 I will speak quickly because I want to make sure that I don't get yanked by Kenshine and I want to give time to the others. And really I'm being optimistic. I've been at this since the early 1970s. I believe strongly that this country should cover everyone. I also recognized that much of the debate up to now in 2009 has really focused primarily on insurance coverage and only a little bit on what we should do for our healthcare system. Without going into detail, when you all get said and done, there really are three different ways that we could cover everybody. We're going to hear about the benefits of a single-payer system. So I won't go into that pro and con. We can have a discussion of that later. The second is to take our complicated public-private system and make it work better. And the third, which has been advocated by your former governor and the former president of the United States, George Bush, about the elimination of using tax preferences and goals. Now as it's turned out that both First Senate Obama and now President Obama and the Congress have opted for the middle system to take our complicated, messy system and make it work better. Now some people say, well, that's terrible. We need a simple system and stuff like that, and I can appreciate that, although I will admit Americans just don't do simple things. As a matter of fact, it's almost un-American to think simple. And for those of us who sort of make our living sort of explaining things, a simple system would probably push us out of business, on the other hand. For most of you that actually provide medical care would probably be an advantage. Now we just recently saw the Senate Finance Committee pass health care reform, and it is now being debated by various members. And for better or worse, and for many of you, you might think of it as worse, many of the components of that plan are likely to prevail as we move through. Not all of them, we can talk about that in the questions and answers. And in a lot of ways, the Senate Finance Committee, just like in the House of Representatives, have used a lot of what we in Massachusetts developed. And quite frankly, I'm very proud of what we've done in Massachusetts. And in spite of what you read from that second-rate newspaper coming out of New York City, Massachusetts health care is working. Not perfectly. We've got problems, but it is working. And we have by far the lowest number of uninsured in the country. Before the economic meltdown, we were down to two and a half percent of our population being uninsured. Now, not to spend a lot of time on this, the basic finance committee would have a limited public plan. Many of you probably want to have a more rich public plan. This is going to be debated. There would be federal subsidized, which expand Medicaid. In a state like this, that would be a massive substantial increase in Medicaid, funded almost entirely by the federal government. One of the more contentious aspects of this debate is to say that every American you have responsibility to have health insurance. And then it's a question of if you don't, what are the penalties? And one of the issues that have come up is how can we force people to have health insurance when they really can't afford it? And the definition of affordability has become a big issue. And yes, there would be significant insurance reform, but yes, the insurance industry in some form would survive. Some of you would find that to be sort of an anathema. But the idea is that in many of the more heinous of their activities that, and they would say themselves they don't want to do it if everyone was covered. And so it would deny, for example, the idea that an insurance company could not cover you because they have a pre-existing condition or retroactively look at your big say that, well, you didn't tell us about that broken big toe, and of course that led to cancer, and therefore you're not covered. Not a good thing, not a good thing. All right, so we're not going to get into this. Obviously, this would cost a lot of money, and the President and Congress have said we are not going to add further to the federal deficit. And so there's a substantial amount of money, but it is going to be sort of made up by increased taxes, and particularly from the health insurance industry to make them give back. But there will be give-backs from the hospitals, from the doctors, from the pharmaceutical companies, like although their give-backs are going to be less than actually they're going to get. Now, unfortunately, and this is unfortunate, this will not solve our problem. While it will cover, based on the best estimates about 29 million Americans, there's still going to be 25 million left, and you're going to still have, particularly here in Texas, a lot of your uninsured, particularly those who we now call unauthorized immigrants. I mean, try to find the right term to say it. And so this work is not done. This work is not done, even if we pass it. Now, there are other proposals out there. One in the House of Representatives would cover substantially more people and actually cost a lot more money, and they're having trouble getting their bill put together. But, you know, maybe we can, why shouldn't we find another $150 billion? Somehow we found $750 billion to bail out the banks. Seems to me we ought to be able to find that kind of money, but that's my preference. And in fact, we would see some changes in Medicare and Medicaid. Now, many of you, including me, the conflict of interest indicates, I want to make it very clear I'm on Medicaid. I'm on Medicare, I'm sorry. I'm a professor, Medicaid might qualify, too, you know. And I like Medicare. And there are many on Medicare who are very nervous about this current reform, because a fair amount of the money that's going to pay indirectly for this is going to come out of the Medicare program. That does not mean, and I want to make it clear, that those of us on Medicare are going to see a reduction in our benefits. So there are substantial benefits, and you have them in your folder, I don't want to lose my time. But here's the issue that I want to spend a few minutes on. While we would see lower spending for healthcare from certain segments, particularly the government, it is not at all clear that we're going to see significant reductions in total spending, or see significant reductions or changes in the practice of medicine. Now, when you look at that 1,300-1,200-page bill, you really have to almost get to page 900 or 1,000 before you see any significant attempt, even, at restructuring the healthcare delivery system. And as I said, as a result of that, we will probably not see much of a reduction in the $2.5 trillion that we're now spending on healthcare. It's sort of hard for me to imagine. I started in this business. We were spending 75 billion, 7.5 percent of our GDP. We've now grown to 2.5 trillion, and 17 percent of our GDP. It just boggles my mind. And there were reasons why we would see increases. And there's been a big debate, and the president has been yelling at the insurance industry, and the insurance industry has been yelling at the Congress. And there is some truth to the idea. Healthcare, and those of you who run HealthSystem, we have a gigantic Ponzi game out there. It's kind of like, squeeze on this balloon, it pops out over here. If the government doesn't pay me enough, I'm going to try to get more from private insurance. If one part of private insurance doesn't get enough, I'll try to get more from the individual. And that's the way many healthcare systems, including, I'm sure, here in San Antonio, as well as throughout Texas, are trying to keep their books balanced. And so, when the government's going to squeeze down, there's no question that in a lot of ways, many of our healthcare people will try to find others. Second, some of our younger people, those around 30, 35 years old, are going to see increases in their premiums. And they're not going to like it. You can tell them, you say, well, with luck, you might actually reach 55 someday, and then you'll see a reduction in your premiums. Just hold on a little bit. As a matter of fact, those of us who are beyond 35, I'll tell them, right now, I'll switch with you. I'll pay the higher premium. So yes, they will see it, and there'll be others, and there'll be substantial increases in copayments and deductibles. So the question is, why? Why is it that after several years of debate, after both the House and three committees and the Senate and two committees, why did they not seriously restructure the healthcare delivery system? And I'm going to tell you. Because if they had seriously attempted to control health care costs, they would not be able to repeal Altman's law. And I'm sure you're saying, what is Altman's law? And so I'm going to tell you. Altman's law says, and this has been watched since the early 1970s, that most every powerful constituent group favors health reform. But if it's not their plan, they prefer the status quo. I'm talking about all of us. All of us, hospitals, doctors, insurance companies, pharmaceutical companies, nurses, taxpayers, everybody says, absolutely, do it, not everybody, most. And then they go, but not on my back. And so what I say to people who have been telling me for years, we have to tackle both coverage and restructure the delivery system at the same time. I say, you are absolutely correct and you're out of your mind. And that's what we did in Massachusetts. We consciously said, let's get everybody under the tent, or almost everybody, and then let's collectively decide how much we want to spend on health care and what our health care system should look like. Don't make the uninsured the responsible for the problems that we created. That's what we did. We consciously did not. And so what I say to the president and to the Congress, you did the right thing. Put it off. But don't put it off forever. We need to have a serious debate as a country on how to regulate and change the delivery system. And you know what, I think we can do it. And in doing it, what do we need to do? We need to change the way we pay. Now, we're talking about a Medicare commission that would regulate the prices and stuff like that. I'm not necessarily in favor of that. And the reason is it's not Medicare alone. What we need to deal with is the total system. And by the way, that's going to come at us very quickly, because Medicare is very close to going broke. And we're going to have to deal with that very quickly. Now, I, for many years in my career, were responsible for trying to get Medicare to function in a more efficient way. And I could stand up with a group like this and say, look, not my responsibility to worry about the total health care system. My responsibility is to worry about Medicare. You can't say that anymore. If you weigh it up, Medicare and Medicaid, another government plan, it's by the year 2020, most hospitals, about 70% of their total revenue are going to come from these government hospitals. And many parts of this country will be 80% and 90%. Medicare can no longer think of itself as a separate program. It's our government, and it needs to think along with the others on what it should look like. Where must we go? We know where to go. We do know. Everybody, Ken knows he's been doing these research when he was president of the medicine. We know we need to change the way we pay for medicine so that we can encourage a different delivery system. The Commonwealth Fund recently, about two years ago, created a framework for high performance hospital. And their conclusion was we need a delivery system that emphasizes coordination and integration. If we don't do that, all the money we're spending on health IT, all the money we're spending on chronic conditions, just it will go down the drain. We need to get the system to work together. And in order to do that, I hope most of you agree, we need to change the fee-for-service system. Right now, you get paid for doing. You don't get paid for value. Now, many of you, if not most of you in this room, do provide value care. And I'm sure most of you who are providers really care about your patients. So I'm not here saying you don't, but the system actually often hinders you from doing the right thing. Now, you heard, and I'm sorry to bring up bad news, but the high performance system has now done this state by state. And according to their definition, Massachusetts was number seventh. We got blue is good, red is not good. We got good grades except for one thing, avoidable hospital use. And then I put representative states, and Texas was number 46th on their list, and you got reds along the line. You got yellow for healthy lives. That was a pretty good. Now, if you look at the map for the country, you'll see what the map looks like. Those of us in New England, we did a little better in some of the Midwest, South didn't do too well. But the point here is, America is a complex system, and yes, it's a lot harder to do it here. I mean, it's easy for me to say, oh, I'm from Massachusetts, we did a great thing. But we had a lot of things going. You have a tougher problem, and we need to work with you. The country needs to work with you to make it happen. And we know what to do. We need to align forces and make this work better. And yes, let me just finish by saying, it's not that healthcare reform legislation is doing nothing. They have set the seeds for change, and there are a number of proposals in there for demonstrations, for changing incentives. We need more primary care physicians. Actually, last year, Harvard, I think, produced two, and we're very proud of them. We're nurturing them. We haven't been a little petri dish. We want them to grow. You do a better job here, I'm sure. So yes, we need to do more. And as I said, healthcare reform in 2009 is not the end of the show. We need to continue with this. So thank you very much. I just want to say one more thing. As physicians and stuff like that, you need to understand that we need more research on what works and what doesn't. We call it comparative effectiveness. Aside from these kind of death panel discussions, we need to learn what works. Thank you very much.