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ANDERSON COOPER 360 DEGREES

Health Care Politics; The War Next Door; Kids in Peril: Obesity in America

Aired March 23, 2010 - 22:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


ANDERSON COOPER, CNN ANCHOR: Tonight, "Keeping Them Honest" on health care reform. Who is putting cynical politics above what is good for America? New moves to kill the bill and new moves by the president and Democrats to sell it -- the latest ahead.

Also tonight, with health in the headlines, a teen girl's struggle with weight, 14 years old, more than 400 pounds. Her fight to lose the weight and radical surgery she has pleaded to get.

And "Crime & Punishment" tonight: seven bodies in a single day, dozens a week, Americans also getting killed right across the border in Mexico. He was warned not to go, but 360's Gary Tuchman went anyway and brought back a front-line look at "The War Next Door."

First up tonight: "Keeping Them Honest." We will show you where over health care fight now heads and the motivation behind the fight. Is it about what's best for Americans or about pure "Raw Politics"?

As you probably know, President Obama signed the bill. Its official name is the Patient Protection and Affordable Care Act. There is the signature up close, actually, one of many. He used 22 different pens to sign the bill, most of which were given away as mementos. That's the kind of thing they do at these bill signings. Two went to the National Archives.

Emotions ran high. There were chants of fired up, ready to go, yes, we can, yes, we did. Vice President Biden forgot that microphones pick up all words, including four-letter ones. He dropped the F-bomb right in front of the mike.

From the White House, Mr. Obama went to the Interior Department, where he began efforts to convince Americans that the bill is a good thing. He ran through some of the immediate benefits of the law. Listen.

(BEGIN VIDEO CLIP)

BARACK OBAMA, PRESIDENT OF THE UNITED STATES: This year, we'll start offering tax credits to about 4 million small businesses to help them cover the cost of coverage.

Parents whose children have a preexisting condition will finally be able to purchase the coverage they need.

This year, insurance companies will no longer be able to drop people's coverage when they get sick, or place lifetime limits or restrictive annual limits on the amount of care they can receive. This year, all new insurance plans will be required to offer free preventive care. And this year, young adults will be able to stay on their parents' policies until they're 26 years old.

(CHEERING AND APPLAUSE)

OBAMA: That all happens this year.

This year, seniors who fall in the coverage gap known as the doughnut hole will get some help to help pay for prescription drugs. And I want seniors to know, despite what some have said, these reforms will not cut your guaranteed benefits. Let me repeat that: They will not cut your guaranteed benefits. Period. I would be wary of anybody who claimed otherwise.

(END VIDEO CLIP)

COOPER: Well, the president is going on the road to sell that message. Democrats all across the country are going to be echoing those talking points, as they try to hold on to their seats in November.

Let's just walk over to the wall here. I want to show you some of what is driving their decisions at least. Take a look at this poll.

We're going to show you poll numbers over time. These are President Obama's approval numbers over time, from 2009 all the way to current time. Now, the president came into office way up here in the 70s, 76 percent, dipped a bit there into the 60s. Then it starts to come down a few bumps as we crossed into 2010, 48 percent here.

But then, right before the bill was passed, it dropped to its lowest ever, 46 percent. That was before the bill was passed.

Now, let's take at look at here. This is a new poll out from Gallup and "USA Today" taken after health care reform passed. It shows Americans now with a favorable view of the plan passing. Forty- nine percent said it was a good thing. Forty percent said a bad thing. Eleven percent had no opinion.

Now, the president and Democrats are hoping that, once people get to know details of the plan, they are going to like those details, and that's going to improve the president's poll numbers and Democrats' chances in the November elections.

But now Republicans are vowing to fight it. They're vowing to slow, it, to stop it, if they can. And they're doing it in a couple of different strategies. Let's take a look at this map. This is their state-by-state strategy, 14 states now suing in federal court to block this law. Thirteen filed just today in a Florida federal court minutes after the bill became law, actually.

Florida's attorney general called it a nonpartisan effort, though, as you see, every attorney general is Republican, except for the one from Louisiana.

So, that's one kind of challenge, is state-by-state challenge. But there are other challenges I want to tell you about. They still to have vote in the Senate, not on the main law, but on that smaller package of fixes to it. So, Republicans may try to offer amendments to gum up the works or to get Democrats on record in ways that they're going to regret in November.

Now, both sides are saying, look, that they are acting purely out of what they think is best for America. That's what both sides are saying. But we wanted to know tonight -- we wanted to look at -- at how much cynical politics is really at play.

Dana Bash tonight is "Keeping Them Honest," both parties.

She joins us now.

Dana, so what's going on?

DANA BASH, CNN SENIOR CONGRESSIONAL CORRESPONDENT: Well, Anderson, to put it simply, the debate that is going on right now on the Senate floor is all about the midterm elections in November.

Republicans know that Senate Democrats have closed ranks, and they're planning to vote no on all of the amendments that are being offered as we speak. So, GOP sources tell me they have devised a strategy to use this health care debate, the remaining debate, to make things politically difficult for Democrats.

They want to force them to take tough votes. And a classic example just happened a short while ago. It is a doozy, Anderson. Get this. Republican Tom Coburn introduced an amendment that prohibits erectile dysfunction drugs sex offenders.

That's right. You didn't hear me wrong: no Viagra and the like for sex offenders. So, I'm sure you're wondering what this is all about. Well, I talk to a Coburn aide tonight. He says there is nothing in the law right now that prevents sex offenders who get government subsidies from using that -- those taxpayer dollars to buy Viagra.

And this was actually a problem, he said, for years with sex offenders on Medicare and Medicaid. But Republican aides tell me they know full well any Democrat that votes against this can be painted as supporting E.D. drugs for sex offenders. That's politics.

COOPER: So, can Democrats vote -- vote for it? I mean, it is basically trying to paint them into a corner.

BASH: That's right. It is absolutely painting them into a corner.

And that's exactly why Republicans are doing it. And they're doing other issues as well. Right now, also on the Senate floor, Republicans know that one of the politically explosive issues for Democrats, very hard for them to vote against, those in tough races, is something -- is something that we have heard a lot about.

And those are special deals that have gone to some states. So, John McCain just tonight offered an amendment to strip out the remaining special deals for states.

And one of the senators who got special help for her state of Louisiana, she got angry.

(BEGIN VIDEO CLIP)

SEN. JOHN MCCAIN (R), ARIZONA: They are provisions that were not allowed or provided to every other state in America. That's what makes them a special deal. That's what makes Americans think that the way we do business around here is not in their interests. It makes Americans believe that we are cutting these deals in order to secure votes.

SEN. MARY LANDRIEU (D), LOUISIANA: This amendment is a stunt that really doesn't deserve the time that I'm even going to give to explain the portion of it that refers to Louisiana.

And the reason I say it is a stunt is because it is actually written for television or the Internet. It is not written for any serious debate here. And, in my view, it is beneath the senator from Arizona, who at one time was a candidate for president of this country.

(END VIDEO CLIP)

COOPER: So, I mean, you mentioned at the beginning are basically Democrats closing ranks, voting no on all these amendments, but why? Why not take them on one by one?

BASH: The reason is because they don't want any amendments to pass that change this fixes bill, because that would mean that it would have to go back to the House and cause problems for this bill, not to mention delay the end of the health care debate even further.

And all Democrats want this to be done. So, I'm told Democratic leaders actually used their weekly meeting today, a lunch that they have every week, to implore rank-and-file Democrats to stick together, have discipline and vote no on everything, even amendments that they may actually agree with in substance, or, Anderson, may get hammered for politically, like the couple of amendments that we pointed out tonight.

COOPER: All right, Dana, stick around.

Let us know what you think of the live chat right now at AC360.com. Talk to viewers around the world who are watching right now.

Coming up next: what the health care law means to three working families, three families, working-class, middle-class, and a wealthy family. See what it might mean for you as well. And our panel, Dana included, weighs in on the political and medical implications of the law.

Later, how young is too young to have surgery to shrink your stomach and lose weight? Tonight, a girl facing that question, 14 years old, more than 400 pounds. Her life is on the line -- when 360 continues.

(COMMERCIAL BREAK)

COOPER: "Up Close" tonight: health care reform and families, your family.

Today, at Arlington National Cemetery, Ted Kennedy's grave site, a note from his son Patrick that reads, simply, "Dad, the unfinished business is done" -- family business. The question is, what kind of family legacy will this turn out to be?

Tom Foreman looks at how the new law affects three families "Up Close."

(BEGIN VIDEOTAPE)

TOM FOREMAN, CNN CORRESPONDENT: Reform may be the cure for health care's problems, but different people will get different doses, some taking effect almost immediately, others in four years.

Let's start with a family making so little money, that they cannot afford insurance. When this program is fully running, by 2014, the government will help buy coverage for pretty much anyone making around $30,000 to $90,000 a year. The more you make, the less help you get. And if you don't buy insurance under those circumstances, you will be fined.

But what about grandma? Well, seniors on Medicare, no matter what kind of income we're talking about, will see mixed results. They will get some breaks for certain tests and drugs. But those who have purchased extra protection, so-called Medicare Advantage plans, will find some of the government subsidies for that being phased out, and some may lose that coverage.

Let's look at a middle-class family making, say, $100,000 to $150,000 a area. They have insurance through their jobs and the bill says, keep it. But they will still face changes which will affect everyone. Look, one child has a heart problem which she inherited from her mother, who has the same trouble.

They won't have to worry about being denied coverage based on those preexisting conditions. The insurance companies cannot limit how much it spends on their treatment, and you can't be dropped for getting sick. What's more, for all families, dependent children soon will be able to stay on mom and dad's policy until the age of 26, which will keep a lot of kids covered through college.

And, finally, let's look at the family that is doing pretty well, more than $250,000 a year. They get the same protections as everybody else, but they're also going to see addition al Medicare taxes coming out of their paychecks, rising from less than 1 percent to almost 2.5 percent.

There will also be new, almost 4 percent taxes on their investment income. And, by 2018, anyone in any tax bracket who has a particularly generous health care plan through work will also be facing new taxes on that, too -- Anderson.

(END VIDEOTAPE)

COOPER: All right, Tom, thanks.

Let's dig deeper now in the impact on families, political parties, the budget, and a lot more.

Joining us is 360 M.D. Sanjay Gupta. Dana Bash is back. Also with us, political contributor and Democratic strategist Paul Begala, who is a veteran of last battle to pass health care reform during the Clinton administration, and, from the right, Reihan Salam, co-author of the "Grand New Party," contributor at The Daily Beast and a fellow at the New America Foundation.

Paul, so, this package of Senate fixes, anything but -- but a done deal, I mean, do you the Republicans are going to be successful in blocking it?

PAUL BEGALA, CNN POLITICAL ANALYST: You know, all they have to do is let one through, and then they will -- they won't have blocked it. They will have gummed up the works a little bit longer. If even one amendment sneaks through, then the House would have to take up the changed reconciliation bill.

But, right now, the Democrats are very united. I think they will be able to knock them off. I think they understand, based on Dana's reporting and their own sense of the Senate, that this is not on the level. I mean, if Senator Coburn really wanted to stop sex offenders from getting Viagra, he would have put that amendment up when the big bill was being negotiated. So, I think -- I think that some of the stunts are kind of backfiring on the Republicans.

COOPER: Reihan, if Republicans are concerned about reducing the amount of the effect of the deficit in this bill, why not now work to try to, you know, make the reform better, rather than try to basically just kill it, throw up roadblocks to it?

REIHAN SALAM, FELLOW, NEW AMERICA FOUNDATION: Well, I think that makes sense. And I think Republicans are going to be working on that. But, for right now, the bill is actually pretty vulnerable in a lot of ways. A lot of the benefits are going to come online later, down the road.

COOPER: Right, 2014, 2013.

SALAM: Some of them -- exactly. Exactly. And, also, a lot of the tax provisions come much further down the road as well. So, really, it is in this awkward moment.

And you have seen previous bills -- for example, in 1988, Ronald Reagan passed a big, comprehensive health package that was backed by Republicans and Democrats. One year later, it was overturned by an overwhelming vote.

(CROSSTALK)

COOPER: So, you think this could still be overturned?

SALAM: I think it is unlikely, but it at least possible.

And I think that folks who believe that this is going to worsen our fiscal situation over time are now betting that we can raise the temperature and maybe get some kind of reversal, rather than talk about compromising now. Whether or not that's a good idea over the longer term is -- is up for debate.

COOPER: Yes. I mean, Dana, what Reihan is essentially that the focus is on what's best for midterm elections, rather than what may be best for the deficit down the road or for the country.

BASH: Shocking, shocking in Washington politics. Right. At this point, especially, it is absolutely true. You mentioned the deficit.

Mitch McConnell was -- was on earlier today, and that -- that was the issue that he was asked. Well, why not vote for this? You want to reduce the deficit. This particular change package adds to that. And, you know, the answer was, well, but there are lots of other things that I don't like.

So, look, the bottom line is that, you know, as much as both sides say that they want to do this substantively, there is no question. And, at this point, when you walk the halls of Congress, people are pretty candid about it.

COOPER: Yes.

BASH: There is no question at this point that they are making their arguments for political gains...

(CROSSTALK)

COOPER: Reihan, I see you shaking your head.

SALAM: Well, here's the thing. I mean, the bill happens in a bigger fiscal context, right? So, Sanjay Gupta has, earlier on, on CNN, talked about the doc fix. This is a separate issue that is not in the bill, but it is a big issue that shapes how much we're going to spend over health care over time.

Similarly, we have put a lot of revenue measures further down the line in 2018, and later in this bill, that may or may not happen, that are going to happen after the president leaves office. And, so, that's the tricky question. A lot of the pain in this is coming later. The spinach is coming later.

But the good stuff, that's coming sooner. So, whether or not this is -- this bill is really going to reduce the deficit is an open question.

COOPER: I want Paul to be able to respond, but I also want to bring in Sanjay in just a moment to talk about fraud in this.

But we have got to take a quick break. The conversation continues right after the break.

We will talk about Vice President Biden and the F-bomb heard round the world.

Also, late word on a settlement in the lawsuit against Oprah Winfrey by the former headmistress at her school for girls in South Africa.

We will be right back.

(COMMERCIAL BREAK)

COOPER: Well, there's been plenty of cursing throughout this health care battle, much of it ugly and raw. As President Obama was signing the new legislation into law today, there was more cursing of a very different kind, the kind you get when Vice President Joe Biden get too close to an open mike.

Take a look.

(BEGIN VIDEO CLIP)

JOSEPH BIDEN, VICE PRESIDENT OF THE UNITED STATES: Ladies and gentlemen, the president of the United States of America, Barack Obama.

(CHEERING AND APPLAUSE)

BIDEN: This is a big (EXPLETIVE DELETED) deal.

(LAUGHTER)

BARACK OBAMA, PRESIDENT OF THE UNITED STATES: Thank you.

(END VIDEO CLIP)

COOPER: All right. Well put, sir.

It's not the first time Vice President Biden has been caught cursing on an open mike. And, at this rate, it will not be the last.

Our panel is back to talk more about the health care bill.

Joining me again, Dr. Sanjay Gupta, Dana Bash, Paul Begala, and Reihan Salam.

Sanjay, you have been looking into this ongoing problem of fraud in the health care system. How much does health care fraud cost us all? DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Well, it's interesting. And no one knows the exact number. But if you look at Medicare overall, conservative estimates say that about 3 percent of all Medicare expenditures are actually fraudulent. And that would put the number around $15 billion a year.

COOPER: And who is committing the fraud?

GUPTA: Well, a lot of -- well, I mean, they're criminals. Criminals are committing the fraud.

But, for the most part, it can be people who are not related to the health care profession at all. These are people -- one case in Florida, Anderson, where there were all these claims made for equipment, millions of dollars of equipment, that were neither -- actually delivered to patients.

What was the real fraud here, the -- the crime was that the doctors who were ostensibly ordering this equipment had been deceased for five to 10 years. And criminals had essentially gathered those doctors' names and were -- and creating those bills.

But the most common type of fraud is actually something known as up-coding or up-billing, where you bill for a service that's a higher level than what was actually performed. And -- and that happens. It is intentional fraud, and it happens quite a bit.

COOPER: So, is there anything in this new health care reform bill that -- that proactively tries to root out fraud?

GUPTA: Well, you know, part of the way that this bill is going to be paid for, again, is -- is possibly by rooting out fraud. And they want to add these investigation units all over the country through the Department of Justice, through HHS, to -- to, you know, look at patterns of fraud, and figure out if you can see things like what happened in Florida...

COOPER: Right.

GUPTA: ... and try and stop them.

Also, you mentioned Senator Coburn earlier. He proposed something about undercover patients, actually taking patients that aren't -- aren't really sick, having them to go to doctors' offices, have them be wired, and seeing if doctors or any health care professionals are -- are committing fraud there as well.

COOPER: Hmm.

GUPTA: So, those are just a couple of the ideas floating around.

COOPER: Well, Paul, to Reihan's earlier point, using an example of a bill that Reagan had passed, and, then a year later, was dead, even though it originally had bipartisan support, I mean, is this health care bill still very vulnerable? Could, a year from now -- I mean, do you think any of the challenges that the Republican are raising, whether it is state by state or whether through the federal courts, is it vulnerable?

BEGALA: You know, I was a brand-new Hill aide in 1989, when that bill was repealed, that -- it was Reagan's -- it was catastrophic health insurance, mostly for elderly. And it was the elderly who wanted it repealed because it taxed the elderly for a benefit that went to the elderly. And, of course, the elderly didn't like that.

No, I really don't see that happening at all. I think that the point that Reihan makes about this so-called doc fix, where doctors are going to be under-reimbursed under Medicare if they don't fix it, is absolutely right. It costs a fortune, $200 billion. It is not in this bill. I do hope, when Congress takes it up, they pay for it. But that's a big debate.

But, if you care about the deficit -- I know Reihan does and a lot of our viewers do -- it is simply a fact that this is the largest deficit-reduction package in a decade. That's not from the Democrats or the Republicans. That's from the nonpartisan Congressional Budget Office.

COOPER: Right. But -- but the CBO -- as Republicans will quickly point out, the CBO numbers are very -- I mean, they're kind of estimates based on projections 20 years down the road, which...

(CROSSTALK)

BEGALA: No, no, no, it's the 10-year number. The 10-year number, first, Anderson, which is much more reliably, is that it will reduce the deficit by well over -- by over $100 billion.

The 20-year number is over $1 trillion. But you're right. That's very, very unreliable, but it all we have got. They are the agreed-upon arbiter here. And they're totally nonpartisan.

COOPER: Reihan?

SALAM: Well, here's one thing I will say. During the Clinton administration, the president didn't get a lot of credit for being honest, but he was actually a lot more honest. Clinton-care counted all of those insurance premiums that were going on to their version of the exchanges as federal revenues.

That was not counted this way this time around. So, the sticker shock that happened during Clinton-care was a big reason why that bill failed. And this time, you did not have that. There are all kinds of ways in which the CBO projections are very different now, because people learned from what happened that time around.

I personally think President Clinton was a lot more honest, you know, when he tried to pass health reform in 1993. And he really tried to take on the medical providers, the hospitals, the pharmaceutical companies. And that is why he had a much tougher time.

This time, we have a deal that is really a sweetheart deal for a lot of powerful interests. That doesn't mean there is nothing good in the bill. There are a lot of good, decent ideas. But it also means that it wasn't as good as it should have been. And now we're all going to have to deal with it. We're all going to have to fix it.

COOPER: Dana, do you -- when you talk to people on Capitol Hill, do Republicans put a lot of faith in -- in -- in this court effort by -- by 13 states right now, by 13 attorney -- attorneys general, in the states to challenge the constitutionality of this?

BASH: Do they put a lot of faith in it? Unclear yet. But is that really their biggest avenue for overturning this? Absolutely.

I mean, this is -- that is really the place where they feel that they have some -- some good arguments. And I think they believe that the best argument, from their perspective, is the whole idea of mandating health care coverage. I mean, they say that that is something that is relatively unprecedented.

Yes, you have to get a driver's license, but you're not required to drive. This is something that is -- is very different. So, they think, from that perspective, legally, they have the best argument.

COOPER: Sanjay, I want to show you something Dr. Andrew Weil said on "LARRY KING LIVE" last night to Wolf Blitzer. Let's listen.

(BEGIN VIDEO CLIP, "LARRY KING LIVE")

DR. ANDREW WEIL, FOUNDER AND DIRECTOR, ARIZONA CENTER FOR INTEGRATIVE MEDICINE: This is not health care reform. It is health insurance reform. And that is a good thing. It is a step in the right direction.

We desperately need health care reform, which means improving health outcomes, making us a healthier society, and getting health care costs down. This bill will do none of that.

(END VIDEO CLIP)

COOPER: Do you agree with that, that this is more about insurance reform, not really health care itself?

GUPTA: I agree with some of what -- what Andy Weil said. And I have talked to him about this in the past.

Two points really to make here. One is that, you know, our -- is the delivery system for health care really being addressed in this bill? So, simply put, more people will have an insurance card that they can put in their wallets, but does that mean they are going to be able to see doctors? There's a shortage of doctors, as we know. Does it mean they are going to get the high-quality delivery that I think that they expect?

The other I think a little bit more obscure point that he's making is that simply having health care insurance, can you draw a line between that and creating a healthier person, or, more importantly, a healthier society? And I think the answer -- that's a tough answer -- that's a tough one to answer.

COOPER: Yes. GUPTA: I mean, a lot of people who have health insurance, they have all the resources in the world, and they still don't live healthy lives necessarily.

So, I don't know that it will necessarily lead to a healthier society, certainly not for sure.

COOPER: Yes, appreciate your comments.

Sanjay, thank you, as always.

Reihan Salam, appreciate you being with us.

Paul Begala, as well.

And, Dana Bash, thanks for your reporting.

Still ahead, talking about, off what Sanjay was saying, a major health care crisis facing kids right now, obesity, you're going to meet a teen whose doctors said she would die if she did not take extreme measures to lose weight, 14 years old, more than 400 pounds -- her story tonight as we begin our special series, "Kids in Peril: Obesity in America."

Also ahead, new steps to keep Michael Jackson's former doctor, Conrad Murray, away from patients.

(COMMERCIAL BREAK)

COOPER: Coming up, a settlement in the lawsuit against Oprah Winfrey by the former head mistress at her school for girls in South Africa. First let's check some of tonight's other important stories. Christine Romans joins us with a "360 Bulletin."

CHRISTINE ROMANS, CNN ANCHOR: Anderson, President Obama's pick to have the Transportation Security Administration says he supports the use of full body scanners. Robert Harding said so at his Senate confirmation hearing. If confirmed, the retired Army major general says he also wants U.S. airport security to be more like Israel's, where travelers are grilled extensively before being allowed to fly.

British authorities say they have compelling reasons to believe Israel was responsible for the use of forged British passports in the plot to kill a senior Hamas operative at this Dubai hotel in January. France is also looking into the use of forged passports in the plot.

Dubai police say this video shows some of the 27 suspects with fake passports at that hotel just before the assassination. They insist Israel's spy agency, the Mossad, carried out this attack, but Israeli officials deny any connection.

The California state medical board will ask a judge next month to revoke the medical license of Michael Jackson's doctor while he is being prosecuted in the singer's death. Dr. Conrad Murray has pleaded not guilty to involuntary manslaughter.

And in Forest Park, Georgia, a hit and run...

COOPER: Yikes.

ROMANS: ... caught on a police officer's dash cam.

COOPER: Ai, yi, yi.

ROMANS: The victim, believe it or not, a 60-year-old woman. She's bruised, badly shaken up, but she is alive. Now the driver, Anderson, apologized and then fled the scene.

COOPER: Ai, yi, yi. Are you kidding?

ROMANS: Police are hoping someone knows the driver and turns her in.

News flash. You can apologize, but...

COOPER: Unbelievable.

ROMANS: ... you can't -- yes. You can't beat the law on something like that.

COOPER: I'm glad she's doing all right.

All right. It's time to take a look at our "Beat 360" winners, our daily challenge to viewers, a chance to show up our staffers by coming up with a better caption for the photo that we put on the blog every day.

So tonight's picture, House Speaker Nancy Pelosi has a laugh during a news conference yesterday after the House passed health-care reform legislation.

Our staff winner tonight, Ed Henry. His caption: "I just knew we could pass this bill without the Botax in it."

(SOUND EFFECT: "Oooh!")

COOPER: I messed that up. I'm sorry.

Our viewer winner is Charlotte from Scurry, Texas. Her caption: "All for the health-care bill say ahhhhhh!!!!!"

(SOUND EFFECT: GROANS)

COOPER: All right. Charlotte, congratulations. Your "Beat 360" T-shirt...

ROMANS: There's something in there about she who laughs last laughs best.

COOPER: Yes.

Still ahead, young, obese and facing the writing on the wall. You're going to meet a 14-year-old girl who was told she would not make it to 18. Her extreme weight is killing her. She had surgery she hopes will save her life and help her feel normal, she says, for the first time in her life. It's part of our new series, "Kids in Peril: Obesity in America."

Plus, Gary Tuchman takes us to the streets of one of the world's most dangerous cities, Juarez, Mexico, just over the border. Three Americans recently were gunned down. They are a horrible crime but also all too familiar one.

(COMMERCIAL BREAK)

COOPER: Welcome back.

You heard Andrew Weil a moment ago. He and others criticize the new health-care bill for not focusing enough on making people healthier. They're concerned about the surging rate of obesity, for instance.

Take a look at this map from the Centers for Disease Control from 1998. Now, in all those blue states, less than 20 percent of adults are obese. In the beige states between 20 to 24 percent -- adults are obese.

Now look at a map from 2008. As you can see, ten years later, you see a lot of red and orange states. Thirty-two in all. In all of those states, a quarter or more of adults are obese. The epidemic is nationwide, and it's trending younger, interestingly enough.

According to a new Kaiser Permanente study, children today may be facing shorter life spans than their parents, 10 to 20 years shorter. It's incredible. And they say that is because obesity is putting them at risk for diseases that can kill.

Well, tonight we begin a weeklong series, "Kids in Peril: Obesity in America" with one young girl's story. Here's Randi Kaye.

(BEGIN VIDEOTAPE)

RANDI KAYE, CNN CORRESPONDENT (voice-over): Her name is Maria Caprigno, and if you're staring at her, she won't be surprised. Because of her weight, people have been doing so since she was a little girl.

Look at these family photos. They tell the story of Maria's ongoing battle with childhood obesity. At 4, she weighed 79 pounds, as much as a 7-year-old. By the time she was 7, 168 pounds. Off the charts, her doctors said. By 9, she weighed 250. Last month, at 14, she topped out at 445 pounds.

(on camera) Does it hurt when people stare at you?

MARIA CAPRIGNO, BATTLING OBESITY: Yes. The first thing that goes through their mind is "Why is she so fat? Like oh, my God, why is she so fat? Why doesn't she just hop on a treadmill?"

KAYE (voice-over): Maria's parents are overweight, too. And admit they don't eat healthy foods. Maria's always been a junk-food junkie. Dieting never worked.

So a few years back, Maria pleaded with her mother to find a doctor willing to do weight-loss surgery on teenagers. Their search led them here to National Children's Hospital in Washington, D.C., and Dr. Evan Nadler.

DR. EVAN NADLER, CHILDREN'S NATIONAL MEDICAL CENTER: I had to help her, because she was 440 pounds and going nowhere except for gaining more weight.

KAYE: Maria was 12 and already pre-diabetic.

NADLER: Her BMI, which is a measurement we use to determine how obese someone is, put her in the highest risk category. Not just morbidly obese but actually two categories higher than that.

KAYE (on camera): Dr. Nadler says 25 percent of all high-school- age children are either overweight or obese. And he believes that those most obese face health risks such as high blood pressure, diabetes and depression that far outweigh the risks of any weight-loss surgery.

(voice-over) But some disagree. Like Dr. Edward Livingston, who turns away most young patients.

DR. EDWARD LIVINGSTON, UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER: Kids don't really know what they're getting into. I think you have to be really careful with children.

KAYE: Before surgery, Maria had to meet with a nutritionist, pediatric cardiologist and psychologist for approval.

CAPRIGNO: My name is Maria Caprigno.

KAYE: She also wrote this letter to her insurance company seeking coverage.

(on camera) You told the insurance company you need this surgery to make it to your 15th birthday.

CAPRIGNO: Doctors have told me for years that if I keep gaining weight, I'm not going to see 18. And that has terrified me. I want to live. I want to do so many things. And I knew that this was my only option to do them.

KAYE: This was a life or death surgery for you, you felt?

CAPRIGNO: Yes.

KAYE (voice-over): Even so, some critics still argue, not enough is known about possible long-term complications.

NADLER: I fully agree that we need to study this more. But I don't think it's fair to the Marias of the world to keep them from having this procedure, based on their age alone. KAYE (on camera): In his own study, Dr. Nadler followed 41 teenagers for two years after weight-loss surgery. He says they lost half their excess body weight, and their health had improved.

(voice-over) Last month, Maria had an experimental procedure known as a gastrectomy. Eighty percent of her stomach was removed, including the area that makes her appetite hormones.

CAPRIGNO: I wasn't hungry after surgery. Like, normally I would have been starving.

KAYE: Maria has already lost 45 pounds and trimmed two inches off her waist. She's off junk food, getting regular exercise, and eating a high-protein diet.

(on camera) What is your goal weight?

CAPRIGNO: It's not about the numbers. I want to be at a healthy size. I want to be able to run. I haven't been able to run since I was 5 years old. I want to be able to wear a bathing suit without feeling embarrassed. I just want to be able to be normal.

(END VIDEOTAPE)

COOPER: She just wants to be a kid. What is -- what is her diet like, Randi?

KAYE: Right now, Anderson, she eats about 1,500 to 1,800 calories a day. Mostly pureed food, really, and anything that she can put in a blender. But all protein. She's supposed to eat all the protein on her plate and then, if she's still hungry, maybe move to carbohydrates.

But she's also expected to lose, she said, 100 pounds a year. This is only going to last a couple years. Then she's going to flatten out and plateau for a while. But that's a lot of weight, and she's well on her way.

COOPER: Sanjay, what is happening inside her body? I mean, what kind of stress does -- this weight has got to put on huge stresses on her.

SANJAY GUPTA, CNN CORRESPONDENT: On just about every part of her body, Anderson. You're absolutely right. A lot of people focus on the outside. But in kids now as young as Maria and even younger, things are happening inside the body.

Take a look. Some of these images here are from this exhibit where they actually look at the insides of thin bodies and bodies that are more overweight or obese. And what they're really trying to show here is what's happening to organs such as the heart, for example.

And you can take a look there. The heart inside, the muscle starts to grow around it. The arteries, even the arteries leading to the brain, the carotid arteries, start to develop plaque. And some of the coronaries, which are the blood vessels on top of the heart, Anderson, something you and I have talked about quite a bit. You can see significant disease inside these coronary vessels that would look like somebody in their 50s or 60s, but you see it in someone in their teen years. Sometimes even younger than that.

COOPER: So does, Sanjay, having the surgery, does that mean she's no longer -- I mean, I guess that helps -- does it help reduce her risk for things like heart disease, for diabetes?

GUPTA: Yes, you know, it does. You know, it's not quite that simple. I mean, taking off weight is taking off weight. So it's going to help with things like your joints, knees and hips, which can also be a significant problem at a young age.

With regard to bariatric surgery in particular, losing the weight alone does have some positive impact on reducing some of those health problems, as Randi mentioned. But it has to be accompanied by diet changes, as well. The person will eat less. But the choice of foods have to change significantly, as well, if you're going to reduce your high cholesterol and address things like pre-diabetes or even diabetes.

COOPER: Well, also, especially for a teen, Randi, I mean, diet is so important. If her parents are not eating well, then she's not going to, in all likelihood, eat well. Have they changed their diet, as well?

KAYE: They have, actually. Her mom said that she's now buying healthier bills. But their food bill has actually gone up, she said, about $60 a month, because buying healthier food is more expensive. Right.

But her mother, actually, had the lap band weight-loss surgery before Maria did, so she could understand what her daughter might go through, even though it was a different surgery. And her father has already lost 11 pounds. He's eating healthier. He's planning to have weight-loss surgery this summer.

COOPER: We wish them all the best. Randi, thanks very much.

You can join the live chat and let us know what you think of this story at AC360.com. Sanjay, thanks very much. We'll talk to you more tomorrow.

Coming up next on 360 -- that series, by the way, goes on all week. We'll have more on that tomorrow. Next, though, tonight, the gangs of Juarez, Mexico. A journey to the violent border city, one of the most dangerous cities in the world right now. We'll take you there.

And later, a late-breaking development in the defamation lawsuit against Oprah Winfrey. Charges relating to a sex abuse scandal at her school for girls in South Africa. Details of the settlement ahead.

(COMMERCIAL BREAK)

COOPER: In "Crime & Punishment," a new push to end the growing violence from the war next door. Secretary of State Hillary Clinton was in Mexico City today, leading high-level talks aimed at destroying the cartels and keeping the bloodshed from spilling over into the -- over into the border region, into the United States.

Her visit come a little more than a week after gunmen killed three people connected to the U.S. consulate in Juarez, which is just across the border, of course, from Rio Grande and El Paso. It is also the murder capital of the world. Tonight Gary Tuchman hits the streets of Juarez and finds deadly violence within minutes of his arrival.

(BEGIN VIDEOTAPE)

GARY TUCHMAN, CNN CORRESPONDENT (voice-over): This man has just watched gunmen ambush his brother and murder him. In one of the most frightening cities in the world, Juarez, Mexico, a place where 16 young people can get killed at a party by narco traffickers, who apparently made a mistake, targeting the wrong house, and few are stunned by it.

Drug cartels are at war in this city of 1.5 million. Law-abiding citizens be damned.

This past weekend, we went to the funeral of an American woman who worked at the U.S. consulate in Juarez. She was shot and killed, along with her American husband and unborn child. It happened right in front of the Juarez mayor's office, a stone's throw away from El Paso, Texas.

Over the next few hours we saw firsthand what has led to Juarez having the highest murder rate in the world.

(on camera) There's no such thing as a quiet day here in Ciudad Juarez. About one hour ago, police got a call that, in this murky river, there was a body. When they got to the scene, they indeed found the body with a bullet hole right in the forehead. Behind me, members of the military with guns, police, these guys will probably be at another murder later today.

(voice-over) We didn't realize how quickly we'd see them again.

(on camera) Only ten minutes after we left that river, a five- minute drive away, this was the scene. Two men in that gold pick-up. Six gunmen came up to them. The driver ran out, was shot, and now he is under that tarp.

(voice-over) Why was he targeted? We may never know. This is the brother of the victim who was also in the pickup. The gunmen left him unharmed.

UNIDENTIFIED MALE (through translator): We were just going to the tire shop to pick up a tire and nothing more.

TUCHMAN: Thirty minutes later, another execution-style killing. A worker in an electrical store shot multiple times at close range. Neighbors are afraid to talk about what they know and fear the murderers will come after them.

I asked this man if he heard anything.

UNIDENTIFIED MALE: Nada.

TUCHMAN: Nada?

As an observer, it is very disturbing how this all starts feeling very routine. We're seeing the same police officers, the same members of the military. No matter how nice the neighborhood is or how light the sky is or how many children are out on the streets, if these narco traffickers are targeting you, or they mistake you for someone they want to target, you're almost as good as dead.

(voice-over) We're told that something horrible happened in the middle of the desert outside of Juarez. We drive on a gravel road to near total isolation to see what police discovered from an anonymous tip.

(on camera) What the authorities found here was a mass grave. This hole right here had five decomposed bodies, one of them without a head.

(voice-over) It had been less than four hours since we arrived in Juarez when we saw this scene. The body of a man shot more than a dozen times at close range in the back seat of a car. Outside the police line, a woman who didn't want to talk sobs.

This woman was one house down from where the execution took place.

(on camera) So did you hear gunshots?

UNIDENTIFIED FEMALE: No.

TUCHMAN: You're right next door to where they happened.

UNIDENTIFIED FEMALE: Well, yes, but no, we didn't hear anything.

TUCHMAN: Would you be afraid to tell me if you did hear something?

UNIDENTIFIED FEMALE: Well, yes.

TUCHMAN (voice-over): So many people are afraid in Juarez. After a sunny Saturday afternoon here, you see why.

CNN, Juarez, Mexico.

(END VIDEOTAPE)

COOPER: A quick note about some international coverage that we brought you last year. 360's special coverage, "Inside the Battle Zone: Afghanistan," won first place for continuing coverage of a major news event at the U.S. National Headliner Awards. We'd like to thank Dr. Sanjay Gupta and the 360 team on the ground, and especially the U.S. Marines for hosting us during our time there in Helmand province.

Coming up next on the program, Oprah Winfrey will not have a day in court. A woman-to-woman talk between the talk show queen and the former head of her South African girls school ended the suit against her.

And live from Alaska, Sarah Palin. According to reports, the former governor and vice presidential candidate could soon be starring in her own reality show. Details ahead.

(COMMERCIAL BREAK)

COOPER: Following some other important stories. Let's check in with Christine Romans for a "360 News & Business Bulletin" -- Christine.

ROMANS: Anderson, we begin with that former university professor accused of killing three colleagues. Amy Bishop made her first court appearance today. The capital murder case against her was sent to a grand jury. Bishop allegedly opened fire last month at the University of Alabama in Huntsville. In a police interview, Bishop denied any involvement, saying, quote, "It wasn't me."

In Mississippi, a 360 follow on the high school that canceled its prom instead of letting a lesbian student bring her girlfriend as a date. Today a judge said it will not force the school to hold next week's prom. The ACLU accuses the school of violating the students' First Amendment rights.

Oprah Winfrey has settled a lawsuit brought by the former head mistress at her Leadership Academy for Girls in South Africa. A statement released today said Winfrey and the woman reached an agreement after meeting face to face. The woman accused the talk show host of defaming her in the wake of abuse allegations at the school.

And taking the pain out of gift cards. The Federal Reserve has announced new guidelines to better protect people who use these gift cards. The new measures include limiting fees on charges and inactivity. The rules take effect in August.

And according to several Hollywood trade reports, Sarah Palin, Anderson, is heading to reality TV. That's right, reality TV. They say she'll star in an Alaska-themed show for the Discovery Channel. And we hear Discovery is paying a million bucks for each episode.

COOPER: We don't know if a million -- I doubt that's $1 million for her. It's probably the price of the episodes.

ROMANS: I would suspect it's what they're paying for each episode of that. But this is -- this is Sarah Palin on her own turf on her own terms, right?

COOPER: You never know.

All right. Tonight's "Shot," this is great. Take a look. One way to stop a baby from crying. This is cute. (BEGIN VIDEO CLIP)

(BABY CRYING)

(DOG HOWLING)

(END VIDEO CLIP)

COOPER: Aww. A howling dog to soothe a little baby. That's adorable. I can't tell if it's working or if he's just drowning the baby out. I think it's working.

ROMANS: I think it's working. I want to make this a cell phone ring. It was nice.

COOPER: We found this at Break.com. The site says the link was uploaded yesterday. No doubt going to go viral pretty quickly. Yes, there you go. And a pretty dog, too.

ROMANS: That's a dog who loves its baby.

COOPER: See, it works. It's amazing!

All right. Christine, thanks so much. We'll have more news at the top of the hour. We'll be right back.

(COMMERCIAL BREAK)

COOPER: Tonight, "Keeping Them Honest" on health-care reform. Who is putting cynical politics above what's good for America? New moves to kill the bill and new moves by the president and Democrats to sell it. The latest ahead.

Also tonight, with health in the headlines, a teen girl's struggle with weight. Fourteen years old, more than 400 pounds. Her fight to lose the weight, and the radical surgery she has pleaded to get.

And "Crime & Punishment" tonight, seven bodies in a single day. Dozens a week. Americans also getting killed right across the border in Mexico. He was warned not to go, but 360's Gary Tuchman went anyway and brought back a front line look at the war next door.

First up tonight, "Keeping Them Honest." We'll show you where the fight over health care now heads and the motivation behind the fight. Is it about what's best for Americans or about pure raw politics?

As you probably know, President Obama signed the bill. It's official name is the Patient Protection and Affordable Care Act. There's the signature up close. Actually, one of many. He used 22 different pens to sign the bill, most of which were given away mementos. That's the kind of thing they do at these bill signings. Two went to the national archives.