and places like geisinger held system in rural pennsylvania and intermountain help insulate city whereigh quality care is being provided and it costs well below the national average. these are all islands of excellence, and we need to make the standard in our health care system. so replicating best practices, incentivizing excellent, closing costs disparities, any legislation sent to my desk that does not -- that does not achieve these goals in my mind does not earn the title of reform. but my signature on a bill is not enough. i need your help, doctors. because to most americans you are the health care system. the fact is americans, and i include myself, michelle and our kids in this, we just do what you tell us to do. [laughter] >> that's what we do. we listen to you. we trust you. that's why i will listen to you and work with you to pursue reform that works for you. [applause] >> together, if we take all these steps, i am convinced we can bring spending down, bring quality up. we can save hundreds of millions of dollars on health care costs are making our health care system work bet