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US Health Care Ruling; Freed from Somali Pirates

Aired June 28, 2012 - 15:00:00   ET


CHRISTIANE AMANPOUR, CNN HOST: Good evening, everyone, and welcome to the program. I'm Christiane Amanpour.

President Barack Obama scored a huge victory today which could mark a turning point in his drive for reelection. It was also a huge victory for the American people when the United States Supreme Court today upheld the president's health care reform law. It's no secret that U.S. politics are deeply divided and perhaps no issue sparks more vitriol right now between Left and Right than health care.

But speaking from the White House, the president said that his plan was about people, not about Democrats or Republicans.


BARACK OBAMA, PRESIDENT OF THE UNITED STATES: I know I lot of coverage through this health care debate is focused on what it means politically. Well, it should be pretty clear by now that I didn't do this because it was good politics. I did it because I believed it was good for the country. I did it because I believed it was good for the American people.


AMANPOUR: And there may have been no stronger endorsement of the president's plan than this.


FORMER GOV. MITT ROMNEY, R-MASS., PRESIDENTIAL CANDIDATE: It's critical to insure more people in this country. Doesn't make sense to have 45 million people without insurance. It's not good for them, because they don't get good preventative care and disease management, just as these folks have spoken about.

But it's not good for the rest of the citizens, either, because if people aren't insured, they go to the emergency room for their care when they get very sick. That's expensive. They don't have any insurance to cover it. So guess who pays? Everybody else.


AMANPOUR: Yes, that's Mitt Romney, who spoke those words back in 2007 during his first presidential campaign before this became such a divisive issue.

My brief tonight then: is health care a privilege, a right or is it even an obligation? Fifty million Americans are uninsured, including 7 million children. Even with today's court ruling, millions will remain left out. Will the day ever come when the United States joins the rest of the developed world in providing health care for all of its citizens?

In a moment, I'll talk to Dr. Donald Berwick, an American health official, who was a casualty of Washington's political wars over this issue; also to Ruth Dreifuss, former president of Switzerland, who implemented her country's health care plan that, in many ways, serves a model for ObamaCare.

But first, here's what's coming up later in the program.


AMANPOUR (voice-over): Kidnapped by pirates, two years in hell, a harrowing tale of survival -- our exclusive interview.

And the importance of a handshake, the first move towards peace when old enemies have skin in the game.


AMANPOUR: We'll get to that in a bit, but first, Dr. Donald Berwick was a key player in President Obama's health care reform as administrator for Medicare and Medicaid, America's public health care providers. He joins me now from Boston.

Dr. Berwick, thank you very much for joining me. Your reaction to this incredible victory, it was -- it was expected by you or not?

DR. DONALD BERWICK, FORMER ADMINISTRATOR FOR MEDICARE/MEDICAID: I sort of expected it, Christiane. I'm an optimist by nature, but this is a big win for the American people. And I think the court has done the right thing.

We have a law on our hands now that makes us move quite a bit farther toward health care as a human right in our country. And it's very good for people who currently do have health insurance, because health insurance gets better, coverage gets better, more secure. It's a great law and I'm so delighted that it's gone this way.

AMANPOUR: You say a human right. But as you know, in the United States, right where we're sitting, it's a huge battle over this right. Do you think that it's going to get politically any easier or more difficult after this ruling?

BERWICK: Much easier, much easier. And this is a step toward health care as a human right. As you point out, it's not -- this doesn't provide complete coverage. But of the 50 million uninsured, it covers 30 million more. And that's a major step forward for our country.

But I think even more, people in our country are going to see what a better health care system can look like now. They're not going to have to worry that the insurance company's going to take away their coverage when they get sick. Their children under age 26 are going to have coverage on their parents' policy. Prevention gets covered.

I think people are going to begin to experience a coverage system that's much more fair, that's much more reliable and a lot in this law helps make health care better. And people are going to see that, health care that becomes more seamless and responsive.

So this was a good law. And I think people, over time, are going to see how much better it gets. And we'll move into health care universally in this country, I'm sure, over time.

AMANPOUR: Well, you say that, but again, you know that your opponents here -- and they were pretty harsh against you when the president was trying to get you confirmed as his key official on this, your opponents call it socialized medicine and don't use that as a compliment. And you did, in fact, look around the world to examine all sorts of different health care systems, particularly in the developed world when it came to sort of helping with the ObamaCare. Tell me about what you found around the world.

BERWICK: Well, first, the opponents are wrong. And this law is distinctly American solution to universality. It's the private sector that's continues to give most of the care in our country, as it does before the law. A lot of the mixture of payment is public and private payment.

This is a partnership, a public-private partnership. There's no government takeover of health care in this law. That's ridiculous. The opponents were completely wrong.

We do -- can learn, of course, from other countries. Many countries around the country are -- around the world are facing the same issues of how to provide continuous, chronic care for people with diseases that they have to live with for a long time. They're dealing with rising costs and finding different ways to deal with that.

And I think the United States can learn from other countries about how to have a care system that's dignified and universal and continuous and they can learn from us. A lot of the innovations that other countries are adopting are coming from the U.S. We're all in this together.

AMANPOUR: Dr. Berwick, stand by, because on that note, joining us now is Ruth Dreifuss, who, as president of the Swiss Confederation, did oversee the rollout of Switzerland's health care reform plan.

Thank you for joining me from Geneva, Ms. Dreifuss. You say that you had to implement your country's law, and that it did work, this whole issue that's very similar to the Obama health care reform.

RUTH DREIFUSS, FORMER PRESIDENT OF SWITZERLAND: Yes, I think it is very similar because it also -- a law that gives a large part to private insurance and a great level of freedom in the choice of the insurance for the insured in the choice of the -- of the medical professional with which you have to build up a confidence relationship and so on.

I mean, it's a law that is effectively private-public partnership. Or better said, a private organization inside a frame given by the state and responsibility of the state to be sure that the services necessary will be offered.

So, yes, I think we had exactly the same discussion in Switzerland and it was clear at one moment that you have to really to have the individual mandate on one side to be sure that the people are concerned and that they are insured also when they are healthy and not only as the candidate Romney said, before not just when they are ill. There is a partnership among all.

But the second thing is the counterpart of this obligation is the obligation of the insurance to accept the people without taking into account preexisting diseases, without taking in account that, for instance, elderly people are more expensive than younger people, men more expensive that women and so on. So it is the key really to have an anti- discrimination in this field.

AMANPOUR: So let me ask you, because from the statistics and what I'm reading, it looks like Swiss people are healthier in general than American people, and that it does cost less in Switzerland to treat a patient than it does in the United States.

How do you manage to keep those costs down while maintaining quality?

DREIFUSS: Well, I think with a large package of benefits guaranteed to all, you have also the means to control how this package is delivered and to control the quality of the services given by the medical entities. So it is true that Switzerland, which is an expensive country in this field, has, I think, assert perhaps less expenses per capita than the United States of America.

AMANPOUR: Let me ask you, Dr. Berwick, because it is extraordinary when you consider that the United States is the most developed country in the world. And yet in general, people are less healthy, as I said. It costs so much more to treat a patient.

How can that issue be resolved, that sort of quality versus cost? And do you think that there will ever be a universal health care, a little bit like, you know, Britain's national health system in America?

BERWICK: I think America will have all citizens covered at some point completely. But I suspect it'll be done with a kind of public-private partnership in which the delivery system remains largely private. In U.K., the delivery system is the -- is generally owned and run by the government; in the U.S., not. And I don't think U.S. will go in that direction. But I think we can certainly assure universality.

The route to affordability is improvement, as President Dreifuss said. Once you have universal coverage, the next question is, can the care be terrific? Because what we know is the better the care is, the more it's focused on needs of patients, the safer the care is and the more continuous it is, the costs fall and the patients do better.

American health care is very expensive because it's very, very fragmented. We've always paid for it in little pieces, fragments. Now under the Affordable Care Act, we get a chance through Medicare to pay much more for journeys and the private sector payors are moving in the same direction. So we can make care affordable by making care better, focusing on prevention and continuity. And that's exactly where we're headed now.

AMANPOUR: Dr. Berwick, thank you very much indeed.

And just one final word for you, President Dreifuss, do you believe that health care is a right, an obligation?

DREIFUSS: I think that health care is a right, but that it is an obligation for everybody to participate in the system.

AMANPOUR: President Dreifuss, Dr. Berwick, thank you very much for joining me.

And we will be hard pressed to top the drama of today's Supreme Court decision. But how about pirates? Yes, pirates, when we come back we'll meet a couple kidnapped on the high seas and who lived to tell about it.

But first, take a look at this picture. Bureaucracy run amok. The United States spends an estimated $2 trillion a year on health care expenses, more than any other industrialized country.

And by the way, as we looked around the world, we noticed one country that's tackled the problem: Rwanda has insured nearly 91 percent of its population. Check out 50 other countries with universal health care at We'll be right back.


AMANPOUR: Welcome back. And now we turn to an incredible story of piracy and survival on the high seas.

Debbie Calitz and Bruno Pelizarri were captured by Somali pirates back in October 2010. The couple were sailing off the coast of Tanzania, heading to South Africa to see their family, when pirates attacked the ship and hijacked it to Somalia.

Debbie and Bruno were held hostage for 20 months as the pirates demanded huge ransoms. The couple was eventually set free last week after intense efforts by family as well as the South African, Italian and Somali governments. They join me from Pretoria, South Africa, for their first interview since being set free.

Debbie and Bruno, it's wonderful to see you; it's great to have you out of captivity. I just want to ask you, though, Debbie, to take me back to that dreadful day 20 months ago. What was it like when the Somali pirates stormed your ship?

DEBORAH CALITZ, PIRATE HOSTAGE: It felt like it was a dream. It wasn't real and I could see there was more fear in their eyes than we had. And I was afraid we were going to panic.


CALITZ: Yes, surreal.

AMANPOUR: When you say you were --

PELIZARRI: I'd just been on night shift.

AMANPOUR: Sorry, go ahead. Go ahead, Bruno.

PELIZARRI: I'd just finished the night shift. So I was asleep when Debbie woke me up, telling me there's a boarding party arriving. And the next thing she said, "It's pirates." What do you do? What do you say?

AMANPOUR: What did you say? What did you do?

PELIZARRI: Put a pair of jeans on and went on deck to face them, of course.

CALITZ: And we tried to calm them down, because if they panic, they can shoot. So we told them, don't worry, everything's fine. We're sitting down. Just relax. You'll be OK. We're not going to fight you. But we have to stop the boat.

AMANPOUR: Must have been terrifying.

CALITZ: It happened so fast, so quickly, there was no time to be scared. We just had to get off and just go with them.

AMANPOUR: So what happened then? You were there for 20 months. What was the conditions of your confinement for 20 months?

CALITZ: Terrible.

PELIZARRI: Can you imagine being put into a cell worse than a prison I can think of, darkness with a tin for ablutions, with no form of --

CALITZ: It was filthy. The places were filthy we were put in. Sometimes we had to sleep on the floor. Sometimes we had a mattress. They treated us -- they wouldn't touch our bowls. We were treated like untouchables. And we were humiliated. We were degraded. They did everything they could. They psychologically tortured us.

AMANPOUR: In what way?

PELIZARRI: You had threats hanging over your head all the time.

CALITZ: They would come in early hours of the morning and shine a torch, a light in our face. They wouldn't say a word. They would just stare at us. We asked them, what? What do you want? And they'd just look at us. And they'd walk out. And then they'd come at 6:00 and they'd bang outside the door. And then they'd cock their rifles.

And we don't -- we didn't know if they were going to kill us. They wouldn't tell us anything about what was going on. They told we were lying all the time. We wanted money. They wanted money. If they didn't have money, they would kill us. So cold.

AMANPOUR: In the meantime --

CALITZ: We didn't know from one day to the next, yes.

AMANPOUR: And in the meantime, Bruno, your sister, Vera, was in touch with them quite regularly, sometimes once a week. We have a little bit of audiotape of some of her conversation. Let's just listen for a little bit.


PELIZARRI: What do we want from our government? We demand our -- we demand our freedom.

VERA: You demand your freedom from the government? Bruns, the government doesn't pay. And I'm trying to collect money for your freedom.

PELIZARRI: Vera? Vera?

VERA: Oh, my God.


AMANPOUR: So, Bruno, that was Vera talking to you, in fact, during negotiations. What was it -- what's it like for you now to hear that played back?

PELIZARRI: Quite heartrending.

CALITZ: (Inaudible).

PELIZARRI: Yes. And get on to the -- get on to the questions said by them. It's so upsetting, because so many things to say and you can't.

AMANPOUR: It must be amazing to know how your family was so involved and so, you know, stuck to it for all these months, trying to get you out.

CALITZ: They didn't give up.

PELIZARRI: At least it gave us hope, that there was people out there, that there had been contact.

AMANPOUR: Did you know --

CALITZ: We knew nothing. They kept us in the dark.

AMANPOUR: Yes, you just said you knew nothing. I was going to say did you know that the kidnappers were asking Vera for, you know, $10 million?


CALITZ: We weren't sure how much exactly. And we weren't sure whether -- how often the communication was happening. We thought every two months there was a bit of communication going on. That's all we thought. That's all we knew.

PELIZARRI: Yes, outside they were asking for $24 million, $8 million, $10 million, just so we could hold them. We're no celebrities. We are just workers, just normal citizens.

AMANPOUR: I know the -- all the governments involved --

PELIZARRI: They've got the wrong people.

AMANPOUR: All the governments involved, the South African government, the Italian government, your Parli Italian, Bruno, the Somali government, refused to talk about ransoms. Do you think a ransom was paid?

CALITZ: We don't know. We're not sure. All we know was that it was a coordinated rescue between the Somali government and the Italians. And the Italian people were wonderful. They looked after us so well. They put us up in a place and they kept us feeling safe, all the way. They were really, really good to us.

AMANPOUR: Well, what was the rescue? Did they storm the place? Were you handed over? How did that happen?

CALITZ: It was very quiet. We weren't sure right up until the time that we didn't believe it, because they had lied to us so many times before that.

PELIZARRI: Three times they told us we were leaving for South Africa.

CALITZ: Yes, they would drive us for 12 hours, from one place to another. We'd stay there for a few days, maybe a week, maybe just one day. And then they'd take us back again, throw us back in the room again and not tell us anything. So we didn't believe them. And we had -- we had decided we're not going to believe them until we actually see the plane.

So when we were rescued, we heard -- as soon as we heard the Italian people on the phone, we were in the car. We thought, OK. Maybe, just maybe this might be real. And when we got to the boarding, the Somali boarding, the Italian boarding that we went to, and we saw the Italian people standing there, we knew. We knew we were safe.


AMANPOUR: Did you think you were ever going to make it out? Did you ever think you'd make it out? Did you think you would die there?

CALITZ: We were never sure. Maybe. We weren't sure. We were never sure.

PELIZARRI: Always in our thoughts.

CALITZ: It's like being on death row. I understand what it feels like to be on death row. We know what that feels like. It's terrible. It's like a nightmare. It doesn't seem real.

AMANPOUR: Do you feel -- ?

CALITZ: We didn't believe it could happen to us.

AMANPOUR: Do you feel the nightmare's over now?

CALITZ: Yes, yes. Our dream has changed now. We've got a new reality now.

PELIZARRI: Most different.

CALITZ: A new dream to look forward to. We're back together with our family. And I think at this, it's going to do a lot of good for a lot of people. And that's what we want. If only this war would stop. It needs to stop around the world.

There needs to be peace throughout the world.

AMANPOUR: You have been in Tanzania, looking for work, actually working, when you were trying to get back to South Africa for a holiday on this boat. Will you move back to Tanzania or are you just going to stay in South Africa now?

PELIZARRI: Well, my boat is based in Dar es Salaam. It's my home. Everything's there at the moment. I've got to go back to it and sort her out first.

AMANPOUR: What has this done to you --

PELIZARRI: I'm looking forward -- it's a new life. Yes, it's a new life. I'm a new person.

CALITZ: We'll never be the same again. It's change our life forever.

AMANPOUR: You have two grandchildren who were born while you were in captivity. Have you seen them yet?

PELIZARRI: No. Not yet.

CALITZ: We've seen one. And we've seen photographs of the other.

AMANPOUR: So what are you looking forward to most right now?

CALITZ: Being together with all our family, with everybody. It's been so hectic with people and so many people are out there supporting us. And that is great. Everybody has been so wonderful to us. It's so overwhelming, what's happening.


PELIZARRI: The dictionary hasn't got the words for it. I think we need new words in it.

AMANPOUR: Well, you have both been very, very expressive. Debbie and Bruno, thank you very much for telling us your story.

CALITZ: Thank you. Thank you for letting us.

PELIZARRI: Thank you for giving us the opportunity, Christiane.

AMANPOUR: Take care.


AMANPOUR: Imagine what that experience was like for Debbie and Bruno and what was required to negotiate their freedom. It took patience and perseverance.

In just a moment, a look at how some negotiations can be as simple as a handshake. Stay with us.



AMANPOUR: And now a final thought. Yesterday we showed you a remarkable picture, Queen Elizabeth shaking hands with Martin McGuinness, former member of the IRA and now deputy prime minister of Northern Ireland.

So imagine a world where a handshake is more than just a symbolic gesture, like this historic moment from 1988. The Cold War began to thaw when U.S. President Ronald Reagan and Soviet President Mikhail Gorbachev reached across the great divide.

Then again, as this next picture shows, a handshake doesn't always bode well. In 1959, the new Cuban leader, Fidel Castro, came to Washington and met Vice President Richard Nixon. The distrust was mutual and has remained that way for over 50 years.

But a handshake can signify momentous change, like this one from 1993. Israelis and Palestinians set out on the road to peace when President Bill Clinton pushed PLO Chief Yasser Arafat and the Israeli prime minister, Yitzhak Rabin, together in the White House Rose Garden.

And lastly, in 1990, South African president F.W. de Klerk shook hands with Nelson Mandela, marking the beginning of the end of apartheid. A handshake isn't everything, but it's a start. And that's it for tonight's program. If you want to share the story about the handshakes online, it's already at Good night. Thank you for watching from New York.