captioning sponsored by newshour productions, llc w druff: good evening. i'm judy woodruff. ro the newshour tonight: condolences and coation. president trump is met with protests wle visiting el paso and dayton to console victims of the weekend's mass shootings. then, one-on-one with democratic presintial candidate tom steyer to discuss guns, environmentalism, impeachment and more. plus, traveling for treatment. exploring the burgeoning industry of health tourism as the high cost of healthcare inth u.s. has many patients looking abroad. >> need to shake up the healthcare industry in the u.s. you need a lot of people disrupting its little ways that add up to big change over a period of time.

re woodruff: all that and mo on tonight's pbs newshour. >> major funding for the pbs newsur has been provided by >> babbel. a language program that teaches real-life conversations in a nes language, linish, french, german, italian, and more. babbel's 10-15 minute lessons are available as an app, or online. more information on babbel.com >> consumer cellular. >> financial services firm raymond james >> supporting social entrepreneurs and their oslutions to the world's mt pressing problems-- unollfoundation.org.

>> the lemelson tion. committed to improving lives through invention, in the u.s. and developing countries. on the web at lemelson.org. >> supported by the john d. and catherine t. macarthur foundation. committed to building a more just, verdant and peaceful world. re information at macfound.org >> and with the ongoing support of these institutions >> this program was made possible by the corporation for public broadcasting. and by contributions to your pbs station from viewers lou. thank you. >> woodruff: two cities united in their grief, but divided over condolences from the commander- in-chief. yamie alcindor reports on th latest from dayton and el paso. >> alcindor: well before president trump arrived, protesters in dayton,hio filled the streets. some denounced his rhetoric on ra and immigration, and

demanded action to prevent gun violence.>> he tempers flare but at the end of the day, how can we not be out here and this is our city. >> >> alcindor: others praised the president and welcomed his visit. >> alc white house, president trump said he hoped congress could soon pass bipartisan gun legislation, though not a ban o assaapons. >> i don't want to put guns into the hands of mentally unstable people or people with rage or hate. d ere's a great appetite, mean a very strong appetite for unckground checks and i think we can bring up backgchecks like we'd never had before. >> alcindor: the president also insistedis comments have not fueled hate. >> no, i don't think my rhetoric has at all.my i thinhetoric is a very uh, it brings people together. >> alcindor: the presient did >> alcindor: critics say he is he problem because just before today's visits, he criticized democrats and doubled down on his hardline immigration stance. presidt trump first stopped in dayton, where a gunman fired an automatic weapon outside a bar

early sunday, killing nine ople. the presidt and first lady went to a hospital where many people were treated. there, they thanked first responders and medical staff. they also met with some of the victims and their families. several hundred demonstrat gathered outside. later, president trump traveled oto the texas border ciel paso, where saturday's racially- motivated shoong at a walmart claimed 22 lives. an "el paso strong" rally was held at the same time to counter the president's visit. many residents and democratic lawmakers there, including el paso native and presidential candidate beto o'rourke, had urgehim to stay away. o'rourke attended a orning remembrance at a local high school. >> what you are doing today hero today,ly and defiantly,an ing up against racism and hatred and terrorism. is the way forward for a states of america that has never

been more divided, more polarized, than it is right nowc >> ador: meanwhile in iowa, former vice president and democratic presidential candidate joe biden sounded offs he insisted ent trump bears some responsibility for inflaming tensions. >> trump offers no moral leadership. he seems to have no interest in unifying this nation. no evidence that the presidency has awakened his conscience in the least. indeed we have a president with a toxic ngue, who's publicly and unapologetically embraced the political strategy of hate, racism and division. alcindor: other democratic candidates also demanded urgent action on gun control. new jersey senator corey booker spoke at an historically black church in charleston, south carolina whe in 2015, nine people were killed in a racist attack. >> there's no neutrality in this fight. you are either an agent of justice or you are contributing to the problem.

addressing this, we must understand this, addressing this is not an act of charity or philanthropy. it is an issue of natial security. >> alcindor: during a speech in washington, montana governor steve bullock made a case for banng high-capacity magazine and assault weapons. >> let me say that as a hunter, no real hunter needs a 30-roun ip. no real hunter needs a weapon of war. no real hunter needs a bump stock.r: >> alcinor the pbs newshour, i'm yamiche alcindor.: >> woodrow to our second lead story. the political turmoil in puerto rico took a new turn tod when the island's supreme courte oved the swearing in of pedro pierluisi as governor. outgoing governor ricardo rossello, who was forced from office last week by public protests, had positioned pierluisi to succeed him.bu the high court today found

that process unconstitutional. justice secretary wanda vazquez is expected to assume the post. for the latest, turn to francesl of the "new york times." welcome back to the "newshour", frances robles. so how did the supreme court arrive at this decisionw? >> ias a decision that was widely expected because there was a contrwhiction betwee puerto rican law says and what puerto rican constitution says.h was never confirmed by the senate, and the law seas that was okay and the constitution sayst's not. >> woodruff: and, so, wanda vazquez, after saying she nwas interested in assuming this position, is now going to be stepping in? >> yes, she was sworn in about an hour ago. i don't know she ever said she would turn down the job, she just wanted to make clear it it wasn't her interest, she wasn't jockeying for the position. it isy widelpected she will

not stay in the job. everyone is expecting here to make a bunch of cabinet nominations and resign herself so that the succession continues. >> woodruff: why do people believe she's not interted and won't stay? >> you know, this is the "game of thrones" without the dragons and the homicide. so what it is is bunch of people in back rooms jockeying of who's going to be in power, and, so, the person who has a lot of power in puerto rico now is the head of the senate, and he and she are arch enemies, and, so,kind of understood he will not allow for her to stayhan position long and there have been deals made as to how this is going to play out. >> woodruff: so what does thatan , frances robles? who steps in if she doesn't stay long and someone has t replace her? >> well, it depends on whose rumor you believe, but the prevailing rumor in the local media is congresswoman gonzales is expected to be named

secretary of state. if she is named and confirmed by the house and the senate which is the prt mr. pierluisi did not do, if ms. vasquezesigns, ms. gonzales will become the governor of puerto rico. >> woodruff: she was a guest on the "newshour" st the other day. so she would be accepted by the people of puerto rico, it's believed? >> i think she is. she doesn't have the baggage a t of people have. even ms. vasquez was suspended from office a few months ago, mr. pierluisi has a got of connections in his family, and they were seen as products of the establishment taking advantage of this popular upmoding to put ie of their own, and though ms. gonzales is a member of that party, she's pretty well respected, she's actually opa prettyar political figure on the island. >> woodruff: and in a few section, how are the people in puerto rico dealing with the topoil at the everybody is kind of waiting to see who's going to be next to see if they have to unleash

those protests again. you saw that when mr. pierluisi took office, and now kind of a calm, a tense calm. s, woodruff: frances robles of the "new york tiwe thank you. >> thanks for having m yod. -- judy. >> woodruff: in the day's other news, u.s. immigration and customs enforcement arrested 680 undocumented workers-- mostly latinos-- at food plants in mississippi. they were the largest such raids in at least 10 years and involved 600 agents. the operation targeted procesng plants in half a dozen towns outside jackson. ice officials id it was planned months ago. in afghanistan, 14 people were killed and nearly 150 wounded when a powerfular bomb exploded in kabul. the blast leveled buildings near a police station and shattered windows in houses and shops for blocks around. the wounded, mosof them civilians, were rushed to hospitals. the taliban claimed responsibility even as it

continues peace talks with u.s. diplomats. pakistan is expelling the ambassador from india and suspending cross-border trade in an escalating dispur contested kashmir. that's after india stripped its part of kash ir of political autonomy. today, hundreds returned to the streets in t pakistani- controlled part of kashmir, condemning new delhi's decision. >> ( translated ): this is a heinous conspiracy, and ro ly condemn it. it has been our demand since the beginning that kashmir should beme autonomous. we are protesting for this and, god willing, we will continue to otest for this. >> woodruff: india's hindu nationalist government is pressing for muslim-majority kashmir to be fully integrated d th the rest of the country. the united states rkey may be close to setting up a so- called "safe zone" inrt astern syria. negotiators said today they have agreed to form a joint operations center that could

head off a turkish military invasion to clear the regioof syrian kurdish forces. the kurds are aligned with the u.s., but turkey regards them as terrorists. in northwestern ria, government forces have recaptured two villages in a renewed offensive on the last major rebel stronghold.au the as on idlib province began in late april, but the syrian military callrief cease-fire over the weekend. three months, air strikes and shelling have forced 400,000 people from their homes and killed more than 2,000 others. back in this country, democrats the u.s. house of representatives moved today to make former white house counselw don mcgahn questions. in a federal lawsuit, the house judiciary committee ded teat mcgahn obey a subpoena. it also rejected wouse claims that he has legal immunity against testifying.

and, on wall street, stocks plunged initially, amid new fears about the u.s.-china trade war, then battled their way back. the dow jones industrial average lost 22 points to close at 26,007. it hadeen down nearly 600 at one point. the nasdaq rose 29 points, and the s&p 500 added two. still to come on the newshour: leaders from both el paso and dayton react to the president's visit. democratic psidential candidate tom steyer on his top eaiorities. the high cost ofhcare has many americans seeking medical care abroad. and much more. >> woodruff: two views from the two cities struck by tragedy, the president visited today. william brangham has those. >> bragham: president trump's first stop today was in dayton, ohio, where a gunman killed nine

people and wounded 26 others early sunday morning. ahead of his visit, mayor nan whaley said she felt it is her du, to welcome the preside but that she hoped he was coming "to add value to our communit" mayor whaley joins me now. mayor, thank you very much for being here and, again, on behalf of all of us, oures condoleo you and what your town has been going through. before we talk about the president's visit, i'm just 'rrious how dayton is doing now. >> well, i think a little tired here in dayton. you know, we've gotten an awful lot of press coverage, and most of the reporters around town have talked about how great and gracious day -- daytonians have ut we're in the process of really undergoing serious grieving. visitations and funerals will be starting in the next few days and we're just trying to keep our community together. >> reporter: and we saw you vited some victims of tis massacre with the president

today. how did that visit go? >> oh, th vpresident wasy well received by the victims and the first we responders. we saw the guys that were so heroic on the streets on fifth street that saturday night, they were super grateful to see the president of the united states, and lots of pictures all around for those folks. >> reporter: you had said, in advance of the president's visi that you had hoped you -- you had said his rhetoric has been painfulma fony in our community, meaning many in your community. what did you mean specificallyy by that? >> i will say when the president announced he was coming tuesday, you could feel a tension in our community that w hadn't experienced before that, and i think that is not anything hesp saidifically today or yesterday, it's just three years of this hyperpartisan way that he works, and that's painful for some people in the community. heam glad the president went,

whe decided to come, he decided to go and focus on the victims and the first responders. i appreciate that he did not go to the oregon district and, actually, the oregon was pretty tense today during his visit with both p--trump and anti-trump people walking the streets, so that's what i mean when his rhetoric is so hot. >> reporter: did his visit today and your conversations with him, did you communicate those concerns to him? did he assuage any of your concerns about his rhetoric and how he is governed? >> myocus has been on getting something done around gun control, so my convertion with the president wasn't anything to do with his rhetoric but everything about getting something done when it mes to common sense gun legislation and likely trying to see if there was a way forward to be truly bipartisan and, frankly, that's something we han't seen for a very long time in washington, d.c. >> reporter: as you know, the people who watch how gun legislation has risen and fallen in washington, d.c., especially aft the sandy hook massacre where all those children were

killed, and peoplid sa if nothing can happen after that event, what makes you think something is different now? >> well, you know, i'm a person of hope, and i know that dayton was the 250th mass shooting in the country this year, and, so, we are getting to the place where every single community has experienced some sor of gun violence that could have beenen prble. when so many people experience it, i think more and more americans make it a higher priority, and i think we're seeing that, as you look at polls, where the majority of americans are for an assault weapons ban. 90% of ohioans are for universal background checks. those are enormous numbers and, really, the n.r.a. and their money can only hold us out for so long. >> reporter: from your conversations with the president today, did you get a sense he would push that? because our utherstanding is the senate majority leader mitch mcconnell has said he

won't bring any bi to the senate floor that he doesn't think the president orwill su did you try to persuade the president today this is something he has to g behind?ly >> absolu senator and i towards the end said, hey, why don't you consider an assault weapons ban? the president pointed out that president obama let the assaultp s ban laps. i said to the president, hey, maybe this is something you could get done that presidentam couldn't get done, that would be something spectacutila, pog out that the senator even voted for the assault weaponan. the president pivoted and said he was going to do something terrificor our first responders who had just met, and senator brown said the best thing you could do for our first responders is get these guns off 'te street so they d have to fight them anymore. >> reporter: one of my colleagues yamicheas in your town a few days ago and spoke with some of yr constituents and she spoke with one i can't

think man who said his fear is once the cameras go and the attention dies down that all the talk of reform and change and do something will disappear with it. i know you said you're a hopeful rson, but where does th hope come from? >> we are seeing some marginal different around gun control. i talked to mayor bloomberg a few days ago who is the godfather of this work for mayors. he said we're making progress. indiana has a red flag law, the republican governor here is going to introduce a red flagfo law ement we're starting to see change. as fast as i would like? absolutely not. but i think, after you go through one of these mas shootings, it changes the community, and it changes your perspective around common senset gun legin, too. and let me be clear -- doing something is not abo video games. this whole farce and video games being the reason why we suddenly have mass shootings is a fool's errand. one exampleth ie most

aggressive video games in the world are actually in japan, and last i've seen, they don't have the mass shooting problem we have here in america. >> reporter: mayor nan whaley, good lyock wit community and the grieving you all have in front of you. so much for being here. >> thank you. >> brangham: and now for the thview from the second cit president visited today, we return to el paso, where i'm joined by iliana holguin. she's the chairwoman of thepa democratiy in el paso county and is also an immigration attorney. ms. holguin, thank r u very much eing here. before we get to the president's visit and all of the protests and the concern over that, i wonder if youould just talk to us a little bit about how the latinoommunity iel paso is doing. >> well, as you can imagine, everyone is still, i think, in a little bit of shock and dielief. one could ever believe that anything this horrific can happen in theirni com. el paso has always been a very

warm, welcoming, frieny mmunity, and we've always prided ourselves on that, so to have someone drive ten, eleven hours specifically to carry out actf hate has just been absolutely shocking andun lievable to swallow this. but one thing that we all know is that el paso is extremelliy ret, and we know that we're going to get through this together. >> reporter: when i was there a couple of day ago, i heard a lot of what you were saying, a lot of fear and anguish and sadness. several people mentioned to me that, all of a sudden, they thk about their dail lives in a different way. they think about going to the store differently or dropping their kids at daycare differently. are you hearing the same thingpl from p >> yes, i am. people are very afraid. we know that one of the motivations of this person coming to our community was cspecifically ause of his hatred of latinos, and we're 85%

latino. so we know that our commuty was targeted specifically because of who we are, because of our identity, and knowing that is certainly making people afraid that we mig something like this happen again. another white supremacist decides to come to our community to cause harm to us, so, yes, i've also been hearing that people are afraid to do thingsma that ny no one would ever think to be afraid of, to do go out -- to go out in public in open space, and certainly that's not ay any community should have to live. >> reporter: i know you wrote a letter to the president in advance of his visit saying, please don't come. can you explain why you didn't want him to visit? >> yeah. you know, el piansight now, we're -- el pasoians now still grieving. we're facing having 22 funerals

here in te next few days and many of us likely holde the presnt responsible in a lot of ways for this increase in, you know, the demonization of ammigrant communities and a lot of the rhetoric the president uses on a daily basis in hiser account and in his rallies. seu heard some of the same phrases beingd by this person in the essay he posted just minutes before he opened fire here in el paso. so really we feel that the president has to acknowledat his language has played a role in what happened. his words have consequences, and here in el paso, we learn that, on saturday, that his words have very, very severe consequences that can chge a community. and, so, we didn't want him to come while we were in this process of grievg and healing, and until he acknowledges that he thews change the way he talks about immigrantsnd immigra

communities and people of color, he has to recognize that his language is what's doing us harm, and saturday was just a manifestation of that. >> the president today was askeq that specifistion, do you think your rhetoric was contributing to this, and he said, no, no, no, m words have not contributed this, and many of his supportlds w argue no one but the shooter, nobody forced the gun into that man's handsfo, nobody ed him to drive 600 miles down and commit llis violence. but you r believe the president sets the table that causes this kind of tng to happen? >> yeah, and that's true. we're not saying that the president is somehow the one that told this person to do this horrific thing, but thepr ident's language definitely contributes to just the dizasiveness, the demonon, the way he talks about communities like ours. he stokes that hatred and that arrange that we know that white supremacists already feel towards communities like ours

so he may not have directly played a role in putting the un into the shooter's hands, but he certainly enurages people with white supremacist views, he certainly condonest. we saw the same thing happen with charlottesville where he tried to somehow, yes, condemn white supremacists on one hand t, at the same timesay that not everyone's that bad. he seems to can just come out and denounce white supremacy and that the what weeed him to do, because if he sounds like he's condoning it, if the president of the united states sounds like he's condoning it, then, of course, we're going to see physical manifestations of that like what happened here in el paso. >> reporter: iliana holguin from el paso, thank you very much for being here.y >> thank you vuch. our dan bush is there and joins now. so, dan, you have been there all

day. you have been talking to pele. tell us what people are saying about the president's visit, how are they doing today? >> well, it's a deeply divided city, judyas we just heard from the previous guests. there's a lot of anger he in the el paso community directed at president trump, and in a conservative state, it's hard to fi republicans in downtown el paso today who were willing to say, yes, we want president trump here, we want to hear what he has to say. but i didak with one person who gave a different perspective and said he was a trump support, he didn't always agree with what the pretodent has ay, he did want him here, and the man also said that he was open to some gun control measures because of what happened here in el paso. so while it is ad dividety, people are trying to find some common ground in some areas, at least. >> woodruff: so, dan, we didn't knad of time what the president was going to be doing or much about what he was

going to be doi in el paso. what do we know now about nshis phile he's there? >> so president trump arrived here a little while ag he was greeted at the airport by abbott,s governor greg the state's two u.s. senators and some others. the president did not speak to reporters. he looked very solemn as he got heto a motorcade with the first lady aned into the city. we know he went to university hospital, judy, where heet with victims and some of their families and first respoers as well. we did see, in the air, en route to texassident trump spar with democratic officias there over the way they portrayed his visit. so we're waiting to see what will come out oflr. this butdy as we're seeing, divisions are very high, and i had an opportunity to speak with senator cruz briefly after president trump left r the hospit and i asked senator cruz what heanted the president to say, he said, this

is a moment ofnity, but senator cruz said both sides need to tamp the rhetorin dow. we'll see what happens. >> woodruff: dan bush reporting for us again today from el paso. thanyou, dan. >> woodruff: now, we continue our series of conversations with 2020 presidential candidateins. g me, billionaire philanthropist tom steyer. tom steyer, welcome to the "newshour". >> judy, thank you so much for having me. >> woodruff: let's talk about your decision to get in. in january, you said i'mg ot runnr president, but then last month you said, i'm going to run, but by this point, there were, what, tw dozen other democrats running. >> yeah. why should people vote for >> well, my basic thesis on what's going on in the united states is that we have broken vernment in washington, d.c., that corporate cash has bought the democracy, and that the only

solution is to push power back to the people, to retake the democry on behalf of, by and for the people. for the last ten years, i have been organizations coalitions of ordinary american cizens to take on that unchecked corporate power and we have beenng win >> woodruff: let's talk about one of the issues that ist motig many americans today and that is in the aftermath of these terrible shootings in ohio, in texas. you have a number of other democratic candidates for presidents this week condemning president trump's rhetoric, condemnic white supremacistid logy. they're also talking about gun control. shat would your priority be to stop these ki of incidents as president? >> as you point out, judy, there are two things coming together rere. there is the fai to check gun violence in the unid ates, and there is the racist rhetoric the president has employed to create an atmosphere

that p empowersple to take on these acts. let's start with the first one, the failure to che gun violence in the united states. these are the el paso and dayton are 250th and 251st mass shootings this year in the united states. we have had, don't forget, parkland, don't forget sandy hook. this has been decades of unchecked gun violence in the country. and why is that? it's because the gun manufacturers, through ther. , controlled the republican -- control the republican party and common-sense gun legislation that over 90%f american citizens support can't get in to bew use of that corporate control of the senate. >> woodruff: and you're saying you would go after those corporations, but let me point out it was president obama, legislation even on background checks could nopa geed. so now you have other democrats ghnning for president who are

talking about t measures, gun licensing, gun buyback programs, do you have a worry that democrats indvocating these kinds of things could go so far to the left that there coul be some kind of blowback? >> no, over 90% of americans wanndt ory background checks on every gun purchase. there is no question herewihat th of the american people is being frustrated and is being from you s gayed byun manufacturers through the n.r.a., and this is just one example. i think it does in this case, to be fair. look, i have been going after this idea of corporate control of our government that is the motivating idea behind m campaign, but let me say i am the person who almost two years ago said, impeach this president, he is deeply corrupt and he is more than met the criteria and he needs to go. woodruff: and that, in fact, is what many people will recognize you for. you are running -- have been

running millions o dollars ads on television and elsewhere arguing for the impeachment of president trump. a few months ago, you said this is something that had to happen this year, it couldn't happen in 2020, but here we are, it's almost the fall, even the democratic congressional leadership is not in favor of the impeachment process. where is this going? >> look, judy. the funny thing, is more than half the congressional democrats have come out publily for impeachment. i've pushed to get as many televised hearings in front of the american people because what we were really trying to do with impeachment is let the american people decide, have televised hearing. all our research says if the american people get the facts, they've said i didn't know that, he's a liar and a crook and if i did at i'do to jail. >> woodruff: but yes or no, you think it can happen this year? >> i think time is extremely shor'r still pushing for it. we'll never walk away from the fact that the righthing iso impeach and remove this

extremel, but time i short because the only way to get this done is bring in the american people andt t means televised hearings like the one in watergateho convinced the american people president nixon was a crook and had to go. >> woodruff: climate change,on you've workehis issue for years, you've spent hundreds of millions of dollars advocating. there are some environmental activists out there who are saying tom steyer would be much better off continuing to focus nn climate change rather t turning his focus to running for president. what do you say to them and o those who point to your report managing a hedge fd where you invested in things like coal minus around the world that were carbon emitters ultimately and companies that, frkly invested in these private prisons, detention facilities for migrants on the border. >> let me first answer the investment question, then i'll talk what i'm doing now in terms of climatchange.

look, we invested in everything, every part of the americanon y, including fossil fuels, and i decided over ten years i realizedy gosh, there is this impact on the climate that's going to be dreadful and i need to divest myself from it. i quit my busines i to the giving pledge to give i money to good causes, and started organizing coalitions to fight to prevent climate changeh then. that's exactly what i have been asking other americans to do. we all grew up in a fossil-fuel based economy, including you. we've all filled up at the pump. is that where we came from. we need to go to a different place, and that's what i have beepushing pushing for for moren ten years ago. successfully giving up companies. in terms of the private prisons, we madan investment i thought about it, decided it was not the right thing to do and made a mistake and sold it 15 years before any of this political stuff came because i said that's not a place where somebody ould be making money,

including us. it was a mistake to buy it, we sold it and thatas 15 or 17 years ago. but let me answer this last questiin, judy, whics why is this a way to attack climate change? if you've seen the climate proposal that i put out abouttw weeks ago, it is the most aggressive climate proposal by far in this campaign. it talks about declaring a state of emergency theirst day of my presidency, it talks abt basically being animated by environment justice going to most affected communities and getting their ideas of adership to mak sure the program works for them, and it talks about start trying to lead an international coalition on day one, not the idea of signing back u. for par of course, we'd sign back up for paris. that is far from enough. if yolook at the numbers in climate -- and i would challenge these climate activists to talk about how they're going to make

an impact - you look at the numbers on climate, it is an emergency, the president should deal with it at way beuse we're talking about the health and safety of every american, and we can't do it unless the global community comes along with us,nless we lead it and unless we've made the commitment to get our house in order. >> woodruff: tom steyer running for the democrat nomination. thank you so much. >> judy, thank you so much for having me. >> woodruff: stay with us. coming up on the newshour: filmmaker ron howa reflects on his long career on both sides of the camera. and, el paso pays tribute to the youngest victim of this weekend's mass shooting. as health care costs continue to rise, especially in the u.s., one hospital chain in india has continued to bring cown. it's now brought some of its ideas very close to america's

shores and is courting american patients. eecial correspondent fre sam lazaro reports. it's part of his series "agents for change" and this week's"l eading edge" segment, focusing on science and medicine. >> what we have here is basically a two-centimeter port that we use. d reporter: with cutting edge imaging, robotics her technology, surgeons like savitr sastri rform the most advanced procedures offered anywhere in the western hemisere-- in this case a slipped disk fixed with very little actual cutting >> it's minimally invasive. >> reporter: but this hospital is not in the u.s. or canada. it's in the british caribbean territory of grand cayman. and dr. sastri and thre medical staff are from india-- ployees of that country's largest hospital chain. called health city cayma in islandis a new frontier for the for profit chain founded

19 years ago by dr. devi prasad shetty, an entrepreneur obsessed with effient health care livery. and technology. even here, on a brief visit to the caymans, he was never far h fre base. >> first thing i do is to do the rounds in my hospital in bangalore. >> reporter: from cayman. >> from cayman! >> reporter: with a new phone app being developed by hcois mpany and microsoft he keeps, tabs on patieneasily call uprd a re, or check a new x-ray, for instance. >> the x-ray technician touches a button in the i.c.u. of bangalore hospital.n in less thaa second, like i said, it appears in my phone. >> reporter: working from his b sprawligalore headquarters, shetty has become a world-rewned and prolific cardiac surgeon... >> hole in the heart. >> reporter: ...doing two to three procedures a d, as he told us in 2015, at very low cost. >> this patient would have paid us about $2,500 to abou$3,000,

but in the u.s., an operation of this nature would cost, i guess, more, anything fro$1$70,000, ,000. >> reporter: since then, dr shetty has sought to prove he mocan transfer his low-cosl to more expensive first world settings, beginning witymh the islands. >> cayman islands is a very unique place. and ideally located close to u.s. >> reporter: health city opened in 2014 and is joint commission accredited, meaning it meets the highest global standards of care. yet its costs are 50 to 65% lower than the u.s. among its competitive advantages: the ability to buy in bulk.we >> w implant one of the largest number of heart valves in the world, obviously, you pay for it less t.n others >> reporter: they also pay a lot less for drugs. >> how much cheaper is it to bring your drugs from india than it would be in a market in this

region? >> it would be around 50 to 60% >> reporter: dr. binoy chattuparambil is clinical director of the newly built hospital. >> reporter: he took us on a tour of the new facility- designed, he says, wboth physicians and architects at the drawi board. unlike most hospitals that buy oxygen from commcial sources, this one makes its own, one of several sml steps that promise savings. another huge cost saving: patient bills are simplified, with a fixed bundled price that is disclosed when a patient is first se. >> we thank you. >> reporter: in the hallway, dr. chattuparambil who is also chief of cardio-vascular surgery, ran into a patient's grateful family. >> and all the arteries that were clogged, they're aleal d? >> all clear. >> reporter: leonie eb husband, eddie, had suffereckd a

heart at his surgery included a double bypass, a tube grafted to replace a rupturing aorta and repairing two leaking heart valves. >> it's quite a complex operation. >> how many hours did it take you too that? >> reporter: it took almost eight hours, and in the u.s. would easily cost a half a million dollars, he says. here, the final bill was $110,000. if you had not been here, where would you normally have gone foh type of surgery? >> miami. >> reporter: miami could have been tough ride. >> could have been. thank god. r orter: but with 104 beds, it's clear the health city project had plans to reach well beyond local patients like eddie >> grand cayman is just a 90- minu flight away from the united states, a tropical paradise whose economy depends heavily on tourism and that's a big reason why the governmente here gae indian hospital chain tax breaks and other incentives to locate a facility here.ic

am tourists would come now not just for the beach but for their healthcare. so far, that hasn't happened. >> american patients still assume that healthcare provided outside the u.s. are not as gooe at that you cain the u.s. >> reporter: northeastern university business professormu ravi rami recently co- authored a book called "reverse innovation in healthcare" that studied the cayman hospital. american tourists are everywhere, he says, just not the one hospital was looking for-- older patients whr needac surgery, or knee or hip replacement, for instance. >> a lot of atople in th generation who need this kind of care probably don't even have a passport. so the idea of going strange place to get an important medical procedure iths something k people want to avoid if they can avoid it at all. >> reporter: for his part dr shetty says even at its current 40% occupancy, the hospital has aying power, treating caribbean, central american and even some canadian patients.

>> we've been profitable forit some time, yes. >> reporter: eventuallyll americans ome, he says. their insurers he predicts will gin to offer an offshore alternative with free travel and no copays. professor mamurti doesn't see a competitive threat but says american providers benefit from studying the indian- caribbean upstart. y we need to shake up the healthcare indus the u.s. i don't think it's going to happen by the arrival of with a single amazon or uber that single handedly turns the industry upside down.ou eed a lot of people disrupting in little ways that add up to big change over a period of time. >> reporter: change that he says is urgently needed to ow cost increases in an industry that now accounts for 18% of the u.s. gross national product. for the pbs newshour, this is fred de sam lazaro in grand cayman. >> woodruff: fred's reporting is

in partnership with the under- told stories project at the university of st. thomas in minnesota. >> woodruff: ron howard has grown up on screen right before our eyes, now he's one of hollywood's leading directors and producers. earlier this summer, jeffery brown reported on howard's latest film pavarott a parol file director as part of our arts and culture series canvass. >> brown: the grand stairway to have the metropolitan opera in new york, perhaps not the place you'd expect to meet ron howard. this isn't your world . >> not at all. >> brown: you didn't stop with pavarotti? >> brown: howard, now 65, has just made a documentary on the

life of opera great luciano pavarotti. and the met, it turned out, was just the place to talk about his long, varied and hugely successful career in show business. itegan early, with both parents working in hollywood, as a child actor, most famously a"" opie" in the "andy griffith show" in the 1960s. and "richie" on "happy days" in the '70s. a decade later and his transition to directing was in full swing, with hit comedies such as "splash", "cocoon", an"" parenthood." leading to fildramas including"

apollo 13" in 1995and "a beautiful mind", which won him an oscar for best director in 2001. when you look back now, does it make sense? >> it makes complete sense. >> brown: it does? >> complete sense because i really wanted it. it wasn't somebody else's idea. it was my idea. >> brown: and you just knew. >> well, it evolved. you know what i mean? so many of the directors on theg andyffith show had been actors and so they might just drop here and there: y, i bet you want to be a director someday. my father directed a lot of theatr, no film. i watched him, i watched him rehearsing. i could see what that process was and just like a ballplayer might one day want to manage or a basketball player might want to coach, i was drawn to the >> brown: what is th to directing for you? >> partly directing for me is trying to create an environment, not just for the actors but also

for all of the key department heads inhe production.en and it's really a matter of interpretation, understanding that story, beginning to understand on a kind of both macro and micro level wh elements are going to be. putting together a film, television show, documentary,of it's sort ike a mosaic. it's built in tiny litt a pieces, unliive performance, which is-- this is it. there's no going back. >> brown: and how much control or how loose is it? >> it depends on the moment.so times you want to be as relaxed and loose and carefree as you possibly can be. d other times you need to get everybody's focus >> brown: many stories have followed for howard, as both director and producer. imagine entertainment, the production company started by howard and his friend brian grazer, is a film and tv powerhouse, including the hits"v arrestedelopment."o

several new prcts are in production, including a documentary on the paradise fire that devastated parts of northern california last year. for him, documentaries, howard says, are an exciting new way of orytellin >> frankly i've always loved documentaries and i was a little ckshy, maybe fearful of sg my toe in those waters. >> brown: you were fearful because what? >> it's a different discipline and if i'm goingo do it and put name on it and i wante to believe i could put my best foot forward. and the good news to me was that i can actually useuch more of my storytelling experience and sensibility in the doc world than i even expected i could. >> brown: one new scripted worke is a dramaversion of" hillbilly elegy", the memoir by p in vance about growing appalachia. the focus of attention: a

portrait of the white underclass mpat helped elect donald t othere's a tendency to so dig in with what's familiar, what you relate to the best and so forth, and, so if entertainment if entertainment can shed light on what its that we have in common, i think that's useful. if it could shed light corner of society that people might have some questions about or curious about in an interesting anengrossing, emotional way, then that's a form of entertainment. >> brown: the film is being shot in georgia, and after the state recently passed a restrictive new abortion law, howard's o company joiners from hollywood in speaking out against it,

for now, though, shooting will continue. >> we didn't want to bail out on all those people whose livelihoods depend on us being there. for whatever that means to this state government. that, as a part of the media industry, if it passed, we'd be disinclined to work in grgia. >> brown: at 65, ron howard continues to exhibit a youthful style and exuberance. for many aricans, he knows, he is forever opie. in reflecting on his latest documentary subject, luciano pavarotti, howard focused on the tenor's drive and willingness to take risks. you come across as an easygoing person. that was your actor persona as well. but there's clearly some drive or ambition or is there a killer instinct in there. >> well, only with respect fo the medium. i mean, i think with pavarotti, he was charming.

people loved working th him. they really wanted to work with him. i hope people feel that way about working with me. i bring a lot of joy and excitement to e set with me because that's the way i feel. >> brown: you're 65, you've been at this a long time, right? >>1 of those years. >> brown: 61 o65, but you seem busier than ever. >> as a storyteller, it's almost like this buffet.re it's ibly energizing to me. >> brown: ron howard,uchank you very >> pleasure, thanks. >> woodruff: finally, tonight, we want to offer a diferent look at the wrenching, emotional toll these mass shootings can take. william brangham is back with that. >> brangham: that's right, judy. monday night in el paso, we went to the very first memorial for one of the vtims of saturday's massacre. his name is javier amir

rodriguez.d he s uncle were shopping at the wal-mart when the attacker entered the store. javier and his uncle were both shot.v his uncle sured. at javier's memorial, held at the football stadium at horizon high school outside of el paso, friends and teachers remembered javier as a happy-go-lucky boy, a great soccer player, and a good friend. the memorial took a particularly emotnal turn when the local school superintendent, dr. juan martinez, spoke. here's a brief, edited excerpt of what he had to say: >> tonight, even though we aren angry and moe death of a friend, our student, our son, we refuse to accept dkness as our closest friend. darkness came from outside of r city and took javier away emom us. but javier willn in our hearts, as a symbol of goodness,

and love, respect and kindness for one another. and that-- darkness can never take away from us. javier did not deserve to be taken away from his family.

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thank you. nd

hello everyoneelcome to amanpour. here's what's coming up. within that category, the majority are white supremacist motivated. >> white nationalism at the top of the agenda now. will domestic terrorism become a federal crime? and we have to be in the lead. you know, i've redone our nuclear. we have new nuclear coming. >> are we entering a new nuclear arms race? i asernest moniz, technical wiz behind the iran nuclear de al. plus, shining a light on to these dark ages of disinformation. peter pomerantsev and the war against reality. you don't want to treat a person who doesn't have a