a) health care reform discussions are not a one sided case. Yes, increased patient access helps unit sales, but if the company is only getting paid half as much for those units, the net effect would be reduced revenues. Shrinking revenues in any company that requires significant R&D expenditure to create new products has the risk of creating a death spiral of reduced R&D thus fewer new products or reduced features which again can eat into revenue.

b) Medtronic is usually 1st or 2nd in market share in most of the areas they compete. So growing share is expensive and not easy. Buying a company is one way to grow revenues, but there are plenty of company's out there bidding on those that are aquireable. So revenue growth via that manner is also expensive.

c) the only real growth opportunties are organic growth of new therapies or expanded indications. There's just not a lot of movement in these areas and not much on the horizon across all of medtronics business'. Most of the focus is on reaching more patients. You're just not going to get physicians to double the number of patients they serve in a year. 10% y/y gains are aggressive and not free.

d) complaining about management is a non-starter to me. Its not as if they're sitting in smokey room trying to figure out what medical problems they should work on. Thats just not how it works. For example in the go-go 90's the explosive growth was funded by introduction of ICD therapies. It wasn't great management that made the company grow, it was the technology was available to solve a major problem (sudden cardiac death). The profits from that had to be invested quickly to prevent someone from swooping in and buying all the cash generation for a quick profit and letting the company die. So they bought new business's further increasing revenues with and put out rosey projections. As ICD revenues plataued, those aquired business were not growing as quickly as hoped. While revenues continue to increase, its not quickly enough to garner the multiple they used to get.


all of these things apply to all the device companies, not just MDT. BSX has their debt problems. STJ has looked the best lately, but just because they are growing from such a small base and have been the most aggressive in willing to operate with lower margins which isn't good for long term (5-15yr) growth. But im sure current management will be gone by then with their millions.