Although Medicare administrators are not permitted to make coverage decisions based on economic considerations, the new law does preserve their longstanding ability to deny payment for a drug if persuasive evidence suggests that it is not clinically effective for a particular condition.

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All too often leadership is seen as the ability to speak well in public, to be persuasive, to be loud.

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Justice Kennedy often says that the court's authority rests on its ability to provide reasons for its rulings and so that until a persuasive opinion has been drafted, he regards his vote on any case as tentative.

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