and we -- this goes partly to joe antos' talk, we thought that accounted for 29% to 43% of the change in growth. and we thought that interacted with technology, again, to go to joe antos' point, and that interaction was another 27% to 49%. the insurance changes mattered less. i do think there's some in our data. we're looking now across the oacd and the demographic changes matter just a little bit. so, it -- and now chronic diseases, to go to ken's point, are also increasing, i think, throughout the developed world. certainly diabetes is increasing throughout. so that in, i think, going forward, that's also going to be driving cost, as he said. but again, i think all of these things are different aspects of the same reality. and i do think there is a mechanism that's driving the growth rates. >> i think dallas salisbury had a hand up. >> just a quick follow-on that set of points is, in work that paul friedsten's been doing with the database that we now have had seven years of data pre and post-design change by a major employer. this goes both to joe's point that it makes sense, and jo

to get us started, we're delighted to have two speakers, joe antos from american enterprises and ken thorpe from emery, to speak respectably about the roles of technology and chronic conditions. and joe, we're very happy to have joe with us today. he decided to have an authentic health care experience over the weekend in order to have a legitimate grip on his subject. but joe managed to come back from a case of sciatica and be us with today. thank you for being with us. we know it was only with considerable effort you were able to join us. so joe has a presentation and then we'll move directly into ken's presentation. joe, all yours. >> thank you. okay, there we are. so i promise to stay on the subject -- oh, sorry. i promise to stay on the subject for whole minutes at a time, technology. and you saw the picture of marcus welby. if you got up this morning and took a pill, you used medical technology. that's probably what almost everybody in this room did. i took quite a few pills. they didn't do much good. rick, get to work. but virtually -- what's that? >> i need incentives. >> i'll

and unfortunately i have to agree with joe antoes. medicare is just this 800-pound gorilla that isn't flexionible and doesn't move like that. and they try to create programs, one size fits all. this is not about one size fits all. as we've looked at what goes on in the private sector, we have a lot of physicians in this country that are in one and two-doctor offices. they're going to have very different needs and have different infrastructure that need to build than physicians that are in groups or part of an integrated system. every time we have this conversation we sort of forget about them and i'm very much worried about them because they need certain support if they're not going to become a group if they're going to actually survive in this whole i also think we have to think of primary care very differently than specialty care. i found it really interesting this was a meeting about technology but we focused a lot about primary concern today. i'm not concerned with primary care and technology. the data we look at shows that techno

to get us started, we're delighted to have two speakers, joe antos from american enterprise institute and ken thorp from emory expect about the roles of technology and chronic conditions. and joe, we're very happy to have joe here with us today. he decided to have an authentic heal care experience over the weekend in order to have a legitimate grip on his subject, but joe managed to come back om a case of sciatica and be with us today. joe, thank you so much for being here. we know it was only with considerable effort that you were able to join us and we appreciate that. so, jo, we're going to start with you. joe has a presentation and then we'll move directly in to ken's presentation. joe, all yours. >> thank you. what do we aim at? okay. all right. there we are. so i promise to stay on the subject for whole minutes at a time, technology, and of course you saw the picture of marcus welby. you know, if you got up this morning and took a pill, you used medical technology. that's probably what almost everybody in this room did. i took quite a few pills. they didn't do much good. ck, get