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1 " I was once driven north along Central Park, all the way from Chinatown. We hailed the cab in front of a building where Orthodox Jews still lived, so they shut down an elevator on Saturdays. In the taxi, I was with my mother. We were visiting her aunt, my great aunt, who was 93. She had no memory of the old country, Lithuania, but she'd been born there. Her parents escaped the pogroms so she could survived a century here. Her American prosperity was half a century of subsistence wages and thirty years of Medicare in an elevator building. The old country for the cab driver was Bangladesh, and he was a talker. He'd just graduated from college, and his prospects were good. He'd majored in a practical field, network engineering or something like that. Young and optimistic, he spoke fluent English. His big idea was to keep his countrymen out of the United States. America was great, but if he got overrun with foreigners, his kind in particular, it would be ruined. " Bangladesh is hot and crowded. Why would want to make America like that." He said this in all sincerity. "
2 " One quarter of Medicare beneficiaries have five or more chronic conditions, sees an average of 13 physicians each year, and fills 50 prescriptions per year. "
― Clayton M. Christensen , Innovator's Prescription
3 " The phone rang. It was a familiar voice.It was Alan Greenspan. Paul O'Neill had tried to stay in touch with people who had served under Gerald Ford, and he'd been reasonably conscientious about it. Alan Greenspan was the exception. In his case, the effort was constant and purposeful. When Greenspan was the chairman of Ford's Council of Economic Advisers, and O'Neill was number two at OMB, they had become a kind of team. Never social so much. They never talked about families or outside interests. It was all about ideas: Medicare financing or block grants - a concept that O'Neill basically invented to balance federal power and local autonomy - or what was really happening in the economy. It became clear that they thought well together. President Ford used to have them talk about various issues while he listened. After a while, each knew how the other's mind worked, the way married couples do.In the past fifteen years, they'd made a point of meeting every few months. It could be in New York, or Washington, or Pittsburgh. They talked about everything, just as always. Greenspan, O'Neill told a friend, " doesn't have many people who don't want something from him, who will talk straight to him. So that's what we do together - straight talk." O'Neill felt some straight talk coming in." Paul, I'll be blunt. We really need you down here," Greenspan said. " There is a real chance to make lasting changes. We could be a team at the key moment, to do the things we've always talked about." The jocular tone was gone. This was a serious discussion. They digressed into some things they'd " always talked about," especially reforming Medicare and Social Security. For Paul and Alan, the possibility of such bold reinventions bordered on fantasy, but fantasy made real." We have an extraordinary opportunity," Alan said. Paul noticed that he seemed oddly anxious. " Paul, your presence will be an enormous asset in the creation of sensible policy." Sensible policy. This was akin to prayer from Greenspan. O'Neill, not expecting such conviction from his old friend, said little. After a while, he just thanked Alan. He said he always respected his counsel. He said he was thinking hard about it, and he'd call as soon as he decided what to do.The receiver returned to its cradle. He thought about Greenspan. They were young men together in the capital. Alan stayed, became the most noteworthy Federal Reserve Bank chairman in modern history and, arguably the most powerful public official of the past two decades. O'Neill left, led a corporate army, made a fortune, and learned lessons - about how to think and act, about the importance of outcomes - that you can't ever learn in a government.But, he supposed, he'd missed some things. There were always trade-offs. Talking to Alan reminded him of that. Alan and his wife, Andrea Mitchell, White House correspondent for NBC news, lived a fine life. They weren't wealthy like Paul and Nancy. But Alan led a life of highest purpose, a life guided by inquiry.Paul O'Neill picked up the telephone receiver, punched the keypad." It's me," he said, always his opening.He started going into the details of his trip to New York from Washington, but he's not much of a phone talker - Nancy knew that - and the small talk trailed off." I think I'm going to have to do this." She was quiet. " You know what I think," she said.She knew him too well, maybe. How bullheaded he can be, once he decides what's right. How he had loved these last few years as a sovereign, his own man. How badly he was suited to politics, as it was being played. And then there was that other problem: she'd almost always been right about what was best for him." Whatever, Paul. I'm behind you. If you don't do this, I guess you'll always regret it." But it was clearly about what he wanted, what he needed.Paul thanked her. Though somehow a thank-you didn't seem appropriate.And then he realized she was crying. "
4 " She's too young for Medicare and too old for me to care. "