(Musical break.)

MS. SHALALA: Hello, I'm Donna Shalala, sitting in for Bonnie Erbe. Welcome to To the Contrary, a discussion of news and social trends from diverse perspectives. Up first, the debt ceiling countdown.

The debt ceiling debate continues to drag on in Washington, but outside of the beltway, Americans are concerned about the impact drastic reductions in spending will have on jobs and on the programs they depend on, as well as the possibility of default. Some financial experts believe the United States credit rating may be downgraded no matter the outcome. That could mean higher interest rates on credit cards, mortgages, and car loans. Women's groups continue to voice their concerns over a deal that slashes Social Security, Medicare, and Medicaid. And if that wasn't enough, Americans are growing exceedingly unhappy with their lawmakers.

A CNN opinion research poll found 54 percent of people disapproved of the way the president is handling his job and 55 percent had an unfavorable opinion of the Republican Party.

Eleanor, what on earth is going on in your House?

DEL. NORTON: Well, Donna, when the dust finally settles on this so-called debate, the response from the American people is likely to be a lot worse than anything we do with the debt ceiling.

MS. HAMEL: It is likely to be worse, but it's - the deal does have the right elements to it. I think you're going to see businesses start hiring again. Right now, they're holding on more cash than they've ever held on, but I think this will, you know, restore some confidence in economy.

MS. WALL: Yes, I think that, you know, that the question will be - where the focus will be as it relates to jobs and job creation, and hopefully that focus will be on small businesses to drive the engines, the drivers behind this economy, and also as it relates to government capping that spending and having to do the real hard work of making some of those cuts.

MS. KUMAR: I think the damage may have already been done and I think what the - (inaudible) - basically said is that there is a possibility of downgrading our AAA. And once that - once we do that, we're in real trouble because as someone that's looking to figure out where to invest their money, is it going to be in a place where we don't have - we have governance issues? That's very real when you're trying, again, to invest your money, as you would, if, for example, if you were CEO and trying to do mergers and acquisitions. Where am I going to, U.S., or do I go elsewhere?

MS. SHALALA: You know, it's interesting. What happens if you pull that much money out of the federal government, though? It seems to be it's going to have an impact on every part of our society. What impact do you think it's going to have on women?

DEL. NORTON: Well, it's really very interesting that the so-called Debt Commission, the one that everybody is afraid of, said something that Congress and especially the Republicans are paying no attention to. They are the ones that want the deep cuts. And they said this: in 2011 cut very little, in '12 and '13, cut gradually more but not much more. You have to do this gradually, or, they said, you will take us right back into recession. And one of the reasons you see Democrats saying this has to be more balanced is that we recognize that the debt has got - we've got to make a strong statement about the debt. But we are in the middle of the worst jobs crisis since the Great Depression. And we have a fragile economy. So you got to handle both of these at the same time, where the Republicans want to only handle one of the levers of our economy, and that's spending and deficit lever.

MS. WALL: Well, I think that, you know, both sides can agree on one thing, that it has to be a bipartisan plan. And there have to be bipartisan solutions. And I think that one of the things Americans don't want to see is all the back and forth, all the name calling, all the, you know, hyperbole about this is - we're going to kill this bill or we're not going to sign this or we're going to do all that. I think at the end of the day, what the Republicans are saying is we have - two amounts - you've got the Boehner plan and you've got Reid's plan. Reid says $2.2 trillion over 10 years. Boehner says $900 billion over 10 years, where the $1.8 billion to be determined after we decide on some real hard cuts that do have to be made.

The Democrats plan talks about making cuts relative to the war. Well, we - we don't know how long we're going to be at war. We don't know if we end up in another war. I think that you have to make sure that we are taking into account that real hard cuts have to be made, wherever those are going to be made. I think that's the stumbling rock. As the president said on Friday, there isn't a whole lot of disagreement. There's a little bit of disagreement, but not a whole lot there. There's still some room to be made, but there's also agreement. So I think there's some fine tuning that has to be made, but you have two very stark plans with some agreement, some bipartisanship, and a little bit further to go before there's a solid decision.

MS. KUMAR: And Tara, to your point, though, both plans actually fall short of the $4 trillion deficit cutting that S&P actually is recommending in order for us to keep our AAA rating. And that's a problem because once we leave it, we basically kiss that goodbye. And it was interesting. I was at the White House recently and they were saying how the AAA rating is equivalent of a birth right for Americans. And it made a lot of sense in the sense that you're talking about making sure that Americans can secure loans and they can secure - they also can secure a pathway to the American dream. Without that, we're in trouble.

MS. SHALALA: One wonders how much credibility Standard & Poor's has -

MS. KUMAR: That's my other point. That's a point that's been made as well.

MS. SHALALA: That's a group that couldn't recognize a soft loan.

MS. KUMAR: That's a fair point.

MS. HAMEL: But we can't get there overnight. We have raised the debt ceiling 10 times over the last 10 years, under the Bush administration, Republicans and Democrats are both all guilty for overspending. We've increased spending by over 60 percent. And we've created this problem for ourselves and if we don't reverse the trajectory of our debt, we will see this downgrade.

Now, going to your point about losing that AAA rating, this is something other countries have gone through before. Canada lost it in 1993, but was able to gain it back in seven years because they took some cutting measures. You know, they did have a little bit of a revenue bounce, but it was seven to one that they were able to cut the amount that they were spending. And let's be frank. How do you get into debt? You spend. So we really just need to cut the spending.

MS. WALL: Well, and I think again, this goes to your point, and this underscores just how important, number one, these so-called ratings are. You can look at it two ways, argue two ways, but it underscores the importance of them, but at the same time, it also shows how much power we're willing to wield the government, U.S. government and others who are having these problems and private who are determining what our ratings are or rankings are. I think that's a whole another issue that maybe -

MS. KUMAR: Well, it does signal a credit score, right, and a very basic -

MS. WALL: Sure, well, yes, it is a standard that you use obviously.

DEL. NORTON: I don't think we're going to be downgraded and this is why. With all of their bellowing, this is the standard of the world. You downgrade us, even after we get an agreement, you downgrade the whole world. I don't think that's going to happen. I think they will see that both sides - you're absolutely right - understand something has to be done. I don't think we'll lose our AAA. But I think we have come so close to the precipice that everybody now gets it and we - and all we need to do is to get the Democrats in the Senate and Boehner in the House in the same room. Poor John Boehner is now negotiated or as went on the air with his own people. Look, just come over and talk to the Democrats in the Senate and let's try to get this done.

MS. SHALALA: And we haven't even had the real debate, and that is who pays? Who in the end is going to feel the burden of this? Is it going to be the poor? Is it going to be single moms out there? Is it going to be people that are wealthy or are we going to share the pay?

MS. WALL: Well, and both plans currently - I mean if you look at - (inaudible) - both plans are going to impact social services, no matter what you end up with.

MS. HAMEL: This is going to affect the American people right out straight. It isn't going to be whether this economy comes back, whether we maintain our credit rating, whether you can afford the things that you can now afford, the services that we're able to provide. This impacts everyone. And this is why we need the attention of both sides on this issue and to come together to find a solution.

MS. SHALALA: Let's turn now to some startling statistics that were out this week. Middle age women are the most at risk for suicide attempts, according to a report by the Substance Abuse and Mental Health Services Administration. The report shows a 49 percent increase in emergency room visits for drug related suicide attempts for women over the age of 50. And women between the ages of 40 and 69 are more at risk of suicide than any other group of women. Doctors believe there are a number of reasons for this disturbing trend. Middle age women are the fastest growing group with treatable mental health conditions. Older women may experience depression because of health concerns, sleep disorder, hormonal and life changes. Baby boomers also have high rates of substance abuse.

Gretchen, what can be done to prevent these issues with middle age women? What's going on here?

MS. HAMEL: I don't know. I wish I was a doctor, but I don't know what it can be done to prevent it. But I think this is something that shows what's going on with the whole society. Those who are hospitalized for depression has increased by 40 percent over the last 10 years. If you look at all the statistics, Americans are more depressed than they've ever been depressed. For the first time in generations, Americans do not believe their children will be better off than they are. I think this is just kind of speaks to where this nation is right now. We've gone through an economic crisis. We've been at war and we are tired and we are weary and we are down.

DEL. NORTON: But I'd like to have a little more optimistic notion. I agree with all you've said, but I'm wondering if younger women who are going to have two lives are going to be less likely to fall into this middle age depression. If your life has been tied singularly to your children and to your household, and then there comes the emptiness along with menopause, the notion of wordiness comes into play. It seems to me now with the average woman working full time, these women having had two lives, got rid of one, said to the kids bye-bye, now I have the other part of my life, the career part of my life. And I think we might be better off that women are not so locked into the early part of their lives.

MS. SHALALA: It's interesting that these statistics show up across ethnic groups as well.

MS. KUMAR: Yes and I think part of it, too, is that a lot of women over their 40s, they're actually right now heads of households because their husbands are unemployed. And not only are they viewing that pressure of being heads of households, but also - they're also taking care of their parents. And I think that stress of that house, recognizing that you have limited income and you actually have to look at multi-generational resources and how do you over - that's a lot of pressure and very few people discuss that.

MS. WALL: Sure. Yes, I would add the disclaimer I'm not a doctor either, but - (laughter) - would sure love to pretend to be one. You know, I think it's an amalgamation of everything that's been discussed already. Essentially, you have women who are taking on greater responsibility when husbands and spouses - husbands, spouses, heads of households are not working are having a tough time finding jobs. Women are having a tough time finding jobs. Unemployment among minorities in particular is double digit, 16 percent among blacks. Women fall within that group as well. I mean it's staggering. That would depress the best of us, even if you are working - I think even if you are working, you have concerns, women have concerns about if they will be able to keep their jobs, if they're able to be - be able to provide in the environment of the economy as it is right now and be breadwinner, be mom, be - even if they're - caretaker, yes caretakers, or even if they are facing emptiness syndrome. It's what - you know - you hear about those who are in retirement who are 50s and 60s. They can't find jobs. They're not even looking at this point because they feel like they're being aged out of the market.

So I think there are some real concerns. While - while - hope springs eternal and I'm one of the biggest optimists you'll probably meet. I think the reality is it is very serious right now. You have, from groceries and home prices and all these things that feed into what's on the minds of Americans or primarily women, who, you know, by virtue, we're kind of worrywarts anyway. So I think that this just exacerbates it.

MS. SHALALA: And with all our wealth, we haven't figured out how to give people good mental health coverage.

MS. KUMAR: That's right.

MS. SHALALA: Still, we have a serious weakness in our health care system in terms of mental health coverage and prevention -

MS. WALL: That's right.

MS. SHALALA: - which obviously is part of it. And the statistics also show when the economy is down that you have more mental health issues -

(Cross talk.)

DEL. NORTON: - wait a minute, it's really quite worrisome, even given all that we've said, that there're more women than men. And you got to consider that. And you notice how men slip into middle age -

MS. WALL: They slip all the time. (Laughter.)

DEL. NORTON: - into middle age and old age and how - they even have children, something women can't do when they are in middle age. They get a new wife and decide that they are young again. These are options not available to women and we've got to look at the difference in these rates of mental illness of women and men. That is what is most worrisome.

MS. HAMEL: And speaking of that, Pew released a study, I think it was last week or the week before, talking about since the recession, those folks who have been getting hired are men. Over 700,000 men have gotten a job, while women have lost over 200,000, nearly 300,000 jobs. So while men are gaining jobs, women are losing even more jobs. So that's another reason to be depressed.

MS. SHALALA: Women also think about their family's health before they think about their own health. So we not only have a weakness in mental health coverage, but we also have a culture in which women are thinking about everybody else.

MS. WALL: And a stigma. I think there's probably a sort of stigma -

MS. SHALALA: Still a stigma attached to mental health -

MS. WALL: - particularly if you're an accomplished woman, a career woman who has done a lot, and maybe the kids are gone. And it's what do I do now? You're rethinking your career. You're rethinking some things. You're re-strategizing. To go and say, you know, I'm having some mental health issues still I think has a bit of a stigma attached for some women.

MS. KUMAR: And I think a lot of it actually comes also - there's a big stigma and taboo when it comes to immigrant communities and the idea that they cannot be self-sustaining. And I think that's where you actually see a huge - for example, the highest suicide rates among teens in New York -15 percent of Latina young women have tried suicide, much more are actually for the mothers. There's a problem out there, but again, it's how do you actually start communicating cross culturally that it's okay and that there are services available.

MS. SHALALA: Big issue. Big issue and it really is an issue that involves countries that are wealthy, very much countries that are wealthy. And it's - our ability to deal with this mental health issue, as part of our health care system is a big challenge. And as we redo the health care plan, hopefully we'll be able to do something more about mental health coverage.

Behind the headlines, paying the poor to end poverty. Brazil and Mexico are using a controversial strategy now that's turning heads around the world. In an effort to close the economic gap, they're paying poverty-stricken citizens. To the Contrary examines how the program operates and whether it could work here in the United States.

(Begin video segment.)

MS. TINA ROSENBERG [Pulitzer Prize Winning Journalist]: If you are a poor family, you will get a certain payment every month, but to get that payment, you have to do certain things. Your children have to be in school and they have to have good school attendance. You have to attend certain workshops that are given on things like nutrition or hygiene or mosquito control, things that will help the health of your family. And you also have to make sure that everyone in your family is up to date with their health clinic visits. And if you don't do those things, you don't get your payment.

MS. SHALALA: Pulitzer Prize winning journalist Tina Rosenberg is advocating these payments as a way to lessen and even end poverty. In many circumstances, poverty is passed down from parent to child and governments are trying to end this cycle with payments with conditions.

MS. ROSENBERG: This is a strategy that's known as conditional cash transfers and it was started in Mexico and Brazil and now has been so successful that it's in use in 40 different countries in the world, almost every country in Latin American and many countries in other continents. And what it does is attacks the - attacks poverty now, but it does so in a way that aims to prevent parents transmitting poverty to their children. The exciting thing about it is that it also has great promise to reduce poverty even further among the children of these families.

MS. SHALALA: Education and health care are two ways Latin American countries are closing the poverty gap. And women are being put at the forefront of their households as government trusts them to uphold these requirements and providing for their families.

MS. ROSENBERG: Poor countries have generally paid only women. And they do it because the women are the ones who will use their money to take care of the families. Unfortunately, if you give men extra money, they will often spend, go to the cantina, and drink it away. That's not the case with women. They'll use it to buy more nutritious food, fruits and vegetables. They'll use it to buy school shoes and things that their families need.

MS. SHALALA: Here in the U.S., the nation's income gap is the highest it's ever been. The top earning 20 percent took home almost half of all the income generated in the United States. A privately funded pilot initiative in New York City called Opportunity NYC is testing conditional cash transfers in the United States.

MS. ROSENBERG: It has been tried in New York City. There were some aspects of it that were successful and some that were not. It would have to be very different in the United States because poverty in the U.S. is very different than poverty in Mexico or Brazil. And the incentives that people respond to might be very different incentives. I wouldn't say it will work or won't work, but I do think it's worth trying.

(End video segment.)

MS. SHALALA: We've done a little bit of conditional cash transfers. For instance we tied WIC saying to women, we'll give you three months of WIC if you'll get your kids immunized. And of course, there have been some experiments with food stamps, for example, taking off the requirements, giving people more flexibility, but nothing at this level. Maria Teresa?

MS. KUMAR: I think this actually gives an opportunity of how do we think of creating partnerships between families and government, instead of government constantly telling parents how to spend their money and how to actually - what measurements they do. This actually creates a partnership where the parents all of a sudden feel that they are in control of what their family needs to do, and it also provides a special level of advocacy when you start giving parents that responsibility to ensure that not only their kids are going to school, but it creates a dialogue at the end of the day, whether or not the kid is gaining the grades that they deserve based on, again, being a partnership.

MS. SHALALA: Right now, our welfare system requires that if you get on welfare, you have to start looking for a job almost immediately or get into the educational system. So there are aspects of this, but not as directly as Brazil and Mexico are doing.

MS. WALL: And I think that's a problem. I mean I worked at HHS as well on those programs, Administration for Children and Families - that was all we did. So I'm obviously very sensitive to that, but I think that this - this really just borders on the ridiculous. I think that you have to be - there's no incentive for work here. That's the biggest difference. And we have to incentivize moms who want to work, who are willing to work, and give them a path to do that. I don't believe that giving them cash incentivizes work in the same way.

(Cross talk.)

DEL. NORTON: - wait a minute. Let's look at where we're talking about it. It's such an Americans know best -

MS. WALL: Well, I'm talking about for here.

DEL. NORTON: Oh, okay, if you're talking about for here -

MS. WALL: I mean it might work for Mexico, but -

DEL. NORTON: Okay, well let's make that distinction because I don't think it'd work here either. And I think that this is a jobs' based society. I think it is a brilliant third world society and what shows it is that it is working. It defines generational poverty at more than you send you kid to college, when we now see kids going to college and moving back home and lying on the couch. It says, you pass on poverty when your children don't go to school or when your children are malnourished. Cash transfers have to occur with these very poor women anyway. They are not equipped to work and there're not jobs for them. So if there're going to be cash transfers, why not do something that benefits them, perhaps, because you don't know if it's just given to the male or to the family - benefits them and benefits the entire society. The fact that is being used in 40 societies that they are doing control studies and that control studies have shown a difference between -

MS. WALL: But I think -

DEL. NORTON: Excuse me - between those who get the money and those who don't, should shut our mouth here. We haven't found a way to do a comparable thing. I'm not for doing that thing. But until we find a way to do a comparable thing, we ought to just look, see what we can glean from this, and maybe adapt it in an entirely new and American way for our own situation.

MS. SHALALA: In fact, the American way is to support people in work -

DEL. NORTON: Yes.

MS. SHALALA: - who have jobs, but those jobs don't pay enough to support their family. So childcare, transportation, housing subsidies are the American equivalent.

MS. HAMEL: Well, we pay people not to work as well. And I - just talking about - pulling some points off of what you said, is we can glean information from this and we can learn from these things, but they definitely do not work here.

I was talking to my girlfriend, my good girlfriend who's a Democrat, lives in Kansas, and she was just railing the other day. She's a mother of three. She's married, has a good life as a nurse and she works so hard, but she has so many people who have quit their jobs, gone on unemployment, and sit on the couch. And she's like what is the incentive? Where is the American dream? Where is the belief in wanting to work and providing for your family?

(Cross talk.)

MS. KUMAR: But I think what we've missed - a part of the point of what they're trying to do is that they're actually - these cash transfers are actually trying to teach people behavior. In this case, imagine if we actually incentivize women who have babies that they'll get $30 every time the kid gets vaccinated. You actually start teaching behavior and actually changing that behavior. So it's not a matter of incentive if people want to work or not, it's more of how do you actually incentivize individuals to change behavior that they may not have realized. At the end, a kid that's vaccinated helps all of us.

(Cross talk.)

MS. SHALALA: - education in a developing country helps all of us. It creates markets. We should be for education around the world.

MS. WALL: Absolutely and I think that - well, I think the point, the latter point that the journalist made in that piece was there're certainly obvious reasons why that wouldn't work here. Our poor is different than their poor. There're so many different comparisons. I don't believe it's government's role to train or change behavior. I think it's government's role to provide an environment that encourages certain behaviors, that educates, that gives people the tools that they need in order to be able to live more - you know, more on their own independently, and those are the types of things I think we should continue to do and equip Americans with as they forge ahead and getting jobs and being independent in society.

MS. SHALALA: That's the last word. That's it for this edition of To the Contrary. Next week, our immigration special. Check out our website for "TTC Extra" where our panelists discuss airbrushed advertisements. Whether your views are in agreement or to the contrary, please join us next week.

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