william hoagland: oh, lisel. [laughter] first of all, thank you, i guess, for putting me on this panel. i feel out of place with all these experts. let's begin with the fact that i agree that prevention, orientation of prevention, things that darshak sanghavi has outlined. we appropriate the money for an activity that does not result in the benefit until sometime in the future. we wait until you are sick before we go to the hospital, as you say. we not reimbursing for the prevention. most of the prevention programs and have in the federal budget start out by being appropriated, at the bottom line, these are annually appropriated moneys subject right now to a cap on the total amount of money that can be spent. you don't get the benefit of a reduction in medicare benefits or expenditures or medicaid extended chairs, until sometime in the future and the people doing the appropriations do not get the benefit of doing that. quite frankly, to make this work long term, you have to go back and change the budget process i

i want to go to our budget at the end of this line, william hoagland. don't always have a deep discussion around costs. bill hoagland always raises cost as an issue and gives us a reality check about, that is an interesting idea, that sounds logical, how in the world are we going to pay for that? what jeff is talking about is multiple sectors all of whom have a shared interest in the health outcomes, whether it is social services, education housing. those are all different budget pockets within that county. how do we make the math work? what do you think is the most promising opportunity to integrate those funding streams and develop a model? mr. hoagland: oh, lisel. [laughter] first of all, thank you, i guess, for putting me on this panel. i feel out of place with all these experts to the right of me. let's begin with the fact that i agree that prevention, orientation of prevention, things that darshak sanghavi has outlined, are important to cost in the long run. the difficult with our budget process, if you like, is that we appropriate the money for a