Michael, your point is well taken that publicly traded firms (and potentially all firms) are hurt by their one-minded focus on quarter-to-quarter results. A short-term orientation is bad for any publicly traded company – or any company, for that matter. My view is that Battlefield judgment calls are best executed by a long-term thinker who understands strategic investments and goals, but who executes daily, weekly, monthly, and quarterly, based on the latest data given. This is called many things in business books, from maintaining the core, to keeping your "strategic intelligence". The reality is that most company leaders fall into one of two camps. Either they are over-relying on a strategy session from months and quarters ago, or they are becoming "firefighters," and reacting to the "initiative of the week". The key is to find the correct balance based on your business, current economic conditions, and your willingness to move quickly.

Michael, I wholeheartedly agree with your comments concerning consumer choice, driving cost and service competition. In healthcare, it seems like we have taken the worst parts of government-run entities and capitalism and put them together – so that while we have "choice," there are very little cost and quality determinations to help us with those choices. Certainly, bedside manner and location do factor in but, to improve all our choices, we will need valid data points. At CH Mack, we are working to increase the care of all members and patients served via our software, while hoping the eventual outcome will be a more efficient and effective system with cost and quality transparency.