captioning sponsored by nehour productions, llc >> woodruff: good evening. i'm judy woodruff. on the newshour tonight: condolences and confrontation. president trump is met with protests while visiting el paso and dayton to console victims of the weekend's mass shootings. then, one-on-one with democratic presidential 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 in the u.s. has many patients looking abroad. >> we need to shake up the healthcare industry in the u.s. you need a lot of people disrupting its little ways thatp add to big change over a period of time. >> woodruff: all that and more

on tonight's pbs newshour. >> major funding for the pbs newshour has been provided by: >> babbel. a language program thaifteaches realconversations in a new language, like spanish, french, german, italian, and more. babbel's 10-15 minute lessons are avai online. an app, or more information on babbel.com. >> consumer cellular. >> financial services firm raymond james. >> suppoening social epreneurs and their solutions to the world's most oblems-- skollfoundation.org. >> the lemelson foundation.

committed to improving lives through invention, in the u.s. and developing countries. on theeb at lemelson.org. >> supported by the john d. and catherine t. macarthur foundation. committed to building a moan just, verdanpeaceful world. more information at macfound.org >> and with the ongoing support of these instutions >> this program was made possible by the corporation for publicanroadcasting. by contributions to your pbs station from viewers like you. thank you. >> woodruff: two cities united in their grief, but divided over condolences from the commander- in-chief. yamiche alcindor reports on the latest from dayton and el paso. >> alcindor: well before president trump arrived, protesters in dayton, ohio filled the strees. some denounced his rhetoric on o ce and immigration, and demanded actionevent gun

violence. >> the tempers flare but en the of the day, how can we not be out here and tyis is our ci.do >> >> alc others praised the president and welcomed his visit. >> alcindor: as he left the white house, presideid trump e hoped congress could soon pass bipartisan gun legislation, though not a ban on assault weapons >> i don't want to put guns into the hands of mentally unstable people or people with rage or hate. there's a great appetite, and i mean a very strong appetite for backgroundhecks and i think w can bring up background checks like we'd never had before. >> alcindor: the president also insisted his comments have not fued hate. >> no, i don't think my rhetoric has at all. i think my rhetoric is a very uh, it brings people together. >> alcindor: the president didti >> alcindor: c say he is part of the problem because just before today's visits, he criticized democrats and doubled down on his hardline immigration stan. president trump first stopped in dayton, where a gunman fired an automatic weapon outside a bar early sunday, killing nine

people. the president and first lady went to a hospital where many people were treated. there, they thanked firs at responde medical staff. they also met with some of the victims and their families. several hundred demonstrators gathered outside. later, president trump traveled to the texas border city of el paso, where saturday's racially- motivated shooting at a walmart aimed 22 lives.ro an "el paso " rally was held at the same time to counter the president's visit. many residents and democratic lawmakers there, including el also native and presidenti candidate beto o'rourke, had urged him to stay away. o'rourke attended a morning remembrance at a local high school. >> what you are doing today here today, proudly and defiantly, standing up against racism and hatred and terrorism. is the way forward for a united states of america th has never been more divided, more

polarized, than it is right now. >> alcindor: meanwhile in iowa, former vice president and decratic presidential candidate joe biden sounded off. he insisted president trump bears some responsibility for inflaming tensions. >> trump offers no mor leadership. he seems to have no interest in unifying this nion. no evidence that the presidency haawakened his conscience the least.de we have a president with a toxic tongue, who's publicly and unapologetically embraced the political strategy of hate,i racism andsion. >> alcindor: other democratic candidates also demanded urgent action on gun contro new jersey senator corey booker spoke at an historicaack church in charleston, south carolina where in 2015, nine ople 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 national security. >> alcindor: during a speech in washington, montana overnor steve bullock made a case for banning high-capacity magazines d assault weapons. >> let me say that as a hunter, no real hunter needs a 30-round clip.ea nohunter needs a weapon of war. no real hunter needs a bump stock. >> alcindor: for the pbs newshour, i'm yamiche alcindor. >> woodruff: now to our second lead story. the political turmoil in puerto rico took a new turn today when the island's supreme court overturned the swearing in o pedro pierluisi as governor. outgoing govern ricardo rossello, who was forced from office last week by public protests, had positioned pierluisi to succeed him. but the high court today fnd

that process unconstitutional. justice secretary wanda vazquez is expected to assume the post. for the latest, turn to frances robles of the "new york time" welcome back to the "newshour", frances robles. so how did the supreme court arrive at this decisio? >> it was a decision that was widely expected because there was a contradiction between whaw puerto ricansays and what puerto rican constitution says. so he was never confirmed by the senate, and the law seas that was okay and the constitution says it's not. >> woodruff: and, so, wanda vazquez, after saying she was not interested ssining 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 sheur woulddown the job, she just wanted to make clear it it wasn't her interest, she wasn't jockeying for the position. it is widely expected she 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 interested and won't >> you know, this is the "game of thrones" without the dragons and the homicide. so what it is is a 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 ten head of thee, and he and she are arch enemies, and, so, it's kinof understood he will not allow for her to stay in that position long and there have been deals made as to how this is going to play out. >> woodruf: so what does that mean, frances robles? who steps in if she doesn't stay long and someone has to replace r? >> well, it depends on whose rumor you believe, but the prevailing rumor in the local media is congresswoman gonzales is expecteto be named secretary of state.

if she is named cdfirmed by the house and the senate which is the part mr. pierluisi did not do, if ms. vasquez resigns, ms. gonzales will become the governor of puerto rico. >> woodruff: she was a guest on the "newshour" just 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 lot of people have. even ms. vasquez was suspended from office a few months ago, mr. pierluisi has a got of coections in his family, and they were seen as products of the establishment taking advantage othis popular upriding to put in more of their own, and thoughs.onzales is a member of that party, she's pretty well respected, she's n tually a pretty popular political figuree island. >> woodruff: and in a few section, how are the people in puerto rico dealing with the turmoil at the top? everybody isind of waitingo see who's going to be next to see if they have to unleashos

protests again. you saw that whenrl mr. psi took office, and now kind of a calm, a tense calm. >> woodruff: francess of the "new york times," we thank you. >> thanks for having me, yod. -- judy.oo >>uff: in the day's other news, u.s. immigration and customs enforcement arrested 680 rs-- mostlyd wor latinos-- at food plants in mississippi. they were the largest such raids in at ast 10 years and involved 600 agents. the operation targeted processing plants in half a dozen towns outside jackson. ice officials said it was planned months ago. in afghanistan, 14 people wereed kind nearly 150 wounded when a powerful car bomb exploded in kabul. nde blast leveled buildings near a police stationhattered windows in houses and shops for blocks around. the wounded, most of thema civi, were rushed to hospitals. the taliban claimed responsibility even

continues peace talks with u.s. diplomats.pe pakistan is ing the ambassador from india and suspending cross-border trade in an escalating dispute over contested kashmir. pethat's after india stripits part of kashmir of political autonomy. today, hundreds returned to the streets in the pakistani- hintrolled part of kashmir, condemning new d decision. >> ( translated ): this is a heinous conspiracy, and we strongly condemn it. it has been our demand since the beginning that kashmir should become autonomous. are protesting for this and, god willing, we will continue to protest for this. w druff: india's hindu nationalist government is pressing for muslim-marity kashmir to be fully integrated with the rest of the country. the united states and turkey may be close to setting up a so- called "safe zone" in northeastern syria. negotiators said today they have agreed to form a joint opations center that coul

head off a turkish military invasion to clear the region of syrian kurdish forces. the kurds are aligned with the u.s., but turkey regards them as terrorists. in northwestern syria, government forces havevi recaptured twages in a renewed offensive on the last major rebel stronghold. the assault on idlib province began in late april, but the syrian military called a brief cease-fire over the weekend. in three months, air stres and shelling have forced 400,000 people from their homes and killed more than 2,000 back in this country, democrats in the u.s. house of representatives moved today to seke former white house co don mcgahn answer questions. in a federal lawsuit, the house judiciary committee demanded that mcgahn obey a subpoena. it also rejected white houseas claims that heegal immunity against testifying. and, on wall street, stocks

plunged initially, amid newar 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 had been 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 presidential candidate tom steyer on his top priorities. the high cost of healthcare has many americans seeking medical care ab mroad. and mue. >> woodruff: two views from the two cities struck by tragedy, and where the president visited today. william brangham has those. >> brangham: president trump's first stop today was in dayton, ohio, where a gunman killed nine

people and wnded 26 others early sunday morning. ahead of his visit,ayor nan whaley said she felt it is her duty to welcome the president, but that she hoped he was coming "to add value to our community." mayor whaley joins me now. mayor, thank you very much for being here and, again, on behalf of aus, our condolences to you and what your town has been going through. before we talk about the president's visit, i'm just curious how dayton is doing now. >> well, i think we're a litt tired heren dayton. you know, we've gotten an awful lot of press coverage, and most of the reporters around town have talked about how great ando grs day -- daytonians have been but we're in the process of really undergoing serious grieving. f visitations anerals will be starting in the next few days and we're just trying to keep our community together. >> reporter: and we saw you visited some victims of this pssacre with thesident today. how did that visit go?

>> oh, the president was verywe received by the victims and the first we responders. we saw the guys that were so heic on the streets on fifth street that saturday night, they were super grateful to see the u president of tted states, and lots of pictures all around for those fepks. >>ter: you had said, in advance of the president's visit, that you had hoped you -- you had said his rhetoric has been painful for many in our community, meaning many in your community.ea what did you specificallyy by that? >> i will say when the presidenn unced he was coming tuesday, you could feel a tension in our community that we hadn't experienced before that, and i think that is not anything he said specifically today orda yest it's just three years of thisan hyperpartay that in works, and that's painful for some peopl the community. i am glad the president went, when he decided t,o co he

decided to go and focus on the victims and the first hsponders. i appreciate tha did not go to the oregon district and, actually, the oregon district was tepretty e today during his visit with both pro--trumanp anti-trump people walking the streets, so that's what i mean whehen hisric is so hot. >> reporter: did his visit today and your conversations with him, did you comm those concerns to him? did he assuage any of your concerns abou his rhetoric and how he is governed? >> my focus has btieen on gg something done around gun control, so my conversation with thgpresident wasn't anytho do with his rhetoric but everything about gettinneg something hen it comes to common sense gun legislation and likely trying to seaif there waay forward to be truly bipartisan and, frankly, that's something we haven't seen for a veryong time in washington, d.c. >> reporter: as you know, the people who watch how gun legislation has ris and fallen in washington, d.c., especially after the sandysa hook me where all those children were

killed, and people said 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 inow that dayton was the 250th mass shooting in the country is year, and, so, we are getting to the place whee every sinommunity has experienced some sort ogun violence that could have been preventible. when s e many peoperience it, i think more and more americans make it a higherir pr, 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.aand their money can only hold us out for long. >> reporter: from your conversations with the president today, did you get a sense he wod push tht? because our understanding is that the senate majority leader mitch mcconnell has said he won't bring any bills to the

senate floor that he doesn't think the president will support. did you t to persuade the president today this is something he has to get behind? >> absolutely. senator ahe i towards end said, hey, why don't you consider an assault weapons ban? the president pointed out that president obama let the assault weapons ban laps. i said to the president, hey, maybe this is somethulg you get done that president obama couldn't get done, that would be something spectacular, pointing out thatna the r even voted for the assault weapon ban. the president pivoted and said he was going to do something terrific for our first responders who had just met, and senator brow said the best thing you could do for our first responders is get these guns off the street so they don't have to fight them anymore. >> reporter: one of my colleagues yamiche was in your town a few days ago and spoke with some of your constituents and she spoke with one i can't

think man who said his fear is once the ceras go and the attention dies down that all the talk ofaeform and nge and do something will disappear with it. i know you said you're a hopeful person, but where does that hope come from? >> we are seeing some marginal different around gun control. i talked to mayor bloomberg goa few days who is the godfather of this work for mayors. said we're making progress. indiana has a red flag t law, republican governor here is going to introduce a red flag law enforcement we're starting see change. as fast as i would like? absolutely not. you gohink, after through one of these mass shootings, it changes the community, and it changes your perspective around common sense gun legislation, too. and let me be clear -- doing something is not about video games. this farce and video games being the reason why we suddenly havegsass shoots a fool's errand. one example is the most

aggressive video games in the world are actually in japan, ad lai've seen, they don't have the mass shooting problem we have here in america. >> reporter: mayor nan whaley, good luck with your community and the grieving you all have in front of you. thank you so much for being here. >> thank you. >> brangham: and now for the view from the second city thet presidsited today, we return to el paso, where i'm joined by iliana holguin. she's the chairwoman o the democratic party in el paso county and is also an imgration attorney. ms. holguin, thank you very much for being here. defore we get to the pre's visit and all of the protests and the concern over that, i just talk tou coul us a little bit about how the latino community in el paso is. doin >> well, as you can imagine, everyone is still, i think, in a little bit of shock and disbelief. no one could eve believe that anything this horrific can happen in their community. el paso has always been a very

warm, welcoming, friendly community, ands we've alw prided ourselves on that, so to have someone drive ten, eleven hours sarcifically to out an act of hate has just beenoc absolutely ng and unbelievable to swallow this. but one thing that we all is that el paso is extremely resilient, and we know thatoi we're to get through this together. >> reporter: when i was there a couple of days ago, ieard 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 think about their daily lives in different way. they think about going to the store diorerentlropping their kids at daycare differently. are you hearing the same thing from people? >> yes, i am. people are very afraid. we know that one of the motivations of this person coming to o community was specifically because of his hatred of latinos, and we're 85%

latino. so we know that our community was targeted speciusically beof who we are, because of our identity, andnowing that is certainly making people afraid that we might see something likehis happen again. another white supremacist decides to come to our community to cause harm to us, so, yes, i've also been hearing that o ople are afraid tdo things that normally 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 a way any communi have to live. >> reporter: i know you wrote a letter to the president in advance of sihis saying, please don't come. can you explain why you didn't want him to visit? >> yeah. you know, el pians right now, we're -- el pasoians now are still grieving. 're facing having 22 funerals here in the next few days and

many of us likely hold the president responsible in oflot ays for this increase in, you know, the demonization of immigrant communities and a lot of the same etoric the president uses on a daily basis in his twitter account and in s rallies. you heard some of the same phrases being used by this rerson in the essay he posted just minutes bee opened fire here in el paso. so really we feel that ide prnt has to acknowledge that his language has played role i 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 changea community. and, so, we didn't want him to come while we were in thispr ess of grieving and healing, and until he acknowledges that he thews change t way he talks about immigrants and immigrant communits and people of color,

he has to recognize that his language is w doing us harm, and saturday was just an manifestat that. >> the president today was asked that specific question, do you think your rhetoric was contributing to this, and he said, no, no, no, my words have not contributed this, and many of his supporters would argue no one but the shoober,y forced the gun into that man's hands, nobody forced him to drive 600 miles down and commit this violence. but you really believe president sets the table that causes this kind of thing 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, bu president's language definitely contributes to just the divisiveness, the demonization, the way he talks abo communities like ours. he stokes thatatd and that arrange that we know that whitae suprts already feel towards communities like ours. so he may not have directly

played a role in putting the gun into the shooter's hands, but he certy encourages people witith supremacist views, he certainly condones it. we saw the sthing happen with charlottesville where he tried to somehow, yes, condemn white supremacists on one hand but, at the same time, say that not everyone's that bad. he seems to can't just come out and denounce white supremacy and that the what we need 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 phonical manifestaof that like what happened here in epel paso. >>ter: iliana holguin from el paso, thank you very much for being here. >> thank you very much. our dan bush is there and joins me now. so, dan, you have been there all day.al

you have beenng to people. tell us what people are saying about the president's visit, dw are thng today? >> well, it's a deeply divided city, judy, as we just heard from the previous guests. there's a lot of anger here ithn el paso community directed at president trump, and in a conservative state,to it's har find 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 did speak with one person who gave a different perspective and said he was a trump support, he didn't always agree with what the president has to say, 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 a divided city, people are trying to find some comm ground in somareas, at least. >> woodruff: so, dan, we didn't know ahead of time what p thsident was going to be doing or much about what he was

going to be doing inl paso. what do we know now about his plans while he's there? >> so president trump arrived here a little while ago. he was greeted at the airport by the texas governor greg abbott, the state's two u.s. senators and some others. the president did notpeak to reporters. he looked very solemn ase got into a motorcade with the first lady and headed into the city. know he went to university hospital, judy, where he met with victims and some of their families and first responders as well. we did see, in the air, en route to texas, president trump spar with democratic officials there over the way they portrayed hi visit. so we're waiting to see what will come out of. this but already as we're seeing, divisions are very high, and i had an opportuny to speak with senator cruz briefly after president trump left for the hospital and i asked senator cruz what he wanted the prident to say, he said, this

is a moment of unity, but senator cruz said both sides t needmp the rhetoric down. we'll see what happens. >> woodruff: dan bush reporting for us again today from el paso. thank you, dan. ow >> woodruff:we continue our series of conversations with 2020 presidential candidates. joining me, billionaire philanthropi tom steyer. tom steyer, welcome to the "newshour". udy, thank you so much for having me. >> woodruff: let's talk about your decision to get in. y in januaru said i'm not running for president, but then last month you said, i'm going to ru but by this point, there were, what, two dozen other democrats running. >> yeah. why should vote for you. >> well, my basic thesis on what's going on in the united states is that we have a broken government in washington, d.c., at corporate cash has bought the democracy, and that the only

lution is to push power back to the people, to retake the democracy on behalf of, by and for the people. for the last ten years, have been organizations coalitions of dinary american citizens to take on that unchecked corporate power and we have been winning. >> woodff: let's talkabout one of the issues that is motivating many americans todad at is in the aftermath of these terrible shootings in io, in texas. teu have a number of other democratic candifor presidents this week condemning president trump's rhetoric, condemnic white supremacist ideology. they're also talking about gun control. what would your e iority b stop these kinds of incidents as president? as you point out, judy, there are two things coming together here. there is the failure to check gun violence in the united states, and there is the racist rhetoric hthe presidentas employed to create an atmosphere

that empowers people to take on these acts. let's start with the firste, on the failure to check gun violence in the united states. these are the el paso and dayton are 250th and 251st mass shootings this year in the uniteds. we have had, don't forget, parkland,on't forget sandy hook. this has been decades of unchecked gun violence in the and why is that? it's because the gun hemanufacturers, through n.r.a., controlled the republican -- control the republican party and common-sense gun legislatiaton over 90% of american citizens support can't t get law because of that corporate control of the senate. >> woouff: and you're saying you would go after those corporations, but let me point out it was under democratic president obama, legislation even on background checks could not get passed. so now you have other democrats running fopresident who are

talking about tougher measures, gun licsing, gun buyback programs, do you have a worry that democrats in advocating these kinds of things could go so far to hathe leftthere could be some kind of blowback? >> no, over 9 a ricans want mandatory background checks on every gun purchase. theronis no ques here that the will of the american people is being frustrated anbed ig from you strayed by gun manufacturers through the n.r.a., a 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 my campaign, b let me say i am the person who almost two years ago said, impeach this president, he is deeply corrupt and he m ise 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 -- ha been running millions of dollars in

ads on television and elsewhere arguing for th impeachment of president trump. a few months ago, you said this is something that had to happen this year, it coul't happen in 2020, but here we are, it's almost the fall, eve democratic congressional leadership is not in favor of the impeachm ptcess. where is this going? >> look, judy. the funny thing, is more than lf the congressional democrats have come out publily for impeachment. i've pushed to get as many televised hearings in frontf e american people because what we were really trying to do with impeachment is let the american peoe decide, have televised all our research says if the american people get the eyfacts, ve said i didn't know that, he's a liar and a crook and if i did that i'd go to jail >> woodruff: but yes or no, you think it can happen this year? >> i thinkxtime ismely short. we're still pushing for it. we'll never walk away from the fact that the right thing is to impeach and remove this president, but time is extremely

short because e only way to get this done is bring in the american people and that means televised hearings like the one in watergate who convinced the american people president nixon was a crook and had to go. >> woodruff: climate change, you've worked on this issue for years, you've spent hundreds of millionsf dollars advocating. there are some environmental activists out there who arem saying teyer would be much better off continuing to focus on climate change rather than turning his focni to r for president. what do you say to them and tnt those who p to your report managing a hedge fund where y invested in things like coal minus around the worldhat wer carbon emitters ultimately and compani that, frankly invested in these private prisons, detention facilities migrants on the border. >> let me first answer the investment ques'lon, then talk what i'm doing now in terms nv climate change. look, weted in everything,

every part of the american g fossil fuels,in and i decided over ten years ago, oh, my gosh, i realized there is this impact on the climate that's going to be dreadful and i need to divest myself from it. i quit my business. i took the ging pledge to give my money to good causes, and i startedrgizing coalitions to fight to prevent climate change right 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 been pushing pushing for for mon ten years ago. successfully giving up companies. in terms of the private prisons, we made annvestment i thought about it, decided it was not the right thing to do and made a mistake and iso15 years before any of this political stuff came because i said that's not rea place w somebody should be making money, including us. it was a mistake to buyt, we

sold it and that was 15 or 17 years ago. but let me answer this last question, judy, which is awhy s thway to attack climate change? if you've seen thema c proposal that i put out about two weeks ago, it is the most aggressive climate proposal by far in this campaign. it talks about declaring a state of emergency the first day of my presidency, it talks about basically being animated by environmental justiceoing to most affected communities and getting their ideas of leadership to make sure the program works for them, and it talks abo start trying to lead an international coalition on day one, not the idea of signing back up for paris. of course, we'd sign back up for paris. thatar from enough. if you look at the numbers in climate -- and i would challenge these climate acttoists alk about how they're going to make at theact -- if you loo

numbers on climate, it is an emergency, the president should deal with it that way because we're talking abou the health and safety of every american, and we can't do it unless the global community comes along with us, unless we lead it and unless we've made the commitment to get our house in order. >> woodruff: tom steyer running for the democratic ucmination. thank you so >> judy, thank you so much for having me. oo >>uff: stay with us. coming up on the newshour: filmmaker ron howard reflects on his long career on both sides of the camera. and, el paso pays tribute to th youngest vic 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 costs down. it's now brought some of its ideas very close to america'snd shoress courting american

patients. special correspondent fred de sam lazaro reports.is it's part oferies "agents for change" and this week's "leading edge" segment, focusing on science and medicine. >> what we have here istw basically centimeter port cuat we use. >> reporter: witing edge imaging, robotics and other technology, surgeons like savitr sastri perform the most advanced procedures offered anywhere in the western hemisphere-- in this case a slipped disk fixed wit very little actual cutting >> it's minimally invasive. >> reporter: but this hospite al is not in s. or canada. it's in the british caribbean territory of grand cayman. and dr. sastri and the entire medical staff are from india-- employees of that countrs largest hospital chain. called heah city cayman islands, it is a new frontier for the for profit chain founded

19 years ago by dr. devi prasad shetty, an entrepreneur obsessed with efficient health care delivery. and technology. even here, on a brief visit toe ymans, he was never far from home base. >> first thido is to do the rounds in my hospita bangalore. >> reporter: from cayman. >> from cayman! >> reporter: with a new phone app being developed bhis company and microsoft he keeps tabs on patients, easily call up a record, or check a new x-ray, for instance. >> the x-ray technician touches a button in the i.c.u. of bangalore hospital. in less than a second, like i g id, it appears in my phone. >> reporter: workrom his sprawling bangalore headquarters, shetty has become a world-renowned and prolific cardiac surgeon. >> hole in the heart. >> reporter: ...doing two to three procedures a day and, as he told us in 2015, at very low cost. >> ts patient would have pai us about $2,500 to about $3,000,

but in the u.s., an operation of this nature would cost, i guess, more, anything from $70,000, $100,000. >> reporter: since then, dr shetty has sought to prove he can transfer his low-cost model to more expensive first world ttings, beginning with the cayman islands. >> cayman islands is a very unique place. and ideally located close to u.s. >> reporter: health city opened in 2014 and joint commission accredited, meaning it meets the highest global standards of care. yet its costs are 50 to5% lower than the u.s. among its competitive advantages: the abilitto buy in bulk. >> when we implant one of the largest number of heart valves in the wld, obviously, you pay for it less than others.>> eporter: they also pay a lot less for drugs. t >> how much cheaper is bring your drugs from indithan it would be in a market in this region?

>> it would be around 50 to 60% >> reporter: dr. boy chattuparambil is clinical director of the newly built hospital. >> reporter: he took us on a tour of the new facility- hisigned, he says, with both physicians and arccts at the drawing board. unlike most hospitals that buy oxygen from commercial sources, this one makes its own, one of several small steps that promise sangs. another huge cost savingpa: ent bills are simplified, ath a fixed bundled price that is disclosed whatient is first seen. >> we thank you. >> reporter: in the hallway, dr. parambil who is also chief of cardio-vascular surgery, ran into a patient's gratefu family. >> and all the arteries that were clogged, they're all cleared? >> all clear. >> reporter: leonie ebanks' husband, eddie, had suffered a

heart attack. his surgery included a double bypass, a tube grafted toe replrupturing aorta and repairing two leaking heart valves. >> it's quite a complex operation. >> how many hours did it take you to do that?rt >> repo: it took almost eight hours, ld in the u.s. would ea cost a half a million dollars, he says. here, the final bill was $110,000. if you had n been here, where would you normally have gone for that type of surgery? >> miami. >> reporte miami could have been a tough ride. >> could have been. thank god. >> reporter: but with 104 be, it's clear the health city project had plans to reach well beyondocal patients like eddie >> grand cayman is just a 90- minute flight away from the united states, a tropical paradise whose economy depends heavily on tourism and that's a big reason why the government here gave the indian hospital chain tax breaks and other incentives to locate a facility here.

american tourists would come now not just for the beach but for their hlthcare. so far, that hasn't happened. >> american patients stillth assume that here provided outside the u.s. are not as good at that you can get in the u.s. >> reporter: northeastern university business professor ravi ramamurti recently co- authored a book called "reverse innovation in healthcare" that studied theayman hospital. american tourists are everywhere, he says, jt the ones the hospital was lookingor-- older patients who need cardiac surgery, or knee or hip replacement, for instance. >> a lot of people in that generation w need this kind of care probably don't even have a passport. so the idea of going to aac strange to get an important medical procedure is something i think people want te avoid if can avoid it at all. >> reporter: for his part dr shetty says even at its current 40% occupancy, the hospital has staying power, treating caribbean, central american and even some canadian patients.

>> we've been profitable for quite some time, yes. >> reporter: eventually americans will come, he says. their insurers he predicts will begin to offer an offshor alternative with free travel and no copays. professor ramamurti doesn't see a competitive threat but says american providers could benefit froming the indian- caribbean upstart. >> we need to shake the healthcare industry in the u.s. i don't think it's going to happen by the arrival of with az single or uber that single handedly turns the industry upside down. you need a lot of people disrupting in little ways that add up to big change over a period of time. >> reporter: change th he says is urgently needed to slow cost increases in an industry that now accounts for 18% of the u.ss grational 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 hre grown up on en right before our eyes, now he's one of hollywood's leading dirertors and prs. earlier this summer, jeffery brown reported on howard's latest film pavarotti. a parol file director as part of our arts and culture series canvass. >> brown: the grand stairwa to have the metropolitan opera in new york, perhaps not the u'place expect to meet rdron howa. this isn't your world. >> not at all. >> brown: you didn't stop with pavarotti? >> brown: howd, now 65, has just made a docentary on the

life of opera great luciano pavarotti.e and t, it turned out, was just the place to talk about his long, varied and hugely successful career in show business. it began 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 hicomedies such as "splash", "cocoon", an"" parenthood." leading to film dramas includi""

apollo 13" in 1995, and "f"a beaumind", which won him an oscar for best director in 2001. when you look back nos it make sense? >> it makes complete sense. >> brown: it does? >> complete sense bealuse i wanted it. it wasn't somebody else's idea. it was my idea. >> brown: and you jknew. >>ell, it evolved. you know what i mean? so many of the directors on the andy griffith show had been actors and so they might just drop here and there: hey, i bet you want to be a director someday. my father directed a lot of theatr, no film. tched him him, i rehearsing. i could see what that process was and just like a ballplayer might one day want to mage or a basketball player might want to coach, i wadrawn to the >> brown: what is the key to dicting for you? >> partly directing for me istr ng to create an environment, not sst for the actors but alo for all of the key department

heads in the production. and then it's really a matter oe retation, understanding that story, beginning toki understand on of both macro and micro level what the elements are goingo be. octting together a film, television show, dentary, it's sort of like a mosaic. it's built in tiny little pieces, unlike a live performance, which is-- this i it. there's no going back.>> rown: and how much control or how loose is it? >> it depends on the moment. sometimes you want to be as relaxed and loose and carefree as you possibly can be. and other times you need to get everybody's focus >> brown: many stories have followed for howard, as both director and producer. imagine entertainment, theio productcompany started by howard and his friend brian grazer, is a film and tv powerhse, including the hits" arrested development."

several new projects are in production, including a sedocumentary on the para fire that devastated parts of northern california st year. for him, documentaries, howard says, are an exciting new way of storytelling. >> frankly i've always loved documentaries and i was a little ery, maybe fearful of sticking my toe in those w >> brown: you were fearful because what? >> it's a different discipline and if i'm going to do it and put my name on it and i wanted to believe i could put my best foot forward. d the good news to me was that i can actually use much more of my storytelling expeence and sensibility in the doc world than even expected i could. >> brown: one new scripted work is a dramatized version of" hillbilly elegy", the memr by j.d. vance about growing up in appalachia. the focus of attention

portrait of the white underclass that helped elect donald trump. there's a tendency to sort of dig in witwhat's familiar, hat you relate to the best and so forth, and, so if entertainment if entertainment can shed light on what it is that we have in common, i think that's useful. if it could shed light on a corner of society that people might have some questions about or curious abt in an interesting and engrossing, 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, 's company joined others 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 georgia. >> brown: at 65, ron howard continues to exhibit a youthful style and exuberance. for many americans, he knows, hr is forpie.in eflecting on his latest documentary subject, lui,ano pavarott 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 >> well, only with respect fo the medi ium. an, i think with pavarotti, he was charmi.

people loved working with him. thth really wanted to work him. i hope people feel that way about working with me. i bring a lot of j and excitement to the set with me because that's the way i feel. >> brown: you're 65, you've been at thia long time, right? >> 61 of those years. >> brown: 61 of 65, but you seem busi than ever. >> as a storyteller, it's almost like this buff. it's incredibly energizing to me. >> brown: ron howard, thank you very much. >> pleasure, thanks. >> woodruff: finally, tonight, we want to offer a differenthe look atrenching, emotional toll these mass shootings can take. willm brangham is back with that. >> brangham: that's rightndjudy. moay night in el paso, we went to the very first memorial for one of the victims of saturday's massacr his name is javier amir rodriguez.

he and his uncle were shopping at the wal-mart when the attacker entered the store. javier and shot.cle were both his uncle survived. at javier's memorial, held at the football stadium at horizon high school outside of el paso, friends and teachers remembered vier as a happy-go-lucky boy, a great soccer player, and a good friend. thlymemorial took a particul emotional turn when the local school superintendent, dr. juan martinez, spoke. here's a brief, editerpt of what he had to say: >> tonight, evenhough we are angry and mourn the death of a friend, our student, our son, we refuse to accept darkness as ouf closeend. darkness came from outside of our city and took javi away om us. but javier will remain 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. ex

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