saw the flags japanese no one will believe me ran back to the town bar ♪ keep your head up my love keep your head up my love keep your head up love head up love head up love ♪ head up love [ cheers and applause ]

tonight on "night line," operation paradise. imagine this. your boss sends you on an all expenses paid trip. you get free life-changing surgery and make 2500 bucks. with american health care up in the air, how do you make sure this is where you land? married to a murderer. he sent his own kids off with a kiss and hours later, opened fire in this amish classroom, killing five little girls. now for the first time his wife opens up in an exclusive interview about what happened. hell on wheels. a motorcycle group surrounds a family in an suv.

how things got so ugly and an encouraging update. >> keep it right here, america. nightline is back in just 60 >> keep it right here, america. nightline is back in just 60 seconds. "i'm terry mcauliffe, candidate for governor, and i sponsored this ad." these are birth control pills. more than half of ameran women use them at some point in their lives but ken cuccinelli sponsored a bill that could have made common forms of birth control illegal, including the pill. cuccinelli was one of only five senators to support this "potentially radical intrusion into domestic, family and individual decision-making" why is ken cuccinelli interfering in our private lives? he's focused on his own agenda. not us.

>> good evening and thanks for joining us. breaking news as the government officially shuts down at midnight for the first time in nearly two decades after a budget stand off over obama care. the president just released a message to the troops assuring them that they will remain on active duty. >> congress has not fulfilled its responsibility. it's failed to pass a budget. and as a result much of our government has now shut down until congress funds it again. >> washington d.c. alone now likely to lose around $200 million a day. growth expected to slow. but in just a few hours, the

affordable care act will still roll out as planned. love it or hate it, obama care won't change some fundamental issues. like some companies, giving employees the option to go abroad for cheaper medical care. already more than a million a year travel out for necessary procedures and there could be more now. could this become the new face of health care? >> this is my family. they're all going to the airport with me. i have everything. >> tonight joy, age 39, married mother of two, leaves on a journey. leaving north carolina to save her life and not kill her family savings. >> i'm going to miss my family a whole lot. so i'm scared. >> with a family history of diabetes and heart disease, she's going to the only place she can afford gastric bypass weight loss surgery.

her destination, costa rica. a tourist hot spot and booming in the business of medical tourism. for joy it will be an adventure of a lifetime. all of this paid for by her employer. >> i guess this is it. >> joining her on the trip is gary harwell, 65. >> i just want it to be over so he won't hurt so bad. >> your first plane ride. >> i know. i'm so excited. >> doing things well. >> with an annual salary of $28,000. even with insurance she couldn't afford the out of pocket expense. >> could you have afforded this procedure on your own?

>> no. >> gary's procedure worked but he was prepared to live with severe near pain. >> it is for me to get things taken care of. >> so it's that important to you to get things done? >> yeah. i feel like i'm slowing her down. and i'm slowing me down because i'm not able to do the things that i need to do. >> both did their research. gary and the doctor earned his medical degree and received additional training in the u.s. >> i ask this question respectfully. how does your training compare with an american physician? >> i don't want to be compared. i am just another option. >> they are a part of a growing wave of americans frustrating with the cost of health care. but here's what's new. their company back home in western carolina is paying the

entire bill. everything. four star resort hotel where they will stay for at least a week. and then there is the personal driver. a built in best friend, what's called a patient assistant along to fill out forms, answer questions including translation. and the love doesn't stop there. a private room in a private hospital with a pull out bed for guests and the pampering comes from the surgeon who offers reassurance in one of the many scheduled consultations. >> you have somebody here? >> no. >> don't worry. we will be your family here. >> it was enough to move joy to tears. in the u.s., gary's knee replacement would have cost more than $50,000. in costa rica, it's half that. back home, joy's surge is 30,000. here less than 18,000. in the u.s. they would have each

paid $3,000 out of pocket. in costa rica, nothing. their employers say it just makes economic sense. they have sent close to 200 employees abroad for surgery. >> the fact that you have decided to give your employees an option a chance to go abroad for health care, what does that say about the american health care system? >> the american health care system is broken at the moment. >> how? >> the error rates are probably the high nest the world. the cost is also the highest in the world. >> what will obama care mean, do you think, for medical tourism? increase it? decrease it? >> i think it will increase because companies will be looking to reduce costs. >> so you expect this surgery will change your quality of life? >> certainly. without a doubt. >> joy and gary could back out at any time. but they are going through with it. >> what have your friends said

about it? and that it's going to cost you nothing. >> you lucky dog. really? who do you work for? i wish that we was offered stuff like that. >> did you sleep much? >> yeah, as a matter of fact, i slept very well. >> day three. it is 4:55 a.m., way early in the morning and gary is headed to the hospital for his surgery. >> and waiting at the hospital door is gomez, gary's patient assistant. a kind of personal escort. his knee surgery will take nearly two hours. we noticed during gary's procedure that much of the equipment is actually made in the u.s. >> there were certain pieces of equipment that they were using and made in the united states but it was cheaper for them to

purchase in costa rica than here at home. we had two partial knee replacements. $90,000 for the two devices alo alone. that is probably $3,000 for those devices. >> so the economics you just couldn't ignore? >> no. >> after successful surgery, gary heads to recovery. about that time -- >> i am ready. joy shows up for a gastric sleeve surgery. that's where we heard another american voice. next to joy is fay holmes. she and her husband moved here in part because of the cheap quality health care here. >> you talk to friends in the states considering going abroad for surgery, what would you say? >> i say that's a really good idea. >> what were your thoughts? >> hell yeah.

her procedure also goes well. there is one more bonus. when the bandages come off, each will receive a check for at least $2500, a percentage of the money saved in insurance costs. that sounds like a win win for everybody. >> it is. it has to be. as i have said all along, it is kind of a no-brainer. >> the medical experts who are tracking the increasing number of americans now more than a million going abroad for medical procedures are concerned. >> the biggest risks are an inabltd to sue for medical malpractice risk of getting an infection. risk of a poorly performed procedure. >> daily visits from a private

nurse, access to free cell phone service to call home. >> even though it's for my health, that's my benefit. and the rest is to help us all. it's a wonderful thing. christmas is coming right around the corner. and so, it's all like a win-win situation to me. >> getting paid to go abroad for medical care is tough to compete with. thanks byron. for the latest on the shut down stay with abc news. good morning america will have full coverage in the morning. >> abc news night line brought to you by viagra. ♪ [ alarm sound for malfunctioning printer ] [ male announcer ] you've reached the age where you've learned a thing or two. [ metal clanks ] ♪

this is the age of knowing what you're made of. so why let erectile dysfunction get in your way? [ gears whirring ] talk to your doctor about viagra. 20 million men already have. ask your doctor if your heart is healthy enough for sex. do not take viagra if you take nitrates for chest pain; it may cause an unsafe drop in blood pressure. side effects include headache, flushing, upset stomach, and abnormal vision. to avoid long-term injury, seek immediate medical help for an erection lasting more than four hours. stop taking viagra and call your doctor right away if you experience a sudden decrease or loss in vision or hearing. [ cellphone beeps ] this is the age of taking action. viagra. talk to your doctor. [ male announcer ] maybe you've already heard what they're saying about the nissan altima. ♪ and we have to admit, that it's all true. but don't just take their word for it, check it out for yourself. the award-winning nissan altima. nissan. innovation that excites. now get a $179 per month lease on a 2013 nissan altima.

♪ you may have heard there's a new rinse that talks about protecting, even after eating and drinking. crest pro-health has always done that. it's clinically proven to fight plaque and gingivitis. rinsing with pro-health after brushing can take your oral health to a new level. now that's the new you need. right from the beginning i could really feel it changing something for the better. i know there's been an improvement. my pearly whites, they feel really good. [ male announcer ] go pro. with the brand you can trust, crest pro-health.

♪ [ male announcer ] more room in economy plus. more comfort, more of what you need. ♪ thahat's... built around you friendly. ♪

itd was a day like any other for marie. she dropped her kids off at the school bus with her husband and they went their separate ways. what he did next tortures her to this day. her high school sweetheart committed a mass murder at a school. what drove him to open fire on innocent children? for the first time marie is opening up about what she thinks happened that day. >> marie is still haunted by her last phone call with her first love. >> to hear the words from a man you have been married to for almost ten years and have him say i am not coming home, my brain was trying to prehend what

he could mean. >> just that morning everything seemed so routine. >> charlie walked down to the bus stop that morning. >> he told him that he loved them. >> did it seem unusual? >> looking back on it, it was definitely a distinct moment. >> now on the phone, suddenly she knew. >> i knew he was serious. he was telling me that it was too late. >> there has been another school shooting. >> too late for marine to stop the horror of that day. she had no idea he would take others as well.

it's been seven years since he stormed a one-room amish schoolhouse before he killed five and taking his own life. >> these victims were shot execution style in the head. >> marine, the one person who may have an answer to why this had to happen spoke with me for the first time. >> it's a question that everybody has from the outside looking in is why. >> what i heard from charlie is about the loss of our first daughter. and in some way he felt like he was getting back at the lord for the loss that we had sustained. >> that's not rational. >> that's not a rational reason. people make choices and they don't always make good choices. >> do you believe your husband was mentally ill? >> on that day he was absolutely mentally ill. i don't see how someone could do something like that and not be. >> but he planned it out?

>> it was suggested to me that all of those years with undealt with depression resulted in a psychotic break. >> what were the days and weeks leading up to the shooting. >> there was heaviness the weekend before. you say what were the signs and how did i mess them and how did i not see any of them coming? i knew how distant our hearts had been. >> this completely surpasses them. >> their innocence was gone. i was soaking in the moment of this could be the end of that sound. >> of laughter? >> of laughter.

and what if i never hear it again? >> did you struggle with the guilt of having your kids? >> i think the amish families spared me a lot of that. their concern for us. the way that they came so quickly to make sure that they're all right. all right. >> members of the amish community came to lift marie's guilty. >> i knew that was not coincidence. i couldn't hear the words that they were saying but i could see the exchange that was happening. i could see the way they laid their hands on my dad's shoulder. i could feel it. the forgiveness and concern. it said everything. >> at charlie's funeral, the amish formed a line to shield marie's family from the press,

sacrificing their tradition against having their photos taken. >> it was one of those moments during the week where my breath was taken away but not because of the evil, but because of love. >> maria started to pick up the pieces. their children from previous marriages not part of their own family. the greatest difficulty is reconciling that the man she loved was also a murder. >> tell me about the charlie you fell in love with. i loved the way he was so tender with them. to me that was a mark of somebody who had the potential to be a really good dad. >> what do you want people to know about charlie beyond what we know. >> it was almost like they were two entirely different people. the one i knew and loved and had

a family with. two completely different people. >> forgiving that man she didn't know. >> give charlie for him. i have to forgive him so that i can be whole. >> marie wrote a book, one light still shining. amy, thanks for that report. what's black and blue and dangerous all over and why are these guys heading right into it? i feel so alone. but you're not alone. i knew you'd come. like i could stay away. you know i can't do this without you.

you'll never have to. you're always there for me. shh! i'll get you a rental car. i could also use an umbrella. fall in love with progressive's claims service. fall in love with progressive's claims service. cheryl burke is cha-cha-ing in depend silhouette briefs for charity, to prove that with soft fabric and waistband, the best protection looks, fits, and feels just like underwear. get a free sample and try for yourself. help the gulf when we made recover and learn the gulf, bp from what happened so we could be a better, safer energy company. i can tell you - safety is at the heart of everything we do. we've added cutting-edge technology, like a new deepwater well cap and a state-of-the-art monitoring center, where experts watch over all drilling activity twenty-four-seven. and we're sharing what we've learned, so we can all produce energy more safely. our commitment has never been stronger.

then i read an article about a study that looked at the long term health benefits of taking multivitamins. they used centrum silver for the study... so i guess my wife was right. [ male announcer ] centrum. always your most complete.

>> tonight, a feed frenzy all about being broken. for anyone still not convinced that "breaking bad "has seeped

into the american psyche, the main character has been a proponent of the affordable care act. the law supporters claim white would have had far fewer expenses under obamacare while opponents aren't buying it saying the star doctors like white will be harder to use under the law. stunning video. a family in an suv targeted by a pack of motorcyclists in the middle of the day. they are stopped and then surrounded on a busy new york parkway. the driver makes an apparent attempt to escape but the cyclists go after him eventually dragging him from the car and beating him. >> how many people see water spouts and t