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our proposal in october 2011 said it. and strain on the number, maximize that gap by cutting specialty fees while holding primary-care constant. if you have more money available though, it would obviously be desirable to increase primary care. thank you, mr. chairman. mr. smith. thank you, mr. chairman, and thank you, mr. hackbarth, for sharing your perspective and insight on some very important issues today. it s my understanding and i think this topic was touched on briefly but there are various factors that perhaps leading to more and more provider consolidation. could you elaborate more on that? and perhaps share what you see on the impact to insurance premiums as a result of? i would say there are basically two. one, there is consolidation. that is aimed at developing new organizations that are better able to effectively care for medicare patients and other patients your so they are integrating in the wa