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NYT Shows Evidence of Trump's Tax Avoidance; Interview with Former NSA HR McMaster; Interview with National Geographic Conservationist Filmmakers. . Aired 2-3p ET

Aired September 28, 2020 - 14:00   ET


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




AMANPOUR: I'm not a real businessman, I just play one on TV. Does President Trump fit that famous Madison Avenue line. The New York Times

tells a staggering story of his massive tax avoidance and chronic business failure and I asked his former National Security Adviser H.R. McMaster

where the foreign powers might exploit this.

Plus ...


UNIDENTIFIED FEMALE: We're in the business of changing the world. We're in the business of conserving the planet.


AMANPOUR: ... world leaders pledge to save our wildlife. Veteran conservationists and filmmakers Dereck and Beverly Joubert tell why their

journey is your business too.

Then, Global Health Professor George Aumoithe tells our Michel Martin how decades of bad policy led to a devastating shortage of ICU beds in low-

income communities.

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

President Trump made his case to the people as a very rich man who made very shrewd business deals. But what's really behind the art of the deal.

The New York Times says, it has obtained access to some of Washington's most sought after files, the President's tax records.

Extending over more than two decades, the records alleged that he paid only $750 in federal income taxes in his first year as President and he paid no

income tax at all for 10 of the previous 15 years. The President has long fought to keep his financial papers away from public scrutiny and resorted

to his usual fake news about the Times scoop.

But Democrats say this shows Trump's disdain for ordinary hard working taxpayers. And it is likely to play out during the first debate between the

President and his challenger, Joe Biden, in Ohio on Tuesday night. The report also suggests staggering debts and potential conflicts of interest

that may directly threaten national security. Something my first guest tonight knows a lot about.

Retired Army Lieutenant General H.R. McMaster, he was President Trump's second National Security Adviser. His new memoir, Battlegrounds, looks at

the threats the country faces at this moment in time and he's joining me now from San Diego in California.

Gen. McMaster, welcome to the program. It's good to have you back on.

H.R. MCMASTER, FORMER U.S. NATIONAL SECURITY ADVISER: It's great to be with you, Christiane. Thanks for having me.

AMANPOUR: You're welcome. You couldn't have arrived on this program at a more auspicious time. So I'm going to ask you, because I know you've been

deliberately apolitical. You have not written a book about the President. You've written a book about policy, not politics.

But I want to ask you as somebody who's followed the law of the land, who's been a military commander, who's followed all of the military rules and all

of that, what do you make of a leader in terms of moral ethical leadership, who has clearly not follow the rules or some of these tax losses, maybe

legal, but nonetheless what do they say about a leader who's trying to be president of all the people?

MCMASTER: Well, as you mentioned at the outset of the segment, this is certainly going to be a topic of conversation throughout the elections, at

the debate and in the military the saying is you lead by example. And I'm sure that's what's going to be drawn into question, are these reports that

the President may not have led by example, in terms of at least paying taxes and so forth. So it certainly is going to be an element of the


But I think what's important Christiane, the subtitle of Battlegrounds is the fight to defend the free world. And you mentioned this as well, our

adversaries will take advantage of any issue that can be used to diminish confidence in our democratic principles and institutions and processes. So

this is sure to be a topic of debate internally in the United States, but also it'll be an issue in a reporting that our adversaries will try to


AMANPOUR: Well, to that point, actually, and I can see you definitely swerving, but nonetheless, you've said that he hasn't led by example. The

former Deputy FBI Director Andrew McCabe said and others have weighed in on this, that we don't quite know who all this debt was incurred from where

the President as Donald Trump, the businessman, get all this money and there may be national security implications.


And the FBI apparently generally tends to look at people who can be compromised if they're in terrible debt or in terrible financial trouble,

they can be bribed, et cetera. This is sort of par for the course. This is what he said about this particular case of the President, given the

revelations of these papers.


ANDREW MCCABE, FORMER FBI DEPUTY DIRECTOR: In all of those cases I've seen, I have never come across an individual who was actually, excuse me,

facing debts that are coming due on this magnitude. I mean, $400 million in the next two or three years is an extraordinary number. But we also have

some serious questions about where those debts are from. As your previous guest mentioned, we don't know where Donald Trump has borrowed that money

from. That information doesn't appear to be in the records we've seen so far.

And if that money is from foreign sources, then it really opens a Pandora's box about foreign influence issues with the President of the United States.

It does not get any more serious than that.

AMANPOUR: Gen. McMaster, do you agree with that, it doesn't get much more serious than that and these are huge numbers?

MCMASTER: Well, Christiane, I can't speculate. I mean, I've just read what you've read and none of it is definitive yet. So I think we all have to

wait to see what are the results. But your point, I think, that is certainly valid that we ought to consider is that the Russians in

particular are brilliant at trying to compromise leaders, so they can use any kind of information against them.

I mean, this is why, for example, President Bill Clinton received a very handsome speaking fee in Moscow. They play all sides and then try to use it

to their advantage. It's to be expected. And what I write about in Battlegrounds is both political parties in the run up to the 2016 election,

made it way too easy for the GRU, which is the follow on to the KGB or the military intelligence arm of the Kremlin.

And so we have to all be very responsible, across the political spectrum to be transparent and then if a deal seems too good to be true, it probably is

too good to be true.

AMANPOUR: So when you say both political parties, what do you mean, exactly? And I'm interested because you do go quite deep into what Russia

is trying to get out of the United States or its goal for the west versus what China is trying to get. But first, what do you mean, both made it too

easy for the GRU?

MCMASTER: Well, what happened is obviously you saw all of the attempts to try to compromise the Trump campaign. The reports from the Mueller

investigation where that those failed, trying to come up with lucrative real estate deals and that sort of thing. Those were never brought to

fruition, at least as far as the Mueller report went.

And then you had the Democratic National Committee. I told the story in the book how they hired retired foreign intelligence officer who then hired

former KGB officers and Russian intelligence officers to deliver a report on President Trump. So really, what you have is, is the Kremlin in the 2016

election was ready to sow dissension no matter who won.

And what was interesting about at the end of the election is they had a campaign ready to go, that if Hillary Clinton won is to say, hey, the

election was rigged, Trump really won but it was stolen from him.

Well, when Trump one, I mean, I think the Kremlin was probably as surprised as everybody else was that President Trump won the election. They turned

that campaign to say, oh, well, he would have won the popular vote, except that the election was rigged.

And so they're ready to really just diminish our confidence, to try to polarize U.S. and hit us against each other. During the 2016 election too,

Cristiane, it's clear that about 80 percent, 80 percent of the Russian bot and troll magnifying of the divisions in our society were around issues of

race. Then, a distant second were issues of immigration and gun control.

So really what the Kremlin wants to do is just drag us down. I mean, Vladimir Putin is in a tough spot these days, as economies not doing great,

as demographics trends aren't good, there's a collapse of oil prices. But the Russian model is for Putin to be the last man standing and to drag

Europe down, drag the west down.

AMANPOUR: So you think that is the some extent of Putin's activity in U.S. elections and others to basically weaken the west and as you say drag the

west down. How do you see that differing because you also say that the United States should be very mindful that China is doing a really good job,

trying to probably surpass the United States.


How do you see the strategic play is being different?

MCMASTER: Well, what I argue in Battlegrounds is that we have to consider what are the emotions and aspirations and ideology that drive and constrain

the other. Putin is preoccupied with maintaining his position of power. He sits atop kind of a big protection racket where he has dirt on everybody

and keeps them from destroying themselves.

And to stay in power, he needs to stoke Russian nationalism and then to regain, what he wants to do is regain national greatness, because he's

driven, the emotion is a sense of sort of honor lost and a feeling of lamenting the breakup of the of the Soviet Union at the end of the Cold

War. He knows he cannot compete with United States head-to-head. Russia's economy is about the size of Texas' economy.

So what he needs to do is drag everybody else down. He's been doing this really since 2007 in Europe, trying to polarize societies within Europe,

divide the European Union, ran the transatlantic relationship and to try to break NATO apart. So Putin is dragging everybody else down.

China is driven and the Chinese Communist Party is driven in large measure by fear and aspiration as well. Fear of the Chinese Communist Party losing

its exclusive grip on power. And so the party is in a race to kind of extend and tighten that grip on power. You see that in the reporting that

you've done on cultural genocide in Xinjiang. The repression of freedom now in Hong Kong, for example. The creation of a technologically enabled or

wealthy and police state, across all of China, the building of the Great Firewall, so they can control all the information that comes into China.

And what you also see though now is this really nationalistic rhetoric within China and much more aggressive behavior. China is trying to

accomplish something much more ambitious, which is to create exclusionary areas of primacy across the Indo-Pacific region and then challenge the

United States and the free world, globally. And they're doing that with a set of sophisticated strategies that combine beautiful option and coercion

and concealment of their activities.

AMANPOUR: So you say in the book that China feels it has a narrow window of opportunity to 'come off trust'. What do you mean by that?

MCMASTER: Well, it's in a race. It's in a race to grow the economy to meet the rising expectations of the population and economically to grow out of

the middle income trap. And the middle income trap means that China begins to lose sort of its advantages in the low wages in terms of manufacturing,

before it can grow the domestic demand to continue to grow the economy and to become what it hopes to be is a leader in high end industrial


A leader because it will dominate the technologies of the emerging global economy. This is under a program called Made in China 2025. China is also

in a race to extend its influence globally and is trying to create survival relationships with companies - countries, I'm sorry, by ensnaring them into

a debt trap, financing, extravagant infrastructure projects, well beyond what governments can afford and then using that leverage to force that

country to support China's international objectives and their foreign policy and oftentimes to trade debt for equity and really gain control of

physical infrastructure.

So China's ambitions are greater, but they feel that that window is closing. They're kind of in a race to surpass the United States and other

developed economies like Japan and the European Union. And I think, Christiane, COVID-19 has acted as a bit of a catalyst for Chinese

aggression and they're accelerating the tempo of their aggressive actions from Europe to Hong Kong to India to the South China Sea to Taiwan to the


AMANPOUR: So I still want to go back to how these world leaders deal with think they can outwit or not the United States President. So I want to ask

you what you make of the fact that these papers reveal that among many other things, the President apparently spent $70,000 U.S. on hairstyling.

And I want to know whether you think that's odd, because there's a bit of a method to my madness.

MCMASTER: Well, Christiane, that's something that's very difficult for me to understand for sure. But I'm just seeing the reports just as you are, so

I can't probably add anything more to that?


AMANPOUR: OK. The reason I'm asking is because it goes to a sort of need, well, grooming, flattering, the sort of taking care of your appearance and

public sort of persona. And this because I've read, obviously, the Woodward book which mentions that the President was very taken on by Kim Jong-un

calling him Your Excellency, was very taken and this is during your time by letters that were written back and forth that the President calls love

letters and I'm wondering what you think.

I mean, you've served in Iraq, Afghanistan and all over the place as a military grunt and a commander. What do leaders have to - I mean, you can't

really be susceptible to that kind of flattery, can you? What really came out of the North Korea-President Trump love story?

MCMASTER: For Christiane, I wrote about this specifically in Battlegrounds. And really what we had determined to do upfront is to

evaluate the Kim regime by its actions, not by its words and its propaganda. And really what we've determined and is still in place right

now is that there would not be a relaxation of these really unprecedented UN National Security Council sanctions on North Korea until there was

irreversible momentum toward denuclearization.

And, of course, that's in the interest of the whole world, because if the Kim family regime, this brutal dictatorship that runs essentially a gulag

state gets nuclear weapons, well, who doesn't after that. And then, of course, you have the reality that North Korea has never met a weapon. It

did try to sell to somebody else, including its nuclear program to Syria until the Israeli Defense Forces bombed it in 2007.

And so it's extremely dangerous for the world that if North Korea has nuclear weapons and certainly long range missiles to pair these weapons

with, and so it's very important to keep those sanctions in place in an effort, what I described in the book is an effort to convince Kim Jong-un

that he's actually safer without the weapons than he is with them.

AMANPOUR: But here's the thing, I mean, I put it in that way, because I'm trying to figure out what this unusual diplomacy actually achieved and

you're rightly saying that it's very dangerous. Obviously, there have been no tests since then, but there's been a huge, according to your

intelligence, building up by Kim Jong-un of his nuclear capability.

So I wonder whether that worries you and I wonder what you make of, this is before the tax story broke, 489 national security experts endorsed Vice

President Biden in an open letter saying, "The current President has demonstrated he's not equal to the enormous responsibilities of his office;

he cannot rise to meet challenges large and small." Including the Republican former Secretary of Homeland Security, Tom Ridge, who said he'd

vote for Biden.

I'm not asking you who you're going to vote for. I'm just wondering whether you also agree that there is a threat or a compromise, potentially, to

national security given everything we know and everything that's transpired over the last three and a half years?

MCMASTER: Well, I think the American people know a lot about Donald Trump. There's probably not a lot that they don't know about him. So I think

what's great about our Democratic system is the American people get to decide. I mean, there are a lot of countries in the world where the people

have no say in how they're governed and whereas this is a very contentious political season.

I myself am disheartened by the vitriolic nature of the partisan discourse in this country. But it's also a cause for celebration, right? The American

people do get to say the radical idea of our revolution is that sovereignty lies with the people. We get to exercise that sovereignty. I personally

don't sign these letters, because I really believe it's up to every individual American to decide.

And by the way, Christiane, I've tried to do my part to keep the military separate from politics. Something that our founders had very much in mind

and is very important to our democracy. So I try to comment on the policy. What I hope is I hope Battlegrounds is kind of an evaluation criteria or it

contains evaluation criteria, you could read it about the most crucial challenges to the free world.

And then each American voter or each citizen in other countries, they can decide, hey, which leader is best going to advance and protect our

interests based on that assessment.

AMANPOUR: OK. Well, specifically then let me ask you precisely that, first of all, as you know better than I do taxes pay for the military. So anybody

not paying their taxes takes it away from the military as well as everything else. But I wanted to ask you this, you say the American people

can make their judgment, but do the American people really vote based on foreign policy? And to that end, I want to ask you because, again, you

served there.


Do you believe that in order to fulfill a promise to remove all American forces from overseas that cozying up to the Taliban is a national security

sensible thing for the United States to do right now? Do you believe that the groundwork in Afghanistan, America's longest war is sufficient to go

into a peace deal with a group like the Taliban?

MCMASTER: No, it's not. And in fact, I think that the Trump administration policy has been absolutely wrong, since the negotiations began with the

Taliban with Ambassador Kurtzer, taking the lead there. And what I think is paradoxical about this, regretable about it, is the Trump administration

has replicated almost precisely the fundamental flaws in the Obama administration approach to Afghanistan and to the problem set in South Asia

that crosses the Afghanistan-Pakistan border, this essentially jihadist terrorist ecosystem.

And that is this flawed assumption, this belief that there's this bold line between the Taliban and al-Qaeda. And I write about this in Battlegrounds,

this tendency towards strategic narcissism. Defining the world as we would like it to be and then assuming what we do is decisive to the outcome and

in this case, creating the enemy we would prefer, rather than the actual enemy.

Cristiane, what I worry about is what is power sharing with the Taliban look like, is that mass executions in the soccer stadium every other

Saturday? Is that every other girl school bulldozed?

So I am very concerned that this negotiation process made too many concessions, forcing the Afghan government to release 5,000 of some of the

most heinous people on earth who could form the backbone of a rejuvenated terrorist infrastructure as well as cutting a deal saying, hey, just don't

plot against the United States. What about the rest of humanity?

I believe, Christiane, that Afghanistan is kind of a modern day frontier between barbarism and civilization. And there are brave, courageous Afghans

fighting every day to preserve the freedoms that they have enjoyed since the end of the Taliban regime in 2001. About 30 Afghan soldiers and police

give their lives every day, protecting them against these terrorists who commit mass murder of innocent people as their principal tactic in a war

against all humanity.

So I think this is a disaster in terms of this policy approach and it's something that I hope can be reversed. I mean, I think the best advocate

that we have for humanity, these days to help us wake up is probably the Taliban themselves, because I predict that the Taliban and the groups with

which they're associated will continue to commit heinous acts in such a way that it will galvanize international support in favor of the Afghan

government to sustain the freedoms that they now enjoy.

AMANPOUR: And, in fact, they have been, as you mentioned, these heinous attacks by the Taliban even though these talks (inaudible) ...

MCMASTER: Oh, the majority hospital, Christiane, I mean, how do you top that, right? I mean, this is that attack in which the these murders killed

infants and pregnant mothers. I mean, I think sometimes we avert our eyes from it, because it's so heinous. It's so brutal, but I think we have to

understand better the nature of our enemies.

That's a big theme in Battlegrounds. We tend to create kind of these strategies based on what the purveyor prefers rather than what the

situation demands. And I think that it's past time to really do what you do on your show, which is to look at these issues in greater depth. Get away

from 280 characters or whatever it is on Twitter, and read and think about and discuss in a civil way really significant challenges to all humanity.

AMANPOUR: Well, you've really given everybody a reality check. Gen. McMaster, thank you very much indeed for joining us tonight.

And we turn now to another threat the concerns not just the United States, but the whole world and that is the collapse in biodiversity. Today, 64

leaders pledged to reverse that by 2030, as they prepare for a UN Summit on the matter this week. But is it too little and too late? To answer that

question, my next guests are filmmakers and National Geographic explorers, Dereck and Beverly Joubert.

They have dedicated their lives to understanding the animal world. And they join me now from Johannesburg, South Africa.

Dereck and Beverly Joubert, welcome to the program. It's good to have you. Can I ask you what you make first of this yet another pledge by world

leaders to do everything they can in this case for wildlife and biodiversity?


Do you believe it? And how does one hold them accountable?

DERECK JOUBERT, NATIONAL GEOGRAPHIC EXPLORER-IN-RESIDENCE: Well, first of all, I think that - hello, Christiane, thanks for bringing us on. I think

that any pledge is better than no pledge.

So I think that world leaders rallying around this is better than everybody turning their back on them, so there's that. The fact that we haven't

really done well and since the pledge is a little bit disturbing and I think that we've lost biodiversity, rather than even maintain the status

quo since the last 10 years ago.

BEVERLY JOUBERT, NATIONAL GEOGRAPHIC EXPLORER-IN-RESIDENCE: And Christiane, in Africa over a 15-year period, we've lost, for instance, on

the top predators between 80 percent to 95 percent of them, so that's a drastic decline. And then, of course, we could go through all of the

numbers. But definitely giraffe 75 percent, elephants has a huge decline.

And so we're concerned that it is a little too late. I think what we need to do is we need a global mindset. And it's each and every single one of us

as well as the decision makers and the decision makers that are working in favor of protecting wildlife, need to do it, in the way of respecting and

thinking about the planet that the planet need to come first.

In fact, governments need to protect the planet as much as they're protecting humanity. We should not be looking at humanity come first and

the planet second. This planet is our home.

AMANPOUR: And you've been documenting wildlife and we've got all sorts of videos from your work since the 1980s. And as you say, big game, I think,

or big predators, big lions, certainly, big cats rather, are your main focus. I mean, the statistics are horrendous in your lifetime, the global

lion population has gone from 400,000 to less than 25,000 in the wild and something similar for leopards, I believe. They fared even worse, there's

only about 6,000, apparently, in the wild since. How does one mitigate that, Beverly and Dereck?

D JOUBERT: Well, I think that the three major problems, I think cheetahs are now around that low number and leopards around 50,000. But I think that

the three major problems, one is ignorance, one is the 1425 [00:02:27] and one is greed.

And as this word poverty, the necessity of people living closest to wildlife, their attitude change and they have to eat. And so what we've

seen in COVID is a surge in bushmeat trade and that's - so we have to deal with that, we have to take care of those communities so that we can have a

balanced ecosystem.

The other of course is ignorance and what you're doing right now talking about it is really helping in eroding that ignorance. If we know that

something is wrong, then we have to be bad to continue doing it.

And the last thing, of course, is greed. And there's no accounting for the capacity of people to do bad things, even though they know it's wrong. But

at least we can call them out. And I think what was gathering and those pledges doing is focusing attention on knowledge more than anything else.

As long as people are talking about it and engaging, we're hopeful.

B JOUBERT: And we really hopeful that after COVID we see that there is a mindset already. People are starting to understand that we could be moving

towards the next pandemic and we're not even out of this one. And I think what we need to understand as Dereck was talking about the bushmeat trade,

the bushmeat trade really is what started 10 years ago, we had SARS and then MERS and then, of course, Ebola.

And now we all know that bushmeats is devastating to human health, if it is done in the way of keeping animals in captivity like in the wet market in

Wuhan, which really was the starter through pangolin to create the coronavirus. And so what is troubling us right now is that even through the

bushmeat trade right now, through six months of lockdown, pangolin have being poached at an alarming rate in almost every single country in Africa.

But they're not only being poached for this scale, they're also being moved as live meat to be able to consume. And so I'm troubled by the

senselessness of that's not waking up to the fact that it's not the right thing to do right now and it's a selfish thing to do, because whoever is

responsible for these 10 years hunt that's hurting a global population and the planet at the same time.

D JOUBERT: We've got to learn that we can't keep doing the same thing and having this rather toxic relationship with nature and the trauma and expect

to have a different outcome.


AMANPOUR: Well, obviously, there are so many allies of yours and leaders in the field like Sir David Attenborough, he just did a program 60 Minutes

in which he was talking about his new film, which is really about sounding the alarm. Let me just play a little clip of it and we can talk about it.


DAVID ATTENBOROUGH, ENGLISH BROADCASTER AND NATURAL HISTORIAN: The way we humans live on earth is sending it into a decline.

Human beings have ever run the world. We're replacing the wild with a tame. Our planet is headed for disaster.

ANDERSON COOPER, CONTRIBUTOR, "60 MINUTES": You call the film 'a witness statement'. A witness statement is given when a crime has been committed.

ATTENBOROUGH: Yes, well, a crime has been committed. And it so happens that, I'm of such an age that I was able to see it beginning.


AMANPOUR: So it's really interesting, as he says, I'm of such an age that I can see it now. And he speaks out more deliberately on this issue than

then he used to do. So we've talked about why biodiversity matters and how many targets have been missed, but I want to ask you to maybe just look at

if it's true that there's some potentially positive stories.

So I mean, for instance, in Africa some of the rhino populations have been reinvigorated. And in India, they return the tigers to the wild. Where do

you see areas of optimism, things that work that others could copy and emulate?

D JOUBERT: Well, most definitely, so there are a couple of projects that we've been involved in our empire labs and one is through National

Geographic with the Big Cats Initiative. We most certainly leaned forward and started to save big cats and we have a number of projects, I think, 150

projects across 28 countries and have saved 4,000 odd lions in that time.

Within that, I'm somewhat hopeful because the vast tracts of land in Africa, at least, that are uninhabited by man and so we can reclaim that

land, as long as we don't destroy it and eradicate everything. We also got involved in those rhino projects.

B JOUBERT: So we created a project at least four years ago called Rhinos Without Borders. And the main goal was, let's try and create a population

somewhere else where they're not being targeted. In South Africa, there was poaching at such an alarming rate. So we managed to relocate after speaking

to both government, relocate 87 rhinos.

And it's been an incredibly successful project, because they're out in the wild running free and we've now had 50 babies, 50 calves born. And so we

always are hoping. I think Rhinos Without Borders is such a powerful one to say, we can all make a difference. We just have to come up with innovative

solutions. But definitely killing an animal is not a form of conservation, keeping animals alive in Africa like a rhino for 35 years, it's bringing an

incredible economy to the country, because it really is a $50 billion tourist industry coming into Africa.

Of course, with COVID, that is now gone away completely and that has given us a set of other challenges.

D JOUBERT: I think we spoke early (inaudible) ...

AMANPOUR: Let me just ask you last question, sorry. Sorry, I can't - the technical difficulties are a little difficult. I want to ask you a last

question that you have seen firsthand the dangers of this kind of work, the story of you both getting wounded and particularly you, Beverly, by that

buffalo three years ago is really dramatic. You nearly didn't survive, right?

B JOUBERT: That's absolutely true. In fact, I get a little bit of a heart palpitating when you say that. Yes, that is true and Dereck said I died

three times in his arms and had to bring me back. But it was a precaster that I wouldn't want everybody to be fearful of Africa. And in fact,

there's similarities to what happened to us to what is happening to the planet.

And I think because both Derek and I are sitting here, we feel that we can bounce back if we only create the change. But to give you a quick idea, a

buffalo came charging out of the darkness. We were just moving from one tent to the other, and connected Derek and I, it was his birthday and he

then connected to Dereck and I and went between us.


But he's horn went up into my armpit through my chest, collapsed my lung and then right through the neck continued into the cheekbone and my face

was completely smashed. I had a 27 broken bones.

AMANPOUR: Incredible.

D JOUBERT: Yes. But what it teach us is that if you go through that and you mark it, you watch the woman you love dying in your arms four times

through the night and survive, you come out of it with a hope and an invigorated mission to change things for the better and not waste a single


AMANPOUR: Well, that's an amazing lesson to learn. I've just such a difficult and dangerous moment. Dereck and Beverly Joubert, thank you so

much for joining us.

Now, numbers and measurements can often be shocking. So how about this one, the global coronavirus death toll is about to hit 1 million. In the United

States alone, it has claimed over 200,000 lives and that's the worst hit. A new study says that in America, black and Latino people are twice as likely

to test positive as white people.

Our next guest has explored this disaster writing an article in The Washington Post called 'The racist history that explains why some

communities don't have enough ICU beds'. Well, that headline tells it all.

George Aumoithe is an Assistant Professor of Global Health at Stony Brook University in New York. And here he is talking to our Michel Martin, about

the history of America's health care policy.

MICHEL MARTIN, HOST, AMANPOUR: Thank you, Christiane. Professor George Aumoithe, thank you so much for joining us.


MARTIN: You've just written a fascinating piece for the Post that I'll just start where you started. I mean,, obviously, many Americans have

become aware that the number of deaths in the United States per capita far exceeds that of other countries, so similarly developed countries, I think

many Americans have become aware that black Americans and other people of color have been disproportionately harmed.

And you say that this should cause outrage, but it should not come as a surprise. And the particular thing that you point to is the lack of ICU

beds in low income communities. There are many communities low-income communities that have no intensive care units at all. And I think that that

might come as a shock to people given that we know that many people who live in poverty tend to have more chronic health conditions, often don't

seek medical care until they're already in an acute sort of state. So how did this happen?

AUMOITHE: Well, Michel, the answer is actually quite straightforward. If you take a look at the policies, beginning in the '70s, during the

inflationary crises that beset cities like New York City, as well as the nationwide economy, there was a turn towards economizing. And the idea that

health policy experts had at the time was that a traditional occupancy rate of around 75 percent was falling down to 60 percent and that this was a

sign that there were too many empty hospital beds that this was wasteful spending and that the organization of care could be rationalized.

So what began to happen, particularly after the formal desegregation of these facilities was this logic that because we no longer had white only

and colored hospitals, that fewer hospitals were needed, bad hospitals could be consolidated, that specialty care could be concentrated. The

unfortunate result of this policy though, was to remove specialty care from a lot of inner city and rural hospitals and to place them closer to suburbs

were majority populations were moving to and commuting away from into the city.

So the idea was even though these inner city hospitals once had ICU beds and had obstetrics and had cancer care, why not just leave the emergency

services and the outpatient services where they're needed and allow anyone with chronic conditions to travel a little further to a newer facility that

had a sort of concentrated range of services.

And so over time from the 70s through the present day, even through the AIDS epidemic, even through major disease crises, policymakers continued to

pursue this economizing, this concentration of resources under the logic that it would save more money. And today we have 50 percent of people in

low-income communities without any ICU beds.

MARTIN: Fifty percent of people in low income communities have no ICU beds at all. Now, I think people who are minimally educated about racial history

in this country know that segregation was a fact of life and that some communities, that black communities always had inferior facilities or fewer



At some point that changed, the hospitals were desegregated under the law. So this sort of concentration of specialized care in these suburban areas,

which just tend to be less integrated, tend to be more white, was that intentional? I mean, was it intended to deprive these communities of this

kind of care or was it the unfortunate byproduct of a race neutral point of view?

AUMOITHE: Right. So that's sort of the difficulty and comprehending the history and, perhaps, the element that is most surprising is this idea of

intentionality, this idea that there's sort of racist animus behind these policies. But when you look at the health policy literature, this was

actually kind of across the board assumption that infectious disease was on the decline, that chronic disease was on the rise, that inpatient acute

care, so staying in a hospital getting cared for was more expensive than just giving someone a drug and following up with them outside of the


So all of these assumptions about the quality of care were undergirding the shift. With that said, it can't be disconnected from the era of

segregation. In fact, the very law that the federal government passed in 1946, the hospital modernization and reconstruction act commonly known as

Hill-Burton, allowed and actually wrote into statute the Plessy v. Ferguson doctrine of separate but equal.

So that 1896 doctrine was allowed to be written into this 1946 law. What was equitable about Hill-Burton was that it included a clause that mandated

that funding could not be concentrated in any one geographic area. So a suburb would get the first grant and then when it rolled over, it would go

to a rural area and then when it rolled over it'll go to the city.

So this actually allowed the United States to build over 6,000 healthcare facilities between 1946 and 2000. But Hill-Burton also changed a lot. And

by the time you get to the Civil Rights Act, and you get to the desegregation drives by the Health, Education and Welfare Department at the

time, by the early '70s, desegregation was achieved.

So the whole doctrine of intentionality of being intentionally racist that was at the core of civil rights law and at the core of the federal

government's mission to desegregate these hospitals was, in many ways, solved. We no longer had segregated hospitals. But when the economic crisis

of the '70s hit, this opened a new window to take away that equitable funding around Hill-Burton and to concentrate it.

And so with the National Health Resources Act of 1974, the federal government for the first time changes this funding structure and allows

municipalities to concentrate that funding into a lesser areas, but with more flexibility.

MARTIN: So what happened, as I'm hearing it, is that actually some of these early sort of funding mechanisms improved health care across the

country, because it poured resources into hospitals both in cities and in suburbs, emerging suburbs and rural areas. It probably lifted the quality

for everybody.

AUMOITHE: Absolutely.

MARTIN: Even though it was segregated, but then subsequently this sort of drive to concentrate the funding, move those resources out of areas where

most people of color live, particularly black people. Does this arise from kind of racist thinking or does this arise just from an overall philosophy

around health care that is just different in the United States than in other countries with resources? I mean, one of the things that you point

out in the piece is that the United States has just 2.9 hospital beds for a thousand people compared to 3.1 in Italy, 4.3 in China and 13 in Japan, why

is that?

AUMOITHE: I think that's an important question, Michel. And I think that we have an unfortunate tendency in our thinking to separate questions of

race from questions of class. When you go all the way back to the New Deal, there was no exclusion formally in the law of black people from the New

Deal. What there was, was an exclusion of every domestic and agricultural worker 90 percent of whom were black.

So there were already, from the inception of social security in this country, exclusions carved out on the lines of occupation, which just

mapped onto race. So again, if you're searching for intentional animists, you're more likely to find it in the 40, the 30s, 40s up to 60s than you

are after the sort of formal legal victories of the civil rights movement.


And what you see in this country is a turn towards the market and towards a private accommodation for care. So this assumption that particularly after

the fiscal crisis in the '70s, cities just don't need to be in the business of providing care, private voluntary hospitals can provide that care. And

we have a strong tradition of that Catholic and Jewish hospitals, publicly serving hospitals that serve a poor or working poor people or underinsured


But it leaves a lot to charity, rather than a sense of right to health care and that is the biggest distinction between our country and other similarly

situated industrialized countries is that per capita, we do spend more on health care provision, because we insure it, we rely on private insurance

to deliver that right and we rely inordinately on private hospitals to deliver that care.

MARTIN: This kind of under resourcing affects people who live in very different places, rural areas, for example, what happened there? I mean,

you could argue that under sort of our constitutional system, rural areas have more political power that you would think that they were given their

populations. So why are they experiencing the exact same thing?

AUMOITHE: The biggest, I think, explanation for the lack of resources in the rural south, goes all the way back to the mid 19th century, the Civil

War. When you have the emancipation of enslaved persons and the complete destruction of the industrial capacity of the south, the South became very

poor, relative to the north and other parts of the country.

So over these years, the redevelopment of these regions of the country, the South in particular, so economic redevelopment took precedence over any

sorts of welfare right. And I argue that this has an impact through today, even though the south can be seen as economically recovered in many ways.

It's growing in terms of population in many ways, places like Charlotte, our major banking centers, it hasn't translated in the same way into

municipal right in places like New York or Chicago, mainly because labor rights, people's right to organize and to demand basic human rights and

health care rights have never gained traction in the south the way that it did in places like New York.

MARTIN: This is so fascinating, because part of the point that you make is that civil rights law hasn't really applied here, in part, because race may

be at the core of it, but it really overlaps more with income. And your ability to kind of negotiate for yourself based on income, which is why

people in sort of rural areas, whether they're white or black are facing the same kinds of issues as people who are low-income cities.

So talk about the current sort of moment, if you will, health care, access to health care continues to be one of the organizing kind of arguments of

the political moment. How do you see it playing out?

AUMOITHE: We have a problem of racial resentment, an idea that programs like Medicare and Medicaid are welfare medicine programs that only benefit

black and brown people. When, in fact, a majority of poor white working class people rely on Medicaid. And so, there's a whole issue around the

ways in which Medicaid has been portrayed and vilified and stigmatized that really needs to be reckoned with.

I see two main things, obviously, this current administration seeks to repeal and 'replace', there's not been very much detail about what to

replace that with. But they certainly want to repeal and return on health care provision for the market, towards a model that existed before

Obamacare. Whereas the Biden campaign seeks to restore Obamacare and re- establish Medicaid as one of the main central planks for providing that care to people.

When it comes to Medicaid, Medicaid expansion is super important. But southern states in particular have been highly reticent against expanding

Medicaid, mainly because unlike Medicare, which is 100 percent funded by the federal government, Medicaid is a state federal government cost sharing

agreement. The one bright spot, though, is a recent voter referendum in Missouri where voters there voted to expand Medicaid finally, against the

wishes of the prevailing governor there and the legislature there.

So there are certain routes, if populations are organized enough to achieve something like Medicaid expansion.

MARTIN: Can I clarify something from you that just - say this again.


MARTIN: You said that the majority of poor, lower income white working class people use Medicaid.



MARTIN: Does that also mean that white people are the majority of people on Medicare?

AUMOITHE: Absolutely. Yes, absolutely.

MARTIN: I would imagine that most people don't know that. You're saying the majority of people who use Medicaid are white.

AUMOITHE: Yes. It's connected to the same obfuscation that occurred, for example, in the Reagan years, when Reagan accused for mothers, for black

mothers, in particular, as being welfare queens. This whole discourse, really distorted people's perception of who uses public benefits. You get

strange permutations like white working class voters in Mississippi saying, I want the government to take its hands off my Medicare.

MARTIN: Don't they know they get their health care that way? I mean, presumably, they know that that's how they get their health care, right? I

mean, do they not know that?

AUMOITHE: You would think, but it just points to how much public benefits have been racialized in this country, how they've been described as just a

entitlement for black people, brown people and even now immigrants.

MARTIN: I'm still sort of puzzled by why we have such a different view of this than other countries in the world that are similarly resourced. This

is a very wealthy country and it's also a country that highly values work. Is it really the case that people don't see the connection between being

healthy and being able to work that people who have chronic health conditions, people who don't have access to care, it's very hard to be

productive when you're sick.

AUMOITHE: We don't see it for one main reason, it's because we do not have a Labour Party in this country.


AUMOITHE: And without a Labour Party, you're not going to get health care and you're not going to get a lot of these associated benefits.

MARTIN: I think most people know that something is not right.

AUMOITHE: That's right.

MARTIN: And you don't have to be, I think, particularly low-income to believe something is wrong. Are you really saying it's just because there's

no political party that specifically focuses on this and that's why it doesn't change?

AUMOITHE: Yes. I think that's really a really key part. I think the Democratic Party around the New Deal coalition got about as close as this

country's ever gotten to providing a sort of universal right to health care. But again, because domestic workers and agricultural workers' wages

were not counted as a contributing Social Security, they didn't qualify for a lot of these benefits and those workers were mostly black people. So we

really need to grapple with the continuing legacy of racism in the law, and in the policy, because it really has structured, the very boundaries around

who is included and under a right, who's seen as deserving of right. And because we prioritize work, certain kinds of work, rather, and that really

shapes the legacies of who can have access to these programs.

Another important point I'd like to bring up is that the designer of the Medicare program actually designed the Canadian program. So the National

Health Insurance Program in Canada is Medicare for All. It's just that in this country, there was a calculation to just restrict that entitlement to

those over the age of 65 and Medicaid was actually an afterthought in the legislative drafting process.

So we need to realize when we look at history that because healthcare hasn't been organized as a right for all people, regardless of race and

regardless of class that it's highly contingent upon where you live and it's highly contingent upon the sort of political economy of the federal

government. So you see when you look at this issue over time, expansion and contraction.

So it's not a given that a law like the ACA will forever guarantee coverage for those who aren't employed or for those who lie just above the official

poverty line. It's very much incumbent upon local people organized in institutions with leverage and power on politicians and policymakers to

ensure that was right stay.

MARTIN: Professors George Aumoithe, thank you so much for speaking with us.

AUMOITHE: Thank you so much, Michel.

AMANPOUR: And health inequity and inequality is a massively important subject to continue investigating.

And finally, on democracy and voting, 10s of thousands of people continue to march in Minsk, the capital of Belarus for the eighth consecutive

weekend to protest what is widely accepted as a fraudulent vote count in the Presidential election. There was tear gas and mass arrests as Alexander

Lukashenko's police force crackdown on protesters.


Last week, he was sworn in for a sixth term. He sat more than 26 years already, but the ceremony was unannounced and unusually low key as Europe

struggles with how to punish him, the French President Emmanuel Macron is taking a stand for democracy. He says he's going to meet with the exiled

opposition leader, Svetlana Tikhanovskaya, tomorrow.

And during talks with Vladimir Putin, he made clear that Europe's last dictator would have to go and respect the legitimacy of the ballot box. How

did Putin respond? I would have loved to have been a fly on that wall.

That is it for now. You can always catch us online on our podcast and across social media. Thank you for watching and goodbye from London.