a former state medicaid director in california under governor swars negativer said this medicaid provides care -- is falling apart as they cut benefits and enrollment increases because of the recession. we are seeing the after effects of the recession. it's a challenging environment out there still. what is health care reform mean for you as physicians? what will be different? what will life be like? the good news is more of your patients will have health insurance. when we were having dinner last night the doctor was mentioning how when he was around in 1965 when medicare got started, basically to close the clinic because older people no longer needed a free clinic because they had medicare. here there will be uninsured americans there will be far fewer of them. that's a good thing. what about primary care? access to primary care will be more challenging than ever. the way i talk about it as health care reform is like building a house without a first floor. there is some provision in the health care reform law terms you may have heard called patient center medical homes. they are wonderf