In a previously unreleased letter, Office of Management and Budget Director Shaun Donovan told the Dept. of Health and Human Services to devise an action plan for reducing wasteful Medicare and Medicaid payments. Gary Cameron/Reuters/Landov hide caption

itoggle caption Gary Cameron/Reuters/Landov

Outreach coordinator Sonny Weahkee (left) talks with a restaurant customer about health insurance for Native Americans in Shiprock, N.M., in early August. Heidi de Marco/Kaiser Health News hide caption

itoggle caption Heidi de Marco/Kaiser Health News

Valerie Davidson, Alaska's health and social services commissioner, drives her 1983 Chevy truck to pick up salmon for a dinner party for 50 people. Annie Fiedt/Alaska Public Media hide caption

itoggle caption Annie Fiedt/Alaska Public Media

Dr. David Burkons holds the licensing certificates that allowed him to open a clinic that provides medical and surgical abortions. It took about 18 extra months of inspections, he says, to get the approval to offer surgical abortions. Sarah Jane Tribble/WCPN hide caption

itoggle caption Sarah Jane Tribble/WCPN

Dr. Bill Mahon says a gorgeous coast and the chance to practice a more personal style of community medicine lured him to remote Fort Bragg, Calif., 35 years ago. Farida Jhabvala Romero/KQED hide caption

itoggle caption Farida Jhabvala Romero/KQED

Heroin sold in the U.S., like this dose confiscated in Alabama last fall, is often cut with other drugs. Tamika Moore/AL.com/Landov hide caption

itoggle caption Tamika Moore/AL.com/Landov