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Amanpour
Examining the New Hampshire Primary; Interview with "The Disappearance of Shere Hite" Director Nicole Newnham; Interview with Brown University School of Public Health Dean and General Internist Ashish Jha. Aired 1-2p ET
Aired January 23, 2024 - 13:00:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
[13:00:00]
CHRISTIANE AMANPOUR, CNN CHIEF INTERNATIONAL ANCHOR: Hello, everyone, and welcome to "Amanpour." Here's what's coming up.
(BEGIN VIDEO CLIP)
NIKKI HALEY (R), U.S. PRESIDENTIAL CANDIDATE: Running against Donald Trump, and I'm not going to talk about an obituary, just because you all
think we have to talk about it. I'm going to talk about running the tape and saving this country.
(END VIDEO CLIP)
AMANPOUR: The last chance for old style Republicans or a done deal? Political experts John Avalon and Margaret Hoover examine what the New
Hampshire primary means for the whole world.
Then --
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: This is going to lead to real change in sex between men and women.
UNIDENTIFIED FEMALE: Is there any danger in that?
UNIDENTIFIED FEMALE: Equality doesn't seem dangerous to me.
(END VIDEO CLIP)
AMANPOUR: A feminist trailblazer who's all but forgotten now, filmmaker, Nicole Newnham, explores the "Disappearance of Shere Hite."
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: And what that does to patients is that they have to pay a lot more out of pocket, which for a poorer person may become
prohibitively expensive.
(END VIDEO CLIP)
AMANPOUR: How private equity firms undermine America's already dysfunctional healthcare system. Hari Sreenivasan speaks with former White
House COVID official Ashish Jha.
Welcome to the program, everyone. I'm Christiane Amanpour in London. Where here, across the pond and in parts far and wide, people wonder, perhaps
wishfully, whether Haley's Comet can puncture Trump's balloon. Otherwise known as the New Hampshire Republican primary.
(BEGIN VIDEO CLIP)
NIKKI HALEY (R), U.S. PRESIDENTIAL CANDIDATE: When you've got a country in disarray and a world on fire the way we do, you need someone at the top of
their game that can put in eight years that can go and get things back on track. That's what this is about, is making sure that we have the best
person.
(END VIDEO CLIP)
AMANPOUR: That's clearly true, but who? Which GOP candidate would restore stability to a world that looks untethered right now? An isolationist chaos
agent like Trump? Or a self-proclaimed hawk like Haley?
And after tonight, as America faces the prospect of another Trump-Biden face off, we look beyond the polls to critical policy issues at stake. So,
here to guide us through all of this, veteran political observers and sparring partners, John Avlon and Margaret Hoover. Welcome both of you to
the program.
Can I just get a lay of the land from both of you first? There's a sense that the outside world is trying to Trump proof itself. There's a sense
that there's a little bit of dread, you know, after what happened in 2016, and they dare not hope that that he might not win again.
So, what do you think of what we just posed, the question we just posed? Who would be the best for stability around the world in these two last
standing Republicans? Margaret, let me take you first.
MARGARET HOOVER, CNN POLITICAL COMMENTATOR AND HOST, PBS, "FIRING LINE": Look, I've been very clear that Donald Trump's return to the White House
would be both bad for American democracy, for democracy globally, for stability globally, and for all the values that we and our allies espouse
to care about.
I mean, if you just even conceive of the difference between a President Haley on Ukraine and what that means for Russia on, President Xi, Chinese
policy and the future of Taiwan versus a President Trump on the future of Taiwan and China and the future of Ukraine and Russia, these are
dramatically different outcomes based on their posture, how they interact with authoritarians, the things that we've all discussed, Donald Trump says
so flatteringly about Putin and about Xi and about other dictators around the world.
But there's also a market difference in how they would -- a president Haley versus a president Trump would manage the American economy would probably -
- you know, frankly, not make enemies of her political rivals in the United States deal with a budget, deal with a border and immigration crisis.
President Haley would have a very different posture and having actually been an executive of a state, understand how to -- a democratic process is
managed. Unlike Donald Trump, who just says, I got to be an authoritarian because I don't actually know how to work with a legislature.
Just day one. I mean, it's just -- it's remarkable how different these candidates are.
[13:05:00]
AMANPOUR: John?
JOHN AVLON, CNN SENIOR POLITICAL ANALYST AND ANCHOR: I mean, it's a rhetorical question. There's nothing about Donald Trump that says -- that
resonates with the word stability. Like when Tim Scott, senator from South Carolina, endorsed him the other day in New Hampshire and he said, we need
a president who can unite us.
You're paying attention to who you're standing next to? I mean, it's self- evidently ludicrous. What Donald Trump doesn't represent is stability. He doesn't represent an ability to unite the nation. He is a divider. And he
is promising an autocratic second term. He's running on an autocratic platform. And the implications are vast.
I mean, you know, traditionally, New Hampshire has been a place where the fever breaks. This goes back to 1952, Eisenhower versus Taft, where that
Republican internationalist foreign policy tradition really began, fighting off that isolationist wing of the party, which has been basically in place
through Reagan, through both Bush's until Trump.
And, you know, among the many implications of this vote today, because it is a hinge of history, it's one of these trajectory defining things if
Donald Trump wins the nomination, because then there's a possibility, he could be president no matter how deeply unpopular he is among vast swaths
of the American people.
Ukraine. Ukraine would be essentially given away to Vladimir Putin.
AMANPOUR: OK.
AVLON: Autocrats around the world would rejoice. He associates himself with them. Donald Trump loves dictators. You can't overstate enough the
amount of instability, chaos, and degradation of democracy, which would result from Donald Trump being elected.
AMANPOUR: So, to that point, I want to play a few -- a couple of soundbites from Trump and from Haley. But firstly, of course, to your
point, he has publicly praised Viktor Orban, you know, the sort of world example of a liberal democracy. He's a very great leader, a very strong
man, et cetera.
But then this is what he said about how he would fix the world. Here's Trump.
(BEGIN VIDEO CLIP)
DONALD TRUMP, FORMER PRESIDENT OF THE UNITED STATES (R) AND CURRENT U.S. PRESIDENTIAL CANDIDATE (R): So, Russia would have never attacked. Israel
would have never been attacked. The Ukraine the situation is so horrible. The Israeli situation is so horrible. What's happened? And we're going to
get him solved. We're going to get him solved very fast.
I actually said, Ukraine, I know President Putin very well. I know Zelenskyy very well. I'm going to get him in. We're going to get it solved
very quickly. It should have never happened. It would have never happened. Now, you have all that death. Far greater than people understand.
(END VIDEO CLIP)
AMANPOUR: You know, so there's a lot of sorts of fragments of thoughts there, and I just wonder because --
AVLON: Yes.
AMANPOUR: -- you know, people do tend to report what he says, so I just want to, you know, make it clear, you know, he had promised the deal of the
century for Israelis and Palestinians. Obviously, he didn't deliver when he was president. He promised maximum pressure to get an even better deal from
Iran when he pulled out of the Iran deal, that didn't happen. And now, Iran is even closer than ever to bomb.
AVLON: Yes.
AMANPOUR: You know, he ripped up the U. S. being in the climate deal. He called Kim Jong Un a very honorable leader and went all the way over there
to meet him. And now, Kim Jong Un is saber rattling in a really alarming way that people are waking up to all over again.
I guess what I'm trying to ask you is, when Trump says those things, how many people believe that he will fix Ukraine in 24 hours or, you know, fix
the Israel Palestinian crisis?
HOOVER: I would wait for you to say people sometimes don't take him precisely literally, but the problem, Christiane, and we have to point this
out, is that he hasn't gotten the Republican nomination yet. But if he does, he will be grinding against Joe Biden.
And if he -- on the -- and specifically in the context of foreign policy, he has some valid arguments that are substantive arguments to make about
Joe Biden's failures on foreign policy. Joe Biden pulled out of Afghanistan. Many believe that the pull out of Afghanistan indicated to
Russia that the United States wasn't going to strongly stand by Ukraine.
I mean, there's a record that regardless of what he says, which is hyperbolic, often times points to really substantive policy points than
people actually --
AMANPOUR: I can see John twitching there, twitching to get in. Because let's not forget, I mean, you'll probably say this, but actually it's the
Trump plan. I mean, Biden -- it's Trump who gave away Afghanistan, and Biden, you know, many would say mistakenly followed that plan.
AVLON: I think that's exactly right. I do disagree with my Republican bride here on several fronts, beginning with that, with Afghanistan.
I mean, you know, it was the Trump administration that wanted to abandon Afghanistan, that did the deals in Doha, negotiating with the Taliban
exclusively, excluding the Afghanistan government.
HOOVER: That's true.
AVLON: The Afghani government. You know, Trump had to be dissuaded from pulling out abruptly before the election. And so, on and on, we see over
and over again, the record of praising Vladimir Putin at every step, including after the invasion of Ukraine.
[13:10:00]
Praising President Xi on the campaign trail this time, as well as Victor Orban. This is a giveaway to the illiberal worldview. And the people who
believe that he can come in and solve it in 24 hours, I'm afraid, have already drunk that respective flavor of Kool Aid.
There's no evidence to suggest that he can deliver on that. And that's why it's important, you know, to not do this parsing of take him seriously but
not literally or vice versa. Not that you were doing that. But I do think that, you know, you got to have a reality-based assessment rooted in his
results.
What he tends to do when he has really policy specifics rather than just bluster seems to always magically line up with Vladimir Putin's wish list.
And I think do think the 21st century, Joe Biden has gotten this right in addition to strengthening and expanding NATO, and I think restoring a
multilateral consensus, which is obviously under threat, is the divining challenge of our times is democracy versus autocracy.
AMANPOUR: Yes.
AVLON: And the U.S. needs to lead the democracies and Donald Trump is an illiberal person and would give his election, would give a green light to
autocracies around the world.
AMANPOUR: And I'm going to dive into that in just a moment. But first, I want to ask you to pass or not pass -- pass judgment on Nikki Haley.
Because look, Ross Douthat -- I'm always getting his name pronounced wrong. But in "The New York Times." He basically said that Haley is not exactly a
Bush Republican, he means W. Bush, but out of all the candidates, Haley's vision still reminds me the most of Bush's worldview, which at a time of
seemingly unconstrained power set us on a path to our era of crisis and constraint.
So, that is essentially about the Bush reaction to 9/11, the war in Iraq, and et cetera. But then I want to play this from Haley, because she's quite
tough and hawkish on what she might do over China, and China worries a lot of voters. So, let's just play this.
(END VIDEO CLIP)
HALEY: Then we will go and end all formal trade relations with China until they stop murdering Americans from fentanyl, something Ron has yet to say
that he's going to do. And then, we modernize our military.
When we strengthen our military, when we modernize it with the focus of cyber artificial intelligence in space, when we make sure that we have the
backs of our friends, whether it's in Israel, whether it's in Ukraine, and we should be arming Taiwan.
(END VIDEO CLIP)
AMANPOUR: You know, that is quite hawkish. How do you how do you judge that? Because America does not seem to be in an interventionist mood.
They're much more isolationist right now. Is that correct? In terms of the people?
HOOVER: Well, I don't know that I would say that broadly about America. There's certainly a strain within the Republican Party right now that is --
that has emerged in these debates that suggests that we are in, I would say in sort of not a neo isolationist period, but certainly a
noninterventionist period having learned some lessons about intervention in the last two decades.
That said, she didn't talk about invading anyone there. She talked about -- she was frankly representing a peace through strength more Reagan esque
version, which is we need to modernize our military. Frankly, the biggest deterrent to China invading Taiwan is having them be armed themselves and
us frankly having the rebuilt our navy, rebuilt our military, updated, modernized our troops' capacities, capabilities and the technologies that
we need in order to prevent wars from happening.
I think that's -- I mean, that's certainly resonant broadly in the country, even though there is this, I would say, you know, noninterventionist strain
arising on the right.
AVLON: And some on folks in the far-left as well. I think, you know, what Nikki -- that idea of peace through strength, it has been a measure of
bipartisan consensus. Let's separate out the misadventure in Iraq. Because I think we can see that clearly over time.
But what I think Nikki Haley was doing was exactly that, peace through strength. The alternative to that, which you hear folks on the right and
some folks on the far left say, is this -- you know, the goal -- peace is giving Vladimir Putin whatever he wants.
Weakness invites aggression. How many more times do we need to learn that in the course of human history? And multilateral organizations like NATO,
which were created out of the wreckage of the Second World War, have proven their effectiveness time and time again. And we should say very clearly,
and Appelbaum wrote a whole piece about this in "The Atlantic," that a Trump re-election would be designed to undercut NATO, if not withdraw the
United States outright, to weaken its resolve.
Multilateral organizations are dovetailed perfectly with the goal of peace through strength. That's how the international order is established and
secured on liberal principles, classically liberal principles.
AMANPOUR: And just --
AVLON: And that's how it can unite people.
AMANPOUR: -- to remind people that it's actually the Trump MAGA Republicans who are doing precisely the opposite in Congress right now by
not giving --
AVLON: Correct.
AMANPOUR: -- the Ukrainians the weapons they need to face down, you know, the Putins of the world. Well, Putin specifically, and the others who might
take lessons from that.
[13:15:00]
I want to switch a little bit because there's this eternal debate on how the press should cover Trump. So, I was speaking to a very, you know, well
known British correspondent, Emily Maitlis. She was a former BBC broadcaster. And she said the following, she said that, you know, one
really has to keep in mind all the time as a reporter exactly who and what Trump stands for. Here's what she said.
(BEGIN VIDEO CLIP)
EMILY MAITLIS, JOURNALIST: I think all the reporting that we do should come actually from that prism (ph), that he is an election denier. That he
has managed to convince people of the lies that he's been telling for the last three and a half years. That he's using his 91 indictments as a
fundraising tool. And I don't think that any of us can be covering your election, the American elections, without actually starting from that
place.
If that is not a sort of a black cloud across your forehead of everything that you're saying on air, of everything that you're writing and thinking
about, then we're not doing our jobs properly.
(END VIDEO CLIP)
AMANPOUR: What's your reaction to that?
AVLON: I agree. I agree. Look, I think the truth and facts are the North Star of independent objective journalism, not doing moral equivalence on
both sides.
And look, this is a complicated real-time exercise, but we've also had eight years to learn the right lesson. I think journalists should have a
pro-democracy bias. They should have a pro-fact bias. I don't think that's bias at all. That's being driven by real principles.
And I do not think, as a matter of personal belief, that you can cover Donald Trump like any other candidate without amplifying disinformation,
misinformation for fear offending his supporters.
I think you need to be guided by the North Star, of truth and facts and resolute about that. And you need to take all the history of covering this
guy to date and taking him unedited over long periods of time, I think amplifies propaganda as opposed to clarifying and fact-checking in real-
time as much as that's humanly possible. That serves the goals of liberal democracy.
AMANPOUR: I want to play this soundbite and get Margaret's reaction to this because, you know, everybody's -- I mean, on Biden's case for gaffes
and age, but, you know, Trump often makes gaffes, and here's the latest one. You know, about he basically in New Hampshire confused Nikki Haley, it
seems, with Nancy Pelosi. Let me just play this.
(BEGIN VIDEO CLIP)
TRUMP: The crowd on January 6th, you know, Nikki Haley, Nikki Haley, Nikki Haley, you know they -- do you know they destroyed all of the information,
all of the evidence, everything? Deleted and destroyed all of it, all of it, because of lots of things. Like Nikki Haley is in charge of security.
We offered her 10,000 people, soldiers, National Guards, whatever they want. They turned it down.
(END VIDEO CLIP)
AMANPOUR: So, Margaret, after all these years, do you think the press actually focused on that enough?
HOOVER: Well, they certainly could be focused on it more, Christiane, because this has been happening. For people who watch Trump with an eagle
eye, who've been watching him in his rallies, who have been following him closely, this has been happening more and more.
And I think the mainstream coverage of the primaries hasn't picked up on this as much. Part of it is, he hasn't done it in these multicandidate
forums, because he's refused to participate in multicandidate forums.
AVLON: Yes.
HOOVER: So, you know, the things that, you know, CNN and the PBS and the, you know, national news organizations have covered with other candidates,
he hasn't had a major flub in front of others. This was really the first one, I think, that's gotten traction.
But there have been many over the last four to six months, and there will be more. So, as he secures the Republican nomination, if that is what
happens after today and onward past Super Tuesday, I think Americans will be introduced to a newer, older version of Donald Trump that they will have
to then measure up against Joe Biden, who is also older.
And, you know, these are the stakes and these are the candidates. This is what -- this is -- you know, this is sadly what happens.
AMANPOUR: Very last question, because our internationals are going to want to know, our audience around the world. What do you think, is he going to
win? So, we have poll numbers which suggest that, as you mentioned, John, he has problems with GOP moderates and also independents. This is Trump.
And they want to know, what will his court cases do? How will that affect his electability?
AVLON: Well, polls show, including CNN's, that if he is convicted in any of these cases, particularly the January 6th case, but not only that,
remember there are 91 counts he's confronting, that that makes a lot of Republicans sort of say, hold on, we can't nominate a convicted criminal,
we cannot elect a convicted criminal.
And to some extent, Donald Trump is running for president to stay out of prison. But the dynamic that's difficult -- remember he has never won the
popular vote in the United States. The dynamic that's different and difficult is with multiple independent candidates running right now. That
creates an X factor which is impossible to figure out which way the ball bounces in these handful of six to eight swing states. And that's where the
real danger comes in.
[13:20:00]
But I will say, the sort of self-protective defeatism that I think, you know, it creeps into the conversation or the fixation on horse race polling
as opposed to looking at the underlying policies and the stakes of the race, not just this -- you know, the top line, those are the things we need
to keep the eye on the ball.
AMANPOUR: That's what we're trying to do, and that's why we had you. I'm sorry, I'd love -- we'll come back to you, but we're out of time.
AVLON: OK.
AMANPOUR: Margaret, John, thank you so much, indeed.
AVLON: Thank you, Christiane, and thanks for doing everything you do.
AMANPOUR: Now, in the '70s, the 1970s, an American researcher named Shere Hite had a brilliant idea. If you want to understand women's sexuality,
why, ask women. Thousands of women, in fact. The results published as "The Hite Report." It became one of the bestselling books of all time and sought
to revolutionize how the world understands sex.
So, why is she all but forgotten today? A new documentary called "The Disappearance of Shere Hite" asked that very same question. Here's a clip.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: Every woman's going to want to read this, and men should too.
They hated the book. They tried to sabotage it. Keep it down.
UNIDENTIFIED FEMALE: It was sold like hotcakes.
UNIDENTIFIED FEMALE: It's the 30th bestselling book of all time.
UNIDENTIFIED FEMALE: How can you shut somebody like this up?
(END VIDEO CLIP)
AMANPOUR: Nicole Newnham's films include the Peabody Award winning documentary "Crip Cramp," and she is the director of "The Disappearance of
Shere Hite." She's currently a juror at the Sundance Film Festival, and joins me from there for a frank discussion about sex.
So, Nicole Newnham, welcome to the program. You know, apart from the fact that Shere Hite had one of the bestselling books and the most forward-
looking examination of women's sex lives. What made you clock onto her? What made you remind -- want to remind people about her?
NICOLE NEWNHAM, DIRECTOR, "THE DISAPPEARANCE OF SHERE HITE": Well, you know, I discovered "The Hite Report" in my mother's bedside chest when I
was 12 years old, kind of in the place where she would hide things that she didn't want me to see.
And reading the book was really a revelation. It brought me into this world of female sexuality and the voices of thousands of women and their real
experiences, not only, you know, the sort of biological facts of sex, but how women were really experiencing it in a male dominated society.
And the things I learned in that book and the stories I read stayed with me for the rest of my life. So, when I saw her obituary in "The New York
Times" in 2020 and the headline said, Shere Hite, she explained how women orgasm and she was hated for it, I immediately wanted to know who was this
woman. How did she do her work? And why was she hated? And how has she been forgotten? You know.
And so, the film is really an attempt to answer all of those questions.
AMANPOUR: So, I want to start then, by who was this woman? She was clearly a beautiful woman. I mean, just staggeringly beautiful. Everybody, you
know, who saw her pictures could see that. People who met her were mesmerized by her. She was also an incredibly bright, clever woman, who was
trying to do, I think, a PhD at Columbia.
And your documentary has her -- or the narrator quoting how she was dissed from the beginning. Tell me about how that shaped her.
NEWNHAM: Yes. I mean, I think she had this experience of coming to Columbia. She had wanted to be a concert pianist at one point. She had
really huge ambition. And I think she was one of those people who kind of comes into the world and even from a very young age, because we even, you
know, know kind of what she was thinking about as a very young woman.
She was thinking, you know, why are people being oppressed by societal structures and not able to you know, live the best lives they could? So,
she was thinking about patriarchy and she was thinking about race and all of these things. And when she got to Columbia, she realized that because
she came from a humble background and she was this incredibly attractive woman, she was not going to be taken seriously in academics.
And furthermore, that even the questions she was asking about female sexuality were not really on the table for the department that she was in.
And so, she quit. She dropped out of Columbia University and was working as a model and including as a nude model and thinking a lot about the dynamics
of that, culturally. And then she found her way into the feminist movement. And this was kind of like the heyday of the second wave of the feminist
movement. And she found herself in a really intersectional exciting milia in New York City. And she was able to really unpack a lot of what she had
experienced in academics and her modeling career.
[13:25:00]
And really the height report grew out of that. It grew out of consciousness, raising groups and conversations between women and this
incredible kind of creative collective energy that was happening at the time. And that was something that we really wanted to try to bring alive in
the film too, I think, today as women's rights are increasingly under attack, it's important to remember that that kind of collective movement
can really bring about cultural change.
And I think that, you know, the research that was the kind of bombshell that was The Hite Report really did change the world, and it really was
brought about by this determined woman and her colleagues in the feminist movement.
So, let's talk about the bombshells that she brought to the world with The Hite Report. She basically turned upside down what everybody thought they
knew about female pleasure. She talked about orgasm. She talked about masturbation. She talked about, you know, how all of this was different
than what had been produced for the public up until now. All these words that were taboo, that sometimes we even have to, you know, still bleep.
But here's a clip, all the way back all those years ago, when the interviewer uses these words and actually is talking to her about them,
when the report came out. Let's just play this clip.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: At the start of your book you write, masturbation is in a very real sense one of the most important subjects discussed in this
book and a cause for celebration. Would you talk about that?
SHERE HITE, AUTHOR: Well, masturbation is really a cause for celebration because it represents female sexuality undergroun. The majority of women,
even since Kinsey's time, know how to masturbate to orgasm easily, regularly, with great pleasure. So, this shows that women know how to have
orgasms when they want, contrary to the popular stereotype that women have a problem "with sex."
UNIDENTIFIED FEMALE: That's pretty radical stuff for 1976.
HITE: Yes, it was. I looked sort of nervous. Yes.
UNIDENTIFIED FEMALE: Did you feel nervous?
HITE: I don't remember.
UNIDENTIFIED FEMALE: I mean, you were talking about things people didn't talk about.
HITE: I suppose I was nervous, of course.
(END VIDEO CLIP)
AMANPOUR: Nicole, talk about the revolutionary stuff. What was it that she discovered that, for instance, the Kinsey report didn't yet, before her
hadn't said, and before that Masters and Johnson? She took the whole exploration and investigation of women's sex much further.
NEWNHAM: She really did. I mean, there was still this prevailing notion at that time that the majority of women were having orgasms from intercourse.
And the idea was that it was -- even though the clitoris had been targeted as the way that women orgasm, there was still this idea that -- you know,
that women should have indirect stimulation and then that should produce an orgasm.
And Shere Hite, by asking 3,000 women and these, you know, kind of beautifully constructed narrative, anonymous surveys, found out that 70
percent of women were not having orgasms through intercourse. And that really did kind of revolutionize everything. But also she really talked
about it in terms of women's voices and women's agency and her hope was that she could what -- she said was undefined sex and, you know, encourage
us to rethink how we define it.
It's just like a little bit of foreplay intercourse. You know, the male has an orgasm and there's an assumption that the women does, but really say how
could we have better sexual relations, better conversations, and understand what each other are feeling? And that was incredibly radical at the time.
And I think it's -- I think that, you know, it's fair to say that we kind of live in a post Shere Hite world. And that's one of the reasons why it's
so stunning, you know, that her work and her contribution have been forgotten.
AMANPOUR: And what was so stunning to be reacquainted with watching the documentary was the immediate backlash, and it was fierce, even from
certain women, even on certain, you know, female driven daytime television programs, most particularly on those with male hosts. I mean, it was
fierce.
And I was -- I mean, it was almost traumatic to watch, for instance, the clip you put of Oprah Winfrey hosting her with an all-male audience. I
mean, she was -- I mean, it was really, really difficult to watch actually.
But they decided that she was against men. She was writing, you know, science or not science, that meant that men were dispensable and women
didn't need men. But she actually was writing about men as well and men's emotional lives. Talk to us about the backlash.
NEWNHAM: Yes. I mean, that was one of the extraordinary things in looking through the footage and constructing the film, was just to see sort of how
horrific it was. If you were to follow one woman through the process of sort of being silenced through this backlash that happened to the gains of
the women's movement in the 1970s, and this was sort of throughout the entire 1980s.
And Shere wrote this book about male sexuality, as you mentioned, and that book was asking men the same kinds of questions that she asked women. And
the biggest takeaway really was that men felt isolated and alone and didn't feel like they could actually express their feelings, even to their wives
and partners.
[13:30:00]
And you wouldn't think that that would be such a contentious topic, but men really did not want to hear that. And there was, I think, at the same time,
the sort of consolidation and rise of the religious right. There was media consolidation. And she really became a punching bag kind of, you know,
standing in for this idea of, you know, a radical feminist and was really attacked.
Her methodology was attacked. Her character was attacked. The old, you know, nude playboy photos that she had taken in her early modeling career
were resuscitated. She was -- she received death threats. It was really horrific.
And I think a lot of people have said to me, well, why did she keep going on these shows just to be taken down and attacked? And I really believe it
was because she believed in her message. She really wanted to get her message across. And I think we forget how hostile the media environment was
for women at that time who were speaking out and suggesting that we change things and challenge the patriarchy. But it really was, and it eventually
became, you know, just too much for her.
AMANPOUR: I want to just play a small clip about the modeling, because a lot of the interviewers and a lot of people said, well, who is this woman
who's talking about and wants to be taken seriously? You know, she's done all this modeling and some nude modeling, as you mentioned. But you know,
she -- this is how she put it.
(BEGIN VIDEO CLIP)
HITE: Having to support myself, what were my alternatives? To become an out and out prostitute, to be a secretary, to get married, of all forms of
prostitution, any job within the system is. I preferred this.
Modeling allowed me the most independence of all with perhaps the least personal involvement.
(END VIDEO CLIP)
AMANPOUR: I mean, it's such a clear answer to those critics. And surely it did give her the money when she needed it. But then, because of the
backlash, you follow her through the fact that her publishers wouldn't publish her anymore. She was running out of money. She was being, you know,
verbally abused. And as you said, death threats and this and that. And she left. She basically opted one night, sold her apartment and went to Europe.
Eventually renouncing her citizenship even in 1995, her U.S. citizenship.
What kind of reaction did she find over here in Europe?
NEWNHAM: She found a better reaction in Europe. I mean, I think what she found was a culture in which she could really express herself and kind of
the fullness of who she was. I came to sort of see her entire -- the creation of her persona and kind of her own identity and who she was in the
world as sort of a big piece of protest art in a way.
I mean, all the way along, she completely refused to not be who she was, which was a beautiful sexual woman who liked to dress up, who liked to
have, you know, red nail polish on and sexy clothes and go on TV and talk about intellectual things. And she was -- you know, she was really a victim
of this double standard that we still hold for women.
And in Europe, I think it was, it was lighter. She could play around with her identity. She got involved in the sort of feminist art projects. And
she was on, you know, kind of very creative TV shows in England. She had a great time in Paris.
But on the other hand, you know, in watching a lot of the media that she continued to do once she moved to Europe and she kept writing and
publishing books, including books, for example, on, you know, the nuclear family, which never got published in the United States, but that's an
incredibly interesting work.
And, you know, she did continue to receive a lot of misogynistic treatment on TV shows. And her friends would tell me that, you know, she would just
go on and wait until they started talking about her appearance or flirting with her or not taking her seriously.
But she never stopped. She was uncompromising how she wanted to represent herself. And I think in that way, she's kind of an icon for a younger
generation.
AMANPOUR: Yes, and I was going to say that's one of the things, I assume, you wanted for the people who watch this, particularly young girls and men.
Nicole Newnham, thank you so much indeed.
As we heard yesterday on the show from leading science and health journalist Donald McNeil, COVID shook the public healthcare system in the
United States to its very foundations, and it's still struggling with high prices and strained budgets.
Dr. Ashish Jha led the Biden administration's response to the coronavirus pandemic, and now he's back to his old job as dean of the School of Public
Health at Brown University. He joins Hari Sreenivasan to lay out how private equity is disrupting the medical industry across America.
(BEGIN VIDEO CLIP)
HARI SREENIVASAN, CNN INTERNATIONAL CORRESPONDENT: Christiane, thanks. Dr. Ashish Jha, thanks so much for joining us.
[13:35:00]
You wrote a recent op-ed in "The Washington Post" talking about private equity and the impact that it is having on U.S. health care today. Lay it
out a little bit for us.
DR. ASHISH JHA, DEAN, BROWN UNIVERSITY SCHOOL OF PUBLIC HEALTH AND GENERAL INTERNIST: Yes, absolutely, Hari. You know, we have seen this explosion of
private equity into healthcare.
What do I mean? Private equity firms buying up doctor's offices, hospitals, nursing homes, and the impact has been twofold. We have seen that that
drives up prices and makes healthcare more inaccessible, more costly. And now, we're seeing emerging evidence, at least from the hospital sector that
when private equity buys up hospitals, healthcare outcomes for patients in those hospitals may actually get worse. So, that's obviously very
concerning.
This is really a very big phenomenon with a large entry of private equity farms into the healthcare marketplace.
SREENIVASAN: So, this is not -- you know, kind of lay out the difference for us. There are a lot of towns in America who see a large hospital chain
come in and take over their kind of facilities and then there have been consequences on whether those facilities have become profitable or not and
changes have happened.
But what is the role that private equity is playing? What part of the healthcare market are these companies going after?
DR. JHA: Yes. So, what's interesting is that that phenomenon of health care chains coming in also can have deleterious effects. And we've seen
that private equity firms. Look, at the end of the day, they're in it for one reason and one reason only, which is that they're trying to make money
out of this.
And their strategy generally has been short-term. Come in a few years, turn it around. And when I say turn it around, I don't mean necessarily turn the
health system around, what I mean is then flip it, sell it to somebody else, make a profit. But often that has real negative effects on the system
they bought, whether it was a hospital, a doctor's office, nursing home. So, it leaves that community often much worse off, even though that private
equity firm made a very nice profit out of it.
SREENIVASAN: You write an example of one of your friends and colleagues who have kind of gone through this process. There are lots of doctors who
have practices, who want to look at retirement, and then they get an opportunity from a private equity firm to buy the practice.
So, what happens traditionally in these cases?
DR. JHA: Yes, the situation I described is very typical. My friend had owned a practice, private practice for a long time. Private equity firm
made him an offer. He eventually agreed, sold it. Initially, his life got better. He didn't have to manage the practice anymore. He got a nice
payout. Things seemed great.
But then that firm also bought up a lot of other practices, got a lot of market power, raised prices. Some of his patients he had taken care of for
20 years no longer could see him. You know, he walked out of this really with very mixed feelings because for his patients, it was not a very good
deal, even though he himself had personally benefited.
SREENIVASAN: So, if a private equity firm buys a group of practices, whether it's cardiology or it's pediatric dentistry, don't they have a
greater opportunity to decrease prices, to be able to negotiate with insurance companies and so forth? I mean, wouldn't theoretically that be
better for the patient?
DR. JHA: It could, but here's actually what's happening in practice. So, let's say there are lots of cardiology practices in a community. A private
equity firm comes in, buys them all up. Then it goes to the insurance company and says, if you want cardiology in this town, we own all the
practices. You have to pay us a lot more.
Of course, insurance companies will then just pass on those extra costs to employers and to individuals. So, what happens is people see their prices
go up. Profits for private equity firms also go up. And eventually it ends up having a really negative effect on that community. So, while
theoretically private equity firms could play all sorts of roles, they're generally driving prices up.
SREENIVASAN: So, how does that impact, say, for example, the patients that you said, for example, people who might have been coming to your friend for
years couldn't afford to come anymore? Is that because the insurance companies are saying, hey, the prices are just too high and this is now out
of network or how does that happen?
DR. JHA: Yes, there are two ways this can happen. One is, so imagine you're the private equity firm, you now own all these practices, you raise
your prices. An insurance company may say, OK, you're no longer in network. Well, all the patients who have that insurance no longer can come see that
that physician. Or they'll say you're still a network, but your deductibles are now much, much higher. And so, what that does to patients is that they
have to pay a lot more out of pocket, which for a poor person may become prohibitively expensive.
Look, I mean, the bigger picture point here is that high prices of health care are causing real problems, real strains for budgets for individuals
and companies across the country. And private equity has become a part of that problem, making that problem worse.
SREENIVASAN: Let's talk, I guess, aside from the money, the thing that most people are concerned about is how does it actually affect how safe I
am going to a doctor or a hospital? Is there a difference that can be measured on how the functioning of medicine is happening?
[13:40:00]
DR. JHA: Yes. Yes. So, this is a question that I think a lot of us have been concerned about for a long time, but we haven't really had data until
recently.
It's a really good study that looked at 50 hospitals that were bought out by private equity firms, compared them to controls hospitals that weren't.
And what they found essentially was medical errors going up in private equity hospitals.
People have often said, well, what explains that? How could that be? It's probably the same doctors and nurses working there.
SREENIVASAN: Right.
DR. JHA: There are a couple of things. We know that private equity firms, when they take over, one of the first things they do is try to reduce
costs. One of the easiest ways of reducing costs is reducing your staffing. Cut back on nursing staffing, it'll save you money, it can put patients at
risk. I think that's clearly probably one part of the mechanism.
The other thing is, you know, if you think about all the progress we've made in making healthcare safer over the last 20 years, a lot of it is
putting in safety protocols, doing a lot of important things that make sure errors don't happen. Those all cost money.
And my, you know, best hypothesis here is companies come in, they buy up these hospitals, they're trying to find ways to save money, and they're
making decisions that are harming patients.
SREENIVASAN: And this study that you're referencing is from the "Journal of the American Medical Association" and it said, private equity
acquisition was associated with a 25.4 percent increase in hospital acquired conditions, which was driven by falls and central line associated
bloodstream infections.
How do, you know, something like central line associated bloodstream infections increase at one hospital versus another?
DR. JHA: Yes. So, central line infections, by the way, just a central line is a big IV catheter, usually use it in critically ill patients. Those,
when they get infected, can be very, very dangerous. People often die because it's a very serious infection.
We have made a lot of progress as a healthcare community, eliminating those infections or reducing those infections. Again, what makes a difference?
Following protocols, having plenty of nurses, making sure you're really doing things to prevent those infections. We know how to do that. If you
make cutbacks on nurse staffing, if you make other types of cutbacks, you can potentially set up people at risk for that.
False is similar. You know, elderly people, high risk people in the hospital, they're not enough nurses around, they get up in the middle of
the night, they can have that fall. So, staffing is really critical to keeping people safe in the hospital.
SREENIVASAN: So, when you think of sort of market power at work here, is there an increased concentration? I mean, there was -- there's an article
I'm looking at here that said that 13 percent of metro areas that a single private equity firm owns more than half of the physician market for certain
specialties now, obviously 13 percent. That's -- we still have 87 left in the country where there might be a more healthy market.
But what happens? Is it in small towns? Is it in midsize towns and big cities? Where do we find these kinds of trends?
DR. JHA: Yes. So, market concentration, first of all, is a bad thing. And here's what I mean. Like when there's not enough competition, there's not
competition for quality, there's not competition for pricing and costs. And what we tend to see in concentrated markets as costs go up, quality goes
down. That evidence is overwhelmingly clear.
In those 13 percent of markets where a private equity firm has more than half the market, they're not facing much competition to deliver better care
at lower cost for patients.
In those other 87 percent, you still have a lot of concentration. That 13 percent continues to rise. What I'm worried about is not just where we are
today, but where we will be in 2, 4, 5 years if we don't pay very close attention to this trend and really work on turning it around.
SREENIVASAN: I'm not trying to paint private equity kind of with one brush. I mean, they're -- obviously, they might have different strategies
in what they're doing. And you're not necessarily advocating for the end of private equity here. I mean, you think that there is a role for them to
play.
DR. JHA: Yes, the way I look at this is we're seeing some bad behavior by some private equity firms, not every private equity firm. There's also bad
behavior by major hospital chains, by other four (ph) companies.
So, instead of asking, is this a private equity problem? What I would like to see is. healthy competition in the marketplace. By the way, we have
federal laws on that. We just need to enforce those laws to make sure that we don't have monopolistic behavior.
What I'm looking for is more focus on making sure patients are safe in the hospital. There are things that Medicare and other payers can do to really
drive that. At the end of the day, what we care about is quality, safety, affordability. What I argue for is let's pay attention to those metrics.
And hey, if a private equity firm can do all that stuff, great. Because that's what there's some patients and that's what we should be focused on.
[13:45:00]
SREENIVASAN: So, I mean, on the one hand, you're asking for some kind of financial supervision on, say, when is there a certain threshold that
private equity takes over, you know, it tips over into kind of a monopoly status in a particular subgroup of health care.
But then, how do we kind of enforce just the safety part of it? How do we kind of look at the data and say, hey, wait, there's something going on
here, the infections or deaths or falls are rising, and we see that the sort of correlation might be this? I mean, correlation is not causation.
So, how do we tease that out?
DR. JHA: Yes. So, this is a really important role for an agency like Medicare. Medicare is the largest payer of health care in America. For a
long time, Medicare has been developing metrics on quality and safety for hospitals, for doctors. And what I call for is when you have a new
transaction, let's say a private equity firm buys up a health system, that should get monitored. Make sure that prices don't go up. Make sure that
quality doesn't suffer. Make sure that adverse events, patient safety events don't go up.
Those are things that are very reasonable roles for regulators, state regulators, as well as Medicare to do. I think they should be doing that
much more broadly across the entire health care system. But given what we're seeing with private equity, probably deserves a little extra
attention to make sure that patients are not being harmed by this kind of work.
SREENIVASAN: Given how strapped Medicare is, what's the likelihood that they can do this?
DR. JHA: Well, these are policy decisions we have to make as a country. I mean, I think it's very important. Certainly, states also often strapped
with their regulators. I think that's a place where, look, if we underfund our government on these issues, if we don't have enough people working at
FTC, if we don't have enough regulators overseeing and making sure that these transactions are not leading to harm, then we're going to allow a lot
of bad behavior to happen, and we're not going to allow the markets to function effectively.
My view is, markets can be a very important way to manage costs and quality, but they have to be enforced, and the rules around monopoly
behavior have to be enforced. And if we don't have enough enforcement capability, we have to bolster that enforcement capability.
SREENIVASAN: And how do we fix that in a political environment where money is speech, so to speak, and that there are probably pretty active efforts
by the people who have a vested interest in perpetuating this status quo?
DR. JHA: This is a problem, I think, across all of our economy. Look, when companies become monopolies, they love being monopolies. They can charge
monopoly prices. And the whole point of our federal laws on -- against monopolies is that we know consumers do better when there is healthy
competition.
And that should be, by the way, totally bipartisan. I mean, the idea that markets need to function and they need to function effectively should be
something that Republicans and Democrats should be able to get behind.
So, I'm hopeful -- and we have seen, by the way, for FTC enforcement, we've seen good enforcement, both in under Republican and Democratic
administrations. I just want to make sure that we're really aggressively enforcing the rules that already -- and laws that already exist, that I
think is really important and it should really be bipartisan.
SREENIVASAN: Dr. Jha, while we have you here, you know, there have been several reports recently about upticks in cancers in people under 50, more
than 10 percent. What is responsible for this?
DR. JHA: Yes, this is a concerning trend that we've noticed. It's not a brand-new phenomenon. It's been going up for some period of time. A lot of
it driven by colon cancer rates going up, particularly among younger people.
In terms of what we should do, it certainly means we should be screening people earlier, looking at risk factors more. You know, the question of
what's causing it, not completely clear. We do know for other kinds of cancer, obesity is a major risk factor. Obviously, rates of obesity have
gone up. Smoking can be a risk factor. Thankfully, smoking rates have declined in the country, but that has also flattened in certain groups.
So, I would argue that we don't fully understand why we are seeing this increase. We need to do more research on that to understand that. But the
solution here is, we've got to move towards more aggressive screening earlier in certain populations to identify these cancers early and deal
with it.
SREENIVASAN: You know, this was not just happening in the United States, but it was also happening in parts of Western Europe and Australia. And
while there might be specific demographic differences, I mean, is there sort of a sociological similarity that we can start to say, hey, but how
does this compare to South Asians or South Americans or Africans?
DR. JHA: Yes, it's a great question. And what I would argue is that right now, most of the data that is looking at this is being collected in the
U.S., collected in Western Europe, Australia. So, this phenomenon may very well be happening in other places like China or South Asia or Latin
America.
[13:50:00]
The screening systems for cancer are not as robust in those places. And essentially, one of the things that I think countries like India, for
instance, needs to do more of is starting to really put more attention screening for cancer.
So, my sense is that what we're seeing in these countries is because that's where we're looking, and this is probably more of a broader phenomenon, but
we just don't have the screening system set up in other places to know for sure that whether it's happening in other places as well.
SREENIVASAN: You know, when you look from like a 30,000 or maybe five miles up view, considering how much Americans and the American health care
system pays, and the fact that as good as we are, we still have so many glaring inefficiencies, deficiencies, cracks where people slip through, you
know, how do we alter that? I mean, how do we try to maybe make this a little bit more of a proactive and preventative system versus a reactive
system after people have the diseases?
DR. JHA: Yes, it's -- there are several things that I think are important here. One is we've had a payment system that has paid piecemeal. It pays
for visits. It pays for doctors visit or the hospitalization.
We have started a ship that actually began in the George W. Bush administration, accelerated under President Obama, but still not as far
along as it needs to be, which is to move payments more towards kind of a population level payment. So, you pay the health system to take care of an
entire population and you pay them to keep that population healthy. That is a -- that has been a trajectory, but I think it has gone too slow. I would
like to see that accelerated.
The second part is something we've talked about, which is this importance of competition in health care. It turns out in most American health care
markets, the market is very, very concentrated. There are not enough different types of doctors and hospitals. And what that has meant is that
that focus on quality and prevention just hasn't really been there.
And I think more competition in the marketplace, more of a focus on a different way of paying for healthcare, all of those things can drive it.
And then, obviously, there's a role for government in a lot of European countries. We see very clear regulatory approaches that countries take on
these issues. That has been less popular, I would say, in the United States. There are other ways of getting there, but that is another
mechanism we could be using.
SREENIVASAN: Dr Ashish Jha, thanks so much for joining us.
DR. JHA: Thank you.
(END VIDEO CLIP)
AMANPOUR: And finally, Oscar nominations have hit Hollywood, as people's favorite films battle it out now for the big prizes.
Many of them we've showcased on this very program. It was a good day to be Sandra Huller. Not only did she become the first German woman to be
nominated for Best Actress since the 1930s, both of her films, "Anatomy of a Fall" and "The Zone of Interest" were nominated for Best Picture, Best
Director, and Best Screenplay.
"The Zone of Interest" is gaining major buzz for its timely portrayal of the Holocaust from the jarring adjacent perspective of the Auschwitz
commandant's family. Here's what Huller told me about how she and the director did not want to exploit the trauma of that time, but instead show
how much people will actually ignore in exchange for daily comforts.
(BEGIN VIDEO CLIP)
SANDRA HULLER, ACTRESS, "THE ZONE OF INTEREST": He was interested in our connection to the perpetrators. What connects us to them? What -- is there
not so much difference maybe? Because what would we do to have a little comfort in our lives, to have our little garden and to send our children to
school and not be bothered by anything that goes on behind the wall?
So, he chose this perspective to, yes, to show that it is -- yes, they are connected to us today.
(END VIDEO CLIP)
AMANPOUR: And it is an extraordinary take. Now, in the best actor category, Colman Domingo got his first nomination in "Rustin." He told Hari
Sreenivasan on this program that he had poured 32 years of work into the role of Martin Luther King's good friend and organizer of the March on
Washington.
And over in documentaries, we're delighted to have featured three of the nominations. "Bobby Wine: The People's President" about the beleaguered
opposition in Uganda. "20 Days in Mariupol" about the terrible Russian siege and destruction of that Ukrainian City. And "To Kill a Tiger," about
seeking justice for victims of sexual abuse India.
And finally, we couldn't talk about cinema in 2023 without mentioning the B word. That's right, "Barbie." The mega hit nabbed eight nominations,
including supporting actress for America Ferrera, who delivered the movie's knockout monologue. Here's what she told me about why she had taken a
chance on that role.
(BEGIN VIDEO CLIP)
[13:55:00]
AMERICA FERRERA, ACTRESS, "BARBIE": When I first read the script, everything, before and after, and including the monologue, I know that I
was just blown away, and it was all just so unexpected. And as a woman, I was just so excited, you know, that, you know, it's the "Barbie" movie that
no one asked for, that no one thought we needed.
(END VIDEO CLIP)
AMANPOUR: And it's the "Barbie" movie and also "Oppenheimer" which drew a huge, perhaps the record number of nominations, that actually helped revive
the movie industry and the cinema industry after the strike, after the COVID, all of that.
That is it for now. If you ever miss our show, you can find the latest episode shortly after it airs on our podcast. And remember, you can always
catch us online, on our website, and all-over social media.
Thank you for watching, and goodbye from London.
(COMMERCIAL BREAK)
[14:00:00]
END
