join pg us ing us to talk how h preparing, president and ceo of the cleveland clinic. toby, nice to have you back on the program. >> thanks for having me. >> the big worry is what will it do to cost and what does it do to cost for the cleveland clinic? >> well, we know and have known this for several years we have to reduce the cost of health care, not just for the cleveland clinic but across the country. we look at it as a patriotic duty to take down the cost of healthcare because it's beginning to jeopardize things like education that are important. so we have been working hard to reduce our cost, and we've done several things, for example, over the last couple years we've taken $180 million out of our purchasing and consolidated services that made them higher quality and lower cost and more efficient, but all of that still means that we're going to be paid less by our private insurers, we'll be paid less by medicare for what we do and we still don't have medicaid extension in the state of ohio, and we're concerned that we need to take our cost down still further. so