exactly what's happened today and you look at the health statistics just like you said, senator standa sanders, and when you look at it you see a lower life expectancy. it's not because of poverty, we have a system that they don't have access to specialists in this country and they don't have access to 40% of the primary care so we give a physician extend tore say oh, now you've got coverage. so we need to be very careful about how we go about this. i believe senator harkin wants as much as i do to make prevention, and i believe everybody at this table, make prevention, wellness and manage your chronic disease a key component of what we do, but how we do it makes all of the difference in the world, and we have a model that's out there now. what we ought to say is how are they getting it done and how are they saving money at it and how can we copy that? >> we haven't done that, we can say here's a top-down approach and here's how we're going to spend money and we've forgotten the thing that makes it successful and that is putting an economic condition in association with the management of chron