and then finally, steve zuckerman, who is a senior fellow and vice president for health policy at the urban institute. and steve promises to mix things up a little bit. and so we're counting on some good conversation. paul with, that, would you take it away? >> thanks, joe. provide an overview of the medicare trustees report that was released yesterday. i'm the chief actuary at cms and it's my privilege to represent the 90 professionals that support the board of trustees who evaluate the financial status of the medicare programs. >> what i'm going to do is walk through a current snapshot and evolution of the program. going to walk you through the formal evaluation of the financial status of the programs that we're included in the trustees' reports that were released yesterday. we'll take a broader perspective of the changes in expenditure patterns, i think some of the panel members might expand on in their discussion. as joe mentioned this is my fifth year as chief actuary representing the cms in our role here. so cma is a number dwizible by five. i d divisible by five. to take a look

i want to briefly touch on something i think steve zuckerman will spend time on, he and his colleagues have written an excellent report that i would commend everybody on, that talks about ways to expand medicare. i just want to make two quick points here. one is, it's well known that on average medicaid rates are way below medicare rates for hospitals, and that -- i'll just stay with hospitals, keep this simple, and that commercial rates are well above medicare. so just to illustrate the effects of redistribution and winners and losers, if we expand the number of people who are covered by -- whose payment rates are dictated by medicare, imagine that you have two hospitals, each of which has 35% of their patients are medicare, but for the remaining 65%, they're mirror image opposites, one is 50% commercial and 15 mercedes medicaid, versus 50% medicaid and 15% commercial. in this case, if we were to simply move everybody to pay medicare and make it very simplified, clearly the hospital that had a heavy commercial presence would lose a lot of top-line revenue, and the hospital that had a