let me introduce the distinguished peter rorzak. [applause] >> thank you, good morning. i am delighted to be here. i want to start today with a story which was embodied in a recent new yorker article which i found so, telling, i followed up by asking the researchers for additional information. i want to talk for a few moments about this story. there are 2 towns in texas which are both -- they have similar demographics, they both have 700,000 people living there. in 1992, not too surprising, given their similarities in their population, medicare expenditures were fairly similar in the 2 cities in texas. since then, there has been a dramatic difference. mcalan has grown more quickly than the rest of the country or al passed though. and the result is that now mcallen spends twice as much as the u.s. average. you can see that difference showing up in all sorts of medical indicators. you can continue down the list. those additional expenditures would be worth it if the result was higher quality and better outcomes in mcallen. but as the data suggests, we are not getting highe