couple. most of the rings by chance? rumor had it that i did. i see them coming. it is good to see you. is going to have to do a monologue for an hour, that would've been something. it's good to see you. grandpa chair. going to have a debate on a classical republican versus democratic debate. we have repeal and replace in the wind, very polarized nation and is impacting us. i thought it would make sense to invite some representatives one from the left, one from the right. will introduce and then allow each to make a statement to provide perspective of where we are and then we'll talk. chris jennings here to my left. he has made his mark in big ways of the city working for the obama administration of the drafting of the affordable care act. prior to that with the clinton administration. highly regarded, well known and very much a d has an democrat. lonnie, a lawyer, fellow with the hoover foundation and mostly what he is now as the top three are number one leading voice on the right in terms of healthcare record. he was an advisor to the rubio campaign. he is a superb speaker. with that, i will join you and chris sensor to my left i will let you go first. >> good morning. i will be happy to tell my thoughts. i feel i should go last that's where the minority right now. thanks to the republicans for the energy. [laughter] democrats only do well when the republicans to poorly that's when they are divided amongst themselves. and their occasional division and dysfunctional he does one good thing to democrats which is to camouflage ours. for which there's much. today, here cnn extraordinarily unique time in the health care debate. we just had the selection. you can talk about the polls and what was asked but it is significant there is no other issue that poll is high among voters interest as healthcare by 20 some points of virginia. the point is, healthcare dominated the domestic policy discussion in the political one. obviously that was done as a consequence and which are perspective repeal and replace failed, at least today. in the midst you had a big debate on to single-payer. the democrats are due to it direction. i think there's an excessive amount of discourse and attention focused on the exchanges. it represents 8% of the market play. most people get healthcare through employer-based medicare and medicaid. 92% of the media coverage is on the exchanges in the marketplace. the filters through misperceptions or what the healthcare system is what the challenges are. the big issues frustration with complexity. that's a huge driver of the debate today. candidates only focus on the exchange of any level are probably missing the boat on having an engaged discussion. the debate around the affordable care act has anchored the discussion for the last year or so. look at almost everything that has been focused on. i like the last discussion. we knew and that is how care is as much local as it is national. it filters into the physical discourse as well. lastly where we are today, i would say the marketplace is not as bad as some people think. the irony of the withdrawal means more money is going into the system. now people are able to buy golden brown's plans for much less if there's subsidize. the population that continues to be screwed are those who have high premiums and poor benefits. that's unsustainable. nonetheless, i would predict markets today are going to have a good year in terms of their revenue intake. that doesn't mean it's perfect. that's why we all have jobs. >> thank you for having me. the title of this panel is the saga continues. rather than another star wars movies seems like we've been through groundhog day more than star wars. there's a few observations. obviously we went through a very tumultuous time where republicans were coming up this problem from different directions with the same outcome. i think that predicts will do the same thing next year. we are likely to see a similar effort next year on repeal and replace of the aca. if you look at public opinion polling the republican voters in particular you'll find a majority still believe the top agenda item for congress to deal with his repeal and replace of the aca. if you think about the ago chamber that republican members of congress are getting they go back to the home districts they continue to hear the aca is a problem and something has to be done. that suggests that even though they went through clinical difficulty in dealing with the aca, they still feel a strong motivation and desire to do something. where the tax reform debate right now, that will wrap up in december or july depending on who you ask. think it wraps up before we get too far into 2018. then we come back to other discussions on the future of the aca. there's a policy issue here on their concerns about where things are going and that's not a huge number of people were talking about. some of the cases were hearing about make for good media. you're seeing stories about rapidly rising premiums. the quality or nature of peace people's plans are changing see of higher deductibles and less access to physicians. those are problems congress needs to deal with. ideally in a bipartisan manner. the energy for bipartisanship that's not where it's at. the second observation is were in an interesting time with respect to health care on the progressive left. in my view it's interesting how quickly we've gone to discussion around government run single-payer alternatives. and by the way the reason why different people call it different things is because different things register with popularity. medicare for all does better than single-payer. the reason you hear people talk about medicare for all the seems to be the way to talk about it. it's interesting how quickly the discussion on the left migrated. because the election is never far away three semi people are migrating is because when we get to 2020 ahead of the next presidential election in order to be successful as a democratic candidate for president needs to have been there earlier. that's why you're seeing this dynamic. it's remarkable we haven't had a more earnest debate about single-payer systems in the united states. i think we'll see that. whether it's thoughtful i don't know. we will see that discussion significantly as we move through 2018 and 19 the last point, i think republicans where they settled in what they wonder about the aca. more more republicans are great -- you saw this in the last reiteration of the republican repeal and replace effort introduce the senators grandma cassidy. that focus on giving states greater flexibility in the loosing of the regulatory scriptures. that effort was too far too fast for a lot of people. his signals were republicans will be comfortable. if there's anything that debate exposed so republicans don't agree on a lot regarding healthcare policy. figurative exposed so conservative movement. if you were to pulled 100 republicans in congress, one thing that would get support his federalism, responsibility for states. whether foundation is the graham cassidy legislation or the loosening around section 1332 waivers. [inaudible] whether it's a broader or more narrow, i think we will see some effort on the right to migrate the discussion to the value of federalism and the importance of it in healthcare policy. i think it's an interesting time. healthcare is never that far away from the center of the discussion. even though attack by tax reform there's a question of what republicans are put into the tax package. that things tend to happen. it's an interesting time. we'll see discussion around healthcare and i'm eager to hear your thoughts. the republicans made a promise to repeal and replace. we've seen efforts to pull that promise, the skinny repeal, and graham cassidy, all of them and i were break it down. there's a lot there we need to look at it. i want to focus on medicaid, all of those republican attempts included provisions that would have the effect of rolling back the expansion. was the republican think? >> i think there couple of reasons why. first of all the notion of putting medicaid on a fixed federal allocation is something that's been around in circles for a long time. that's motivated by two things. one is a sincere sense that the federal obligation for medicaid is growing at an unsustainable rate. i think there's a sense the program has gotten too big and that has to do with expansion of the aca being broad in scope. with the fiscal issue government programs to bake those are the policy motivations. there's an argument that if republicans want to undermine the aca, the core of what the aca did in my mind is the medicaid expansion. whether you think it's a good idea or not we can agree that medicaid expansion explains a significant amount. the other part is the politics which if you wanted to strike a blow at the aca, getting at the medicaid expansion would be a big part of that. you can make the political argument but with the debate exposed is the there's republicans who like the medicaid expansion and are comfortable with rolling it back. i think. people realize that. there's a sense that they wanted to pull it back but the coalition is more limited than we thought. >> all the attempts included that rollback. computable rollback. does the future cost difference. >> and hearing easily but somehow can't be afforded. is that true? are those costs borne by somebody somewhere, somehow. >> i think it's fair to say nothing is free so we need to look systemwide and figure out if the costs are not observed by medicaid where are they observed? there's also this issue which is will be the most effective way to cover the population? in some states medicare is very effective. other states, less so. that variation across states gives people who argue that it's not an efficient form of coverage, something to shoot it. when you seen one medicaid program you've seen one. there's a lot of variation. this argument to be made that medicaid is consuming a greater percentage of the federal budget. the question is is that useful federal spending? some would argue it isn't because there's more effective ways to get that population. >> i feel sorry for you. i feel like i'm double teaming. i think the medicaid debate exposes some important points. there are some republicans in the senate were liking it. but also the stakeholders and providers. they don't think it's as bad as it was going to be. now going to get payment for these patients. then there's those who expanded medicaid. but if you ask most people in washington was the most effective opponent of the repeal and replace, it would be republican governors. they have more of an impact than probably anyone else. the second issue on medicaid is that when you look at the media coverage and the legitimate policy problems raised specially been focused around the exchanges. the medicaid expansion has been expanded in a significant where little negative reaction. the repeal and replace rather than focusing on the exchanges was a political mistake in the end. as a concer consequence medicais become stronger than it ever has been. bradley, the republicans need an offset to do some policies they want. i'm please they strategically made snares but one not just to repeal the expansion that the cap growth of the medicaid program. it was a one-two punch. that brought in different people into the argument. for these reasons i think it was a huge mistake. lastly, you often hear medicaid costs and growth are out of control. on a per capita spending level as opposed to an aggregate at low levels. the reason the democrats expanded to 138 instead of 100% is cbo's quoted is less it will cost because you could secure coverage because of the reimbursement rates. i would argue against plaintiff medicaid. i think they made a mistake about strategically what happened after the election which didn't turn out the way i had hoped or expected it was pretty much expected you'd have a quick repeal it was with certainty. i think what happened this sadly the media focused on the debate in ways they hadn't before. republicans had repealed this many times. no one covered it. now, it was real. republicans were prepared for that of the work prepared to produce the type of products that the media was hungry for. president trumps that i would never repeal it without replacing it. then a number republicans said will have to repeal and replace at the same time it did expose those divisions. they were not ready to produce a product that could sustain republican consensus. they're not good democratic support. particularly in the aftermath of this debate. >> their issues of affordability and so on and trust funds. but underneath the more fundamental question. it becomes more graphic as we go into the single-payer debate. is a country in 2017? where the parties will the question about his health care all right is no provision? >> i think the most part number republicans are saying we want to cover everyone but we want to do it our way. one criticism they have is income which is sweet. i like that. but the political notion that we should be covering everyone and that no one should be exposed to discrimination on the basis of a pre-existing condition it has been folded into the ethers of the debate. that makes the alternatives that are not single-payer difficult to achieve. >> i disagree slightly. it's not the case still amongst all republicans that is the agreed-upon relief. i said that's all just agree that the goal of any reform ought to be to move us toward the goal of universal coverage. and now from your people. you people were very supportive. >> it was not surprising to me. it was surprising to me, it is the case there are disagreements of the movement about coverage was meaningful or not. so very much, that's fired republicans are having this difficult time. the four republicans agreed that we had to be moving toward coverage the terms of the debate would be different. we don't even have that in common. >> let me turn to the exchange. >> i think people in the republican party forcing coverage is not the best metric, it's actually an honest way because if you pretend otherwise, you connect up with it. but what i'm suggesting is the political messaging and a pose is, from the underlying opinion. that creates problems and turns of reconciling policy and rhetoric. >> will start with you, what is wrong with the exchange? the members of the audience now reserved that the premiums are rising outside the exchanges well. what's your perspective on the exchange? >> i think there are technical questions about about whether the in some situations you have private marketplaces growing up that are stunted by some of the regulatory pieces put in place by the ca. those are the minority of cases. the problem the exchanges are experiencing are symptomatic of the health insurance system more broadly. i would necessarily say in the it's exchange specific problem. to think the ca regulatory regime put in place was good or bad? that's what the debate comes down to. when republicans want to effectuate change what i think they're saying is they don't like the fact a lot of the decisions previously been made have been federalize. that's what this comes down to. i think it's the case in some states you seen challenges created by the patient mix showing up on the exchanges. some have decided is not a particular group with them. if you look ahead to 2018 and discern why premiums are rising, most would say a good chunk that has to do with uncertainty around cost-sharing and what that created. there is regulatory uncertainty bolton. part of that is because there are elements of the law that were not written in a way that were precise or anticipated these. the easy answer would be to go back and fix these things have gotten caught up into the larger discussion of repeal and replace. some states is of problems. >> answer that in the light of the recent open enrollment were numbers are higher now than in the past. >> it ends up being a binary discussion. in an ideal world you would fix, pull the levers you need to pull to make them more attractive. i have no problem with that that's not the reality. exchanges are part of the aca. if you don't like the aca you can't like the exchanges. while i see technical corrections that could be made there's a bipartisan proposal right now on the table from senators alexander and murray that i think both sides would say those are reasonable. it is close to zero traction because of the environment. >> first of all, you're right that premiums have gone up but also it's appropriate to say the non- -- market is the perfect place to make it work. you have a file little population going in and out the zero pre-aca imposed aca. as a consequence there'll always be challenges there. secondly, and notwithstanding that fact, most republicans prior to the affordable care act would say we need exchanges is an alternative. we need a private base coverage approach. i would argue respectfully is that similar to the exchanges specifically because it's hard to argue for such policies that i want medicaid or medicare to be in private plans without having a viable marketplace. i never understood this discourse. also, ironically when the aca passed we provided the stakes with opportunity and resources to set up your own exchanges. mostly blue states made that she. in retrospect maybe they would want to be the ones. they didn't want to buy into the affordable care act. to do not want to deal with other populations above the medicaid population. you have to understand the conduct. for the life of me i don't understand why we can't work together. these exchanges are functioning fairly well they can be addressed without blowing it up and should be. the issue with the non- subsidized population is that they're not subsidized. the take is pretty good at the lower income bracket. the subsidies i would awfully generous. are buying out some of the base, and i would think is a productive approach is to focus on cost-sharing reduction. those that need the assistance of targeting usable existence assistance. >> yes. i would say and i welcome that pressure the truth is, healthcare comes down to affordability. it has to be affordable to a relatively decent package. i would argue the tech where people in california where it's like boom, you don't have access to subsidies. they are mad. they have a reason to be. the not getting protections against high premiums. all one has to do is to eliminate it. it automatically is income adjusted. you fix it. you find another way to strengthen the marketplace. this is a very fixable marketplace and will always be a challenge. i think we can build on the efforts of allison and murray and others. >> is a goal to increase coverage or adjust the fact that individuals talk to the benefits of the tax exclusion that other employee individuals to. >> i'm a democrat, i want to cover everyone. i want to figure out a way to make it work. besides some of our party -- the affordable care act will was not very great levels during the presidency. not just because republicans hated it. there are some of the left you said you didn't go far enough. now, healthcare is like relationships. you never care more about them until you're about to lose them. so we've just seen. you can do that. the tax exclusion piece is critically important. if we were not operating in the balance of political constraint one could argue that why do we have a subsidy available to people who get insurance through their employer but not individuals? you can say it took a step in the right direction included the cadillac tax which is designed to function like altering the existing tax treatment of healthcare to those who get it to their players. most economists would argue the original sin was the revenue ruling in the 40s from the irs that made healthcare nontaxable to the employees as a fringe benefit as a way to circumvent wage control. if you were to change the treatment of healthcare to equalizer say -- instead of giving the tax benefit to the employer will just give it to. there might be an interesting thought experiment. in the reality where we were it will be difficult to migrate to the system. . . . . republican efforts here that failed, all of them dealt with the individual mandate, central health benefit inside way that would have fragmented the sort of single risk pool that i think was envisioned by the affordable care act. right? so you have higher risk pools, lower risk pools and populations migrating. is there a republican philo >> >> we have extent it is fragmented then that is problematic. but with the republican philosophy that i missed? the zero. the philosophicalal way to state this may be politically is in a great way to talk about it during the transparency of risk. so the philosophy behind dividing the market places to help people understand exactly what it is. criticism of the risk pool where everybody gets in is a c tremendous process for lot of republicans they feel that is relatively non transparent but in reality you are subsidizing the risky. but if he were to create a separate pool of higher risk than you could see from the aha government perspective where is my subsidy dollar going? if you have a reinsurance mechanism to see it is going directly to subsidize those in high-risk. otherwise it is more opaque. that is the philosophical argument. i have never heard that the that is the of philosophy behind its but the challenges of high risk pool and insurancece mechanism has not worked particularly well in the past arguably because they have not been funded fully i do believe those arrangements could work if fundedry the right way but with the challenge of history. >> s in india independent of legislators states like alaska and others with reinsurance approach that has stabilize the marketplace to reduce premiums and now tune justify for the federal m government because of the lower premiums. reinsurance probably, but sometimes you get into languageth associated with one party and god forbid so with that mechanism was phased out because of the affordable care act. we cannot replace something but so to talk about a stabilization not the insurance or know what your problem is talking about reinsurance but nonetheless we do need to find some common ground on this area. i talked to republicans than democrats so that reinsurance mechanism why did they have it? they wanted to insure there is a marketplace that works without prescription in drug benefit. but guess what. is at large in the works. so we have too slowly get through this where the of this bipartisan movement i have been part of that agreement in the best part it is much easier to sustain that policy over time but then it becomes very difficult. so in some ways democrats have to get that by in but sometimes they think they have to knock down the pillar to the she the outcome that is the challenge we face right now. >> you said you think we will see another effort from 2018? what do you think we will see with legislation of that value movement?. >> here is the thing it is crucially important but almost no popular attention paid to what is happening with the huge regulations last week and i can guarantee you there were zeroo coverage in the mainstreamo press and certainly not ont television but the short answer is that the legislative level items happen i think it will all be agency behind the scenes and probably better off that way because the more public attention paid the harder it is to get anything real don. so we will see a sustained effort for repeal and replace with large-scale architectural issues but what you deal with on a daily basis i would be floored and shocked even more than election night last year. [laughter] if anything were to happen legislatively to impact the direction. >> a you are aware of those discussions going on right now?. >> i think there band with the sole limited so think how long it took to get rid of it and that was broadly agreed upon because at some point they were sick of sticking your room for the holidays. the policy recommendation aside i just don't see how they deal with a sea a repeal andn, replace tax reform, infrastructure, fund ing the government, raising the debt ceiling, but i just don't see that. >> tom price was here for a while and we were worried we would see the oval back with the regulatory we have not seen that but there is that anxiety. >> but predominantly looking at what they would be doing and in my mind with the of buyout recently people should be engaging in that. one area i find it frustrating in the community is telling us what the barriers are and the consensus. the employer community says it won the value and they want to be more proactive to engage as. that is the direction we want to do that. of course now the question is a big issue as to whether or not we can move nationally and if the department will move in that direction and some in the congress who like that because they want to have credit for the policies that they do and that they are scored in mattis day complicateds. issue but the plaintiff is for now to focus on the executive branch. they have to get that reauthorization and define those offsets with the budget resolution and the tax bill ice-cream resolution week is tough by the congress. [laughter] >> what will congress look like 2018 after the election and?. >> i hear a lot of people say with new jersey and virginia this is the signal but 2018 that is one year away it is difficult to say what will t happen but one thing is t clear that there is a lot more energy in the progressive base that on the republican side right now partly because they deal with these existential questions about what it means to be a republican. there was some division in the progressive movement as well so i do think if they favor a republicanng senator -- senate and house but on the senate side it would be disappointing if they cannot do more to pick up seats with the state's the democrats have no business winning quite frankly. so we will see what happens but it is a function of candidate string in the capacity of president john than the status of the economy then this october surprise that shakes up the race to make it competitive like alabama. >> i am under the category of making lemonade out of lemons the fact that president trump won the electoral college is probably a health for those democrats who would've been more vulnerable in the clinton and world. in ohio and indiana never have done much better so this is the year to the republicans inp the senate they need to pick up seats because of 2020 it is reversed i wouldn't bet on the right now but there will be tremendous increase in the house reason why 2018 is something to watch politically is they feel is a political necessity to do something in thisso area and that is why we're all worried about 2018 because that would be even harder. >> i am getting the hook but we have time for a couple of questions. >> by the way we could see more expansion of medicaid so what that in virginia and main. >> you mean by the initiative?. >> initially that a referendum is the majority in the state of maine and virginia there is much more republicans and perhaps even the state legislature. it is very, very close. i am pretty confident they are making progress. i am trying to understand the logic of very brief hypothetical with two parts the costt that generates out of the providers because we spend money. not the insurance. so add to the hypothetical market so one hospital system that is dominant because of dominance the triple the rates then they go to conferences to decide itsev do as many services as possible everybody gets radiation every heart isma studied and then make a lot of money but in another market two groups have been working for some time and maybe because there is more competition the rates are not crazy high. so when people in the exchange go out to buy they will pay more in one class as will the employers and everybody else because the rates are high during to a much unnecessary stuff. medicare and medicaid take the price difference because they get the price they impose not necessarily that utilization difference. so the problem i have of the republicanns side to say we need more insurance competition the market's is that the insurance company are like car dealerships if you'll put that quality that there is nothing much they can do but put the lights element so we watch this bill on and on but the only way to get the cost down is us and we are forbidden to do it by the economics of the world we live in. we came here to do this but they keep stopping us so how expensive the exchanges are. so in many instances i could give you a list of the ohio markets the price is through the roof and they don't get medicaidbo benefits will cost more than anybody can afford. >> i think as sentiment is right in part because we have a relatively opaque health care system where the reason why the focus is on insurance premiums because that is the actualization most people understand to see in front of them but not because it iss illustrative of whatf is really happening with care delivery or the value but people see the premium and that associated elements of the plan. that is why you see the discussion because insurance premiums are a reflection of the trends in many cases not within the control of the insurance companies. but we're not having that discussion. ir agree. because that is not what most people see on the day to day basis. it is generated from insurance premiums because that is what people see. >> that consolidation issue is getting more and more attention you could be pleased by republicans and democrats but the media tends to i focus much more them the hospital so that system is becoming the you could feel whole issue of market consolidation it is still a little underneath that phase but i am seeking more encouragement from both parties to send signals that they're focusing on that more and more so at the end of the day, you are right right, historically this has been a huge issue. but here's the problem. the question is once the policy maker sees the problem of what is the policy intervention? so with that enforcement people don't have a lot we all have ideas to be both in and out of the executive. >> here is a plot to eliminate fee-for-service in medicare. [laughter] make medicareul advantage be the default. >> there are people that would drive a better model civics have you lived in their rural area of the g lee? how do they get access? isn't going to have been. and i would say we want to have fee-for-service model so i hear that. but let's be real. the second issue is look, i do think the marketplace with the population with tremendous growth with reduction of payments, the trendline looks pretty good good, additional incentives incentives, people would be interested with that pushed back on the democratic side but it is a mistake not to combine those that is superimposed some of that value for fee-for-service it would be a mistake because we need to do better for those who have no alternatives. >> 30% is waste you hear that all the time and if they get is generally true stowe, urges congress aware of that?. >> i think they are aware but the way they conceptualize waste is different. >> we think of fraud and abuse. >> yes. the challenge to get back to the point that people white what they have to was certain degree even if not efficient so shortly after passage it is difficult to put people into things that they are not comfortable with. i am not saying that is the right approach but the reality. >> but that needs to be better.and executed we have to deal with safety issues people are dying as a consequence.lk i was talking yesterday a reportro issued late 90's probably projected 90,000 people were dying as the consequence for pour care. you think that number has declined? since that time? so we need to have a refresher on some of these issues t of how we deliver care. >>th were you bernie sanders for a moment, what approach with a single payer advocate suggest with 30 percent waste?. >> here's the thing they conceptualize that is focused on the insurance companyr. administering. >> but that is not the case but i think politically the argument has traction. they said understand and by private insurers are involved so everybody makes the argument about waste the we need to get a better handle exactly what we mean where is it happening? with that goal to route to that out other than make people feel better we're dealing with waste and fraud abuse. >> we heard yesterday from thee congressman wanted to reduce medicare vantage. >> democratic view sold their arean those that are opposed to medicare advantage in the worse surprised by that. we thought that have largely vanished. >> don't let get be looked at them but. [laughter] they make the decisions not combination of republicans and democrats who now are very comfortable with the plan to have beneficiaries disproportionately in the urban u setting are not as hostile. does that mean if there are perceived over payments they say we should not do more oversight? of course i hope people in this room would say the same thing but amongst your problem that is not first on your list let's just say that. >>. >> [inaudible] [inaudible] >> and your question? the audience notes that. [inaudible] [inaudible] [inaudible] [inaudible] >>gh i fake their reaction is yes, yes, yes. [laughter] and we do agree completely. >> we are a lot of time. >> so i came away with a certain sense of discouragement about what to expect from the administrative side of the equation with those various agencies perhaps people traditionally who held the pieces together. >> you mentioned this morning our real action has to happen on that side so i am wondering if you think that is realistic?. >> starting with my assessment with high quality people are serving and i sincerely believe there are good people those that are part of thissi administration but if the president goes in theis direction they expect him to go with his nomination secretary of hhs he is tremendously well qualified and will be a very good leader for the agency. i don't count as a measure of concern of the people in those roles. and it is the overall direction so to the degree there could be hostility so i tend to think that was focused on the person who sat in the secretary share previously. that is a very important role so if alex sense those signals. >> so then it is a question of who is setting the tone. i am not doubting this company people are filling the roles to get the workk done. >> in my experience with two separate administrations the high quality people there has been some flight, but not all and a lot of these people remain but frankly is the most underappreciated and underutilized by the stakeholders as the access point to change and we have a whole fascination with congress but the day-to-day operation of the executive branch has far more impact from what we do every day. so that we value if we like your opinion but they should take heed with that message and not give up. so let me underscore that's. [laughter]ve >> thanks very much.h. [applause] >> ladies and gentleman please enjoy the 15 minute break. [inaudible conversations] [inaudible conversations] [applause] >> good morning. thanks for having me here. with the national association of medicaid directors we are just finished with their own annual meeting here in d.c. but today is veterans day so all of my kids are off from school in day care so i had to make all sorts of arrangements to get here but this is an important opportunity and i was thrilled to put the pieces together tome make this work because honestly anytime i can talk a m