my name is rubens paismies, i'm a physician and researcher who has tried to understand and find a solution to health disparities. i think i need to discuss very briefly nine different areas that i think contributes to or explained the dilemma we now face. first, understanding the diversity. it's important to look at diversity in america. over the past 20 years the proportion of white americans has dpe creased from 83 percent in 1970 to 69 percent now in 2000. during that same period, african-americans have increased slightly from 11 to 12 percent, however, the proportion of hispanics has jumped from 5 percent to nearly 12-and-a-half percent, this makes our health care issues uniquely different from comparable nations around the world. the u.s. census bureau, in fact, had originally estimated that by the year 2050 nearly 1 in 2 americans will be a member of a racial ethnic group, however, now they indicate this could occur as early as 2037. currently we have four states who already