Commentary from Dave Durenberger

January 31, 2008

President Bush seemed to enjoy himself, and skipped over any analysis of how well we are doing as a nation thanks to his two terms as our leader. He seemed to have no problem telling the members of Congress what they ought to be doing this year and, as one who has experienced an epiphany of sorts, told them to kick their "earmark" habit by threatening to veto their spending. Like any good enabler's advice (Bush signed spending bills containing 55,000 earmarks totaling more than $100 billion already) he suggests they cut their earmarking this year by 50%. His line about the IRS taking checks or credit cards for advancing tax payments was great. But the amount of time spent trying to prove that his Iraq initiative and all it has cost us a nation (including the 70th Minnesotan whose life was lost last week), was way out of proportion to the public concern about what he or we are going to be able to do about it

TED KENNEDY AND BILL CLINTON
What do they have in common? High visibility Democratic leaders. Devoted to public service and politics. Both suffer from battling weight fluctuation and both suffered through high-visibility character tests. There the similarity ends. As of this past weekend we know why. I need not add to what's been recently said of Bill. The Economist calls it "downgrading himself from global statesman to political hatchet-man." Kennedy in his endorsement of Obama summed up their difference in these words: "With Barack Obama there is a new national leader who has given America a different kind of campaign - a campaign not just about himself, but about all of us…The world is changing. The old ways will not do."

If you wanted a race for President between experience and judgment you were getting it; until Bill's narcissism possessed him to save the Clinton's version of experience. Many of us were concerned about Billary Clinton. What might this man do to destroy her effectiveness as a President for us and to the world? Wasn't he busy enough negotiating a $20 million buyout from his friend Ron Burkle over its investments in Dubai? The more Hillary allowed Bill to set her tone, the more we wondered whether she'd even get there because he was undercutting the ground on which she rightfully stood. As we approach February 5 we still don't know. Or whether there is such a thing as momentum.

©2008 Steve Sack, Star Tribune

AND BARACK OBAMA
Not much in recent campaign history can rival the reaction to Barack Obama's 55-27 win over Hillary Clinton in South Carolina. First reported reaction was President Clinton in Missouri who launched into a narcissistic parody of himself as President of the U.S. to the point that one by one the news channels sign off and every couple minutes "he's still talking and hasn't mentioned her yet." Next was the Obama speech. In its content and its setting there hasn't been anything this impressive in American electoral politics in a long, long time. Finally we briefly saw Hillary pacing up and down in front of her cardboard cutout voters (including a real Chelsea) never mentioning South Carolina until after the TV reporters turned to other news.

I can't tell you how many of my friends had the same experience watching the TV coverage after South Carolina that I did. The speech and the environment in which Obama delivered it evoked a lot of emotion. As did the concerns we felt as he made his way slowly through a heavy crowd.

SEARCHING FOR MEANING
The 2008 election campaigns seem to be just that. Candidates use words and phrases and polls to test and alter messages - even on the "straight talk express" - to influence and to motivate. How strange it is then that nothing seems to stick for very long? A few successes in Iraq wipe out terrorism and Giuliani. Talk of recession minimizes health care costs in favor of economic security. Race and gender seem more divisive than ever. And age - as in "Mack is Back" - is no factor.

Change and experience and leadership and authenticity. These words have meaning to many. So did "shining city on a hill" or even "the audacity of hope." Reflecting our loss of confidence, or better said, our search for accountability. In our world, our country, our leaders of all institutions, institutions themselves (healthcare, higher education, banks and insurance). Accountability for ourselves (thus the increased reliance on religious metaphors and "values" driven observances.

HOW MANY POLITICAL INDEPENDENTS ARE THERE IN AMERICA THIS YEAR?
When asked by a Dartmouth student about the fatigue of having two families running this country for decades, Bill Clinton is said to have replied: "I'm not responsible for the 12 years that the American people gave to the Bushes." That's Clintonesque. But also not responsive. Bush 41 was Reagan's Vice President and Americans preferred him in 1988 to Michael Dukakis. By 1992 they decided Bush was not committed enough to the job with which they'd entrusted him and they chose eager beaver Governor Clinton. Compared to Bob Dole, Clinton was their choice again in 1996, but by 2000 they (we) had tired of living with charisma and untrustworthy judgment in our President and gave the job back to a Bush. Some would have preferred the better Bush who was Governor of Florida, but George W. was chosen and "all the rest is history," including the foregone conclusion that George 43 could not be re-elected in 2008. And the conclusion by the Dartmouth student, that we can do better as a country. Regardless of how different Hillary is from Bill, or George the first from George the second or Florida Jeb.

MOVING MONEY AND THE WORLD'S EXCESS LABOR FORCE
Among the insights from President Bush's tour of the Arab world is that Arab monarchies believe the people of this world will live longer and better on economic profligacy than on representative democracy. In recent years we saw enough of the financial and amusement city being built in Dubai to scare us off allowing a Dubai shipping country to buy a controlling interest in the Port of New York.

This detail of the King Abdullah Economic City on the Red Sea from the January 20th New York Times highlights the recent construction boom

Thanks to Bush's visit we see "new cities" on an even grander scale dredged out from the Persian Gulf and the Gulf of Aqaba. One is left to wonder, not where the money's coming from. We know we're paying for it at the rate of $5 a gas tank full. But what's it doing there and where's it going. We are learning some of its coming back home. Not to you and me, but via Sovereign Wealth Funds, to bail out the investment bankers who have contributed to the economic roller coaster we are all riding this year.

CLINTON—OBAMA AND ROMNEY—MCCAIN
Heading into Super Tuesday in Minnesota and 20 other states it is clear that the primaries won't end February 5th. Obama has some momentum but Clinton has delegate power and voters taught Bill a lesson early. This race goes on and on as Democrats and independents search for meaning in the Democratic Party. On the Republican side, the primary/caucus votes so far have eliminated all options but Romney for "right wing" Republicans who dominate the early turn-outs. If the public continues its apparent preference for Democratic candidates, the Republicans will settle on a Romney who talks their credo rather than a maverick McCain who has proven willing to question it.

JUST WHAT REPUBLICANS NEED
Former GOP House Majority Leader Tom DeLay has been steadily attacking John McCain among conservatives and Republican Congressional staff in Washington this month. "A McCain nomination would destroy the Republican Party," says the one Republican who best exemplifies why Democrats took back Congress in 2006. "There's nothing redeeming about John McCain," DeLay told Fox News, "He's not going much further than New Hampshire.

Former Republican Senator (PA) Rick Santorum told a right radio host, "There's nothing worse than having a Democratic Congress and a Republic President (McCain) who would act like a Democrat in matters that are important to conservatives."

KENYA
From 1964 to his death in 1978, Kenya was thriving with the leadership of its first elected President Jomo Kenyatta. What it has suffered from since his Vice President Daniel arap Moi took office if the insatiable greed of the few around a relatively weak President, their willingness to turn one group of Kenyans against another to achieve their goal - a lack of focused opposition. Kenyatta's son tried unsuccessfully in 2002, but there were too many candidates. Raila Odinga this time was successful in getting many others out of the race and claims to have won.

The looting, burning, killing began in Eldoret in the west and is proceeding slowly down the main E-W highway and will be in Nairobi quite soon. This past weekend it reached the area of Naivashu in the Navaru area, a beautiful part of the Rift Valley where you can see for miles on a clear day. Take in the city, beautiful Lake Naivasha, Mt. Longokot, and two national parks: Hellsgate and Longoro. This is where Father John Kaiser's body was found in 2000 after his murder by President Moi's minions. It's the site of Delamere Farms, one of the largest of the old British dairy farms and one of the largest rose nurseries in the country - perhaps in all of east Africa.

The only way out is for the President Mwai Kibaki to reach an agreement on the terms of a Presidential election in six months and an agreement on the role of the parliament and the national security forces respectively in the lead-up to the elections and their conduct.

NOT IN MY BACKYARD
U. S. Intelligence agencies acknowledge that around March 1 our latest burned-out spy satellite will crash to earth somewhere. You could be the lucky recipient of this ten ton vehicle the size of a small bus. It won't be the first. Back in my days on intelligence oversight I wondered aloud about how long these things lasted out there 22,000 miles in space, and where they landed when they ran out of propulsion. The answer always was not to worry. The last reported return a few years ago ended up in the Indian Ocean. All other returns are classified. Yours won't be because a nosy neighbor will likely report it.

SPORTS STADIA
In mid-December, I watched the finals of the Arizona State High School football championship in the "University of Phoenix" stadium in which we will get to watch the Super Bowl February 3, 2008. Most impressive 72,000 seat stadium I've seen with a movable roof, a moveable grass floor, and concourses big enough to hold any size crowd, 16,000 car parking on site and right off an Interstate. Built in a cotton field, like its neighbor the Phoenix Coyote's hockey arena, the football stadium cost $455 million to which the NFL Cardinals contributed $147 million and the Arizona Sports and Tourism Authority contributed $298 million.

The new Minnesota Twins Baseball stadium in downtown Minneapolis is scheduled to cost Hennepin County taxpayers $350 million and the Twins Baseball club $130 million. HOK Sports Architects are doing both stadia. This week we learned the Twins owner's costs are going up a lot. Someone discovered they were building this 40,000 seat stadium on the former silt bed of the Mississippi River.

Indianapolis, like Minneapolis, is often referred to as "fly-over city." Since Indianapolis made a commitment to become the national capitol of amateur sports and to steal the NFL Baltimore Colts, the city - and central Indiana - is booming. Even though Tony Dungy's Indianapolis Colts lost a heart-breaker to San Diego, the team has come up with consistently winning records and last year's Super Bowl title, something we have given up on up here. "We're under the national media radar," says Colts President Bill Polian, but we're not sneaking up on anybody we play. We get most people's A-game." And they are financial wizards. Later this year the Colts leave their 1984 stadium which cost $77.5 million for 55,530 seats, for a new, and much larger, $720 million stadium, geared for the corporate crowd, but paid for by taxes on rental cars, luxury boxes, hotels, motels, and restaurants.

BOB BALL PASSES
Everyone who has labored away at entitlement reform, or dealt with the intricacies of the Social Security Act, has known Bob Ball. Bob has been part of our lives for so long and with such celebration, there were times when someone quoted him only to here, "Is he still alive." No longer. Bob passed away Tuesday evening at the age of 93 having known he spent a lifetime making life better for millions he would never meet. Those of us who met him, relied on him, and were lectured by him, are so grateful for his life and grieved by his passing. We thank all his family for sharing him with us.

CLINICAL EFFECTIVENESS IS A SCIENCE
By now we've all read about Peter Pronovost in Atul Gawande's New Yorker argument for investment in effectiveness research and intensive care "check lists." We've also watched the reaction to the HHS Office of Human Research Protection to applying check-lists in clinical research without IRB approval. We've read nothing of the Pronovost IC Check List sweeping through America's hospitals. But then who expected it would?

We are all waiting for Congress to invest $6 billion in a public/private/Federal Reserve authority in Washington DC. The latest on the bandwagon is the Institute of Medicine. Modern Healthcare replies with a front-page surgery entitled "Read Instructions Before Assembling" followed by a lead story entitled "Sticking to the Recipe." This is not the journal of the AMA, folks. Comparative /clinical/ treatment/cost effectiveness was not invented by health services researchers, even those who help govern America's health insurance plans. It is the scientific research/education/clinical motif of some of the best physicians and surgeons and medical groups in the country. And it always has been.

What we need in health policy is, as suggested by the Gawande article, is a Congress and an NIH willing to invest in fostering the science of effectiveness research by professionals already driven by a desire to continually improve clinical outcomes not just the staffing of the bio-med-stem-cell towers of academic medicine. Followed by a commitment from private and public health insurance plans and programs to pay only for safe, effective high value outcomes however arrived at. Out with the cookbook and in with paying for the performance many are capable of, but none but the "brand names" rewarded for.

PRODUCTIVITY AND EFFICIENCY
Tor Dahl is a medical economist who knows more about the productivity, or lack thereof, of U.S. hospitals than anyone I know. He's a former student at the University of Minnesota of Nobel Laureate Leonid Hurwicz, teaches at the University and lectures around the world. Dr. Atul Gwande's story on "checklist" efficiency caught his eye, too and he wrote a short piece I recommend titled "How to Fix Health Care Delivery in the United States."

MEDICARE ADVANTAGE PROGRAMS "undermine incentives for efficiency and innovation by failing to exert the kind of financial pressure that maximize efficiency. Although Medicare Advantage plans provide extra benefits, their costs for providing the Part A and B benefit package are demonstrably higher than fee for service." On behalf of the Medicare Payment Advisory Commission (MedPAC), its executive director Mark Miller told the Senate Finance Committee this week that "the original vision of the potential of private (health insurance) plans has been compromised and ultimately undermined by successive payment increases to plans."

Miller went on, "The increases (authorized by the Medicare Modernization Act of 2003) have been so large that plans no longer need to be efficient to attract enrollees...in addition to promoting inefficiency in MA, this misalignment increases the burden on taxpayers and beneficiaries, who must pay higher Part B premiums, whether they are in managed care plans or not." And further: "MedPAC is also concerned that the MA Private fee for service plans are not held to the same quality standards and regulations that other MA plans are...such as HMOs."

No single legislative prescription has done as much to undermine the future value of private health insurance plans to Medicare beneficiaries as did the MMA of 2003. In their eagerness to use prescription drug benefit modernization to provide a gravy train for commercial insurance into the world of Medicare, the industry destroyed decades of hard work by many local health insurance plans and HMOs to demonstrate the value to beneficiaries of using private plans to improve care quality, care coordination, and care costs.

ACCOUNTABLE CARE ORGANIZATIONS
My colleagues at MedPAC speak increasingly in advising Congress about paying accountable care organizations for performance and for results. Given what we have the current ability to measure Medicare (and by implication, Medicaid) should pay for performance and should pay more to the high performers than the low. Performance is measured by resource use, quality measurements. Results mean outcomes. While it is possible over time to measure and reward individual performance, it is more practical now to begin to reward collective performance as in all those involved in a patient's chronic illness or in an episode of acute illness or injury. That's where medical groups, hospital staff arrangements, medical homes and other like organizations or virtual relationships come in.

©2008 Roger Schillerstrom, Modern Healthcare

A good example of that, which has been in the news lately, is Essentia Health and the Benedictine Health System. As of January 1, 2008 Essentia is a $1.2 billion headed for $1.5 billion acute care organization which is a physician led system integrating hospitals, medical clinics, and health management services of many kinds. Essentia recently acquired Fargo, ND based Dakota Clinic (with 21 medical clinics in three states). Its CEO is Peter Person, M.D. Its largest tertiary care hospital is St. Mary's in Duluth. Its former long term care partners in the Duluth Benedictine system are called Benedictine Health System which is the largest Catholic long-term care system in the nation with facilities in seven states. BHS CEO is Dale Thompson, a veteran national long term care leader who has served on national commissions and recently chaired Governor Pawlenty's Veterans Long-Term Care Advisory Commission.

As reported in the January 18th Star Tribune, Essentia has also taken the leadership in this area in reducing even the appearance that patients' well-being can be affected by physician relationships with drug and device companies.

MEDICAL MARKETS MINNESOTA
Like many large metro medical communities, the Minneapolis-St. Paul based hospital systems continue to battle each other for specialty medicine market share. Fairview UMN and MN Children's are taking their market wars north to the St. Cloud area as it gradually becomes a part of the larger MSP market place and CentraCare Clinic (owner of St. Cloud Hospital) cuts deals with each for specialty services in what they claim to be an "underserved" market. CentraCare has successfully fought off any effort at hospital competition using the MN moratorium law to dictate its future and the future of specialty access - and referrals - in their "territory.

Meanwhile, medical market whiz Tony Miller and friends launches CAROL their newest medical mall on your lap(top) from which consumers can select conveniently packaged health and medical services with prices to boot. Miller is the genius who created Definity when few gave credence to high deductible insurance and made $300 million selling it off to United Health. The money became Lemhuil Investment and the next level of marketing became Carol. He had lots of help from Dave Wessner at Park Nicollet, proving that health care consumers are a factor to be reckoned with in the future of health system performance.

ANOTHER MINNESOTA FIRST
At the initiative of Governor Pawlenty and support from our Democratic Legislature, we will be the first state in the country in 2009 to standardize data in the electronic execution of common health care administrative transactions. The initiative had the support of both the MN Hospital Association and Council of Health Plans. It provides more reliable and less costly information on coverage and on services, expedites billing and payment and assures much greater reliability of the information. Assistant Health Commissioner, Scott Leitz, says, "And, believe it or not, this one is actually going to save the money it claims to save."

On the healthy eating front, University of Minnesota researchers have found the biggest contributors to the precursor of diabetes and heart disease are red meat, fried foods, and diet pop. This is the second big hit diet pop has taken from health researchers recently. They all increase the risk of "metabolic syndrome", a group of symptoms including high blood pressure, high level triglycerides, blood sugar, cholesterol and "fatty buildup around the waist line." And it's MS that creates the serious medical problem.

The Board of Health of New York City voted this month to require restaurants in the city which are part of chains with 15 or more outlets nationwide, to show calorie information on their menus and menu board. Another sign of things to come on the "healthy people" front.

MENTAL HEALTH IN MINNESOTA
We have a long history of pioneering reforms in mental health in Minnesota. And in treating chemical dependency. But our professional and financial ability to keep pace with the problem of mental illness in the aftermath of deinstitutionalization, and the growth in addictions and behavioral health problems, has created problems that have been too long ignored. State government has not been ignoring the problem. It has tried replacing most of its regional treatment centers with 16-bed acute care psych hospitals. It first tried to persuade community hospitals to add psych units, an effort that was largely unsuccessful because hospitals couldn't afford to take on more patients whose payers could not/would not meet hospital costs. Thus the Paul Wellstone/Pete Domenici/Jim Ramstad/Patrick Kennedy effort at "mental health parity" legislation.

But that's still not the getting at the real problems. The problems start with inadequate community response to emerging mental illness. Over-reliance on primary care physicians and the inadequate numbers of mental health professionals is a serious problem here as elsewhere. As unattended problems mount the pressures increase on hospital emergency rooms. Waiting for psych beds is today's biggest ER problem. Experts say our problems are not the total number of in-patient, acute care beds in the state; it's that the problems are in one place (mainly in Minneapolis-St. Paul metro) and the solutions are elsewhere. Importantly, what Minnesotans really need are more intermediate or sub-acute level beds for patients who are ready for hospital discharge, but not ready to go home. And a lot more qualified and compensated mental health professionals.

PRAIRIE ST. JOHN is a Fargo-based non-profit treatment company specializing in chemical dependency and psychiatric treatment. To build a new psych hospital in east metro's Woodbury, PSJ must receive legislative authorization because of Minnesota's long standing moratorium on new hospitals. PSJ must also overcome the concerns, and some objections, of Minneapolis-St. Paul health systems which have been arguing for years the need to improve access to and coverage of professional treatment for mentally ill before they become hospital ER and in-patient visitors on a regular basis. But Woodbury's Mayor Bill Hargis has no such problems, as you'd expect. The mayor says the "proposal would be a nice addition to Woodbury's economy and fits well with the city's vision of a medical district." So much for efforts at "transformation" of our health care system and its medical arms race syndrome.

ENVIRONMENTAL HEALTH
The Mississippi Market co-op grocery on Dale St in St. Paul, of which I am a member, will lead a pack which includes Whole Foods and the Wedge Co-op over in Minneapolis in banning plastic grocery bags. They will encourage me to bring my own paper bags from now one. Which might be a challenge because I'm never sure how much I intend to buy. So, for me, and people like me, they will sell paper bags for a buck. Some locals are using biodegradable plastic bags (or so they say) - how does it biodegrade in -10 degrees? Others are using reusable bags. Most Americans who use 29 billion plastic bags a year aren't ready to change.

MINNESOTA'S UNITEDHEALTH reported profits to meet market expectations, but little else for stock market analysts of health insurance plans to cheer about. United's core business in employer-sponsored plans (commercial risk) continued to decline and the economic forecasts are that won't stop. Medical claims costs rose from 79% six months ago to 83.7% this last quarter indicating big pressure on premium pricing or profits. All this puts pressure on United's government business, especially Medicare and Medicaid. Would anyone bet with fiscal pressures on governments at all levels, that realistic payments in either of these areas is possible? With Democrats dictating health financing policy, Medicaid may do somewhat better, but the big Medicare bonuses dictated by sellers of private Medicare Advantage plans aren't in the cards. That leaves United with its ace-in-the-hole - the franchise they have from AARP to sell boomers and the oldsters whatever we need.

Public relations geniuses from the Twin Cities of Minneapolis and St. Paul have spent $1.5 million worth of their creative time and decided there is no longer any "value-added" in calling ourselves the "Twin Cities." So, from now on, we Lake Wobegoners will not take our weekend jaunts down to "The Cities," but to Minneapolis or St. Paul. Friends in other parts of the country will be enticed to "Minneapolis St. Paul" and delegates to the 2008 Republican Convention in St. Paul will have to come to Minneapolis St. Paul because little old St. Paul just ain't big enough. I like that just fine.

FROM MINNEAPOLIS TO ST.PAUL by the convenience of "Light Rail." Rather than building a light rail system from downtown to downtown along I-94, locals are debating a $1.2 billion system of light rail "street cars" down the center of the avenue that used to connect the cities with stops every six blocks and a lot longer ride than anyone's car today.

MINNEAPOLIS-ST.PAUL-DULUTH
For another $362.6 million, Minnesota can build a 110 mph rail link between our former Twin Cities and Duluth, our "San Francisco of the North," on Lake Superior. The design includes 5 stops along the way, including one at the Mille Lacs Band of Ojibway's Grand Casino Hinckley whose money will help build the rail. This is actually less than it costs to re-build the I-35W bridge in Minneapolis and has the same politicos spending 80% "federal money" to get it done. So why not. Railroad buffs can take us back a century in time when private investors built the same rail link and their passenger trains could move at more than 110 mph.

GARRISON KEILLOR and Jennie Lind Nilsson have agreed with Paul Olson and Lori Anderson over the design of Anderson's new garage/studio addition to the back of her house. It took high-powered mediation in the form of retired Supreme Court Justice Ed Stringer to get the neighbors to agree. Stringer, who with another colleague decreed Bill McGuire should pay $468 million, swore the hopefully now "good neighbors" to secrecy over the new design and its impact on Garrison's light and air.

NO SUPERBOWL BUT we'll be happy with Oscar nominations for Minnesota's Coen brothers' "No Country for Old Men" and Diablo Cody's "Juno" which she says she wrote at a cafe at the Target store in the Minneapolis suburb Crystal. Twins owner Carl Pohlad comes close again as his son Bill Pohlad, who produced "Brokeback Mountain", gets a couple nominations for "Into the Wild." Susan and I loved "Juno" and were appalled by "Old Men."

Finally it's done. The Minnesota Twins have helped decide Johan Santana's future and that of the New York Mets. The two-time Cy Young Award winner goes to the Mets - if they can do a six-year, $160 million deal by Friday - and the Twins save a lot of payroll to invest in three 6'5" pitchers and a 6"4" centerfielder who might grow into a Torii Hunter. For the umpteenth time in their 4-5 decades in Lake Wobegon, the Twins will be "rebuilding" but a smart deal may give them the additional raw material they need.

STATE OF HOCKEY
Or so say the Minnesota Wild now dubbed the Team of 18,000 after the St. Paul team that sells out every seat at Excel Energy Center for every Wild game. Only in a place like this would we notice that the drop in the value of the U.S. dollar has made it possible for U.S. NHL hockey franchises to be more attractive in Canada. Everyone knows the sport is the national sport of Canada. But with the Canadian dollar worth 50 to 60 cents on the U.S. dollar as it was for so many years, Canadians went over the border to play in increasing numbers. Only hard core franchises stayed in Canada. Now, however, international billionaires are bidding on Canadian franchises and U.S. franchises (like Nashville Predators) are looking for homes in Canada.

CRYING'S CONTAGIOUS
"The man accused of bullying at a Little League baseball game and threatening to shoot his son's coach cried on the witness stand (in a St. Paul courtroom) Thursday, saying he regretted a racial comment about the coach." Apparently the coach, born in the U.S. but of Mexican ancestry, was not giving the defendant's son enough playing time. No word from the son for whom Lake Wobegoners are all concerned.

Worry grows among Wobegoners at news that Congress is attempting to raise the tariffs on Honduran socks, many of which are worn of necessity in our six month winters - sometimes we wear two pairs for the long walks to/from school. Congressman Aderholt of Alabama is adamant about protecting Fort Payne, AL, the "sock capital of the world" from the poor Hondurans. President Bush promised Aderholt and others that if they voted for CAFTA their textile industries would not get wiped out. Fort Payne says they lost 1,500 jobs. For their part, the Honduran sock makers say they'd rather stay in Tegucigalpa making socks than trying to climb that darned wall in South Texas. Some days it doesn't pay for a Republican Rep to get out of bed.

"We are here on earth to do good for others. What the others are here for, I don't know."
- W.H. Auden

"It would be ironic if, just when capitalism seemed to have won the global battle for consumer hearts and minds, its venal banking sector had sown the seeds for its own destruction and replacement by a newly resurgent spirit of socialism and protectionism."

"What's missing from the current market is a sense of contrition or remorse, any reflection that 'maybe we should have done things differently.'"
- Tim Price, Investment Director at PFP Wealth Management, London

©2008 Steve Sack, Star Tribune

"They feel that Washington is broken. And they've heard time and again promises that haven't been fulfilled by Washington."
- Mitt Romney

"My biggest problem is not money or candidates, its Republican morale."
Congressman Tom Cole (R-OK), chair National Republican Congressional Committee

"In this era of personalized medicine, it's not just enough to define a new drug. It's also important to understand for whom that drug is appropriate."
- Andrew von Eschenbach M.D., Commissioner of the FDA

"I believe that House Republicans, having shown they have quickly mastered the improved tactics of a minority party, need to break tradition and reassert the strategies of a majority coalition."
- Tom DeLay, former House Republican majority leader

"In the end, Fred Thompson fell victim to his own distaste for all the things candidates have to do to be elected President."
- Columnist Byron York, The Hill

"A loss for Thompson's campaign is a victory for conventional wisdom."
- John Dickerson, Slate

"As soon as we take back the majority, that's when I am going to get a haircut."
- Congressman Mike Simpson (R-ID) whose hair has reached his shoulders (he also grew a beard on a Middle East trip, but shaved it when his wife said he looked like a terrorist).

The most informative health policy event of the year in Washington DC is "Getting to Universal Health Insurance." It will be held at the National Press Club on January 31 - February 1, 2008 and is sponsored by the National Academy of Social Insurance. It draws in almost every important policy topic and the nation's best recognized experts.

On February 7th, the Health Care UST MBA will hold a workshop on "Board Effectiveness in Health Care." This interactive workshop will feature a panel of board experts and an audience of current and future board members to discuss the common challenges and successes of working with health care boards. It will take place at the University of St. Thomas in Minneapolis February 7, 2008 from 4-6:30 p.m. Please visit their website for more information and registration.

Former Senate Majority Leader Tom Daschle will discuss his new book and bi-partisan approach to health care reform at the University of St. Thomas on March 12, 2008. More information about this event can be found on NIHP's website.

If you wish to SUBSCRIBE to the commentary, please click here.

If you wish to UNSUBSCRIBE from the commentary, please click here.