you must be concluding that cbs caremark. so i guess the question then is back to you, paul.the search recommend what to open this up to questions from the audience. you've got a lot of people engaged in the social movement. we've got now the capacity for the government to step in and institute pilot projects unaccountable care organizations and patients and medical homes. but it doesn't look like we're quite at the tipping point yet, or maybe we are. what do you think? if what you describe is really out there and have been, we could begin for just phenomenal in the organization of the delivery system a change in the next two years and probably o the curve, but are we? >> i think we are. i think we really passed that tipping point a year or so ago. i think probably one of the dod and the da both stepped up and said this is our future, this is the workforc we need. and the social engine that they have both had, you saw what the dod and the va did after world war ii. i think they have the same social phenomenon. and i think that the large employers really stepping up and say we

before joining cbs caremark he was chief medical officer of aetna and served as president and ceo of women's physician organization and professor of medicine at harvard medical school and prof. of law and public health at harvard school of public health and from the institute of medicine of the national academy of sciences. paul, we will turn this over to you. >> thank you very much. i personally want to thank you for the tremendous leadership that you and health affairs have really had in this full arena for some years and is much appreciated. jolt made the comment that this really is going to take social and political movement to make this happen. i can't agree more. that is why we formed the primary care collaborative to do exactly that. for us, this is birmingham. occurrence system of health care delivery is a form of violence and we are going to change it. that is our conversation today. it is a multistate effort, the authors reflect, senator kay hagen on the political side of the house, it reflects the leadership from the consumer groups, with the president of the aarp, reflect