reduce that population. justice kennedy said, it could do such things as transfer prisoners within... between prison. it could build new facilities. it did not have to release 43,000 prisoners. >> suarez: was it unusual to open a ruling of the united states supreme court and see photographs? this is one of a set of holding cages where they keep mentally ill prisoners. how do they get in there? were they a striking addition to the normal run of opinion? >> it is very rare to see photographs. generally we see drawings or maps in cases, for example, involving the redistricting of congressional districts. but the court has from the parties to the original cases received photographs. it's received videos.

in fact the court has now on its home page a special web page in which it posts audio and video in certain cases where the court has really split over how to interpret the video or the audio. >> suarez: there are overcrowded prisons in a lot of states. some of them joined california in opposition to this suit. what does i mean for them? >> 18 states actually joined california in this appeal. their argument was primarily one of concern for public safety. if prison populations had to be reduced through the release of prisoners. and also their state attorneys general feared that they would face similar litigation. so i suppose we'll just have to wait and see what the long- term impact of this particular order might be. >> suarez: but as of now they're not necessarily ordered to reduce overcrowding in their own prisons? >> they're not. i'm not even sure they're the subject of the same type of litigation.

but clearly they fear that. california, by the way, has begun to take steps to reduce its prison population. governor brown and the state legislature have approved legislation to transfer roughly 32,000 prisoners to county jurisdictions. but california legislature has not fully funded that plan. >> suarez: marcia coyle of the national law journal, thanks for being with us. >> my pleasure, ray. >> ifill: from the campaign trail to capitol hill, republicans continued to face questions about the party's plan to overhaul medicare. newshour congressional correspondent kwame holman has our report. >> reporter: house budget committee chairman paul ryan's proposal to reform medicare has tied his party in knots. yesterday he attemptd to quiet his critics and reassure fellow conservatives in an appearance on nbc. >> look, of course people are scared of entitlement reform because every time you put

entitlement reform out there, the other party uses it as a political weapon against you. both pears have done this to each other. here's the problem, david. if we don't get serious about these issues, if we don't get serious about the driers of our debt we're going to have a debt crisis. >> reporter: ryan's plan came under fresh scrutiny last week after former house speaker newt gingrich charged it amounted to right wing social engineering. speaking on cbs yesterday, gingrich admitted he should have chosen his words more carefully but stood by his broader point. >> i probably used unfortunate language about social engineering. my point was really a larger one, that neither party should impose on the american people something that they are deeply opposed to. >> reporter: in fact, a new associated press poll released today found 72% of respondents believe medicare is extremely or very important to their financial security in retirement. the survey also showed respondents trust democrats over republicans to do a

better job handling medicare by a 54-3% margin. amid the signs public opinion is on their side senate democrats want to force a vote this week on the republican budget in an effort to highlight the g.o.p.'s divisions over it. appearing on fox news sunday senate republican leader mitch mcconnell acknowledged his conference with a not be united in support of the ryan plan. >> what i've said to our members are that we're not going to be able to coalesce behind just one. we may well vote on the ryan budget. i'm going to make sure that the democrats get to vote on the obama budget which my counterpart harry reid thought was terrific back in february. there will be votes on several different budgets in the senate. >> reporter: the first concrete sign of fracture appeared today when massachusetts republican scott brown said he would vote no on the g.o.p. budget. brown wrote in a politico op-ed our country is on an

unsustainable fiscal path but i do not think it requires us to change medicare as we know it. we can work inside of medicare to make it more solvent. in a conference call this afternoon, new york democrat chuck schumer said a vote on the g.o.p. budget would be a lose-lose for republicans. >> the republicans are getting the worst of both worlds. they want to distance themselves from this vote but there's no face-saving way to do so. they have tried to turn themselves into pretzels to figure out how to deal with this awful plan passed by the house. >> reporter: the medicare issue also has played a central role in upstate new york where a closely watched special election for the 26th congressional district is being held tomorrow. at a debate last week, republican jane core win and democrat kathy hoekel offered very different takes on the g.o.p. plan. >> if we want medicare to be around for our current seniors and for future generations we need to make changes now. so i am very supportive of a plan that will ensure that the

seniors currently get the benefits that we currently enjoy or are expecting. anyone under the age of 55 create a program that we will have for the future. >> i think we ought to stay with the facts here. it is a voucher program. it ends medicare as we know it. for current seniors, they'll be affected because it limits the plans that are shrinking the donut hole. even current seniors are very afraid of this program. that's what's scaring them. >> reporter: a new poll out today showed democrat hoekel leading core win by four points in a district that traditionally has favored republicans. >> ifill: next: combating the poverty that's at the root of many of pakistan's problems-- in this case, by providing affordable health insurance. newshour special correspondent saima mohsin reports from the nation's largest city.

>> reporter: he's just got back to work at a hotel in karachi where he stands guard as a member of the security team. he was hit by a car on his way to work one morning. two months later the severity of his injuries came to light. >> i had a brain hemorrhage and collapsed. my son rushed me to the hospital and i had an emergency operation. >> reporter: an operation he could not have afforded on his $150 a month salary. >> i'm the sole bred winner. my sons are very young while i have grown-up daughters. this operation and treatment was beyond my means. >> reporter: but he and his colleagues have been covered by a health insurance plan for the urban poor. >> it provides access to quality care for three types of groups. the first is low-income families who are making less than $20,000 rupees per month who are domestic household

staff, drivers, maids, et cetera. the second group are uninsured contract workers or workers who are working in factories with corporations, schools and any other organization. and the third group are kids who are studying in school and their families. >> reporter: the private sector serves nearly 70% of pakistan's population. yet after the estimated 40 million low-income families here 99.3% of them don't have health insurance. >> the introduction of this program in pakistan hopes to change that. it is simple and affordable for employers, sponsors and beneficiaries. it's $2.50 a month provides access to private health care and crucially regular health checks for contagious or infectious diseases as a preventive measure for a country that is still battling polio, malaria and hepatitis. and hundreds of local

companies, restaurants and multi-national corporations are signing up for the plan for their low-income employees. >> it made a huge difference because before we even had health insurance we would be responsible for our staff and their wives and their children. so every time they fell sick, we would either give them a loan or as a gesture of good will we would pay for them because we knew they wouldn't be able to afford it. now that we do have health insurance, we have peace of mind because we pay a small amount every month. the entire family is covered. every time someone falls sick, whether their children or anyone completely unrelated to the business, we don't have to do anything. it's been taken care of. they have peace of mind. they have no burden. >> reporter: and the scheme is already paying off the staff members. >> my wife was six months pregnant and she suffered complications. she was rushed to the e.r., and they said she'd have to have an operation. it was a really difficult time. it was costing 45,000 rupees

which i couldn't possibly afford. we turned through the health center through our insurance and they really helped us. >> i have a four-year-old daughter. she was diagnosed with typhoid. we took her to the hospital. when we got the hospital bill it was very expensive. we were very worried about how we would pay it. then we remembered we had health insurance. we showed them our card and she was admitted into hospital immediately. thank god she's much better now. >> this is the first time that it has engaged in such a program. there are no programs like this globally neither in south asia. we're hoping to set a precedent not just for our company but other companys in the country too. >> reporter: medical calamitys can lead to generational poverty among millions of vulnerable people in pakistan. low-income families in urban centers are particularly at risk of being trapped in a cycle of poverty and debt because of medical expenses. >> public health care system

in pakistan leaves much to be desired to be honor. many of our member s would go to hospitals where they would not be properly diagnosed and their health would deteriorate further. it's it's the unqualify doctors on the sidewalk to be honor. now there's a toll free number to qualified surgeon or doctor who directs them to the proper clinic, proper hospitals where they are met by a doctor who will treat them and diagnose them appropriately. as a result, compared to before, they would be absent for two or three weeks. >> reporter: public expenditure on health care across south asia is as low as 3% its total expenditure. >> organized public health care system on paper. the system is working. more than 30%, no doctors, no nurse, no midwife.

more than 50% of the centers are empty. >> reporter: although in theory this public health care system is free, there are plenty of add-ons like x-rays, blood tests and of course medicines, making affordability a huge concern. so is private health care the way forward tore pakistan? >> no. private health care is never the way forward. no. i will say again, health care is the right of every citizen of pakistan. free of cost. and it is government who will provide it. i'm for two things in the world: education and health care. it should be done by the government. >> reporter: the plan has been recognized by the clinton global initiative and is becoming popular amongst employers.

but the plan does have some limitations. it specifically is targeted for the urban poor. it's only currently available in three major cities. and is reliant on the cooperation of conscientious employers. it's this core conscience that the doctor says needs to be tapped into. he says the program is not just about health care but about helping low-income familys in a developing nation rise up from poverty. >> first of all we're trying to introduce a paradigm. pakistan is a post colonial country. there's a mind set that has existed here which is a master- slave mentality which is, you know, extortion of low-income people and low-income labor. we're really beginning to try and flip that on its head to say every employee, whether they work in a home, whether they work in a factory, a school, a corporation, each one of them is entitled to quality health care and a number of other services and

benefits: education for their children, socioeconomic opportunity, vocational training, skill development. so over time as this paradigm or as this thinking begins to pervade into society hopefully we'll begin to see that these low-income people will emerge into the middle class. that can only be a good thing for pakistan. >> reporter: and his plans don't stop there. he is now spreading through schools and slums and being offered to people in affected areas providing health insurance, health care workshops and preventive checks. >> brown: finally tonight, amid roiling international markets, we update the financial crisis in europe, as president obama begins a six-day, four-country visit. the president kicked off his trip in ireland today. his stop included a visit to a

house once owned by his great great great grandfather in the town complete with a pint at the local pub. that was prelude to an ecstatic welcome of a crowd of near 30,000 in dublin. >> my name is barack obama. ( cheers and applause ) >> brown: but the jubilant scene came amid a back drop of troubled economic realities facing ireland along with a number of other countries-- spain, portugal, greece and italy-- in the southern parts of the so-called euro zone. in spain today, demonstrators remained camped out in central madrid's square after a week of protests over the government's handling of the economy. spain unemployment tops 20%. and tough austerity measures aimed at bringing spending under control. the anger led to a drubbing for the ruling socialist party in local elections held yesterday. >> what we want is to be

listened to, to get real reform. we don't want this to be an andy dote. >> brown: also this weekend italy got another kind of shock. credit agency standard and poors lowered its rating from stable to negative. citing slowing economic growth. and that came just after greece's credit was pushed further into junk bond status by ratings agency fitch. greece has been rocked by protests in response to government austerity measures undertaken in response to a large bailout package offered by its european partners last year. for its part, ireland too was forced to take a bailout last november and has seen protests although not on the same scale as those in greece. its package came with conditions that called for a number of austerity measures including slashing government jobs and increasing taxes. meeting with president obama today, irish prime minister acknowledged the ongoing crisis.

>> myself and the president are dealing with the issues that affect our countries. >> brown: addressing the crowd in dublin later, president obama compared ireland's financial troubles with america's. and offered some reassurance. >> i think we all realize that both of our nations face great trials in recent years including recession so severe that many of our people are still trying to fight their way out. naturally our concern turns to our families, our friends and our neighbors. we're people. the irish and the americans, who never stop imagining a brighter future. even in bitter times. >> brown: tomorrow the president travels to the united kingdom which has recently implemented its own set of austerity measures for a two-day state visit. there was late word that president and mrs. obama

actually left ireland early to avoid the ash cloud from the icelandic volcano and arrived in london this evening. and we continue our update of europe's troubles with gillian tett, u.s. managing editor of the "financial times," and kenneth rogoff, professor of economics at harvard and co- author of "this time is different: eight centuries of financial folly," a book exploring various banking and debt crises throughout history. gillian tett i'll start with you. if you look at the markets and this weekend's event, is there a new concern that europe's problems are nowhere near being under control? >> well, absolutely there is a new concern because basically what people in the market are starting to ask is whether countries like greece, italy and spain are going to be able to repay their debt. if they can't pay, who is going to take the loss? is it going to be the long- suffering tax payers who are already getting pretty angry? is it going to be the bond holders or will the richest parts of europe like germany be forced to cough up money to support the weak?

right now there are no clear answers. european leaders have produced a series of band-aid solutions, short-term solutions that essentially paper over the cracks. the concern the market is growing because those questions are still very much unanswered. >> brown: and ken rogoff i note that the imf issued a report last week that said onwards to emerging europe remains a tangible down side risk. translate that for us. how serious is the situation? >> the trouble is that the smaller countries, the periphery countries, greece, portugal and ireland are in deep deep trouble. but if they default on their debt, that hits the banks in the richer countries and the governments there have to bail them out. people are afraid that there will be a chain reaction and that spain and italy and maybe it will even hurt germany and france. >> brown: talk about italy in particular. was it a surprise, this downgrading of italy's credit

rating over the weekend? >> no, i wouldn't overstate it. i mean, remember, they downgraded the united states too. i think it's a recognition of reality. italy's definitely not on the front line. it's really spain that's the immediate problem if the other three countries have problems. spain has a 20% unemployment rate and a very, very tough road to travel to get back to a sustainable fiscal policy. >> brown: speaking of spain we mentioned they had this election over the weekend. that goes to the political pressures that all governments are under in any sort of austerity measures or that they undertake. how strong are these pressures being felt in spain and our countries? >> well, political anger across europe is rising right now. not just inside countries like spain that are suffering from the austerity measures but countries like finland are seeing growing levels of plit cats protest because the finns who are in a pretty good

position are saying we don't want to help the weaker countries. those political tensions are certainly rising. what really worries the markets right now is that many of those plit calgary pressures are quite unpredictable. can you can't put them into a spreadsheet and for get the future as you can perhaps with g.d.p.. it's very uncertain about what is going to happen and of course markets hate uncertainty. >> brown: and ken rogoff, how much is the debate continuing over these austerity measures and exactly how severe they should be in terms of their impact on economic growth in particular countries? >> well, it's particularly acute in the countries which are in most desperate straits, greece and ireland where president obama was visiting, upon gal... portugal and also spain. these countries are looking like they might have to be in a recession for a very long time in order to repay their debt and still at the end of it they'll still have a lot of debt. they still might have to

default. it's just not clear if the austerity measures that the germans want, that the e.c.d.wants and others are realistic. is it politically sustainable? frankly at the levels of debt that some of the smaller countries have, we've seldom seen it. the political resistance you're seeing in spain, the resistance in ireland and greece i think is just the tip of the iceberg if they try to continue along this path. but they're hoping growth will pick up and some of this resistance will subside. >> brown: can you fill in the picture a little bit more in ireland where the president was today? >> well i have a lot of irish relative, a large part of my family comes from ireland. i can tell you that the picture on the ground in ireland is pretty grim. frankly to my mind it's surprising that more of my relatives aren't more angry. but if you step back for a minute, the big question hanging out is this. europe is at a cross roads. if it wants to keep on board the weaker countries, the

countries like ireland or greece and ensure they remain part of the single currency, the richer countries are going to have to help them and there's going to be more unions in the form of federal... probably common bonds being issued, fiscal transfers and things like that but that concept is still very scary to many europeans both in countries like germany and even in places like ireland so in some ways if europe is is not willing to accept more union and more coordination, then you will see potentially more fragmentation going forward. >> brown: ken rogoff, that goes to there's been a lot of commentary of course about an economic and potentially political split within europe of the mostly northern countries that seem to be coming back and getting stronger and mostly southern countrys that are not. do you see that happening? >> well i think gillian tett framed it very well saying there's just enormous uncertainty. i think the most likely outcomes if they manage to

hold europe together but they take a more realistic attitude towards having to deal and confront with the debt problem which right now they're really wishing away. they just say suck it up, greece, suck it up, irish, just run surpluses forever and everything will be fine. it won't be. they can probably afford to deal with this problem. ill thrill it's a manageable problem but politically they don't seem prepared to manage it. it's absolutely true. they probably in the end if they want to stick together need more unity in ways they can't imagine at the moment. we'll see if it happens. >> brown: ken rogoff, the inevitable sort of "why we care" question for americans. what are the implications now for the financial and economic troubles in europe? >> i can only tell you that i was at a meeting of european financial leaders as the u.s. financial crisis was unfolding, and they were almost giddy thinking they had done things right and wouldn't have a

problem, not realizing the tidal wave that was coming across the atlantic. if they have a financial meltdown in europe, our companies are connected. our banks are connected. our investors are connected. it won't be good for the united states. i think washington must be pushing very hard for them to try to find at least a patch that takes them out a couple years hoping that there's a miracle. but i'm not sure that it's coming. >> brown: gillian tett, what are you hearing from americans as they look across the ocean? >> there are two points to make. firstly if you want to look at the potential connectist, just look at the number of american market money funds and pension funds that hold assets. they could be affected as things get worse. secondly in many ways what's happening in the euro zone is a pretty big wake-up call for washington as it looks at its own debt problems. it shows that frankly trying to sweep problems under the

carpet for a long period of time simply doesn't work. >> brown: thank you both very much. >> thank you. >> thank you. >> ifill: again, the major developments of the day. at least 116 people were killed by a half-mile-wide tornado that tore through joplin, missouri. local officials expected that toll to climb as search-and- rescue operations continued. and the supreme court ordered california to slash its overcrowded prison population by 30,000 inmates. and to hari sreenivasan for what's on the newshour online. hari? >> reporter: find more photos from the deadly tornado, and listen to our interview with ksmu reporter missy shelton from the scene. on this week's political checklist, david chalian chats with gwen about the medicare fight and the gop presidential field. plus, we caught up with actress geena davis to talk about gender roles in film and a new public media project called "women and girls lead." that's on art beat. all that and more is on our web site, newshour.pbs.org. jeff? >> brown: and that's the newshour for tonight. on tuesday, we'll look at israeli prime minister netanyahu's address to a joint session of congress.

i'm jeffrey brown. >> ifill: and i'm gwen ifill. we'll see you online, and again here tomorrow evening. thank you and good night. major funding for the pbs newshour has been provided by: >> auto companies make huge profits. >> last year, chevron made a lot of money. >> where does it go? >> every penny and more went into bringing energy to the world. >> the economy is tough right now, everywhere. >> we pumped $21 million into local economies, into small businesses, communities, equipment, materials. >> that money could make a big difference to a lot of people. ♪ ♪

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