Enclosures in the best way forward and handling payment disputes. This is two hours and 20 minutes [inaudible conversations] the committee on Health Education labor and will come to order. Senator murray has an important meeting right now and she has asked me to proceed with the hearing because we have six excellent witnesses and we want to make sure that we hear from each of you. We want the senators to have a chance to ask questions of each of these so patty should arrive around 10 lock. When she comes we will enter and let her make her Opening Statement and then we will resume the hearing. Good morning senator murphy. Nearly a year ago after brent james from the National Academy testified before the Senate Health committee with a startling statistic. Up 21 2 of what the American People spend on Health Care May be unnecessary. Let me repeat that. Up to half of the 3. 5 trillion the United States collectively spent on health care in 2017 was unnecessary according to dr. James and many