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You funding move titles even programs which support expanding residency programs amongst other things the likelihood have decreased funding GM me I’ve mentioned in another context and you know one other things that was in the Accountable Care Act was really a desire to have do move toward a more rational workforce and it's so part of what was there was eight national Workforce Commission thus far the congress has not appropriated a penny for it and so it has met once by telephone and that's its impact is going to be contained I'm afraid so let me start by just pointing out the land statement by tom Daschle when hews up for confirmation for Secretary of Health and Human Services he show this slide in the this triangle here's shows what the system of primary care that’s present in most other countries strong primary care base in this said here is his description primary care in this country and his statement was quote every other country starts at the base of the pyramid with primary care and they Biohealth Garcinia Cambogia work their way up until the money runs out d we start at the top of the pyramid and we work their way down until the money runs out and so we have to change the pyramid we have to start at the base.

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