i want to thank first of all our friends at the kaiser family foundation, diane roland and her colleagues, for not only helping to support and sponsor this series, but offering us this wonderful facility in which to have the discussion. you'll notice that we've configured the seats, those of you who are here for the first of these three briefings, in a way that we hope will encourage everyone around the table. and i see a lot of illustrious faces around this table, to get into the conversation. and we've reserved a fair amount of time for that to happen. so don't be bashful. i don't see anyone around here who would be usually characterized that way. so we will look forward from contributions from everybody sitting around the square. thanks also to everyone whose name appears on the screen above you. we have had broad and gratifying support from a variety of parts of the health care world, and every organization represented there has been extremely helpful, not just in financially supporting the series but helping us to plan it out and make sure that we had the right folks around the table

we heard from diane roland about the very important fact that the high spenders in the medicare program are different from the medicaid program. which is a recipe for us to developing a much more nuanced understanding about how to restrain excess cost in those two pockets of the population. we heard from bruce chernof again much on that same theme that half of the medicare enrollee with chronic conditions have functional limitations. and half of them are dual eligibles but half are not. not. and we have to be mindful, he said, of the problem we're trying to solve. the problem as many patients see it, that they lack all of those words he put up in his wonderful word cloud. they're not spending a lot of time thinking about how to get access to surgical robots, they're spending more time thinking about how to have independent, dignified existence independent of as many health care providers as possible, very often. and then we heard from susan rinehart that patients and caregivers sense that a lot of the issues that they face in health care is due to factors such as poor communication, the

so diane roland, at kaiser family foundation, you have done a lot of thinking about the high-cost patients and some of the challenges to delivering improving care and lowering the cost. so tell us about that thinking. >> thank you, susan. i think i can do it with this, right? well, i always come to these forums and we talk about the medicare program and we talk about private insurance. when we talk about health care costs we don't always bring the medicaid program into perspective. so i wanted to remind us about why medicaid takes care of a lot of people with chronic illness and why it spends a lot of its resources on that population. and of course, this is our most classic slide showing that one in four beneficiaries are disabled and elderly, but they accounts for two-thirds of the spending. a large reason for that of course is that there is a lot of long-term care expenditure on behalf of those populations. but let's focus for one minute on that under 65 disability population for medicaid. and we like to talk these days a lot as melanie mentioned about the dual eligible population. but t