Commentary from Dave Durenberger

January 12, 2010

NATIONAL NEWS

by Scott Stantis

12-25-09 AND 01-05-10
These dates may mark a necessary turning point in the Obama presidency. On Christmas Day, a respected Nigerian businessman's son turned Islamic fundamentalist zealot nearly did a repeat of 9-11-01 in a NWA/Delta flight to Detroit. President Obama came off the beach in Hawaii and expressed deep concern for all involved, but did not disagree with the "system worked" explanation of our security preparedness by his Homeland Security Secretary.

On January 5 of this year, the president gathered his security staff in the White House, chewed some butt, and assured the world they'd know why it happened and that it would not happen again. The National Security Council is now in charge and its chief of staff, Denis McDonough, was on TV that evening explaining why the president means what he says. Denis, if you didn't already know, was an allconference tackle on John Gagliardi's St. John's University football team, graduating with honors in 1992.

On Christmas Eve in 2009 the Senate ended an historic and abysmal 25 days of public debate on health reform on a party-line vote and headed for home. On January 5, 2010, both the Senate and House were in pro-forma session to kick off the second half of the 111th Congress. In between these dates, Nebraska voters told Sen. Ben "Cornhusker Kickback" Nelson they did not approve of the trade he made for his vote. Senators John McCain and Joe Lieberman were in Baghdad apologizing to PM Maliki for the fact a federal judge threw out the poorly founded criminal case against five Blackwater guards. In Washington, Senators Byron Dorgan (DND) and Chris Dodd (DCT) announced their retirement.

IS THIS THE OBAMA TURNING POINT?
I'd like to believe that these two weeks marked the turning point in the Obama presidency. Experts agreed that 12-25-09 had every making of 91-1-01. Obama knows he was lucky and odds are that luck won't last (see seven CIA agents/contractors blown up in Khost by double/triple agent.) If he doesn't take charge - not just responsibility - for the leadership this country desperately needs, the voters will in 2010.

President Obama kept the Bush Great Recession from becoming the next Great Depression by keeping the Bush/Clinton/Wall Street Treasury team busy investing hundreds of billions of dollars of debt. He's kept hope alive in the stock market and on many main streets that we are weathering a game-changing economic storm with more debt in the name of stimulus. But the effort to engage the Congress in tackling the uncontrolled costs of an inefficient medical system that cannot provide for the needs of many Americans was abysmally inept.

PERHAPS HE IS WHAT MANY BELIEVED HE WOULD BE
Peggy Noonan ends the year 2009 with an upbeat Wall Street Journal analysis of President Obama. Albeit in the third person, quoting a young correspondent who worked for and loved the man a year ago and does, even more, today, as well as others who work as staff to the president and an "old Reagan hand." What her opinion piece suggests is that the president will not be judged by the attacks on him and his policy initiatives from the right or the left, which are much of what "public opinion" has to go on, but his fealty to the beliefs that brought out the best in millions of voters last year - people who may be unsure right now, but who want him to succeed as our president.

by Tom Toles

SCORPIONS IN THE BOTTLE
Polls show the decline in the president's job approval and pundits show the rise in the popularity of Republican, conservative, independent and tea party alternatives to Democratic members of Congress. Not rocket science. "Change we can believe in" takes time and you don't get there from two or three or more wars plus an international nearcalamitous financial system collapse. But the inaugural message, "Change Can Happen...Keep Hope Alive," is very possible.

The war on fundamentalist Islamic terrorists is a problem for every person in this world. Look at the passenger manifest on NWA flight 253. Looks like the victim list from 9-11. It needs to be made the No. 1 problem for the leaders of every nation. North Korea and Iran are problems, but Russia and China and their coattailers are much bigger challenges to this war. On this, Republicans are more than ready to agree. The world needs us to lead, and President Obama needs to make the war without national boundaries a priority for every nation that claims to respect political boundaries. If he does, he will and we will be successful. As success follows success, the Congress has no choice. You can't argue with success and you can't be Jim DeMint (RSC) or Ben Nelson (DNE) or Joe Lieberman (ICT) and expect to survive politically.

A SECURITY PROBLEM WHEREVER HE GOES
Some of us remember when President Harry Truman walked his dog ("If you want a friend in Washington, get a dog") daily for a mile or two around the White House. On his vacation President Obama and his family went to see the movie Avatar at a Hawaiian shopping center theater and security cleared the entire theateer. The city shut down a beach so the Obamas could swim and they picnicked alone on Hamauma Bay. A shopkeeper in Obama's old Honolulu neighborhood said "I hoped to see our first black president, but all I saw was white security." Let me tell you, that's not why people like Barack Obama want to be president. It's forced on them by circumstance. This is a really, really weird world.

DODD DORGAN
There's nothing like an historic 25day battle over health care legislation, following a ninemonth battle with death panels, public plans and town hall zealotry, to discourage older guys from Senate service. Add to that the decline in public approval of the new president and the rise of Republican/conservative/libertarian/tea party/ power on the right in most every state. Republican Senate and House campaign committees are raising record amounts of money. Even the Republican Governors Association raised $30 million in 2009 to the Democrats $22 million, and has $25 million of that as cash on hand compared to a much, much lower amount by the majority party. And this is where lots of the Senate candidates are coming from, having promised to cut spending and taxes.

North Dakota is a Republican state that has sent either moderate GOP members like Mark Andrews, or the likes of Kent Conrad, Dorgan, and Rep. Earl Pomeroy to the Senate, because they stand up against Cargill and ConAgra and the big corporate interests. Pomeroy's decision not to run for the Senate is interesting because it defies the logic of a statewide officeholder moving up. On the other hand, Pomeroy was on his way from insurance commissioner (where they all started) to a Peace Corps job in Russia when he was talked into running for Congress a few years ago. So maybe he's happy just where he is or as the next to leave. Governor John Hoeven (RND), now a candidate for Dorgan's seat, is a brother to Sen. Kent Conrad's (DND) first wife.

Chris Dodd saw the handwriting on the wall, as the Bible says of Daniel and the King. Arlen Specter needs to see it next but he likely won't. Bob Byrd needs to exit before he dies in his chair. There comes a time when you can "call it a day" and get to know your kids and grandkids and rebuild personal relationships. It's just hard to say yes when you're in a position where the president of the United States and of every corporation in the country returns your phone calls ASAP. You actually get to thinking you're the only person who can do the job well. That's the lesson I learned.

John Warner was a 1978 Senate classmate of mine who left the Senate at age 80 after five terms because, quoting Thomas Jefferson: "There is a fullness of time when more should go, and not occupy too long the ground to which others have the right to advance."

TOO BIG TO FAIL COMMISSION
Early last spring Congress created a commission to investigate the causes of the financial industry collapse of 2008 and recommend policy steps to prevent a recurrence. Cochairs are two tough guys: Phil Angelides, the former Democratic State Treasurer of CA, and Congressman Bill Thomas, also a Californian, who retired two years ago after being Republican chair of the House Ways and Means Committee. The commission starts hearings this week, after carefully assembling an investigative staff with the $8 million appropriated for the purpose. Eight million dollars is eight soldiers per year in Afghanistan. Eight billion dollars is the amount just three of the nation's financial institutions spend per year lobbying Congress.

RIGHT WING CONSPIRACY
Remember when Hillary Clinton was the wife of our president and railed against something called the "vast right wing conspiracy." I heard her several times myself. It's beginning to look as though she was onto something. Call it what you will, there is a political force in America today which, like the movie "Network" in 1977, has this guy screaming "I'm madder than hell and won't take it anymore." The result then was two straight years of Republican Senate wins and a majority along with Ronald Reagan's election in 1980. We are headed in that direction again.

David Carr and a colleague do an insight piece in the New York Times on one of the architects, Roger Ailes. Roger is CEO of Fox News and, at $23 million per year, the highest paid exec in Rupert Murdoch's enterprise, which includes Murdoch and half his family. Roger is the real deal. He took my first campaign for Senate in 1978 when I had 7% name recognition and was 41 points down to Congressman Don Fraser (DMN) and created a winner with 61% of the vote. He did all the media for my two subsequent re-election campaigns. Roger is a "true believer." His values are deep, his ability to translate opinion polls into sound bites unbelievable and his business judgment sound.

THE CONFEDERACY IS ALIVE AND VERY WELL IN AMERICAN POLITICS
Election experts predict that Republicans will do extremely well in 2010 elections in the old and new South. Parts of the country that President Obama did not carry in 2008 are more politically polarized than ever this year. Democratic Congressmen are retiring from swing districts and the lone Democrat from Alabama, an M.D. elected in 2008, used the health reform bill as his excuse to switch parties and bolster GOP chances at a House majority in 2011. Said 67 year old Parker Griffith M.D., elected in the Democratic sweep in 2008, as he warmed up his seat on the GOP side in the House, "Health care reform is bad for doctors."

There is little the national government does that is politically palatable in the confederacy. Except waging wars, spending money on military bases, arms production, earmarks, health care access, and protecting gun owners, cotton and rice farmers, and tax loopholes for new business and industry. By the way, Mississippi did not ratify the 13th amendment to the Constitution, abolishing slavery, until 1995.

GOODBYE NORTHWEST AIRLINES
Delta Airlines has the government's permission to officially phase out NWA by the end of March 2010. I'm not old enough to remember the birth of Northwest in 1927, nor its conversion to Northwest Orient, but I well remember the days it was debt-free, created the safest airline in the world, fought ruthlessly against a new international airport in MSP, offered very good careers to lots of often unhappy employees. Northwest Orient Airlines was always one of the best claims we Minnesotans had to international fame that we could count on.

The "Marriott/Disney" debt-financed takeover changed all that. The selfishness of takeover specialists, who never really made us their home, began the slide to anonymity. Since the merger was accomplished I've watched Delta's farepricing structure work against that of NWA and of those of us from MSP. I sympathize with the two NWA pilots lost in their laptops between Redwood Falls and Eau Claire when they shoulda been down in MSP!! Delta CEO Richard Anderson made MN his home while CEO of NWA and of UnitedHealth Group's Ingenix. He is credited with getting pilots from two airlines to agree on seniority lists, but he's also running the airline with the worst passenger performance record in 2010.

SOME MINNESOTANS DO BETTER THAN OTHERS
Wells Fargo is a San Francisco banking giant (4th largest in the country), but to this day we oldtimers think of it as Norwest National Bank run by Minnesotans. In Minnesota. But that doesn't make it immune from the need to reward its Pierz, MN, CEO John Stumpf and three other key execs with $25 million in "performance" stock bonuses. As though a kid from Pierz, raised on Thielen's meat who still owns the family home up there, is ever going to leave for US Bank or Goldman Sachs.

The chairman of Wells' human resources committee, which issued the bonuses, is Steve Sanger, former CEO of General Mills. Making it clear that the days of salary as performance are over, Sanger informs us "stock grants are necessary to hold onto successful executives in an increasingly competitive environment for top banking talent." Sanger ain't from Pierz.

CELEBRITY MARKETING 101
Research by two University of California at Davis economics professors shows that nine Tiger Woods corporate sponsors lost $12 billion in shareholder value in just 13 days following Tiger's fire hydrant collision. Investors in three Tiger Woods related enterprises lost 4.3% of their value or about $6 billion....Sacramento Bee.

Insiders at General Mills inform us that the Minnesota corporate giant was insightful enough to cancel its contract with Woods a couple years before the accident and subsequent disclosures. "Something just didn't feel right," says GM sources. Woods is the only superathlete the company ever paid to feature on their famous cereal(s) of champions

DEBORAH HOWELL WAS GREAT FUN TO BE AROUND
Every one of us in politics in Minnesota knew and admired Deborah Howell. She was hit and killed by a car while out walking on a visit to New Zealand with husband C. Peter Magrath. Ms. Howell was city editor of the Minneapolis Star at 34 and a few years later was managing editor and executive editor of the St. Paul Pioneer Press. She left St. Paul in 1990 to become Washington Bureau chief at Newhouse News Service before going to the Washington Post in 2006 as its ombudsman. Debbie was married to Nick Coleman in 1975. Coleman was Democratic leader of the MN State Senate and a candidate for governor before his death. Also the father of Pioneer Press and Tribune columnist Nick Coleman and St. Paul mayor Chris Coleman. In 1988 she married Magrath, who retired from the presidency of the University of Minnesota in 1984 to become president of the University of Missouri. 1n 1992 he become president of the National Association of State Universities and Land-Grant Colleges in Washington, D.C.

HEALTH POLICY

THANK YOU HEALTH POLICY REFORMERS
Most people are totally confused by the rhetoric surrounding the health policy debate. It should become abundantly clear that what each of us is experiencing personally is now commonly experienced. The U.S. health system is broken and getting worse. Nothing we value as much as health and health care needs to cost each of us personally and as taxpayers and businesses, as much as this system does. And produce - for each of us annually - as little for our money and as much in concern and fear for ourselves and our loved ones.

Yes, there are medical miracles - thousands every year in a country of 304 million; and most of our 775,000 practicing physicians do a great job with what they have to work. But the expectation that each of us will need that miracle is not sufficient justification for the escalating costs each of us must bear.

The reform debate has highlighted where a lot of the money is going: Into private investments that produce huge financial rewards for investors, both professional and medical investors. Into research and development of technology, not all of which works. Into a system which fails patients so often that, were it a business, it would be gone. Into product and service prices that vary with the depth of the pockets of the payer, but a system which resists volume purchasing of the medical products themselves.

Every week, and some weeks every day, a national journal highlights another settlement with a corporation in the medical industry of a government lawsuit for criminal fraud or abuse. Almost to the person, American doctors admit to practicing more medicine on all of us than is medically necessary, calling it "defensive medicine" and blaming it on patients' lawyers, awards by juries of our peers, and malpractice law. To preserve this state of affairs, the entire medical industry will spend more money purchasing influence on elected policy makers' elections and policy decisions, than any other industry in this country.

MCCAIN THE REPEALER
It seems fitting that Senators John McCain and Joe Lieberman are buddies. They have similar attitudes toward the Senate, their political parties and their own gifts to the world. In the Senate health policy debate, Joe and John brought out the fighter in Harry Reid we hadn't previously experienced. They may not be been done yet. McCain led the effort in Congress in 1989 to repeal major health reform legislation - after it was passed by large bipartisan margins in Congress and signed into law by President Reagan. Because his Arizona politics told him all those retirees were mad about having to pay higher Social Security taxes to get added Medicare benefits. He has a right-wing challenger in AZ in J.D. Hayworth, a Congressman turned radio pundit, who keeps chipping away at McCain's "independence."

MEDICARE'S VALUE INDEX
While PelosiReid reassembles the health reform legislation, the medical industry special interests are busy picking it apart. Of course, the high cost/low quality regions have fixed on the "pay for value" authority inserted in the House and Senate bills by Democrats from the Upper Midwest. Because Mayo Clinic was highly visible in the reform fight, they have been chosen as a target for complaint: "How can you possibly compare Rochester, MN, or the Mayo Clinic in Scottsdale which takes neither Medicare nor Medicaid patients with south Los Angeles?" I've heard it all before, but expect this time to be different. So to Liz Quam and colleagues on an Internet thread in Minnesota, the following: Mayo Clinic does have Medicare patients, don't know about Medicaid - but it just may limit the number of Medicare patients it sees.

Dave Durenberger wrote: I love it! And I hear what Liz Quam is saying. BUT, if this administration and this Congress want to do health reform that is affordable for all Americans, it must make a political decision about value in medical care. It must be prepared to fight off the attacks from the selfinterest of a few states and the national associations of the lowest common denominator. Let everyone be an Atul Gawande for a change!!

It's not as easy as it looks to those of us in the Upper Midwest who believe we're always better than LA and Miami. Back in 1985, as we launched the HMO Risk contract demos, we were all at or above (Ramsey County, Olmsted County, North Dakota) the national average Medicare payment per beneficiary. Two years into implementation of demos we were as low as 17% below the national average, and that's what's led us to believe we're so darned good.

The work on a value index should begin ASAP. MedPAC's recent analysis of utilization differentials is a bit different from the Dartmouth Atlas we've been using to justify our claims. Chairman Glenn Hackbarth tells me that 90% of U.S. Medicare beneficiary payments are within 15% of the national average. Yes, southern CA and the eastern U.S. (I think it's South Florida) and parts of TX and LA are off the charts. But Boston and New York are not because other factors like GME/IME/DSH and other payments skew the results (I guess you have to immerse in the report to get this one and the public copy doesn't identify regions by name).

In addition, the Mayo Clinic has its own set of distortions and probably doesn't deserve "poster child" status. In fact, their "out front" role on this issue may be unhelpful as they bail on Medicaid and Medicare in various parts of their operations and as the detail comes out on the prices they charge in the Mayo Health System communities in which they have near monopoly control.

Having said that, I don't think we should all share Liz's pessimism. Instead, the rest of the care delivery community needs to take charge of its future and find a way to get the demo money into the region and to demonstrate what value really is, how it can be measured, how to overcome the B.S. arguments from UCLA, Martin Feldstein, New Yorkers who don't know what they're talking about, and the CDHC advocates of abandoning the value approach for an "everyone for him/herself and your hideductible catastrophic insurance" approach to health care service design, delivery and financing.

Our House and Senate Democrats have worked hard to make "value-based payments" a reality. In addition to the geographic politics of variation, they have to deal with the uncertainty of comparative performance measurements. It's one thing to identify "outliers" all can agree on, but differential payment for all providers, all services, and all patients is more difficult. This is a task for the new Center for Innovation in CMS in both House and Senate versions of the bill.

MEDICAID AN UNDERFUNDED FEDERAL MANDATE
Senator Ben Nelson (DNE) responded to criticism of his demand that the state of Nebraska be paid 100% of the cost to expand Medicaid by stating "I was getting rid of an underfunded mandate." That's one way to look at it. On the theory that Medicaid is a federal health care program foisted on the states, Nelson, a former governor of Nebraska, is right. Make us all pay through our federal taxes for the costs of Medicaid to all 50 states, not just for its expansion.

But it's not really that simple. Historically, health care access for lowincome persons was the responsibility of state and local governments. In 1946 it also became the responsibility of nonprofit community hospitals that accepted HillBurton Act federal construction funds. By 1960 the feds were persuaded to pick up 50% of rising state/local costs and in 1965, Medicaid was enacted as Title 19 of the Social Security Act to provide anywhere from 50% to, now, 88% of the state costs of lowincome health care and longterm care services. The percentage distinction based on a state's per capita income.

Medicaid is a vastly complicated array of benefits and eligibility providing some financial security for these expenses for more than 60 million Americans. The financial security provided varies with the willingness of each of 50 states to chip in financially, and that willingness now varies with the biennial ups and downs of the economy and other state/local demands for lower taxes or public spending on other needs. Most clearly it no longer always reflects state tax capacity. Most southern states have incredibly low income eligibility, which enables them to keep taxes way down and shift costs of health care to private insurance plans.

What Congress must do, but can't, is redesign the Medicaid program so that it provides income-related subsidies for all persons in all states to health care, and a separate funding program which helps insure supportive services for people with disabilities (called longterm care in today's lingo). For that reason, the Obama administration and Democrats in Congress have authorized the creation of MedPAC, the Medicaid Payment Advisory Commission, which is to be headed by Diane Rowland, a former Henry Waxman staffer and longtime executive director of the Kaiser Commission on Medicaid and the Uninsured.

THE APPEARANCE OF CONFLICT OF INTEREST
The medical ethics debate goes on as some individuals and institutions adopt a zero tolerance policy where personal advantage and professional advice are involved. And others insist they cannot be unduly influenced and can draw their own lines. Conflict of interest rules at Partners Healthcare in Boston (Harvard's two medical school hospitals) are tough on medical researchers. No speakers' fees from drug companies. Top scientists serving on medical technology company boards are limited to $5,000 per meeting. Few other medical schools are this strict. Said Tom Donaldson, who teaches business ethics at Wharton, "It strikes me as a breath of fresh air in a room that's getting progressively more stale."

Why do you suppose that's the case? Most likely, because university medical schools depend financially on attracting faculty members whose clinical research, more than their clinical or educational performance, attracts large numbers of research grants from public and from private sources. The University of Minnesota medical school is way over its head in debt despite having the highest public med school tuition in the nation. It thinks it must build bio-science buildings and recruit reputed medical researchers to bring in research money. It can't get to zero tolerance on appearance of conflict policies, because too many medical researchers depend on income from device or drug companies.

I believe financial support for my work in the Senate from those affected by my work never influenced my professional performance because I depended for support on so many with conflicting stakes in my outcomes. Yet, I became a poster boy for money as the appearance of conflict. My constituents, like Dr. Polly's patients, for example, can't discern whether I'm unduly influenced by - as in Dr. Polly's case - Medtronics money.

WHEN THE ETHICS DEPARTMENT DRAWS ETHICAL LINES
The New York Times reported Harvard Medical School's tough ethics policy next to a story on Secretary of State Clinton raising money from Clinton corporate contributors for the $61 million necessary to build a U.S. pavilion at a 2010 World's Fair in Shanghai. One government lawyer wondered, "Would Thomas Jefferson do this?" Of course not. The State Department ethical line is drawn between allowing the secretary to give speeches promoting the U.S. pavilion and prohibiting her from oneonone appeals for cash. You don't have to be Jefferson or a government lawyer to see right through this one. Where major global U.S. corporations know they earn the gratitude of the one person with the most influence over our foreign relations.

CONFLICT LEGISLATION IN HEALTH REFORM BILL
While Senator Chuck Grassley (RIA) is the posterpol for conflict of interest at the doctormedical technology companypatient interface, the House bill has much stronger disclosure language. Device companies have resigned themselves to a lot more public disclosure, simply because so many companies - including big and ethical companies like Medtronic - have been caught with some outrageous financial deals. Pfizer also had to pay $2.3 billion in fines to settle charges they illegally marketed Bextra when an anesthesiologist in MA - on their pay - was found to have falsified his research on Bextra and Celebrex.

What companies really want - that they should not get - is a federal preemption from state ethical practice laws that are more stringent than the federal law. Companies argue logically that it's too hard to operate in 50 states with 50 different state reporting requirements. The truth is otherwise. There never are 50 different laws. For a long time only Minnesota had the tough disclosure law that produced the information that exposed the unethical behavior was rampant. Four others have since joined. . .

A federal preemption takes away from Minnesotans the right to demand high ethics from medical companies doing business here. You cannot legislate ethical behavior. It doesn't take long for companies to figure out new deals with docs and for docs to justify them as in the patient's interest. It does take ages and some scandals where people might die, before Congress gets around to passing a patient protection law like this one.

REVOLVING MEDICAL POLICY DOORS
Former Centers for Disease Control and Prevention (CDC) Director Julie Gerberding has been hired by Merck to head Merck Vaccines. Merck, at $15 billion a year in sales, is the 4th largest drug company in the world. Merck Vaccine does about $5 billion annually worldwide. Gerberding is as experienced as most national leaders in dealing with emergency responses to every kind of health threat.

MARY KENNEDY GOES TO SENIOR POLICY ROLE AT CMS
Cindy Mann is the administrator for Medicaid programs at CMS in the Department of HHS. She knows who the top Medicaid state people are in the country and she asked Minnesota's veteran Medicaid policy person to be her Senior Policy Advisor on Medicaid in Baltimore. Mary Kennedy was Medicaid Director in Minnesota DHS for many years. She worked with Mann in the Clinton administration to get a waiver for MN when the CHIP statute did not allow money for states that had already covered all kids, and worked recently at Ovations a UHG company. Mary has a daughter who is a chemical engineer, has lived in Boston 12 years, but is moving with her Mayo Med School graduate husband to his fellowship at Dartmouth, while mom sets herself up for alternative commutes with husband Mark Larson who is stoking the home fires in MN.

UNDUE INFLUENCE
One hundred sixty-six former staffers from Congressional leadership offices and five major committees plus 13 former members of the House or Senate represent 388 health care clients in Washington today. Health care industry spent $635 million lobbying in 200809. Total amount spent on lobbyists for all causes last year exceeded $3.3 billion. There were 1,500 fewer lobbyists in D.C. this past year than in the previous year....LA Times, Medill News service, and Center for Responsive Politics.

by Chris Britt

SPEAKING OF WEATHER
We anticipated the Christmas blizzard in MN and headed for San Rafael, CA, early and from our 5860 degree daily highs often look back to what we left behind this year. Our St. Paul side streets are full of snow and rutted with ice and always "more on the way." Rita adds Brrrrrrrrrrrrrrrrrr on every other email. Two of our sons have Maximas that broke down from age and overwear, so both our cars are doing extra duty. Right after we paid a $1,000 Excel Energy bill this caught my eye in the San Francisco Chronicle: "PG&E reports that average California electricity usage costs $77.00 per month and average monthly home gas use is down 9% from last year to $88.20.

QUOTABLES

"The only person more arrogant than a newly certified physician is a newly ordained priest." … anonymous.

"Variation is the biggest enemy of quality" …Tianjin Lishen Battery Company, China

"I expect my health reform proposals to reduce the premium costs of an average family insurance plan by $2,500 by the end of my term" …Senator Barack Obama

"Our data shows that Medicare payments for 90% of beneficiaries are within 15% of the mean average payment." ...Glenn Hackbarth, Chair of MedPAC, on its recent study of healthcare utilization variation.

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