i'm debbie goldstein. i am a gastroenterologist, but i have spent a lot of time in primary care as well. i could spend an hour counterpointing and raising. there are so many issues. it is infinite. i wanted to make a couple of points. that is, the first thing is the whole issue of primary care. the primary care physician is being asked to be the foundation the primary care physician has the most responsibility of any other position. they have to know everything. they have to know what the right and left hand is doing. they have to coordinate. there responsible for everything that they refer people to. they have the least amount of time. there the ones that have to talk to that patient who went to the orthopedic surgeon and really could have been talking about going somewhere else for palliative care. they can't do that because they have to go faster because they have to see more patients. and its crushing. it is crushing. and there is no incentive for people to become primary care physicians. the get the l