as this graph shows, if you live in fairfax, virginia or marin, california, uf as high a life expectancy is anywhere in the world. whereas, if you live in tunica, mississippi, you are worse off than if you were in algeria or bangladesh. why is that? why do we tolerate that? we've got to figure that out. there is not easy answers to that and it's been a problem for decades. we have mechanisms to start addressing this. if we are going to start doing these things, we have to look at these things. we have to think about not just the top small fraction of the most complex cases but the broad routine care that we get day in and day out and geographically distributed. finally, let's talk about price and costs. costs and value are all tied together. value is outcome divided by cost. if we're going to see was variability and outcome and we have variability of prices, it's pretty straightforward to see how we can have huge variations in what we see in our performance and we need to figure out why that's happening and try to reduce it. i was fascinated to see these graphs on the left of the cost sp