there is only one provider. there are five states in this nation where there is only one insurance provider, one-third of the counties in this country only have one insurance provide provider. we must, as policymakers, and end as folks administering these programs, we must ask ourselves, what is going on? what are the problems out there? that may work for the insurers in certain instances, it may work for government, but that doesn t work for patients. so we keep the patients at the center of all of this we will get to the right answer, and that is what i hope to do with each and every one of you. i appreciate that, and i got to work for years with senator kennedy on biologics and bio similars, and having the requirements for the bio similarity has needed some additional information. the fda has issued guidance documents since the law passed, but they haven t set policy on interchangeability with the reference to that.