>> this week on "billoyers jonal." >> moyers: this week on e journal, tning point in ghanistan. >> either e united states committo this and really commits to it, or italks away. to me, the good news is least we are now cominto a head, we're at least coming tohat decision point. and that's a ctical decision that needs tbe made. >>oyers: and, the surprising w president of dartmouth is physician with a preription for heth care. >> in my view, the rocket science in health and healthre isow we deliver it. and unfortunately, theres not a single medic school that i kn of that actually teaches the devery of healthcare as one of the essential sciences. >> moyers: sy tuned.

captioning sponsored b public affai television >> moyers: welco to the urnal. that was one figing speech barack obama deliver wednesday night. plain spoken a clear, he spelled out details of h own plan for health ca reform, rallied hiside of the aisle, met his adversaries he-on, and

amed the partisan wrecking crew that ewed lies into the suer's heat. >> when any efforts to hp peoplen need are attacked as un-amecan; when facts and ason are thrown overboard an only timidity passesor wisdom, and can no longer even engage in civil conversation with each other over the things tt truly matter-- that that point we don merely lose our capacityo solve big challenges. we lose somethinessential about ourselves. >> moyers: it was higholitical drama thatould have pleased e two roosevelts. but spches are soon forgotten, and the atmosphere they eate dispelled, and the rhetoc, no matt how dramatic or efctive, challenged by reality. now comes the fit to the finish, and we'll st with the story as the weeks uold. bufirst, we turn to another big decision bearing dn on the president, what too in afghistan. a conflict americans cano longer put out of mind or ouof

sight. once again, weave been remied that war is not a video me. the photo of an american mine dying in afghanistanreated a contversy that threw the press into conflict th the pentagon and the young marine's famil and it threw tho of us in the press into conflict wi ourselve on aust 14, lance corporal joshua bernard w on patrol in afghanistan's helmand ovince. an associatepress photographer emdded in his unit. that's bernard tre, on patrol, shortly fore a taliban ambush. hit by a rocket-propeld grade, lance corpol bernard was mortally wounded. he died later in a hostal. the a. released the picture over the objections ofis family and defenseecretary robert gates, and itppeared in many newspapers d on websites. i can't even imagine how would feel if that were my son o grandson.

i do understand e reaction. i would wanto remember him the lastime i saw him alive, not bleeding to death in aoreign ace. for so intimate a matt as death to bece a public event can only add to the pain and grief. but as a journalt, i know that e reason americans tolerate wars along as we do is that most of us look thother way while others do the ffering in our stead. our soldiersave been fighting in afghanistan longer thane fought in the firsand second world wars combined,ut just try to remember the tis you've actual have seen one of our fallen there yet,ugust was the deadliest month for our troops in afghanistan since the u. retaliated there to deroy the bases from which terrorists d attack us. 51 amecans died in august; 44 in july. now eight yearin, the taliban is resurnt, despite the additional 16,0 u.s. troops, almost two-thirds of theountry

reportedly too dangerous fo humanitari agencies to deliver much need help. cilian casuaies this year have reached morthan a thousand, including suicide bombings and the so call llateral damage from air stkes. as "the economist magazi" noted lastonth, resentment againse karzai government, nato forces anwesterners in general is growing. "it seems clear," the gazine reported, "that the international efforto bring g.iny aiilfa" failin"il and t, consir is open letter to esident obama from so of the very same armchair warrio whose claim of expertise suorted president bush'secision to invade iraq. they were wrong then-- wng time and aga-- but their tragic errors haven't stped th from demanding that prident obama now escala the war in afghanistan. once again, eir enthusiasm for war is as great asheir distance from the actual battlefield. their lett lands as european

aders are calling for an international conference to assess the deterioting situation and the commander ouforces in afghanistan, general stanley mcchrystal delivers aeview to the white house. it's a report many belve sets the stage for an even grter exnsion of the war. but recently, the "mcclatc" news service reported that se top pentag officials fear that without a ear definition of our mission ere, further escalation will be in in. as a reaty check, with me now is o of the reporters on that story, recently rerned from afghanista ncy youssef is the chief pentagon corspondent for "mcclatchynews. she coverethe war in iraq for four years, includg two as baghdad reau chief. nancy youssef, welme to the journal. >> thankou. >> moyers:efore we get to afghistan, let me ask you about is photograph of a young marine who died. and tha.p. as you know circuled the picture, even thgh the parents and robert

gates, the sectary of defense, objected. what was your reaction to th? >> you know, when at photo came out, i talked ta friend of mine, she's a coloneln the my. she served in ir and many years ago, she'd lost her dauger, who was a toddler at the time to illness, so she could speak tot as a soldier and a parent. and she was real angry about the photo. shsaid, "no one has the right tell me what my last memory of my child should be." and it really stay with me. and so as i could have emphy for the familyand i felt a lot of pain, bause i can only imagine having that image ared in your mind. but m conflicted, because as a jonalist, and as someone who has to go out and sethis war day in a day out, it's hard to say that these ptos shouldn't be seen. in a way, i feel like the wa in iraq d afghanistan have been sanitized. and that photoas gruesome as it i captures the reality of war. it's ugly. and it's wt these troops are facingay in and day out. soi always... this is my

ultimate objectiven all of this is to maintain the humaty inhe coverage of war. and so, i'conflicted, because that parof me wants to preser the rights of that family. and athe same time, i want the general public tknow what's happening. >> moyers: does it get difcult for you to separate ur role as a journalist from your humanitarian impuls and instincts? >> yeah, but i think in way they have to be coected. i think e of the mistakes in iraq wasnd i think where "mcclatchy" d knight ridder anat that time, was able to distinguish itse, was to bring that humanity to the w. i think it's easto reduce people to numbers, 50 lled, 20 killed, ur troops killed. but it's the humanity th makes it, i think, aost relevant to the viewer, tohe reader. you kn, i remember a time we were covering the war in iq and my editor callede. he said, "how ma were killed?" and i said, "50." and i just said itike it was a number. and he said, "we, isn't that a lot, nancy?" and it occurred to me th i was losing my sense of wt really mattered.

it got more challenginand it doeset more challenging as those numbers rise to make people realize that these en't just stistics that they're people. d i think it's the most essential we can do as journalists. >> moyers: ayou talk i'm thinking about theime in '64 and '65 wh i was in president johnson's whithouse as we calated the war in vietnam. never saw a photograph of a dead or dying soldier. we talked abt body count and that still seed anesticized. thene started talking about body bags and thatecame more personal and disturbing, bute never real talked about individual solers or saw their death. >> what i thk the distinction vietnam had an impact on th nation, becae of the draft, because everybodcould be touched by it in some y. where when i go to iraq or ghanistan, i come back, and m always struck by how littl i feel t war not only in the united states, not only ong my iends, but in washington itlf. you don'feel the war. and i don'know what that feelinis supposed to be, but

you would think that you wou el the impact of engaging in two wars. and you don't feel it. it's so distant. 's so, almost academic. so, ybe humanitizing it or putting a na on it is the wrong way. there mu be some way to make people realize what th country's asked its serviceman. there's a solemn oatwe make wi the troops that we won't send them into w unless it's absolute necessary. wewn part of that decision. and so, in a wayas a jonalist, it bothers me when you don'feel that in the city, inhe nation's capital, where these decisions are beinmade. >> moys: what about at the pentagon? you spenyour days there, every week now. what's t sense there? do they grasp what happening to men like lance corpor bernar >> i don't know. you kn, when i go there again, it's so rtified because of security meares. during vietnam, ople would row blood on the steps, and you would feel the ang about the war. you know, people think othe pentagons this big place where war plans are de.

and it's really athe end of e day a place, it's a marketplace whe contracts and decisions are de. and it feels like an offe building. so, doou feel it? not particarly, because people have a different vange point. you know, it fee like at 4:00 the halls arempty. and i'm always st of disturbed by this. where isverybody? and again, don't know what 's supposed to feel like. bui know it shouldn't feel like ts. >> moyers: what about the soldrs you personally met in afghanistan? what do you thinthey might say about the photogra? whether to show it or t to show it? >> that's a good qstion. i think it depends on whyou ask. i think a lot of them uld be offended, because it'so persal. these are guys that ey were sittinnext to the day before. it's sething to them that's not for so of public consumption. it's gruesome, is graphic. it's somethinghat belongs to them andomething that they ha to deal with. but athe same time, i think many would want to s a public that's more engaged on what they're doing there. mo interested in what they're

doing ere. re aware of what they're bei asked to do. >> moys: is it clear to you whatur goals are there? >> well, the sectary lays it out the following way. he saythat because the taliban coerated and collaborated with al qaeda, the united statemust make sure that the talan's not allowed toeturn so that it therefore doesn't low al qaeda to return. i guess the estion that i have, d that hasn't really been answereis, that may have been true then, but wh is the relaonship between the taliban and al qaeda now? because if t premise of the strategy tt is that the taliban n't be allowed to return, becausthey'll provide nctuary for al qaeda, i want to underand what that relaonship is between those two, to determine if that,n ct, will really happen. for me, it's not cle yet. d it's a very hard question answer. because the word taliban, a way it doesn't meaanything anymore. moyers: who is the enemy? who are thessoldiers fighting? >> i don't know. i mean, they're fiting this nebulous group called th taban. and some of themre fighting men who are joining becausthey need mon. or because they've bn forced

or crced into fighting the ericans. so taliban are people who have no ties the ideological taliban at all, but arjust angry that occation forces, in their mind, are in their cotry. some are people who are ideologilly driven, who want an islamic staten afghanistan, who want to work with al qda. 's a very, varied enemy. and think that's what part of what makes a straty so hard and at makes it so difficult for the troops. because everyonehey're fiting could be a farmer the next day, uld be a local. therare no borders. thers no uniform. ere's no way to distinguish one fromhe other. so, think that's what makes it so hard. the taliban that iaw, and i was in kandahawere people who... >> moyers: that's the soutrn rt of the country right near the pakistan border. >> that'right. d it's one of the most important ovinces historically. and yogo there and the taliban ishis bullying organization that is a form of der that at least the afghans are miliar with. and they control the communi. the local governme that we've

establisd does not. the police chief, the taliba lice chief, lives in the cit the u.s. backed lice chief doesn't. he lives on base or lives in kandahar proper. and i'm talking about inhe princes. the local district lear who works on behf of the karzai government. it's tooangerous for him to live in the city. he lives on the base, or he ves in kandahar. so, it's a coerc, forced order. it's sorof the devil you know versus t devil you don't. >> moyers: and what about al qaeda? the guys w did attack us on 9/11. ere are they? and who e they now? >> the united states belies that the learship is in pakistan. but, you know, somhing i struggle with rsonally is what happs if the next attack is planned in somia or yemen or europewhere they've expanded have a presence there? what is the unit states responsehen? i sometimes worry that wre fighting the last war stead of the next one. ani think when you look at al qaeda and how it's sprea you art to wonder. they don't use a sctuary anymore. it's n an apartment and

internet access to start anning these attacks, and ho you defend against that? i don't ow. >> moyers: so, whado the generals whom you terviewed, the colonels and on do tell you remains our goal? >> you know, i ske to general mcchrystal when was there. and i ink more than anything, heants the opportunity to try this out. that if wee going to do it, let's do it. let's ally put our effort towards this. we think about thias... >> moyers: what doeshat mean? more tops? >> more oops. more time, more th anything else. that this isot something that cabe turned around in time for a political or an election cycle. he needs time more than ything el. moyers: you know, nancy, that's what e generals kept telling president johnsoin the earldays and at the peak of the escalati in vietnam. >> but, you know, we talk out afghanistan as an eight year wa but the truth is it's been eht separate indidual years of war. so, i think at's the... >> moyers: whas the distction? >> because we've ner gone after this in a real way. there was a strategy 200to 2003. and then wtried something else 2003 to 2005 and then iescalated and we tried mething else.

so, i thk if we... to me, i think wh general mcchrystal's really sayinis if we're going to do, let'so it. let's really do it. and think that's the disparity thatrom the military perspective they'll ll you we haven't really been gin the chance, because weere too busy in iq. so it's true argument. it's fair argument. that was an argument made the past. we need moreime. we need mo time. but i think for the mmanders on the ground, it feela bit of a rollercoaster. it went fromeing the just war, ring the campaign, and in th early days of e obama administration, to potential quagmire that we're t sure we want to sendore troops to. >> moyers: butow, obama's made it a, ote, "war of necessity". >> he's made it a waof necessity, but yet, there'a real debate aboubasic qutions on this war. this war of necessit what's happening now in washingn and all ese assessments. we're trying tanswer very basic questions,what is the goal? what is the sttegy? how do you implement the strategy?" so, even thougwe call it a war of necessity, i don't ink it's ever beetreated at a war of necessity, even now.

that debate isust starting, in ar eight of the war. it's eraordinary. >> moyers: things just sm to be going offhe rails there. is that your judent, too? i think... remember that president obama sent 21,000 re oops, and what happened was the united stateexpanded its reach. now, you ask the afghans, they'll say that when s. troops show , more problems showp for us. becae then the fight starts. >> moyers: ty're caught in the middle. >> that's right. then they are ught in the middle. i mean, when you go to afghanistan, the afgha are not tryi to work with karzai, embrace their new mocracy. they're trying to survive thin the confin of the district. they're manipulang the taliban, whicher local dirict leader or warlord in charge. they are not looking f some grand decratic process. at's not what's happening. so, when the u.s. trps show up, fr their perspective, it's more problems. no the united states will say, "this could get worse before they get betr, because we have to engage them in the fit." but i don't ink the afghans are on board witthat yet. i think ey feel like we... i can't ll you how many afghans said to me, "ion't want the

americans. i don't want the tiban. i just wanto be left alone." >> moyers: what arthey like these people who are caut in the ddle? i mean, you got to kw a lot of em. you wrote about th in your dispatches. what do they sayo you? >> you know, they'reired is what the sense i got more th anything els there's this renewed eort in the united states to eage in afghanista and they've en living with it for eighyears. we talk so much out the washington clock. and w the president... >> moyers: the whington clock? >> yea how they have 12 to 18 mons by the administration's eimates, the military doe to turn things around. i think the afghan clo is ticking lot faster. they're tired. ey're frustrated that this country has brought corrupt central government that don't serve their interes. ey're smart. they're say. and theyre trying to survive. yoknow, so many people tell me that afghanistan's not rdy for democracy. i would argu "look at the decracy that they've seen. who would ready for that?" and that's where theare. they. >> moyer what do you mean? what democracy he they seen? >> well,he democracy they've

seen is fromheir perspective a fraudulent eleion that's ought about a government that's me corrupt, in their view, than even the taban was. d by the way, they don't get any more basic serces. they have to pay a lotore in bribes to t basic things done. their rlords in some cases are more empowed under the system, not le. who wod want to democracy under that? i think have to think about how we've defined democry in their mis. 's really become about suival. >> moyers: i know fr reading that o forces are trying to do some good things tre. roads, schoo, they move into a villag get acquainted with the elrs, try to establish some bas of trust and credibility. and yet, tn, you know an attack during a dding party, i was reading e other day, will completely nege those good intentions, right? >> that's righ i was in zhari dtrict, which about 20 miles west of kandar. when the canadians fst came in, ey painted schools and th built new schools for the residents.

and yoknow what happened? the nato forces entually had destroy them, because the taliban tookhem over. so... >> moyers: what do youean the taliban ok them over? th suggest the taliban are far more sophisticated tn a lot of us thi. >> i don't think theneed to be sophiscated. they own everythin they own the terin. they know the terrain beer thannyone. all ey have to do is sort of bully their way in because wiout enough forces, how much security can yoreally prove that school. that'she thing. we've taed about this taliban as theve come up with a strategy. i don't think they rlly had to anything too complex. we have currently. there are 101,000 troopsu.s. and nato oops in afghanistan. it's an extraordinarily sml number for a coury of that si and that level of complexity to it. so, why build these schos if you can't establish secuty? it was a problemn iraq, too. they would brag out, "well, we puup this new school. we provided new electrical grid." and the xt day it would be, it would beombed. and afghanistan's in tt same ace. but afghanistan, think, will ta longer. it'sust a far more complex country.

and i'm not re that the united states is ready for at yet. or at leashas been readied for it y. it's gng to take years. >> moys: what's your greatest fear of what might happen the? >> younow, because i'm the pentagonorrespondent, someone said this to me thattayed with me forer. my biggest fear from t mitary perspective is that iraq doesn't fall apt quickly, t that... >> moyers: iraq? >> iraq. that iraq fallapart slowly. and that we fi ourselves in a ple where we're doing this withroops. that as we're slowly bringg down troops in iraq and slow building up in afghanist, we find ourlves in a really difficult tuation in both countries. >> moys: so, you fear we have to reengagin iraq? >> i fear that we're goi to find... don't know that the united stes will. mean, the status of forces agreemenmakes it very clear that the unid states is not going to engage. >> moyers: the iraqis nt us out. >> that's ght. >> moyers: the's a legal agreement to get out. >> that's right. but what happens whethe violence srts to escalate in iraq and starts escalate in afghanistan, and wre say, at 80,000 troops in both untries? what is the uned states role

at that pot? is the plato sit aside and do nothing? will the iraqi government stl feel tt way? depending on whathe violence is? that's wt keeps me up at ght. ishat fear of that point where the unitedtates finds itself engaged in both wars or least heavily mmitted to both and not quite out of onenot quite in the other. >> moyers: predent obama has said thaon the 24th of seember, as you indicate, he will setorth his strategy. do the officials you covert the pentag have a sense of ere his head is on this? >> you know, that's e fundamental oblem in all of this. you'll heathis. you might hear these pases about counteerrorism versus counterinsurgency. counterterrorism argues r a very narrow approach. we lve some drones there. leave a few troops there. we kp an eye on things and we atta when necessary. and in whington, that's sort of being ledy joe biden. and thenhe counterinsurgency argument is we do everythi. we build up a stable goverent so tt there's no room at all r the taliban to come back i weuild the economy.

we build bter governance. and on thicamp is, hillary clinton, general peteus, genel mcchrystal. and thproblem is nobody knows where obama is on that sperum. >> moyers: suppose he mmits to a long war. will the american people. do we have th kind of patience? >> i don't know anore because you see these pos come out and the majorityow don't think th war is worth fighting. i was thinkingbout it. 60ays ago, when general mcchrystal started the assessment, the political capital for this waras much, much higher. we hadn't had the healthare debatehe way it has. we hadt seen the kind of troop deaths that we h seen. and the political capil has diminished so quicy. at the minimum, neral mcchstal's arguing for a strategy to build uphe afghan forces to capacity that would costbout $3 billion a year. this is in a count that generates $800 millionf total revenue every year. so, at the minum, he's talking about committing the united

states and eope and nato to an indefinite financi commitment to afghanistan. how do you sl that in this rrent economic climate? i don't know how you dthat. >> moyers:nd in the last eight years, there's beeabout $32 billion of forei aid that's beenplashed across afghanistan. can you see any the effects of that? >> it's very, very mimal cause at the core it's curity. i mean, that same nuer, you'll hear talked out how much has reached e afghans. 's something ridiculously small. li $4 billion to $6 billion that actlly has reached the ground in afanistan. do youee it? not rely. u'll see it in pieces. you know, u'll see the ring ad, or a paved road of some kind there. or you'll see a new water system, or a new school,r a new crop buildup. but there's noing linking all ose things together. that's what's missing. so, it very piecemeal. soit's sort of like a mirage of a big pool of water ithe ddle of the desert. you know, you see and then it

sort of disappears, because doesn't have any real lo term impact >> moyers:ou're reporting depicts a ve dismal picture there. so does ery other bit of reporting i've seen, inclung the cor story a couple of wes ago of "the economist", which reaches a grim cclusion about the state ofhings there. but is there... i'm not lookg foa silver lining,ut for a reporter's assesent, is there any good news there? >> yeah, the good newss that the unit states is committed to it. the good news is thathe world thinks that this ia priority. the good news is tt there's now a newed effort and that thbest minds are on this and tryi to come up with a solution. and that.. >> moyers: the best and e brightest? >> i don't want to s... maybe. but to me, i think the queion at this point becomes eith the united stes commits to this and reallyommits to it. or it walks away. but this middle grou of sort of holding on isn't going work anymo. and that, to me, theood news is at least we areow coming to

head. we're at least comg to that decision point. and that's aritical decision th needs to be made. anto me, that's good news, becae at least it gives everybody inlved some sense of where this is gog. think that's something worth looking forward to because wh's been going on up until now is unacceptabl >> moyers: buteople say to me, you know, they're opposeto escalang the war. but they say, "h can we walk away from the people w joined th fight in no small part, because we've asked them to? >> right. and what happens ithe united stes and the coalition leaves? the taliban invariablyomes back. d there's the potential now for al qaeda to co back and we start it allver again. this is the prlem with afghanistan. you can't stay. you can't go. there are absolutes in this. and it this fine line that everybody's tryi to walk. are prepared for the risk that comes with aving and allong the taliban to come backn and potentially for that sanctuy to rise ain? and now you've got a pulation that's morangry and more powered in a very, very powerful and dangerous pt of the region. >> moyers: b you're going back. >> i have to go back.

you know... >> moyers: why do you ha to go back? >> because i'm the ptagon correspondent, and i think is really dangerous to dend on people in the peagon to tell you what's hapning on the ground. ere's no way to understand i otr than to go. and i'm not smarenough to just sortf read reports. i ha to feel it. i have to sml it and touch it d feel that fear in some way i ve to be in the humvee and feel the feaof not knowing what's going to happen or be in the car with e afghan with my afgh friends and feel what it's like to not knowf that coalitionoldier's going to kill u or not. ere's just no way for me to understand it. and the vantage int of washington, in some wa, doesn't matter. it just doesn't maer. at matters is what the troop ardoing. and you can't reicate anything going there. and really do love it. it's a beaiful country. i love the pple. i love hanng out with the troops. i lo understanding it. to me it's a great pvilege to ha a job where i can go to the ontlines and really see what happeng. it's a great way to make a living. >> mers: but just this week the "new yortimes" correspondent, farrell, s held

hostage. and as he and his urnalist friend, who in afghan interpreted fohim, was killed. he got away, but the ahan was killed. anjust this week, your collgue, who was in afghanistan,onathan landay of "mcctchy," was in a hostile action a in a perilous tuation. why do y put yourself in that? >> it'sort of like afghanistan, thelternative is far woe to me, which is to do nothing, which is toay noing. you know, i have a unie backound. my parents are from egt. d i'm, i'm raised muslim and feel like have something to say. i feel like i can walk thaline between what t local populations are feelin wh the military is feeling. and i don't walk in bldly. every time i go, i sort ofook at mhands and feet and say, "oh, i hope i comeack with all of these." i mean, i know what's invoed. i know those risks, d it's ound. i an, it's become personal, in a way. every y this week, i wake up, and the's a bombing. ani worry about my friends in afghistan. and my colleague whoits right across from me at rk is caught

inn ambush. ani think, "what can i do to sort of tell people out this? what people ve to know. they just ve to know." >> moys: so, since you know what you know, and since youay we havto know, where do we come down on showi the photograph? >> it's reallyard. because as i sd, you know, you can't lose your manity in war. and i feel for that faer. i can'imagine that image being foisted upon me ofy son in th position. i st can't imagine. but sometimes i feel le we as a blic need to be hit almost violently th the reality of wa and that's what thathoto does. so, m really conflicted about it. you kn? >> moyers:he reality of war is? >> it's ugly. it violent. it asks tremdous things of troops. and puts troops in incredible danger. and wes a country have put these troopsn that position. we he to know what that means. i want the waro be relevant. and i thk that was the intent behind it. the details of how it was handled maybe weren't be.

but think at the end of the day, that wathe goal. and it's an impoant goal. >> moyers: nancyoussef, thank you for being on theournal. d good luck to you. thank you. >> find out what ty are shootingt! i need to know exactly wt they were shootg at. >> when wathe last time we ok fire from that direction? >> moyers: if anyo understands the bichallenges when it comes to healthcare systems, notust a domestic but a wldwide scal it's the man you are about to meet. drjim yong kim is a physician and anthpologist who has combined thekills of both to become onef the most acclaimed visionaries in t field of global health. he world's troubles are your troues," that's what he urged the recent graating class of young doctors always to remember. that imperative has en the

inspiration fohis own work. as co-founr of the humanitarian grouppartners in health, and senior official with the world health organizati, jim yong kim has been a cruder against fectious diseases and an advocate f the poor among the forsen of the world in cities and villagesn haiti and peru to rwanda ansiberia. "u.s. news and world rort" said he one of america's 25 st leaders. "time magazine" named m one of the 100 st influential people in the world. the chair of three, that's righ three departments at harvaruniversity, dr. kim was a macarthur foundation gius whose efforts helpedo treat three million new hiaids patientsn developing countrs. by the way, he waslso the quarterback for s high school football team in mustine, wa. so why at 50 yrs of age is this world rowned scholar and physician leaving all that behind forhe hills of western new hashire? just a few days from now hwill be formally inaugurated as t

17th preside of dartmouth college. weome to the journal. >> moyers: welme to the journal. >> tnk you very much, bill. >> moyers: i am inde curious. you havepent the last 25 years of your lifeorking with the sickest anthe poorest people in the wor. and here youre, now about to sit in t corner office of a wealthy, elite school with fer than 6,000 undgraduate students. what in the world did yotell the search comttee? >> well, it was entirely unexpected. i waminding my own business, working with colleues who were interested iglobal health. but also colleaguein harvard business schooand the engineering departmentt m.i.t., to try to gure out how to make healthare programs in developing countries wormore fectively. dartuth came out of the blue and said"would you look at this job?" you know work with paul farmer, who was chronicledn the book "mountainbeyond untains," and he's one of my heroes and my closest iend in the world... >> moyers: great publi health.. >> great public health advate, made a lotf personal crifices in his life. ey call him the modern day albert schweitzer. but he is a person who wor

tilessly for the health of poor peoe. and i ha been very touched by the extent to which younpeople are motivad and moved by his lifetory. i think that there's always sense in young people thathey nt to do something great. i think there's a daer. a lot of youngeople don't think they can make difference. that's really what am at dartmouth to do. i'm there toell the young people, "loo a few committed souls can change the world the famous margaret mead le, you know, at, never doubt the capaci of a small group of committed souls to change th rld. in fact, that's e only thing that ever has. so i am there toive them that message. anyou know i'm not sure. i'm not sure if that will rk in my role as college presidt, but i'm gointo give it a shot. >> moyers: but you kw, you're coming with t the most popular message ght now, because you knowwhen you told those young doctors graduating from medil hool last may, "the world's troublesre your troubles." and th's the last thing many young people and old people erica want to hear right now becae we've got so many of our

owtroubles right here at home. >> right. well, i don't thk that i would exclude our troubl. for exampl one of the projects that i started jt before leaving harvard was a projec looking the health care of native americans in w mexico. so there are a lot of probms right here. you know, in my own ew, the life expectancy of nive americanin the united states is onef the really great moral criseshat we face. >> moyers: how so? >> well, the life exctancy is often very much lower than le expectancy in some othe developi countries that i work in, in the 40s and 50s in me mmunities. so the world's troles are right here as well. and i was just tantalized the notion of reaching bacinto the undergraate curriculum. and ying to think hard about wh would it take to train a group of young people,ho would leave the college energid, inspired, and really thinkg at there's no problem that they coun't tackle. >> and ihink that this is a good time to get them thinki abou look, you know, there's global warming. there's the crisis in e health care system the united states. there's global hlth problems. there's a lot ofuge problems

out there. what do you needo do to prepare yourselfor a meaningful life, tacing those kinds of problems? that'she question i'm going to ask them ery day, as college president. >> moyers: why are we lking out the american health care system as a crisis? what'srong with our health ca system? >> my own particul take on it is thai think for many, many years, we'veeen working under the fanty that if we come up with new drugs and new treatments, we'rdone. the restf the system will take care of itlf. in my view, throcket science in health and heth care is how we delivert. and unfortunately, tre's not a single medical school that knowf that actually teaches the delivery of health ce as one ofhe essential sciences in other wordswhat we've learned about orgazations is that it is verdifficult to get a complex organizaon, a group people, to work consistentl toward a gl. the business world, if you don't do it ll, the market gets r of you. you go out of business. but many hostals executing very poorly persist r a very, very long time. so my own view of it is th we

have to rethink ndamentally the kind of research wdo and the kind of peoplee educate, so that they'll think abouthe complexity of delivery as topic that we can take on an study and learn about as a science. >> moyers: what do youean, complexity of delivery? >> well,ust think about a singleatient. so a patient comes io the hospital. the's a judgment made the nute that patient walks into the emergency om about how sickhat person is. d then there are relays of information from the triag nurse to the physician, fromhe physiciato the other physician, who comes on the shif om them to the ward team, th takes overhat patient. there's so many st transfers of informati. you know, we hen't looked at that transfer of infmation the way at, for example, southwest airles has. aprently they do it better than any otherompany in the rld. >> moyers: computers >> no, they have taken siously thhuman science of how you transfer sime information from one person to thnext. and in medical school, a in the hospitals at i've worked in, we've done it ad hoc. sometimes we do well. sometimes we don do it well. but what we know ithat transfer of information is

critical. now to me,gain, that's the rocket science. that's the human rket science of how youake health care systems work well what we need now is a ole new cadre of people who undetand the science,ho really are committed to patient care. but th also think about how to makehose human systems work effeively. we've been calling it, pirationally, the science of heth care delivery. and weo it at dartmouth. 30 years ago, one of our gat faculty members, jack wennbe, started asking a prettsimple question. why ishere variation, for exple, in the number of children who get theironsils takeout, between one county in vermont versus another? cause one of his children wa in school one place. another ofis children were in the school in another ple. and in one place, almost everyonead their tonsils out. and in another place, most no one did. and of course, he fod that there happened tbe a doctor there o liked to take tonsils out d benefited from it. and he kept asking this qution, you know, outcome variation. he cald it the evaluative clinical sciences. and i think that's reallthe forerunner twhat we're talking

about in terms of e science of. >> moyers: fancy... >> .health care delivery. >> moyers: that's a ncy name. what ds it mean to the layman? >> it means how do youvaluate clinicalutcomes? how you understand variation in doctorspractices, for exampl and ultimately, how do y fix the proble? so t group at dartmouth stitute does all of that. weook at variation. yoknow, why is a medicare reimbursemt rate, you know, almost a third in the yo clinic are as opposed to miami? it's around 6,000 and arnd 15,000, huge difrentials. and they simply ask that question. that the dartmouth atlas, that looks at variationn health care expentures from one place to the other. and we keep aski the question. "why does is happen? why does this happen?" d we continue to do that resech. d then we find places that a spending a lot of money d not getting the outcomes that th want folks in the darouth institute have developed technues that borrow from industry, at borrow from, f example, the toyota production syst models, six sigma, these great management too, and try to bring them to the hospit. so not only we study the

problem and y to understand why there's variatn and why there's po outcomes in one place, but we also work ve hard in the nds of interventions that wilchange the tide i think that's the science o health care delivery. and that's what we're gointo really grow at dartmouth college. >> moyers: why have weeen so resistant to doing this? it sounds so sensible. >> wl, i've noticed over the ars that when it comes to ou most cherishedocial goals, not only do tolerate poor execution, sometimes we celebrate poor execuon. sometimes it's parof the culture. you know, ese folks are trying to solve this terrle problem. theyan't keep their books straight. they really don't knowhat they're tting. t hey don't asure anything. but they're on the right sid so that's okay. i think we're in a different time. >> moyers: so at can we learn, for our own health car purposes, from the partnerips you've spent the las25 years creating arod the world? >> o of the things that we've learned that community health workers, whi are really members of the communityho help people go through very fficult treatment regimens,

this can work anywhere. we've done it first in hti. then we did it in pe. d then in africa. but most remkably, we've also implemented that program in boston, and are w thinking of implementing it on theavajo reservation in new mexico. >> moyers:nd in essence, it means what? describe it me briefly. it means that for people wh are, say, taking h.i. medicaons that are very difficult, that they have take every day, that ty have to really be careful aut, with nutrition, et cete, that having someoneho just visits every day, justo make sure at you're taking your medicines and you'reoing okay, that h a huge payoff down the line iterms of overall outcomes, overall health outcomes. you knowwe found a group of patients living with.i.v. in boston, whare really falling through the cracks. and we implemented almost an identicaprogram in roxbury. and we've had real astounding results. thcost of their care has gone wn. and of course,hey're back and they're working, and they' productiveembers of society. and they're t landing in the emergency room, en their disease getsut of control. so we think at that's one of the lessons. buthere are many more that i

think can be directly plied to health ce in the united states. >>oyers: does president obama get it? did you tch his speech? >> did. >> moyers: what do you thi about it? >> well, i thoht as a speech, it was really stunni and maerful. he's a wonderful speak. but what was most intesting to me was the republican sponse afterwards. and w many things that they seem to agree on. wh do they agree on? one, everyonshould have health insurance. two we need toower cost. three, we need to maintain quality, that thexpenditures that right now, in heah care, escially public expenditures are unsustainable. but view of this goes back to what i said rlier. there's no simplsolution to this problem. i think we havto take very seriously that health care delivery is rocketcience. and we'vgot to bring the best anthe brightest to work on this proem. and the only wayo do that is to get more people thinking every day about it. ght now, the physicians who are running ese hospitals have never been trained. most of them have ner been trained inystem thinking, in

strategy, inanagement. and the aces where there are leaders. intermountain healthcare, ich president obama mentione is ruby a visionary leader named brent mes, who was a biostatistician and s been an expert on studying ocomes for a very lontime. so wheyou bring that kind of expertise to the runni of a hoital system, it gets better. >> moyers: one of the big disappointments to a lotf people is th the white house seems to he made a deal, reportedly has made a dealith the drug industry, not tuse the wer of the government to negoate lower drug prices, or through medicare and medicai now i know younow something about negotiating folower drug prices, en you were at the wod health organization, right? right. >> moyers: tl me about that. >> it's a very complated busine. if you lk at three diseases, the three major kiers, hiv, turculosis and malaria, the onlyisease for which we have really good drugs isiv. and it's very simple, becae there's a market in the ited ates and europe. so what know is that market

incentives to drive drug delivery are critical. we have to maintain them somehow, because if yodon't have market inntives, there are almo no malaria or berculosis patients, we have almost no new drug so somehowwe have to maintain the market incentives, f the phmaceutical industry to keep workin now ving said that, i've rked a lot with the drug compies to say, "okay, so make as much moy as you can on the hiv drs in the first world. we will work with yoto protect those rkets and protect your intellectual property. on the other hand, in ose areas where you make nmoney anywaywork with us to make those drugavailable." and they've donehat for h.i.v. drugs, in way that's really quite tounding. so somehow... you kn, this is a complicated issu 've got to make sure that th incentive for the ug companies to make new drugs is still there. but at the samtime, be reasonable about makinsure that people ve access to them. >> moyers: yeah, there was a strain of t.b., if... >> rht. >> moyers: ...understa the story, that could be cured ba drug, but the drug was s exnsive that poor people couldn't aord it in the

developing wor. and what did you do about th? >> what happen was, we looked at the cost these drugs and the drugs r a complete cure for a patient ling in a deloping world. when wstarted, was about $25,0. but what we later learnewas that the only reon they were so expensive is because they were oy sold in first-world countries. what we did was we got everyone who w interested in purchasing the drugs. we went to doctors whout borders. we wt to other health organitions and said, "can you help us get the indian and chine drug industry to start making tse drugs?" and they did it. w, the real key was at eli lilly ancompany, that was makingwo of the drugs, they came on board and id, "you know wha we're going to help you with this program. we don make any money off these drugs, they' off patent a long time ago. we're going to actually he you find manufturers in those countries th can make these drugs at lower cost." so i thi it's one of the greatest acts of corporate philthropy i've ever seen, eli lilly and company epping in on two drugs that they don't ke anmoney off anymore, helping

us to craft the overall reonse to drug-resistant tuberculis. we're not there yet. if there were market for tuberculosis drugsthen i think we'd have ts of new drugs. but because there's noone in the developed world, we're sll struggling. so those of us w have been really working, you know, a dato-day level to try to provide those drugs, we've learned a couple othings. one, intellectl property is important, but the dru compies, if you keep working with tm, they'll see that ere is a great philanthropic and humanitarian achievemes that they can claim r emselves, by helping to make them accessible. now we're not there yet. but you ow, the gates foundation, foexample, is working ve hard to fill the holes that the markeis not lling. you know, we're l... got our fingers crosd, hoping that bi and melinda gates will be suessful in getting us these new drugs and ccines. moyers: but when you see health fai where people so poor in is country go because they can't afforto have a toxic tooth pulled, w do you justy spending that much

effort and thamuch money in africa and haiti andouth america and otr places, when we havsuch desperate need in this country? and that's a qstion... >> right. >> moyers: ...i get lot. >> if you look at what wre doinin those developing untries... so for example, a of the efforts that we'rmaking in some of the poorest we're taki annual expenditures countries, what we're ing is we'rtaking annual expenditures on health carerom two or three dollars up to maybe $15, $20or $30. wheras in the united states, it's well over $7,00per person per year. so they're two verdifferent problems. both of them break my het. so in a countrwhere we're ending, on average, $7,000 p person per yr, we should be able to find aay to provide health care for evyone. and i think, we can do tha and think we can do that fairly quickly, if we put ou minds to it. the problems with health in e developi world, for example, drug-ristant tuberculosis. the majority of e cases of drug-resistant tuberculosiare among e foreign-born. so iis not a smart idea to think that tse kind of diseases arever there, and

wee immune from them. we're not, in fact. and you ow, with h1n1 and the other paemic flues, we are-- that has shown us mo than anything else-- i was at the world heal organization and involved in the very later stages of e response to the sars epidemic. boy, younow, there's no question that in terms of infectious deases and other health proems, we are one planet. >> moys: you are trained as an anthropogist too, as well as in medice. whato you think the eye of an anthropologist sees, tt a physician his or her own mighnot see? >> wel i think that in mecine, what we're trained to do is to look for patterns, build der out of great complexity, out of very sule gns and symptoms, and then have a plan wheryou can act. anthropogists are a little bit different, we don't often t on what we do. i'm sort of in the middle now. i do the ethnography, to t to get a sense of what the cuure is. you know, ifou want to know what anthrologists do, one of

my great pfessors, sally falk moore once said,t's very simple. you wa into a room and you say, "who are these people a at do they want?" so if you're consttly asking that question, over timeyou build up a sense ohow a particular sociasystem works. that's alws what we've done. ul farmer's also an anthropolost, we've done this together for man many years. at is it that we need to do actually change policy aroun h.i.v. treatment or drug restant t.b. treatment? and that anthropologal piece of it, lind to a physician's approach to solving a proble and putting a soluon on the tabl taking people through diffult times... that's been a very good combination for . >> mers: friends of mine and viewers who are anonous will write or say to me, you know, "moyers, don't bring us anmore bad ne. we don't want to see a more stving children in rwanda, si children in the congo or dying children in iti. if bill gates cat save them, there's nothing can do." what keeps y from getting depressed? >> well, again, .. for 25 ars, in working with partner

in health, we've really seen some tremends changes. i mean, in the central pteau of haiti, haiti suffers fromo many problems, inclung deforestation, poor health ce, poverty,ll these different kinds of proems, but in our one little are not only have we built a health re system that now sees almost t million patients a year, but the tre have come back. we just so of did this almost ixotic little project where kept planting trees. and the area arod our clinic looks most like the rainforest that it once was. so, in goingo those really diict situations, first of all, it does somhing to me, make..you know, it brings out a kind of mility that i don't feel unless i and see the most excruciatg thing in the face of the earth, whicho me is a mother who can't feeder chd. so having the perience of eing those things, i think i

does something to me aa personto my soul. but then iseeing the possibilitie the programs that can turn things around, th's the most inspiring thi that i' ever seen. >> moyers: where does is passion come from in you? i meanif an anthropologist walked ihere and said, "who is th person, where he's from?" what's the answer? >> well, i've been very fortunate. u know, my father came by himself, across thnorth korean rder when he was seventeen. and hasn't seehis brothers or sisters parents since then. and he died some time o, but never saw anof his relatives. my mother was a fugee, in war- torn korea. and was plucked,ecause she was a good student, to come to scarri college in tennessee. there have been so many accidents luck that have gotten me to this positi. >>oyers: where did you all come to om... >> so we first camto dallas, texas, where my father... y father had been a well-

tablished dentist in korea, but then had to do denl school alover again, because they didn't recnize korean degrees. so dals, texas, southern thodist university-- excuse me, baylor universit-- he did his deal degree... >> moyers: there's a big difference, e's methodist, one's baptist. >> i know. i know. ( lauger ) that's right. i couldn't get that wrong. so he got his dental degree om bayl dental school, and then we moved to small town in iowa, and grew up inowa. and even though, you know,e lid a very... a sheltered kind of existence, always kind of knew from my mother, whoagain, lived through war and th did her mast's with reinhold niebuhand paul tillich and these folks union theological seminary. >> moyers: t great theologians of the twentieth century. >> absolutely. it was one of e most exciting tellectual environments in t country at that time, in the 1950s. so we always h the sense from my mother that we shouldo mething great, that there ar great things to be de in the world. >>oyers: what does she say to you? whatoes she do with you? >> well, she wld read to u

the speechesf martin luther king in 19. she uld... she even gave me, at one point, i member reading booker t. washington whei was in gradechool. so i had the exposurto a lot of great thinkers. so s kept trying to convince us that, you know,e had a responsibility in the world. now my father was a ntist, one of the most praccal people on e face of the earth. when i came back from myirst semest at brown university, he picked me up at thairport and we were iving home. and i said to m, i said, "dad, i ink i'm going to study phosophy." so he slowly pulls h car over to t side of the road, looked back at me and says,look. when you finish your residcy, you can do anythinyou want." it was clear. if i wasoing to make it in this countrys an asian- americ, he said, "you're going to need a ill. you can do anying with that. you know, whatever youo after you have that skill okay. t i can't go to my grave," h basically said, "withoutnowing that youave some way of supporting yourself, if

everything else falls throh." >> moyers:ere you the only asian family in that ltle town? >> we were. >> moyers: what was that experienceike? >> well, we were comrtable, economically. but if you go to a mall, jusup the road, where theyon't know who you are, of urse, back in those days kung fu was the b exposure to asian culte. so you know, everyone would me up to and either be fearful or mocng. so racism was ere. but you know, i've come to underand that theacism that we felt was more le sort of indignant, it was was embarrassing. it wasn't e kind of racism at, in fact, that impacted, for example,frican-americans in the south in the '30s and '40s. it was different. i think i developed a sensivity for people who are marginalized and ocast. but i don't haveny illusions about me being an opprsed person. .. you know, my father was a dentist. my mother was a philosophe we loved ia hawkeye football, so we had a great time tre. >> moyers: i gave the

commencement at rtmouth a few years ago, and i discoved that roughl80% of the students there participate inarsity, club or interaive-- intramural sports. so my onlydvice i would give u is: don't go without a frisbee. >> well, i havto tell you, bi, i've already played with e women's volleyball team-- ayed volleyball in college-- i' already been out throwing the foball around with the football team, and that's e of the really gat perks of this job, these fantast young pele who are both athletes and studts. i happen to belie that athletics is a really imrtant rt of one's educational experience. sohat's really the fun part of a job. >> moyers: doctor m yong kim, thank you for being th me on the jourl, and good luck at dartmouth. >> tnk you, bill.

>> moys: that's it for the journal. don't forget tlog onto our webse at pbs.o. click on "bill moyers jourl" and you can learn more aboutr. jim yo kim and his pioneering workn education and global health. you'll also be able to obser the human st of war as seen through the eyes of some othe world's finest phojournalists. that's all at pbs.org. i'm bill moyers. see you next tim captioning sponsoredy public affrs television captioned by media acss group at wgbh access.wgbh.org