and then we heard from susan rinehart that patients and caregivers sense that a lot of the issues that they face in health care is due to factors such as poor communication, they don't feel that they are empowered sufficiently often to make decisions with their health care providers. they're also clearly lacking in health literacy. she gave a number of examples underscoring that. and that they too would very much like to engage in much more constructive dialogue with their health care providers approximate how to have the care systems that they really want and that deliver on some of those wonderful words that bruce mentioned in his word cloud. so with that, the floor is open now for greater discussion about how we move forward, knit some of these issues together, and continue to work on actionable solutions to press forward. joe, did you want to answer the question i just briefly tossed out at you before we get going? >> sure. well, i would distinguish again between the level of costs, growth rate of costs, the phase that was fashionable awhile back but i haven't heard lately, the cur