so that those payments in medicare would be paid not for a transaction, a test, but whether or not you get an outcome for a patient. that is important. better use of data is important for both the patient, as well as providers. in term of moving to better costs and affordability, as well as better quality. >> why is it, then? we are all looking at the same numbers. i think we all at this table any way and most of the people in the country agree we know where the spending is in mandatory areas. why is this such a difficult problem to tackle. if everybody knows what the problem is why can't anything be done about it in washington? >> one of the things i think is important and doesn't get talked about a lot is a lot was done in the medicare space. if you look at the numbers of savings, the dollars that were saved from the time that the affordable care act was enacted and the time that we just left, and even if we didn't have the final numbers, it was over $300