as projected the medicare rate would be about only a little over 25% of private health insurance and would be less than half of the medicaid rate, the current level of medicaid rates. obviously that would have severe consequences and less providers can adapt to all this in some ways. we will take a quick look at the projected income and expenditures over the next ten years for part b of medicare. you can see on the cost incurred for the outgrowth kerf the drop in the total expenditures in 2012 that is because of the position reduction affecting the entire program and then you can see the growth rate which is in fact a good bit lower than what we have seen his slickly for part b. almost all of the part to be providers outside of physicians almost all of the part b providers are also affected by the productivity adjustments to the payment rate updates. now over the last five years, part b costs have grown by an average of just under seven per cent per year and the projection