Pay Close Attention To The Insurers Behind Rep Paul Ryan’s Curtain
Democrats who think Paul Ryan and his Republican colleagues have foolishly wrapped their arms around the third rail of American politics by proposing to hand the Medicare program to private insurers will themselves look foolish if they take for granted that the public will always be on their side.
Rep. Ryan’s budget proposal would radically reshape both the Medicare and Medicaid programs. It would turn Medicaid into a block grant, which would give states more discretion over benefits and eligibility. And it would radically redesign Medicare, changing it from what is essentially a government-run, single-payer health plan to one in which people would choose coverage from competing private insurance firms, many of them for-profit.
Poll numbers would seem to give the Democrats the edge in what will undoubtedly be a ferocious debate over the coming months and during the 2012 campaigns. An NBC/Wall Street Journal poll (pdf) conducted February 27-28 showed that 76 percent of Americans considered cuts to Medicare unacceptable. The public is almost as resistant to cutting Medicaid, at least for now: 67 percent of Americans said they found cutting that program unacceptable as well.
According to a story in Politico this week, Democrats “with close ties to the White House” think Ryan has handed them a gift that will keep on giving. They believe the Ryan blueprint will enable them to portray Republicans as both irresponsible and heartless, hellbent on unraveling the social safety net that has protected millions of Americans for decades. That message will be the centerpiece of the Democrats’ advertising and fundraising efforts, unnamed party strategists told Politico.
Perhaps. But know this: Ryan et al would never propose such a fundamental reshaping of those programs unless they were confident that corporate America stands ready to help them sell their ideas to the public. Like big business CEOs, Congressional Republicans wouldn’t think of rolling out Ryan’s budget plan without a carefully-crafted political and communications strategy and the assurance that adequate funding would be available to carry it out.
Republicans know they can rely on health insurance companies — which would attract trillions of taxpayer dollars if Ryan’s dream comes true — to help bankroll a massive campaign to sell the privatization of Medicare to the public.
The Secret Meeting, and the Secret PR Plot
Four years ago, in a secret insurance industry meeting in Philadelphia, I saw numbers that were similar to those in the NBC/Wall Street Journal poll. The industry’s pollster, Bill McInturff of Public Opinion Strategies, told insurance company executives, who had assembled to begin planning a campaign to shape the health care reform debate, that Americans were rapidly losing confidence in the private health insurance market.
For the first time ever, he said, more than 50 percent of Americans believed that the government should do more to solve the many problems that plagued the U.S. health care system. In fact, he said, a fast-growing percentage of Americans were embracing the idea of a government run “Medicare-for-All” type program to replace private insurers.
The executives came to realize at the meeting that the industry’s very survival depended upon the successful execution of a comprehensive campaign to change public attitudes toward private insurers. They needed to convince Americans they “added value” to the health care system, and that what the public should fear would be more government control.
Knowing that a campaign publicly identified with the industry would have little credibility, the executives endorsed a strategy that would use their business and political allies — and front groups — as messengers.
The main front group was Health Care America. It was set up and operated out of the Washington PR firm APCO Worldwide. The first objective was to discredit Michael Moore’s documentary, Sicko, which was about to hit movie screens nationwide. Moore’s film compared the U.S. health care system to those in countries that had “Medicare-for-All” type programs run by governments. The American system, dominated by private insurers, did not fare well in Moore’s cinematic interpretation.
The front group painted Moore as a socialist but also went about the larger task of scaring the public away from “a government takeover of the health care system.” Part of that work involved persuading Americans that any reform bill expanding Medicare or including a “public option” would represent a government takeover.
The industry knew it had to enlist the support of longtime allies such as the U.S. Chamber of Commerce, the National Federation of Independent Business and the National Association of Health Underwriters to repeat the term “government takeover” like a mantra. It also had to get conservative talk show hosts, pundits and politicians to play along. And play along they did. In the debate preceding one key House vote involving a public option, a parade of Republicans took to the floor to repeat the industry’s favorite term: government takeover.
To help make sure the term stuck, America’s Health Insurance Plans (AHIP), the insurers’ lobbying group, funneled $86 million to the Chamber of Commerce to help finance its advertising and PR campaign against any reform legislation that included the public option. It worked like a charm. Polls showed during the course of the debate that public opinion was increasingly turning against the Democrats’ vision of reform. By the time the bill reached President Obama in March 2010, the public option had been stripped out, and public support for reform was well below 50 percent.
“Government Takeover of Health Care”: 2010’s Lie of the Year, Courtesy of Insurers
As a testament to the success of the industry’s campaign, PolitiFact, the St. Petersburg Times’ independent fact-checking website, chose “a government takeover of health care” as its Lie of the Year in 2010. (The 2009 Lie of the Year was the fabrication that the Democrats’ reform bill would create Medicare “death panels.”)
While they were leading the effort to torpedo the public option, the insurers were lobbying hard for a provision in the bill requiring all of us to buy coverage from them if we’re not eligible for a public program like Medicare or Medicaid. They won that round, too. That provision alone will guarantee billions of dollars in revenue the insurers would never have seen had it not been for the bill the president signed.
But even that is not enough for the insurers. For many years, they’ve lobbied quietly for privatization of Medicare, with significant success. They were behind the change in the Medicare program in the 1980s that allowed insurers to offer what are now called “Medicare Advantage” plans. The federal government not only pays private insurers to market and operate these plans, it pays them an 11 percent bonus. That’s right: People enrolled in Medicare Advantage plans cost the taxpayers 11 percent more than people enrolled in the basic Medicare program.
During the Bush administration, the insurers persuaded lawmakers to allow them to administer the new Medicare Part D prescription drug program. That has been a major source of new income for the many big for-profit insurers that participate in the program.
Rest assured that insurers have promised Ryan and his colleagues a massive, industry-financed PR and advertising campaign to support his proposed corporate takeover of Medicare. If Democratic strategists really believe that Ryan has all but guaranteed the GOP’s demise by proposing to shred the social safety net for some of our most vulnerable citizens, they will soon be rudely disabused of that notion. The insurers and their allies have demonstrated time and again that they can persuade Americans to think and act — and vote — against their own best interests.
By: Wendell Potter, Center for Media and Democracy, April 7, 2011
The Democrats Have A Plan For Controlling Health-Care Costs, Paul Ryan Doesn’t
There’s increasingly an understanding that the mixture of cuts and taxes in Paul Ryan’s budget aren’t quite fair, and the underlying assumptions it uses don’t quite work. But it’s left people hungry for a budget that does work, and annoyed that Democrats haven’t provided one. “If Democrats don’t like his budget ideas, they should propose their own,” writes Fareed Zakaria. “The Democrats and Obama now have to offer a response,” warned Andrew Sullivan. “As of this evening, the Democratic policy plan consists of yelling ‘You suck!’” complained Megan McArdle.
I’ve made similar comments. And I think those comments are mostly right. Democrats need to step up on taxes, on defense and non-defense discretionary, on Social Security, and on energy. But there’s one huge, glaring exception: controlling health-care costs. There, the reality is that Democrats have a plan and Ryan doesn’t. But the perception, at this point, is just the opposite.
At the heart of Ryan’s budget are policies tying the federal government’s contribution to Medicare and Medicaid to the rate of inflation — which is far, far slower than costs in the health-care sector typically grow. He achieves those caps through cost shifting. For Medicaid, the states have to figure out how to save the money, and for Medicare, seniors will now be purchasing their own insurance plans and, in their new role as consumers, have to figure out how to save the money. It won’t work, and because it won’t work, Ryan’s savings will not materialize.
Even Ryan’s fans agree you can’t hold health-care costs down to inflation. But even if you grant that Ryan’s target is too low, his vision for reforming Medicare would like miss a more reasonabke target, too. Consider the program Ryan names as a model. He said his budget converts Medicare into “the same kind of health-care program that members of Congress enjoy.” The system he’s referring to is the Federal Employee’s Health Benefits Program, and cost growth there has not only massively outpaced inflation in recent years, but actually outpaced Medicare, too. Ryan’s numbers are so fantastic that Alice Rivlin, who originally had her name on this proposal, now opposes it.
Democrats don’t just have a proposal that offers a more plausible vision of cost control than Ryan does. They have an honest-to-goodness law. The Affordable Care Act sets more achievable targets, and offers a host of more plausible ways to reach them, than anything in Ryan’s budget. “If this is a competition betweenRyan and the Affordable Care Act on realistic approaches to curbing the growth of spending,” says Robert Reischauer, who ran the Congressional Budget Office from 1989 to 1995 and now directs the Urban Institute, “the Affordable Care Act gets five points and Ryan gets zero.”
The Affordable Care Act holds Medicare’s cost growth to GDP plus one percentage point, which makes a lot more sense. It’s the target Ryan’s Medicare plan originally used, back when it was called Ryan-Rivlin. But the target is not really the important part. The important part is how you achieve the target. And the Affordable Care Act actually includes reforms and new processes for future reforms that would help Medicare — and the rest of the medical system — get to where the costs can be saved, rather than just shifted.
The Affordable Care Act’s central hope is that Medicare can lead the health-care system to pay for value, cut down on overtreatment, and cut out treatments that simply don’t work. The law develops Accountable Care Organizations, in which Medicare pays one provider to coordinate all of your care successfully, rather than paying many doctors and providers to add to your care no matter the cost or outcome, as is the current practice. It also begins experimenting with bundled payments, in which Medicare pays one lump-sum for all care related to the successful treatment of a condition rather than paying for every piece of care separately. To help these reforms succeed, and to help all doctors make more cost-effective treatment decisions, the law accelerates research on which drugs and treatments are most effective, and creates and funds the Patient-Centered Outcomes Research Institute to disseminate the data.
If those initiatives work, they head over to the Independent Payment Advisory Board (IPAB), which can implement cost-controlling reforms across Medicare without congressional approval — an effort to make continuous reform the default for Medicare, even if Congress is gridlocked or focused on other matters. And if they don’t work, then it’s up to the Center for Medicare and Medicaid Innovation, a funded body that will be continually testing payment and practice reforms, to keep searching and experimenting, and when it hits on successful ideas, handing them to the IPAB to implement throughout the system.
The law also goes after bad and wasted care: It cuts payments to hospitals with high rates of re-admission, as that tends to signal care isn’t being delivered well, or isn’t being follow up on effectively. It cuts payments to hospitals for care related to infections caught in the hospitals. It develops new plans to help Medicare base its purchasing decisions on value, and new programs to help Medicaid move patients with chronic illnesses into systems that rely on the sort of maintenance-based care that’s been shown to successfully lower costs and improve outcomes.
I could go on, but instead, I’ll just link to the Kaiser Family Foundation’s excellent primer (pdf) on everything the law does. The bottom line is this: The Affordable Care Act is actually doing the hard work of reforming the health-care system that’s needed to make cost control possible. Ryan’s budget just makes seniors pay more for their Medicare and choose their own plans — worthy ideas, you can argue, but ideas that have been tried many times before, and that have never cut costs in the way Ryan’s budget suggests they will.
That’s why, when the Congressional Budget Office looked at Ryan’s plan, they said it would make Medicare more expensive for seniors, not less. The reason the deficit goes down is because seniors are paying 70 percent of the cost of their insurance out-of-pocket rather than 30 percent. But that’s not sustainable: We’ve just taken the government’s medical-costs problem and pushed it onto families.
No one who knows health-care policy will tell you that the Affordable Care Act does everything we need to do in exactly the way we need it done. That’s why Resichauer gave it a five, not a 10. But it does a lot of what we need to do and it sets up systems to help us continue doing what’s needed in the future.
Ryan’s proposal, by contrast, does almost none of what we need to do. It appeals to people who have an ideological take on health-care reform and believe we can make Medicare cheaper by handing it over to private insurers and telling seniors to act like consumers. It’s a plan that suggests health-care costs are about insurance, as opposed to about health care. There’s precious little evidence of that, and when added to the fact that Ryan’s targets are so low that even his allies can’t defend them, the reality is that his savings are largely an illusion.
The Affordable Care Act has taken a lot of hits. It’s not popular, and though very few of the political actors confidently attacking or advocating it can explain the many things it’s doing to try and control costs, people have very strong opinions on whether it will succeed at controlling costs. But the irony of everyone demanding Democrats come up with a vision for addressing the drivers of our deficit in the years to come is that, on the central driver of costs and the central element of Ryan’s budget, Democrats actually have something better than a vision. They have a law, and for all its flaws, their law actually makes some sense. Republicans don’t have a law, and their vision, at this point, doesn’t make any sense at all.
By: Ezra Klein, The Washington Post, April 8, 2011
“Revere America”: Another Conduit For A Super-Wealthy Family To Influence Elections
On March 23, 2011 a group called Revere America issued a dire-sounding PRNewswire press release titled, “Americans Fear Loss of Freedom on Anniversary of Health Care Reform Law.” It warned that “a majority” of Americans view health care reform as “a threat to their freedom” and cited a poll by Bill McInturff of Public Opinion Strategies to prove it. The release came well after Revere America had spent $2.5 million on attack ads in the 2010 mid-term elections to defeat Democratic candidates in two states — New York and New Hampshire — who had voted in favor of health care reform. Just prior to the mid-term elections, in the autumn of 2010, Revere America ran a a slew of false and misleading attack ads against the health care reform bill that erroneously called health reform “government-run healthcare” (a Republican and insurance industry buzz-phrase). The ads said that the new law will result in higher costs and longer waits in doctors’ offices. In another false claim aimed at inducing fear, the ads told viewers that “your right to keep your own doctor may be taken away.”
But who, or what, is Revere America? And how did it pull together enough money in less than a year to run a multi-million-dollar attack ad campaign, engage an expensive, professional polling firm and pump their message out on PRNewswire?
“Revere America”: Another Veil for a Wealthy Family
Revere America (RA) is a Delaware-based advocacy organization that sprang up in April, 2010. Like so many similar groups springing up after the Supreme Court’s ruling in Citizens United, RA is set up in a way that allows it to accept corporate donations, and that keeps it from having to reveal its funders. RA’s titular head at the time of its startup was former New York Governor George Pataki. The group pushes to repeal health reform, also known as the Patient Protection and Affordable Care Act, which Pataki described a “horrific” and “costly bungle.” Donations to RA are not tax deductible, which would seem to make donating huge sums of money to the group less attractive to large numbers of people if it was a real grassroots group made up of ordinary people.
The Collier’s Hamilton Yacht ClubBut it turns out that Revere America is not made up of ordinary people, and its primary funder isn’t all that concerned about money. According to Citizens for Responsibility and Ethics in Washington (CREW) and other sources, Revere America’s primary funder is Parker J. Collier of Naples, Florida, the wife of Miles Collier, a wealthy Florida land baron and real estate developer. Ms. Collier has given half a million dollars to the Republican Party of Florida, $60,800 to the Republican National Committee, and gave an overall total of $1,239,014 to Republican interests — and that was just in 2009-2010.
The Collier money flowing towards Republicans and Revere America is old family money. Parker’s husband, Miles Collier, is the grandson of Barron Collier, who bought over a million acres in south Florida in the early 1900s, and after whom Collier County, Florida is named. Through their company, Collier Enterprises, the Colliers develop tony yacht, golf and members-only country clubs in southwest Florida, where the rich play, dine and sail. In recent years, Collier Enterprises has even been developing entire towns in Florida.
Influencing Elections Throughout the U.S.
The Collier’s private, members-only golf clubFor the Colliers, though, it apparently isn’t enough to have all the amenities of uber-wealth. Through Revere America, the family’s apparent political front group, the Colliers have also been using their money to influence elections throughout the rest of the country. They have financially supported far-right Republican candidates not only in New York and New Hampshire, but in many other states, including Michele Bachmann (R-Minnesota), Senator Scott Brown (R-Massachusetts), and Republican Sue Lowden in her failed primary bid to gain the Senate nomination in Nevada, to name just a few. The list of Republican candidates RA funded and Democrats they worked to defeat in the 2010 election cycle numbers over 100, with some elections meriting six figure donations — amounts that far exceed what individuals can legally donate to influence an election.
The professional Republican pollster doing work for RA, Bill McInturff, conducted the message and advertisement testing for the infamous “Harry and Louise” television commercials that helped defeat the Clinton-era health care reform effort. Some of McInturf’s other clients include insurer Blue Cross Blue Shield Association, America’s Health Insurance Plans (the health insurance industry’s lobbying group) and drug maker Pfizer — all of which have a stake in undermining health care reform.
Pataki resigned as RA’s chairman in February, 2011, citing a Florida judge’s ruling the same month that the new health reform law’s federal mandate to purchase health insurance is unconstitutional. Pataki cited this ruling, and the House of Representatives’ symbolic vote to repeal health reform, as creating a good time for him to step down, and as proof that RA had been “successfully launched.” RA’s spokesperson and president is now Florida attorney Marianne R.P. Zuk, who is listed in Florida incorporation records as an officer or director for several Collier-owned companies.
Revere America is a “grassroots group” for the uber-wealthy Collier family in the same way that Americans for Prosperity is a “grassroots” group for the uber-wealthy Koch brothers. Such groups are conduits through which the super-rich are increasingly exerting powerful influence over elections nationwide. RA is yet another group that demonstrates the growing trend in which the wealthiest Americans — in the forms of both human beings and corporations — use their money to create fake “grassroots” front groups to hide behind and influence elections across the U.S.
Be on the look out for many more such groups to crop up in the future as the richest one or two percent of U.S. citizens come under increasing pressure to pay their fair share of taxes, and as we move closer to the 2012 elections.
By: Anne Landman, Center for Media and Democracy, April 8, 2011
Government Shutdown: It’s Not Really About Spending
If the federal government shuts down at midnight on Friday — which seems likely unless negotiations take a sudden turn toward rationality — it will not be because of disagreements over spending. It will be because Republicans are refusing to budge on these ideological demands:
• No federal financing for Planned Parenthood because it performs abortions. Instead, state administration of federal family planning funds, which means that Republican governors and legislatures will not spend them.
• No local financing for abortion services in the District of Columbia.
• No foreign aid to countries that might use the money for abortion or family planning. And no aid to the United Nations Population Fund, which supports family-planning services.
• No regulation of greenhouse gases by the Environmental Protection Agency.
• No funds for health care reform or the new consumer protection bureau established in the wake of the financial collapse.
Abortion. Environmental protection. Health care. Nothing to do with jobs or the economy; instead, all the hoary greatest hits of the Republican Party, only this time it has the power to wreak national havoc: furloughing 800,000 federal workers, suspending paychecks for soldiers and punishing millions of Americans who will have to wait for tax refunds, Social Security applications, small-business loans, and even most city services in Washington. The damage to a brittle economy will be substantial.
Democrats have already gone much too far in giving in to the House demands for spending cuts. The $33 billion that they have agreed to cut will pull an enormous amount of money from the economy at exactly the wrong time, and will damage dozens of vital programs.
But it turns out that all those excessive cuts they volunteered were worth far less to the Republicans than the policy riders that are the real holdup to a deal. After President Obama appeared on television late Wednesday night to urge the two sides to keep talking, negotiators say, the issue of the spending cuts barely even came up. All the talk was about the abortion demands and the other issues.
Democrats in the White House and the Senate say they will not give in to this policy extortion, and we hope they do not weaken. These issues have no place in a stopgap spending bill a few minutes from midnight.
A measure to prohibit the Environmental Protection Agency from regulating greenhouse gas emissions came up for a Senate vote on Wednesday and failed. If Republicans want to have yet another legislative debate about abortion and family planning, let them try to pass a separate bill containing their restrictions. But that bill would fail, too, and they know it, so they have chosen extortion.
The lack of seriousness in the House is reflected in the taunting bill it passed on Thursday to keep the government open for another week at an absurdly high cost of $12 billion in cuts and the ban on District of Columbia abortion financing. The Senate and the White House said it was a nonstarter. Many of the same House members who earlier had said they would refuse to approve another short-term spending bill voted for this one, clearly hoping they could use its inevitable failure in the Senate to blame the Democrats for the shutdown. What could be more cynical?
The public is not going to be fooled once it sees what the Republicans, pushed by Tea Party members, were really holding out for. There are a few hours left to stop this dangerous game, and for the Republicans to start doing their job, which, if they’ve forgotten, is to serve the American people.
By: Editorial, The New York Times, April 8, 2011
In This Fantasy Budget Deficit And Debt Fight, the Tea Party Refuses To Take ‘Yes’ For An Answer
Suppose I told you that I knew of a simple way to alleviate the budget deficit problem, and that it would require Congress not to do anything at all. You’d conclude that this was the poor start to a late April Fools’ column.
But unhappily the April Fools’ joke unfolding in the nation’s capital is the fantasy budget and spending debate itself. It’s rooted in an unreality that is about to crash into an unyielding real world, possibly in the form of a government shutdown.
The Congressional Budget Office, a nonpartisan fiscal scorekeeper, projects the budget deficit will be $1.5 trillion this year, or 9.8 percent of gross domestic product. In order to achieve budget stability and sustainability, according to economists, that figure should be around 3 percent of GDP. But here’s the good news: The CBO projects that the deficit will “drop markedly over the next few years as a share of output and average 3.1 percent of GDP from 2014 to 2021.” We’re saved! And it gets better: “Those projections . . . are based on the assumption that tax and spending policies unfold as specified in current law.”
In other words, all Congress has to do is what they seem ideally suited to these days—nothing. Ah, but there’s the rub. CBO continues that its projections “understate the budget deficits that would occur if many policies currently in place were continued, rather than allowed to expire as scheduled under current law.” Those policies include the Bush tax cuts. They also include annual spending punts that enjoy broad bipartisan support, like preventing the Alternative Minimum Tax’s bracket creep from snagging the middle class, and the “doc fix,” which pushes back a scheduled cut in Medicare payments.
So the solution isn’t so simple. But lawmakers wishing to do more than talk about dealing with the deficit could demand offsets for these policy changes. Instead, we’re reminded of the reality that even the toughest self-styled budget hawks–including Budget Committee Chairman Paul Ryan, who describes dealing with the deficit as a “moral imperative” but advocates extending the Bush tax cuts in full in perpetuity at a cost of nearly $4 trillion–are actually strutting budget peacocks more concerned with perception than results, or fiscal results anyway.
Take, for example, the Republican Study Committee, the hawkiest of the GOP budgetary birds of prey and enforcers of the party’s economic dogma. Going by reputation, they should be able to proffer a budget plan to bring the deficit into line. But the Concord Coalition, a group focused on eliminating the deficit, last month used CBO numbers to examine a scenario under which the Study Committee got its tax-and-spending wish list, which includes an extension of the Bush tax cuts, repeal of the Obama healthcare law (which CBO scores as a money-saver, meaning that repeal adds to the deficit), and $2.7 trillion saved in a spending freeze and cuts. The result? “Under this scenario, the resulting deficits would be $2.1 trillion larger over 10 years,” according to Concord, which concludes, “A budget that uses honest numbers and reflects Republicans’ current policy preferences will result in large continuing deficits.”
But nevertheless, and in the face of six recent years of GOP control over both the White House and Congress, Republicans have won the budget perception battle, and soundly. A poll released last week by Democracy Corps, a group of prominent liberal pollsters including Stan Greenberg and James Carville, found that independent voters are “still hesitant to trust Democrats on spending.”
Meanwhile the debate in Washington has focused almost entirely on spending cuts, even though polls show that voters are more concerned about jobs and the economy than the budget and the deficit—and even though most economists agree that the GOP’s proposed spending cuts would set back the recovery.
But the clearest example of the GOP having the Democrats on the run can be found in the current negotiations aimed at averting a government shutdown in a week. House Republican leaders originally wanted $32 billion in spending cuts for this year; that figure prompted a conservative backlash that ended with the House passing $61 billion in cuts. Now, according to press reports, negotiators have settled on $33 billion in cuts. In other words, the GOP, which controls one of three players in this negotiation, has already achieved its original budgetary goal. In this regard, House Speaker John Boehner seems to have (intentionally or not) used his Tea Party wing as a perfect foil to pull the debate to the right.
But judging by last Thursday’s Tea Party demonstration on the Hill—aimed at the GOP, mind you—conservatives don’t seem capable of banking their win and moving on to the next fight. They see anything less than total victory as an abject surrender.
And in that sense reality is about to intrude upon their budgetary-political fantasy land. The reality is that while voters like spending cuts in the abstract, polls show they object to the particulars of the GOP agenda. That reality is already taking hold at the state level where, Politico reported last week, the wave of newly elected governors trying to get tough on budgets have seen their approval ratings collapse.
And the experience of state governments also provides an insight into the possible winners and losers in a government shutdown. A pair of political scientists published a paper last year looking at the effects of such budgetary breakdowns (167 of them since 1988) at the state level, reports the Washington Post’s Ezra Klein. The study found that voters tend to punish legislators while rewarding the executive. So a shutdown would benefit President Obama while hurting lawmakers in both parties.
So if members of Congress let the government shut down on Friday, they will be the real April fools.
By: Robert Schlesinger, U.S. News and World Report, April 6, 2011
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