we fwhknow there's been efforts before to do this but you also have hersea for funding of ode educations to intereducation collaboration. lots of different things that are efforts in place that i think we should all be trying to reinforce, because it's got to be done from the ground up and we have to change the culture among the existing professionals. >> great. thank you. bob helms? >> okay. one of the major topics today is technology, but i've heard very little discussion about the process of innovation. i think we all sort of believe in, want to the think there's possibilities for improvement in innovation and technology. but a lot of the literature over the years has complained with a system both private and public nominated by fee for service that the incentives are more sort of cost increasing innovation as opposed to cost decreasing or value seeking innovation. so my question to the panel is sort of, is this distinction important? and is, as long as we stay with, in medicare and the private sector a system dominated by fee for service, how do you get this sort of change in incenti