i will say one thing if you read what george halverson says any read articles in health affairs you would think we are describing two different worlds. my only problem with halverson's description as he calls the medicare fee-for-service and calls medicaid advantage decapitated. our best plans are planned fee-for-service but the distinction is how the doctors pay. over here we have an integrated coordinating care with the objective of keeping people healthy ander over here it's not integrated and not coordinated and people make more money when the patients get sicker and require more treatment. >> thank you very much john. in chapter 12 of your contribution to the book you do cost estimates that show that a comprehensive defined contribution often referred to as premium system driven by consumer choice in a rather robust competition would result in major savings for both medicare patients and also taxpayers. your focus chapter, your chapter focus is primarily on taxpayer and beneficiary savings. i think the question though for a lot of americans is the need or the desire to move into a pr