so just to briefly recap what we have heard so far this morning, first of all, we heard from jo antos that technology is a factor both in the supply of and demand for it. there has been some discussion about whether technology can directly be measured as a contributor to health costs. often it's not and it's treated as he said as a residual. it's the i don't know factor. if i can't explain it by oth other -- four other reasons, i call it technology. nonetheless, as he pointed out, we can clearly see the role of technology. he gave a number of the historical examples of how technology has evolved over time. he offered a list of some -- a menu of some options, some of which he thought had some possible workability attached to them and others of which he was a lileas compare and effectiveness research. notwithstanding there's a lot we can do even within some of the constraints that exist, for example, in terms of medical program. he mentioned coverage with evidence development. notwithstanding the fact that medicare is as he said a political program. some of these changes could be made o