dr. cutler, any comments? yes.utler: dr. cutler: getting more firms into insurance, more competition is beneficial. anything we can do to make it easier. my sense is that that is less of an issue than some other things. i do think we ought to be moving medicare payments away from a fee-for-service level. >> i'm not saying that. dr. cutler: we would think about some kind of transition, it here are how we are going to move rates over time. >> calpers has used reference pricing effectively to lower expenses. they do a survey of providers. quality is equal so they say we will give you 20 k. you can pay the difference. it turns out everybody lowered their prices and we pay the same across the board. it seems to have worked. can we use more of that? it is price transparency and bringing it relevant to the patient. what are your thoughts about insurance companies using it more? i will open it up to the other panel. we're over time. >> thanks, senator. i think there is interest in looking at innovative pricing models to mature we are

dr. cutler: it is true. some do not have it. some have it and they do not make it available, or it is difficult to access. >> sometimes they get it wrong. a provider told me there was some left on my deductible when i had filled my out of pocket for the year. so the information is not always correct. and it great concept works well in the pharmacy but it does not seem to work anywhere else. >> i am way over. thank you for your indulgence. : the cost ofn health care is too high and today we are focused on in ministry to cost. i want to talk about how much private insurance companies pay -- spent on administration. there has been debate about how to do this comparison. the 2018 trustees report states administrative costs for medicare are $8.1 billion. that is 1% 2% of expenditures. that is a lot lower than in private insurance, which is between 10% and 12%, depending on who paid for the study. some people argue medicare beneficiaries have higher medical costs than younger people on private coverage. so we should use dollar amounts