>> less kcompetition, and that s a problem. the ftc really has to look at that market by market. >> we know that as a result of obama a care, you're now lookin at an uninsured population. that is the good news, what do you think needs to be fixed? >> we have to ask what are the drivers or health care expenses and how will we curtail that increase. and part of the problem is the 25% of medicare dollars is spent in the last year of life. we have still done very little to change the way we approach end of life care. advanced directives are very helpful, but what we often find is that as patients get end of life diseases, there are no end of like directives. >> frankly it is a conversation from our own personal experiences that you usually don't have until the midst of things and that is difficult emotionally. >> it is too late then, and we don't want to ask hard questions like should a condition for being in the medicare program be that you have to give us an advanced directive when you seen up. that would change everything. >> yo