my colleagues here on the committee know that every time i ask questions when it comes to healthcare always to the length of what is the effect on our rural areas in areas in my state that are beyond rural and so i look at all of this through the perspective of one who says we don't want anti- competitive provisions but if i only have one hospital or only have one clinic or one provider how does this work? i want to start with you, mr. kavanaugh. you spoke to the potential impact of the transparency and anticompetitive provisions on rural health providers and when we are looking at the various proposals that we have in front of us as ways to reduce the cost i am curious to know whether your review has included situations where you have community with both a single hospital or single prominent insurer who has the most negotiating power there. how do you determine an in network rate in an area where you don't have in network providers connect when we talk about similar geographic areas and a lot of my communities and in 80% of the communities and the states were not connected by the ki

one of the things i noticed from democrats when they talk about healthcare two things they agree on. the current healthcare system is an absolute mess. nobody seems to point out that is obamacare. the media seem to be very generous in just not saying, the system you pass ten years ago and said this is going to work really well, the second thing is they all agree, a single-payer healthcare system. some want to keep employer-based health care for a while before it gets here. i have been tracking health policy issues for 30 years now, used to get over to england and canada, a fair amount and when i did i looked at the newspapers and saw the stories in the newspapers that were running in the media there. and i thought this is a different story than you hear in the media. i have been carrying these things around with me for a long time. we didn't have the internet back then but i kept a lot of these stories, from the major media, from the united kingdom and canada, this is not breitbart london reporting these stories. these are major media stories where they talk about the healthcare syste

>> we welcome your calls and comments on camping 2020, the focus is on healthcare.. let's go to tennessee on the republican line. >> good morning, thank you forer taking my call. i'm an insurance agent. ten years ago, the health insurance in the program was $1000. once the bill got up to $5000, the insurance company paid one 100%.ha because they screwed up, the cost is $10000 deductible. 15000 or 20000 and two, three, $4000 a month. if it's not broke, don't fix it. insurance agency brought in business and the national average. but the stakes handle it. >> the insurance agent there. >> the affordable care act from one of thego big problems is tht they continued what is tradition at this time, which is week subsidized healthcare very explicitly and with a lot of money. however, we'd be much less to control the cost of healthcare. i don't think it is a surprise that will we have seen as long as prices keep going up, once you hit your maximum, that's not a great system.nt we are trying to actually control the cost of healthcare.o so it's not surprising we've seen best. >>

healthcare costs in this country. it could cut administr waste out of the system immediately and save a tremendous amount of money on overall healthcare costs. >> i have heard thathere is a fallacy with this idea that the government would be more efficient, that, somehow, l of this would be administered in a very streamlined way, because ie is administhrough different departments, and so it is hard to get a cost of how this administration would work. it would be admi through hhs. it would be administered through the irs. it would be administered through so many different agenciesat t isn't just one. >> medicare is the closest example to that. i mean, you can look at the dicare system, which the government administers today, and the cost of just pure medicare is 2%. the ea that government can't do this efficiently is just not borne out by experience. >> and so then, ultimately, you would raise taxes in some way on the wealthy or on corporationsn ordividuals to pay for that delta? >> for the final delta, yeah, you could make any number of, you know, small tax increases on the very wealthiest. a financial-transactions tax woul

healthcare consumers. but here in washington and on state level. ur mission is to allow every individual to limit their greatest potential by entering their best health and healthcare are equally accessible and affordable to all. thank you for the opportunity to testify. the cost and quality of the american healthcare, is a profound economic and public health problem. utterly bipartisan issue. the most half of the public cannot see a dr. when they need to because of cost. about one third say they had trouble paying for basic necessities because of healthcare costs. nearly two thirds of the public believe that we as a nation, do not get good value from the us healthcare system. in analyses of our healthcare system support the public's perception. despite spending two or three times more than other wealthy nations on healthcare, we live shorter lives than those in other wealthy nations. the us healthcare system is more likely to sell his people and even on moms and our babies are dying at higher rates. as a nation, we can do better for families and it

healthcare. it would allow for a robust private market to kind of float on top. o the german model for healthcare, but it's not a single payer healthcare system. >> congressman delaney -- go ahead, kevin. >> it's kevin kelly, one of the things we haven't touched base today on is actually china. and we saw the markets do really well today because it seemed to be a temporary truce, but that doesn't actually ease what's going to happen in the future. we think it is in the national interest to try to figure out how do we address state-owned entities, right, and how they are dumping into the markets. we're actually worried about, you know, the buildout of 5g using huawei products what would you do to address the chinese situation right now because the current administration is having a hard time negotiating. >> the first thing i would do is get us in the transpacific partnership which i think was a huge mistake that president trump tore that up. i think it is a huge mistake that all of the other democratic candidates i'm running against don't support it because i think

conjunction with bernie sanders' senate version of the bill... >> our job is to lead the world on healthcare, not to be woefully behind every other major country. >> ...everyone would be covered and everyone would be affected. no more copays, no me premiums, and no more private insurance. the idea is catching fire on tha aign trail. >> we need to have medicare for all. >> medicare for all. >> i support medicare for all. >> medicare for all. >> he should put billions dollars toward medicare for all. >> but are some candidates rallying behind the catchy slogan without really embracing the policy? >> who here would abolish their private health insurance in favor of a government-run plan?a juhow of hands to start out with. [ applause ] >> what does representative pramila jayapal say now? >> "firing lin with margaret hoover" is made possible by... s additional fundingovided by... corporate funding is provided by... >> representative pramila jayapal, welcome to "firing line." >> thank you, margar. i'm so happy to be here. >> it's a delight to have you here. you are now in your second term in the h

the ideal one is to minimize healthcare costs and optimize member experience. i'd like to have the members take a look on that slide as we move forward and ask questions because you have a lot of mergers and everything but what really drives us is really to minimize healthcare costs, improve the population health of the members and the member experience. i'd like to go to that slide. >> thank you. >> all right. >> so mike will walk us through some concepts for consideration and we'll get into this model. >> so slide 17 illustrates a model construct from a spectrum around care coordination and management at the top. it is correlated with cost the at the bottom. you can see the highest cost tends to be associated with models where you have a minimum amount of care coordination and management happening. contrast that cost contend to be optimized where you have more of them happening. so, from the left side of the page, the open system approach so the united healthcare p.p.o. is an example of that. so no surprise it's the highest cost plan on your platform. as an ex

on? if i lose my healthcare, wouldn't it be easier to just die? and the spanish governments have said they want to carry on offering a reciprocal healthcare agreement to pensioners from both countries but nothing yet has been formalised and it is that uncertainty which many are finding so unsettling. my battle with cancer has been hampered by actually having a fight with brexit as well. lisa moved to spain three years ago and is undergoing treatment for breast cancer. expats have been advised to register for cancer. expats have been advised to registerfor spanish cancer. expats have been advised to register for spanish residency. lisa says her application has been rejected on a technicality even though she has been here for three yea rs. though she has been here for three years. if i don't though she has been here for three years. ifi don't have residency, i don't have my healthcare rights. do you feel if there is a no—deal brexit, your treatment could eventually stop? it could! suddenly countries could decide they don't like each other too much.

should vote for her husband because she is electable. >> your candidate might be better on, i don't know, healthcareen joe is but bottom line is we have to be trump. heather: should the party unify behind one candidate or is it too early in the race? we will ask the one who used to work for biden. remember the world war ii veteran who won't stop working at the grocery store? the big birthday surprise that you have to see. ♪ we go and celebrate eterans it lets you borrow up to 100 percent of your home's value. the newday va loan lets you refinance your mortgages, consolidate your credit card debt, put cash in the bank, and lower your payments over $600 a month. call today. and get the financial peace of mind every veteran deserves. >> and on the east coast. missing firefighter stretching from florida to south carolina. justin walker has been missing since friday when they left cape canaveral on a fishing trip. the white house expected to roll out new immigration rules today extending the amount of time migrant families can be detained at the border. the trump administration plans to extend the curren

those who lean democrat trust him the most on healthcare. this has been a top tier issue for democrats for some time now. here's the thing. i moderated a forum last week down in florida and i asked the senator this very question. how do you pay for something like this? his contingent is that there's money that's already in the system that would cover the coast of medicare for all. is this something that's resonating with voters on the ground in iowa? >> i would say that voters in iowa, first of all, are definitely primed to hear a message about healthcare. it was a big issue even in 2016 when bernie sanders ran. and if you ask voters now, healthcare is definitely one of the top issues really kind of behind picking a candidate who can beat donald trump. so medicare for all is a -- is a good slogan, but as was just mentioned, when you start digging into the details, people start having a lot more questions. that the registers and poll in spring and march had. the vast majority of iowa caucus members said they wanted a candidate who proposed me

healthcare system. we're spending an increasing amount of gdp on it as a society and not necessarily getting the returnshat we would, that the us is not better in most of the measures of having good healthcare. we're way down the list and we're spending a lot of money and not getting a lot of value and everybody agrees we need to do something about it and the debate is what is it we as a society want to do? an>> for our system, how does it compare to other systems and what are they doing better than we are? >> old everything. a lot of our trade competitors do, they have universal health insurance and it's mostly run by the government so employers in some countries they are attacks but at least it doesn't fluctuate so there's more state ability in those other countries. they control the prices of healthcare, of hospitals, of doctors, of drugs. we don't really do that, the insurance companies triedto negotiate . some do a better job than others. it depends where you live, if there's a single hospital system and the insurers basically have to take it or if there's a single insurer, the hospitals have to ta

joe biden on the issue of healthcare specifically. oint while the former very much was trying to essentially defend obama ware against the california senator pitching something similar to medicare for all, the senator harris told biden that his plan would leave 10 million americans uninsured. she said that that is without excuse. but biden shot back and he said that her plan would cost too much money and he reminded her this is just her latest healthcare proposal. she said they are not going to beat president trump with double talk on healthcare. kamala harris has referred to the former vice president joe biden as senator bind at least three times that i have heard. we don't know why that is. it could be when they greeted each other on stage, the former vice president said to kamala harris and he said go easy on me, kid, and it doesn't look like she liked that. trish: the story behind this viral video. one young american learning a live lesson from noo monopoly. >> it's the worst part of monopoly. taxes. at comcast, we didn't build the

garrett, let me start with you, biden focusing on healthcare today.at has been his message to voters there so far as you've seen? >> reporter: look, biden is doubling, tripling down on the idea that he will build upon and defend obamacare. this does two things for him. number one, it sets it on a path largely separate from the other front runners this race who talk about medicare for all. biden is building on the affordable care act. he sees that as a path to bring in a broader coalition of grattic voters, not just liberals, but some of the other folks who are worried about what medicare for all would mean for their private healthcare. second, it allows him to position himself in a place where there is no daylight between him and barack obama. it's another part of how he keeps his coalition together. it's part of his appeal to african-american voters particularly down here in south carolina where they are such an important voting block. and, craig, unless and it will somebody makes a dment bidenents support in african-american voters, even in a field

just to give some perspective from a patient's perspective and the healthcare setting, one in three patients are still burdened with furnishing their own healthcare information when they are seeking care in a healthcare setting. i can attest that i have actually had this myself as a patient. i am just pointing out that there is a lack of reality to this and i don't know if everyone remembers these guys. the average p.c.p. interacts with 229 specialist through 117 settings over the course of the year. i would also say it looks less like this and more like this, and then with the use of healthcare information technology, if you ask the general provider, that is the perspective they get. again, the patient is being circumvented to access the technology. if anybody wants any great satirical commentary on the state of healthcare, this is the dog who is a hospitalist who came out of harvard. i am going to use interoperability not by the engineering term, but by what is actually called out by the onc, and the tests. that is the ability of the system to exchange electronic health information from ot

i want to show you the amount of minutes on the topics they talkeds about. healthcare mints, immigration 27, climate change electability. foreign policy only getting 17. but that's pretty common in domestic debates leading up to a presidential election. i wanted you to listen to senator biden. he did speak about veterans. i'll get you to respond before we let you go. >> i carry a card with me. i have it with me every day. it has my schedule on it. every single day i have the staff check with the defense department, how many people have died? how many people have died or were wounded in these wars? we have 300,000 people coming home from afghanistan, iraq, the wars in the middle east with post traumatic stress. we have more people committing suicide, more veterans getting killed in battle. we need to care for them. >> dana: conditions for veterans a big topic, especially in the 2016 election. we're sure to hear more of it in 2020. let me hear what you have to say. >> yes, ma'am. i have to say, he is absolutely right. we do need to take care of our veterans. what i also

district attorney out of san francisco and as attorney general of the state of california, but also on her healthcare plan. and this is risk. on monday she decided to put out her own new healthcare plan, a version of medicare for all that would allow private insurers to offer plans as part of that medicare for all system. but what you saw was not only incoming fire from joe biden, but you saw it even from the likes of michael bennet that was going toe to toe and critiquing kamala harris's record. when you're up there, the only person that's going to defend your record is yourself. and that's exactly what kamala harris tried to do at about a very nuanced proposal. that was her health care plan. i had the opportunity to go through that white page there, but it was suddenly kamala harris that was trying to describe to the american public what her plan actually was and offer up that context. now it's a matter of how did iowa caucus five months from now, not only going into these debates but going to campaign events and trying to articulate exactly what her plan is and why it is that middle ground between

balat, director of the right on healthcare initiative. like to thank others that are here to testify. believe we all want affordability, accessibility in healthcare but have different there.ow to get for those patients here today, who may have benefited from the a.c.a., thank you for your bravery in telling your story because i know the difficulty you face in dealing with this broken system. healthcare is an american issue, not a political one. not partisan. my experience as a healthcare executive, hospital patientrator and advocate precedes my work in health policy. my journey coming from the industry into the realm of policy came because consistently conflated and confused health insurance with healthcare. i'm here to confirm that coverage is not care. a hospital administrator, i've seen people use the for basicdepartment care because they're unable to deductibles. the a.c.a. sought to reduce emergency department services but the consequence has been the opposite particularly in states that expanded medicaid. americanhe departments, acce

a merit poll drilled down on healthcare finding 64% of registered democrats support medicare for all 90% support medicare for all with a private insurance, registered republicans with 14% and 46%, back to fox news 4, 82% of democratic primary voters say they have a favorable opinion of donald trump's healthcare reform as opposed to 52% of all voters. on immigration issues the fox poll found 75% of democratic primary voters favor allowing refugee political asylum. 50% of voters agree with that idea. a slight majority, 51% of democratic primary voters support decriminalizing entering the united states without proper documentation. 34% favor that idea and on the question of providing health insurance to undocumented immigrants 53% of democratic primary voters say yes compared to 32% of voters overall. a lot of food for thought and debate among democrats vying to be there party's presidential nominee. >> with all those positions in mind, the last couple nights exposed a growing rift within democratic party. progressives even suggesting the obama administration was not left leaning enough

political world coming together, we also get some firm policy commitments, both on education, on healthcarerica. queen elizabeth's second son, prince andrew, has released a statement about his friendship with the disgraced financierjeffrey epstein. it's the first time he has spoken directly about his links since epstein took his own life in a new york prison cell earlier this month. prince andrew said "at no stage" did he "see or suspect" prince andrew said "at no stage" did he "see or suspect" any any criminal behaviour. epstein had been awaiting trial on sex trafficking charges when he killed himself. here's our royal correspondent nicholas witchell. what was prince andrew doing at the home of a convicted paedophile in new york in 2010, peering out through the door as young women came and went? the questions about andrew's friendship withjeffrey epstein have shown no sign of abating — and so, from the prince today, a statement in which he says he is eager to clarify the facts. he states... andrew does acknowledge that it was, in his words, "a mistake "and an error" to see epstein after hi

she had to defend her record as prosecutor and her position on healthcare. >> while the debate highlighted divisions within the party, one topic that brings democrats together is when he backed the white house. paul chambers is here. tell us about round two. >> reporter: the debate has familiar issues, race, healthcare, immigration, and criminal justice. some democratic hopefuls were more diverse than last night. plenty of the candidates know they need to make a big impression to keep their campaigns alive. they went after the front runners. former vice president joe biden [ applause ] denies debate between the democratic presidential candidates it was combative at times. >> reporter: an ironic greeting from joe biden to senator kamala harris. joe biden did not he does on request, as he challenged her over her health care plan, which he said will be phased in over 10 years. >> you notice there's no talk about the fact that the plan, in 10 years will cost $3 trillion. you will lose your employer- based insurance. is >> reporter: unfortunately, you are inaccurate and what you're describing.

one of the outrages of the current healthcare system. 500,000 people in this country are going bankrupt. what did they do to go bankrupt? they got sick. they gat cancer. they had heart surgery. how insane is that that people are going bankrupt because they can't afford the healthcare that they need and the bills that they receive. it is absurd that despite all of we are spending twice as much on healthcare than the people in any other country. that is crazy. the only thing that keeps this system going is not because the american people want it. they don't. it is the power of a drug companies and the insurance company who is mark my words, i'm going to make a prediction here right now. they will spend hundreds of millions of dollars to defeat medicare for all. some of you may remember the last cnn debate right in the middle of the debate they were attacking medicare for all. that will not stop. but i believe that the momentum is with us. dysfunctional healthcare system is not defensible. people cannot defend it and we're going to win this fight. thank you all very much. >> bernie sanders

on message. lauren: it's also, cliff, healthcare. healthcare is a big issue. mentum and he's now attacking kamala harris on her healthcare plan. you have to remember the back story is that she co-sponsored his medicare for all plan, now she's tweaked her own plan, saying let's phase in medicare for all and let's not completely take away private insurance. your thoughts, cliff. >> i would like to see her make up her mind and tell us what she supports. by the end of the campaign, hopefully we'll find out what her healthcare plans are. what you're seeing is bernies has been this unabashed let's just say socialist and he's pushing a lot of these candidates and it's really forcing them, because they're going after the base of the party, to come clean and i think that's a democrat problem right now that they're having to move as far left as possible to try to win the nomination. it's not going to bode well in the general election. lauren: bernie sanders keeps pushing them. kamala harris and i'm going to ask you this again, cliff. >>> she was at a fundraiser in the ha

he was on his a game, did what he needed to do by all measures which front and center of the issues was healthcaredicare for all. kamala harris unveiling her own version of medicare for all this week, that was on stage last night. listen. >> vice president biden's campaign called your plan, quote, a have it every which way approach and said it is just part of the confusing pattern of equal indicating about your healthcare plan. what do you say to that? >> they are confused because they've not read it. >> you wonder why it takes 10 years. it will require middle class taxes to go up, not down. >> the cost of doing nothing. >> harris was also a main target, she didn't do well in the first debate and it was totally gathered taking on senator harris over her former role as a prosecutor of criminal justice. listen. >> senator harris says she's proud of her record as a prosecutor and she will be a prosecutor president but i'm deeply concerned about this record. she put over 1500 people in jail for marijuana violations and left about when asked if she ever smokes marijuana. >> i'm proud of making a decisi

job and just one job, not two or three because you are paid a living wage, to be able to depend on healthcare something that is right that you don't have to worry about so that you're well enough to link to your full potential, to know that your community, that you and your family counts, not only is it the right thing to do, to make sure that this country is realizing its full potential and promise for every single one of us, when we fail to do that, you provide fertile ground to the kinds of demagogues that we have in office right now who would use your fear and her frustration against you, against us, against one another. demonize immigrants and minorities, blame them for the problems that you have. i see more clearly now that i ever have before, that immigrants in this community, in this state, in this country will continue to be attacked, not just killed as they were at the walmart, but terrorized as we just saw last week in mississippi 600 people who came to this country for the privilege of working the toughest, should his jobs and what else here would allow their children to work in c

kamala harris on healthcare.enerally healthcare it's as bad as the others and terms of ending up with the abolition of private insurance but there's one particular element of what she's talking about that is worth considering. >> i have met so many americans who stick to a job that they do not like and are not prosperous simply because they need the healthcare that employer provides. it's time we separate employers from the kind of healthcare people get. >> i think that's really interesting. still private sector but the concept of separating healthcare from employers, still doing it through the private sector. we do have more labor mobility and flexibility, i think it sounds like a good idea. i've run businesses here and i think if people had their independence back that would be better. >> i agree. if you look at the history why are hi healthcare is so distorted and expensive to begin with it dates back to this world war ii wage freeze where they were not allowed to increase wages. they had to compensate their e

he did clashed with miss harris over healthcare and with senator cory booker over his record on criminals attorney general in california. mr biden did stumble from time to time, but by and large he ca pably defended from time to time, but by and large he capably defended his record. it wasn't a standout performance, but probably enough to reassure his supporters. barbara plett—usher there. we'll bring you any developments and significant updates on that in the coming hours here on bbc world news. thursday marks a year since the beginning of the ebola outbreak in the democratic republic of the congo. at least 18—hundred people have died so far. earlier this week a second person died of ebola in goma — a city of two million people on the border with rwanda. that's raised fears the outbreak could spread quickly in the city and across the border. 0ur senior africa correspondent, anne soy has returned to the epicenter of the outbreak in beni city and sent us this report. it takes a lot to beat it bowler. those who seek treatment have a better chance of survival. —— better. at the heart of the

rob: his ideas are the ideas everyone is stealing and using. >> on healthcare specifically last nightyou saw bernie sanders mentioned by four candidates on a night -- he was the overall winner. jillian: your overall loser as we discussed was joe biden. anything you want to mention about joe biden q i want to get your take on how you think kamala harris did, she was touched by a lot of candidates. >> she did good. did she do the best? i think she landed some punches but in some fell flat but for the first time she got attacks, take the tulsi gabbard moment, got attacked and pushed back by the biden moment so i don't think she came out of this on top and standing alone like she did in life debate, polls show where we she will end up and she had a medium performance. rob: she got hit hard on criminal justice stuff. thanks a lot, we appreciate your time. jillian: joe biden gets grilled over the obama administration's deportation and child separation. >> with higher deportation rates resumed. >> looks like one of us is learned the lessons of the past and one of us hasn't. >> i don't hear a

my view, the president undoing aca in healthcare will and pre-existing conditions, that is a fight that we want so we have a 25% advantage onlity related to healthcare. >> one of the things people forget about his third-party candidates really like hillary clinton. howard schultz, ceo of starbucks, if he's looking at these debates and deciding he will really get into this thing. >> ask him. >> colin, i don't know. my guess is howard agrees, as i've also said there's one test beating trump, everything else we can work out. last question, if you look at the map do democrats have to take back the state you refer to or other targets? >> i would take her category, there is bentivegna, michigan, wisconsin, ohio. then there is order, and then there is arizona, north carolina and georgia. and i would tear them that way and they go to another break, women, noncollege, geographic suburban and all those various. >> in the mix is for the central question. >> you have to play in how to be aggressive. rahm emanuel they can so much. one thing we do not hear much about during this week a presidential debate. stay with us. ♪ >> we heard tho

the ad focusing on the economy, healthcare, two key issues that call for stable leadership. trump, it all focused on electability with the polls, a point jill biden drove home last night in new hampshire. cnn has new polling on the 2020 race at the top of the hour on "new day." a couple lines that stand out, our allies can trust and your kids can look up to, and you can't help but wonder about that argument on healthcare, he is the one who wants to build on obamacare while, for now, his chief rivals want medicare for all. how important will that be and will some of them shift that stance in the weeks and months ahead? >> what i noticed about this ad it's very direct and he is certainly leaning on what happened in the past and what can happen in the future, but that direct sort of punch right in the face to president trump, that's clear. >> well, you know, the thing that he can thank president trump for is inoculating the voters against those gaffs because biden has made some doozies, poor kids are just as bright as white kids, he also said we choose truth over facts but they

healthcare system. we have a sickcare system. >> stephen: "and i should know. i am the only one yang made an interesting revelation. >> when i told my wife i was running for president, do you know the first question she asked me >> stephen: "who are you?" ( laughter ) ( cheers and applause ) "what's going through your mind?" ( applause ) when biden said harris's numbers on healthcare did not add up, she shot back. >> let's talk about math. >> stephen: to which andrew yang responded, "hey, that's my only thing!" get your own thing! you've got the busing thing!" then, biden began to explain his healthcare plan, before he kind of ran out of steam. >> we immediately are able to cover everybody who wants to get off of their insurance plan they don't like, no matter what one it is, and buy into a medicare option. and they can buy the gold plan, and they're not going to have to pay... anyway. ( laughter ) >> stephen: i don't know what-- i don't know what just happened. >> jon: he didn't finish. >> stephen: biden just joined the ranks of history's great orators. for who can forget linco

healthcare system working. david: we have already seen the beginnings of a shortage. oneing in 10 years we could have 100,000 fewer doctors than we need. >> the association for american medical colleges over 100,000 short. imagine if they only had government insurance to choose from. doctors are fleeing government insurance now. almost 30% won't see new medicare patients. are you going to give them only that or are you going to quit? >> we have seen examples of the waste and fraud and government controlled medical centers, whether it's dealing with va hospitals. for all of the good news about medicare. the bad news is it loses 10% of everything we put into it which comes up to 60 billion a year to waste and fraud. you multiply that by a factor of two or three or four or more to get healthcare, how many dollars would object going down the drain. you lose innovation. we are talking about a time of personalized healthcare. we are talking about genetic treatments that only work for one person, not another. genetic therapies. we won't be able to pay for that. we have medicare