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Lecture #1212 on Health Care
August 7, 2012
August 7, 2012 | Lecture on Health Care
Abstract: Medicare patients today face reduced access to care, which will inevitably be rationed through the Affordable Care Act's relentless payment cuts. On paper, Medicare will continue to appear as a model of administrative cost control, but real administrative costs—borne by doctors, hospitals, and clinics—will continue to soar, and medical professionals will struggle to comply with the numerous rules and reporting requirements governing care delivery. Medicare premium support, long a bipartisan proposal, is the best alternative to this unhappy scenario. It would guarantee better choices and broader access to quality care, faster innovation in care delivery, and less waste and fraud in medical transactions. It would also deliver superior cost control. For the next generation of taxpayers and retirees alike, there is no better future.
Certain Congressmen keep telling seniors that they will keep "Medicare as we know it." They are talking nonsense. In fact, the Affordable Care Act of 2010 (ACA)—with 165 provisions amending or affecting the program—has already ended Medicare "as we know it."[1] Nostalgia for the 1960s notwithstanding, change is inevitable. The need for change is confirmed by expert testimony. Just consider three propositions.
Senator Ron Wyden (D–OR) put it neatly: "Absent a bipartisan effort to fix Medicare and protect this guarantee—if nothing is done—what the years ahead ensure is that seniors and health care providers will be getting a steady diet of cost-shifting and arbitrary cuts until the Medicare guarantee is kaput."[4] Bet on it.
As early as 2019, courtesy of the ACA, Medicare payment for Part A benefits is already on track to dip into the nether regions of Medicaid reimbursement. The result: a progressively larger number of Medicare providers running into the red and thus unable to deliver benefits and services at the scheduled reimbursement levels. The Medicare actuary says 15 percent by 2019, 25 percent by 2030, and 40 percent by 2050.[5]
Physicians, under current law, also face Medicare payment cuts that are so draconian—31 percent in 2013—that Congress once again will likely stop them from going into effect. Yet the prospects remain profoundly unfavorable for physicians. More seniors plus fewer providers does not—and cannot—equal "guaranteed" benefits.
Those who disagree with Senator Wyden must pine for an alternative universe. In Lewis Carroll's Through the Looking Glass, Alice, finding herself in such a state, declares plaintively that she simply cannot believe impossible things. Irritated, the White Queen insists on persistent practice: "Why, sometimes I've believed as many as six impossible things before breakfast." Faith in congressionally "guaranteed benefits," based on polticians' promises just takes practice.
The Heritage Foundation has developed a detailed prescription for Medicare "premium support" in Saving the American Dream,[6] a comprehensive program of fiscal and budgetary reform. There are several other major premium-support proposals.[7]
The core concept is simple: The government makes a defined contribution (premium support) to the health plan of a beneficiary's choice.[8] The per capita contribution, a fixed dollar amount, is based on a process of competitive bidding among insurers to provide Medicare benefits.[9] The beneficiary may buy richer coverage by paying more or may buy less expensive coverage by paying less and pocket the savings. Insurance plans would compete directly for enrollees' dollars and market share. This approach reflects a broad bipartisan tradition.[10]
Decentralized Decision-Making. While current payment centralizes control over provider reimbursement on a fee-for-service (FFS) basis, premium support would decentralize financial decision-making through the personal preferences of enrollees. Dollars would go directly to the plans that enrollees decide, and plans and providers would compete to deliver what enrollees want, need, and value. Intense plan competition for market share, with plans and doctors and hospitals working cooperatively together to provide the best product for the lowest price, would drive innovation in benefit design, encourage superior productivity in care delivery, and enhance patient satisfaction.
Defined-contribution financing, however it is characterized by its critics, is already operable in funding benefits for the vast majority of Medicare enrollees. About 60 percent of Medicare's population is enrolled in private drug plans (PDPs) in Medicare Part D, the drug program, which is a working model of premium support. Also, 27 percent of all seniors are enrolled in private plans offered under Medicare Part C, Medicare Advantage (MA). MA, however, is hobbled by a flawed payment formula that increases Medicare costs.[11]
While some critics see this approach as radical and disruptive,[12] in fact, it would largely import Medicare Part C and D financing—vital parts of Medicare as we do know it—into the provision of benefits in Parts A and B. There would, of course, be some crucial modifications, but the result would be much better than the status quo: All enrollees would have integrated insurance products, competitively priced, that would provide an array of medical services plus guaranteed catastrophic protection.
The federal government also uses this defined-contribution approach in health coverage of its own employees and retirees through the popular and successful Federal Employees Health Benefits Program (FEHBP). Between 1960 and 1983, before federal annuitants were eligible for Medicare, it was the main form of health care financing for all government retirees.
All Medicare reform proposals differ in details. While details are vitally important, they are less important than the economic incentives at the core of the reform: a fixed dollar payment with enrollee freedom to purchase above or below that amount in an intensely competitive environment. This would create a program that is sustainable for seniors and taxpayers.
Points of Progress. Such a reform would secure progress in many areas, but three are worth noting.
First, beneficiaries could keep the plans they have today and get a better plan if they wish tomorrow, securing them a wide range of benefits and providers. Historically, Americans have been highly satisfied with their health insurance options, including seniors enrolled in traditional Medicare, Medicare private plans, or employer-sponsored plans that provide Medicare-subsidized drug coverage.[13] Under the Heritage proposal, for example, persons satisfied with employer coverage could have the option of taking it with them into retirement.[14]
No one on traditional Medicare today will be worse off. The reason: All major premium-support proposals continue traditional Medicare as an option and also require private plans to offer a benefits package that is the same as or at least actuarially equivalent to that provided by traditional Medicare. It's hard to imagine how any enrollee would not be better off. Most reform proposals, such as that offered by Heritage, require offering benefits richer than traditional Medicare, including drugs and catastrophic coverage. Experience with Medicare Parts C and D, as well as the FEHBP, shows that continual benefit improvements are a regular feature of these programs.
Second, it would slow the growth of Medicare spending, securing savings for both beneficiaries and taxpayers rather than merely shifting those costs to seniors in reduced access and to the private insured through higher premiums.[15] Former Senator John Breaux (D–LA) recalls that the 1999 proposal endorsed by the majority of the National Bipartisan Commission on the Future of Medicare, which he co-chaired with former Representative Bill Thomas (R–CA), would have reduced Medicare spending growth by 12 percent.[16]
Third, it would reduce the politicization and the costly micromanagement that today burden the program. The politicization of health care decisions, fueled by powerful special interests, undercuts efficiency, stops innovation, and kills even worthwhile demonstration projects.
Premium support offers a way out. Because health care decision-making is radically decentralized among millions of enrollees and thousands of plans and providers, the impact of special-interest lobbying is thus limited. Traditional FEHBP governance in particular is an excellent model and demonstrates how federal officials can avoid costly micromanagement and sideline special interests that can block or hinder improvements in benefit design and patient care.
Premium support, its critics notwithstanding, would indeed be much less disruptive and wrenching than the pending impositions on patients and medical professionals under the Affordable Care Act plus the additional Medicare payment cuts (the sequestration) mandated by the Budget Control Act.[17] It would also be less onerous than an even deeper set of Medicare payment reductions prescribed by President Obama, reinforced by his even sterner budgetary targets. Obama's harsh prescription invites demoralization among medical professionals and guarantees access problems for Medicare patients.
Because there is no other serious alternative to this unhappy scenario, former Medicare Administrator Thomas Scully says that premium support is inevitable.[18] Though strongly critical of Representative Paul Ryan's (R–WI) budget proposal, which he deems "deeply flawed," Matt Miller, senior fellow at the Center for American Progress, nonetheless writes, "Even so, Democrats should want the flexibility after 2012 to include ideas like premium support in their own agenda. It was invented by Democratic economists, after all."[19]
Various Members of Congress, as well as certain prominent policy analysts, strongly oppose Medicare premium support. Some analysts who once favored it have even switched sides.[20] Among the critics, certain themes have emerged.
1. Premium support would destroy traditional Medicare.
In response to the Wyden–Ryan proposal, for example, the White House declared, "The Wyden–Ryan scheme could, over time, cause the traditional Medicare program to 'wither on the vine' because it would raise premiums, forcing many seniors to leave traditional Medicare and join private plans. And it would shift costs from the government to seniors."[21]
As noted, changes enforced by the Affordable Care Act would indeed "end" traditional Medicare FFS as enrollees have known it. Under all major premium-support reform proposals, however, Medicare FFS would be offered as a readily available alternative to private health plans.[22] Any beneficiary who wanted to remain in traditional Medicare FFS would be able to do so.
In some markets, reflecting regional health care costs, FFS may be the low bidder with premiums economically attractive to beneficiaries, and in others, it may not be. Just as every beneficiary would have the right to stay in the plan in which he or she is enrolled, every beneficiary would also have the right to get a better plan. Consumer choice would tell the tale.[23] As Joseph Antos of the American Enterprise Institute notes, "Indeed, the point of the proposal is to give seniors a good deal through competition, not to drive out traditional Medicare and not to dictate what plan seniors must choose."[24]
If champions of traditional Medicare believe that the fee-for-service option can survive the competition, then they should have no problem putting their faith to the market test. A "doomsday scenario" for FFS must otherwise tacitly assume its inability to compete on a level playing field with private plans. Curiously, this is a reversal of so-called progressives' vehement insistence that a "robust public option" was essential to health reform in 2010, keeping private health plans "honest" while emerging triumphant.[25]
2. Premium support would "privatize" Medicare.
In response to the Ryan 2013 budget proposal, Senator Richard Durbin (D–IL) charged that "Paul Ryan wants to privatize Medicare."[26] In fact, the critics' privatization charge is meaningless. Medicare's entire delivery system—doctors, hospitals, home health agencies, hospice care, and skilled nursing facilities—is almost entirely composed of private agents or institutions. The small number of exceptions would be public hospitals that are reimbursed for treating Medicare patients. Nine out of 10 Medicare beneficiaries are enrolled in supplemental insurance, mostly private and employer-sponsored plans. So Medicare is already heavily "privatized."
Since the 1980s, private health plans have served as an alternative to traditional Medicare. Medicare Advantage plans now enroll more than one out of four beneficiaries, and Medicare drug plans enroll roughly six out of 10 beneficiaries. Even the Medicare bureaucracy, as powerful as it is, does not directly administer Medicare: It is administered through private contractors, usually large private insurance carriers like the Blues, who process Medicare claims. In all cases, the financing of care provided by these agencies and institutions is public financing. In all cases, the rules governing these agencies and institutions are public rules.
3. Premium support would leave Medicare patients at the mercy of rapacious insurance companies.
In an interview on CBS's Face the Nation, Representative Debbie Wasserman Schultz (D–FL) insisted that Ryan's FY 2012 Medicare proposal would "allow insurance companies to deny you coverage and drop you for pre-existing conditions."[27] While Politifact flatly declared Wasserman Schultz's statement false, she has left a vivid impression of hapless seniors cast adrift on wild, open "free market" seas, fending off insurance industry sharks. It's a recurrent theme among opponents of reform.
In fact, every major premium-support proposal would retain or reinforce insurance rules that prevent "cherry picking" or coverage denials based on health status.[28] Every such proposal would also authorize a federal agency to ensure a level playing field for market competition among diverse health plans and enforce uniform rules for health insurance and consumer protection, such as marketing rules and fiscal solvency requirements.[29]
4. Premium support would increase beneficiary premiums.
In response to the Ryan budget and the Wyden–Ryan proposals, critics often assert that premium support would raise beneficiary premiums to unacceptably high levels. But Medicare premiums are already scheduled to increase substantially under current law.[30] A transition from a defined benefit to a defined contribution would not necessarily increase premiums over current projections. Indeed, with premium support, premiums could increase at a slower rate than current-law projections or even decline.
Under premium support, the government's contribution would be based on an annual process of regional or national competitive bidding among health plans; a market-based contribution, whether set at an average or a low-cost bid, would thus be tied to real health spending trends.
This market-based bidding process, designed to yield a real market payment, could reduce initial costs for enrollees and taxpayers alike. Whatever the market-based contribution, enrollees would be free to buy plans above or below the government's specified amount, paying more if they wish or paying less and securing the savings.
Unlike Medicare premium support, not all competitive bidding programs encompass consumer choice, such as market bidding for goods and services in government contracts or procurement programs. Even so, the process of competitive bidding itself yields a market payment and savings. In the initial round of Medicare's competitive bidding for durable medical equipment, for example, Topher Spiro of the Center for American Progress reports, "Not surprisingly, the benefits to seniors and taxpayers were substantial; the average price savings was 35 percent. The program is now projected to save $17 billion for taxpayers and $11 billion for beneficiaries through lower coinsurance and monthly premiums over ten years."[31]
Intense competition among plans would also greatly contribute to a downward pressure on premiums. In Medicare Part C, average monthly premiums for Medicare Advantage plans declined from $39 in 2011 to $35 in 2012, with the lowest premiums in HMOs and regional PPO plans.[32]
In Medicare Part D, plan premiums have been impressively stable. The monthly average premium was approximately $31 in 2011 and fell to $30 in 2012. From the inception of the program, beneficiaries have enjoyed a positive experience with drug plan premiums. In 2006, the average premium was $23; in 2007, it fell to $22; in 2008, it increased to $24; in 2009, it rose to $28; and in 2010, it increased to $30.[33] As the Medicare Trustees report, the patent expiration of popular brand-name drugs and generic substitution contributed to this downward pressure on premiums, but as Antos has also noted, seniors' price sensitivity plus the health plan marketing of generics also encouraged seniors' choice of lower-cost drugs.[34]
The most extensive empirical analysis of premium support was conducted in 1999 by the National Bipartisan Commission on the Future of Medicare, the special panel created by the Balanced Budget Act of 1997. The commission concluded that Medicare beneficiaries' premiums would decline by 20 percent after 10 years as Medicare patients were able to share in the projected savings of the commission's premium-support proposal.[35]
5. Traditional Medicare does a better job of controlling costs than Medicare Advantage.
Paul Krugman, a professor of economics at Princeton University, writes, "Privatizing and voucherizing Medicare does nothing whatsoever to control costs. We've seen that from the sorry history of Medicare Advantage."[36]
In fact, Medicare Advantage has no such "sorry" history. MA has a broader range of benefits than FFS, including care coordination, disease management, and specialized care for patients with chronic illnesses and disabilities, as well as preventive care. Preliminary evidence shows that MA enrollees also receive higher-quality care than those enrolled in traditional Medicare.[37]
The MA payment system is indeed flawed because it is tied to traditional Medicare's administrative payment system, but the additional costs of the program largely reflect the richer benefits. Overwhelmingly, MA plan bids to provide the standard Medicare benefits come in at or below the government's benchmark for plan payment,[38] and slightly more than half of enrollees pay no premium.
Current law requires that 75 percent of the difference between the lower MA bids and the government benchmark be rebated to enrollees in the form of richer benefits or lower premiums. This increases Medicare spending. Not one of the major premium-support proposals, however, replicates the Medicare Advantage payment formula.
6. Premium support would end Medicare's guaranteed benefits.
Writing in The New Republic, Jonathan Cohn emphasizes the risk: "Remember, Medicare is a guarantee—a compact, really. In exchange for paying into the system during their working years, all Americans receive a promise of comprehensive health benefits once they turn 65."[39]
One imagines a "guarantee" as something rock solid, but a politician's "promise"—which is essentially what an entitlement "guarantee" is—can range from the merely aspirational to the downright deceptive. Cohn elides the distinction. If a political guarantee is to be the standard, for the sake of argument, then all major versions of premium support guarantee beneficiaries at least the Medicare benefits or the level of benefits they get today with access to new plans with even higher levels of coverage at competitive prices tomorrow. In the Heritage proposal, for example, market bidding would be based on the provision of Medicare benefits in Parts A, B, and D, or their actuarial equivalent, plus catastrophic coverage.[40]
As for the wealthiest Americans, the Heritage proposal would build upon today's legal requirement that upper-income beneficiaries pay more for their benefits. Such retirees today must pay between 35 percent and 80 percent of their Part B and D premiums. Under the Heritage proposal, these upper-income Americans would continue to have guaranteed access to Medicare's benefits under Medicare's insurance rules, but the highest-income beneficiaries—about 3.5 percent of all Medicare enrollees—would not get taxpayer subsidies for their coverage.
By insisting on current policies, the Congressional Budget Office (CBO) projects that the level of federal debt could reach 200 percent of America's gross domestic product (GDP) as early as 2037.[41] Because America is seriously threatened with dangerous debt, all federal spending must be reduced, and continued taxpayer subsidies for the wealthiest recipients are no longer sound policy. In the face of an oncoming fiscal catastrophe, the old '60s model of universal entitlements is an extravagant antique.
Often, critics of "privatization" conveniently overlook another salient fact: Traditional Medicare does not provide anything close to "comprehensive" benefits. There are big gaps in coverage. In fact, traditional Medicare has been eroding as the primary payer of seniors' medical bills as private payment, mostly through supplemental insurance, progressively picks up the growing tab. To illustrate, traditional Medicare's share of total spending for seniors declined from 72.2 percent in 1997 to just 50.8 percent in 2005.[42]
7. Lower-income seniors would be vulnerable to higher out-of-pocket costs.
In reference to Ryan's FY 2013 budget proposal, for example, Paul Van de Water, a Senior Fellow with the Center on Budget and Policy Priorities, says, "The Ryan budget thus would significantly raise the out-of-pocket health costs that Medicare beneficiaries with modest incomes face, even as it proposes tax cuts for the wealthiest Americans."[43]
In fact, all of the major premium-support proposals, including the Heritage plan, would establish limits on out-of-pocket expenses and retain or enhance current income-based protections for low-income beneficiaries.[44] The Ryan budget proposal is explicit in its protection of low-income persons from higher out-of-pocket costs:
If costs rose faster than this established limit, those low income individuals who qualify for both Medicare and Medicaid (also known as "dual-eligible") would continue to have Medicaid pay for their out of pocket expenses. Other lower income seniors (those who don't qualify for Medicaid but are still under a certain income threshold) would receive fully funded accounts to help offset any increased out-of-pocket costs.[45]
8. Seniors would be confused and unable to choose health insurance policies.
Complaining of Ryan's Medicare proposal, economist Paul Krugman, for example, insists that "patients are not consumers."[46] Paul Abrams warns:
Imagine…the attraction to scam artists of people in their declining years having to select among a variety of plans—assuming, of course, that any such plans were available in the first place, and assuming that millions of senior citizens will [pore] over competing plans and be able to choose the one best suited to themselves.[47]
Henry Aaron of the Brookings Institution doubts most Americans are very good at making health insurance choices for themselves: "Considerable research suggests that most people, to say nothing of a population that includes the frail elderly and the disabled, are not very good at evaluating insurance plans and choosing the one that is in their best interest."[48]
In fact, today millions of seniors make all kinds of health care choices, ranging from the kinds of physicians and specialists they engage to treat them to the kind and level of insurance coverage they enjoy. Roughly 90 percent of seniors in traditional Medicare enroll in supplemental health insurance to close gaps in coverage, including private plans sponsored by AARP.
Retirees enroll in Medicare in their mid–60s, and fewer than one out of 10 of all Medicare beneficiaries report poor health.[49] Millions of baby boomers starting to enroll in the program are often tech-savvy, many of them retiring from jobs in an information-driven work environment. Compared to previous generations of retirees, they have enjoyed a broader range of health options and a wider range of experience with managed care arrangements in their employment-based insurance.
During 2011, in Medicare Part D, seniors chose among more than 1,100 prescription drug plans nationwide in 34 market regions. Likewise, roughly one out of four Medicare beneficiaries were able to choose from among almost two dozen Medicare Advantage plans on average in 26 market regions throughout the country. Their choices included HMOs, PPOs, and private fee-for-service plans (PFFSs). Seniors can also enroll in special-needs plans (SNPs), targeted to "dual eligible" seniors and those institutionalized or suffering from chronic medical conditions: in other words, the very old, the frail, and disabled.
Individuals like their choices. Survey research sponsored by the Commonwealth Fund and the Kaiser Family Foundation established the strong relationship between plan choice and enrollee satisfaction.[50] In Medicare Parts C and D, research replicates these findings. In the case of Medicare's drug program, according to one recent survey, more than nine out of 10 enrollees said they were satisfied, and the highest rate of satisfaction (95 percent) was among those with disabilities.[51]
In a government program without choice, there is only official direction. While there may indeed be "considerable research" that indicates that individuals are not good at determining what plan is best for them, there is no evidence that government officials can make wiser choices to meet individual wants and needs.
9. Premium support will not work because risk-adjustment mechanisms are imperfect.
After years of experiment, Aaron, for example, says it is unclear "whether adequate risk adjustment is feasible."[52] Van de Water agrees, notes that the process is "imperfect" and argues that it "still leaves insurers with a financial incentive to attract healthier people and discourage sicker ones from signing up; and the resulting overpayments to some plans inflate Medicare's overall costs."[53]
In fact, risk adjustment is clearly improving.[54] As former CBO Director Alice Rivlin reports:
[R]isk adjustment techniques improved substantially as relevant data and experience accumulated in MA and other programs, and can be expected to improve more. Moreover, some health plans are developing effective techniques for managing chronic diseases, such as diabetes, and are now actively trying to attract patients with these risks.[55]
Domenici–Rivlin and Wyden–Ryan, for example, have proposed a "back end" risk adjustment that would negate plans' efforts at "creaming" of healthy enrollees and would redistribute common risk pool funding to "make whole" plans that enrolled disproportionately high risks.[56] Heritage has endorsed both prospective and retrospective risk-adjustment measures to guarantee market stability.
Intense competition will control costs. Experience with premium-support programs, such as the FEHBP and Medicare Part D, does show significant savings.[57] It is impossible to predict with certainty the dynamics of a new competitive market. As former CBO Director Rivlin observes:
If you asked the Congressional Budget Office to "score" the effect of market competition on the prices the government must pay over the next ten years to buy computers or automobiles, CBO would tell you that they could not do so. CBO's response to scoring the effects of competition on health care would be precisely the same, for precisely the same reason.[58]
So Rivlin (like Ryan and Wyden and Heritage) proposes that Congress adopt some form of a Medicare spending cap to guarantee savings if competition falls short, with the added advantage of securing a CBO score. The cap would thus operate as a fallback.[59] Such caps would indeed lock in big reductions in the growth of Medicare spending and would restrain rather than accommodate medical inflation. In all such proposals, Congress would, of course, retain the authority to adjust Medicare spending to accommodate changing circumstances.
Looking Backwards. Our vision of the future is blurry, but looking backwards, we have a pretty clear picture.[60] Over the period 2002–2010, Medicare's average annual growth rate was 8.79 percent. If we applied the fully implemented ACA's spending cap of GDP plus 1 percent, over the 2002–2010 period, Medicare's average annual growth rate would have been reduced to slightly more than 2.4 percent. Over the period 2005–2010, it would have been 3.3 percent.
If one were to retrofit Medicare with President Obama's recently proposed budget cap (GDP plus 0.5 percent), Medicare's average annual spending growth would have fallen to 1.94 percent over the 2002–2010 period. If one compressed that cap over the period 2005–2010, the results would have been an even more draconian Medicare reduction: an average annual growth rate of 1.7 percent.
Using the Heritage spending cap of Consumer Price Index (CPI) plus 1 percent over the period 2002–2010, Medicare's average annual growth rate would have been slightly more than 3.4 percent. Over the period 2005–2010, the Heritage cap would have yielded an average annual growth of 3.7 percent.
Future projections are perilous. Whether tying Medicare spending growth to price changes or economic growth works best would only be revealed by the unfolding of events. One can expect different impacts under different conditions. A raging inflation combined with slow economic growth—a replay of the terrible state of the economy in the late '70s—would obviously make the Heritage proposal far more attractive than the others. Based on trends of the recent past, the Heritage proposal would have been much more generous in providing Medicare dollars to America's retirees than President Obama's prescriptions.
If, as a matter of policy, a Medicare spending cap is undesirable under premium support, then the caps in the Affordable Care Act or the President's stricter budget proposal are even more objectionable. In fact, a cap in premium support would impose fewer problems for beneficiaries than the Independent Payment Advisory Board's colder and more distant decision-making; it gives them options that rigid administrative pricing does not. Notes Heritage Distinguished Fellow Stuart Butler, "Seniors ultimately get to decide which plans or providers will get their money and how much, as opposed to an IPAB determining what their providers will be paid."[61]
Representative Pete Stark (D–CA), no fan of market-based reform, perhaps summarized it best: "In theory, at least, you could set the vouchers at an adequate level. But, in its effort to limit the growth of Medicare spending, the board is likely to set inadequate payment rates for health care providers, which could endanger patient care."[62]
Medicare patients today face reduced access to care, which will inevitably be rationed through the Affordable Care Act's relentless payment cuts. Despite advertisements to the contrary, IPAB deliberations will surely evolve into a highly politicized process of Medicare payment redistribution fueled by special-interest lobbying.
On paper, Medicare will continue to appear as a model of administrative cost control. The reality will be different. Real administrative costs—borne by doctors, hospitals, and clinics—will continue to soar. The Federal Register will fatten, and medical professionals will struggle to comply with the numerous rules and reporting requirements governing care delivery.
Medicare premium support, long a bipartisan proposal, is the best alternative to this unhappy scenario. It would improve the environment for medical practice, guarantee retirees better choices and broader access to quality care, encourage faster innovation in care delivery, and discourage waste and fraud in medical transactions. It would also deliver superior cost control. For the next generation of taxpayers and retirees alike, there is no better future.
—Robert E. Moffit, PhD, is a Senior Fellow in the Center for Policy Innovation at The Heritage Foundation. This lecture is based on his presentation to a meeting of the Association of Health Care Journalists in Atlanta, Georgia.
Show references in this report
[1] The new law ends Medicare as an open-ended entitlement, imposes record-breaking payment reductions on providers, and starts a phaseout of fee-for-service (FFS) payment, the very essence of traditional Medicare financing.
[2] President Barack Obama, "Address by the President to a Joint Session of Congress," September 8, 2011, http://www.whitehouse.gov/the-press-office/2011/09/08/address-president-joint-session-congress (accessed July 19, 2012).
[3] Ezekiel J. Emmanuel and Jeffrey B. Liebman, "Cut Medicare, Help Patients," The New York Times, August 22, 2011, http://www.nytimes.com/2011/08/23/opinion/cut-medicare-help-patients.html (accessed July 19, 2012).
[4] Matt Dobias, "Wyden: Time to End the Medicare 'Street Fight'," Politico Pro, March 6, 2012.
[5] 2012 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and the Federal Supplemental Medical Insurance Trust Funds, April 23, 2012, p. 217, http://cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and Reports-/ReportsTrustFunds/ Downloads/TR2012.pdf (accessed July 19, 2012); hereafter cited as 2012 Medicare Trustees Report.
[6] See Stuart M. Butler, Alison Acosta Fraser, and William W. Beach, eds., Saving the American Dream: The Heritage Plan to Fix the Debt, Cut Spending, and Restore Prosperity, The Heritage Foundation, 2011, http://savingthedream.org/. For the details of the Heritage premium-support proposal, see Robert E. Moffit, PhD, "The Second Stage of Medicare Reform: Moving to a Premium Support Program," Heritage Foundation Backgrounder No. 2626, November 28, 2011, http://report.heritage.org/bg2626.
[7] These include the Burr–Coburn plan, the Domenici–Rivlin plan, the Ryan FY 2013 budget proposal, and the Wyden–Ryan plan. To compare and contrast these proposals with the Heritage plan, see Robert E. Moffit, "Saving the American Dream: Comparing Medicare Reform Plans," Heritage Foundation Backgrounder No. 2675, April 4, 2012, http://report.heritage.org/bg2675.
[8] Many critics of this approach to health care financing describe it as a voucher program. Today, "voucher" has a negative connotation, conjuring up images of hapless seniors at the mercy of unregulated health insurance companies. It is perhaps noteworthy that defined contribution pension arrangements, where companies contribute directly to stock, bond, or equity funds chosen by employees, are usually not described as voucher programs. In fact, a voucher is a certificate given directly to a consumer that is redeemable for cash value for the purchase of a good or service of that person's choice, often without restriction. While such a voucher is a form of defined contribution, no major Medicare reform proposal today is designed to operate in such a fashion.
[9] Conservatives and centrists are not alone in thinking that competitive pricing is a superior system of Medicare payment. Analysts with the Century Foundation, a "progressive" public policy organization based in New York, observe, "Replacing the current system of payments to plans, which is linked to fee-for-service rates, with one based on competitive pricing, under which a plan's premiums would reflect its bid to cover a basic Medicare benefit package, might result in fairer payments." Lisa Potetz and Thomas Rice, eds., Medicare Tomorrow: The Report of The Century Foundation Task Force on Medicare Reform (New York: The Century Foundation Press, 2001), p. 11.
[10] While the Wyden–Ryan proposal has attracted the most media attention, Senators Tom Coburn (R–OK) and Richard Burr (R–NC) are also champions of a well-fleshed-out premium support plan. On Capitol Hill, the basic idea of a defined contribution for Medicare financing goes back to the 1980s, when Representatives Richard Gephardt (D–MO) and David Stockman (R–MI) offered a Medicare voucher program. Their proposal was supported by the Reagan Administration. During the 1990s, Senator John Breaux (D–LA) and Representative Bill Thomas (R–CA), co-chairmen of the National Bipartisan Commission on the Future of Medicare, unveiled a comprehensive Medicare premium support proposal modeled after the FEHBP, but it was opposed by the Clinton Administration. Today, top analysts from a variety of institutions—the Brookings Institution, American Enterprise Institute, National Center for Policy Analysis, and Progressive Policy Institute—have endorsed this approach.
[11] The payment formula for Medicare Advantage increases Medicare spending. It sets a benchmark based on traditional Medicare payment and mandates that 75 percent of the difference between the benchmark and plan bids must be realized in lower premiums or richer benefits for enrollees, not cash rebates.
[12] According to Henry Aaron, a senior fellow at the Brooking Institution, for example, "To move ahead now to commit or enroll the Medicare population in entities that do not yet exist and whose capabilities have not yet been tested and proved would be a rash legislative act carrying the threat of hardship and disruption." Henry J. Aaron, Bruce and Virginia MacLaury Senior Fellow, The Brookings Institution, "The Current State of Medicare," statement before the Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives, April 27, 2012, p. 9, http://www.brookings.edu/research/testimony/2012/04/27-medicare-aaron (accessed July 19, 2012).
[13] While government subsidies for drug coverage in employer-based plans are a feature of the Medicare Modernization Act of 2003, signed into law by President George W. Bush, House and Senate Democrats, in their Medicare Prescription Drug Act of 2000, also proposed federal subsidies to employer plans.
[14] This was also a feature of the Breaux–Thomas proposal. "Part of the attractiveness of premium support is its ability to better integrate with employer-provided retiree coverage; similar to the way employer-provided pensions and Social Security benefits are currently integrated. By easing the integration of the two systems employers will be under less pressure to further reduce or drop retiree coverage." National Bipartisan Commission on the Future of Medicare, "Impact of the Commission Premium Support Proposal on Different Types of Beneficiaries," 1999, p. 5, http://medicare.commission.gov/medicare/impact.htm (accessed July 19, 2012).
[15] An often overlooked cost of the Medicare status quo is the price all Americans pay in higher premiums for their private insurance because of price controls and the resultant cost shifting from Medicare.
[16] The Honorable John Breaux, statement on Medicare premium support before the Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives, April 27, 2012, p. 4.
[17] For an excellent discussion of this simple truth, see J. D. Foster, "Premium Support Is Incremental, Not Radical Medicare Reform," Heritage Foundation Backgrounder No. 2649, February 7, 2012, http://report.heritage.org/bg2649.
[18] Marilyn Werber Serafini, "Ex-Medicare Administrator: Premium Support 'Is Going to Have to Happen'," Kaiser Health News, May 31, 2012, http://www.kaiserhealthnews.org/Stories/2012/June/01/scully-medicare-premium-support.aspx (accessed July 19, 2012).
[19] Matt Miller, "Wait! Paul Ryan Has a Point," Washington Post Opinions, May 25, 2011, http://www.washingtonpost.com/opinions/wait-paul-ryan-has-a-point/2011/05/25/AGeH5GBH_story.html (accessed July 19, 2012).
[20] For example, Henry Aaron of the Brookings Institution and Robert Reischauer of the Urban Institute originally coined the term "premium support" in 1995, but they no longer support it. Aaron says that an acceptable Medicare premium support program must have three characteristics: a government contribution linked to health care costs, a restricted market with a limited number of "prototype" health plans, and an effective risk-adjustment system to combat adverse selection. Aaron says that none of the major proposals meets all of these conditions. See Aaron, "The Current State of Medicare," pp. 6–7.
[21] Jed Lewison, "White House Rejects Ryan–Wyden: 'This Plan Would End Medicare as We Know It,'" The Daily Kos, December 15, 2011, http://www.dailykos.com/story/2011/12/15/1045680/-whitehouse-rejects-wyden-ryan-this-plan-would-end-Medicare-as-we-know-it (accessed July 19, 2012).
[22] Even a top adviser to President Obama commented favorably on this approach in a recent Senate Budget Committee hearing: "David Cutler, a professor of economics at Harvard University, praised the idea of a marketplace that maintains the traditional fee-for-service Medicare program and gives seniors a guaranteed benefit that they can rely on." Emily Ethridge, "Conrad 'Really Encouraged' About Options for Reducing Medicare Spending," CQ Today, March 1, 2012.
[23] In examining this question in 1999, the National Bipartisan Commission on the Future of Medicare reported that, based on CBO projections, beneficiary enrollment in private plans would account for half of all Medicare enrollment. National Bipartisan Commission on the Future of Medicare, "Impact of the Commission Premium Support Proposal on Different Types of Beneficiaries," p. 2.
[24] Joseph R. Antos, "Fact Checking the Fact Checker on Paul Ryan's Medicare Reform Plan," American Enterprise Institute, April 6, 2012, http://blog.american.com/2012/04/fact-checking-the-fact-checker-on-paul-ryans-medicare-reform-plan (accessed July 19, 2012).
[25] The issue of the level playing field was the central point of contention during the 2009–2010 health care debate. Proponents of the "public plan" usually designed it with special funding, regulatory, or risk advantages while fixing payments to doctors and hospitals below private market rates. The objective: the "crowding out" of private coverage and the triumph of a government monopoly.
[26] "Durbin Slams Paul Ryan Budget Plan," CBS News, March 21, 2012, http://www.cbsnews.com/8301-505267_162-57401429/durbin-slams-paul-ryan-budget-plan/ (accessed May 31, 2012).
[27] "Debbie Wasserman Shultz Says Ryan Medicare Plan Would Allow Insurers to Use Pre-existing Conditions as Barrier to Coverage," Tampa Bay Times Politifact.com, June 1, 2011, http://www.politifact.com/truth-o-meter/statements/2011/jun/01/debbie-wasserman-schultz/debbie-wasserman-schultz-says-ryan-medicare-plan-w/ (accessed July 19, 2012).
[28] Moffit, "Saving the American Dream," pp. 2–3.
[29] Ibid.
[30] Under current law, the standard Medicare Part B premiums are projected to increase from $99.90 in 2012 to $161.20 in 2021. 2012 Medicare Trustees Report, p. 229, Table V.E2. For seniors, the continuation of current policies will guarantee even higher premiums. If Congress overrides the scheduled physician payment reductions in 2013, which it almost certainly will do, Part B premiums will be significantly higher than projected by the Medicare Trustees.
[31] Topher Spiro, "The Independent Payment Advisory Board: Protecting Medicare Beneficiaries and Taxpayers from Special Interests," Center for American Progress Issue Brief, March 5, 2012, http://www.americanprogress.org/issues/2012/03/aca_ipab.html (accessed July 19, 2012). So that there is no misunderstanding, neither Mr. Spiro nor the Center for American Progress has endorsed competitive bidding for Medicare premium support or any other variant of a defined contribution for Medicare.
[32] Marsha Gold, Gretchen Jacobson, Anthony Damico, and Tricia Neuman, "Medicare Advantage 2012 Data Spotlight: Enrollment Market Update," Henry J. Kaiser Family Foundation Data Spotlight, June 2012, p. 1, http://www.kff.org/medicare/upload/8323.pdf (accessed July 19, 2012).
[33] 2012 Medicare Trustees Report, p. 231.
[34] Joseph R. Antos, "What Does Medicare Part D Say About the Ryan Plan?" American Enterprise Institute, June 15, 2011, http://www.aei.org/article/health/entitlements/medicare/what-does-medicare-part-d-say-about-the-ryan-plan/ (accessed July 19, 2012).
[35] National Bipartisan Commission on the Future of Medicare, "Impact of the Commission Premium Support Proposal on Different Types of Beneficiaries," p. 1.
[36] Paul Krugman, "Privatizing Medicare," The New York Times, April 4, 2011, http://krugman.blogs.nytimes.com/2011/04/04/privatizing-medicare?/pagemode=print (July 19, 2012).
[37] See Jeet S. Guram and Robert E. Moffit, "The Medicare Advantage Success Story—Looking Beyond the Cost Difference," The New England Journal of Medicine, Vol. 366 (March 29, 2012), pp. 1177–1179, http://www.nejm.org/doi/full/10.1056/NEJMp1114019?/viewType=Print&viewClass=Print (accessed July 19, 2012).
[38] For 2012, the bids from all MA plans averaged 98 percent of Medicare FFS for the standard Medicare benefits, while HMO plans bid an average of 95 percent of Medicare FFS spending. Medicare Payment Advisory Commission, A Data Book: Health Spending and the Medicare Program, June 2012, p. 146, http://www.medpac.gov/documents/Jun12DataBookEntireReport.pdf (accessed July 16, 2012).
[39] Jonathan Cohn, "Ron Wyden, Paul Ryan, and the Future of Medicare," The New Republic, December 15, 2011, p. 2, http://www.tnr.com/blog/jonathan-cohn/98588/wyden-ryan-medicare-voucher-premium-support-reform (accessed July 20, 2012).
[40] The actuarial equivalence standard would encourage plans to develop new and different combinations of benefits, stimulating innovation in delivery options. Among the many drawbacks of '60s-style Medicare has been its historic sluggishness. From 1965 to 2003, there was relatively little change in the Medicare defined benefit structure. This inertia was compounded by the fact that almost every serious benefit decision, like the addition of Medicare drug coverage, was accompanied by a major political fight.
[41] Congressional Budget Office, The 2012 Long-Term Budget Outlook, June 2012, p. 11, http://cbo.gov/sites/default/files/cbofiles/attachments/LTBO_One-Col_2.pdf (accessed July 20, 2012). This level of debt would be based on CBO's "extended alternative fiscal scenario," which refers to an extension of current policies as opposed to current laws. Because higher debt and government borrowing "crowds out" private capital investment, the continuation of current policies would have catastrophic economic consequences for the American people.
[42] Robert A. Book, PhD, "Illusions of Cost Control in Public Health Care Plans," Heritage Foundation Backgrounder No. 2301, July 24, 2009, p. 7, www.heritage.org/Research/Healthcare/bg2301.cfm.
[43] Paul N. Van de Water, "What You Need to Know About Premium Support," Center on Budget and Policy Priorities, March 19, 2012, pp. 1–2, http://www.cbpp.org/cms/index.cfm?fa=view&id=3704 (accessed July 20, 2012).
[44] Current Medicaid funding for those who are eligible continues under all major proposals, or additional assistance is made available for low-income persons who are not eligible for Medicaid. See Moffit, "Saving the American Dream," pp. 2–3.
[45] "The Path to Prosperity: A Blueprint for American Renewal," The Fiscal Year 2013 Budget Resolution, House Budget Committee, March 20, 2012, p. 53, http://paulryan.house.gov/UploadedFiles/Pathtoprosperity2013.pdf (accessed July 20, 2012).
[46] Choosing a medical service and a health insurance policy involves very different sets of choices. In his condemnation of "consumer-based" health care as a failure, Krugman says, "Medical care, after all, is an area in which crucial decisions—life and death decisions—must be made. Yet making such decisions requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping." Paul Krugman, "Patients Are Not Consumers," Economist's View, April 22, 2011, http://economistsview.typepad.com/economistsview/2011/04/paul-krugman-patients-are-not-consumers.html (accessed July 20, 2012).
[47] Paul Abrams, "Saving Medicare from 'Private-izing' Ryan," Huffington Post, Blog, April 16, 2011, http://www.huffingtonpost.com/paul-abrams/saving-medicare-from-priv_b_850004.html (accessed July 20, 2012).
[48] Henry Aaron, "Vouchers or Premium Support: What's in a Name?" Health Affairs, Blog, April 6, 2011, http://healthaffairs.org/blog/2011/04/06/vouchers-or-premium-support-whats-in-a-name/ (accessed July 20, 2012).
[49] Based on 2008 data, 8.4 percent report poor health, while 41 percent report excellent or very good health and 51 percent report good or fair health. The largest cohort of Medicare beneficiaries, of course, are those aged 65 to 74, or 43.4 percent of the total. See Medicare Payment Advisory Commission, Data Book: Health Care Spending and the Medicare Program, pp. 22–23.
[50] Karen Davis and Cathy Schoen, "Managed Care, Choice, and Patient Satisfaction," The Commonwealth Fund, August 1997, p. 5, http://www.commonwealthfund.org/Publications/Fund-Reports/1997/Aug/Managed-Care--Choice--and-Patient-Satisfaction.aspx (accessed July 20, 2012).
[51] See KRC Research, "Seniors Opinions About Medicare RX: Sixth Year Update," PowerPoint presentation, October 2011, http://hlc.org/blog/wp-content/uploads/2011/10/Oct-2011-KRC-Medicare-Today-Survey-of-Seniors-with-Medicare-Rx-10-14-11-FINAL1.pdf (accessed July 20, 2012).
[52] Henry J. Aaron, "Medicare Reform: Rhetoric Versus Substance," The Brookings Institution, October 11, 2011, p. 11, http://www.brookings.edu/~/media/research/files/papers/2011/10/11%20premium%20support%20aaron/1011_premium_support_aaron (accessed July 26, 2012).
[53] Paul N. Van de Water, "Converting Medicare to Premium Support Would Likely Lead to Two Tier Health Care System," Center on Budget and Policy Priorities, September 26, 2011, http://www.cbpp.org/files/9-26-11health.pdf (accessed July 20, 2012).
[54] The CMS model for risk adjustment uses demographic data and medical conditions to adjust per capita plan payment. Glenn Hackbarth, Chairman of the Medicare Payment Advisory Commission, says the current model is "a much better predictor" of a patient's costs than previous models. For further improvements in the CMS model, MedPAC recommends an increase in the number of medical conditions and two years worth of diagnostic data to improve payment accuracy. Glenn Hackbarth, J.D., "Report to the Congress: Medicare and the Health Care Delivery System," testimony before the Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives, June 19, 2012, pp. 15–16.
[55] Alice M. Rivlin, "A Bipartisan Approach to Reforming Medicare," testimony before the Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives, April 27, 2012, p. 5.
[56] See Moffit, "Saving The American Dream," pp. 12–15.
[57] Moffit, "The Second Stage of Medicare Reform," pp. 15–17.
[58] Rivlin, "A Bipartisan Approach to Reforming Medicare," p. 3.
[59] Premium support does not, of course, logically entail an external budget cap. Some champions of this reform, such as Senators Coburn and Burr, oppose such caps and others, such as former Senator Breaux, vehemently so.
[60] Calculations by Drew Gonshorowski, policy analyst with The Heritage Foundation's Center for Data Analysis, based on Centers for Medicare and Medicaid Services (CMS) national health expenditure data.
[61] Stuart M. Butler, "The Debate Over How to Rein in Medicare Costs," The JAMA Forum, April 13, 2012, http://newsatjama.jama.com/2012/04/13/jama-forum-the-debate-over-how-to-rein-in-medicare-costs/ (accessed July 20, 2012).
[62] Cited in Robert Pear, "Obama Panel to Curb Medicare Finds Foes in Both Parties," The New York Times, April 19, 2011, http://www.nytimes.com/2011/04/20/us/politics/20health.html (accessed July 20, 2012).


text:
News Advisory and Photo Opportunity: Solar Power and Energy Initiatives Announced By Malone Central School District and N.Y. Power Authority
Senator Elizabeth Little will be joined by Allen Schriver, regional manager for Northern New York, New York Power Authority (NYPA) and Stephen T. Shafer, superintendent of schools, Malone Central School District, on Friday, November 18, to announce the completion of a 6-kilowatt photovoltaic (PV) installation at the Franklin Academy High School. In addition, energy efficiency initiatives at the Franklin Academy and the Davis Elementary School will be announced.
The PV installation is mounted atop Franklin Academy and is the first NYPA solar power installation in the North Country. It will provide a continuous source of clean energy for the high school by supplementing power the school receives from the grid. A special connection to the school's computer network will allow students to monitor energy production.
Immediately following remarks from Senator Little and Schriver, a student will demonstrate the computer connection.
Solar Power and Energy Efficiency Announcement,
and Computer Demonstration
WHEN: Friday, November 18, 11 a.m.
WHERE: Franklin Academy High School
42 Huskie Lane, Malone NY 12953
CONTACT: Brian Warner, NYPA, 914-584-5024
Donald Merrick, Franklin Academy, 518- 483-7807

subset: commoncrawl


text:
Paul McCartney Live Perfornance @ The Queen's Diamond Jubilee, June 4 2012, Buckingham Palace
Magical Mystery Tour
All My Loving
Let It Be
Live and Let Die
Ob-La-Di, Ob-La-Da
Watch here: http://www.youtube.com/watch?v=M1eM-d2mu6Q
Moderator: Mike
oobujoobu1971 wrote:He did "Her Majesty" 10 years ago at the end of the Golden Jubilee concert, so I guess he felt it was appropriate to do something different this time.
2 of 3 wrote:Abe always sings along doesn't he? That's what I heard. Anyway, way back in the day, Hamish did the same thing.
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text:
Student Services
Counseling Services
Mission: Counseling Services strives to educate and empower students to make realistic and attainable decisions as they pursue their academic, career, personal, and social goals.
Academic, Career, and Personal Counseling Services are provided to currently enrolled students.
What Counselors Can Do For You:
- Provide Pre-Program Advising in program areas of interest
- Provide "general" course selection
- Assist with academic, transfer, and career planning
- Work with you on personal concerns that interfere with educational and career goals
- Work with potential students on career exploration for your time at PCC and for future planning
- Provide advising for undecided students
- Help you develop success strategies and life skills
- Guide in placement testing clarification and interpretation
- Provide a general orientation to PCC
- Provide preliminary graduation checklists
- Assist with setting and clarifying goals
- Intervene for crises management
- Offer short-term personal counseling
- Help strengthen academic standing
- Assist with test anxiety and stress management
- Conduct workshops in admissions, career/educational planning, decision making, and personal development.
(NOTE: For Crisis Intervention Services, contact the Student Assistance Program Coordinator, Olivia Sutton at (252) 493-7222.)
Students are requested to schedule an appointment for counseling sessions but may be seen on a walk-in basis for emergency and extenuating circumstances.
Normal Operating Hours:
Mondays, 8:00 am to 7:00 pm
Tuesday-Friday, 8:00 am to 5:00 pm
Summer Operating Hours:
Mondays, 8:00 am to 7:00 pm
Tuesday-Thursday, 8:00 am to 5:15 pm
Fridays, 8:00 am to 1:00 pm
Location: The Goess Student Center, Suite 120.
Contact Counseling Services by Calling: (252) 493-7245.


text:
Anichebe - Jelavic needed a rest
Everton striker Victor Anichebe believes he has learned greatly from fellow forward Nikica Jelavic, but sees no irony in the fact he has replaced the Croatian in the team.
- Related Content
- Profiles
Anichebe was preferred to Jelavic for the second successive match and responded with a goal in the Toffees' last-gasp 3-3 draw at home to struggling Aston Villa.
Manager David Moyes said Anichebe has earned his place on merit - and his fifth goal in eight league starts appeared to back that up - as Jelavic has lost his way in front of goal with his last top-flight goal almost two months ago.
But Anichebe believes that is only a temporary situation and it is more important everyone plays their part as Everton bid to qualify for the Champions League.
"I wouldn't look too far into him not playing," Anichebe said. "Nikica has been unbelievable since he came to us and his record speaks for itself (18 goals in 45 appearances).
"I was injured for two months and he took the burden on his own and he has been playing on his own every game.
"There comes a time when you have to take him out because he is pretty tired but the best of him will come.
"He has been playing for a long time on his own. Now I am back it is probably good time to give him a rest.
"I talk to him all the time and some of the positions I am getting into is because of him, he has helped me get into more goalscoring positions.
"We can play together. If he doesn't play, if I don't play, it is not a big deal."
Anichebe produced the first-half equaliser to Christian Benteke's strike, but Gabriel Agbonlahor's header and then a second for Benteke put Everton under real pressure.
However, Marouane Fellaini popped up with two of his own, the first assisted by Anichebe and the second in the third minute of added time, to snatch a point.
"With the way we are pushing for fourth spot we are disappointed with the result," Anichebe added. "But to come back to 3-3 was a great team performance.
"You can see the frustration with the fans, they expect us to win all the time and it is a big burden to have but I am sure we are up for it.
"I am pleased with the goal. I seem to be able to do that skill well and the players look for me in those positions but without the pass I wouldn't have been able to score so I give credit to Kevin Mirallas as well.
"People say to me 'This is your chance, take it' but I don't look at it like that, I look at it as us all together as a team.
"We (him and Jelavic) give each other confidence and a push to do well.
"But the most important thing is the team keeps pushing and it shows how far we have come that we are so disappointed with a draw against Villa."
Moyes believes Anichebe's form is down to improved self-belief.
"I think there have been a lot of times when Victor has been questioned and maybe even our faith in him at times," he said.
"But I hope he has seen we always believed there was a really good player in there if we could get it out of him.
"He has been needing support from the crowd because for a long time I think he was probably believing they weren't behind him or didn't value him as a player and maybe some of the things he has done on the pitch you wouldn't have (done so).
"But we have tried to keep with him and work with him and he made a big contribution, scoring a goal, was a threat and was challenging high up the pitch.
"He is doing really well for us at the moment. We have brought him in and given Jela a breather and I think Victor is deservedly playing up front at the moment by how he is doing."
Aston Villa boss Paul Lambert praised his own two-goal striker Benteke, who took his Premier League tally into double figures.
"He's only 22, just turned 22. For someone who has just come into British football he's been exceptional," he said.
"I probably got criticised for signing him because he wasn't a name, no-one had heard of him, people thought 'What's Aston Villa doing signing him?' I'm pretty sure he's put that to bed.
"The frustrating thing is we didn't win having scored three goals but if we play like that we will win more games than not."
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text:
In 2007 The New York Times hired Alan Schwarz largely on the basis of his initial freelance reporting for the paper on the problem of head injuries in professional football. Since then, Schwarz's persistent coverage has helped make the issue—which had been kicking around the edges of sports journalism for twenty years—part of the national conversation, prompting two congressional hearings and a sea change within the National Football League on how it deals with head injuries. After years of denying that concussions can produce long-term health consequences, including dementia, the league did an about-face in December and agreed to financially support research into concussions by the Center for the Study of Traumatic Encephalopathy at Boston University, one of its harshest critics. That came on top of rule changes announced in November that prevent players exhibiting any signs of a concussion from returning to either a game or practice on the same day as the injury occurred, and then not without clearance from an independent brain-injury expert. CJR's Brent Cunningham spoke to Schwarz in November.
CJR: How did you get on this story?
Schwarz: Like many big journalism projects, this one fell out of the sky. A friend of mine was friends with a professional wrestler, Chris Nowinski, who had sustained several concussions both as a wrestler and as member of the Harvard football team. And this young man was writing a book about concussions and about the severity of them in the summer of 2005, and our mutual friend told him that I had written my first book the previous summer, that it did very well, and that maybe I could give him some advice on his book. So we met and I looked at his manuscript and it was fantastic. And we became friendly and I believed in his project. I guess very few people did because the following December, 2006, when he had taken it upon himself to investigate the [former Eagles defensive back] Andre Waters suicide, and he found out that in fact Waters did have this terrible brain damage, he called me back—we hadn't spoken in maybe a year—and he said, "Alan, you're the only one who took me seriously. What do you think I should do with this finding?" I was not on staff at the Times. I had contributed a good deal to the sports section over the previous ten years, and I knew this was something they'd be interested in, and I set up a meeting between me, the sports editor Tom Jolly, and Chris and this was early January '07. Tom immediately saw how important this was. After the meeting I took Tom aside and said I totally understood if he wanted to have a staff person handle this. He said that it was my story, and I will be forever grateful for that trust, because I did do the Waters story and then [former Patriots linebacker] Ted Johnson wanted me to write his story, and the topic became part of a national sports debate, almost immediately. The Times hired me virtually on the spot.
CJR: I would say that it became part of a national debate largely on the strength of your reporting.
Schwarz: Well, yes and no. Because it's always been known that hitting one's head over and over and over and over and over again is dangerous. And to many doctors the leap from suggesting that what happens to boxers might happen to football players is not a particularly significant leap. And yet there has been great resistance on the part of a certain segment of doctors to allowing that connection to be made. So I think what you have is the collision of something some experts find so reasonable and what some people just don't want to consider possibly being true. What if football is really that dangerous? There are an awful lot of dominoes that fall from that. It's a very difficult problem. It is very difficult to know what era of football is dangerous. Just because we find out that a lot of players from '60s, '70s, and '80s have brain damage, doesn't mean the current players will incur that damage.
CJR: Is it simply a matter of better equipment?
Schwarz: The equipment is better. The awareness of the injury and the possible severity of it is higher, particularly among medical staff, but also among players. Players aren't as foolhardy and unaware and uneducated as they were twenty or thirty years ago. But of course the speed of game is much higher, players are larger—but helmets are better. So it's hard to know. By no means do my articles about retired players speak directly to the safety or lack thereof of today's game. I think it's a very important distinction that a lot of people aren't making.
CJR: But even as awareness of these injuries has grown, what comes through in the articles is that the warrior culture is still very much intact from the pros on down to little leagues.
Schwarz: Absolutely. I do think, though, that more players are more aware than ever that, "Hey, if I get knocked unconscious or I get really dazed I should come out and have a doctor look at me." Or that they should just be more careful and not treat it so cavalierly. Does it still happen? Of course. I don't know to what extent, but I can tell you that it certainly happens less. How much less? I don't know. I try to be very careful about making the distinction between what we know about football from the '60s, '70s, and '80s and what we believe to be true today.
CJR: Do you ever hear from current players?
Schwarz: The reaction from players has been overwhelmingly positive. Current and former. At least what we've heard from these players. Of course, I don't know how many are harboring feelings that they aren't sharing with us. The reaction from retired players has been overwhelmingly positive because we are showing how the game was more dangerous than many people realized and these are gentlemen who got hurt on the job and don't feel like they've been fairly compensated for it. The wives and families—I get calls every week from wives crying about their husbands. So it has been very positive because a lot of people believe this has been the NFL's dirty little secret for a long time and we have made it more okay to discuss it openly. Now, do players who believe that their roster spots are in danger speak about this stuff openly? No, but it is better than it was.
CJR: What has been the reaction from the NFL?
Schwarz: I think that the NFL's reaction to our work is very clearly evidenced in their comments that are included in the articles. And I can't speak for them. I will not characterize the nature of their response.
CJR: Have they attempted to persuade you guys to drop the story?
Schwarz: They have repeatedly complained to the highest levels of the editors at The New York Times that we should not be doing what we're doing. They have complained about us collectively and me personally. The Times is very careful about the latitude it gives its writers, and I have not been told, ever, that what I was doing was inappropriate. The feeling within the building that I get is that this is what a newspaper is supposed to do: apply scrutiny to areas that really matter and that haven't gotten the scrutiny that they deserve. We've been credited with saving lives with this story—specifically teenagers. There's no question that rules have been changed because of the awareness and conversation that we've catalyzed regarding this injury and these risks. We have never once—never—even suggested that football should not be played. All we have done is say these are the risks if you don't play it safely, and this is how one can play the game more safely. Beyond that it is a decision for adults to make in the National Football League, for young adults to make in college, and for parents to make on behalf of their children who are under the age of eighteen.
And I'd like to say that I get a lot of credit for the work that we've done, but this is so much more of a team effort here than a single byline atop stories can possibly convey. They trusted me to go out and do a good job and to do the right job, and have been integral in the directions the reporting has gone. It's very humbling to be here and be allowed to pursue the story. How many media outlets today, with all the budget problems, would devote what's probably been half a million dollars and a good chunk of three years of an employee's time to a single story? Not many.
CJR: What have you learned, in the course of your reporting, about what it will take to make the game safer?
Schwarz: A lot of experts believe that improvements to helmets will be important but not necessarily revolutionary over the next ten years. There are some coaches who are uneducated about this injury, and some foolish ones, but the era of the Neanderthal coach who sends his players out to slaughter has passed in general. The amount of medical care that is given to college and pro players is very high, and it would be quite a stretch to suggest that those doctors are just company "yes men." Now, are some, probably? Yes. In the same way that the worst things that people think about journalists are probably true sometimes. Some people do make up quotes. Does that mean, though, that a majority, or even 2 percent do? No. In high school football the coaches' response and the medical care are not what they should be, but it's getting better.
CJR: For the high schools, though, that's often a matter of resources, right?
Schwarz: Yes, but I've never heard a school say, "You know what, the budget's really tight, so we can't afford helmets this year. We're going to play without helmets." You can't do that. The question that is fair to ask is this: Is high school football too dangerous to play without a physician or athletic trainer properly trained in the diagnosis and treatment of brain injuries on the sideline? In the same way you can't play football without a helmet, can you play football without a doctor? Those are things that different states are considering, and even Congress is considering various ways that the federal government can get involved in this issue.
My main point, though, is that far more than ever, the biggest opportunity to make football safer lies with the players themselves. They must respect when they sustain anything that feels like a concussion. I don't care how much of a warrior you want to be, I don't care what the score is, I don't care what the standings are. If you get a brain injury, come out of the game and go, hopefully, to the trainer or doctor on the sideline and get checked out and realize that you cannot mess with it.
CJR: Do you think that's realistic?
Schwarz: There more opportunities for players to do that now than there were three years ago, and I think we deserve some credit for that. But far more has to be done to teach the kids that it's okay to put down the sword and get yourself checked out. It's not war. It's not win at all costs. It is a game. It is an important game for a lot of people and communities and it's meaningful. But I don't know any parent who would say, "It's worth my kid getting killed or put into a coma for two weeks because East Side High is leading by four." So the question is, how do we teach them before the game starts? And how do we make them feel it is okay to act on that knowledge after the game starts? That's the adults' responsibility and it's going to take a long time to change the football culture, to say, "Hey, wait a minute, we've gone a little too far with this warrior thing." That doesn't happen overnight.
CJR: From a reporting standpoint, what's been the most challenging aspect of this story?
Schwarz: Particularly, when it comes to dealing with the National Football League, you can't fight illogic with logic. You have to find another way to do it.
CJR: What other ways have you found?
Schwarz: One of the things I bring to this story that's important is that I have a mathematics degree. I know how to see things in numbers that the average Joe probably doesn't.
CJR: For instance?
Schwarz: Look at a story I did on the 88 Plan data in October. That was some serious number-crunching.
CJR: This is the data from the program that the NFL and the players' union launched in 2007 to reimburse medical expenses of retirees being treated for dementia. And a lawyer for the union presented an analysis of this data that concluded that the prevalence of dementia and other brain trauma injuries among former NFL players was basically in line with the rates for those problems in the population at large. And your article said that the union analysis was incorrect, and that in fact the data indicated that the rate among former NFL players was significantly higher than in the general population.
Schwarz: Correct. When the union did its analysis it did it in what looked like a reasonable way, but it wasn't a reasonable way. I looked at what they did and instantly saw it was wrong.
CJR: What specifically?
Schwarz: I looked at the prevalence numbers and knew they were wrong. Not only had they taken the wrong column of data from a published chart, but they didn't notice that it was rate per thousand rather than rate per hundred. Also, there were errors in logic and sampling. They interpreted the 88 Plan rate as being the dementia rate for all NFL retirees, and that is preposterously wrong. It is a bare minimum of a certain level of dementia, because to be on that list you had to be aware of the program and also had to have volunteered that you have the disease. There is a lot more dementia out there—either unreported or cases that don't reach the level of severity where it qualifies for the 88 Plan. That doesn't mean the NFL is evil. It just means that the person who did the work didn't know what he was doing. And that's okay. But why isn't this stuff being done proactively by the league and the union? Why does it have to be done by The New York Times?
CJR: Would you let your son play football after what you've learned?
Schwarz: That's like asking a political reporter before the election, "Who are you going to vote for?" It's my job to cover the issue, it's not my job to decide or even discuss how I will let the issue affect my family.
CJR: It's not your job as a journalist, but as a human being it is difficult to avoid.
Schwarz: The point is there are certain things you don't allow to creep into your head because it's your job to make sure they don't. And I really haven't thought about it because if I were to decide that Teddy won't play football, then the mindset with which I follow the story could come from the wrong place. It cannot come from concern about my little boy. The New York Times is not writing about this to protect Teddy Schwarz. The New York Times is writing about it to protect the 1.2 million kids who play high school football every Friday, and their 2.4 million parents. Those are the people whose opinions matter. Not mine.
CJR: Let's assume for a minute that your son, who you said is three years old, is actually ten years old and he is clamoring to play Pop Warner football. Would the fact that you would then have to decide disqualify you from covering the story?
Schwarz: No, it wouldn't disqualify me, though of course that's up to my editors. But there is something about working here—and I'm not saying we're better than everyone else, blah, blah, blah—but there is something that really inspires you to do the right thing, and to do the thing that helps you to cultivate the trust that allows readers to take you seriously. So I would probably let him play because if I didn't it would compromise the reporting. It would compromise the trust that others and even the league may have in me. Now, I would not send him out to slaughter, but getting one concussion is not that big of a deal—it just isn't. And to suggest otherwise is incredibly irresponsible. So if my kid gets one concussion then yeah, he doesn't play anymore probably. But to not allow him on the field is, frankly, an overreaction. And if I didn't allow him to play then yeah, it would be harder to cover the story, if only in my own mind. I believe that the cost to others of my not being able to cover this story as well would be greater than the cost of my kid getting one concussion and never playing again. I'm a very mathematical guy. I follow certain precepts. And those are the things that make sense to me. And I can't tell my kid he can't play, because then what am I going to tell the league? What am I going to tell my editors? It doesn't work. It's dissonant.


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EXCLUSIVE: Trader Joe's Coming to Medford July 2012
The long awaited question of whether Trader Joe's would come to the Rogue Valley has been answered. Northgate Shopping Mall developer Steve Morgan has confirmed that several stores, including Trader Joe's, will be among the first to be built now that bulldozers are at the site in the beginning stages of construction. The mall was first scheduled to open in 2006, but with factors including the national economic downturn; construction plans were altered. Now the earth is turning at the site across from the Rogue Valley Mall between Court and Central streets. Along with Trader Joe's, Morgan tells theDove that additional stores including REI, PetCo, Ulta Cosmetics and Discount Shoe Warehouse will be among the first to be constructed with an opening date of July, 2012.
The first phase involves construction of 87,000 square feet of retail businesses on 7.82 acres with 3 subsequent phases including an office park to be built over several years.
Location of new Northgate Center:


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I don't think folks criticizing him here is just a matter of their egos.
In the movie, and in videos, I think he really does come across as a weird blend of clueless, smug, condescending, and somewhat insensitive to a culture that he is supposedly interested in. I don't think that being turned off by his public persona is being overly judgemental. It's true that movies and newspaper articles invariably slant a story one way or another, so perhaps it's not fair to judge him as a person, but I think we can judge what he puts out there to the world in terms of his business / hobbies.
In his defense, while I think the press stuff about him being a "pioneer" is a bit of an overstatement, there really weren't many non-ethnic-Chinese doing the stuff he was doing in the 90s, and it was probably a lot harder to acquire Chinese language ability then (though certainly many foreign folks who spent time in China in the 90s did learn to speak fluently). I think that watching the full film (vs. the clips in the preview) gives you a good sense of that - you really do have to put it into place / time / cultural perspective.
I call shenanigans on his supposed ability to tell whether pesticides and fertilizer were used simply by smelling the dry leaf.
My favorite scene in the movie is where he's giving a long speech (apparently without a translator) about tea farming to a bunch of Chinese tea industry people. He seems quite pleased with himself, but I have a slight feeling that, other than the novelty of having a foreign guy at the front of the room, there's probably not a lot of comprehension in the room.


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Condition: 7/10- works perfectly but could use another paint job
Known Problems: Runs perfect<
Asking Price: 90 Shipped OBO (Price is negotiable)
Shipping Options: Flat Rate Priority
Trades of interest: None.
Location of item: Las Vegas
What is Included: Exalt Speed Feed (beat up), Brand Spankin new white Rotor lid.
I got to admit, this rotor has seen better days but nothing a quick paint job wont fix. If you can look past its looks, you will have a pretty darn good hopper.
Edited by azn paintballer, 30 November 2012 - 07:29 PM.


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This Clock Keeps On Ticking
April 3, 2012
Talk about vintage...this Sanpan clock has been around a while. Assuming it was born around the same time as the very first Sanpan in 1958 (the very first aluminum pontoon boat in fact), we can safely say that this classic timepiece has ticked in the neighborhood of 28 million minutes. Just think about all the pontoons, all the designs, all the craftsmanship that has gone on under this clock. And think about all the generations of hard-working Americans who took time to make sure each boat was put together the right way before it left the plant, headed for dealerships out there somewhere. Headed for your family's dock. And think about all the memories that have been made over the years out on the water aboard one of our boats. We believe we build the best pontoons, and we take a lot of pride in that. But we are every bit as proud to be part of so many stories. Generations of great stories, funny stories, stories that help us remember where we came from. Stories that link us to families all around the world. We've been around for more than 50 years. And in all that time, throughout all those 28 million minutes, one thing hasn't changed. We want the next boat — maybe your boat — to be the best one we've ever put together. We're just as committed to quality and innovation today as the very first time someone climbed up on that beam in the factory and hung this clock for everyone to see. But maybe it's not just a clock. Maybe it's a time machine.


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Share Your Reflection

Thank you very much for introducing this particular
Thank you very much for introducing this particular "thread"; the question of how shows "emerge" has been on my mind recently.
Recently the "Emergent Church"/"Emerging Church" movement has attracted the attention of the Lutheran rank-and-file, albeit with (IMHO) a fairly superficial treatment in The Lutheran. A bit of research shows that the Emergent Church movement has existed globally for at least 20 years, originating in the UK; more interesting is how controversial Evangelicals and fundamentalists find this movement. Reading only The Lutheran. one might think this movement is about guitar services and "conversations," but reading and listening to evangelical leaders (pastors, seminarians, etc) one sees that this movement is much more threatening!
So here's my suggestion: consider doing a show on The Faith of the Postmodern. I'm not a theologian so I can't provide much more advice, but the thesis is that "postmoderns" of all backgrounds are questioning everything about their faith traditions. This is related to your (wonderful) show on "The New Monastics" but is not the same.
Thank you very much for your amazing and wonderful show; I have nearly very episode on my iPod and every show gets multiple listens.

Having worked here for only six months, it's been
Having worked here for only six months, it's been fascinating for me to see how shows emerge from that first whiff of curiosity about some subject. But as I said, the hard part is finding a specific voice on that subject. And for us, that right voice usually has to be someone who can speak from personal experience, not just from their knowledge. So, can you think of anyone who could speak both knowledgeably and personally on this topic?

"Vanishing Voices: The Extinction of the World's
"Vanishing Voices: The Extinction of the World's Languages" (Oxford, 2000) is one of the most compelling nonfiction books I've read in the past 10 years.

Thanks for the recommendation. I love reading engaging
Thanks for the recommendation. I love reading engaging books about languages. The last one I read was John McWhorter's "Tower of Babel". Can't wait to pick this one up.

I have an idea for a show to put out there - how about
I have an idea for a show to put out there - how about one on yoga nidra - and you could interview Richard Miller, Clinical Psychologist and yoga teacher. They teach his 'iRest', which is a version of yoga nidra, at the Walter Reed Army Hospital in DC. I'll be interning there this fall. Just thought it would be great to hear something on yoga!


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As I gain confidence in my cullinary chops...it's time to tackle a bird for Thanksgiving.
The denizens in here are always spot on, so I will turn here first for help.
Who has a great turkey recipe for Thanksgiving----lay it on me.
Thanks in advance. (No deep frying for me...going to go a more traditional route)


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by Anton Shilov
To further capitalize on the opportunity for accelerated processing units (APUs) in embedded applications and form factors, AMD on Monday announced the formation of a new Embedded Solutions Group and appointed Arun Iyengar as its corporate vice president and general manager.
"AMD APUs have been extremely well received by embedded system designers who require more graphic-intensive displays and compute power, while continuing to increase our engagement with ecosystem partners to deliver a complete solution. Arun's appointment and dedicated focus on expanding our differentiated embedded offerings will help ensure we are seizing the opportunity to expand in this rapidly growing market," said Lisa Su, senior vice president and general manager of AMD global business units.
The embedded microprocessor market is expected to reach $6 billion this year, and is projected to expand at an annual growth rate of 12% - 15% through 2014 according to VDC Research Group. AMD embedded APUs, along with AMD discrete graphics and AMD Opteron processors are designed to address a wide range of sub-segments in the embedded market including communications, storage and a number of other applications which are performance intensive and power sensitive.
The AMD embedded solutions group will operate as a separate business within AMD's global business units under AMD Senior Vice President Lisa Su.
Arun Iyengar brings more than 20 years of industry experience to the new Embedded Solutions Group. Prior to joining AMD, Iyengar held several leadership roles at Altera Corp., including his most recent role where he served as vice president of Altera's military, industrial, computing (MIC) Business Division. He also led Altera's communications business unit, overseeing revenue and market share growth during his tenure.


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Topic: Database installation problem?
Alrighty, I am on a ppc running osx 10.4
I have currently downloaded Locomotive, and i got pretty far until i realized that i kept getting the error 'sqlite' does not exist?! (I though this came with Locomotive) Anyway, I went and downloaded MySQL and got it running.
Now my problem is, how do i use it? I was following the screencast from Locomotive, to get the ball rolling. And I am stuck at creating the database. I had written a 'myfile.sql' file, within my 'db' directory. In the screencast, they run sqlite < schema myfile.sql (or something similar).
How do I go about doing this with mySql installed?
Thanks so much for the help.


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Fly with us to St Kitts to discover this unspoilt gem and neighbouring Nevis.
Buchen Sie Ihr Hotel über British Airways und profitieren Sie von großartigen Vorteilen:
Fly with us to St Kitts to discover this unspoilt gem and neighbouring Nevis.
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Book an unforgettable Caribbean break for less with our St Kitts & Nevis deals.
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A perfect choice for budget holidays, the affordably priced Timothy Beach Resort is located directly on the stunning white sands of St Kitts' Frigate Bay, within walking distance of buzzing bars and restaurants. Stay in your own private bungalow in lush tropical gardens at the historic Nisbet Plantation in Nevis. Or experience incredible facilities and service at the luxury Four Seasons.
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Take to the crystal-clear Caribbean waters and discover the beauty of St Kitts during this exhilarating kayaking and snorkelling adventure. You'll meet your tour guide for a kayak lesson and safety briefing before enjoying a 45-minute ride, taking in dramatic cliffs and beautiful remote bays. See fascinating local wildlife including turtles and vervet monkeys. You'll then explore the amazing underwater world of the Caribbean, filled with exotic fish and marine creatures, on a thrilling snorkelling expedition.
Take in the essential sights of beautiful St Kitts and explore its rich cultural heritage on this island tour. Your first stop is the capital of Basseterre, for some shopping in this historic city. Then enjoy wonderful scenery on the drive to magnificent Romney Manor, formerly home of the Caribelle Batik sugar plantation and set in stunning gardens. From there it's on to the spectacular Brimstone Hill Fortress National Park, before your tour concludes at the dramatic Black Rocks.
Experience the eco-adventure of a lifetime on this 3.5 hour guided walking tour through the rain forest of St Kitts. You'll be amazed at the exotic flora and fauna that this stunning island has to offer – including tropical birds and playful green vervet monkeys. After a scenic drive through the rain forest outskirts, you'll continue on foot to experience its amazing scenery first-hand while learning about this fascinating habitat from your knowledgeable guide. Your walk concludes with some light refreshments.
Experience the beauty and tranquillity of Nevis, known as the 'Queen of the Caribees' on this comprehensive tour. Your expedition begins with a 45-minute ferry ride around the island, accompanied by a professional guide. Next, explore the history and heritage of Nevis during visits to important attractions including the Museum of Nevis, as well as the sites of former sugar plantations. Take in the awe-inspiring 3,232ft extinct volcano and beautiful Botanical Gardens before your tour concludes with a little shopping.
Experience the spectacular scenery of St Kitts on this unforgettable hiking adventure to the top of Mt. Liamuiga, an extinct volcano. Your 8-hour round trip begins with a drive by Land Rover to the base of the 3,792ft volcano. During the vigorous 2.5 hour hike to the crater, admire and learn about the exotic surrounding flora and fauna from your guide. Be sure to bring a camera to capture the breathtaking vistas that await you at the top.


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March 27, 2013
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quote thebutcher99999Hunting doesn't necessarily mean you get a trophy, you can still hunt and kill it thus you can hunt more than dear.you can, but your not ment to. and you cant take them as trophies, therefor you CAN ONLY hunt deer!
quote thebutcher99999You can hunt more than deer. Your allowed to hunt Platypus/Turkey/Rabbits/Lizards etc just they don't count towards your bag limit. Can't remember there ever being a bear though.no, that sounds like cabels big game hunter, you can only hunt deer on this game.
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Here's how RW members rated this race in the past (326 votes).
In short: In full: Third time I have run this gruelling off road race, but it is excellent race for improving your stamina. The Organisers are friendly and supportive. Date of review: February 26, 2008
In short: Fantastic race - easily one of the highlight of the yearIn full: I did this race last year and couldn't wait to come back for more. In a perverse sort of way I preferred last years conditions, but a top event, well organised by Pewsey Vale. The gloroius, dry weather meant I was another who knocked 20 minutes off last years time. Roll on 2009 and more mud! Date of review: February 26, 2008
In short: Will take me a long time to forget those hills!! maybe again tho..Date of review: February 26, 2008
In short: Tough but Fantastic!In full: Once again Pewsey has put on a first class event, this was my first Terminator although I have frequented there 5 mile and half Marathon Races.Although its tough (and that was with good weather this year), the race runs through some glorius countryside and offers you so much more.I ran with some friends and each of us felt exhilerated at the end and will almost definately be back.The marshalls were brilliant and proffessional and the race had a comfortable atmosphere about it from start to finish.As the event appears to be growing, I imagine it wont be long before extra loo's etc are a must given the que's (NB: There were more toilets than people realised by the bag store).Baggage facilities out shone many of the larger races by offering a really rapid service to runners, showers and cafeteria were welcome and essential touches.Well done to Pewsey and all those associated with organising this event.Date of review: February 26, 2008
In short: Great fun, nice scenery, short intense hills with fun downhills.In full: Lot less muddy than last couple of years and weather was good on the day making for a much faster race overall. Usual good marshalling with nice distinctive tee shirt at the end applied. Big thanks to Pewsey for organising such a good event. Date of review: February 25, 2008
In short: its my third and its great !!!!!Date of review: February 25, 2008
In short: This is an excellent, challenging race, well organised & supportedIn full: I did this for the first time last year and decided to give it another bash this year. Those hills don't really get any easier. I though how well organised it was with lots of encouragement from the Marshalls. Date of review: February 25, 2008
In short: Enjoyable and friendly, but toughIn full: Enjoyed this well run race only one slight problem and that was 3 gents and two ladies loos are just not enough for a 1000 entrants maybe portaloos next year?Date of review: February 25, 2008
In short: Fantastic challenge and great hills?!Date of review: February 25, 2008
In short: Lots of fun and a great atmosphereDate of review: February 25, 2008
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This method of writing Scottish Gaelic with Tolkien's Tengwar alphabet was devised by Uilleam Stiùbhart (email@example.com).
Please note: Scottish Gaelic is normally written with the Latin alphabet.
O language that's close to my heart,
My food, my spice, my breath, and my strength,
you are as old as the abundant heather on the hills.
The hills, slopes, and peaks were named by you when they were young.
Gael, you're needing and you're wanting,
like a stringless harp or a vein without blood.
(Verse one of Cànan nan Gàidheal - 'Language of the Gael')
Tengwar for Quenya, Tengwar for Sindarin, Tengwar for English, Tengwar for High Valyrian, Tengwar for Hungarian, Tengwar for Icelandic, Tengwar for Portugese, Tengwar for Scottish Gaelic (1), Tengwar for Scottish Gaelic (2), Tengwar for Spanish, Tengwar for Latin American Spanish, Tengwar for Welsh
Cirth | Sarati | Tengwar for Quenya | Tengwar for Sindarin | Uruk Runes | Quenya phrases | Tolkien-related links | Books about Tolkien's invented languages | Tolkien's books in various languages


text: In this presentation, the presenter talks about different aspects of innovations in Power Delivery & Energy Utilization Sector. The R&D roadmap which provides direction for the portfolio reflecting the core strategies are discussed. Standards and Interoperability, Communications Technology, Security and Privacy, Customer Integration Strategies including Behavior, Communications and Automation etc are mentioned as top R&D challenges.


text: Imagine stretching, posing and meditating while hovering a foot above the ground. Antigravity, or aerial, yoga involves performing standard moves while suspended in a silk hammock. With roots in the circus and aerial arts, this practice is a fun and challenging take on traditional yoga that improves flexibility, strength and agility, all while strengthening core muscles and elongating the spine. Aerial yoga classes are offered in Palm Beach County at Sunshine Circus Arts locations (954-857-6390). All levels of experience are welcome, and students should wear shirts with a sleeve and workout pants that cover the leg.


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all this effort to make the same pie as mack is amazing. especially Pete, never even tried a slice
James,Norma is my "seeing eye dog" so to speak. Unless I am trying to demonstrate a point, I usually prefer to wait until I feel I have succeeded with a clone dough formulation before posting it and discussing it. Typically it is someone else who has to tell me if I succeeded. However, since Norma is the only one who knows the real Mack's pizza, or some other member who is helping out, I am trying to help her to make it to the promised land by posting my results as I achieve them. However, trying to replicate a pizza you have never eaten before or at least seen in person does put your knowledge and research skills and instincts to the test. It is a humbling and sometimes frustrating experience. Peter
what about my other question ? do you have recipe you call your own ?
how to you like the balance of sauce when applied like that ? They said it was done to save time.