ancillary drivers are that have pushed prices up have been sort of caused by the fact that the country has not focused on getting its money worth out of health care. let me broach one topic with you which is difficult to explain, will there be rationing of care and the term that makes people s eyes glaze over is comparative effectiveness, this idea that you figure out what works and you pay for those things or reimburse for those things and things that don t work you don t necessarily pay for those things or it s not as easy for those particular procedures or treatments. is that a type of rationing and let me take it a step further, given your background, how much is it over skience?