mr. pollack and mr. shea might be willing to speak to that. >> i appreciate the question, and i think you're right on track. one of the ideas that has been widely discussed is the notion that we need to be able to, as we link payments to quality, we need to be able to do rapid cycle testing of the way to do that so that we're not in the system where medicare once a year makes set rates and so forth. we need a more -- we need a more flexible and nimble approach that really matches the quality improvement efforts that are being done around the country and rewards those and incentivize those. i know that in the senate health bill i was admiring some of the things that they did that were beginning steps to do this but sensible kind of things like we're going to pay a physician's office extra money if they do follow-up on hospital discharges. this is a huge problem. it costs us an enormous amount of money. it's very simple to solve but the current system we have has nobody responsible for that. well, why not

mr. pollack? >> they should have that right. they may be required to pay an additional amount of money. >> if they want to use their own resources they ought to have that right? >> i do believe that. >> are you aware that isn't included in the present bill? would that give you pause? >> most health plans, even things like epos, we can go outside the network. i assume there will be retained. >> mr. scheck, you agree with that? does anyone in disagree americans ought to be able to opt out fifth they so desire? i was always frustrated when someone stepped between me and my patient and said you can't do that even though i felt it was in the best interest of the patient and the patient clearly trusted that decision. the comparative effect of this research on this new health choice panel that is in the bill, there doesn't appear to be any language that provides a for society is to be the final determinant of what is quality and what care ought to be provided. is that something you believe to be important? >> as i read the bill, as the