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Mr. Ryan's new prominence has abruptly thrust Medicare into the top tier of issues, but it was always going to be a theme in the 2012 House and Senate elections and was already playing a role in advertising.
That put it below some other mainstays of political concern healthcare, pensions but nevertheless put it in a tier of issues that may actually make a difference, especially in pushing youth to go to the polls.
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Related to clinical governance are the many tiers of workforce issues.
It will impose tighter limits on their payroll costs, force them to issue more detailed and more frequent accounts, and make it illegal for a higher tier of government to take on the debts of lower tiers.
He is trying to force Congress to accept his priorities on a wide range of second-tier issues, even as he acknowledges that two of his biggest hopes, for Medicare drug benefits and a federal law defining patients' rights, will probably go unfulfilled.
"We're in the top tier of the top tier for population growth, and things like this cemetery encroachment issue are undoubtedly symptoms of that growth".
A second tier of guardians -- Wall Street analysts, rating agencies, the Securities and Exchange Commission -- failed to issue warnings of corporate deceit.
Yet, among family planning experts, consensus remains elusive on the important issue of whether and how client counseling should emphasize this top tier of highly effective contraceptive methods.
A second tier of competition in Jamaica.
Mr. Robinson said students also improperly wedged the second tier of logs into this lowest tier.
This is the second tier of NIH's lauded two-tier system.
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