First and foremost, ever-present low interest rates have squeezed bank profitability as measured by net interest margin, or the spread between what banks pay to borrow and what they're paid to lend.
And keep in mind that while the spread between the two projections represents real money, it is margin-of-error stuff when it comes to the size of the federal budget and total health spending.
Size gives Wallace an edge with suppliers, but he gives back some of that spread in commissions and cocktails at the Crown Club, leaving a net margin of just 3%.