dr. michael bulter knows those patients and the money. he's chief medical director at jackson health, a public hospital system in miami. medicare and medicaid combined are responsible for over half of jackson's revenue. >> though we discuss it in terms of millions and billions of dollars, that these are services that are being rendered to people in a daily basis that you're talking about... who are most vulnerable and most at risk who have limited alternatives. >> reporter: dr. bulter acknowledges the rate of growth for health care spending is unsustainable. he worries politicians want to reverse that trend too fast. >> this has been the standard model for decades, and they expect changes to occur on a one- to two- to three-year basis for something that has been going on for decades is going to be very hard to do in an orderly controlled fashion. >> reporter: it's a concern echoed by those working directly with patients, such as muthra the physical therapist assistant. >> it may not be a critical thing that or need the physical therapy...