the bottom line, as far as I am concerned, is what happens to patients.

We have begun to lay the groundwork for payment reform by passing the IMPACT Act, which will give us the data we need to improve quality in post-acute care settings.

Last year, we came together with MACRA. That landmark reform repealed the SGR and already started the process of transforming how we try to pay physicians under Medicare.

It is not what happens in Mr. Kind's district, where about 80 percent of the people have advance directives.

Mr. Blumenauer put through a bill, Mr. Levin and I put a bill in 25 years ago, that everybody in Medicare ought to file an advance directive.

We have made some substantive bipartisan progress recently. We need to build on our success.

Now, the reason I raise this issue is that we all know that about 70 percent of healthcare costs occur in the last 6 months of life.

None of us on our side who were involved in drawing it up thought for one minute that we had created the Ten Commandments off the mountain, which haven't been changed since Moses brought them down off the mountain.

This is the kind of hearing where there isn't much disagreement about the fact that we want to have quality.

I always love to come to these propaganda hearings before the elections, and it is obvious we are trying to hold the insurance companies harmless here.

The Governor of Texas decided he didn't want health care coverage for 1.2 million or 1,314,000 people.