ms. burke: thank you very much. i have to admit i've never been called a visionary but maybe it is my trifocals reflecting my age. it's a pleasure to be here to talk about the medicare program. i am essentially going to start where juliet left off and then try to reflect looking forward on what some of my colleagues have commented on in terms of the challenges facing medicare but i want to begin by underscoring a point that was made on how we pay, who we pay and what we pay for makes an enormous difference. as the have seen since the passage of the program in 1965 and as medicare goes, so largely does health care delivery systems. we saw it and how we transition the payment and how that occurred. the private sector has an enormous role as well, but the collaboration that we put in place with respect to the private sector will in fact fact drive the delivery system going forward. so again, let me start with where juliet began. let me talk about these three groupings of issues on the spending fin