do better. a case in point -- front page of the "wall street journal" today, an article came out in jama showing that there's a $20,000 decision for heart disease patients. do you get a stent put into your heart or not? and about 50% of the time it's put in without a clear indication, and about 10% of the time with -- where it's clearly the wrong thing to do, a $20,000 decision, where about half the time it's overused. we can learn to make sure how to weed out and make better decisions with patients about the right thing to do. >> now, is there something inherit in the way that american medicine is practiced that leads you have at this gdp, when other nations are at 10% or 11%, and can the steps you're talking about, can it close that gap? is there something deeper at work?