here's a study by elliott fisher looking at regional variations in medical spending. and this is an index called the end of life expenditure index. so these are medicare patients at the end of their life, i didn't read the article close enough to know how close to the end of their life they were but you knew they were. so pretty close. and look at the distribution of tests and procedures that were done on people close to the end of their life. and lo and behold what do you see? very few major procedures, quite a few more minor procedures but a lot of imaging, tests, evaluation and management. that's where the money is for the very sick people and obviously that's where the money is for the not very sick people. it's not in that -- i mean, there's plenty of money in those fancy machines, don't get me wrong. but where is the real through-put? it's in the seemingly ordinary interventions that we're all used to and expect. that's where the money is. okay. so, well, everybody says, well, let's do some effectiveness research and figure out what we really should be doing and

here's a study by elliott fisher looking at regional variations in medical spending. and this is an index called the end of life expenditure index. so these are medicare patients at the end of their life, i didn't read the article close enough to know how close to the end of their life they were but you knew they were. so pretty close. and look at the distribution of tests and procedures that were done on people close to the end of their life. and lo and behold what do you see? very few major procedures, quite a few more minor procedures but a lot of imaging, tests, evaluation and management. that's where the money is for the very sick people and obviously that's where the money is for the not very sick people. it's not in that -- i mean, there's plenty of money in those fancy machines, don't get me wrong. but where is the real through-put? it's in the seemingly ordinary interventions that we're all used to and expect. that's where the money is. okay. so, well, everybody says, well, let's do some effectiveness research and figure out what we really should be doing and