March 22, 2023 - PBS NewsHour full episode

AMNA NAWAZ: Good evening, and welcome.

I'm Amna Nawaz.

GEOFF BENNETT: And I'm Geoff Bennett.

On the "NewsHour" tonight: The Federal Reserve Board raises interest rates again in the wake of multiple bank failures.

AMNA NAWAZ: The political ramifications of former President Trump's legal troubles widen GEOFF BENNETT: And doctors work to address the health care gap in rural parts of the country.

DR. MICHAEL LONDNER, Berkeley Medical Center: Some of the folks I see have never had health care ever, and they're in their 60s or 70s.

WILLIAM BRANGHAM: Never had health care... DR. MICHAEL LONDNER: Ever.

WILLIAM BRANGHAM: ... meaning they don't have a doctor?

DR. MICHAEL LONDNER: Correct.

Not only do they not have a doctor.

They may not have had one as a kid growing up.

(BREAK) GEOFF BENNETT: Good evening and welcome to the "NewsHour."

The Federal Reserve has raised interest rates again by another quarter of a percentage point.

Today's decision came against the backdrop of troubles in the banking industry.

AMNA NAWAZ: The rate hikes are being blamed by some for weakening banks.

But Fed policymakers stuck to their stance that higher rates are essential for the moment to try bringing inflation under control.

After announcing the Fed's ninth rate hike, Chairman Jay Powell suggested the agency might slow or pause any future increases.

JEROME POWELL, Federal Reserve Chairman: We believe that events in the banking system over the past two weeks are likely to result in tighter credit conditions for households and businesses, which would in turn affect economic outcomes.

It is too soon to determine the extent of these effects and therefore too soon to tell how monetary policy should respond.

AMNA NAWAZ: The Fed has been doing its share of damage control and emergency assistance for nearly two weeks in the wake of the second largest bank failure in U.S. history, the collapse of Silicon Valley Bank, followed by Signature Bank.

That sparked broader concern about the stability of America's small and midsized banks, like First Republic, where an exodus of customers fled to larger banks.

Even before the bank failures, some economists and policymakers had been encouraging the Fed to stop interest rate hikes over fears of a recession.

The Fed is also weighing whether additional rate hikes could destabilize other parts of the economy.

At the same time, job growth remains strong and steady, with more than 300,000 new jobs created in February.

Powell is facing fire from Republicans and Democrats on a number of fronts, including banking oversight, as it conducts its own review of the Silicon Valley Bank failure.

Senators Rick Scott and Elizabeth Warren introduced a bipartisan bill that would replace the Fed's internal watchdog with an independent one appointed by the president.

Warren called out the Fed on ABC's "This Week" on Sunday.

SEN. ELIZABETH WARREN (D-MA): I'm calling for an independent investigation of the Fed and the whole regulatory system here.

The Fed doesn't just get to do its own investigation.

AMNA NAWAZ: Powell today spoke to that issue.

JEROME POWELL, Federal Reserve Chairman: It's 100 percent certainty that there will be independent investigations.

When a bank fails, there are investigations.

And, of course, we welcome that.

AMNA NAWAZ: The Fed is also reconsidering rules for midsized banks around liquidity and stronger capital, something Warren and others say they strongly support.

Chairman Powell also repeatedly said today that he thought the banking system is -- quote - - "sound and resilient."

For a closer look at these decisions and the state of the economy, I'm joined by Kenneth Rogoff.

He's an economics and public policy professor at Harvard University and the former chief economist at the International Monetary Fund.

He's also the author of several books on financial crises.

Ken, welcome back to the "NewsHour."

So let's just start with the news of the day.

What do you make of the Fed's decision?

KENNETH ROGOFF, Economist, Harvard University: Well, I think they pretty much did the only thing they could.

A couple of weeks ago, Jay Powell was warning everyone: I'm going to raise things 50 basis points.

Well, after we're really in start a possibly a banking crisis ongoing here, that's out the door.

But I think he was worried that, if he set it at zero, everybody thinks, well, what do they know that we don't?

And so he said, I'm going to keep pushing with inflation.

But I think, really, they are very nervous of not knowing, is inflation going to go higher.

Is the banking crisis going to get worse?

It's a tough place to be in right now.

AMNA NAWAZ: Would this have been different, would we be having a different conversation today if we hadn't just seen the second largest bank failure in U.S. history and the entire banking industry wasn't on eggshells?

KENNETH ROGOFF: Oh, absolutely.

I mean, inflation is still high.

It whatever -- people thought it was going to go away.

It isn't either.

There are lots of different measures of it, but it looks like it's going to last for quite a while.

Even on the most relatively optimistic Fed forecasts, it's still well above their target at the end of the year.

So they don't want that.

The reason they don't want that is, if they allow that to happen, interest rates might creep up to take that into account.

And that's really what they want to nip in the bud.

But we have this banking crisis.

AMNA NAWAZ: So we have heard a lot over the last year about working towards a soft landing, right, slowing the economy enough to curb demand, bring down inflation, but not so much as to spark a rise in unemployment.

Do you see that soft landing as still possible?

KENNETH ROGOFF: Honestly, I think what they're going to do now is fly over the airport.

And, by that, I mean, leave inflation higher for longer, whatever they're saying.

I think that's what they're going to decide to do, because if they raise interest rates as much as they might need to -- and they say they might -- we might get things worse in the banking sector.

And I don't think they're ready for that, even though they -- we're being told left and right that everything's really sound.

By the way, deposits are fine.

The real questions, are they going to be making loans in the same way?

Is it going to be harder to get a mortgage, harder to get a car loan, harder to get a business loan.

I think that's a real concern now.

AMNA NAWAZ: Well, you say deposits are fine, but, clearly, people are nervous.

We know those previous rate hikes helped to erode the value, right, of many of those bank assets and bank failures to prepare for that, manage around them, partially led to some of those collapses.

Should Americans be concerned about right now small and midsized banks, about their futures?

KENNETH ROGOFF: I feel like the Federal Reserve and the Treasury have kind of broadcast that they're going to protect depositors, even ones with billions of dollars they have bailed out with Silicon Valley Bank.

I think they're going to continue that.

That has a lot of problems, because bankers will do more risky things.

It's going to lead to bigger problems in the future.

But they really telegraphed that.

The problem is, the other side of the coin is that everyone's worried the banks will not be able to lend as much.

The regulators are going to be looking harder.

They're going to have to raise deposit rates, and they will have less profits to lend out.

So, for the moment, it looks like they have contained the panic.

But, longer term, bankers do risky stuff, and they certainly aren't reining that in.

And the more they regulate it, the harder it's going to be to get loans.

So there are certainly problems ahead.

AMNA NAWAZ: Ken, you did hear some of those concerns from lawmakers about the Fed's oversight ability.

Given what we know, do you believe the Fed is up to the job of monitoring the banks, as it's meant to be?

KENNETH ROGOFF: Well, yes and no.

I mean, it's a very professional-grade staff.

But there are problems with the governance of the Fed.

There's the center in Washington that everyone talks about, but there are the regional Feds, which have their own world of governance.

And, typically, the board of directors will have people from the financial sector.

I was very concerned about that in 2008.

And they even appointed someone from Goldman Sachs to run the New York Fed, the most important regional Fed.

And I believe the CEO of Silicon Valley Bank was on the board of directors of the San Francisco Fed regulating the Silicon Valley Bank.

So that's been a problem.

I don't know what the Fed has to say about that, but I feel like that ought to be addressed.

AMNA NAWAZ: That is Kenneth Rogoff, economics professor at Harvard University, former chief economist at the IMF.

Thanks for joining us.

KENNETH ROGOFF: Thank you.

GEOFF BENNETT: In the day's other headlines: Russian missiles and exploding drones slammed into residential and other targets across Ukraine.

Security camera video showed a missile striking an apartment building in the southern city of Zaporizhzhia.

At least one person was killed.

South of Kyiv, drone attacks damaged a high school in two dormitories, killing at least eight people.

Police condemned the indiscriminate firing on nonmilitary targets.

IRINA PRYANISHNIKOVA, Kyiv Regional Police Spokesperson (through translator): The attack began after 3:00 a.m.

The reasoning is beyond explanation, because Russia attacks civilian objects without any warnings or conditions, and they don't care who is in the buildings.

And now we see children and civilians suffering.

GEOFF BENNETT: The attacks came as Chinese leader Xi Jinping left Moscow after meetings this week with Russian President Vladimir Putin.

He appeared to make no progress on a peace plan for ending the Ukraine war.

South Korea's military says North Korea test-fired multiple cruise missiles into the sea today.

The North has stepped up weapons testing in recent days, as South Korea and the U.S. hold joint military exercises.

As part of those maneuvers, tanks conducted live-fire drills today less than 20 miles from the demilitarized zone between the two Koreas.

The exercises end tomorrow.

Back in this country, the head of Norfolk Southern Railroad faced calls for tougher regulations after the fiery and toxic derailment in East Palestine, Ohio.

At a Senate hearing, Alan Shaw voiced general support for new legislation, but Democrat Ed Markey and others pressed for specifics.

SEN. EDWARD MARKEY (D-MA): Mr. Shaw, will you commit to supporting legislation requiring at least two-person crews on all freight trains?

ALAN SHAW, President and CEO, Norfolk Southern: Senator, we will commit to using research and technology to ensure a railroad operates safely.

SEN. EDWARD MARKEY: Will you commit to a two-person crew on all trades?

ALAN SHAW: Senator, we're a data-driven organization, and I'm not aware of any data that links crew size with safety.

GEOFF BENNETT: Other witnesses said they're still waiting to hear whether the railroad will compensate them for damage to their property values.

The FAA issued a safety alert to airlines and pilots today after several near-collisions.

Six serious runway incidents have occurred since January.

The agency said it's urging airlines to review safety procedures and consider additional training.

At least two people have died in the latest powerful storm to better California.

Heavy rain and fierce winds blasted the San Francisco Bay Area and Sacramento on Tuesday.

Drone video showed extensive flood damage in the central part of the state, with homes, roads and farmland left underwater.

Forecasters warned of more flooding today.

And, on Wall Street, stocks fell after the Federal Reserve hiked interest rates, with major indices down 1.6 percent.

The Dow Jones industrial average lost 530 points to close it 32030.

The Nasdaq slipped 190 points.

The S&P 500 dropped 66.

Still to come on the "NewsHour": the government announces plans to overhaul the organ transplant system; the U.S. Supreme Court hears a trademark case involving whiskey and dog toys -- we will explain -- and the head of the Ford Foundation on his new book about changing the way we think about giving.

The Manhattan grand jury hearing evidence in a case involving former President Donald Trump's alleged hush money payments to an adult film actress didn't meet today, as regularly scheduled, with no immediate word on why, leaving open the question of whether Mr. Trump will be indicted.

Meantime, the former president is said to be invigorated by the possibility of an indictment.

The New York Times reports that he's told his friends he welcomes the idea of being paraded by the authorities before a throng of reporters and news cameras, all of it raising questions not just about his fate, but that of the Republican Party, which has largely tied its future to Donald Trump's.

Republican strategist Doug Heye is a former communications director to House Majority Leader Eric Cantor and the RNC.

And he joins us now.

Thanks for being here.

DOUG HEYE, Republican Strategist: Good to be with you.

GEOFF BENNETT: So, Donald Trump has successfully fund-raised off of what he says is an expected indictment.

What do you make of this notion that he would use a potential arrest, a potential indictment as part of a campaign strategy to galvanize his supporters?

DOUG HEYE: Well, Donald Trump very skillfully uses anything to his advantage, even if sometimes we have to scratch our head and say, why would that be to Donald Trump's advantage?

The rules have never really applied to him that they would with any other candidate.

And, certainly, in this case, in the short term, meaning the primary calendar, this is something that he will be able to use to help galvanize support, because it's entirely consistent with what his opening message was when he took that escalator ride down in his own building in New York, that the system is rigged.

It's rigged against you.

It's against -- rigged against me.

So he's consistent here.

And that's why it helps him short term.

Long term, if he's the general -- if he's the nominee in the general election, disaster.

GEOFF BENNETT: Meantime, President Trump's allies in the House, to include a trio of committee leaders, have used their new majority to demand the testimony of the Manhattan DA, Alvin Bragg.

It reads to many people like an extraordinary effort to influence an ongoing grand jury deliberation, investigation.

This topic has also consumed much of the GOP's retreat in Florida this past week, with House Speaker Kevin McCarthy talking to reporters.

REP. KEVIN MCCARTHY (R-CA): I look at it from this perspective.

We live in America and there should be equal justice.

This was personal money.

This wasn't trying to hide.

This was seven years ago, statute of limitation.

And I think, in your heart of hearts, you know too that you think this is just political.

And I think that's what the rest of the country thinks.

And we're kind of tired of that.

GEOFF BENNETT: Is that the smart political move?

And I ask the question because it's not just the Manhattan case that he faces in terms of legal and criminal exposure.

It's also the case in Georgia, another New York case, and the two federal investigations.

DOUG HEYE: Well, as usual, there's a lot going on here.

And a lot of things can be true at once.

It can be true that what's happening in Manhattan is political, and that Donald Trump might have just committed a crime somewhere.

And the challenge, I think, for Republicans here is if -- and we have seen this for years now.

If you want to play Donald Trump's game, you have always got to back him up.

And the problem there is, Donald Trump is not somebody who gives points.

He only takes him away, one at a time.

So you have to back him in Manhattan.

You're going to have to back him in Georgia.

And one of these places, he might have just done something wrong, which means he will be indicted, and then potentially found guilty.

And so this is where Republicans have backed themselves in a corner.

And that's not going to change anytime soon.

It's been a long time as the party's history already.

GEOFF BENNETT: Well, after months of waving off taunts from Donald Trump, Florida Governor Ron DeSantis is starting to hit back.

He took some shots in an interview that's expected to air tomorrow at Donald Trump's character and his leadership.

And, earlier this week, he spoke about this hush money case.

GOV.

RON DESANTIS (R-FL): I don't know what goes into paying hush money to a porn star to secure silence over some type of alleged affair.

I just -- I can't speak to that.

(LAUGHTER) GOV.

RON DESANTIS: But what I can speak to is that, if you have a prosecutor who is ignoring crimes happening every single day in his jurisdiction, and he chooses to go back many, many years ago to try to use something about porn star hush money payments, that's an example of pursuing a political agenda and weaponizing the office.

GEOFF BENNETT: Governor DeSantis knew what he was doing there with that statement.

I mean, is there room for criticism of Donald Trump now in the Republican Party?

Have the political winds shifted?

DOUG HEYE: What we're seeing is, there is some room, depending on how you do it, where you can go after Trump on Trumpy things.

A lot of Republicans have been critical on Trump on specific policy things.

Marco Rubio very tough on the Trump administration on China, Lindsey Graham often very difficult and tough on Donald Trump on a Tuesday or Wednesday, might be playing golf with him on Saturday.

But DeSantis obviously is in a different position.

He's potentially running against Trump.

Everybody thinks that he will.

And this isn't exactly taking the gloves off yet.

The gloves are still on.

So these are soft blows that he's -- that he's throwing at Trump.

Ultimately, he can do this for a while.

He can't do it in perpetuity.

But he's smart, DeSantis is, and strategic, in taking on Trump a little bit at a time, but also not taking Donald Trump's bait, because what is he ultimately doing there?

He's taking Trump's line as well that this is -- the system's rigged.

It's unfair.

And part of what you're hearing, you heard from Kevin McCarthy, you heard from DeSantis, is very Clintonesque.

When we had the Bill Clinton impeachments scandal, a lot of the Democratic rhetoric was, this is old news, we need to move on.

It's what a lot of Republicans are saying right now too.

GEOFF BENNETT: Well, on that point, I mean, if you think about what happened in the 2020 election, in the 2018 midterms, in the 2022 midterms, independent suburban voters who are inclined to vote for Republicans don't like Donald Trump.

That was clear at the ballot box.

Republicans paid a price for that.

Looking ahead, I mean, at what point do Republicans break from the tried-and-true deep-red base, the demands and the desires of that base to attract a wider base of support?

DOUG HEYE: Well, the challenge is, it's not up to the Republican Party, however you define that.

When I worked at the RNC in 2010, we had a great cycle that year, but we also knew you don't really win or lose races in Washington.

You win and lose them in congressional districts and in states.

And the problem Republicans have is, just look at some of the candidates they have nominated, not just in 2022, but we can go back to 2010, 2012, 2014, a lot of these elections where very winnable races were essentially thrown away because Republicans nominated the wrong candidate.

And that's really difficult, whether you're the NRCC, the NRSC, or the RNC.

The RNC doesn't get involved in primaries, as a rule.

NRCC and NRSC is -- they're starting to flex their muscles a little bit more than we have seen in the past, because they know that mistake.

And this ultimately is what Mitch McConnell has warned the party.

We need quality candidates.

If we don't have that, Trump or no Trump, Republicans are going to have the same problems they have had and disappointing elections as we did in 2022.

GEOFF BENNETT: Doug Heye, thanks for coming in.

DOUG HEYE: Thank you.

GEOFF BENNETT: Appreciate your insights.

AMNA NAWAZ: The Biden administration announced plans today to overhaul the network that's run the nation's organ transplant system for nearly four decades.

The United Network for Organ Sharing, known as UNOS, has faced criticism for inadequately managing the process.

In 2022, doctors performed more than 42,000 transplants in the U.S., but there are still 104,234 men, women and children currently on the organ transplant wait-list, and, every 10 minutes, another person is added to that list; 17 people die every day waiting for an organ transplant.

The proposal would open up a competitive bidding process for other organizations to possibly take over the network, with a goal of shortening wait times and saving lives.

To help us understand why this overhaul is crucial, I'm joined by Dr. Jayme Locke, director of the Division of Transplantation at the Heersink School of Medicine for the University of Alabama in Birmingham.

Dr. Locke, welcome and thanks for joining us.

There's a lot the administration's plan seeks to do.

At the heart of it, though, is breaking up this network that's basically operated like a monopoly for almost 40 years.

Help us understand, how did it come to be that way in the first place?

DR. JAYME LOCKE, Heersink School of Medicine, University of Alabama at Birmingham: Yes, thank you so much.

I think, in many ways, it's been that way because sort of there's been a lot of inertia to overcome.

In part, it reflects how the National Organ Transplant Act was written, and sort of some of the requirements that HRSA has in terms of administering that contract.

But it's great to see a desire to reflect on where we are and how we can get a lot better, so that we can help our patients.

AMNA NAWAZ: So, that UNOS system relies basically on a network of more than 50 local organizations to both procure the organs and also help to manage the transplant process.

And we should note that network is responsible for increasing the number of transplants performed over the years, but critics say that system has led to vast regional inequities.

Where have you seen that shown up?

DR. JAYME LOCKE: Well, I think for us, in particular, in the southeastern United States, particularly when you look at things like kidney disease, there's no question that, recently, we have seen an increase in the number of transplants, but that really reflects, sadly, an opioid crisis that's really increased the number of deceased donors as a result of that.

But what those numbers don't reflect is the increase in discards that we have seen as a result of some of the new allocation systems.

And, currently, due to inefficiencies with our allocation systems, as well as logistics, one in four kidneys are actually discarded in the United States, are not transplanted.

That's one in four.

That's 25 percent.

And those are really lives that could have been saved if we could have utilized those organs.

AMNA NAWAZ: There is the issue of the wait-list as well.

And we should note there have been previous attempts to fix the system.

HHS back in 2021 pointed out that Black people were four times more likely and Latinos were almost one-and-a-half times more likely than white people to have kidney failure, but are less likely to be on those transplant wait-lists and less likely to have transplants.

Why is that?

Why is it so hard to even get on the wait-list in the first place?

DR. JAYME LOCKE: It's a great question.

Well, quite frankly, simply put, you have to have resources to be able to complete your evaluation and your workup to make it to the waiting list.

So, if you look, there are about 700,000 Americans that have kidney failure.

Fewer than 100,000 are currently wait-listed for transplant.

So we know not all patients who would benefit from transplant ever make it to the waiting list.

And that certainly disproportionately impacts people who self-identify as African American or Black.

And, certainly, social determinants of health drive a large proportion of this.

So, you see individuals who are from areas of high social vulnerability struggle to a much larger extent to make it to the waiting list and to achieve transplant.

AMNA NAWAZ: Dr. Locke, you -- you're on the front lines of this every day.

I have to ask, when you look at this plan, do you believe a competitive process, the proposal, as they have put it forward, that this can help to fix the system?

DR. JAYME LOCKE: I think it certainly can.

And it certainly can't hurt.

There's nothing worse than going into clinic and evaluating patients, and knowing that even those patients who qualify for wait-listing, many of them are going to die before we ever have an opportunity to offer them a transplant.

And we know that transplants are lifesaving, life-giving.

They are associated with a substantial survival benefit.

And what is just so disheartening is to know that, in many cases, organs are being discarded simply from logistical challenges, from not getting the organs where they need to go fast enough.

Organs have a shelf life.

They can only be out of the body for so long, they can only be on ice for so long before they're no longer good enough to transplant.

So, no matter how good an OPO is at finding an organ, or how good a transplant center is at accepting those and doing the transplant, if they don't get where they're needed quickly enough, then it -- the game is over.

And so I think anything that can help our system get better, to be more efficient, so that we can help those individuals waiting, that's a win.

AMNA NAWAZ: Meanwhile, as we mentioned, there are more than 100,000 people currently on that wait-list.

What does this proposal mean for them?

DR. JAYME LOCKE: Well, my hope is that it means that they have a new, renewed hope for the opportunity to achieve the gift of life in the form of a transplant.

My hope is that it gives them a voice.

I think this is the Biden administration, along with the Senate and the House, which has had bipartisan support, saying we need to do better.

We need to do more for these individuals who have been waiting, and to let them know that they're not forgotten, and that we need to do better collectively to help them achieve this extraordinary gift of life.

AMNA NAWAZ: That is Dr. Jayme Locke joining us from the University of Alabama at Birmingham.

Thank you for your time, Doctor.

DR. JAYME LOCKE: Thank you.

GEOFF BENNETT: When it comes to health, rural America lags far behind the rest of the country.

The reasons are complex, from demographics, to doctor shortages, to the sheer distances that many people have to travel to see a provider.

These challenges are the focus of a series we start tonight.

With support from the Pulitzer Center and in collaboration with the Global Health Reporting Center, William Brangham reports from West Virginia for our series Rural Rx.

ANGIE GRAY, Berkeley Medical Center: And this is where I grew up.

I have lived in Morgan County my entire life.

We're up here on a mountain.

You're an hour from your nearest Walmart.

So, some people may not want to live that way.

But, to us, this is home.

WILLIAM BRANGHAM: This mountain, this slice of West Virginia has been home to nurse Angie Gray's family for six generations.

ANGIE GRAY: Hey, Erin (ph).

Hi, Patti (ph).

WOMAN: Hi.

WILLIAM BRANGHAM: Gray is visiting a family friend, Patti, who has chronic obstructive pulmonary disease.

She struggles to afford her medications and cannot live without her oxygen.

The power at their house is unreliable, so there's a generator at the ready so Patti can always breathe.

WOMAN: It's hard finding someone good around this area to help you.

ANGIE GRAY: Yes.

WILLIAM BRANGHAM: Gray says these kinds of struggles are everywhere here.

ANGIE GRAY: So, that might be an option that can help.

We take care of our own.

I always say that West Virginians are all connected.

We're all family.

But, really, my mission is to advocate for people who are so vulnerable that they don't have a voice.

When you look at West Virginia specifically, we have the highest numbers of chronic disease, diabetes, heart disease.

We're losing so many of our people to death, and early to death.

WILLIAM BRANGHAM: On nearly every health metric, rural America fares worse than the rest of the country, from life expectancy to maternal mortality.

Compared to urban areas, rural residents are a third more likely to die of diabetes, about 20 percent more likely to die from heart disease, and more likely to die of cancer or accidents.

There are higher smoking rates here and fewer people with health insurance.

In many health categories, West Virginia, a heavily rural state, ranks dead last.

These are the challenges that Dr. Michael Londner and his colleagues face.

He's chairman of the emergency department at Berkeley Medical Center in Martinsburg.

DR. MICHAEL LONDNER, Berkeley Medical Center: For as many of the myths there are, some of those myths are not urban legends.

They're reality.

The idea that someone waited four days having a heart attack at home because they couldn't get transportation, and they wouldn't call 911 because it cost too much, even though it's free in most of the regions.

But they don't know that.

WILLIAM BRANGHAM: People in rural areas are less likely to have access to good-quality health care.

Compared to urban areas, rural America has fewer nurses and fewer than half as many doctors per person.

People have to go farther to access care, unless they have someone like Angie Gray to help them.

ANGIE GRAY: So, if you already struggle for transportation, or you live in a more rural area that's going to take you an hour to access health care, some places in West Virginia two hours to access health care, you're less likely to make it there.

And it can help.

WILLIAM BRANGHAM: When people do come for care, they're often using the emergency room as a doctor's office, something Dr. Londner and his team have turned into a virtue.

DR. MICHAEL LONDNER: For a lot of those folks, we can actually use our emergency department sort of as a primary care office sometimes.

And so a number of those people are here with kids with fevers.

So we're giving antipyretics and we're doing swabs.

Why do you need to be in a room doing that?

And, on any given day, you have three rooms with 8-year-olds that have flu, two overdoses, and then five people who are elderly and looking for admission because their chronic diseases.

WILLIAM BRANGHAM: In some cases, he says, that emergency room visit is the first time a patient has seen a doctor in their entire life.

DR. MICHAEL LONDNER: Some of the folks I see have never had health care ever, and they're in their 60s or 70s.

WILLIAM BRANGHAM: Never had health care... DR. MICHAEL LONDNER: Ever.

WILLIAM BRANGHAM: ... meaning they don't have a doctor?

DR. MICHAEL LONDNER: Correct.

Not only do they not have a doctor.

They may not have had one as a kid growing up.

They may have never been vaccinated.

For them, the opportunity might -- just to meet a physician for the first time.

Or they come in and you say, do you have any history of high blood pressure, diabetes, things like that?

They're like no.

And they're hypertensive.

Their sugar is 400.

And you're like, oh, you have never been tested before, so you don't know that you have those things.

WILLIAM BRANGHAM: Not going to the doctor for preventive care is not uncommon in parts of West Virginia, a pattern that is repeated across rural America.

DR. MICHAEL LONDNER: If you want someone to come to the hospital, you have probably got to get them here.

If you're going to put them on dialysis, and they can't go, you might as well not write the prescription.

If you're going to give them $700 worth of antibiotics or hypertensive medicine, just realize they're going to throw it away, because they can't afford it.

I felt like places I had been in the world doing disaster work were better off than certain people who lived here.

A certain percentage of my people don't have indoor plumbing still.

Access to power in certain regions here is still not 100 percent available.

There's a lot of places that we have ambulances go into, and they show up here, and they're like, I don't know if they're going to have a medical problem, but you can't send them back to that.

And you're like, to what?

And they will show you pictures of, they're living in a place that is rat-infested.

There's raccoons inside the house.

There's feces everywhere.

Like, this is where they live.

And this is the best they can do.

DR. MADISON HUMERICK, West Virginia University Medicine: We go out and meet them where they are.

WILLIAM BRANGHAM: Since getting to a hospital or a clinic can be difficult for so many, Dr. Madison Humerick goes to them, delivering preventive and essential care straight out of her toolbox.

DR. MADISON HUMERICK: It looks like you have had ear infections in there before, huh?

WOMAN: Yes.

DR. MADISON HUMERICK: We probably prevented a couple urgent care visits today with this.

WILLIAM BRANGHAM: Is that right?

DR. MADISON HUMERICK: Oh, yes.

It was awesome.

I mean, we got to prescribe some antibiotics.

So, it was convenient for them.

We're just going right back to old-school family medicine, which is what we love.

WILLIAM BRANGHAM: Urgent care out in the open.

DR. MADISON HUMERICK: Urgent care out on the street, yes.

WOMAN: Pain recovery.

This is Jamica (ph).

WILLIAM BRANGHAM: At times, practitioners here say the need can be overwhelming, especially when it comes to mental health.

Rural Americans report higher levels of depression and suffer suicide rates more than 30 percent higher than people who live in cities.

And yet, for those people, it's harder to find help.

Rural areas have fewer than half as many psychologists per capita.

SAMANTHA DEAMER, West Virginia University Medicine: That means that we have a year-plus wait-list in our outpatient clinic.

It was recently two years.

I think we have gotten that down to a year-and-a-half for adults.

WILLIAM BRANGHAM: Dr. Samantha Deamer is a clinical psychologist who works out of the Harpers Ferry Family Medicine Center.

In atypical fashion, she embeds with this family practice to make it seamless for patients who want mental health care.

But, elsewhere, people face big obstacles.

SAMANTHA DEAMER: That mean, for kids, they're waiting a year-plus for specialty services, like testing for ADHD or developmental disabilities.

Our neuropsychologist wait-list is incredibly long.

So, just a lack of available services overall.

WILLIAM BRANGHAM: So people who could be in a in a crisis-like circumstance... SAMANTHA DEAMER: Yes.

WILLIAM BRANGHAM: ... would call and say, "Hey, can I get help?"

and they're told?

SAMANTHA DEAMER: Go to the emergency room, because that's all we can offer, yes.

ANGIE GRAY: Can you start browning the chicken while I get the vegetables cut up?

MAN: Yes, I can.

ANGIE GRAY: OK. WILLIAM BRANGHAM: We caught back up with nurse Angie Gray after she visited her friend, Patti.

How typical is that circumstance of what we saw today?

ANGIE GRAY: Typical, very typical, yes.

A lot of people that I know personally, a lot of patients that we have, they're all dealing with that, trying to be able to afford to get their medications, trying to get to good health care.

WILLIAM BRANGHAM: Hoping the power stays on.

ANGIE GRAY: Hoping the power stays on, so that you're not out of your oxygen.

WILLIAM BRANGHAM: Gray says these problems are ultimately fixable, but not if we tackle them piecemeal, one patient at a time.

ANGIE GRAY: There's a parable in public health.

There's a villager who walks up to the river and there's a baby floating down the river.

So he pulls the baby out.

Another ones comes floating down the river, so he pulls the baby out.

All the villagers are gathering around the river.

And all these babies start coming down the river, and they're jumping in, pulling them out, until one villager walked upstream to see who was throwing the babies in the river.

And we need to get more upstream.

WILLIAM BRANGHAM: Gray admits it's an uphill climb, but it's one they're taking step by step.

For the "PBS NewsHour," I'm William Brangham in rural West Virginia.

AMNA NAWAZ: Supreme Court arguments often deal with weighty matters, like abortion, religion and discrimination.

Today, as John Yang reports, they focused on a chew toy for dogs in a case that raises questions about free speech and commercial trademark protections.

JOHN YANG: The maker of Jack Daniel's whiskey has a bone to pick with a marketer of dog chew toys.

The distiller of the iconic American liquor wants to muzzle VIP Products, America's second largest dog toy company and part of the $100 billion-a-year pet products market.

For more than 120 years, Jack Daniel's has used a distinctive square bottle adorned with Old No.

7 and Tennessee Sour Mash Whiskey.

Beginning in 2014, VIP began selling a squeaky dog toy called Bad Spaniels, a replica of a Jack Daniel's bottle that proclaims "The Old No.

2 on Your Tennessee Carpet."

NARRATOR: The hilarious dog toy that will have everyone talking.

JOHN YANG: It's part of their Silly Squeakers lines.

VIP says it's a playful parody.

Jack Daniel's says it could confuse consumers into thinking it's their product.

So now this dog toy tug-of-war has come to the Supreme Court.

The question the justices are being asked to decide is, when does parody crossed the line from protected free speech to commercial trademark infringement?

Free speech advocates lined up behind the dog toy company, filing amicus briefs defending parody as a recognized form of social commentary.

Companies such as Nike, Patagonia and Campbell's Soup support Jack Daniel's, saying notable trademarks need protection.

JOHN ROBERTS, Chief Justice of the U.S. Supreme Court: We will hear argument this morning in case 22-148.

JOHN YANG: The justices worked through the competing interests during today's oral argument, which included references to a pornographic movie depicting the Dallas Cowboy cheerleader uniforms.

The attorney for Jack Daniel's, Lisa Blatt: LISA BLATT, Attorney for Jack Daniel's: The movie "Debbie Does Dallas" was not aesthetically pleasing.

It infringed a trademark.

So the other side wants to talk about the uses they like.

They don't want to talk about the pornographic and poisonous things that can be done when you infringe someone's trademark.

JOHN ROBERTS: Thank you, counsel.

JOHN YANG: Justice Samuel Alito worried about the case's First Amendment implications and seemed skeptical that Bad Spaniels could be confused as a product from Jack Daniel's.

SAMUEL ALITO, U.S. Supreme Court Associate Justice: Could any reasonable person think that Jack Daniel's had approved this use of the mark?

Let me envision this scene.

Somebody in Jack Daniel's comes to the CEO and says, I have a great idea for a product that we're going to produce.

It's going to be a dog toy.

And it's going to have a label that looks a lot like our label.

And it's going to have a name that looks a lot like our name, Bad Spaniels.

And what's going to be in -- purportedly in this dog toy is dog urine.

You think the CEO is going to say, that's a great idea, we're going to produce that thing?

JOHN YANG: Justice Elena Kagan questioned how a dog toy could be protected speech expressing a message?

ELENA KAGAN, U.S. Supreme Court Associate Justice: This is not a political T-shirt.

It's not a film.

It's not an artistic photograph.

It's nothing of those things.

It's a standard commercial product.

I don't see the parody, but, you know, whatever.

BENNETT COOPER, Attorney for VIP Products: The distinction between utilitarian goods and expressive works is a nonexistent standard.

ELENA KAGAN: Dog toys are just utilitarian goods.

And you're using somebody else's mark as a source identifier.

And that's not a First Amendment problem.

JOHN YANG: "NewsHour" Supreme Court analyst Marcia Coyle: MARCIA COYLE: This court is very strong on First Amendment speech.

There are justices who are concerned about not killing parody, which is a very useful and fun part of our lives and products.

So, I do think that they're trying to balance the First Amendment concerns here with the actual parody and whether it does damage to Jack Daniel's trademark.

JOHN YANG: The justices will chew over the arguments as they consider their decision, which should come by the end of June.

For the "PBS NewsHour," I'm John Yang.

GEOFF BENNETT: In 1889, the industrialist Andrew Carnegie, one of the richest men of his age, wrote an essay titled "The Gospel of Wealth," calling on those with money to use it to promote the general good, and laying a foundation for philanthropy in this country.

Now comes "From Generosity to Justice: A New Gospel of Wealth" that proposes shifting the focus of giving, its author, Darren Walker, president of the Ford Foundation, which, for the record, is a funder of the "NewsHour."

Jeffrey Brown spoke to Walker for our arts and culture series, Canvas.

DARREN WALKER, President, Ford Foundation: This was the original office.

JEFFREY BROWN: Darren Walker says the mission of the Ford Foundation is simple, hope.

He's a true believer in that mission and the power of institutions like his to advance it.

But he also sees a problem.

DARREN WALKER: I wanted to say that, while philanthropy is good, and we should be proud of it, there is so much more we can do to move from the idea of generosity to the aspiration and a belief in justice for all.

JEFFREY BROWN: Walker, now 63, became president of the $16 billion foundation in 2013.

He's in the business of giving away money in this country and abroad.

He's also part of a movement in recent years to shift philanthropy's focus, seen in the renaming of Ford's Manhattan headquarters to the Center for Social Justice, even in the art on its walls.

We spoke recently in the foundation's atrium garden.

What does justice mean, though, in the context of philanthropy?

DARREN WALKER: What we see in the world today is, too many people live without dignity, are stripped of their dignity.

Their humanity is ignored, while we do charitable activities, which are commendable and we need.

But philanthropy needs to go deeper.

And part of the aspiration of this book is to lift up the voices and the experiences of those philanthropists who are doing it here in America and around the world.

JEFFREY BROWN: Walker is now part of the power elite.

But his roots go back to small-town East Texas, where he was raised by a single mother who worked as a nurse's aide.

He says the opportunity to attend a then new publicly funded Head Start preschool program for lower-income children changed everything.

DARREN WALKER: It changed my life.

It put me on a trajectory where I could go to public schools, a great public university, Texas, and then be off into the world.

But that was because, Jeff, I lived in a country that believed in my potential and the potential for me to have a life with dignity.

JEFFREY BROWN: Do you still hold that past, that outsider, even though you are now a big player here in the world of philanthropy?

DARREN WALKER: I do see my role as an insider, as understanding the plight of those who are outside, who are left out and left behind.

And so, yes, I absolutely believe in it.

But I have to say, I believe in this country,.

I believe in the idea of America.

And when I feel angry at this country or rage for some injustice, it's because my patriotism, my belief and the words of our founding fathers is unwavering.

JEFFREY BROWN: One of the things you write in the book is, you say, wealthy people should ask themselves, where are my resources most needed?

Aren't they asking that question?

Isn't that the question they normally ask?

DARREN WALKER: The reality is that most philanthropy in this country goes to wealthy institutions that often serve the wealthy and the privileged.

JEFFREY BROWN: From wealth to wealth serving wealth.

DARREN WALKER: Well, when you look at the percentage of philanthropy that goes to wealthy colleges and universities, to hospitals, to independent private schools, these institutions primarily serve the wealthy or certainly people who have more privilege.

And I'm simply saying, we should ask ourselves, how do we direct our philanthropy to those who are most excluded?

JEFFREY BROWN: Is it hard to change that mind-set of where the money goes?

DARREN WALKER: Well, I don't mean to say that people need to have some foundational, transformational change in their thinking about philanthropy.

What I mean, to say is, get a little uncomfortable when you look at organizations working on the front lines in homelessness, in building affordable housing, working on disability issues.

These are areas that are heavily under-resourced in philanthropy.

JEFFREY BROWN: And that means, inevitably, some who are getting it now might not get it.

DARREN WALKER: I think, if we are prepared to interrogate our privilege, we will conclude that philanthropy is not only about giving back, but it may be also giving up something, so that we can have an America where opportunity does exist for all.

And that social mobility escalator that I was able to ride continues to go up, doesn't slow down, doesn't stop, as it has for far too many Americans, which is contributing to our political and civil unrest, and the sense that too many Americans feel left out, rural America, where there is not enough work going on in philanthropy, parts of our country that truly have been left behind, and where the people there feel angry.

And they have every right to be angry.

JEFFREY BROWN: You know the critiques better than anyone.

Philanthropic organizations, foundations are often built on the fortunes, right, of the very kinds of inequities that you're critiquing in our society.

And they enjoy many tax breaks that many of us don't.

And you yourself write: "They live off and extend the privilege of wealth and power."

DARREN WALKER: There's no doubt, Jeff, there is a contradiction in a foundation having billions of dollars in an endowment and talking about inequality.

But I believe we have to talk about a different kind of economic system, where capitalism, which, in my view, is the best way to organize an economic system, produces less inequality.

And so people like me, we need to ask ourselves, how do we deal with these contradictions of our privilege and our aspirations for opportunity?

They are reconcilable, but we have to be intentional.

JEFFREY BROWN: All right, "From Generosity to Justice."

Darren Walker, thank you very much.

DARREN WALKER: Thank you, Geoff.

AMNA NAWAZ: Opening day for professional baseball is just around the corner, and, this year, it will be notably different.

Major League Baseball has enacted a series of new rules intended to make the game more exciting.

Stephanie Sy went to a spring training game in Arizona to check out the action.

STEPHANIE SY: On a perfect 73-degree day, baseball fans young and old flooded into Scottsdale Stadium.

Spring training is Major League ball without the high stakes, explains 11-year-old Mitchell Earnest.

MITCHELL EARNEST, Utah Select Team: Yes, it's relaxed.

and, like, they get to learn the new rules.

And if they make a mistake, it doesn't matter.

STEPHANIE SY: The matchups -- this game was between the San Francisco Giants and the Milwaukee Brewers -- gives players a chance to find their groove before opening day.

But, this season, it's particularly critical.

JOHN SHEA, The San Francisco Chronicle: You have four rules, basically.

STEPHANIE SY: John Shea is the national baseball writer for The San Francisco Chronicle.

JOHN SHEA: You have the pitch timer, the bigger bases, the ban on shifts, and the limited pickoff attempts.

STEPHANIE SY: Shea explained the new rules before play started.

JOHN SHEA: The biggest rule changed is the pitch clock, which is going to make the pace of the game much quicker.

And the pitch timer makes sure that the pitcher will throw the ball within 20 seconds with a runner on base or within 15 seconds with nobody on base.

Gabe Kapler, the Giants manager, was initially indifferent about the new rules.

Now that he's seen them in action.

he's sold.

GABE KAPLER, Manager, San Francisco Giants: It's been a lot quicker pace, and we have gotten the same good brand of baseball.

STEPHANIE SY: The average length of games during the first weekend of spring training was down 23 minutes.

But not everyone's a fan.

What do you think about the pitch clock?

RHODES POWELSON, Utah Select Team: I kind of think it's kind of stupid, but... STEPHANIE SY: Why do you think it's stupid?

RHODES POWELSON: Because it's an automatic ball if they don't throw it in 20 seconds.

STEPHANIE SY: Ten-year-old Rhodes Powelson likes to take his time when he pitches.

for Giants pitcher Sam Long, who usually works fast on the mound, the rules ain't so bad, at least now that he understands them.

SAM LONG, San Francisco Giants: I got my first violation in my first inning of spring training, and before I even threw a pitch.

STEPHANIE SY: How did that feel?

SAM LONG: It felt like I was at a little bit of a disadvantage to start.

STEPHANIE SY: And a week into spring training, New York Mets pitcher Max Scherzer tried to push the boundaries of the new rules to his advantage.

But he was called for a balk because he pitched too soon after the pitch clock had reset.

The other major adjustment?

The bases are bigger now, 18 inches across, instead of 15.

The new distance between home plate and first base is three inches shorter.

It's a change that favors runners and could lead to more aggressive stolen base attempts.

Giants manager Kapler says he's already seeing it pay off.

GABE KAPLER: We are seeing more stolen base attempts so far in spring training.

Fans want to see more action.

The stolen base is an exciting part of baseball.

So, the rules are being set up so that you see a little bit more of that.

STEPHANIE SY: Giants fan Chris Sorauf, who watches more than 70 baseball games a year, says the bigger bases are an offense to history.

CHRIS SORAUF, San Francisco Giants Fan: I think you have to throw out all of the stolen base records in some of the hits that are going to be achieved now.

And Rickey Henderson, the all-time steal leader, I'm sure that he's not too happy about it.

(LAUGHTER) STEPHANIE SY: But Giants first baseman LaMonte Wade Jr. sees the perks.

LAMONTE WADE JR., San Francisco Giants: The runner has more room on the base to step on the bag, and so they're not really stepping on your ankles or on your feet.

So I like to bigger bases for that aspect.

STEPHANIE SY: The last big change involves how players stand on the field.

Long gone are the days of the infamous shift, where players crowd onto one side to anticipate the direction a power hitter will direct the ball.

The new rules force two players to stand on each side of second base, with all their feet on the infield dirt when a pitch is thrown.

That means more hits and more action the field, running, fielding and the like.

GABE KAPLER: It takes a little game strategy out of the mix for managers and coaches and puts the onus on the players to be more athletic, because we're just not going to have that perfectly optimized defensive positioning anymore.

And athletes are just going to have to cover a little bit more ground.

STEPHANIE SY: Brewers fan Gary Wray was taking in the game without much thought to the new rules, although he says it was about time.

GARY WRAY, Milwaukee Brewers Fan: With all the other, I would say, major leagues out there -- you have NFL, NBA, NHL, even -- the emphasis on making sure there's more excitement to the game.

So I think MLB was kind of long overdue to make some changes.

STEPHANIE SY: It's the game folks in the '60s and '70s grew up watching, when pitchers couldn't stall for eternity.

There were more stolen bases and players took risks, says John Shea.

JOHN SHEA: It's a quicker pace.

And that's kind of the game I wanted all along.

STEPHANIE SY: Opening day in a new era for Major League Baseball is March 30.

For the "PBS NewsHour," I'm Stephanie Sy in Scottsdale, Arizona.

AMNA NAWAZ: I don't know.

What do you think?

GEOFF BENNETT: There's nothing wrong with a four-hour baseball game.

I'm a purist.

(LAUGHTER) GEOFF BENNETT: I like the old rules.

AMNA NAWAZ: I don't know.

I thought we'd see Stephanie Sy sliding into base during that story.

(LAUGHTER) AMNA NAWAZ: Next time.

In the meantime, that is the "NewsHour" for tonight.

Hey, join us again here tomorrow when the head of TikTok is set to testify before Congress in the wake of growing calls to ban the app.

I'm Amna Nawaz.

GEOFF BENNETT: And I'm Geoff Bennett.

Thanks for spending part of your evening with us.

Have a good night.