gerri willis espy and joining me now on the same topic former adviser for centers of medicaid medicare services. welcome and we will start with that story and you were laughing and smiling. why? it is a great big bill. >> is a resource mining at his predicament but it is all too common it is looking at the health care mketplace and 51 percent of all health care charges are hospital related it is the least efficient part of the healthare system. gerri: what you said dr. you are in touch with this part of every single day. >> the hard prt there is no the transparency of hospital charges that finally in may was released. medicare/medicaid and showed hospital charges over 2011 we could see even within new york city one place was 15,000 another was 150,000. free competition will help if patients can be consumers to shop around. >> it will get worse under obamacare with consolidation and we already see that. 70 percent of doctors already work for the doctor or the health system or the independent practices. that will raise prices and hospitals have more local leverage with the monopoly. the