Mr. Brinkerhoff, Given that paid and incurred claims typically comprise 80% of the cost of insurance premiums, to what extent have you investigated the rise of the cost of care. The cost of care (i.e. claims) are merely the payments made to doctors, hospitals, pharma and other providers. The cost of care is the driver of the rising costs. Insurance premiums are merely a symptom. To get to the root cause of medical inflation, the cost of care needs to be the focus. Where are the studies on this subject? To be sure, insurance companies need more competition to reduce prices on their end, as well. The impediment to insurance competition are the state and federal laws that protect the insurance monopolies in each and every state. Blue Cross Blue Shield plans were charted by each state's legislature and are therefore very closely aligned with state government. The Blues are independent companies and are not one single corporation. The states have virtual control over BCBS and therefore provide them with a money-making monopoly in each state as is evidenced by their dominant marketshare positions - see Center For American Progress table http://tinyurl.com/mhv8al Employer-based health insurance serves as another impediment as does the federal government withholding of ERISA preemption for non-employer groups. Individuals should be free to purchase health insurance as part of group of their choice - a fraternal organization, bank customer group, association, university or other bonafide group. The federal government currently only provides ERISA preemption to large mulit-state employers, unions and the federal government itself. Non-employer groups must also be recognized by states to legally hold a medical insurance contract for its members. Currently states only allow non-employer groups to hold disability, life, accident and dread disease policies. These types of reforms are necessary and will provide immediate competition and lower insurance pricing.