room". all eyes on the supreme court expected to issue its ruling on thursday on president obama's signature first-term achievement, health care reform. it's a hot topic on the2007 supporting president bush's use of the same authority. >> that's right. and with the supreme court case on health care reform expected to come down on thursday, joe, i think it's going to get a lot hotter. >> jim acosta, thanks so much for that. appreciate it. now we're just going to get a little more on this with cnn chief political analyst gloria borger. the candidates argue over the economy and who has a better plan for the future. when you start looking at the water's edge, it gets more complicated. >> it is very complicated. it's very difficult when you're president to talk about how the rest of the world effects us. because you don't want to look like you're whining. you don't want to look like you're assigning blame elsewhere. but having said that, the truth of the matter is that what's going on in the rest of the world does effect us. and this president's been talking about it. i talked to a senior white house advisor who said to me on the substantiative issues we're fine, and then he said, but that's not always what matters in the end. take a listen to president obama at the g-20 summit. >> today we recognize there are a wide range of threats ongoing global economic recovery and growth. but the one that's received the most focus, obviously, and that is having a significant impact in the united states as well as globally is the situation in europe. as our largest trading partner, slower growth in europe means slower growth in american jobs. >> so there's the european fiscal crisis and its impact on our economy and our banks. and of course that's not even mentioning what's going on in iran. the instability there a question of whether israel would strike iran and how that would effect world stability and oil prices. and the list goes on and on and on. and those things, let's face it, are not in the president's control. >> domestically jobs, jobs, jobs. the president said it right there. that's certainly going to effect the vote in november. >> yeah. and if you ask any pollster, what's this election going to come down to, the answer is of course the unemployment number. and that's sort of the indicator of how the country's feeling. take a look at this. i looked at unemployment back when ronald reagan was running for re-election in 1984 versus president obama right now. and that red line is ronald reagan. you see? it went up to a high in the year of his presidency. but then it started heading downward. the blue line is president obama. and it is that unemployment number is plateauing. and that is a real problem for him. because ronald reagan seeing that number going down could claim it was morning in america. >> absolutely. >> and president obama cannot say that yet. >> but we did get an indicator, what, today? >> we did. consumer confidence. again, not good. down for the fourth straight month. unemployment numbers have been higher than 8% for 40 straight months. now, gas prices have gone down considerably. but that still hasn't been factored in yet by the american people. so i think the big question is when does this sort of pessimism really get cemented? is it now? or does the president have a couple more months over the summer to try and get people to believe we're headed on the right track? pollsters disagree about that. >> and you have some stakes that certainly show some improvement in the job numbers, but nationwide there's an issue. >> that's right. and luckily for the president, a lot of the states doing better are those battleground states that he needs to win. so he may be able to say, things are better in your state and it may be a state that he needs for the electoral college. so, it's difficult to predict. >> gloria borger, thanks so much. >> sure. jack cafferty's here with the cafferty file. jack. >> president obama and congress get a big fat d as a grade when it comes to their handling of the economy. cnn money asked 20 economists to grade these lawmakers. and both the president and congress got ds. hard to imagine any other profession where you could keep your job performing at that level. these experts say congress is more interested in scoring political points than in helping the economy. really? they're also worried about the so-called fiscal cliff and the looming disaster if congress can't get its act together. but congress doesn't seem too worried about any of this. "bloomberg news" reports congressional leaders are talking about delaying the $1.2 trillion in automatic spending cuts until march. these cuts are scheduled to go into effect january 1st. at the same time, they might temporarily extend the bush tax cuts and other tax breaks until march. in other words, kick the can down the road some more without making any serious choices. the d grade is looking a little generous. meanwhile, ordinary americans continue to suffer under a weak economy. a new survey shows 28% of americans have no emergency savings. nothing. zero. the general rule of thumb is you ought to have enough to cover at least six months of expenses in the bank. only one in four people have that. and just last week the federal reserve chairman, ben bernanke, said he expects unemployment to remain above 8% through the end of this year. the real absurdity is congress and the president will look at you with a straight face and tell you how they think they deserve to be re-elected. here's the question, economists give the president and congress a d on the economy, how would you grade them? go to cnn.com/caffertyfile. post a comment on my blog. or go to our post on "the situation room" facebook page. joe. >> jack, i think people are worried on capitol hill that the cuts will be so deep they're going to cause real pain. >> these are cuts they agreed to during that huge fight last summer to raise the debt ceiling. this stuff was passed in the law and signed off on by the government. now they don't want to do it because, hey, it's an election year and it could cost them votes. >> jack cafferty, thanks again. when it comes to health care reform, he may be the decider. we take an in depth look at the supreme court's man in the middle, justice anthony kennedy. also, life saving equipment that comes with a huge price tag. dr. sanjay gupta takes us inside the emergency room and shows us what's behind those outrageous hospital bills. plus, heartbreak in florida as families find their homes flooded by tropical storm debby. we're standing by for an update from the national hurricane center this hour. the future of u.s. health care could be decided this week with the supreme court set to hand down its ruling on health care reform on thursday. one goal of the affordable care act is to reign in soaring costs. and if you've ever received a hospital bill, you know some of the charges can be eye-popping. cnn chief medical correspondent, dr. sanjay gupta, takes us in depth. >> one of the questions that comes up all the time is what about these hospital bills? how exactly do they break down? how do you make sense of it? a question that leaves a lot of people scratching their heads. i want to give you an example by taking you into the operating room. this is the hospital where i work where i'm a neurosurgeon. just a room like this costs about $3,000 an hour. that's for starters. come on in. couple quick examples. if you look at a bill you might see an iv bag charge, about $280 just for the bag. that might strike people as very high. stapler. this is a stapler often used in surgery. something like this costs about $1,200. this is a chest tube. if someone has compression of one of their lungs, they might need a chest tube like this. that costs about $1,100. you'll find examples all over the room like this. suture, something in about every operating room in the world, this costs about $200. if you look at even devices like this is a needle used for biopsy, so if there's a concern someone has a tumor, they would use a needle like this. this is going to cost about $800. it's important to keep in mind if you ask the manufacturers of a device like this, why so much money? they'll say, it took years to develop something like this. the research and development costs are significant. also, the guarantee certain level of effectiveness of this needle. that costs money as well. but something maybe you didn't know, when you look at a hospital bill, it's not just the cost of the supplies, there's also administrative costs that are built-in. there's a cost of covering people who simply don't have insurance or can't pay. that's built into these costs as well. and, finally, keep in mind that what is charged and what is ultimately paid are two very different numbers. >> the typical hospital collects about 4% of every dollar that they -- about 4 cents of every dollar that they bill. so it's not coming out in massive profits. it's coming out as results of underpayment from the government. >> i'll tell you, the cost breakdowns like i gave you on lots of these different supplies, a lot of people simply never see. what we have found is a lot of people don't care as well f. you're insured, some people may not even open the hospital bill. but there are about 50 million people uninsured out there and they care very much about hospital bills like this. and what you can do is you can call the hospital and get a detailed breakdown. while you're on the phone with the hospital, if the costs still seem too high or hard to understand, you might be able to negotiate some of these prices down. >> sanjay is joining us live from cnn world headquarters. $800 for a needle? that's pretty incredible. a lot of this at the bottom is really about paying for the uninsured, isn't it? >> yeah. i mean, people i think sort of generally know this and get this, joe, but there's a thing known as uncompensated care. when someone is uninsured and they go to a hospital and have certain costs associated with the health care, that cost is spread out. it's spread out as the taxpayers, increase taxes, but also spread out in the way i showed you. hospitals charge more money and therefore insurance companies charge more money to everybody else. everyone else who has an insurance plan, their premiums are going to go up to pay for that. i wanted to give you a little bit of an example, a concrete one of how that all comes together, joe. >> i think the other thing we have to talk about just a little bit is this individual mandate which supposedly adds more people to the pot, which president obama says will lower overall costs. but the question here is what happens if that mandate is struck down and whether those prices we're talking about are just going to go up to try to cover the other provisions that end up left in play. >> yeah. you know, it's interesting, joe, i've been thinking about this a long time. as you know, i used to work at the white house and work on issues like this. i think the best way to sort of look at it is, if you don't have a mandate but still have the part of law in place that says you can't charge anymore in terms of premiums to someone who is already sick or has a pre-existing illness, what happens is the people will buy health care insurance when they get sick. they're not going to charge more. why not wait until you get sick? the analogy on a car insurance for example is call the car insurance company and ask for car insurance just after you get into a wreck and your car's on the side of the road. obviously that doesn't work. and this has been tried before, joe, in kentucky, at the state level, they tried doing this exact thing. no mandate, but insurance regulations demanding people wouldn't charge anymore in terms of premiums for people who are sick. what they saw is everybody's premiums went up. everybody's premiums went up by as much as 40%. which is why everyone needs to pay attention to this issue, joe. >> car insurance a very interesting example there because a lot of people say so many states require people to buy car insurance, like this thing we're talking about right now. thanks so much for that sanjay gupta. a stunning revelation about swine flu. a new study says a lot more people died than we first thought. just how many may shock you. if you use a mac instead of a pc, you could wind up paying more for a hotel room? we'll tell you what popular site shows mac users pricier rooms. and john edwards could have gone to jail for the affair he had with rielle hunter. now she's dropping a bomb shell about their relationship. standby. 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[ spokesman ] when you refinance your mortgage with quicken loans, you'll find that our rates and fees are extremely competitive. because the last thing you want is to spend too much on your mortgage. one more way quicken loans is engineered to amaze. ♪ a staggering new calculation of the number of deaths from swine flu. marry snow is monitoring that and some of the other top stories in "the situation room" right now. mary, what do you have? >> hi, joe. well, a new study estimates 15 times more people died from the 2009 h1n1 pandemic than previously thought. the world health organization originally said under 19,000 people died. but researchers now say it's more like 284,000. one reason, some countries lacked the ability to identify the virus. now, the study estimates 51% of the deaths occurred in africa and southeast asia. it pays to be a pc if you're using orbitz.com. "the wall street journal" says mac users spend as much as 30% more a night in hotels because orbitz is steering mac users to more expensive rooms. orbitz says mac users are more likely to book four or five-sta pictures when the dock completely gives out. all 12 people in the lake. yikes. including the bride and groom. at least they'll always have a great wedding story to tell. and it's apparently splitsville for rielle hunter and former presidential candidate john edwards. >> we are a family, but as of last -- the end of last week, john edwards and i are no longer a couple. >> the break-up with hunter described as mutual comes just days after the two were photographed together at the beach. and two weeks after the remaining charges were dropped against edwards for allegedly violating campaign finance laws to cover up their extramarital affair. hunter just launched a tell-all book about the relationship. joe. >> you know, i covered that trial. and after all the stuff that came out in the trial, it's really hard to see how they stuck together as long as they did. >> yeah. so much details and drama in that relationship. >> i know. who knows. all right. thanks so much for that, mary. >> sure. it's among the most influential votes they'll ever cast. how will the supreme court justices split on health care reform? we'll go in depth with cnn's senior legal analyst, jeffrey toobin. and another top democrat deciding to skip the party's convention. we'll talk about that more with hi lair rosen and alex in strategy session. so i can get three times the coverage. 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