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tv   MSNBC Live With Ali Velshi  MSNBC  October 27, 2017 12:00pm-1:00pm PDT

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ali velshi picks things up now. >> have a great afternoon. i'm ali velshi, the white house on a mission for a legislative victory and all eyes on tax reform. the questions at today's white house press briefing mostly about puerto rico and controversy surrounding that contract to help restore power there. we're awaiting a press conference on san juan's mayor and senator bernie sanders and will bring that to you when it happens. we begin at the white house briefing. hallie jackson, just talking to chris jansing. she'll be back with us in a few moments. let's talk about some of the things that the white house is trying to get done with respect to tax reform. they were hoping to have tax reform done. i want to walk to the board here and show you what we're talking about in terms of the goals for tax reform. the goal is to have tax reform introduced on november 1st in the senate, and then in the week of november 6th, to have the ways and means committee mark it up. and then the week of november
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13th, have the finance committee mark it up. the goal here, of course, get everything done by the end of november, in the senate, end of december in the house. the white house is pushing to cut the corporate tax rate. it claims that's going to raise wages. right now the corporate tax rate, the statutory rate, is at 35%. often you hear people say highest in the world. that's because it is, at least one of. not the highest, one of the highest in the industrialized world except most don't pay that. pay a different rate depending how many loopholes. we calculate to be about 18.5%. they want to bring it down to 25% insisting those cuts will stimulate growth and increase the annual household income by an average of about $4,000. they were saying $4,000 to $9,000, now we're hearing $4,000. i'll ask about that in a moment. this plan says dropping the
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corporate tax rate will increase economic activity to something between 3% to 5% in as little as three years. it says that this 3% to 5% increase in the gdp will cause a boost to economic output basically between $700 billion and $1.2 trillion over ten years. so that's all the good news. here's the problem. the debt. some analysts predict that this -- this tax cut will increase the deficit by between $2.2 trillion and $2.7 trillion. this is the kind of stuff we need to understand and for this i turn to an economist and my old friend kevin hassett, chairs the white house council of economic advisers. he led an on-the-record briefing this afternoon laying out, or this morning, laying out the white house's plans. kevin good to see you. thank you for being with us. >> thanks for having me. >> talk to me about this idea of the growth that will emanate from a tax cut for businesses.
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tell me how you get from a. to b. that you put this tax cut out there. given that what you and i talked about, that stock markets are doing well, corporate profitability is good and money available to companies, what will the tax cut do that causes the economy to grow? >> right. well, the headline is that people who are watching your show right now i would guess most peel they're wages haven't been going up nearly as much as they should given how many profits are soaring. that int twhags we have is consistent in the analysis doing, seeing a disconnect between what happens to companies and what happens to workers. it's our belief that that disconnect occurred because the factories are all over in ireland and other countries that have much lower taxes than ours. one of the newsworthy items in the report put out today, ali, that conference on this morning, was that we looked back at capital deepening. the amount of wage increases people get over time, because there are more machines, more factories to work with in u.s. history. on average, since the second
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world war, end of the obama administration, dropped into negative territory first time in u.s. history. but it's not -- finish one last thing. it's not my belief because president obama did something super harmful to taxes. collective inaction in washington, all other countries were cutting rate made us so unattractive we stopped even having enough capital to give wage growth. >> two things you said i want to explore. first, explore wages. ask my control room to put up a graph of wages. going back to about 1964. i've taken average hourly wages seasonally adjusted. describe this to you. you're familiar with this. bottom line is a graph, a chart, a line going up from $2.50. average hourly wage in 1964. to $20.67 roughly now. it's gone up. adjust for inflation, back in -- 1964, people earning about $19
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an hour. in 2014 earning $20 an hour. so the average hourly wage has been stagnant throughout ups and downs, recessions, tax cuts and tax increases. fundamentally, if you're the average worker in america, you've been stuck a long time. >> stuck a long time, and, again, just simple economic theory suggests that the way to make it unstuck is to either help workers become more productive giving them better training or give them better machines to work with. and what the president's plan does is at least creates the hope that firms will bring activity here, locate the plants here and give people the jobs and the higher labor demand should drive wages up as well and we don't have evidence within the u.s. in modern times of an experiment like this but lots of evidence from around the world and countries around the world have done this, rewarded with higher wages and higher income growth. >> i can't get through a conversation without talking about canada. you like to bring up ireland. corporate tax rates for ireland and canada.
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ireland statutory race 12.5%, ireland, 15%. white house proposes reducing the corporate tact race to 25 prsz percent. why come back for a tax rate higher than other countries? >> ali, gave me 12.5% i would take 2. the 20 tahrir square proposal, though, makes us a lot more attractive than 35% does now. the other thing about this is, you mentioned the deficit coming in. don't forget, we have the highest tax in the divested world but nobody pays it. the way they don't, locate the money offshore. the idea this will rip a hole in the deficit is loony tunes. we're not getting revenue from these guys. cut to 20%, more activity, collect tax from them and get taxes on wages. >> issue, a 35% statutory tax rate. grange this talking to you we don't have to have a silly conversation about the fact a lot of companies don't pay it.
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we know that. if you don't fix all the loopholes and bring the 35% amounts to call it 18%. we can find whatever number we want. i come out to about 18.5%. 35% statutory paying something like 18.5% bring down to 20% statutory don't you have the same problem ultimately companies will be paying 10%, 12% or 15%? >> don't forget, which you locate the activity offshore you're doing something inefficient. better to have it here. invented it here. people who know it best are here but going to ireland, someplace else with a lower rate and training people to do it at great cost to yourself and shipping costs and everything else doing that. because the gap in the rates is so high. if we go down to 20% all advantages that america has to offer will lure the business back, and that will increase wages and growth. you're right. if we then have that positive experience, my guess is what we see in the u.s. is what we've seen in other countries, like france. mack crohn argued go even though
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below, down to 25% for them a positive experience and do it again. my guess, we would do that. >> not against people paying lower taxes at every level. i'm trying to make the connection between the success you think you'll have in the study you cited from harvard. bip fritz foley and james heinz university of michigan. mr. desai, wrote the study with harvard's foley says his own estimates of the effect of this corporate rate cut was closer to $800 a year and thinks somehow you've misinterpreted his numbers. >> i've spoken with him, an old friend and can say his co-author jim heinz, i was his research assistant in graduate school. i've spoken to them about it. the report out today, we went through the entire literature in that space and estimated the wage effect for every single paper in that literature and went back and did that, many
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were up around 9,000, like we said his was and saw a subtle point raised relevant. they did a two equation modeled. you needed extra assumptions, we thought reasonable to get 9,000, pe disputed those. a fair thing for him to do and we mentioned their paper in the study. look, lots and lots of other sites not just his in the -- >> i saw that. >> reached the same conclusion. >> added citations to it. kevin, good to talk to you. >> great to be here. >> chair of the white house council of eck nomic advisers. secretary of defense james mattis delivered tough talk on the peninsula today. >> as the u.s. secretary of state secretary tillerson made clear our goal is not war but rather the complete irrevocable denuclearization of the korean peninsula. >> mattis sent that message from one of the most dangerous borders in the world. the demilitarized zone. the dmz between north and south korea, a stretch of land between
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the two countries spanning about 2.5 miles wide, 160 miles across. the secretary's trip is ahead of president trump's visit to asia next week. joining me with more, msnbc's hans nichols. what do you got? >> reporter: look, anytime you go to that part of the world it can be seen or heard as provocative. i heard secretary mattis talk about military options, he couches that, twins that with a talk of diplomacy and need to keep diplomatic options open. in this visit seemed his south korean counterpart was almost giving a more hawkish view and arguing about maybe how you take out long-range artillery pieces, what you do for that threat there. a quick note on that, ali. the estimate, an old estimate, we don't have up-to-date intelligence. the current estimate what would
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happen if there were conflict on the korean peninsula. half a million artillery rounds per hour fired by the north. context, 500,000 artillery rounds per hour. during the height of the korean war the chinese only mustered 100,000 rounds per day. massive amounts of artillery there. >> five times the artillery in an hour than they used to be able to do in a day. more than 30,000 u.s. troops in south korea, more than 100,000 americans and you're talking artillery war. not even discussing nuclear war. >> or kchemical or bilal. and what happened, a dangerous nerve gas north korea obviously has, could use that in any sort of conflict. this isn't just artillery shells or specter of a nuclear conflict. also chemical and biological.
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>> hans nichols at the pentagon. we're minutes away from a joint conference with senator bernie sanders and the san juan mayor. despise the fact more than a month since two devastating hurricanes irma and maria devastated puerto rico, more than 75% of the island is still without power. particularly high interest in the $300 million contract awarded to whitefish energy a tiny montana company to restore power to puerto rico. even the white house is weighing in saying "the decision to give a contract to whitefish energy was made exclusively by puerto rico electric power authority, and aren't aware of any federal involvement. fema has significant concerns how they secured the contract and not confirmed whether the contract prices are reasonable. the governor of puerto rico ordered and audit of company. that report is expected to come out today. a spokesman poor whitefish says the company welcomes the audit and they're on the ground getting work done." in san juan, gabe gutierrez.
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governoring this since maria devastated the island. what's going on with respect to this and the whitefish allegation? >> reporter: as you mentioned, awaiting a joint news conference between the mayor of san juan and bernie sanders. if you've followed the story you recognize the spot we're standing in. a shelter where many people spent the storm, bernie sanders, senator bernie sanders visiting this area and that news conference expected to start within a few minutes. plenty of aid, bottled water, and supplies. is this aid getting to people who need it quickly enough and is enough being down restore power? you mentioned ali, a controversy over whitefish, more than 300 contractors on the island but questions raised whether this contract was properly awarded with a company with just two full-time employees at the time maria made landfall.
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saying the front of government had nothing to do with this or the interior secretary. the company says the same thing, but, again, a lot of people on capitol hill and here in puerto rico are wondering whether enough was done to make sure this contract was above board. now, whitefish energy certainly not the only company here trying to restore power. another contract was $200 million given to a company out of oklahoma as well. the army corps of engineers is also trying to restore power here, but as you mentioned, 73% of this island, more than five weeks after hurricane maria, still does not have power. we've been speaking with people here on the ground and asked them about this controversy about whitefish energy. ali, many of them, while they are frustrated with prepa, electric power authority, many aren't familiar with the details because they don't have power and it's tough to communicate here in puerto rico. many parts of the island, rural areas and here in san juan, business at a virtual standstill.
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the economy add a virtual standstill and they want to know when the power will be restored. the governor saying he hopes that 95% of this island will have power by mid-december. folks here are xetskeptical. awaiting the results that should come bich ty the end of the day >> we'll be listening in at the press conference. gabe, thanks. gabe gutierrez in san juan, puerto rico, continuing our ongoing coverage in puerto rico. coming up, the road to recovery a long one for the millions of puerto ricos still 12r struggling. andrew cuomo, new york governor, joins me next to talk about the latest recovery efforts and what he's doing to help.
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a major development in the ongoing political crisis in spain. looking at live pictures from barcelona. catalonia's carlment officially declared independence from spain in an act of defiance from the spanish government looking to form a catalan republic. a live look at streets, celebrating the vote which comes as the spanish government was directing rule over the semiautonomous region. the united states supports the spanish government's constitutional measures to keep spain strong and united. it's worth noting the declaration of independence for now will not be officially
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recognized by spain or by the international community. we'll keep you up to date on this developing story. the u.s. footprint in west africa is larger than even some u.s. members of congress knew, and it could get bigger as we learn more about the special forces mission in niger that ended the lives of four u.s. soldiers, we're also learning that the ambushed group was among 26 or 27 missions operating in the area. in a press conference yesterday, joint staff director lieutenant general mckenzie also told reporters that one additional team was involved in the niger attack. congress members who emerged from the two closed briefings on the matter said that americans should expect to see even more u.s. troops deployed to africa. now, in the more than three years since isis seized control of theaticy city of mosul and declared a ccaliphate, they've
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recruited people, bringing them to syria and iraq. now that the terror group is losing footing, those recruits and their families need to go somewhere. this exodus is creating an entirely new threat for the countries that these isis fighters once called home. that's the focus of a new report by a group and global strategy network. among the findings, at least 5 had 600 foreign fighters from 33 countries returned home from isis territories. according to the report, states have not found a way to address the problem of returnees. the ceo of the group that missed the report and a former fbi special agent. good to see you. >> good to see you. >> you have always warned about this. that the isis strongholds in syria and iraq will collapse. that was to be expected. were not going to be able to hold up against superior forces but the fighters are going around the world and implicit and explicit message from isis, wreak some degree of havoc.
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except they go back with pa passports to other countries. >> we warned about that early 2014, bringing the issue of foreign fighters to the forefront. today we are seeing basically a lot of people who went to join isis returning. you have thousands of people, not only going back to their home countries, but sometimes going back to third countries, trying to find safe havens in different places. we have foreign fighters participating in the so-called jihad in syria and iraq and are now in southeast asia or in africa or libya and so forth. it's extremely important for the international community to realize, this trend line essentially will be coming forth lines. from the thousands who already went back to their countries, 1,200, for example, went to western europe. 425 went to england. almost half of the foreign fighters who joined in iraq and syria uting significance pressure on the intelligence
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agencies and law enforcement in these countries. surveilling and assessing them will take away resources people as dangerous inspired also by the message. >> and possibly trained. >> absolutely. absolutely. >> is it a crime? when these people go back to their home countries, are they able to be arrested? do they get tracked? what happens? >> a good question. every country is very different, and the united states, yes it is. we have seven who already returned from the 129. >> you were a member of isis and come back to america, you should get arrested? >> we have conspiracy laws, other laws on the books that give the law enforcement and the fbi the right to arrest and dethad detain these individuals. other countries around the world unfortunately don't have these laws and sometimes allow these people to stay free until he do some bad and get arrested. >> when you listed the countries, which provided these, the countries from which these fighters came from, russia had the largest number?
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>> 3,417. russia is now the first nationality of isis fighters. foreign fighters i mean. >> the russian government, the spokesman for vladimir putin today took issue with your reporting. they seemed to be disagreeing with it but weren't really able to say what they disagreed with. >> mr. dmitri peskov basically says he tends to doubt the number, the kremlin tends to doubt the number. so they didn't doubt it, didn't deny it, but later on members of the duma and other politicians in russia seems to indicate there's a conspiracy behind these numbers. look, you know, isis is an enemy for everyone, an enemy for russia as much as our own enemy. our numbers, as we stand by them, russians saying where did we get our number? from president putin, sfv and minister of interior.
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>> russians acknowledged, another part of the russian government acknowledged -- >> president putin himself in a speech back in february to a russian northern fleet said about 4,000. citizens of russia. are fighting with isis. and also the ministry of interior of the russian government said basically the same thing. >> strange for them to dispute your number. he said 4,000. you said 3,417? >> again, law enforcement agencies in russia, above all the president of the federation, president putin, acknowledged this. >> to a bigger point, it doesn't do good for any country to downplay the reality of this. if you have people with a passport to your country and come back and wreak havoc in the name of isis you need to know it and take action? >> absolutely. this is a global problem. why i think we need to have an international solution that can be applied locally and domestically in all of these other countries. we need to basically create an
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environment where we share information and share intelligence with each other, because, you know, probably we have some information about russians who are working there. probably the russians don't know about, and they have information probably about americans working there that we don't know about and we need to create that sharing of information in order to prevent death threats from coming back home. >> i want to play something steve bannon said monday at the hudson institute conference on countering violent extremism. i don't think we have it. read it. eight months in president trump's strategy executed by general mattis, the strategy not a war of attrition. specifically, a war of annihilation. we will physically annihilate the caliphate. that's what's been accomplished. >> sounds good. reality, this strategy was established under the former administration. searing the fruit of what the former administration did, campaigned by air, supporting the kurds, supporting the iraqis, to fight the fight, but also at the same time we always knew that we started the show
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about this. we always knew that what happens after we destroy the caliphate, what happened after isis loses its territorial caliphate and this is the whole issue the foreign fighters components and the returnees is one vertical of it. what's going to happen is, it's going to be inspirational. sorry, i can't talk today, and the message will live and outlast raqqah and outlast mosul. >> good to see you. the ceo of the sufan group and a special agent. coming up, governor andrew cuomo joins me to talk about the ongoing crisis in puerto rico.
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a republican congress once impeached a president for far less. yet, today, people in congress and his own administration know this president is a clear and present danger who is mentally unstable and armed with nuclear weapons. and they do nothing. join us and tell your member of congress that they have a moral responsibility to stop doing what's political and start doing what's right. our country depends on it. i would plan to be prudent that situations are going to happen again. and how do we make sure we don't have the same amount of damage next time? how do you rebuild the home, rebuild the road, rebuild the infrastructure? so there's less damage. >> that was new york governor andrew cuomo speaking in puerto rico yesterday while progress continues to be made on the
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island, there is still an unfathomable amount of work to be done. 72% of the island lacks power. 2% still doesn't have running water and people in areas where water has been restored are saying their access to it is neither reliable nor consistent. for more i want to bring in new york governor andrew cuomo just back from a visit to puerto rico yesterday. governor good to see you. thank you for being here. this is obviously a concern for you as governor of new york, because new york has one of the largest populations of puerto ricans in the continental united states and a fundamental problem the speed at which things are being repaired in puerto rico. what are you seeing on the ground? >> thanks for having me, ali. it's a concern for me as an american, it's a concern for me as the governor. let's remember, the people in
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puerto rico are americans. i was there the first day and now it's about five weeks later and it's amazing how little progress has been made. after one month, still have 75% or whatever figure you want to use without power. people who are drinking water that may be dangerous. so i believe that puerto rico has been treated as second-class citizens. we are better than this. we know how to do this. we do this all around the country, all around the world, and i think puerto rico deserved better response, faster response and more effective response, frankly. >> when you look at the recovery that is still undergoing in places because of sandy, in new york, you mentioned yesterday in puerto rico that there should be a rebuild that takes into account the fact that it's a place that another hurricane could hit. they had a weakened infrastructure and need to sort of get to a place that is better than they were, but also an island that is deeply, deeply in
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debted. you heard the president's comments on this. how do you rebuild a puerto rico in a way that is stronger than before and deal with the financial problems that it's got. >> yeah. two points, ali. first, on the point, well, puerto rico had problems before. yes. that's true. but it's like a doctor saying, well, you know, the patient was sick. yeah, i know. that's why the patient came to you. when you're dealing with puerto rico on an emergency, obviously, you need to deploy sooner. you need to deploy more resources, because it's more problematic. because the infrastructure is stressed to begin with. but to be sitting here a month later and the federal government is basically running the effort and we still don't have power up. they still haven't used what's called mutual aid, which is the states send their power utility companies to help, i have -- i
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could send hundreds of power crews. >> right. >> to puerto rico as soon as the federal government gives me the go-ahead, and i haven't gotten it. >> right. >> second point -- when going through this reconstruction, whether in new york, florida or texas, i think someone whose think wog say, let's assume we have another situation. right? because i believe in climate change, but at this point, you either believe in climate change or you believe mother nature is having a nervous breakdown. right? in either event, would you have to guess you're going to have another climate-related event. >> y>> yep. >> and how do we make sure we don't sustain the same damage? raze homes, harden sewage treatment plants, harden the infrastructure. that's what we're going to work with puerto rico on. we've gone through it a number of times. the governor of puerto rico may come up to new york as soon as next week and that's the only
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silver lining here. it's that puerto rico can actually be better after the storm than it was before. there's going to be billions of dollars of construction going into puerto rico. let's make sure we use it intelligently and we build resilience and sustainability into the new puerto rico. >> governor, i want to talk to you about taxes and things. we have to make another appointment to do that because i know this is really important, what's going on in the budget and the tax reform bill and how it may affect new yorkers. i'll make arrangements to talk to you again. thank you for your time today. >> i would love to you. talk to you about tax deductibility. didn't bring it up in your piece talking about tax reform. >> we talk about it every day. i'll make sure we come back and talk about that. andrew cuomo, governor of new york. thank you, sir. after the break, an eye-opening conversation with doctors about our nation's deadly opioid epidemic and the
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role they've played in it. >> we were betrayed, misled and now have a decade hence to fix. i switched to geico and got more. more savings on car insurance? yeah bro-fessor, and more. like renters insurance. more ways to save. nice, bro-tato chip. that's not all, bro-tein shake. geico has motorcycle and rv insurance, too. oh, that's a lot more. oh yeah, i'm all about more, teddy brosevelt. geico. expect great savings and a whole lot more.
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afi sure had a lot on my mind. my 30-year marriage... ...my 3-month old business... plus...what if this happened again? i was given warfarin in the hospital, but wondered, was this the best treatment for me? so i made a point to talk to my doctor. he told me about eliquis. eliquis treats dvt and pe blood clots and reduces the risk of them happening again. not only does eliquis treat dvt and pe blood clots. eliquis also had significantly less major bleeding than the standard treatment. eliquis had both... ...and that turned around my thinking. don't stop eliquis unless your doctor tells you to. eliquis can cause serious and in rare cases fatal bleeding.
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don't take eliquis if you have an artificial heart valve or abnormal bleeding. if you had a spinal injection while on eliquis call your doctor right away if you have tingling, numbness, or muscle weakness. while taking eliquis, you may bruise more easily... and it may take longer than usual for bleeding to stop. seek immediate medical care for sudden signs of bleeding, like unusual bruising. eliquis may increase your bleeding risk if you take certain medicines. tell your doctor about all planned medical or dental procedures. eliquis treats dvt and pe blood clots. plus had less major bleeding. both made eliquis right for me. ask your doctor if switching to eliquis is right for you. vice president spence at minot air force base in north dakota just finished speaking to troops there. moments ago he had this to say an north korea. >> in the threats of provocations by the regime in north korea i can assure you the united states will continue to
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marshal economic and diplomatic pressure to demand that north korea abandon its nuclear and ballistic missile programs. while president trump has made clear that the united states has in his words great strength and patience, all options are on the table. our enemies should never doubt the capabilities of the armed forces of the united states of america. anyone who would threaten our nation should know that america always seeks peace, but if we are forced to defend ourselves or our allies, we will do so with military power that is effective and overwhelming. now to our ongoing series "one nation overdosed" our own dr. torres spoke to a group of doctors. you met the group yesterday furst. let me remind you you'll hear from dr. anna, a chief of addiction medicine and stanford university of medicine author of
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"drug dealer m.d.," and dr. scott hamlin, research takes aim at the influence of pharmaceutical money on the rate of opioid prescriptions and dr. peter grinspoon, on staff at mass general teaches at harvard medical school, former opioid addict clean for ten years and wrote "free refills: a doctor confronts his addiction "and an oral surgeon and add jumpjunct minnesota school of dentistry. her history spurred by her brother's addiction and abuse. and chief medical examining who retired after 20 years. all these doctors got real and held nothing back. let's hear more of their eye-opening conversation. >> how did doctors become major suppliers, get tricked into
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thinking pain is best treated with addicted medications? >> i think betrayed by an academic physician and because i'm one i feel i can say that. folks who supposed to be our thought leaders. hired from pharma and others, told them sa prescribes more opioids is supported by science. practicing evidence-based science. and a whole group of doctors, myself included, absolutely believed this myth. believed it was based in science, patients couldn't get addicted and worked for chronic pain and now we are seeing the results. >> there's no one who could convince me otherwise. yes, we were betrayed. we were misled, and now we have a much bigger problem, a decade hence, to fix. >> unfortunately you see the end result of this as a medical examiner, how much patients that you examine actually died from overdose because they were taking it for pain? >> when i first started in new
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hampshire, in 1997, we were seeing anywhere from 30 to 40 drug deaths a year. now in the last two or three years we've seen upwards to 500 drug death as year. when we started to see that peak, an initial rise, i should say, 2004, 2005, that was clearly, clearly, driven by prescription opioids leading to habituation and addiction, eventually seeking out some of these opioids illicitly and ultimately dying of their addiction. >> it's becoming increasingly evident that our education and our residency training was infiltrated by the influences of pharmaceuticals, and re-education of ourselves is what will solve it. >> it's a case at this point of the path to hell paved by good intentions. we hear these horror stories about these pill mill doctors that write, you know, obscenalities of prescriptions. >> they're the ones that -- give the rest of us a bad name. >> right.
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but most prescriptions are written by primary care doctors trying to do the right thing. >> you did a study, family physicians, i believe one in five, actually end up getting payments from pharmaceutical companies. >> most for meals, yet we know with every meal a doctor receives from a pharmaceutical company they become more likely to prescribe the medications marketed. >> pharmaceutical companies have brainwashed physicians in particular to prescribing them. >> doctor, your brother was prescribed opioids for cancer? >> correct. yes. >> it didn't turn out so well. >> did not turn out so well. he survived his cancer in 1999 at the age of 26. he was diagnosed with testicular cancer, had a surgery procedure done, prescribed oxycodeine and became physically dependent and never recovered from his addiction. he's now living on the streets in seattle as a heroin addict.
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yeah. >> what's your take on -- >> we're hearing that, you know, in some instances opioids are appropriate. >> yes. >> but still prescribing too much and even the appropriate ones need to be very careful. your opinion on that? >> if i'm going to provide an opioid now it is done very differently. with patient education. i actually have patients if they're a minor, they sign it as well, opioid, it's like a contract. that they have read the potential side effects. the risks. it does tell them it's addictive and most importantly in my opinion, if you have any left over, where to go to the website to dispose of them. definitely every time i fill out a prescription for an opioid i have a flash of my brother in my head. >> we know these 24ithings work. physical therapy. why don't we use more? >> you've got to get the
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insurance companies to pay for these things. a lot of the time they won't pay for it. okay. we paid for your you know, two sessions of physical therapy. good luck. >> right. >> you can understand the temptation a lot of doctors who who my not be savvy as this panel is of the dangers of opioids just to write a pill and have the problem go away. >> primary care doctors see upwards of 40 patients a day, 5 minute a patient. hard to do physical therapy, talk therapy. pressures in terms of having patients be satisfied customers. more and more patients are asked to fill out patient satisfaction surveys and how doctors are rated can really influence their professional trajectory. >> a struggle as physicians. in the office, we meet all the time. >> i get reimbursed more for a five minute medication management visit where i basically fill out a prescription than i do for an hour of psychotherapiy. >> what does that tell everybody? >> a lot how medicine is practiced today. >> doctors take an oath that says first do not harm.
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i think that as we think about the best way to do good for our patients, we used to think doing good was providing a medication we perceived would get rid of all of their pain and now are waking up as a medical community realizing sometimes the best things we can do for our patients is not give that medication. >> remarkable discussion. i want to continue it with gary mandel, ceo of shatterproof, started t eed nonprofit after t death of his son brian who lost his battle with addiction in 2011. gary, thanks for being with us. as we were listening to this, listing off things that can happen immediately, specifically in the doctor/patient relationship, where this all got started. not the doctor's fault but where it all got started. people prescribed opioids without knowing the risk and in cases the doctors not fully understanding the risk. >> absolutely. and doctors prescribing way more than needed. even if they knew the risk, way more than needed. in the last 15 years the amount of pills went up four times.
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it's do you to three times but still three times where it was. still four times the amount of pills previbed in the united kingdom. their population isn't different than ours. >> is this a difference concept of pain management? is it just the way our -- that one doctor said she makes more money for a five-minute appointment prescribing something than an hour for psychotherapy? >> a lot of different pieces to this. the main spepiece is not that. the main piece, doctors were taught traditionally these pills are very dangerous. only previbe them in limited circumstances. the world changes in 1995. the fda approved a slow release ex-tebl extended release oxycodeine, different. released over 12 hours. hundreds of millions of a marketing campaign by perdue and others because it's 12 hours not 2 hours they're not addictive. you can't blame doctors.
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that's what they were now taught. and then the v.a. and joint co-mission came in. and a vital sign. office you see a thing that says measure pain 1 through 10. it's cultural change. couldn't blame doctors. up until a year and a half ago. a year and a half ago, the cdc issued a set of 12 recommendations called the cdc prescribing guideline for opioids for chronic pain. in there it's guidelines. it's not telling doctors what you can or can't do. just follow these 12 steps and make your own decision. the issue that i have is, and most americans should have, starting a year and a half ago, now the information is out there. we have data that shows chronic use of opioids has no evidence of improving pain and function. and there is loads of evidence it's killing people. based on that, these 12 recommendations came out.
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>> you believe that if these 12 recommendations, check the database to see what else they've got. don't prescribe an opioid to somebody who has xanax. it's a very popular -- >> and vice versa. the two together, it's four times the likelihood of overdosing if taking the two together. most public doesn't know that. some doctors don't know that. the doctor won't know unless he checks the database. it literally takes seconds. 30 seconds to have an administrative nurse who is certified to check the database and have it in a file when the patient comes in for the checkup or -- >> to know what they've been doing. thanks for joining us. gary mandel, the ceo of shatterproof. want to go to puerto rico. i would take you to the press conference. the mayor is holding a joint press conference with senator bernie sanders. started moments ago. let's listen in. >> on behalf of everyone in san juan, i'd like to welcome again senator bernie sanders who has so kindly just come down today to visit a place that was very
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hit by the storm. and who was here to listen to different -- a different spectrum of ideological and issues that have been hitting puerto rico. the educational issue, the energy issue, the economic development issue and the issue of the fiscal control board. and how do we make sure that we have immediate plans in order to get puerto rico out of the humanitarian crisis that it's in and how do we develop medium and long-term plans from the municipal standpoint and so forth. most of the time when people tend to come to these visits, they just talk. today was a different experience. the senator mostly listened to what everyone had to say without judging but with a firm
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understanding that he came with his heart open as he has come to puerto rico many times before. and going back with an immediate agenda that will -- he will take on to washington and that i tell you here senator that i would be honored to take with you anywhere in the united states or anywhere in the world. so that the world listens to the plea of the puerto rican people and the right of the puerto rican people to be dealt with in a dignified and respectful manner. without any further comments, senator bernie sanders. >> let me thank the mayor for her hospitality and for organizing the events that we participated in today. and as she said, the reason i am here today is to listen and to hear from the people of puerto
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rico about how we address the immediate set of crises the island faces short-term. how do we get the electricity back on? how do we make sure the people have drinkable water, adequate food, that the schools are open. how do we deal with the fact that tens of thousands of homes in this area and throughout the island have either been damaged or destroyed. that's no small task. but clearly the role of the federal government and our agencies is to do everything possible to bring the reconstruction of puerto rico to where it should be as quickly as possible. as some of you know, just last week, a $4.9 billion loan was passed. it is my expectation that that loan will be converted into a grant. it will be forgiven as a loan. in three or so weeks, there will
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be a very big debate in the congress about what we call a supplemental package, disaster relief, which will include substantially more money for puerto rico, for florida, for texas and for the virgin islands. and that amount of money will be in the many, many billions of dollars. there is a full understanding, i think, on the part of many of us that to rebuild puerto rico will require a very substantial sum of money. >> we're going to continue to monitor that press conference, but we're going to take a break. when we come back, a look at today's markets as they close for the week. stand by. you're watching msnbc live. ore. more great camera features and more power. and more than just unlimited data, we give you unlimited plans with hbo included for life. because you deserve more entertainment. and more spokespeople. talking like this, saying the word more.
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that's ridiculous. well, i happen to know some people. do they listen? what? they're amazing listeners. nice. guidance from professionals who take their time to get to know you. lesson one on why not to take investment advice from me. i was thinking the dow is about to turn negative for the day. headed down. and now we're back up again at 16 points higher with 40 seconds to go in trading. we do not have a record on the dow. we've been setting a lot of records recently. we're about 20 points off the record, unless it happens to. we have closing highs on the s&p 500 and the nasdaq. we are going to close this thing off in 35 seconds. i don't think we'll get a record, but we're close.
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the market has been doing very well over the last several weeks, largely because of interest rates. some good news on the gdp today. that wraps it up for me for this hour and for this week here on msnbc. i'm ali velshi. "deadline: white house" with nicolle wallace starts right now. hi, everyone. it's 4:00 in new york. it's fitting that the end of a week that started with gop senator bop corker describing donald trump as utterly untruthful, donald trump started his day today by tweeting this. it is now commonly agreed after many months of costly looking that there was no collusion between russia and trump. was collusion with hc? it turns out that donald trump often tweets the opposite of what is true. in this case, not five hours after he sent that tweet this morning, "the new york times" is reporting that the russian lawyer na tal

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