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Interview with Southern District of New York Former Federal Prosecutor and Cardozo School of Law Professor of Law Jessica Roth; Interview with "Courage in the People's House" Author Representative Joe Neguse (D-CO); Interview with Former U.S. Republican and "White Flag with Joe Walsh" Host Joe Walsh (R-IL); Interview with "The Overlooked Reason Our Health Care Systems Crushes Patients" Writer Chavi Eve Karkowsky. Aired 1p- 2p ET

Aired August 02, 2023 - 13:00:00   ET



CHRISTIANE AMANPOUR, CNN CHIEF INTERNATIONAL ANCHOR: Hello, everyone, and welcome to "Amanpour." Here's what is coming up.


JACK SMITH, SPECIAL COUNSEL FOR THE U.S. JUSTICE DEPARTMENT: And indictment was unsealed, charging Donald J. Trump with conspiring to defraud the

United States, conspiring to disenfranchise voters, and conspiring and attempting to obstruct an official proceeding.


AMANPOUR: The United States of America versus Donald J. Trump again. What happens now that the former president has been indicted for a third time.

This one for attempting to overturn the results of the 2020 election. We get the legal view with the former federal prosecutor Jessica Roth.

Then how Republicans are reacting to the news with former GOP congressman and presidential candidate Joe Walsh. And the democratic take with

Congressman Joe Neguse, who served as a prosecutor in the second impeachment trial of then-President Trump.

Also, ahead.



to clinician burnout, and I think it's going have to be addressed.


AMANPOUR: The overlooked reasons why the U.S. health care system crushes patients. Dr. Chavi Eve Karkowsky talks to Michel Martin about how

administrative burdens impacts health care.

Welcome to the program, everyone. I'm Christiane Amanpour in London.

That United States and the world reacts to perhaps the most important indictment in American history, it is against Donald Trump for trying to

overthrow the 2020 election. The Special Counsel, Jack Smith, laid four federal charges at his door, stating in a 45-page document that the former

president conspired to defraud the United States in his attempts to overturn that election, it ultimately led to the January 6th attacks.



January 6, 2021 was an unprecedented assault on the seat of American democracy. It is described in the indictment. It was fueled by lies. Lies

by the defendant, targeted at obstructing a bedrock function of the U.S. government, the nation's process of collecting, counting, and certifying

the results of the presidential election.


AMANPOUR: If convicted on all charges, Trump could face living out the rest of his life behind bars. He continues to deny any wrongdoing. And we are

going to be looking at this from all perspectives tonight. First on the legal side, joining me to make sense of all of this is Jessica Roth, a

former prosecutor with the Southern District of New York and a professor now of the Cardozo Law School.

Jessica Roth, welcome to the program. So, this is the third of these indictments. And yet, it is the most serious everyone is saying. Why so?

JESSICA ROTH, FORMER FEDERAL PROSECUTOR, SOUTHERN DISTRICT OF NEW YORK: I agree, these are the most serious charges we have seen to date against the

former president. They are serious because what they allege is a scheme with Trump at the center to overturn the results of the 2020 election,

deprive the American people of their right to have the votes legitimately counted. And to prevent the peaceful transfer of power.

Those are allegations that go to the heart of our democracy, and they describe a scheme that was ongoing over a period of months. So, well before

the events of January 6th itself that was multifaceted. It was built on lies that the former president told again and again about election fraud.

But it went well beyond his words.

What the indictment describes is an orchestrated scheme perpetrated in several states to have state officials delegitimizes the legitimate

electors who had been elected for Biden by the people of the state to substitute other electors, fake electors who would vote for Trump, and then

submit those to the U.S. Congress and then further the scheme also included efforts to directly pressure members of the U.S. Congress to accept those

false electors and efforts to pressure Vice President Pence to accept those false electors, or at a minimum, to delay the certification process.

So, it is a vast scheme and it goes to the heart of our democracy.


AMANPOUR: And, you know, I hear you saying scheme several times. And I'm interested in that word you use because the actual indictment and the words

of Jack Smith use conspiracy, conspiracy, conspiracy. And conspiracy is even more underworldy. It smacks of racketeering and all the rest. Do you

make a distinction between scheme and conspiracy?

ROTH: I don't, and that's important to point out. A scheme in a sense could describe the actions of one individual, although, usually, it does not with

something this complex. What is the hallmark of a conspiracy, which is the nub of three out of four of the charges, is that involves an agreement

between two or more people to achieve a common purpose. And so, that is at the heart of this case. And when I say scheme, I could be substituting the

word conspiracy.


ROTH: There are six conspirators named in this indictment, or I should say who are described in the indictment, although, they are not named, who were

key to the perpetration of the plan that I've alluded to.

AMANPOUR: So, you've obviously no doubt heard, because everybody's been listening to the reaction on both sides. The Trump people, the people who

are completely on his side are basically saying, this is just political. This is all about, you know, weaponizing of the Justice Department,

weaponizing the government.

And let me just read what it says. The response is, these un-American witch hunts will fail and President Trump will be re-elected to the White House

so he can save our country from the abuse, incompetence, and corruption that is running through the veins of our country at levels never seen


From a legal perspective, we just said that, you know, if he's convicted it could be 50 years or so on all charges, which is -- which would be the rest

of his natural life behind bars. What would you say, and I know this is political, but from the legal perspective to that kind of defense by the


ROTH: If anyone reads the indictment, and I hope that people will, it is impossible to come away with the conclusion that you just described that

this is political and unfounded as a prosecution. The indictment is detailed, it references contemporaneous notes by people who were in

communication with the former president, including Vice President Pence, about the pressure that the former president was pushing -- putting on him

to obstruct the certification of the legitimate electors.

It recounts in detail all of the actions taken by Mr. Trump and his co- conspirators to perpetrate the subversion of the election results. And it shows how he was told repeatedly by advisers, including the attorney

general of the United States, who he appointed and other top officials at the Department of Justice and in the White House Counsel's Office that the

theories that were being promoted as for why what he was trying to do was possible, that those theories were completely unfounded, he was told

repeatedly that he had lost the election.

And so again, if you look at the evidence, at least as presented in this indictment, and a grand jury found was supported by evidence to the

standard of probable cause, it's really impossible to come away with the conclusion that this is anything but a just prosecution founded in

evidence. That's very important for accountability and the rule of law in this country.

AMANPOUR: So, there's been a lot of speculation about what kind of defense he and his team could mount. And to CNN, to Kaitlan Collins, this is what

his main lawyer said about what they would come back with.


JOHN LAURO, TRUMP ATTORNEY: Our defense is going to be focusing on the fact that what we have now is an administration that has criminalized the free

speech and advocacy of a prior administration during the time that there's a political action going on.


AMANPOUR: So, freedom of speech. I mean, does that sound remotely possible under the framework?

ROTH: If the prosecution focused solely on statements that Mr. Trump had made, lies he told in public, then it would be a very different case and

there might well be a First Amendment defense. But that is not the basis for the charges here. The charges are based on conduct that Mr. Trump and

his co-conspirators allegedly engaged in to create these false slates of electors and have them substituted for the legitimate electors and also, to

exploit the violence of the capitol on January 6th, to increase the pressure on members of Congress and the vice president to accept the false

slates of electors. So, this is a case that is very much focused on conduct as opposed to solely speech.


The former president's speech is a critical part of the overall conspiracy because by saying the lies repeatedly about election fraud he helped create

the conditions in which people in the public might have accepted the notion that there would be these other slates of electors who had voted for Mr.

Trump. So, his speech is part of the evidence in the case. But he is not being charged for his statements but rather for the conduct.

AMANPOUR: And to the notion of a speedy trial, there are many who have objected to the pace of the appointment of the Special Counsel, of Jack

Smith, and he said that he wants a speedy trial. Well, the Trump people say, well, what does that mean? You just want to throw a trial out, you

know, in the middle of my election campaign, where I'm leading the polls. You could've done it a couple of years ago. Why now?

ROTH: Well, I do you think that it is going to be a challenge to get this case to trial before the election. My suspicion is that the Special Counsel

charged only Mr. Trump in this indictment, notwithstanding having identified other co-conspirators in order to maximize the chances that this

could be brought to a trial in the most expeditious fashion.

Mr. Trump will, I believe, argue that he needs more time in order to re- litigate certain issues like whether there was election fraud. His attorney also had suggested in his remarks yesterday that that was something that

they wanted to pursue.

I suspect that the judge presiding over the case may well say the question of whether there was election fraud has been litigated repeatedly in the

state courts and it has been found repeatedly by those courts that there was no fraud. So, there's no need to allow Mr. Trump and his lawyers in

this case to pursue those issues again.

If the judge were to take that position, then I don't see a reason why this needs to be a delayed any longer than the timeframe that the Special

Counsel is likely to propose. There will be many witnesses in this case that. It is a complex case. And so, it will take a good deal of time to

try. But I don't see any reason why it needs to be prolonged indefinitely, or certainly past the election to re-litigate issues of election fraud, nor

frankly, is there a basis for saying that because it was delayed this point that it needs to be delayed further.

AMANPOUR: Jessica Roth, as you know, also their side, the Trump side says, that there is no way in this earth that Donald Trump can get a fair trial

in Washington, D.C. They've called it the swamp from the beginning. They say that, you know, overwhelmingly, it votes Democrat, it vote for Hillary

Clinton, the judge in charge was apparently appointed by President Obama. She herself as spoken out frequently against what happened in 2020, the

election. And she said, presidents are not kings, and plaintiffs is not president.

Do you think that they will have any luck or traction, his team, in saying that this is -- the decks are stacked against us?

ROTH: I don't think they will. The presumption is that trials occur in the location, in the venue and the district where the events in question

occurred. And here, that is the District of Columbia. It is rare to transfer a case out of a venue where the events occurred. The key will be

whether or not a jury can be found of people who can be fair and impartial to both sides in trying this case. And even in other cases of extraordinary

public importance, judges have been able to find jurors who meet that standard.

With respect to the judge, she does have familiarity with events of January 6th. She has sentenced individuals who are committed convicted of crimes

related to January 6th riot. She has used stern words in those sentencings. From what I have seen, I don't see anything that suggests a reason why she

would need to be recused from this case.

AMANPOUR: Jessica Roth, thank you very much indeed.

Now, joining me for more on this from the Democrat side is Congressman Joe Neguse. He served as house manager for the second congressional impeachment

of Trump over the January 6th attack. The congressman is also an author and his new book "Courage in The People's House" is out now.

So, Congressman Neguse, welcome to the program. I mean, I guess, you know, having been house managers during impeachment, I guess I first need your

reaction from yourself and from the party on this very, very serious indictment.


REP. JOE NEGUSE (D-CO), AUTHOR, "COURAGE IN THE PEOPLE'S HOUSE": Well, it's good to be with you, Christiane. Good evening and thank you for having me


I can only speak for myself, certainly my reaction is that it is a solemn day, it has been a solemn 24 hours for the country. The charges that the

grand jury ultimately issued in the indictment are very serious, serious crimes. The facts that are in the indictment as stated by the Special

Counsel go to the heart of our form of government here in the United States of America as a constitutional republic and the bedrock principle of the

peaceful transfer of power, which as you know, was at the center of the impeachment trial two years ago in the United States Senate.

So, look, I think it's important for the criminal justice process to play out without any kind of political interference by any parties, the former

president is entitled to the presumption of innocence under our laws. He's entitled to due process of law and a fair trial. So, I think that we need

to let the indictment speak for itself and I encourage, you know, folks to read the indictment and the various facts that are alleged therein. And I

will certainly be following the case as it proceeds.

AMANPOUR: You mentioned, you know, two years ago and the -- that impeachment trial over which you presided in the House, before sending onto

the Senate, which you just mentioned, you delivered an impassioned speech. And we're just going to play a little bit of that.


NEGUSE: We humbly, humbly ask you to convict President Trump for the crime for which he is overwhelmingly guilty of. Because if you don't, if we

pretend this didn't happen, or worse, if we let it go unanswered, who is to say it won't happen again.


AMANPOUR: So, of course, as we know, he was not convicted by the Senate. Now, he is basically contending with the federal justice system. Is this

accountability for you?

NEGUSE: Well, I'd say a couple of things, Christiane. First and foremost, it's important contextually remember that although he wasn't convicted

during the impeachment trial and, of course, you just played the closing speeches of that trial, it was the most bipartisan vote for conviction in

the history of the United States as far as impeachments go. 57 senators, including seven Republicans who ultimately chose country over party and

voted to convict.

Now, as you also know, and I understand that there are many who -- or some rather who are criticizing the grand jury or the Special Counsel and their

collective actions in this instance, what I would say -- or rather point folks to is the statements made by the Republican minority leader of the

United States Senate, Mitch McConnell, who just moments after I deliver that speech and the verdict was ultimately rendered, said in a floor speech

that he believed that President Trump was practically and morally responsible for provoking the events of that day, and of course, stated the

understanding here in the United States that is long governed our constitutional system, which is that former presidents are not insulated or

immune from legal liability from the criminal justice system or from civil liability. Again, those are the words of former Republican -- or rather

current Republican senate minority leader, Mitch McConnell.

And so, again, from my perspective, the decisions made by the Special Counsel are decisions that he and the grand jury will, of course, defend

during the course of this particular case. And I'm not going to opine about, you know, the nature of the charges --


NEGUSE: -- that he is alleged, beyond simply saying that they are very serious. And again, they go to the heart of our democracy.

AMANPOUR: And we will be digging further into this from the Republican side with our next guest. But first, we mentioned that you are the author of a

new book. Preparing for that second impeachment, you dove into history, and you realize that there are so many important congress people who Americans

know nothing about. And you wrote "Courage in the people's House," which so many have criticized today for actually, you know, there not being enough

courage, certainly in some quarters of the people's house.

Why do you think, and who do you want most want to profile and talk about right now? Why do you think there's this lack of knowledge?

NEGUSE: I think there are a number of different reasons. And you articulated well the -- kind of the reasoning, the impetus for why I

decided to write this book. You know, from my perspective, it can be easy in this current political environment to develop kind of a skepticism, a

cynicism about our ability to solve big problems and address big challenges, the rancorous and the kind of vitriolic political environment

that we find ourselves in and that's, of course, a scene, you know, on full display often in the House Representatives where I serve, colloquially

referred to as the people's house.

And I think it is important for us to push back into that temptation. And the best way to do that is to remind us of our best examples. Ordinary

Americans who did extraordinary things in service of their country, their constituents, and the constitution.


And so, I, you know, detail profiles of nine particular members of Congress, men and women of both political parties, from all walks of life

who over the last century, you know, in my view, served courageously here in the United States, in the people's house.

In terms of why we might not necessarily have that knowledge or perhaps folks don't know as much about these individuals, I think there is a bit of

a historical bias, you know, as far as scholarship goes for the presidency, the Supreme Court, the United States Senate, of course, and, you know, the

larger-than-life characters and individuals that have served in those various units of our government. And very little attention has been paid to

the people's house, which as James Madison and other framers of our constitution often said is the branch of government closest to the people.


NEGUSE: So, I thought that this would be a value and perhaps giving readers, Americans, folks across the world a sense of hope and optimism

about all that I think we can --

AMANPOUR: And many of their stories are incredible. You focus on a lot of black congress people, for instance Joseph Rainey, he was born enslaved, he

became the first black man to serve in the House. That was around 1870. You are the first black congressman to represent Colorado.

But Representative Barbara Jordan also is the topic of your last chapter, a very prominent black female in Congress, and she had what many say is one

of the great speeches of the history of the Congress during the impeachment into Richard Nixon in 1974. Let's just listen to what she said.


FMR. REP. BARBARA JORDAN, (D-TX): And hyperbole would not be fictional and I would not overstate the solemness that I feel right now. My faith in the

constitution is whole, it is complete, it is total. And I am not going to sit here and be an idle spectator to the diminution, the subversion, the

destruction of the constitution.


AMANPOUR: So, that was 50 years ago, about. She -- it could have been said today, given the circumstances. What do you draw from the speech about --

you know, as you sit in Congress today?

NEGUSE: Yes. Well, listening to her words -- and thank you for playing that clip, Christiane. I mean, her speech inspired so many and her words ring

true today. I came across that speech during the preparations for the first impeachment proceedings of the former president in 2019, during the

Judiciary Committee's investigation and ultimately, our vote on the impeachment articles, and her speech was considered a north star of sorts

in terms of how to articulate very weighty and complex constitutional subjects. In this case, this constitutional standard for impeachment.

I think that, you know, her -- as I said, her words, her -- the passion with which she says those words, her faith in the constitution being hole

and complete, I certainly share her sentiments today. The United States has been tested many times during the course of the last two centuries. But on

each occasion, we have ultimately risen to the occasion.

AMANPOUR: Yes. So --

NEGUSE: And that fidelity to our constitutional principles is something, I think, we need to hold dear to. And of course, following Barbara Jordan's

example and the examples of any members of Congress from my profile.

AMANPOUR: Right. It's really fascinating a look back in history. I want to ask you a today political question, and that is the black vote has

systematically helped Democrats, certainly propel them to the presidency. And we know it was South Carolina that, you know, really changed the

trajectory of Candidate Biden's election last time around.

Now, Democrats apparently worry that the black vote won't turn out for him in 2024. Do you share that work and what needs to be done by the president

between now and election day?

NEGUSE: I am confident that African American voters, as well as, you know, voters of all races here in the United States will ultimately support

President Biden and Vice President Harris's reelection, and that's because of the work that we have done over the course of the last three years to

deliver for the American people.

As you know, this is reflected in the empirical data that continues to come out on a weekly basis in terms of the economic growth that our country is

experiencing, the lowest unemployment in literally over half a century, including the lowest unemployment rate for black Americans, Hispanic

Americans, again Americans of all races and all creeds.


NEGUSE: Incredible job growth. The work that we're doing --


NEGUSE: -- to lower costs, to invest in our infrastructure. We've got a great story to tell in terms of the work that we have done to improve the

lives of everyday Americans.


NEGUSE: And so, I certainly look forward to talking about that work over the course of the next year and a half into the next presidential election.


NEGUSE: And I suspect that the American people will agree.

AMANPOUR: Congressman Neguse, thank you so much indeed for joining us.


Now, let us see how the Republican Party is responding to the indictment against Donald Trump. His rivals for the presidential nominee are split on

these charges. Some, like the Florida governor, Ron DeSantis, accusing the special prosecutor of "the weaponization of the federal government." He

claims, "Washington, D.C. is a swamp and it is unfair to have to stand trial before a jury that is reflective of the swamp mentality."

But Trump's vice president, Mike Pence, refuses to back his former boss saying, the indictment serves as an important reminder, anyone who puts

himself over the constitution should never be president of the United States.

So, what will Trump's legal jeopardy mean for the Republican Party and his own presidential ambitions? Let's get the details with the former GOP

congressman, Joe Walsh, who voted for Trump in 2016, grew disillusioned with him in office, broke with him and even ran against him for the

Republican nomination in 2020.

Joe Walsh, welcome to the program where you are in Washington. I will get to the whole swamp and fair or unfair in a moment. But first, you know,

obviously, you are not a Trumper. What do you make of this incredibly serious indictment and what it says about your party, frankly?

FMR. REP. JOE WALSH (R-IL), HOST, "WHITE FLAG WITH JOE WALSH": Christiane, good to be with you. It says that my former political party is a cult. I'm

not the only one who has said that. But it says that my former political party, the voters in that party, Christiane, are completely radicalized.

I can't emphasize this enough because I speak to Republican voters every day, because as you rightly recognize, I come from the base. And to them,

he can do no wrong. I mean, he can do no wrong. They cross that bridge a while ago. They consider him to be a victim. So, every new charge and every

new indictment only strengthens him. This will lock up the nomination for him.

AMANPOUR: You said and you tweeted today, personally, this is a good day, this is a happy day, this is a day to celebrate justice. So, clearly you

are happy. You believe what you tweeted. Do you think that justice will be done as you think it should be?

WALSH: I don't know. Look, this is really, really serious and I think we've become so numb to help that Trump's. Two and a half years ago, you know, he

tried to end our democracy. The first sitting president in American history who lost an election and tried to halt the peaceful transfer of power.

That's off the charts serious.

I think he belongs in jail. He deserves his day in court. But my God, thank God he was indicted. It's not a tragic day. It shows that this country can

hold even ex-presidents accountable for what they do.

AMANPOUR: Congressman Joe Walsh, you tweeted, maybe it wasn't today, but it's been in the past over this drama, using an expletive, calling him a

traitor and that he had committed treason. How do you -- I mean, how a traitor?

WALSH: Oh, boy, Christiane, I so believe this. He -- again, he tried to and our democracy. He refused to accept the will of the people. He refused to

accept an election loss. You know that elections are the heartbeat of a democracy. 80 percent of my former political party does not believe Joe

Biden won fair and square. That is all because Donald Trump lied about that election. He attacked our country. That's an attack on our democracy. If

that is not the act of a traitor, I don't know what is. Is it formally treason? No. But informally, it is a traitorous act what he did.

AMANPOUR: So, I want to ask, given what you are saying and given the very serious wording and nature of the charges in that 45-page indictment. When

somebody like Ron DeSantis, the sitting governor of Florida, talks about, you know, this weaponization of the federal government, is the reason for

the politicization of the rule of law, the divisions in the country, Tim Scott saying, what we see today, two different tracks of justice. One for

political opponents, another for son of the current president.

You know, it's not just people who -- as you call, a cult followers of Donald Trump. It is the established leaders who are running for the highest

office in the land who also believe this stuff. In fact, Pence, his vice president, is the -- and obviously Chris Christie, are the only ones who

have really come down very hard, and Asa Hutchinson too.


WALSH: Well because the reality on -- in -- on the ground is, this is Trump's party. I make no bones about it. There is no room in this party for

me or Liz Cheney or Adam Kinzinger. There is no room in this party for anyone who publicly opposes Trump. In the nomination fight to become the

nominee next year, there's only one lane, that is the Trumpy lane. And Trump is in that lane, Ron DeSantis is trying to be that lane. There's no

other lane.

So, if you came out against Donald Trump on this indictment, you have no shot at the nomination and you are done as a Republican. I like what Chris

Christie is saying, but Chris Christie knows he has zero constituency in this party. The only ones who kind of do are DeSantis, Scott Haley, really,

and they -- Christiane, they're not trying to beat Trump, which is why they are embracing him. They're hoping that a heart attack or the justice

system, something will take Trump out, and they can be the last man or woman standing there.

AMANPOUR: Oh, gosh. You know a lot of people obviously want to know, he's - - it looks like he is clearly, barring what you just said, going to get the nomination.


AMANPOUR: But will he be president? Will he get another term? Many people around the world want to know that and its cause of great concern for many

of the reasons you have outlined. So, I want to know from you, the first few indictments, the first two, seem to give a spike in his popularity, in

his polls and in his fund raising. It's said that this one is not having a similar effect today yet.

Do you think that it will or do you think that cult or no cult this seriousness will be reflected amongst the Republican voters?

WALSH: Well, Christiane, I have a contrarian view here. I think this serious indictment will boost him even more among Republican voters because

it fits their narrative of Trump as the victim of the deep state going after him. This fits that narrative perfectly. I think the indictment in

August down in Georgia that's coming will strengthen him even more.

And I really -- look, I think the nomination is his and I think that the world needs to understand that one of our two major political parties is

fully radicalized. That is why the rest of the world that never heard has a real difficult time understanding this. But the other warning is Donald

Trump has a really good chance of being elected again. And the country and the world needs to wrap their arms around that.

AMANPOUR: Well, I can assure you from all of the conversations we have on this program that that possibility, that worry is very foremost in the

minds of many people around the world.

Do you think that -- you know, you said that his voters, his cult followers see him as a victim and see him embodying, I guess, what they think is

their own victimhood. So, when people talk about the swamp in Washington and it's unable, you know, the deep state to get a fair trial, et cetera,

do you think that's going to be a winning -- another winning political message?

WALSH: Sadly, I do. And what really concerns me, Christiane, is I have heard from independents and Republicans last night and today who are not

Donald Trump hard-core supporters, and even they are telling me that, Joe, this really seems like the Justice Department is piling on, it seems like

the Justice Department is trying to put their thumbs on the results of the 2024 election. My worry is that Trump will be able to use that, that the

Justice Department is interfering in this upcoming election to his advantage.


WALSH: And I think that will really resonate with people.

AMANPOUR: Well, certainly, the -- you know, the organ of choice, being Fox News and Newsmax and the others, are saying that kind. Here's what they

just said after the indictment. Let's listen.


SEAN HANNITY, FOX NEWS HOST: Are we now living in America where equal justice is dead? The equal application of our laws is a thing of the past?

That where -- the shredding of our constitution, we are witnessing this in real-time in front of our own eyes?

JESSE WATTERS, FOX NEWS HOST: This is only the beginning of politicians putting other politicians and their families in prison. It's sad we had to

go down this road, but this is where we are and now, we have to finish it.



AMANPOUR: So, I guess the question to you, and we asked, you know, the legal expert, Former Prosecutor Jessica Roth, what is the alternative? You

know, you say -- these people have said, you know, it looks like piling on. What is the alternative?

WALSH: Christiane, that's such a great, smart question? There was no alternative. Nobody is above the law. He committed crimes, he tried to end

our democracy. But, you know, the magic of Trump is -- and I had advisers during his presidency tell me this, he -- every day he says and does so

many bad things that you become numb to it all. And I think that is where we are now.

There are going to be four indictments and a lot of Americans are just going to roll their eyes at the whole thing and say, this is crazy, it

doesn't feel right, it doesn't feel fair, but there was no alternative. He had to be held accountable. And now, it is up to the rest of the country to

make sure that guy isn't in the White House again.


WALSH: It's a political solution now.

AMANPOUR: OK. So, the next political, I guess, performance is going to be the first of the presidential debates, right, the nominating debates. And

we will see who gets onto the stage. But do you think absent -- I guess, maybe Pence, maybe a couple of the others if they get the -- you know, the

-- whatever it is, the number of percentages that they can get onto the stage. Do you think they will use that platform to do what you are saying,

you know, to hold him accountable in public?

WALSH: No, no. And I don't think Trump will be there. But to do that, Christiane, in today's Republican Party is a career killer. So, again, I

expect Chris Christie who will be onstage to do that, but he does -- he is doing something different here. He knows he can't win.


WALSH: Pence, Scott, Haley and DeSantis still believe that they can so they will embrace Trump and go after the deep state.

AMANPOUR: All right. Gosh. Thank you so much, Congressman, for joining us. Thank you, Joe Walsh.

Health care in America is not yet a big election issue despite patients facing many hardships. Dr. Chavi Eve Karkowsky is a maternal fetal

physician and she has written an article that details the false that she is found in the system. She joins Michel Martin to discuss how red tape

complicates access to care and also endangers lives.


MICHEL MARTIN, CONTRIBUTOR: Dr. Karkowsky, thank you so much for joining us.


MARTIN: You wrote a page for "The New York Times," an op-ed piece, about the administrative burden that Americans experience in the U.S. health care

system. Now, that's kind of a formal way of talking about what we are talking about. But we're talking about paperwork, right? Is that what we

are talking about here?

DR. KARKOWSKY: I think we are talking about paperwork, but everything in medicine is also boring and also heartbreak, right? So, we are talking

about paperwork, but we're also talking about human suffering.

MARTIN: You open the peace with a scenario that just is -- just terrifying and heartbreaking, and encouraging in some ways. So, as briefly as you can,

would you just tell us how you opened the piece for people who haven't had a chance to read it?

DR. KARKOWSKY: Sure. I started the piece with the story from several years ago. I am a high-risk obstetrician, a maternal fetal medicine specialist. I

was in the hospital working a shift on labor and delivery, and I was called emergently to our triage unit, just our small emergency room that we have

for pregnant patients.

And there, I found a patient who was about 20 weeks pregnant. She had a very high fever and she wasn't breathing well. And the story that she told

me was that she had started to have symptoms of urinary tract infection, which is very common in general but is very, very common in pregnancy. She

had gone to her doctor and gotten a prescription, but when she went to the pharmacy, they wouldn't fill it.

Then, she wasn't very clear on why, whether there was a trouble with payment or identification, but she just didn't her medicine. And over the

next few days she started get progressively sicker. Back pain, started to contract and she eventually called 911 when she became short of breath.

When she came to see us, we very quickly were concerned about a kidney infection, which is something that happens if you have an untreated UTI.

And also, can lead to preterm labor or even respiratory distress, breathing difficulty if it's really uncontrolled.

MARTIN: So, then, what happens is people rush in, they focus all their attention, you know, years of training and expertise and dedication to

saving this patient's life, but you juxtapose with -- what -- how much would that antibiotic have cost?


DR. KARKOWSKY: I mean, I did some searches and I think it depends. But the one we tend to use and the one I believe she was given is a really old,

generic medication, I think $12 to $20 for a five to seven-day course. We are talking about -- you know, it's very cheap, you know, for what it is.

MARTIN: So, a $12 antibiotic, if she had gotten it on time when she was supposed to get it, when it was prescribed to her, she didn't. Not to put a

dollar, a price on this, but how much do you think all that medical intervention cost to save her life when she didn't get that antibiotic?

DR. KARKOWSKY: I hesitate because I can't fact-check any of this. But I will tell you this. Ballpark, a day and a half bill like $2,000 to $3,000.

But you add ICU level care, which is what we often managed to provide on a labor and delivery unit for somebody who is experience preterm labor and

needs that higher level of nursing, higher level of doctor care, it's often $5,000 a day, right? So, it's very cost-effective to prevent that kind of


Even at the same time, I'm really, really proud of my team that can assemble and often does assemble so quickly for a patient who is sick and

brings so much expertise and so much passion and so much devotion. You know, I've got a team that's obstetricians and anesthesiologists and the

NICU team, we are ready. But you are right, we are very expensive.

MARTIN: You've also written a book called "High Risk: A Doctor's Notes on Pregnancy, Birth, and the Unexpected." And you also wrote an op-ed in 2021

for "The Atlantic" titled, "Vaccine Refusers Risk Compassion Fatigue." And of course, the reason we called you today is for the op-ed you wrote for

"The Times" called "The Overlooked Reason Our Health Care System Crushes Patients." But taking those altogether, do you think that there is a

through line there?

DR. KARKOWSKY: You know, it's really interesting. One of the chapters in my book, my book that came out one week before the pandemic, which would not

recommend as a marketing technique, just in general. My longest chapter is about systems. And systems always sound like such a boring topic, right?

Paperwork and rules and work flows and algorithms.

But I think what I am hoping I have shown in that chapter is that it is also people's lives and people's time and people getting sick or people

getting what they need because of those rules and algorithms and administrative burdens. And this has been something that as I have become

more experience in medicine, as I become somebody who manages more and more of my colleagues, I am starting to see the bigger picture and I am trying

to put that together in my writing to show all of us, to show all of you so that we could have these conversations.

So, it's something that I talked about in my book. And then, I think that you can see in my evolving understanding of the systems that I work in that

I sometimes say, I swim in like a fish in the ocean, and trying to bring that to everybody, because I actually think that it has a bigger effect on

your care. And the care that I give and the care that you receive and anybody really knows and I think it deserves some attention.

MARTIN: Your piece is titled "The Overlooked Reason Our Health Care System Crushes Patients." I got to tell you that before our conversation today,

you know, I mentioned to a couple of people I was going to talk to you, to a person, everybody had a story, everybody had a story. How is this


DR. KARKOWSKY: I have to tell you that I think is sort of the curriculum that I learned in med school, right? Immediately after learning all of the

pharmacology and all of the anatomy, you start working with patient, and the first thing that you start to learn is that nothing that you need to do

is helpful in any way until you can get it to the patient, right?

And then, getting it to the patient is its own discipline. Its own sort of academic pursuit. It's an own complicated experience. And I think for

patients, they are learning that as well. Sometimes, over years of a chronic illness and sometimes very, very quickly as they get very abruptly


MARTIN: How did it start that filling out forms became so fundamental to American health care?

DR. KARKOWSKY: I don't know a historical view for you. What I can say is this, the American health care system -- and when I talk about that I don't

just mean me or a hospital or even a clinic, I mean all of it. Your insurance provider, their claims adjusters, every single one of us who is

adjacent to how health care gets both provided but also paid for and approved and disapproved, all sorts of things. It's a massive

multitentacled beast of an industry, right?

Most of which is there to help you, but like any large system, I think, has to make rules. I sometimes compare to like the military, except unlike the

military, you are all going to end up in it at some point because it's very rare to not be a patient at some point in your life. And there's going to

be a lack of transparency and orientation to the processes which are going to govern your life, often when you are at your most stressed or feeling

your least well, unable to handle them.

So, I think there are things that are particular about the American sort of medical system that we can talk about that make it particularly difficult,

even as some of those things are things we are very proud of.

MARTIN: Would you say more, you know tell us, you know, a couple of other stories?


DR. KARKOWSKY: I mentioned in the piece that I was in the clinic, I have a clinic where I oversee our high-risk fellows on a Wednesday and had a

patient who have not been able to pick up her glucose finger stick, the testing strips. And she had been three, four weeks without them, which for

pregnancy is an eternity, right? Every week counts. Everything I do is time sensitive.

And she had taken off the morning off of work. She's an hourly worker, that's not work she's ever going to get back, it's not time she's ever

going to get back so that she could ferry between, you know, her insurance office and the Medicaid office and the pharmacy, and she finally got the

test strips.

And I helped her. I went with her to the Medicaid office, because it's right across the street, and I went with her to the pharmacy and we cleared

it all up. And she got her test strips for, I think, $5 or $10 copay, but it also cost or all of the morning and whatever childcare she had to get

for all her other children, right?

On the other hand, I was happy to do it because it was much cheaper than admitting her for a diabetic coma. That depends on who you think is paying

for the diabetic coma, right? So, I know that especially if you worked with an underserved population. I work in an area that serve some of the poorest

ZIP codes in the entire United States, you are often working with patients where life is very hard already. These barriers become sometimes

insurmountable but very onerous. And a large part of providing good care in this setting ends up being this administrative work.

MARTIN: A lot of people are going to be like, well, you know, this is folks who are minimally insured, who are uninsured or, well, maybe people whose

English isn't their first language or people who are under resourced, who don't really navigate systems. You cite in your piece a Harvard Medical

School study that found a quarter of insured adults reported that their care was delayed or missed entirely because of administrative tasks.

DR. KARKOWSKY: Yes. I work in New York State. In New York State, and I feel very blessed by this. If every single pregnant patient is insured, done.

Eligible for Medicaid. I feel very, very lucky in this setting. I never have to worry in that way. Postpartum coverage could be better.

Preconceptual coverage can be better. But once they're pregnant, and because I exclusively take care of pregnant patients, that's all of my

patient population, and I still see this tremendous burden. It's not just about being uninsured.

I think everybody who has insurance handles this, how many phone calls did you have to make to get to a specialist? How many forms did you have to

fill out to get your right medication? How many times did you press the wrong number on a phone tree and you spent another hour waiting for

somebody who really knew what the right answer was and could provide you that expertise?

MARTIN: Has the medical establishment itself played a role in this? To be fair.

DR. KARKOWSKY: I guess I feel like I work with some of the most devoted people, right? Like what I would say is this, I spent a lot of my time

overcoming administrative burden for patients. And that itself is both very beautiful and extremely dumb. It's a dumb use of, let's say, my time,

right? I am somebody who if I could go see five more patients, I'd say, that's probably better, right? Probably a more economical use of my

particular 20 years of training time.

But I work in a system that I can be smart and give you the right insulin, give you the right antibiotic, but if it does not get to you, you will end

up sicker, I'm going to take that 10-minute, that 15 minutes, that 30 minutes, talk to your pharmacy, talk to your insurance office. The choice I

often have is not, do you want to be optimally efficient for the -- you know, for medical system at large? That's not the choice in front of me.

The choice in front of me is, are we getting this patient what she needs or not? And I have always gotten the patient what she needs.

But I will tell you to be angry at providers or doctors I think is the wrong thing. I am doing something that is suboptimal because the system I

am in a suboptimal and the choices that I have are bad.

MARTIN: And I am asking you, though, have not medical professionals been obstructionist in -- for figuring out how to provide affordable care and

access across the board. Is that not the case?

DR. KARKOWSKY: I don't know if that is the case. I don't know who medical professionals are. You know, is medical professional me and my doctors? I

don't know. We are pretty in the trench's kind of folks, right? We're taking care of the patients in the hospital.

If medical professionals are CEOs of insurance companies or giant medical systems, that -- they have a different agenda. I am extremely clinical. I

am both very focused on the patient in front of me, but as I have become more senior, more aware of the way the system affects them all.

MARTIN: In the real world, do you think that policymakers think about the time costs for both patients and providers, physicians in their rulemaking?

DR. KARKOWSKY: I think that's it. I think we do not count time cost. And time cost is a really, really interesting subject, because time costs is

valuable only if you value someone's time, right? So, a lot of these tasks are done by people who -- the insurance company doesn't pay their salaries.

So, two hours spent on the phone doesn't show up on the bottom line.


I mean, I would argue that many of these tasks are done by women and are a part of the unpaid work that many women do to sustain their households. And

historically, we tend to not value a lot of that. But it is costly. It does take time and it should be counted. When it is not counted, we don't

ultimately value it because we don't even understand what we are paying.

MARTIN: How do you fix this? How would you fix this?

DR. KARKOWSKY: You know, it is very interesting because I asked this question to some of the people that I spoke to for the article, and they

really said that they didn't have a lot of great ideas. It's very, very hard to estimate time cost. It's very, very hard to know a much time people

are spending.

But I will say this, I see how we fixed other things. So, for example, the way that we pay attention to maternal mortality and morbidity. The way we

pay tension to not delivering babies before 39 weeks at a very good reason, causing complications of early term birth. The way we do that is we pay

attention. We publish metrics. We grade people. We sort of shine light on the subject and we also make that knowledge public. We tell people this

clinic has an A plus. This clinic has B minus. Where would you rather go?

And I guess I wonder if there is any room for calculating time costs and requiring a metric that reflects that kind of time. Maybe something that we

would do across the country so that people would know, this place is a place that values my time and has soothes the way. This place doesn't. And

that would allow, I think, for more knowledge for patients to pursue things that are in their best interest perhaps.

MARTIN: Well, you know, I mean, the IRS does that. I mean, the IRS will describe how long they estimate it will take to fill out one form or

another in tax compliance. In other spheres, this was a part of public conversation, but it doesn't seem to be when it comes to this, and I am

just wondering if you have a theory about that?

DR. KARKOWSKY: I do think there's something here that we haven't discussed, which is cost. You know, the United States pays more, overall and per

person and, you know, as a percentage of GDP for health care than anywhere else. And there are ways in which we get less for it, right? There's -- our

maternal mortality is awful. Our maternal mortality for women of color is truly shameful. And we spend more money than anyone else.

And some of this, I think, is from the complexity of the system we are in. We don't have a single payer. We don't even have a single payer per region.

We have a capitalist marketplace, right, mostly combined with public insurance, which is a very large player. And so, I think it's just a very

strange and complex scenario and one that's very, very hard to drive, one that's very hard to drive change in because it's really complicated. There

is a fair amount of government interference but there's also a fair amount of just market forces.

And because of the unique mix that we have, we have some wonderful things. I am really proud of my team that could gather and provide amazing care in

under an hour for our sick patients, but we also have these cost, which is that everybody's got six different forms because if six different insurance

companies and seven different pharmacies and nobody has come to any sort of agreement or standardization.

But the cost, I think, is real and a real driver. And I don't think it is wrong to want to bring that cost down. I mean, we all pay for, that right?

We pay for premiums. We pay in the federal budget. Bringing the cost down is something I think we are going to have to do. It is just that sometimes

companies make the decision to bring the cost down by making the administrative burden higher, and that only works if you don't count the

administrative burden as a cost.

MARTIN: I have heard anecdotally, and I think there may be data to back this up, but there are doctors who have left the field because of the

paperwork burden. Have you experience that with your colleagues? Has anybody, friends, people you want to med school with, do you think that

that might be true?

DR. KARKOWSKY: This is very personal to me because I feel like I am just seeing such profound burnout in the medical profession right now, which is

hard. Most of us love the work we do. We love our patients. We spent a long time becoming good at this work, and this work is very, very hard. But it

is also true that many of us spend hours and hours and hours on administrative burden.

You know, these are tests that they don't bring revenues, they are not billable for the most part. And so, because of that, depending on what

setting you work in, they may or not be supportive. And I do think it all adds up, it all adds up and adds to the dissatisfaction on top of sort of

post pandemic difficulties, fatigue and malaise. I think there's a true burden here that is contributing to clinician burnout, and I think it's

going have to be addressed.

MARTIN: Dr. Chavi Eve Karkowsky, thank you so much for talking with us.

DR. KARKOWSKY: Thank you so much.


AMANPOUR: And that was and is an important conversation, the hard work, the dedication of our medical professionals all over the world.


Finally, though, some good news on the medical front, thanks to artificial intelligence no less. A new study shows that it improves breast cancer

detection for mammograms by 20 percent. That would also mean a significant reduction in workload for radiologists. Experts are saying it offers huge

promise in the fight against breast cancer. Hopefully, that is just the beginning.

That's it for now. Goodbye from London.