that outlook for federal health spending much improved from the pre affordable care activase. >> i don't have the 2009 projections. the outlook is a good deal better. we have seen slow growth for a number of years. we have taken some of those on board. >> that is a significant reduction. >> a little below. hideo that has come and pray a and b of medicare and also how the private sector. we look ourselves very closely at what has happened in medicare the entire health care system, and the conclusion is that the weak economy plays some role in the national health care spending, but much more than that. in fact, we do not think that they believe much of a role at all. when we talk to people in the health care system they are clearly working hard to make their operations more efficient than they have been. the question for us and everyone is whether they can keep that it going, whether they will under the current incentives provided by law and whether that process will wrap up. in the late-1980s ago we saw was a marked slowdown. but then it came back up begin. we do not know at this point ho