medicare beneficiaries, those with multiple severe chronic conditions, such as alzheimer's, als, parkinson's and other complex debilitating diseases who also need help with two or more activities of daily living, such as dressing, feeding, et cetera. cbo has reported that 5% of medicare beneficiaries account for 43% of overall medicare spending, and cms has noted that approximately 20% of medicare beneficiaries are with five or more chronic conditions account for 66% of program spending. could you talk a little bit about how we can focus on those medicare beneficiaries with multiple chronic diseases, and how perhaps a program like that focusing on home and better coordination can help reduce the costs? >> well, we have not only the demonstration that you are responsible for, but i think a number of projects under way looking at coordinating care, particularly for the vulnerable high-cost individuals, and certainly having an opportunity to do that in a home base, instead of a hospital based service is not only better for the patient, but may provide some enhanced cost savings. so we are eager

us cubic feet of gas, british companies are now competing for further contract and roles was an parkinsons' discussing with the ministry of electricity proposals for a new power generation infrastructure where an additional $200 million. british funding will support lending to thousands of businesses, a youth employment program to give training and work to young in basra could be rolled out as a result of its success brought the whole of iraq, and we are supporting the transport ministry for the resumption of civilian flights. working with a major education program. iraq has already identified the first 250 students, an early initiative and the contribution for the plan for 10,000 overseas scholarships for iraqi students. mr. speaker, issues and the region still confront us. iran is an independent nation that deserves our respect and the iranian people are proud people who deserve democracy. that is why the regime must address the serious questions that have been asked about the conduct of the iranian elections. the way the regime responds to legitimate protest will have implications for i

dress well and come to washington and lobby and have way more interest from regular people that had parkinson's in their family or have multiple sclerosis in their family, organized groups that advocate on behalf of the sick and we all supported that. cdc doesn't have the same kind of organization lobbying for them. they're far and away in georgia or somewhere. and they're not even nearby. they're seen as an organization, a government agency that helps the poor but nobody else for reasons i don't understand because it's all about public health. the point is that we have been generous as we should have for nih. we have been way less than generous in funding public health in this country. we know that from visiting our own public health departments. we know that from visiting with cdc campus and seeing the fiscal facilities, the contrast of senator mccull ski and her state. as a result, public health is -- we don't have the public health system we should have. just the other day and my thursday morning coffee i have for anybody that comes -- that's from ohio that's in washington, they -- a woman

concern about cancer and autism but there are also legitimate and equally important concerns about parkinson's, the gerd disease and diabetes, you name it, and i think virtually all of us are more comfoable with the final decisions being made on the basis of what peer-reviewed-- with pier refute process leads us to the best scientific judgments as opposed to doing the a political balancing act. mr. tiahrt. >> thank you mr. chairman. i want to go back to the first, compared effectiveness. we were for did million dollars the stimulus bill passed on to your agency and it is to determine the optimum procedure or pharmaceutical for a given some them. as we experienced with jenny when she came to our office, she lost access to the best solution for some time because of medicare. how would you apply comparative defected this? will you allow it to be used like it was ford jenny joe with a ration healthcare or will you use it as an advisory tool for physicians and clinics and hospital so they can make the best decision in how to apply the information they have? >> congressman, let me start by saying ay