The MacNeil/Lehrer NewsHour

Intro JIM LEHRER: Good evening. Leading the news this Wednesday, Iran said it was releasing U. S. reporter Gerald Seib. The Senate voted to override President Reagan's clean water veto. And America won back the America's Cup. We'll have the details in our news summary in a moment. Robin? ROBERT MacNEIL: After the news summary, our major focus are the proposals that applicants for marriage licenses and life insurance be screened for AIDS. We discuss both the need and the ethical and constitutional objections. Then we have a documentary view from Iraq's side of the war with Iran. Finally, essayist Anne Taylor Fleming describes the conflicting emotions raised by the surrogate mother trial. News Summary MacNEIL: Iran today ordered the American reporter it had accused of spying expelled from the country. The Islamic Republic News Agency said the reporter, Gerald Seib of the Wall Street Journal, would leave the country tomorrow. Seib was handed over to the Swiss embassy in Tehran. He was detained on Saturday and accused of being a spy of the Zionist regime. Iran's Prime Minister Hussein Musavi said, after being questioned, the issue has been clarified. State Department spokesman Charles Redman had this comment.

CHARLES REDMAN, State Department spokesman: We've seen reports from Tehran -- the same Tehran radio reports that are available in the media -- that the Iranian prime minister has stated in a press conference February 4 that Gerald Seib is to expelled from Iran. We've also seen wire reports that he has been expelled. In both cases, we await confirmation of these reports through diplomatic channels. We're staying in closest contact with the Swiss government in that regard. MacNEIL: Seib's family in Hays, Kansas, was reported elated but reserved until they knew he was definitely releases. In New York, Iran's ambassador to the United Nations said his country would help free U. S. hostages in Lebanon when the U. S. stopped being hostile and returned Iranian assets.

SAID RAJAIE-KHORASSANI, Iranian ambassador to U. N. -- will come only when the animosity of the United States comes to an end and only when the United States is prepared to reciprocate accordingly. It means that what they owe us must be returned to us, and it is a very legitimate demand. MacNEIL: The White House tried to dampen speculation about why the administration has put such large naval forces near Lebanon. A third task force carrying 1,900 marines left Spain yesterday to join 21 warships patrolling in the Eastern Mediterranean. A few of the smaller ships have moved 50 to 100 miles from the Lebanese coast. White House spokesman Marlin Fitzwater urged reporters not to speculate about possible military strikes. He said, ''The forces are there to protect our strategic interests and to support our friends in the region, but we would not urge you to jump to any conclusions about any military activities. '' Jim? LEHRER: The Senate made it unanimous on the clean water bill today. It voted 86 to 14 to override President Reagan's veto of the $20 billion bill. The number was considerably more than the two thirds needed. The House voted the same way yesterday, so it means the legislation becomes law, despite President Reagan's strong opposition. Today's Senate debate, like yesterday's in the House, showed the President's position had few supporters from either party.

Sen. JOHN CHAFEE (R) Rhode Island: This is a strong environmental bill. It's a fiscally responsible bill. And it lives up to our national goal of making the nation's waters fishable and swimmable. Sen. STEVEN SYMMS (R) Idaho: Don't be intimidated by the argument that if you vote against this bill, you're voting for dirty water. You're not. You're voting to help clean out the polluted budget process of the United States government. Sen. GEORGE MITCHELL (D) Maine: This legislation has strong public support. Why, then, did the President veto the bill? He called it a budget buster, pork laden. And he called the non point provision of the bill federally controlled and directed. The President is wrong. The bill is none of these things. LEHRER: On the federal pay raise story, there is more confusion to report. Both the House and the Senate today, by voice votes, passed resolutions to rescind the raises for themselves and other high level federal officials that went into effect at midnight last night. There is confusion, because no one knows for sure if the repeal action is legal. Congressional leaders said the issue will probably have to be resolved in the federal courts, whose judges were among those who got raises at midnight. During today's House debate, several congressmen criticized their colleagues for not voting on the pay raise before last night's deadline.

Rep. ROBERT SMITH (R) New Hampshire: The hypocrisy is unbelievable. Yesterday, we had the opportunity to vote up or down. Never mind whether you feel we deserve the pay raise or not. That's not the issue here. The issue here is, are you willing to stand up here and say, ''Yes, I deserve it,'' or ''No, I don't,'' like you do on Social Security, like you do on defense, like you do on environment, like you do on education, and like you do on everything else that the American people have to deal with. The answer is no. You didn't have the courage to do it. Rep. WILLIAM FORD (D) Michigan: It is clear that the deadline for congressional disapproval of the President's pay recommendations expired at midnight last night, February 3. Since the House did not act by that deadline, what we do today with respect to that language in the amendment is meaningless. MacNEIL: Attorney General Edwin Meese clashed today with Democratic liberals now in charge of the Senate Judiciary Committee. They criticized Meese for budget cuts and infighting among agencies in the war on drugs, for watering down protections for accused persons, and for backtracking on civil rights. Senator Edward Kennedy led the attack.

Sen. EDWARD KENNEDY (D) Massachusetts: Tax credits for segregated schools, opposition of the Voting Rights Act, resistance to the Martin Luther King holiday bill, the assault on the Civil Rights Commission, relentless hostility to affirmative action, nomination of racists to the federal courts. I'm not accusing the administration of being responsible for racism in our society, but I am accusing them of creating the climate that encourages discrimination or repudiates opportunity. Howard Beach, Forsyth County, are happening on your watch. EDWIN MEESE, Attorney General: Most of the things that you've said in your political diatribe, you are just flat wrong. But I don't have the time to go into detail, probably, to answer all of those without unduly infringing on the time for other members, but I will be happy to answer those points specifically in writing for the record, because there were so many inaccuracies and misstatements of fact. LEHRER: Also in Washington today, a former secret police officer from Chile made an unusual admission. Armando Fernandez Larios pleaded guilty to being an accessory in the 1976 car bombing death of former Chilean Ambassador Orlando Letelier. Fernandez resigned Monday as a major in the Chilean army and a member of its intelligence corps. He then came to Washington to enter his guilty plea, saying he felt remorse over his role in the Letelier killing. Letelier died with a remote controlled bomb exploded in his car as it drove down Washington's embassy row. Ronni Moffit, an associate of Letelier, also died. Fernandez will be sentenced April 6. He could be imprisoned up to ten years. MacNEIL: The America's Cup will be coming back to the United States after a three year stopover down under. The American yacht Stars and Stripes surged across the finish line in Fremantle, Australia, today in the winning time of one minute and fifty nine seconds. It was the fourth straight victory for the American vessel over Australia's Kookaburra III, and it allowed skipper Dennis Conner to reclaim the 136 year old America's Cup helost to another Australian contender just over three years ago. The race was beamed to this country at an hour when most landlubbers are asleep. That didn't stop members of the San Diego Yacht Club, home port of the Stars and Stripes, and many other U. S. television watchers from being in at the finish. And the victory had an added finish for Conner's supporters. He was the first American to lose the cup to a foreign challenger after the New York Yacht Club had held onto it for 132 years. LEHRER: And finally in the news, Liberace, one of America's more flamboyant performers, died today in Palm Springs, California. The 67 year old entertainer had been seriously ill for several weeks with what a spokesman said was anemia, emphysema and heart disease. MacNEIL: That's the news summary. Coming up, proposed AIDS tests for marriage licenses and life insurance, Iraq's view of the war with Iran, and ambivalent thoughts about surrogate motherhood. AIDS Test Controversy LEHRER: There is a new uproar about testing for AIDS, and it is where we go first tonight. The noise is about the suggestion that the use of AIDS blood tests be dramatically expanded -- that they be given to couples seeking marriage licenses, patients entering hospitals, pregnant women and people seeking treatment for venereal diseases. Officials of the federal government's Centers for Disease Control said in interviews published today, such broad proposals will be discussed at a special two day AIDS meeting later this month. They said they are designed to help find ways to stop the spread of the deadly disease that has already killed more than 15,000 Americans and promises to cause 50,000 or more deaths a year by 1991. But they also emphasized the ideas would be on the table for discussion only, and any CDC action would come only in the form of guidelines recommended to the states for adoption. The discussion has already started, and we pick it up now. First with Kristine Gebbie, health administrator for the state of Oregon and chairman of the AIDS Committee of the Association of State and Territorial Health Officials. She is with us tonight from station KOAP in Portland, Oregon. Generally, first, what do you think of these proposals? KRISTINE GEBBIE, Oregon Health Division: Well, I think they deserve very serious consideration. A couple of them have already been recommended in previous documents. The suggestion that persons coming to venereal disease or sexually transmitted disease centers, for example, be tested for the HIV virus; the suggestion that pregnant women, particularly those who have any possibility of previous exposure, be tested has been discussed. The two that are most controversial and that I think a few public health officials are behind right now are those of testing persons when they come to hospitals for routine care and testing persons at marriage license time. That last one is particularly interesting, because many of us have just spent up to ten years changing existing state laws to remove the required test for syphilis, which had been done for many years but was not useful in finding new cases. LEHRER: Well, what would be the -- excuse me -- what would be the problem in testing -- having premarital tests for AIDS? Ms. GEBBIE: Well, the issue is, you want to test people who are apt to be positive. You're looking for a cut of people where you expect to find a reasonable level of infection. The test, if widely applied to an uninfected audience, is going to yield a fairly high percentage of positives which are actually false positives, and you will have invested a great deal of time and money in your testing program and your counseling program and your follow up program on persons who are not infected. So most of us in public health are looking for some sort of a funnel, if you will, to identify the likely persons who may have been earlier exposed, persons whose behavior puts them at risk, then use the test with those people to find those who are actually infected. LEHRER: And hospital admissions would not be a place to do that either? Is that correct? Is that what you're saying? Ms. GEBBIE: That's correct. Because both of those are simply a cut across the general population. And in most parts of the country, a broad cut of the general population is not going to yield a high percentage of infected people. Infected people are those who have practiced risky behaviors, such as use of IV drugs and sex which is unprotected from the transmission of semen or blood. So persons who are longtime monogamous partners, persons who are not sexually active, persons who have not used IV drugs, persons who have not had blood transfusions or treatment for hemophilia aren't in that pool. And it is not a good use of resources to test them. LEHRER: Now, you have no objection to testing people who seek treatment for venereal disease. Is that correct? Ms. GEBBIE: I think that's an excellent place to use the test, but I want to emphasize that in any case where the test is used, it needs to be done with the informed consent of the tested person. This, as with any medical procedure or test, people need to know what they're getting in for. And the opportunity to do the pretest counseling is a key place for doing education about spread of this disease, even if the person doesn't accept the test. LEHRER: What are they getting themselves in for? Ms. GEBBIE: They're getting themselves in for some information they may or may not want. If the test is positive -- LEHRER: Why would they not want it? Ms. GEBBIE: Some people would rather practice safe sex either way -- that is, they're already informed of the risks. One of the major reasons people don't want to find out about this test is that they don't want records kept about it, because of their fears of the potential discrimination. Other people just say, ''I'm taking my chances. Don't tell me this. '' They don't perceive themselves at risk, and they don't see that the test would be useful. LEHRER: I think we need to make -- we need to clarify something. This test does not say this person has AIDS. What it says -- it has -- the person may have the AIDS virus, right, that may sometime develop some years down the road into AIDS. Is that correct? Ms. GEBBIE: That's correct. It only tests for antibodies to the virus. We presume, however, from everything we know, that that means the person is infectious -- that is, capable of transmitting the disease to others and, therefore, needing to practice safer sex practices, make decisions about protecting other people. LEHRER: Infectious, even though they may not have it themselves. Is that what you mean? Ms. GEBBIE: That's correct. They're a symptomatic. They may have no clue that they have the disease. But they are a potential of being a danger to others. And some percentage of them -- perhaps as low as 20%, perhaps as high as 50% -- may at some point develop AIDS or AIDS Related Complex. LEHRER: All right, the other category that's been mentioned is pregnant women. What's your feeling about that? Ms. GEBBIE: If a pregnant woman has any reason to think she might have been exposed to the virus -- has had sexual partners whose history she does not know, has had -- or some bisexual partners who are infected, or has used IV drugs in the last seven years -- that woman probably should be tested, so that she can enter into delivery knowing the status of her child, because there is a strong possibility that that child may be born infected. Some women, knowing that, might make a decision early in the pregnancy about carrying it to term. I think a more vital group to get to are sexually active women who are not yet pregnant -- those who are at risk of becoming pregnant -- so that, knowing their antibody status, they can make informed decisions about whether or not to bear a child. LEHRER: And how do you get to them, Ms. Gebbie? Ms. GEBBIE: That means getting to those women at sexually transmitted disease clinics, at family planning clinics, through gynecologists, through family practitioners who see young women who are sexually active -- anyplace where women who are sexually active come to seek advice, counseling and physical examination. Persons should be prepared to explain about AIDS and HIV infection, to tell them about their potential for infection and, if they're infected, to offer them the test. LEHRER: All right. Ms. Gebbie, thank you. We'll be back. Robin? MacNEIL: Now we have the perspective of a man who has written and lectured widely on the ethical implications of the AIDS epidemic. He is Ronald Bayer, co director of the AIDS Project at the Hastings Center, a think tank in Hastings on Hudson, New York. Mr. Bayer, Ms. Gebbie has been stressing the use of medical resources aspect of how it's appropriate and who it's appropriate to test. What do you think of the kinds of tests that have been discussed from an ethical point of view? RONALD BAYER, Hastings Center: I think the overriding both public health and ethical consideration facing America today is how to interrupt the spread of this lethal virus, with its untold consequences for the next generations. And it seems to me that the talking proposals that have been put forth by the CDC -- at least those that involve premarital screening, the screening of all hospital admissions -- don't address the issue of heterosexual transmission in an appropriate fashion. They in a way present a posture of being aggressive and effective while, in fact, avoiding the more difficult and more long term tasks which lay ahead of us. And those involve methods of getting to the broad masses of the American people to teach them about how to protect themselves from infection by this virus and how to -- teach them how to protect others if they themselves are infected. MacNEIL: In other -- do I understand it correctly? So all those people eminently qualified to meet later this month and talk about these things put on the table by the CDC will be talking about proposals that are posturing and not really seriously getting at the issue. Is that what you -- Mr. BAYER: I suspect that in laying out a range of proposals for discussion in Atlanta later this month, the intention of the CDC was to clear the air. Proposals for mandatory premarital screening have appeared in state legislatures across the country over the past couple of years and have been voted down uniformly. I think because it is recognized that focusing on premarital screening, though it appears to be a reasonable and rational and ethically justifiable way of interrupting the spread of this disease, is, in fact, not the way to do it. MacNEIL: Why is -- let's take that one. Why is it not an ethically justifiable way of trying to control the disease when, for example, it's been commonplace in many states to screen for venereal disease before marriage licenses are issued. Mr. BAYER: Well, as Kristine pointed out, in fact, many states have begun to reevaluate the use of premarital screening -- especially syphilis screening -- because they turn up so few cases. The misuse of public health resources, which are always in short supply, is, in fact, an ethical concern as well. Furthermore, when you make a decision to intrude upon the privacy of individuals, there has to be a good reason for that intrusion. The good reason in the case of AIDS is that it must bear some relationship to the interruption of the spread of this disease. If, in fact, the intrusion upon the privacy of a couple deciding to be married bears no relationship to the interruption of the spread of this disease, then what we have done is, we have intruded upon them. We've forced them to subject themselves to a test without doing very much for the public health. Furthermore -- and I think this is very important -- it creates the illusion that we are stopping the spread of the virus when, in fact, the virus is being spread not at the point just before marriage, but is, in fact, being spread in the hundreds and thousands -- and in fact, millions -- of sexual liaisons that occur before marriage. MacNEIL: Okay. This country faces an almost unprecedented plague, if you like, from the AIDS disease -- certainly unprecedented since medical knowledge reached the stage it is. And it is a direct danger to the public health of this country and future generations. There is a test. The test is a clue to who's at risk and who might, as Dr. Gebbie said, spread the disease. Who are the appropriate groups to use that test on to be most effective in stopping the spread of the disease? Mr. BAYER: The most appropriate use of the test at this point, outside of the context of blood donation centers, is in settings where it is an adjunct to counseling as an adjunct to getting people to alter and modify their behavior in a very profound and in long term ways. The test in and of itself is a technique. The question is, what do individuals do with the information they get as a result of that test? We hope that those who take the test who are uninfected will double their efforts to remain uninfected. We hope that those who take the test and find out they are infected will use every bit of moral fiber to act in ways which will not result in the transmission of that virus to others. That is our only hope. It sounds like a very weak hope in the face of what everyone is characterizing as a major public health crisis of the last part of the 20th century -- a very kind of slender instrument for protecting American society against a devastating catastrophe. I think that Secretary Bowen may have exaggerated, perhaps for political, perhaps for purposes of appropriately alarming us, when he suggested that AIDS may dwarf the plague, which, after all, wiped out half the population of Europe. I think that appropriate targets of testing -- that is, the appropriate populations who should be encouraged to be tested -- are gay men who have not been able to alter their behavior, women who have been exposed -- who may have been exposed through intravenous drug use who are considering pregnancy. I think there are strong reasons to screen prostitutes, both male and female, who are picked up on prostitution charges. There are reasons for heterosexual couples where both individuals have led very sexually active lives to discuss this matter and undergo screening. But since the critical issue is a modification of behavior, not the result of the test, it is critical to get people to come to the test voluntarily, rather than under conditions of coercion. MacNEIL: Thank you. Jim? LEHRER: Ms. Gebbie in Portland, Oregon, do you agree with his list and his prescription? Ms. GEBBIE: Yes. I think he's outlined very well both the critical problem and the groups of people most appropriate to be tested. I can't emphasize enough that issue of behavior change. But this epidemic is clearly preventable if people stop doing those acts that can spread the virus from one person to another. That takes a very great amount of personal introspection and consideration of how I choose to express my affection for other people or what I do for recreation or what I do to get a high or all of those things. And we have not been terribly successful in this country at getting people to change behavior around many other things that are less deadly than this particular disease. We're going to have to do a lot more exploration of how to use our skills in education, counseling, support, to get those changes to happen. LEHRER: If those changes do not happen, do you see somewhere down the line that these broad population tests are going to have to be done -- that the public pressure and the political pressure is going to lead right to it? Ms. GEBBIE: Again, I think there will be a lot of interest in the test. The test looks very good to people. It starts to resemble the magic bullet that we've come to expect for diseases. I think by talking so much about the test, we somehow mislead people into thinking, if we test everybody, that will cause them to change something. Whereas, in fact -- LEHRER: You don't think it will? You don't think it will? Ms. GEBBIE: I don't think the test in and of itself changes much of anything. And if you talk with people who are involved in the settings where the test is provided, it's very clear that the behavior change is associated with the extensive counseling and support before and after the test and that it's only for a percentage of the people that the actual test result is what makes the magic difference. The lure of the test may be something that gets them in the door. And that's why we need to make sure the test is readily available for those groups at highest risk and not divert our resources into pushing the test where virtually the virus currently isn't, because it won't accomplish that. LEHRER: Mr. Bayer, is one of the results of a testing -- an extensive testing program going to lead to isolation and quarantine? Is that the next step? Mr. BAYER: I think that's the grave concern. The grave concern is that the mass use of the test, where there's no real relationship to counseling and the modification of behavior, is the identification of those who are, in the language of some alarmists, the Typhoid Marys of the latter part of the 20th century. Those individuals will be identified and potentially isolated. The calls for isolation and quarantine thus far have really only come from the lunatic fringe of the political spectrum in the United States. There is not a responsible public health official in this country who talks about mass isolation or mass quarantine. Where the issue is raised -- and it's an issue that public health officials talk about privately and where there is enormous concern --is what to do about individuals who are identified as carrying the virus but who continue to behave publicly in ways that reflect a lack of concern for whether or not the virus is being spread -- male and female prostitutes, for instance, who continue to act as prostitutes, despite the fact that they're infected. LEHRER: Let me ask you this, though, Mr. Bayer. You mentioned -- you used the word politics a moment ago. Political, you said -- a particular decision, a particular statement. You used the word alarmist, etc. We live in a real world. How many people are going to have to die -- let's say the education programs and things that you and Ms. Gebbie and others support don't work. How many people are going to have to die before something -- whether it's mass testing and quarantine, isolation, or something drastic -- is going to have to be done? Mr. BAYER: The modification of the course of this epidemic is not going to be affected by Draconian measures like mass quarantine and isolation, even if we could consider undertaking such programs within the norms of a constitutional, liberal democracy. The sheer impracticality of trying to identify and round up close to 2 million people, isolate them, control them -- not for a brief -- you know, people think of isolation and quarantine the way they think about scarlet fever. In the old days, the health officer put a sticker on the door. It was there for two weeks, and that was that. This is a virus that infects an individual and, as far as we know, results in lifelong infection. So when we speak about isolation and quarantine, we have to be very clear. This means lifelong isolation and quarantine -- certainly something that would tear at the fabric of American society, and without, I think, really having a demonstrable impact on slowing the spread of this disease. LEHRER: Mr. Bayer, thank you. Robin? AIDS: Coverage ControversyMacNEIL: Another area obviously affected by the AIDS crisis is the insurance industry. Parts of that industry want people tested for AIDS before issuing health and life insurance policies. But that proposal has met with strong opposition. We have a report now about how one state, Wisconsin, is grappling with the issue. It's narrated by David Iverson of public station WHA in Madison.

DAVID IVERSON [voice over]: Sue Dietz is the executive director of the Milwaukee AIDS Project, a place where the numbers of AIDS cases become people instead of statistics and the costs a financial reality. SUSAN DIETZ, Milwaukee AIDS Project: Insurance or public assistance never pays for all of the cost. It doesn't for anyone -- not just AIDS, but for any kind of illness that's like this. IVERSON [voice over]: The number of AIDS patients continues to grow, and so do the costs. The average bill now stands at $147,000 per patient. And insurance companies are worried about both the mounting number of cases and the mounting costs of potential AIDS claims. Dr. Robert Gleason is the associate medical director for Northwestern Mutual Life in Milwaukee. The company says it has already paid almost $6 million in AIDS death claims and anticipates more. Dr. ROBERT GLEASON, Northwestern Mutual Life: Using the 20% figure, you can arrive at a mortality of 2,600% for simply being an a symptomatic, infected carrier of the virus. Now, some companies around the country have tried to price this mortality. They have looked at this and said, ''What would we have to charge somebody who is antibody positive?'' And we can't do it. IVERSON [voice over]: Northwestern's Gleason is blunt. AIDS patients are simply not a good risk. Dr. GLEASON: When you think you're going to die, there is a wonderful incentive to buy life insurance. You get a fabulous return on your dollar. Unfortunately, the system can not work if that's the way the game is played. IVERSON [voice over]: But insurance companies would obviously like to find a new system. The problem is that right now the state won't let them. Wisconsin, along with New York and Washington D. C. , does not allow insurance companies to conduct tests that would screen out potential AIDS claimants and possibly discriminate against those whose lifestyle puts them at risk. The debate over who pays for AIDS has now come to the legislature. The anti discrimination statute is under review. Insurance companies, along with many legislators, believe a compromise is necessary. BETTY JOE NELSON, state representative: The issue is who's going to pay. IVERSON [voice over]: State Representative Betty Joe Nelson, the new Republican minority leader in the state assembly. Ms. NELSON: Do you want to have a hidden tax in your insurance policy to cover the cost of very severe, long term patient care, or do you want it to be up front -- an issue that the state takes care of? And that's the dilemma. IVERSON [voice over]: Other legislators want to make sure that discrimination against all high risk groups will not occur if insurance companies are allowed to test. DAVID CLARENBACH, state representative: We would like to see Wisconsin's insurance code specifically prohibit any form of discriminatory application of this HTLB3 antibody test. And I don't think -- IVERSON [voice over]: State Representative David Clarenbach, author of Wisconsin's anti discrimination statute. Mr. CLARENBACH: We as a society -- certainly we as a state -- are ill prepared to care for these AIDS victims. IVERSON [voice over]: Clearly, there are problems with public or private support for those who have AIDS. It is only the latest and surely not the last societal question about the spread of this insidious disease. Who will pay? MacNEIL: Joining us now to discuss the problems of paying for AIDS treatment and the question of AIDS testing for insurance, we have Robert Waldron. He's director of the New York offices of the American Council of Life Insurance and of the Health Insurance Association of America. Mr. Waldron, first of all, does the insurance industry as a whole think it should not pay for AIDS treatment? ROBERT WALDRON, insurance industry representative: Oh, not at all. Any of our policy holders who are currently policy holders and who are now putting in claims, we will, of course, pay those claims. The problem with insurance -- especially individual insurance in the private marketplace -- is that you can not sell it to someone after they become ill. If you do that, the system breaks down. And that's been acknowledged all throughout the whole system by politicians who have been dealing with this and by consumerists also. There are other areas in the health insurance and the life insurance system where you do not have to pass a medical examination. MacNEIL: In fact, most health insurance is group insurance, is it not, and there are no medical tests for group insurance. Mr. WALDRON: That's exactly so. MacNEIL: What is the percentage? Mr. WALDRON: About 85% of all health insurance is group insurance. And I would imagine about 90% of the under 65 population is covered by some form of group insurance. MacNEIL: Let's go to the personal -- the individual who wants to buy individual insurance, because he isn't part of a group. Does the insurance industry now, in states other than where it's prohibited, require an AIDS test for health insurance? Mr. WALDRON: Many companies do. We have not surveyed all of the companies, and there are quite a few out there. But many companies do, and most companies feel they have to. Otherwise, they are subject to raids on their funds by people who have already become sick. MacNEIL: And do they refuse health insurance to the people who test positive? Mr. WALDRON: Those who are using the tests, yes. They are refusing it. MacNEIL: Let's move on to life insurance. The industry wants to test people who apply for life insurance -- test them for AIDS. Is that correct? Mr. WALDRON: They want to test for the antibody. MacNEIL: Is that an industry wide policy? Mr. WALDRON: That's the position of the industry. And we've asserted this in any number of settings. Many companies are already testing in those states where it's permitted. The industry feels that if you can not, you are, again, subject to raids by people who are speculating that they're going to die very, very soon. And the test procedure that we're using is not just a simple test. We are using a series of tests. And as has been stated before in the program, if you use a single test on a broad, uninfected, un risked -- or risk free population -- you are going to get a lot of false positives. You can't refuse insurance when -- MacNEIL: So you do three tests to make sure. Mr. WALDRON: We do three. We do two ELISSA tests. And then to confirm the results of that second ELISSA test, we do a western blot test, which actually weighs the antibody molecularly, and it is very, very specific. It doesn't signal positive for anything but AIDS. MacNEIL: Does the industry typically now refuse life insurance to people who test positive? Mr. WALDRON: Those companies that are using the test, they do indeed. MacNEIL: Does anybody grant life insurance to people who test positive? Mr. WALDRON: I don't think so. I have not heard of anyone trying to insure or trying to put a price on life insurance for that kind of risk. We can insure people who are ill or have had illnesses, and sometimes very severe illnesses. We can insure probably people who are seven times less healthy than the standard population. But we can't insure people who are more than 50 times less healthy than the standard population. We're talking probabilities now. We never know who's going to live or die, but we do know how many and when when we have appropriate risk groups. MacNEIL: Are there any places where you are prohibited from testing people for life insurance policies? Mr. WALDRON: We are prohibited absolutely from testing anybody for the AIDS antibody or even testing the immune system in Washington D. C. Nowhere else is there such a prohibition. In Wisconsin, we can test the immune system. While that is not AIDS specific, it nevertheless will tell us who is very sick. If someone's immune system is impaired, they're open to opportunistic disease. And we can do that also in California. Nowhere else has there been a ban passed. MacNEIL: Let's bring our other guests in here. Mr. Bayer, as an ethicist, what do you think of the insurance industry's posture on this? Mr. BAYER: I would like to make a distinction between life and health insurance. I think it's very important. MacNEIL: Let's discuss them separately, then. Mr. BAYER: Let's turn first to the issue of health insurance. The United States and all Western democracies has chosen to insure its population against the cost of illness, to the extent that it does insure its population against the cost of illness, basically through the private sector -- either the blues or other insurance carriers. The insurance industry, therefore, is a private industry serving a social function. It seems to me that to allow health insurance companies to screen individuals for the AIDS antibody as a way of either denying them insurance or of increasing their premiums, perhaps prohibitively, suggests that those who are at risk for developing AIDS must either bear the cost of illness themselves or must become wards of the state -- the welfare system -- after they have depleted all their resources. In a way, that's almost the way we treat the elderly. When they run out of all of their resources in nursing homes, we make them Medicaid eligible. Why is this unfair? Why is this unjust? I believe that all Americans ought to have access to all the health care that they need. And I don't believe that their financial ability should be a barrier to that health care. By allowing insurance companies to discriminate against those who carry -- MacNEIL: But can we bring it to the present? This has been debated a number of times, and so far the political consensus in this country hasn't supported that position. With the situation the way it is now, is the -- what do you think of the insurance industry's posture? Mr. BAYER: The insurance -- by the way, I will say that the insurance industry often says, ''We don't want to treat AIDS any differently -- or HIV infection -- any differently than the way we treat other medical conditions which place individuals at extremely high risk for very expensive illness. '' And I think the industry is speaking truthfully when it says that. I think what the issue of AIDS forces us to confront is a very fundamental question. Ought individuals at high risk for illness be barred from protection of health insurance? MacNEIL: Let's get Dr. Gebbie's position on this -- on the health insurance issue. Ms. GEBBIE: Well, clearly, what AIDS has done is highlight a fundamental problem in our system of paying for illness care. Some way or another, our whole social system pays. And if persons can not pay for it by using a privately purchased health insurance program of some kind, we're going to pay for it through our bills for unpaid hospital bills or through our welfare system. These -- the bills so far run up for AIDS, while they look rather large per patient, are in fact not larger than the individuals run up by very high risk newborns who need multiple surgeries, persons with cancer who have long term therapy. It is the specter of adding somebody new to the groups that are difficult to insure that has forced the discussion and may, in fact, force a change in the social ideas that you rightly point out have not gotten very far in the last 50 years in this country. MacNEIL: And what you're saying on behalf of the insurance industry is, ''Yes, that's going to be the case. We can't --'' you're saying, ''We can't insure without wrecking our system. '' Mr. WALDRON: Wrecking a number of individual companies. The weight would fall unevenly. But I would hate to be placed in the position -- MacNEIL: And the cost will have to go onto society is what you're saying. Mr. WALDRON: No, not necessarily. There are ways of sharing these costs differently. Everyone is going to have to pay, obviously. The insurance business is going to be paying through its group mechanisms and going to be paying very dearly. The life insurance business also has a group system. MacNEIL: Are people -- excuse me. I keep interrupting you, but thoughts occur to me. Are people who -- the great majority of Americans -- employed Americans who are part of group health insurance plans -- are those plans and their benefits going to change as a result of AIDS disease? Are the costs of those plans going to go up? Mr. WALDRON: The costs of those plans are obviously going to go up. Are they going to change? That will be a matter of choice by employers when they start to get pressed up against the wall by these things. But it hasn't happened yet, and we don't expect it will happen in the very near future. Excuse me. I do wish I could finish this point. The point is that there are systems for sewing up the seams in this plural system of health insurance that we have -- government takes care of some of it, the private sector takes care of most of it. And there are other types of plans that can be brought into play. It was mentioned before about the elderly and long term care. Well, we support mechanisms that would make things happen for that very uncovered area. There is talk about risk pools in states that would cover all of the uninsurables, including AIDS patients, provided those risk pools would share the assessments they would need equally among all of the payers. Otherwise, in a competitive society, one of those payers is going to take it in the neck and go down the drain, and we think it might be us. But we'll support risk pools if they can be made -- MacNEIL: Can you make your point briefly? Mr. BAYER: I think one of the things to point out is about half of the American workers are employed in so called self insured systems. That is, the employer himself pays the full cost of whatever health benefits he provides to his workers. That means that every employer in such a situation has an interest in not hiring an individual who might stress the benefit plan. MacNEIL: We have to leave this discussion there. We will watch with interest what happens at the conference of the CDC. Dr. Gebbie, thank you for joining us. Mr. Bayer, Mr. Waldron in New York, thank you. We asked the CDC to be with us tonight, and they declined. Iraq: Nation at War LEHRER: The Iran Iraq War is still the war that never ends, and information about it is still as hard to come by now as when it started six and a half years ago. But in recent weeks, both Iran and Iraq have allowed Western journalists in to have a look at their respective home fronts. Our update report tonight is from Iraq. You should know it had to be cleared by Iraqi censors. The reporter is Sheila MacVicar of the Canadian Broadcasting Corporation.

SHEILA MacVICAR [voice over]: In the markets of the old city of Baghdad, there are few visible signs of a seven year old war. Soldiers may patrol the street, but here, several kilometers from the main battle zone in the south, they are relaxed. That doesn't mean the war is forgotten. Even men above the age for conscription say they too would go to fight. If his country wants him, he says, he would close his antique shop and join the army. Everywhere, there is talk of the war with Iran -- a war the Iraqis say is a just war. IRAQI [through translator]: We are thinking about the war, because we don't like the war. But we are part of this country. MacVICAR [voice over]: The Iraqis know that there are reports of shortages in Iran. But here, the shops are full. There is lots to buy and, most importantly, still plenty of food. Some things aren't available, but the Iraqi government has made sure that even expensive imported goods are still on the shelves. By itself, that's an impressive but necessary feat for a country caught in a costly, exhausting war. Just 12 days ago, these soldiers were cab drivers, construction workers, shop keepers and students. Now they wear the uniform of Iraq's Popular Army, a paramilitary force first established as a way of involving the people in the development of Iraq's government. Some have already been in Iraq's regular army. Some are now too old for service, some are still too young. This man is 51. SOLDIER [through translator]: Of course, it is my country. I have to defend my country. MacVICAR [voice over]: This 17 year old is eager to be a soldier. ''I want to be a hero,'' he says. ''My mother took me to the Bath Party Office. She wanted me to volunteer. '' What began as a kind of home guard in 1970 is now a serious military force actively participating in front line battles. After nine months at the front fighting side by side with regular army units, these Popular Army soldiers are on their way home to Baghdad. Yes, their commander says, his men did see fighting. But thanks to God, he insists, all of his men are going home safe. In just a few weeks' time, some of these new soldiers could find themselves at the southern front, the most important battle zone of the war. Iraq's minister of information and member of the powerful Revolutionary Command Council says Iran has failed in its main objective to take the Iraqi city of Basra. LATIF NASIF JASSIM, Iraq information minister [through translator]: The Iranian military tactics have failed, and the war slogans to control and end war this year have failed too. And Iran now is defeated both psychologically and militarily. MacVICAR [voice over]: Western journalists haven't yet been taken to the front lines to see the Iraqis' well defended positions. But CBC News was taken to see other victims of the fighting today -- prisoners of war. Neither side will release figures, but it's believed the Iraqis hold about 12,000 Iranian prisoners. [on camera] These are among the youngest prisoners taken in the seven year war. Some were not yet teenagers when they were ordered to the front, then captured. Most say they believe what they were told by the Khomeini government -- that if they were killed, they will go straight to heaven. [voice over] Most of these Iranians say they don't believe that anymore. ''It was a trick,'' he says. ''They cheated us. '' Khomeini made him a prisoner here, and he says, ''I don't like him anymore. '' This prison camp is something of a showplace for the Iraqis -- probably the only prisoner of war camp for child soldiers in this century. The Red Cross inspects it. There are classrooms where the POWs can learn skills -- how to type, how to speak and read another language. Boys who came here as 13 and 14 year olds are now 17 and 18. They have spent four, five, even six years -- for some, their entire adolescence -- as prisoners. This boy is just 14. He was taken from his school in Iran when he was 12 and sent to the front. Older boys say they were given just ten days' training. They barely knew how to fire their Soviet made guns when they were sent into battle. The Iraqis once tried to return some of these children to Iran. The Iranians wouldn't let them come home. No matter how much they miss their families, they claim they won't go back to Iran until Khomeini -- the leader they believe wanted them to die -- is gone. LEHRER: There is a coda to that report. After correspondent MacVicar left Iraq and was away from Iraqi censors, she did this story on Saddam Hussein and his one man rule of Iraq.

MacVICAR [voice over]: His picture is everywhere -- at the entrance to the ruins of Babylon, hanging in shops in the bazaar. Larger than life, the image of Iraqi President Saddam Hussein overseas all that he controls. In his eight years as leader, he has become synonymous with his country and his people. MAY ADNAN, journalist: You love him, and he loves you, so you are one. You are united to him. MacVICAR [voice over]: That's an often expressed view in Iraq, but it's almost impossible to find someone to disagree. The remarkable public affection for Hussein has been gained, at least in part, by extraordinary repression. Per capita, Iraq has one of the largest secret police forces in the world. Public criticism of only a minor official can bring seven years in jail. Criticizing Hussein could mean death. Daily newspapers print only what is favorable to the government, and Iraqi TV features endless songs of praise for their leader. Opposition to the government and the president from groups like the Shi'ite Moslems in Southern Iraq has been dealt with by execution. Iraq's powerful minister of information bluntly says there is no opposition in Iraq. The only opposition, he says, should be against Iran's Ayatollah Khomeini. But Hussein's years and oil wealth have also brought greater prosperity to average Iraqis. There are expensive new housing developments. Campaigns against illiteracy have forced people to learn to read. Education -- especially education for women -- has been improved. And in Iraq, unlike Iran, women are free to choose how they will dress. The enveloping black [Arabic word] is not mandatory. Iraqis see themselves and their government as modern and progressive. Like this mother and daughter, they support the war, because a Khomeini victory, they think, would send them back to the dark ages. Ms. ADNAN: I hate Khomeini. I hate the way he is ruining Iran. Because you feel they are going back to the bad old days, bad old ages. MacVICAR [voice over]: At a medal ceremony in Baghdad this week, Hussein told his senior military officers that if the war continues, Iraq will break Khomeini's head. But Ayatollah Khomeini insists Saddam Hussein must be removed as president before talks can even begin. That is so unacceptable a demand in Iraq, we were not even permitted to ask the minister of information for his response. He would say only that the Iranian conditions for ending the war are stupid and silly. But Alia Izzat was more outspoken. She says it's not something for Iran to demand. ALIA IZZAT, pharmacist: Who put them to think for us? We choose our own leader. We want our own leader. It's none of their business. Whether they like it or not, we will still fight. MacVICAR: Even though the Iraqis will permit no public discussion in the future of Saddam Hussein, Western observers here in Baghdad say they believe what happens in the war will determine what happens to him. If Iraq succeeds in holding off the Iranian forces, if there are no major losses, then Hussein is probably secure. But if Iraq loses or is seen to be on the verge of losing, then Hussein's future will be imperiled, because the Iraqis would rather sacrifice their leader than their country. Second Thoughts MacNEIL: Finally tonight, we have an essay. In New Jersey this week, the custody battle over a ten month old baby called M continues. For the past six months, she has been living with her biological father and his wife, but her surrogate mother has changed her mind about giving up the baby and has gone to court to get her back. However that case is eventually decided, California writer Anne Taylor Fleming is having second thoughts on surrogates.

ANNE TAYLOR FLEMING: When I first heard about surrogate mothering in the late '70s, I thought it was just fine; noble, even; the ultimate act of sisterhood. By that time, a lot of women my age were having trouble having babies -- also having trouble finding babies they wished to adopt. Prodded by lonesomeness and husbands who wished to father, they were susceptible to the idea of renting a womb in another woman's body. It all had an aura of sweetness, of sharing. Some of the original surrogates seemed to have a strange, virginal quality about them, a kind of magnanimous innocence. SURROGATE MOTHER: I don't need to have any more children. I have two. I have a station wagon. I have a dog. I have my own house and my own microwave. FLEMING: True, there was money involved -- usually $10,000, more or less. And yet, they seemed more tickled by what they were doing than by what they were being paid to do it. They carried their wombs for rent like invisible badges of honor. SURROGATE MOTHER: I don't need any more. But I'd like someone else out there to be able to have a baby. FLEMING: So when the trial began in New Jersey, pitting the surrogate with second thoughts, Mary Beth Whitehead, against the Sterns, the couple for whom she bore the baby she was now trying to get back, my sympathies, though stretched, were pretty clear. They were largely with the Sterns, not with the flighty female, the surrogate manque who had not adequately taken the measure of her own heart before agreeing to bear them the child. How dare she now renege, causing all this fuss, all this mess? Hundreds of surrogates have already signed on and yielded up their babies as promised. Why couldn't Mary Beth Whitehead simply do the same? Why did she have to open the whole thing up? Where was the hitch -- her hitch? Was she not adequately screened, not adequately counseled, not adequately steeled against her own maternal instincts? Did I say that? Is that what I meant? Is that what's desired -- to have women adequately steeled against their own maternal tugs, so they can breed for others? As time has gone on, I found myself increasingly unsure, increasingly full of a whole host of questions which, in my initial enthusiasm for surrogate mothering, I simply did not ask. Leaving the surrogate herself aside, what about her husband, who will watch his wife grow large with another man's child? Or the surrogate's own children, who will see their half sibling given away at birth? And what about the effects on the infertile woman herself, whose child will be biologically linked to her husband and some other woman? Conceptual adultery? Procreative promiscuity? Is that what surrogate mothering comes down to? I'm beginning to think so. What I took as the ultimate liberated act of generosity -- having a baby for another woman -- now seems like an un liberated act of biological betrayal which women have been encouraged to commit against themselves. In an effort to be equal, free, grown up, I think we women walked away from our own maternal magic, agreed to barter it away, contract it away, pretending that it didn't matter, that we were tough enough to do it. Mary Beth Whitehead found out she wasn't tough enough after all. And I find as the days go on that I have a grudging but growing admiration for her weakness. LEHRER: Again, the major stories of this Wednesday. Iran said it was expelling Wall Street Journal reporter Gerald Seib. The decision means Seib will be free to leave the country, probably as soon as tomorrow. He was arrested Saturday night and accused of spying for Israel. The Senate followed the House and voted to to override President Reagan's veto of the $20 billion clean water bill. It means the bill will become law without Mr. Reagan's signature. And Stars and Stripes won the fourth and final race against an Australian yacht, returning the America's Cup to America. Good night, Robin. MacNEIL: Good night, Jim. That's the News Hour tonight, and we will be back tomorrow night. I'm Robert MacNeil. Good night.