Thursday, December 11, 2014





This afternoon, Senator Robert Menendez declared, "I know some may see this as limiting but at the end of the day, Americans will not be supportive of an authorization of an endless war."

He was speaking at the Senate Foreign Relations Committee  hearing on the Islamic State and the administration's lack of authorization of force, from Congress, to conduct the current bombings taking place in Iraq.  Secretary of State John Kerry was appearing before the Committee "to provide the administration's views," as Committee Chair Robert Mendendez explained.

But he appeared to believe he was elsewhere -- possibly on a parade float?

Kerry was looking around, grinning and waving.

As Menendez declared Americans would not "be supportive of an authorization of an endless war."

As Menendez declared, "They do not want us to occupy Iraq for decades."

Has John Kerry morphed into Johnny Kardashian?

"I think the American people expect their Congressional leaders to engage fully on this issue," Chair Menendez  said as Kerry all but pulled out a compact and mirror

AUMF is the "Authorization of the Use of Military Force."  ISIL is one of the names tossed around for the Islamic State.  With that in mind, we'll note these remarks from the hearing.

Chair Robert Menendez:  Well thank you, Mr. Secretary, let me just say there is I think undoubtedly and I'll let members express themselves, there is a bold bipartisan view that we need to defeat ISIL and I think there is no debate about that.  And virtually every political element from the spectrum those who might be considered dovish to those who might be considered hawkish -- and everybody in between -- I think, has a common collective goal of defeating ISIL.  Now I must say that the administration has not sent us -- five, six months into  this engagement -- an AUMF.  And had the administration sent us an AUMF maybe we would be better versed as to what the administration seeks or does not seek and that would be the subject of Congressional debate.  But that has not happened. And with reference to my distinguished Ranking Member's comments?  You know, if we wait for that and it's not forthcoming by this or any other administration then the absence of getting an AUMF from the executive branch and Congress not acting because it's waiting for an AUMF from the executive branch would in essence create a de facto veto of the Constitutional prerogatives and responsibilities that the Congress has.  And so, there are many of us on the Committee who, in the absence of receiving a AUMF for the purposes of understanding the administration's views felt that it is Congress' responsibility to move forward and define it.  Now no one has worked harder in the last two years as a chairman of this Committee to make this a bipartisan effort not just on the AUMF but across the spectrum.  And I'm proud to say that we have -- working with the Ranking Member, we have virually passed out every major legislation on some of the critical issues of our time from the AUMF on Syria and the use of chemical weapons to OES reform to Kor -- to North Korea to Iran -- On a whole host of issues, we have been bipartisan.  Virtually ever nomination except for three -- of hundreds -- have largely been on a bipartisan basis.  So there's no one who has striven harder in this process.  But there are some principled views here that may not be reconcilable.  And it starts with when the administration itself -- and I think you've reiterated what you've said -- earlier in your previous visit here that the president has been clear that his policy that the United States military forces will not be deployed to conduct ground combat operations ISIL.  That it will be the responsibility of local forces because that's what our local partners and allies want.  What is best for preserving our coalition and most importantly what is in the best interests of the United States.  Now there are those members of the Committee and the Congress who have a much different view than that.  They would have a very robust and open ended -- uhhhhh-- use of combat forces in this regard.  And if the administration wants that then it should come forth and ask for that.

Menendez was speaking after Kerry finished reading his opening statement.

Combat forces?

The Chair must have been mistaken, right?

Surely the White House doesn't want US forces in combat on the ground in Iraq, right?

Kerry, reading from his opening statement:

On the issue of combat operations, I know that this is hotly debated, with passionate and persuasive arguments on both sides. The President has been clear that his policy is that U.S. military forces will not be deployed to conduct ground combat operations against ISIL. That will be the responsibility of local forces because that is what our local partners and allies want, what is best for preserving our Coalition and, most importantly, what is in the best interest of the United States . However, while we certainly believe this is the soundest policy, and while the president has been clear he's open to clarifications on the use of U.S. combat troops to be outlined in an AUMF, that does not mean we should pre-emptively bind the hands of the commander in chief oo  or our commanders in the field -- in responding to scenarios and contingencies that are impossible to foresee. 

If you found Kerry confusing, you weren't the only one.

Secretary John Kerry:  Let me try to help you a little bit on this.

Ranking Member Bob Corker:  Well help me this way:  Are you going to ever explicitly seek an authorization from Congress?

Secretary John Kerry:  We're seeking authorization now.  With respect to  --

Ranking Member Bob Corker:  So you are.  And if you didn't receive the authoirzation, will you continue the operation?  That's a --

Secretary John Kerry:  The authorization for what we're doing nowin both Iraq and Syria?

Ranking Member Bob Corker:  That's correct.

Secretary John Kerry:  Absolutely we will continue it because we believe we have full authority under the 2001 AUMF and parts of the 2002 AUMF but here's where I want to help you.

Ranking Member Bob Corker:  Good.

Secretary John Kerry:  If Congress passes a new Dash specific AUMF we will support the inclusion of language in the AUMF that will clarify that the Dash specific AUMF rather than the 2001 AUMF is the basis for military force.  And I think that will give comfort to a lot of people.  Second, we will also support the repeal of the 2002 AUMF as part of an effort to clarify the ISIL specific AUMF would be the only source of legitimacy for the use of military force against Dash and therefore we would live under the confines of what we pass here.

John wants to play like Congress is confused.

No, the senators knew what they were talking about.

US President Barack Obama told the American people no US troops would be on the ground in combat.

He made that promise.

And now they want to change it.

Throughout the hearing, Kerry repeatedly insisted that the use of ground troops needed to be put into the AUMF.  Such as when he insisted, "It does not mean we should pre-emptively bind the hands of the commander-in-chief or our commanders in the field in responding to scenarios and contingencies that are impossible to foresee."

If refusing to send US troops into combat on the ground in Iraq would "bind the hands" of anyone then maybe that needs to be taken up with Barack Obama who is the one who made the promise.

In fact, when he did, there was criticism from some member of Congress -- mainly Republicans -- that he had tipped his hand, let the enemy know how far he'd go.

If Barack wants to take back his promise, the coward needs to stand before the American people and make that announcement.

Congress should not provide him cover to break his promises, cover to lie.

RECOMMENDED:  "Iraq snapshot"

Wednesday, December 10, 2014





The Democrats lost control of the Senate in the November mid-term elections.  Mary Landrieu was forced into a run-off which she lost to her Republican opponent over the weekend.

When the new Congress is sworn in next month, Republicans will control the Senate (and they remain in control of the House of Representatives).  Community member Brandon wanted to know if I could score the outgoing Chair of the Senate Veterans Affairs Committee?


It's Bernie Sanders.  He is not a Democrat.  He votes with Democrats (way too often for someone supposedly opposed to corporate control of the Congress) and is often referred to as an "independent" but as Laura Flanders noted the night he was elected to the Senate (in 2006), she doesn't want to hear anyone calling him an independent because he is a Socialist.

He will not be Chair in the next session, a Republican will be.

Sanders as Chair was a disappointment.

If you're a third party, you need to be better than good because there are so few of you.

But Sanders wasn't even good.

His pet issue was non-traditional medicine.

And no one ever forgot it.

That's not what you do as Chair.

That he would advance, for example, acupuncture was not a surprise.

That he would be unable to set aside his pet issues when a scandal emerged?

That's appalling.

But that's exactly what happened and exactly why he lost the support of veterans.

He refused to allow a hearing that was scheduled as the scandal of the VA keeping 'official' lists and secret lists emerged to acknowledge that scandal and insisted that if this was indeed a real scandal he would be the one to lead on this and the Committee would lead on it and blah, blah, blah.

Reality: It was a real scandal.

Reality: The Committee never dealt with it in a hearing.

Over in the House, they did.

Not in the Senate.

Then there's VA Secretary Eric Shinseki whose tenure was one scandal after another -- usually one of his own making.

And when he had lost the confidence of veterans, there was Sanders prattling on about how it was too soon . . .

I think President Barack Obama realized he had to ask Shinseki to resign before Sanders ever grasped their might be a serious problem here.

I spoke with veterans last week as I attended two Senate Veterans Affairs Committee hearings -- two.

What was Sanders' sudden interest, everyone wanted to know?  He held very few hearings which became even more noticeable when the scandals kept breaking.

Last Thursday may have been his final hearing as Chair (until the next election cycle).

If so, he went out looking like a huge disappointment.

The hearing was on the nomination of Leigh A. Bradley to be the General Counsel for the VA. In 1998, when she was nominated to the same post by then-President Bill Clinton, the post was described this way, "The General Counsel serves as the chief legal officer of the Department of Veterans Affairs and is responsible for the interpretation of all laws affecting the department and for the review of all regulations implementing such laws. The General Counsel directs the legal, litigative and legislative activities of the department, provides legal advice and assistance to the Secretary of Veterans' Affairs and represents the Secretary in Congressional committee and other hearings and in interdepartmental conferences on legislative matters."

Chair Bernie Sanders showed up late for the hearing and noted there were impending votes.

Chair Sanders had Bradley stand and swore her in -- something we support doing for all witnesses who come before Congress.

She then began reading from her prepared statement.

Leigh Bradley:  We'll Chairman Sanders, Ranking Member [Richard Burr is the Ranking Member and was listed as such in her written statement, in the hearing Johnny Isakson acted as Ranking Member and she acknowledged him verbally], Distinguished Members of the Committee on Veterans’ Affairs, thank you for the opportunity to testify before you today. I am humbled and honored to have been nominated by President Obama to be VA General Counsel, and grateful to Secretary McDonald, and Deputy Secretary Gibson for their confidence in me. Mr. Chairman, from the start of my legal career in 1987 as an active-duty Air Force Judge Advocate to my present position as Director of the Department of Defense  Standards of Conduct Office, I have been guided by a deep and personal commitment to our nation’s Armed Forces and its Veterans. I come from a long, proud line of military Veterans. My father is a Vietnam Veteran who served as a career officer in the Army Corps of Engineers. Both of my grandfathers served in the U.S. Army--one in World War I and the other in World War II. My husband served for 20 years as an Air Force Judge Advocate, and my brother-in-law currently serves as an Air Force B-1 Weapons Systems Operator. Finally, and I say this with great joy and pride, my daughter has decided to follow in the family’s footsteps. She is a 2nd Lieutenant in the Air Force, studying to be a doctor at the Uniformed Services University of the Health Sciences at Walter Reed. I am immensely proud of her decision to continue our family’s tradition of service in uniform. I have spent the majority of my legal career supporting the mission of the Armed Forces and the needs of our nation’s Veterans. After five years on active duty, I was selected for a civilian position in the DoD Office of the General Counsel. Later, I served as the Principal Deputy General Counsel of the Navy, the second highest ranking civilian attorney in an office of over 600. In 1998, I was nominated by President Clinton and confirmed by the Senate to be General Counsel of the Department of Veterans Affairs. And in my current position, I advise the senior DoD leadership on ethical compliance and creating and sustaining ethical cultures across the Department.

[. . .]
Of late, however, VA has not fully met its responsibilities and obligations to Veterans, and we must make restoring their trust our top priority. To quote Secretary McDonald, “the seriousness of this moment demands urgent action.” I am deeply inspired by the dedication, vision, and leadership of Secretary McDonald and Deputy Secretary Gibson. While this is a challenging time at VA, it is also an exciting and transformative time in which the leaders of the Department, in cooperation with Congress, Veterans Service Organizations, and other Veterans’ stakeholders can collaborate to reform and improve services to Veterans. Yes, there is hard work to be done. But for me, there can be no higher calling than to be part of this historic moment which will have lasting, positive impacts on the care and benefits we deliver to Veterans and the way VA operates going forward. Accordingly, if confirmed, I will work closely with the VA leadership team to strengthen the Department’s ability to serve our nation’s Veterans and restore trust with them, with Congress, and with the American public. I will do all in my power to provide thoughtful, expert advice and counsel on all legal matters including those associated with the implementation of both the Veterans Choice Act and MyVA (the Secretary’s ground-breaking initiative to bring a singular focus on customer service to Veterans), improving access to medical care, better delivery of other VA services and benefits, protecting the rights of whistleblowers, and helping to ensure that the processes to hold employees accountable for wrong-doing are expedient, fair, and defensible. I will do this by exemplifying VA’s core ethical values of integrity, commitment, advocacy, respect, and excellence. 

Half-way into the year, Leigh Bradley was named special counsel to (then acting) VA Secretary Sloan D. Gibson.  "On loan from DOD's Standards of Conduct Office" as Leo Shane III noted July 2nd.

That position was supposed to be a temporary assignment for her and the understanding was she would return to the Defense Dept.  So one question for her at the hearing might be about that.

I'm sorry.

Questions for a witness?

Not in Bernie's world.

This is a transcript of what followed when Leigh Bradley stopped stop reading her statement.

Chair Bernie Sanders: We thank you very much for your statement.  You and I chatted yesterday and I am strongly supportive of the nomination and you answered my questions yesterday.  Mr. Isackson?

Senator Johnny Isakson:  Thank you, Mr. Chairman, and I too met yesterday with Ms. Bradley and we had a wonderful meeting and I want the record to reflect this is one Georgia Bull Dog that's going to pull for an Alabama Roll Tide, Crimson Tide lady in the fall game coming up pretty soon.  Good luck this weekend.  Mr. Chairman, I told Leigh this is probably the most important appointment in the VA other than the Secretary themselves.  And the implementation of the Veterans Choice Act is going to require an awful lot of work from legal counsel to support the Secretary in whatever disciplinary action he takes as well as expedite the review process in cases that are appealed because we're getting more and more disability determinations coming out faster and faster which means we're going to have a higher and higher volume of appeals which means legal counsel is going to be under the gun.  We want to be supportive of you.  We want to streamline that process as much as possible.  We have a two-year window of opportunity to make the VA the best VA in the world and we want to make that happen.  And you're a key part of that. I'm very supportive of your nomination.  Appreciate your willingness to accept the job.  And I really have no questions for [her], Mr. Chair.

Chair Bernie Sanders:  Thank you very much, Mr. Isakson.  Ms. Bradley, thank you very much for your willingness to serve.  As Senator Isakson indicated, the position is enormously important.  We're seeing transition in the VA right now but I'm confident you're going to do a great job for us.  Okay.  And with that, if there are no other comments -- Okay?  Okay.

Leigh Bradley:  Thank you both.

Chair Bernie Sanders: This hearing is adjourned.

That was the entire hearing.

And it goes to how awful a Chair Bernie Sanders has been.

The position is important, the one Leigh Bradley is up for.

It's a shame the hearing couldn't have treated it as such.

And I'm sorry but I thought Socialists in the US led the call for transparency?

Where was the transparency in that hearing?

Bernie and Johnny going on about how they had spoken with the witness the day before?

Well good for them but did those conversations mean that there was no reason to have a conversation for the record?  No reason to question a witness publicly?

What was the point -- besides wasting time -- in having the witness sworn in if no one was going to ask her one damn question?

And with all the scandals in the VA, let's grasp that a lot of them happened because of people in positions of power.  No one thought this person or that would be inept or worse. 

Hopefully, Leigh Bradley will be a huge success.

But with the problem in the VA, the Committee was required to ask questions.

They failed.

Veterans around the country have interest in this appointment and were looking to how the nominee would respond under questions.

But a candy ass, poorly led Committee refused to do its job.

This is the typical nonsense that has taken place over and over under Bernie Sanders' leadership. 

There was never time, while he was Chair, to address serious issues or problems.

There was always time to explore acupuncture and other holistic medicines.

That's really all he ever made time for.

We're all so very sorry for Chair Sanders and the Committee that they were put out, that they're valuable time was shortened with the expectation that they'd do their damn job and hold a real hearing on a top post at the VA.

Going through the motions, that's all Bernie Sanders offered during his time as Chair of the Committee.

RECOMMENDED: "Iraq snapshot"

Sunday, December 07, 2014




"It is estimated that the VA will spend $1.3 billion over the next two years just on this hepatitis C treatment," Senator Mazie Hirono declared at Wednesday's Senate Veterans Affairs Committee. 

The issue was hepatitis C in the veterans community.  And it was one of two hearings the Senate committee held this week in the final month of the Committee.  Next January, new senators take office and the Senate will be under Republican control.  Longterm Ranking Member Richard Burr should transition over to Committee Chair with current Chair Bernie Sanders transferring to Ranking Member. 

Democrats have controlled the Senate since the results of the November 2006 mid-terms.

During that time, Daniel Akaka and Patty Murray have been Committee Chair and now Vermont's Bernie Sanders.

A very wealthy corporation, Giliad, is getting extremely rich off the price of medications.  They refused to attend the hearing,

Committee Chair Bernie Sanders:  Prior to the developments of the new drugs from Giliad, the primary method for treating Hepatitis C was interferon -- an injectible medicine that has many side effects that are terribly painful for many patients.  Additionally, many patients required additional intervention including liver transplants.  These treatments were expensive.  According to research by Dr. John Gaetano of the University of Chicago who has special expertise in hepatitis, it is estimated the costs for a person with liver damage over a ten year period can exceed $270,000 and the average liver transplant in 2011 cost $577,100.  This brings us to the purpose of today's hearing -- the new treatments for Hepatitis C now on the market and the exorbitant price tag associated with them.  Gilead, the manufacturer of Sovaldi, is selling the drug at an astounding price of $84,000 for a twelve-week course of treatment, or about $1,000 per pill.  I had invited Gilead to testify today.  I had hoped they could share their perspective on the cost of their new hepatitis C drugs.  Maybe they could have explained to this Committee why they believe their pricing is fair and reasonable.  But unfortunately they declined our invitation because all of their executives who could have spoken on this issue are traveling internationally.  Just like any for-profit company, drug companies charge what they think the market will bear.  Gilead clearly made the calculation that they could charge excessive prices for this groundbreaking drug and that the federal government would pay.  And I get it -- companies are motivated to make a profit.  But Gilead is making profits in spades.  They purchased Pharmasset -- the original developers of Sovaldi -- for $11 billion and, according to some estimates, are expected to make more than $200 billion on the sales of the drug.  With numbers like these, we're not talking about a company looking to make ends meet -- or even fund their next great medical breakthrough.  So we must ask, how much is too much?

The issue of cost was at the heart of the hearing which consisted of two panels. The first panel was composed of the VA's Chief Consultant on Pharmacy Benefits Michael Valentino and the Director of HIV, Hepatitis C and Public Health Pathogens Programs Dr. David Ross.  The second panel was the president of Public Citizen Robert Weissman and the National Coalition on Health Care president John Rother.

Senator Hirono insisted the current spending on hepatitis C was "not sustainable.  It will strain VA resources at a time when veterans are increasing in number and complexity of conditions."

Her concerns included that hepatitis C was "three times higher" in the veteran population than in "the general population" and that "many people infected are unaware that they have it."  She also noted that 35 patients at Hawai's VA -- Hirono's home state -- have benefited from the new treatments.

But the new treatments, from Giliad, are very expensive.

Chair Bernie Sanders: Very interestingly, and maybe we can explore this in the second panel, Giliad is making this drug available to countries like Egypt which have a very serious problem with hepatitis C, my understanding and please correct me if I'm wrong, that they are selling -- in this country, they are selling the product for $1000 a pill, in Egypt it is a few dollars a pill. Is that correct?  Do you know anything about that?

Dr Michael Valentino: I personally don't.  Dr. Ross might.

Chair Bernie Sanders: Dr. Ross, are you aware of that?

Dr. David Ross: I-I --

Chair Bernie Sanders: My understanding is it's ten dollars a pill.

Dr. David Ross:  I-I couldn't speak to the specifics of that.

Chair Bernie Sanders: Okay, we'll get more into that in the second panel.  Why do you think it's the case that they're selling it to a general American consumer who walks in for a thousand, they're selling it to a huge federal agency -- the VA, which treats more hepatitis patients than anyone else in the country -- at $540 but they're selling it in Egypt for $10?  How come they negotiated a better price than you did?

Dr. Michael Valentino:  I can't answer that question. I don't know what Giliad's business model is.  I don't know how that was able to -- able to be achieved.  Uhm, you know those -- A lot of other countries have different regulatory processes.

Chair Bernie Sanders:  They sure do. Which results in the United States paying the highest prices of all in the world for prescription drugs.  And this may be outside your portfolio in a sense but if the VA is going to spend -- I mean, we have a deficit and some of my colleagues don't like spending a whole lot of money on things -- if the VA is spending billions of dollars -- 1.3 now and maybe more later -- to treat one illness, is it fair to suggest that that will mean that we have less money available to take care of veterans needs in other areas?  Is that a fair supposition?

Dr. Michael Valentino: Well, we did -- we did ask for more money and-and-and so, uhm, VA is undergoing a lot of changes right now with, uh, --

Chair Bernie Sanders:  All that I'm asking, which I think is pretty common sense.  I mean there's a limit to how much -- I'm a strong supporter of the VA, would like to put more money into the VA, but there's a limit to what can be done.  All that I'm saying is that if you're spending billions of dollars in one area, common sense suggests that we may not be able to spend in others.  That may be a fair supposition?

Dr. Michael Valentino:  I would not disagree with that.

Nor on the second panel did John Rother.

This is not just a matter of a thousand dollars a pill.  This is a matter primarily of a drug that is potentially beneficial to three to five million people so it's not an orphan drug at all.  It's a drug that would be appropriate for a large number of Americans.  And, uh, the problem is the total cost of treatment, not so much the individual pill price. Inevitably as you suggest -- as your question earlier suggested, this kind of costs is going to force trade offs with other necessary treatment within the VA, within Medicaid, within prisons, within private health insurance.  We are seeing this every day today.  And, uh, it's-it's a deep concern because in many cases the services not delivered are the very preventative services that have the greatest return on investment and if we neglect those than we are just making the problem more difficult down the road. 

Let's stay with the first panel to note an exchange covering a few basics on hepatitis C.

Senator Mazie Hirono:  I think my series of questions deals with whether the marketplace really can -- is operating in a way where there really is more competition for different kinds of treatments that are effective and much less costly though is there a way to prevent hepatitis C?  Because once one is infected, there is a progression to the disease.  So what are we doing on the prevention side?

Dr. David Ross: Briefly, there is no vaccine for hepatitis C.  Transmission for most people occurred decades ago. There are about 20,000 or so new infections a year.  The number is actually going up -- almost entirely because of the sharing of needles from injection drug users.  So thinks that we are doing within VA is to -- and this is done within hepatitis C care -- help people with substance abuse disorders.  We also are doing things -- and again this is integrated with their medical care to try and reduce exposures that could also damage the liver -- particularly thinking of alcohol abuse.  And an integrated care approach is much more effective at getting people ready for treatment.  One brief anecdote, I have a patient who I saw yesterday who I started on methadone maintenance about six months ago and he is now ready for treatment. In other words he'll be able to reliably take the pills 

Senator Mazie Hirono:  So these prevention  methods that you are utilizing do they -- are they working?  I realize it's not that easy to determine whether something that you're doing is actually preventing --

Dr. David Ross:  I-I-I think yes.  I think the-the-the-the -- It's a matter of keeping people from getting it in the first place but it's also a question of getting people ready for treatment.  We're -- What we've done in VA has shown that if you take people who have these barriers to treatment because of other diseases -- frequently substance abuse or alcohol abuse -- and you give them integrated psycho-social care in the same clinic -- this is what has worked at Minneapolis VA and I should mention this is what was done at the Matsunaga VA in Honolulu  -- they are more likely to complete therapy and be cured than people who don't have those problems in the first place would be who don't get that kind of supportive care.

But for most Americans with hepatitis C, the costs for the needed treatment are too high. 

It doesn't have to be that way, as Robert Weismann explained:

Now some have held out hope that new treatments will lead to price competition or that hard bargaining by payers -- of which the VA is the best -- will be able to yield sufficient price reductions and I think that's misguided.  Based on prior experience, new drugs don't necessarily come in at a lower price.  In fact, they often come in at a higher price.  In general, brand name competitors try not to compete on price.  And when you have a starting point price of $84000 even if we have substantial reductions in price due to negotiations we're still going to be stuck with a super high price just because the starting point was so high.  However, we do have solutions available to us and really fundamental solutions. Now we should say -- I think it's correct, everything you say, Senator Burr about both the importance of innovation and looking at government policy.  The reason for this price level -- as both of you asked -- is a single thing which is Giliad has a monopoly.  Giliad doesn't have a market created monopoly, they've got a government granted monopoly, a patent monopoly, a monopoly that comes from other exclusivities. If we choose to address that monopoly through government policy -- since We The People gave the monopoly in the first place -- we can bring the price down.  And we know we can bring it down to less than 1% -- at least at the manufacturing level -- leaving aside  whatever fair compensation we need to pay to Giliad because of the price reductions that already exist in developing countries as you referenced, Senator Sanders. Two methodologies we might pursue to reduce price.  One. we might have just government use of the product -- government use of the patent and other technologies -- in that case we could source the product to generic competitors and pay Giliad a royalty.  If we pay Giliad a royalty of five thousand dollars per patient, we'd actually still have cut the price overall by 90%.  We've got existing staturoty atuhority to do that under 28 USC Section 1498.  A different approach might be to look to buy out Giliad's patent all together.  We could do that in one way which would be to say we're just going to give Giliad as much money as we anticipate the company will make by virtue of it's patent monopoly.  Why would we do that?  Well we'd do that because we're already going to pay them that much money but we could then provide treatment to everyone whereas under the current system we're going to pay all that money and have rationing.  Now I wouldn't advocate doing that.  I think we can adjust down significantly what we would pay for a patent buyout but it is another method we might consider to provide treatment for all.