The change that has gone on in the American Economy is such and the growth of the American Healthcare system is such that in communities run the country, hospitals are the major employer or certainly one of the major employers. Cedarssinai is the sixth largest private employer in los angeles county, just as an example. At the same time, all of us have to recognize that as organizations, we are going to have to be more efficient. We are going to have to figure out how to deliver care in ways we have not thought of until now. Technologies are that are coming along, whether that technology is in the form of new discoveries around Molecular Medicine and other things that allow total cost of care. We have to work on the issue of total cost of care, not just the unit cost. We have to work on both, keeping in mind what is the total cost of care. Over time, using the International Comparison that john mentioned earlier, if you look at what are the reasons for that, i think your observation is