provision targeted to providers and three is the special payment preserve incentives for cost conscio consciousne consciousness. targeting could be tighter or better justified. with that i'm happy to answer your questions. >> the medicare benefit has not changed in structure since 1965. can you explain why the commission found it was necessary to offer recommendations on how the fee for service benefit should be redesigned? >> yes, the most important element of any insurance program should be to protect people against very high cost of illness. as you well know, medicare does not include any catastrophic limit on out of patient cost. the existing structure of patient cost sharing is quite complicated and very difficult for many beneficiaries to understand. we had the web of co payments and co insurance that can be be wildering to many. that lack of catastrophic coverage and the complexity of the cost sharing creates uncertainty and anxiety and we believe contributes to the demand as a way of protection against this uncertainty. we think by redesigning the program we could update it and make it mo