for us to do care coordination or medical homes or care management to improve utilization and the prefb lens and intensity of the disease when they get on medicare and those on medicare there's a lot to be doing to prevent decline on to medicaid. so far the financing and the incentives between two programs haven't supported that work and i'm hopeful that once we kind of get through dealing with the 9 million folks on the program we can shift attention to preduals and doing a much better job of managing i'd say the progression of folks to duel eligibility status. with that, i will close and say thank you again for being part of the panel. >> thanks very much, melanie. we're going to turn to joe new house. it's often asserted that the u.s. is an outlier in outspending. how big of an outlier are we really if we are? >> thanks, susan. this discussion somewhat reminds me of -- russia mount home. how many have seen it? it's a classic japanese movie and basically presents four different views of the same reality. i think that's some of what we're hearing here. i noticed in the green book that you w

for us to do care coordination or medical homes or care management to improve utilization and the prefb lens and intensity of the disease when they get on medicare and those on medicare there's a lot to be doing to prevent decline on to medicaid. so far the financing and the incentives between two programs haven't supported that work and i'm hopeful that once we kind of get through dealing with the 9 million folks on the program we can shift attention to preduals and doing a much better job of managing i'd say the progression of folks to duel eligibility status. with that, i will close and say thank you again for being part of the panel. >> thanks very much, melanie. we're going to turn to joe new house. it's often asserted that the u.s. is an outlier in outspending. how big of an outlier are we really if we are? >> thanks, susan. this discussion somewhat reminds me of -- russia mount home. how many have seen it? it's a classic japanese movie and basically presents four different views of the same reality. i think that's some of what we're hearing here. i noticed in the green book that you w

you have a list of the ones that have had greater treated prefb lens. when you do your time series, what have we had any reduction in, in term of treated prevalence? what's gone off the list. great savings in smallpox. is it an added key to the keyboard? >> that's a good question. we've probroken these into i gu we have 260 that we've looked at, and i'd say most of them are fairly constant. i mean, obviously big ones like heart disease and cancer are getting improvements in. the one that has been the biggest d

you have a list of the ones that have had greater treated prefb lens. when you do your time series, what have we had any reduction in, in term of treated prevalence? what's gone off the list. great savings in smallpox. is it an added key to the keyboard? >> that's a good question. we've probroken these into i gu we have 260 that we've looked at, and i'd say most of them are fairly constant. i mean, obviously big ones like heart disease and cancer are getting improvements in. the one that has been the biggest decline which actually adds to, you know, actually adds to a lot of the cost is trauma. the prevalence of trauma cases has gone done fairly substantially. that's a big redux. but most of these have seen, you know, fairly substantial increases over time. a lot as i mentioned have been owe decemberty related and a lottery lated to cardiovascular risk factors. i think kind of the interesting thing is, is that if you look the spending growth of the united states, going back to '40s for '50s, not that it's a whole lot difference. it's 2, 2.5 percentage p