Commentary from Dave Durenberger

February 28, 2008

HHS SECRETARY MIKE LEAVITT, in presenting the President's Medicare "trigger" recommendations to Congress, talked of "two competing visions of what America's healthcare system should look like." This will be the theme for the presidential campaign as well. "Some see a system run by the government,'" Mike says without naming names. He goes on to say, "I envision a healthcare system where consumers define the priorities of the system." What does that mean exactly? "Consumers choose their doctor or their hospital on the basis of one who gives them the best care at the best cost." So, Mike, which candidate for President is going to argue with that?

Leavitt's view of government's role is hard to argue with, "I see government acting as an organizer of efficient markets, eliminating injustice and subsidizing the poor." Except for the fact I don't think government needs to "organize" markets. It simply needs to set national rules by which they operate. But Leavitt's CDHC advocates have his cart before his horses. They tell him that the two biggest health plans in America sold 1.13 million individual health plans in 2007. More are on the way if only we keep increasing tax subsidies for them and allow consumers to buy any plans anywhere in America. Not only do we consumers know nothing about the quality of the health insurance we are buying, we know little or nothing about either quality or cost of the services for which we and they are paying. So without the information in Mike's cart, what good are his horses?

Leavitt concludes by saying "We need a healthcare system based on value. Only then will Medicare be sustainable." Okay, Mike, I heard about Medicare Parts C and D, about CMS P4P demos and disease management pilots and value exchanges and your other efforts to "organize markets." Until your Medicare and Medicaid programs, and your allies in the private health insurance business, pay only for the best quality care and the best cost, I think Congress must spend its money on your "eliminating injustice" (like overpaying MA) and "subsidizing the poor" (like SCHIP and Medicaid.) I can tell from the primaries that our presidential candidates may need a little work to debate this topic. But focusing on value for money as well as the policy issues of injustice and income security, would go a long way beyond rhetoric in convincing voters we are ready to "turn the page" on the old way of doing things in our government.

FEDERALISM AND DEVICE PREEMPTION
Justice Antonin Scalia, for a near-unanimous Supreme Court in Medtronic v. Reigle, held that the PMA process, based on a finding of safety and effectiveness of the device, preempts state product liability actions alleging defective design. A sensible ruling where the allegation of injury is premised on a design defect in the device or approved components. It is less clear whether the decision also preempts other liability actions including claims based on defective manufacture, materials, misleading marketing, or the medical professional installing the device made a mistake. Not easy to draw that line as illustrated by the lawsuits against Medtronic in St. Paul over the Sprint Fidelis defibrillator leads alleging they were prone to fracture more so than the original Quattro.

The larger issue raised for the device industry and for policy-makers is the adequacy of the FDA's PMA process and its dependence on research and information provided by the manufacturer both prior to approval and subsequently by the manufacturer. Plus the FDA's dependence on user-fees provided by the regulated industry to support its safety and efficacy obligations. One of the original interpretations of preemption after the passage of the 1976 device amendments came in a University of Virginia Law Review article by Prof. Susan B. Foote at U. Cal Berkeley whose work is cited by Scalia in his opinion.

Later this year the Court will be dealing with federal preemption cases involving the prescription drug industry. That means the Congress has little time to lose in focusing on the adequacy of the FDA to protect consumers in this increasingly new world of technological cures and palliatives.

MEDICAL ETHICS
Senator Herb Kohl's (D-WI) Senate Select Committee on Aging Wednesday heard testimony on ranking GOP Finance Committee chair Chuck Grassley's Physician's Payments Sunshine Act. The issue is the degree to which doctors' decisions are influenced by the money paid them by drug and device companies. There was testimony about payments which bear no relationship to the alleged value received. Companies admitted to exceeding ethical boundaries and have already settled criminal suits for millions of dollars without acknowledging liability.

Among the policy issues raised: (1) Are doctors' decisions about medically necessary and appropriate care for patients affected by supplier payments? (And do patients care?) (2) What role government should play, federal or state, in limiting payments for anything more than services rendered patients; and (3) Whether the burden of prohibition or, a lesser approach, of reporting requirements, will stifle innovation and thus should fall on large companies only?

These issues have been too long debated and need some policy decisions. Hospital systems, clinical groups, and professional associations like the American College of Physicians have already moved to limit gifts, access, and financial payments. Minnesota is an oft-quoted leader but could do more. Technology company associations have responded with Codes of Ethics. But the practices continue. The Medicare Payment Advisory Commission (MedPAC) at its meeting next week will discuss a staff paper suggesting a comprehensive federal law requiring public reporting by drug and device companies.

©2008 Tony Auth

CLINTON VS. OBAMA ON HEALTH REFORM
Hillary turned a really good question about what it takes to be a good commander-in-chief into a viewer's non sequitur by banging on her universal coverage drums with individual mandate and no enforcement. What's anyone including a fellow Senator and candidate to say to that? A 16 minute disagreement over mandates in the next debate. She has of apparent necessity taken the health policy debate so far down in the "reform" weeds as to make no contribution to her presidential credentials.

We are a nation of 300 million people who are required to pay more than $2 trillion a year for access to medical care. We have been debating "universal coverage" since FDR and Harry Truman. It's always the financing scheme that dooms national consensus. Lately, however, pols have found that universal coverage has become a proxy for "affordability for all" and that's why Hillary is so intent on the UC issue. But, debating mandates seems lost on most non-wonk Americans. It may assure that the Democratic v. Republican debate will be about affordability rather than the issues of value for money that the next President must face or fail. Maybe the two could be linked?

ANOTHER ARGUMENT FOR UNIVERSAL COVERAGE...OR IS IT?
American Cancer Society researchers reported via The Lancet Oncology that uninsured Americans are two or three times more likely to be diagnosed with breast, lung or colon cancer or melanoma in Stages III or IV, rather than in Stage I. This leads to increased morbidity, decreased quality of life and survival, and increased costs. Another argument for universal coverage? Not so fast.

The authors speculate that health literacy and an adequate number of appropriate health professionals in communities of poorly or un-insured people are contributors. I do not believe you can translate insurance into access. Only a health system in which everyone is assured equal or equivalent access to persistent health education, individual responsibility, and accountable family and community care and professionals trained to do appropriate diagnosis and referral will get us to a society in which the incidence of morbidity, survival and treatment costs go down.

Others would argue that there is a certain amount of over-testing and misdiagnosis that goes on when insurance brings payment incentives to diagnose and treat everything that's a potential cancer or melanoma. Others would say our current system pays a lot for drugs and devices that prolong life at any cost, that will install anything insurance will pay for regardless of the "Quality of Life" years left relative to the installation and maintenance costs.

Each of these studies and each of these conclusions argues not for the expansion and perpetuation of our current pluralistic health insurance system, but for a total re-focus of our health care system and a more appropriate role for insurance that is designed to meet our national policy goals of access for all to the highest quality care available at an affordable cost.

THE MASSACHUSETTS PATH TO UNIVERSAL COVERAGE seems more challenging with each passing day. The Boston Globe reports that officials are considering raising premiums for members with incomes over 150% of poverty and co-pays for those over 100% of poverty. In part the cost increases reflect increased program costs; and in part a desire to discourage employers from dropping their employee coverage in favor of the state-subsidized program. Meanwhile, in Minnesota, a Democratic legislature is moving toward individual mandates. And a likely veto from a Republican governor.

DIRECT TO CONSUMER MARKETING
The ethics of some parts of the medical industrial complex, and our tolerance thereof, seems to have no bounds. If it weren't for Senator Chuck Grassley and some Democratic committee chairs, we would still be swilling the Lipitor because the inventor of an artificial heart told us it was keeping him in superb physical condition. Or so the marketing of Robert Jarvik, Ph.D implied. 99% of Americans - and plenty of others - assumed Dr. Jarvik was a medical doctor and qualified to prescribe the Lipitor solution. They even believed he invented the artificial heart because Pfizer said so until colleagues at the University of Utah made them stop lying to us. Shame on Pfizer for setting us up like that. Lipitor is the world's top-selling drug earning $13 billion last year for Pfizer…any guesses at what it earned for Jarvik?

Last year PHARMA companies raised wholesale prices on their top 50 drugs by nearly 8% and increased lobbying expenditures by 50% to a reported total of $22 million. Last year the drug industry lobby association, the Pharmaceutical Research & Manufacturers of America (PhRMA), says it spent $22 million to lobby Congress mainly against changes in Medicare drug purchase/pricing which they, not competitive markets, now control. This was 25% higher than the previous year. Poor guys!

FAST TALK - FINE PRINT
In America marketing for products that could be inappropriate, unhealthful or unsafe for some are required to comply with rules that fulfill the "buyer beware" obligation we delegate to government. As more and more products - insurance, drugs, devices - come to the market it is increasingly difficult for government regulators to keep up with change and impossible for government to communicate caution. So we are asked to read the fine print and understand the fast talk at the end of TV and radio commercials. As we age that becomes a near impossibility.

This is a nice challenge for the "consumer directed health care" entrepreneurs to take on. Rather than banning DTC marketing as our Governor and others have suggested, get creative about reducing/eliminating consumer risk and about ensuring none but the gullible miss the warnings.

I am fortunate to be able to meet with an increasing number of internet age entrepreneurs who are eager to provide consumer interest, experience amd satisfaction products to the healthcare industry. Or to ride the e-health waves into the professional patient relationship. All of this is good news. But none of it is a substitute for the professional-patient relationship. The unsatisfactory state of health and medical information and of risks inherent in the choices we as consumers or patients make is not readily overcome. "Ask your doctor" is a totally inadequate safeguard because that costs time and money which we have learned neither she nor we have enough of. SO, what are we to do?

AND TO ERROR-FREE HOSPITAL USE OF PRESCRIPTION DRUGS
The New England Healthcare Institute and the Massachusetts Technology Corporation reported on a survey which revealed one in every 10 patients in six MA community hospitals experienced "serious and avoidable" prescription drug errors which added four days onto a patient's hospital stay. They claim there is an electronic prescribing system available which, if installed, would eliminate most of these errors, the cost of which could be recouped in two years.

HIGHER EDUCATION FINANCING AND MEDICARE ADVANTAGE
If you wonder why we need to pay private insurance companies 13 to 30% more than the cost of traditional Medicare, you should look no farther than the Student Loan Program. In 1971 Congress decided that it would be less costly to provide students access to higher education through private lenders than through the government. The price we paid to do this was to remove the risk of loan defaults and add back an extra charge for making loans. What did we get for our money? Nothing we wouldn't have had with government loans except a lot of extra costs.

Ditto the new Medicare Advantage program. Private health insurance plans were effective in the late 1990s in defeating Congressional efforts to force them to bid competitively for Medicare business. With Republicans in charge in 2003 the private insurance companies were successful in securing the same risk-free protection the student loan companies received in 1971. The companies get to set the prices they will have to be paid by Medicare and they bear no risk because they can always raise rates or drop out of the so-called market. Taxpayers are subsidizing these companies amounts varying from an average 13% for ME to 30% for private fee-for-service plans.

NON-PROFIT COMMUNITY BENEFIT
The Service Employees International Union (S.E.I.U.) continues its war on non-profit hospitals and their use of exemption from taxes to do business just like for-profits. The I.R.S. issued a new nonprofit reporting form which continues to recognize charity care as qualified community benefit for exemption purposes. But it does not include bad debt as charity care. The SEIU is threatening the directors of Boston's Beth Israel Deaconess hospital who also serve as directors of for-profit companies, with violating Sarbanes-Oxley requirements that they use the specialized knowledge gained from their positions in the for-profit world in governing the non-profit.

DR TOM DEAN is a member of a small family practice in Wessington Springs S.D. and a new member of the Medicare Payment Advisory Commission. I misreported his cancer earlier in the year. He reports now, however, he is doing quite well. His hip, which had collapsed, is repaired and doing well and he is handling the treatments for his myeloma as well. "We are optimistic" is the word from west-central South Dakota.

HEALTH COVERAGE FOUNDATION
Washington super health policy lobbyist, Mike Bromberg, and his ranking seniors tennis doubles partner Marlys (excuse me - wife - Mike does not play), have launched a 501c(3) to help finance access to medical services for qualified persons. They put in $250,000 to launch and hope to get it up to $5 million over the next two years. What a couple.

FROGS AND THE BOILING WATER
Louisiana Governor Bobby Jindahl and the Louisiana Legislature have come to agreement on what for Louisiana is an historic agreement to limit conflict of interest and ending financial relations with outside interests. Jindahl, a Republican veteran of the ethics wars in the U.S. House, was just elected and made ethics his first step in major overhaul of the role of government in meeting the needs of the people of Louisiana.

Back in the Congress, however, his former colleagues are still fighting the idea of replacing the body's ethics panel of members with an independent board of six persons with experience and reputation in ethical conduct. To prove ethics is not a partisan issue, Democratic Rules Committee chair, Congresswoman Louise Slaughter (D-NY) says: "What makes people think six people chosen at random would have more ethics, more intelligence, more judgment than we have?" If you are not a member of Congress you will not believe your ears on that one. Believe it. They just don't get it.

BILL BUCKLEY
I will always consider myself a conservative and, hopefully, a Republican. I grew up a Catholic, who attended Catholic schools, and grew in the 1950s into an anti-communist who volunteered to serve in the U.S. Army in Military Intelligence. William F. Buckley was my hero and, after I came to the Senate, a mentor. Along with Senator Daniel Patrick Moynihan, a New York Democrat, he had more influence in how I thought about the role of government and society than any others of comparable education and intellect. Both wrote prolifically so generations will be blessed by the way they used their gifts. They have both, now, passed. And we are left with the harangue of imposters who praise them, but can't understand them, so will have little lasting impact on their little worlds.

SNOWSTORM PRIMARY IN WISCONSIN
It may have been an indication of their relative positions in the presidential campaign. But on the Sunday before the Wisconsin primary Hillary Clinton was stuck in a blizzard in Milwaukee unable to move out. Barack Obama cancelled his flight to Wisconsin and headed for a Sunday meal with John and Elizabeth Edwards in North Carolina. Mike Huckabee was in the Cayman Islands collecting a nice size personal honorarium for a speech to off-shore financing experts "because my speakers bureau made me do it…and I need the money."

A GOVERNOR FOR VICE-PRESIDENT
No one expected two Senators to be the party's candidates for President. It hasn't happened but once (1964) in anyone's lifetime. But why a Governor? After the National Governors Association mid-winter meeting in Washington DC I am wondering myself. Because their chair, our own Governor Tim Pawlenty, asked them, they endorsed national enviro-energy policies. They split on whether large public investments in infrastructure now would stimulate the economy or just raise taxes.

On issues that are killing state budgets - and taxpayers - the economy, housing finance, value-based health care and education, they seemed mute. They did tell President Bush they objected to his latest round of Medicaid rules that the administration believes ends more "creative financing techniques" not intended by policy, and Governors believe sucks yet more billions of federal dollars out of state programs. Maybe because he's a former TX Governor and a lame duck President, Governors muted their criticism of George Bush for cutting domestic spending while defending a two-war national security policy that has added nearly a trillion dollars to the national debt.

Tim Pawlenty had a busy week. The day before he left for Washington the MN Legislature passed a highway bill which would raise taxes in our high tax state by $6.7 billion; as promised, he vetoed the bill on his way to the airport. While he was still in DC, the Democrats plus some Republicans in the Legislature re-passed the tax bill over his veto and all he could say is, blame the Democrats for raising taxes.

©2008 Weyant, The Hill

One reason Tim gave for not raising highway users fees like fuel and vehicle sales taxes is that the nation will soon have "plug-in vehicles" implying gasoline as a transportation fuel tax source may become obsolete. Enviros would suggest that raising the price of highway use with taxes - as Europe has done for decades - would encourage high efficiency auto and other transport design and production. Which it has. Except U.S. auto makers keep resisting while they lay off or buy-out thousands of employees from a world competitive industry in which they are losers.

From the left, Wayne Cox of organized labor's Minnesota Citizens for Tax Justice, describes Governor Pawlenty as "the gift that keeps giving" to Democrats in Minnesota whose House numbers have gone from 36 to 60 since the Governor took office, and "the only Minnesota Governor in recent history to see the state's unemployment rate go above the national average." From his right, Jason Lewis, who bills himself as "Minnesota's Mr. Conservative" and "America's Mr. Right", did a Wall Street Journal op ed attacking Tim for everything from raising state spending, the minimum wage and renewable energy mandates, to throwing in with environmentalists, Canadian drug importers, and tobacco abolitionists.

JOHN MCAIN AND BARACK OBAMA
Some say they haven't seen eye to eye in the Senate. McCain says of Obama, "to encourage a country with only rhetoric, rather than sound and proven ideas that trust in the strength and courage of free people, is not a promise of hope." As we will discover, and those in DC who left him for Romney discovered long ago, John McCain seems notably free of most of those "sound and proven ideas", David Brooks reminded us in a kind-of defense of John McCain this week, that what John is, is the antithesis of the special interest group.

He is well known for taking on the telecommunications giants, the tobacco companies, the ethanol industry, Big Sugar, Big Auto, Big Mining, Big Energy, Big Earmarks, Big PACS. He has "challenged the winds of the money gale and battled concentrated power."

Right. But where are the "big Republican ideas" for which we elect Presidents at times of dire need in national and economic security, affordable health care, quality education, and other decaying infrastructure with which to compete in an aggressively competitive world. We have eight months to see what twenty five years in Congress may have taught him.

NEW YORK TIMES AND JOHN MCCAIN
As everyone knows, the New York Times did a story last week on the Senator's involvement on behalf of lobbyists for the telecommunications industry. Usually this is one of those "where there's smoke, there's fire" stories. Not this one. Across the demographic board the reaction was negative to the Times and positive to McCain. There will be residue reminder that no one in Washington is a frog immune to the boiling water. Even McCain, who almost lost his job in the Senate over his too chummy relationship with Cincinnati/Phoenix savings and loan swindler Charles Keating. But the Cindy McCain look-alike lobbyist is pretty much "over the top" for this guy.

DON'T TAKE PUBLIC FINANCING
The special interest money candidates (Clinton and McCain) are putting pressure on Obama to agree to accept public funding of his campaign and forego political contributions. I made it into elected office by tens of thousands of individual contributions which were dwarfed by the self-funding of my multi-millionaire opponent. I continually broadened the base of campaign contributions by working with my Senate colleague from Minnesota and at least one Republican house member to the point where together we came close to 100,000 individual contributions. Yes, we accepted PAC contributions, and when I ran against a Dayton married to a Rockefeller they made a big difference. But each of us learned the value of individuals making a decision with their money as well as their vote.

The explosion of lobbyists, special and single issue groups, independent expenditures, PAC s and 527s etc turned me into a campaign finance reformer and I led the little GOP group that McCain took over after my retirement. None of the "reforms" have removed the dependence on corporate interests in DC. Only the Ron Paul and the Barack Obama grassroots campaigns (and Howard Dean in 2004) can make a candidate truly independent of the interests that destroy his/her independent judgment. So, Barack, stick with folks like my wife who after every primary sends the contributions needle up - maybe $50 or $150 at a time. Ron and Barack, we've never seen anything quite like this before. Let's keep it going right through the election.

OBAMA'S RUNNING MATE
As the popular decisions are made to go with audacity and Obama, it becomes even more likely that the Illinois Senator's choice of a running mate will be someone close to the Clintons, but with the skills to be his/her own person and bring some experiences to the office which Obama has lacked so far. There are many experienced Democratic elected officials who would fit that bill. The most likely today looks a great deal like Governor Bill Richardson of New Mexico

©2008 Steve Sack

TURNING BACK THE CLOCK
Two big events this month: (1) Fidel Castro resigns/retires as President of Cuba, and (2) the New York Philharmonic Orchestra performs in Pyongyang, North Korea. Republican members of Congress who have lived off Cuban refugee politics and money for decades began to consider ways and means of laying a policy path to a future on that island nation off our shores.

Accounts of the Philharmonic's visit to North Korea, especially reactions of orchestra members to what they observed, reminded us of why this part of an "axis of evil" is not to be compared with any other on earth. Except, perhaps, Cuba. I visited both Havana and Pyongyang after leaving the Senate in 1995.

What I saw reminded me of the way the world was when my father was my age. What in Cuba was a commitment to health, education, sports, and medicine - all on a shoe string - in North Korea was "museums of industry" and artistic performance halls with an emphasis on music and dance. Cuba was a cult of personality in which freedoms were restricted but information was impossible to keep out. North Korea is a cult. Period. No freedom. No information. No ambition or hope or thought. Except inside those who were in the military, or the "government", and whose defense of the cult leader required them to deal with some part of the reality of what they are missing. The more invitations we accept the better.

CHANGING MY RETIREMENT
John Rother at AARP is one of my heroes. Right after passage of MMA 2003 he described it as "a faith-based policy." In a WSJ weekender this month on the 12 people who will most influence American's retirement, John says "I've got the best job in Washington" providing policy guidance to AARP and others on the future of social insurance programs. He knows how much the policies behind them need to change. For example, he has long fought for an insurance system to provide supportive services for long term care, knowing it must be a combination of private and social insurance. He seizes every opportunity to persuade the private insurance industry, Congress and Governors, it is the only way to go. And soon.

MN CITIZENS LEAGUE
Executive Director Sean Kershaw is from another generation but has reached the same conclusion. He speaks passionately to the need for political leaders to take on the issue of long term care financing in the January 2008 issue of the Minnesota Journal.

PROSPERITY GOSPEL churches are based on the notion that success in business or personal life is evidence of God's love. Senator Chuck Grassley, the Iowa Republican who chairs the Senate Finance Committee when the GOP's in charge, doesn't acknowledge God's role in the mega-church success story. But he does believe that the non-profit exemption granted these folks carries with it some kind of an obligation for accountability. Rev. Kenneth Copeland of Texas doesn't agree and told the Senator "It's not yours. It's God's, and you're not going to get it - and that's something I'll go to prison over." The good Senator can't send Kenneth to jail, but someone ought to.

One of Copeland's acolytes in Lake Wobegon is Pastor Mac Hammond of the Living Word Christian Center. It is here that Congresswoman Michele Bachmann heard God tell her to run for Congress. And earned a seat on the aisle of the House of Representatives from whence she delivered her now-famous State of the Union hug and a kiss to President Bush in January 2007.

Copeland isn't kissing Bush, but he is raising lots of money for Mike Huckabee who he says agrees with him on his 501c(3) obligations. Hammond's in a different kind of trouble, losing money on his church and having to sell his private jet on which there's a questionable $2 million loan involving the church. Amen.

LIFETIME AIR TRAVEL PRIVILEGES
Airline employees receive tax-free air travel privileges for themselves and their families while employed. Only C-suiters like CEO Doug Steensland at NWA, is entitled to travel, as is his "family", forever, without cost to themselves and without paying any income tax on the benefit. If you shop airline prices these days, you'll know this is a potential million dollar benefit. While Congressional tax policy committees have forever debated how much to limit the privileges of employee benefits, this one survives. Health insurance benefits are gradually shifted to employees, and post-retirement benefits are limited. Post-employment benefits like Medicare are gradually means-tested. But not free airline travel for a few.

BOOKS WORTH A READ
Coming next month from Oklahoma U President and former Senator David Boren: A Letter to America. Both David McCullough and Jim Lehrer endorse your reading this 120 page message which, as I related here a couple months ago, comes right from the heart of this committed American. Boren, who has a son in Congress, led a brief uprising against the party's candidates by 17 grumpy old men and women of both parties, has little faith in political parties as our future. Will be interesting to see what he says about the two likely national candidates for President (I know what he thinks of Hillary Clinton).

It isn't every day that a former Majority Leader of the U.S. Senate writes a book on the need for bi-partisanship in health system policy reform. Senator Tom Daschle has done it in his new book, Critical: What We Can Do About the Health Care Crisis. Tom will present his views on this and other timely issues at 7:30 pm on March 12, 2008 at Schulze Hall of the Opus College of Business at the University of St. Thomas. The event is sponsored by the National Institute of Health Policy and is open to the public free of charge. Daschle's presentation will be followed by a book-signing opportunity and reception.

UNLICENSED DRIVER BRINGS OUT OUR NOT-SO MN NICE
A 23 year old unlicensed driver calling herself Morales sped through a stop sign in rural Minnesota, hit the rear of a school bus, killed 4 and injured 12 MN children. She is an illegal alien from Guatemala named Olga Marina Franco. Right wing radio's fuse was lit and an e-mail tirade to and from GOP legislators to report and deport, to require English only driver's licenses and God knows what else crusade is under way in our state. The same day as the Morales collision, a St. Paul man of African American descent named Terrance Oliver killed a pedestrian with his car and fled the scene. Oliver hasn't had a valid drivers license in 13 years and has been repeatedly arrested for driving without a license. Deport him to where??

Congresswoman Michele Bachmann told Fox radio in MN today that every illegal alien "should be thrown out of this country as soon as possible." She continued by calling illegals a threat to the safety of people in this country, endorsed English-only vehicle operator licenses, elimination of access to any public benefits, and mandates that federal employees report any suspected illegals to ICE or other authorities.

No state in the country has a higher percentage of teenagers behind the wheel of automobiles in deadly crashes that Minnesota. For example, seven teenagers have died in four car crashes in the last 11 months in the town of Princeton, MN, just north of here. A Minnesota teen dies in a crash about every five days. This sad statistic does not reflect millions of dollars in medical bills incurred by families of injured and disabled youngsters, some of whom face a life time of supportive services. One wise driving school operator said, "Parents wouldn't let their kids swim off beaches closed for shark attacks, but they'll let them go out driving on Friday night when the odds of getting hurt are much worse."

The MN Department of Public Safety reported that from 2004-06, unlicensed drivers in this state of 5 million were involved in 14,305 crashes resulting in 758 serious injuries and 197 deaths. Only 4% of drivers in MN are not licensed, but they account for 12% of the accidents and deaths. The penalty for driving without license in MN is 90 days or $1,000. Some judges order auto licenses revoked for repeat offense. But MN law does not require purchaser of automobile or its registration to prove owner has a valid license to drive in MN.

Rumor has it that Garrison Keillor and wife Jennie Lind Nilsson have decided that new neighbors and a better view are what they want next in life in St. Paul. They will soon have their home next door to Paul Olson and Lori Anderson for sale. Garrison and Jennie Lind will move two blocks to the old Weyerhauser home on Summit Avenue overlooking downtown St. Paul, the Mississippi River and both the east and west side bluffs of the city. If they are in town in early September it will make a great spot for keeping an eye on Republicans who will be conventioning at the bottom of the hill. Garrison recently endorsed Barack Obama for President.

Thursday night Garrison and singer Tony Bennet will be in Las Vegas to headline the 70th anniversary of the Carlson Companies during which founder's daughter, Marilyn Carlson Nelson, hands over the keys to the $37.1 billion revenue kingdom to Hubert Joly. Garrison travels out of MN a lot in winter, as he relates in a wonderful Star Tribune piece last Sunday.

Actress Jessica Lange opined recently that she and Sam Shepard and their family have had it with our idyllic old river community - Stillwater. "Stillwater," she says, "has become ‘yuppified'" since she and Sam came out here 20 years ago to raise their kids. "Too many gift jobs and those dumb condominiums." Their home has been on the market for years and the only roots the Cloquet, MN native claims to Lake Wobegon is "a cabin north of Duluth."

Francisco Liriano is the Minnesota Twin we vote most likely to replace two-time Cy Young Award winner Johan Santana. Or I guess we pray. But not even prayers could get the native of the Dominican Republic to spring training camp in Fort Meyers, FL on time. His visa was held up by U.S. consular officials because Francisco was arrested in Florida in 2006 on charges of speeding and drunk driving. He is required to take a sobriety test and go to counseling sessions before they will permit him to take the mound in Fort Meyers to test the arm that had Tommy John surgery 18 months ago.

COMATOSE MIRACLE?
One day last month, Rae Kupferschmidt lost brain function for all bodily functions but continued breathing. At United Hospital in St. Paul they listed her as dead. 24 hours later Rae responded to stimulus, began to stir, and in a relatively few days was back home in Lake Elmo with her husband and negotiating stairs. Her doctor says the brain's ability to wake up from death is zero. So Rae and her family believe God selected her for a miracle. And others are left to wonder, why not me? This week former Israeli Prime Minister Ariel Sharon turned 80 in a hospital. He has been comatose for more than two years, but is breathing without mechanical assistance.

Despite record cold this winter, the contractors re-building the I-35W bridge are making progress. On February 18th, with the temperature around zero and headed lower, they reported all the footings for the new bridge have been poured and we are beginning to see massive concrete piers which will hold the bridge rising - along with the steam, from the ice-cold Mississippi River. How do you pour 50,000 cubic yards with 16,000 tons of re-bar, the highest-strength concrete ever used on a Minnesota bridge, in this weather? You build "warming houses" the size of office buildings with stairs on which workers run up and down in the 40 degree temperature required to cure the concrete. There are 120 separate segments which require this operation on the 200 foot long bridge.

Snow-kiting is our "Up North" version of surfing and sailing for Californians. Parts of Minnesota and North Dakota rank first in the nation in wind energy potential. Snow-kiting enables the adventurous to use paraglider-like canopies to pull skiers or snowboarders at up to 20 mph for great distances - or at least until your body or your packed food gives out. The U.S. Department of Energy has encouraged North Dakota by calling it the "Saudi Arabia of Wind" and those who aren't sailing are investing heavily in converting wind to energy.

Minnesota Moose are dying from mysterious causes. The NW MN moose population dropped from 4,000 to 84 and the NE MN population from 8400 to 6500 in just 20 years. Suspects are parasites from an exploding MN deer population and climate change which has warmed NW MN by 11 degrees in just the last 40 years. Moose thrive on cold weather only.

OBAMA IS MINNESOTA FAVORITE
In the month prior to the February 5 caucuses in Minnesota, Obama raised $266,338 in our state compared to $54,200 by Hillary Clinton and $86, 976 for John McCain. Mike Huckabee outraised Mitt Romney, the GOP caucus winner, by $33,300 to $26,104. In total Democratic candidates are out-raising Republicans 3:2 in MN.

I once served with a famous person of Irish descent who always gave up drinking during Lent. So when I saw this bit, I couldn't resist sharing it:

LENT IN COUNTY KERRY
An Irishman moves into a tiny hamlet in County Kerry, walks into the pub and promptly orders three beers. The bartender raises his eyebrows, but serves the man three beers, which he drinks quietly at a table, alone.

An hour later, the man has finished the three beers and orders three more. This happens yet again. The next evening the man again orders and drinks three beers at a time, several times. Soon the entire town is whispering about the Man Who Orders Three Beers.

Finally, a week later, the bartender broaches the subject on behalf of the town. "I don't mean to pry, but folks around here are wondering why you always order three beers?"

"Tis odd, isn't it?" the man replies. "You see, I have two brothers, and one went to America, and the other to Australia . We promised each other that we would always order an extra two beers whenever we drank as a way of keeping up the family bond."

The bartender and the whole town were pleased with this answer, and soon the Man Who Orders Three Beers became a local celebrity and source of pride to the hamlet, even to the extent that out-of-towners would come to watch him drink.

Then, one day, the man comes in and orders only two beers. The bartender pours them with a heavy heart. This continues for the rest of the evening. He orders only two beers. The word flies around town. Prayers are offered for the soul of one of the brothers.

The next day, the bartender says to the man, "Folks around here, me first of all, want to offer condolences to you for the death of your brother. You know-the two beers and all."

The man ponders this for a moment, then replies, "You'll be happy to hear that my two brothers are alive and well. It's just that I, meself, have decided to give up drinking for Lent."

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