As I mentioned, one measure of the degree of federal control of the health care system is the ratio of spending by the federal government to the total spending in the system. In recent years this has been fairly stable at one third to the total. As part of the roadmap for health care reform we need to attempt to project the effect that the changes are likely to have. In particular, the impact of introducing more competition into the health insurance market by regional health care cooperatives should be examined. Of course in the long run the current federal programs such as Medicare will grow more rapidly as the demographic shifts toward a greater aging of the population.