i'm eager to discuss the view on how to better improve care coordination on ben fieficiarien the dual population. some of the past successes may be at risk. some of this is clearly necessary but i'm concerned that the unilateral actions to address this population's needs may undermine the protections guaranteed to all medicare beneficiaries. this is a critical issue to get right the first time and i know that med pack is concerned about it as well. thank you for being with us today. i look forward to your suggestions on how we can improve medicare and i want to congratulation and thank you for accepting an pointment. medicare is one of our nation's best programs. but it needs fine tuning and changing to keep it relevant. do iing so would dest nate them. the majority on them list on tight fixed in cucomes. increased coste iing leads to increased production. the costs discourage people from receiving necessary health care. the home health co payment for instance, i think is largely ascribed to be used by old sick poor widows. there are other offsets available as well. the over seas oper