interesting that's driven, clearly, by technology particularly with high-speed internet connections and something we're hearing a lot about is social networking web sites, sites like facebook and myspace or linkedin which provide a way for people, friends and colleagues and even strangers and whatever to communicate, basically provide a community where people can discuss in a semiprivate area, you know, a variety of topics. and the basic idea behind the social networking web site is you register with the web site, so it's a voluntary, it's a voluntary activity, and you get an account, and from that, from there you say to that web site who your friends are, and so you get connected up to them. and that creates an area where

everybody can can can commune candidate. ormation you provide as part of that social networking is made public in can be used by anyone. if you google people, some of the first things you will see our protocols -- are profiles at places like facebook and link in. l. ink -- facebook and linked in. another aspect going on behind the curtain in the social networking site is the use of information that you provide as part of your profile as well as part of your discussions with france, the advertising aspect. you are being targeted with advertising as you use this site based on all the information available either in the profile

or on >> and in another area that becomes very interesting is many of these websites support features, what are known as third party applications. where the website allows other parties, other software developers to come in and provide content, games, applications that run within the context of the social network on networking website. and these applications in many cases are supported by advertising, and what folks are using these websites in many cases don't realize it is these applications also have access to some amount of personal data that's being collected by the website. and again, that's often been used for advertising purposes and potentially other uses that are not clear. the last area that i want to look at here this morning here on the collection of data, and i think it's a very important one,

something that has become a very much more important over the last, say, three or four years is mobile phones or smartphones in particular. a smartphone is basically a computer that's portable. it just happens to have a cell phone attached to it. but the key thing about that computer is that it can to mitigate through the internet through wireless connection. so we are able to collect data, or observation with that device at any place, at any time. and so i key feature of these new smart phones is the ability to locate themselves. that is, find out where they are on a map, at any point in time. and they use a variety of technologies to do that, including gps, wi-fi and cell towers. so you have a very powerful combination therefore doing data collection.

you have a smart device that can run applications, arbitrary applications. you have a communication network which allows the phone home and you have something to provide location. so we have companies out there now developing whole interesting host of applications using these technologies. and it's sort of the next level of data collection, if you will, on the chart here, we show a couple of different applications using smartphones. one of the mobile coupons application, the idea that as you're walking around, you can run this application and it can provide coupons for businesses in the area that you are currently at. and so the idea is you download the application to the cell phone, and at the same time you provide personal information to the vendor who is providing coupons. and the application runs, and as you execute it it will provide

you with a variety of coupons and you can do things like, say, here's the kind of coupons i'm interested in. skinny. excuse me. i still have 30 seconds in spite of the. you say what kind of coupons you like, restaurants, bars, so i. based on your location and the types of coupons that are available to the coupon provider, they are sent to your phone. another more interesting application, one that seems to be targeted at the younger crowd, i'm not sure i would want this one, but is the mobile friend locator. it provides sort of the next level of the ability to watch us as we go round our lives. the id issue sign up with the service, get, download an application. and it shows on a map when you run the application where all your friends are located. they also have to opt in to the service.

so the idea is that friday afternoon and you want to get together for dinner that night, you can go see who is close by and then meet up. again, what else is going behind the scenes is a free service. there's advertising that goes beyond kind of scene. so the ads are shown on part of a map with the idea of trying that's where you meet your friends at. in addition, one of the services we looked out allows you to also upload your position here, your social networking, home page. so not only people with phones can figure out where you're at, but also your friend who are following you on a particular social networking website. again, advertising can then be provided on the website based on your location. it's a level of surveillance i think a lot of people will be surprised, if you go back 20 years ago, would be accepting. but it's out there and it's something if people want to participate in, can. with that, i would like to move onto the first panel here. and thank you very much for the

opportunity for speaking. [applause] >> im chris. i want to thank you all for coming for this round today. if it's possible for folks to squeeze in time if there are open seats in the middle, i would ask folks to try to do that. we have some analysts i see in the back there, reserved seats up front for the analyst. if you want to come up. one more administrative detail. we have a wifi connection, and there are information sheets up front about how you get access to the wi-fi. again, i would like to thank everyone for coming. first i would like to thank and introduce my co-moderator, professor rosen that he is one of the leading scholars and

privacy experts are key teachers at george washington university law school, legal affairs editor at the new republican and a fellow at brookings institution. we are very pleased and he agreed to help us with these issues. i am equally pleased to introduce our other panelists. he is associate professor, susan graham is director of consumer protection at consumer federation of america. jim harper, director of information policies at the cato institute. leslie harris is president and ceo of the center for technology. michael hintze he. david hoffman director of security policy. richard purcell, senior ceo of corporate privacy group. i need allen could not make it here this morning unfortunately.

and we apologize for that. i would like to say just a couple of words and explain how the panel will go. as we heard already, technology has gone through many dramatic changes. many of these changes have brought tremendous benefits. one of the most dramatic of which is the internet itself with its ever-expanding array of easing access, free content information, and communication and services. yet at the same time, consumers are becoming increasingly concerned about how technology may be used by companies to collect information about their online behavior. to segmented into special categories based on their online activities. and use information about the many ways they may not know about or understand. for a long time companies have been gathering information about consumer habits, interests, and

activities in the off-line world through wordy cards, surveys, contests, subscriptions and census information. that collection of off-line information is now being enhanced through the collection of online information. information such as click stream data showing where you travel around the web, online surveys at websites offering guidance for specific problems, purchase information, reading habits, and search queries. this opening panel and ftc's dialogue on privacy is to explore this dramatically changing landscape. look at ways in which information about consumers and their everyday lives is gather gathered, analyzed and shared among companies from marketing and other purposes. we will talk about the ways in which information may be compiled and used, and ascot panelists for their thoughts on how the collection and use of information offer benefits or create risks for consumers.

whether certain information collection and sharing activities are subject to existing rules or laws, including whether there are limits on how long companies can retain information, or how they may use information. whether consumers understand or are aware of the extent of data collection compilation, and whether they can exercise control over that collection and compilation. our format this morning is a bit different than usual. rather than having each panelists offer remarks or make presentations, we plan to explore the issues through a series of a real-world scenarios. the fact pattern to allow the panelists an opportunity to discuss some of these questions and engage in a dialogue. the obvious is also invited to submit questions. we have staff members with index cards in the room. if you have a question, please raise your hand to get a card.

staff will collect the questions for us. also, webcast audience members may submit questions to privacy roundtable at ftc.gov. professor rosen is going to lead us off with the first scenario. you may also have a few remarks. >> the ftc has begun this roundtable series on explore in privacy and i am honored to be part of it. i was so pleased that chairman liebowitz in his introduction cited louis brandeis because brandeis of course was not only the patron saint of american privacy law, but also the patron saint of the ftc. and i think he would have been very pleased by the ftc's turning its attention to this important subject. brandeis was deeply aware of the threats that new technologies posed to privacy. in the 1890s, as the chairman said, it was the kodak camera and the tabloid press that made him concerned what used to be whispered in the closet was now being shouted from the rooftops.

by 1947, in his famous olmsted doesn't come it was a different technology, namely wiretapping that made it possible to listen in on telephone conversations without physical trespass. but brandeis was astonishing and a remarkable passage. he predicted the invasions of the internet. he said that weighs some days may be developed by which you will be possible without physical trespass into the home to extract papers from the secret guestrooms, introduced them in court. was a remarkable bit of presence that he wanted originally to include a reference to a new technology, namely television, and that newspaper clippings about about he was persuaded to him as the reference by his law clerk who thought it would sound too sci-fi and no one would believe it. it may have been discussion that led a later law clerk to indicate that front it was a law clerk, but he was not really.

he said the constitution should be translated to take account of these new technologies and at the fourth amendment should protect as much privacy in the age of wiretapping and the electronic age as it had in the colonial era. but in his role as a founder of the ftc, brandeis is also deeply sensitive to the role that government regulars could play. he was convinced that by bringing different constituencies to the table, labor and business, government, says as it was interesting that brandeis hated the word consumers. that a thoughtful balance between competing interests could actually be struck and that's what i think he would've very much uproot up our efforts today. as chris said, we're going to proceed by way of scenarios. the danger privacy as all of you well know, you're all-pro chacon is that if you stay too far in the clouds you can miss many of the textures that make this debate so relevant. so i'm going to begin with a scenario that many of you will recognize.

we will ask our panel is to talk about it, and then chris and i will alternate with other scenarios. here's the first one. in 2006, aol released a text file of 20 million web search queries for 650,000 users. it later apologized saying he was an unauthorized move by a team that hoped it would benefit academic researchers. nevertheless, by linking search query to a common identifier, "the new york times" and others were able to locate individual searchers, including a georgia widow who frequently researched her medical am as. another user gained wealth and notoriety after searching for holocaust rape, japanese flavor and rayborn, virtual children. the disclosure led to the resignation of aol's chief technology officer. the next year, 2007, as part of a copyright suit, a federal judge ordered google to turn over to buy, it's wreckers of which users watch which videos on youtube. for every youtube video the

judge ordered google to turn over the login name and internet protocol address for every user who watched it. in the face of privacy concerns, google and viacom negotiate a plan to anonymize the data. and imagine however if the data were hacked and published on internet. i want to ascot panelists is, what concerns are raised by the possibility that our search terms may be exposed to the world? when i began thinking about privacy in the '90s, we were worried about monolithic and the disclosure of her bookstore received that she was worried she might be just as context on the cases of snippets of information that would come to define her in the eyes of the world. these disclosures that we're thinking about today, aol search terms, google search terms, youtube videos, seem broader indie potential out of context. leslie harris, why did you start us off by describing what are people afraid of? >> i think what people are afraid of is a continual harm,

starting with embarrassment, disclosure, perhaps to their family about things that they have been searching. i think people forget, we don't tend to have a computer, so there is a broad set of people who may be involved. obviously, evil are concerned that they will be labeled, identified, that piece of data will be combined with other data when you talk about search data, you talk about search data over time. i will get back in a minute of whether to i think it has to be hacked into what to do this, because i think that's not the case. what if you're talking about search data over time, you can well be talking about any other kinds of surfing data over time. it's the question of can you ever get and put back together from a bunch of individual brands and not just pieces of data, sufficiently rich profile

that you identify a person. and once you identify a person and have that range of data, what we don't know because we know very little about secondary uses, is is this going to be used or employment that is is going to be used for insurance. is this going to be used for credit. is this going to be sure for other. i will give you an example. my team was researching, one of my young researchers, going through all of the cookies and really doing, she's a technology, trying to figure out how all this was connected together. ran into a network, not one of those who publicly has talked about yahoo and google now are creating the space is where can see what you're being searched against. it was none of those that we know. and most prominently is said they were searching a medical marijuana and marijuana. i mean, sort of on its face forward and about 50% of the

other things that were on that alleged profile made absolutely no sense. but that is a single data point that was plainly connected to her through cookies. and it is pretty appalling. i could have gone on her computer and seeing that, but we also know what's happening with the data. >> very helpful. so leslie says you can actually be harmed by information that is judged out of context or are there broader concerns, the right to read anonymously, and the privacy, even freedom of thought that our state your? >> yes there are. i think it is important to go back to the basics that privacy is a fundamental human right. the ability to maintain autonomy to be anonymous, to maintain your dignity is an important societal value, which we are very pleased to see that the federal trade commission has

recognized, and that it is reorients in its approach to privacy on the basis. so when you think about the fact that most people believe that they are a anonymous when they are doing things like searches, and when you think about the fact that consumers shouldn't have to give up their fundamental right to privacy in order to use these tools, it means that if people were to realize that their rights are being violated in this way, it could have a really chilling effect on their use of these tools for all kinds of very viable things. it's not a trait often consumers should be asked to make that spirit the chilling effect and are both these interest and anonymous reading and also businesses that are trying to

encourage the use of these technologies. let's start to think about the potential solution to anonymisation is obviously one. can anonymisation address these fears, or is the dissension between personal identification and nonpersonal identification boring is the likelihood that bit of our digital footprint can be reassembled likely to support any effort into anonymisation? >> well, i do agree that we have a sense. the data has changed her week and take personal information which may not be very sensitive, and we cannot any interesting way and identifying information or very sensitive data, passports. that said, i do see on them as asian or as an economic problem than a technical problem. and let me explain by what i

mean. that it doesn't sound like another case of economic strength of imperialistic science like every other discipline. the point is the last five, 10 years in computer science of privacy anonymity it has made enormous progress. we do have a very good theory of when the system can be anonymous, and we have technologies to put that data. however, the conditions under which data can be proved anonymous, not often the reality in the sense the attacker can often bypass this kind of constraints or these conditions. he can use additional data, the creator did not consider an end the world of sophisticated data mining, shipped source technology and incredible amount of self revelation and logs,

twitters, is very easy to bypass this kind of protection. now, my message, it's not there for that privacy, i don't mean it is impossible in this word. is instead that privacy technology may not be a sure in any condition that can make the word defined data harder. including terrace more costly which means it reduces the incentive for another entity to try to identify that which has been protected. more important than that, the best privacy technology is to not simply lock data. they try to allow certain data to be shared, which is usually for the consumer and the corporation, while they stop and protect other data. we can. i am a strong believer in the technology and i believe that we can use technology to meet the

interest of both parties. >> richard purcell, how much faith do you have in anonymity as a solution here? researchers are knoxville and ways of anonymizing tenet mails and other data so as expiration dates that can only be read for certain at a time and it becomes an accessible. is anonymity a solution to our concerns about search is being read out of context? >> first of all, anonymity is not yet well defined. so we struggle to a great degree with making a lot of assumptions. so like privacy, like happiness. a lot of these words are words that are more subject than objective. so first of all, we have to begin to think about what anonymity needs. and frankly, we have to start thinking about the more difficult question for me, becomes how do we begin to apply privacy rules to data that is

perhaps not personally identified with data. our underlying concept for privacy is that there is personal identifiable information. if indeed represent are difficult to identify an individual within, can become identified should we start applying regulatory and other standards to those that are a greater standard of care. that might be very helpful. there are researchers who believe that the identifying anonymous record is relatively easy today because the di dedication processes are so poor and they can be improved. as he said, this becomes an economic bother calculated very, very difficult to really identify data, and what's the cost trade-offs of attaining that level of difficulty and preventing any exposure. whether a timeout can matter, whether it expire, over those can be overcome relatively easy.

is a bit like saying i have encrypted access to my hard drive, find. i will use a screwdriver and take your hard drive out and mounted in a different machine and bypass the encryption routine. there's ways around most of that. what i worry about most in the anonymity world is how are we going to reasonably protect really sensitive data? let's take the health data, personal health record information. we depend as citizens on very, very robust research in order to help all of us develop better health practices, better medicines, better treatments, etc. most of that is based on the examination of patient health records and histories that are anonymizing someone or another. if we can't achieve anonymity in that space, we threaten the ability for us to advance our general health care understanding as well. this is a very serious problem that has to be overcome.

>> we have talked about some risks. odyssey there are tremendous benefits to services offered by all aol, u2, others. how can companies make use of this data, monetize it so they can sell ads and also avoid these dangers. i wonder, michael, if you could talk us through some possible solution. should there be a data retention policies of the data may not be retained more than a period of time and therefore it cannot be accessible even if it is demanded, increase transparency, what in your view our solutions? >> i think the answer is all of the above of. the benefits as you mentioned of search technology are enormous and consumers find that very important service. search companies collect and retain search data for a variety of purposes, to enable that service to work the login in order to protect the security of

the system. they analyze the data in order to improve the efficacy of the search service of the results. and those alternately benefit the users of those search services. but as we've talked about, there are enormous privacy implications to this data, the terms that people search on can be quite sensitive and among some of the most innermost thoughts and when you string it together over time, there is obvious a very important privacy evocations to that. the way to do with that, the way to enable those benefits, while minimizing and addressing the risks, if you take a multifaceted approach to protecting privacy from the beginning, from the design stage. when you're putting together a search service, you need to think about privacy up front. we talked about anonymization. anonymization i think it is quite important. but it's not a silver bullet.

and as richard mentioned, there are many definitions of anonymization out there. and some are better than others. i think if you look at the aol search example, the way the data was read in a fight was the ability to link search queries over time. and when you amass enough data about a unique individual, in some cases that was enough to identify the person. i think the court also to keep that in perspective. there were 650,000 users in that record. the data has been out there on the internet for over three years and a handful of people haven't we identified as result. but that's still a problem. we can do better and we should do better. anonymization method that we use on our search engine involves not only deleting the entire ip address, but also deleting all cross section cocaptain fire so you break that link, search sessions over time. dramatically reducing the likelihood of that data being identified. but you need to data security around that system. you need to have transparency

about how the data issues and yes, you need retention, limitations on that as well. all the major search engines, the three big ones, have adopted data retention methods, data anonymization method as will. they differ from search engine to search engine, but all search engines have tried to address that problem. you to think these might become owners from a business perspective, as michael mentioned, yahoo and google now with only a limited period time yahoo police and more quickly than google. what if the government were to require purging after a very short period of time? shorter than yahoo is now a louse, would that be economically feasible and inappropriate? >> i think depends on how you address the question. you could always come up with a period in time that is going to frustrate and get to be incredible short, which i think also the need for having these kinds of discussions about --

and a more detailed discussion on individual issues and try not to set specific legislative or regulatory requirements of certain periods of data that would apply to a wide range of business purposes. at the same point in time, there are a number of cumbers out of that should be absolutely committed for the practices that are being put in place. i think the question we really need to ask is what kind of enforcement and what kind of regular tour structure needs to be put in place for the companies that are not doing that? and in line with that, i think one of the things we haven't talked much about at this point in time, and connected to retention is data minimization. so the end of last year, the department of homeland security did something i that wasn't really important which was included data minimization as a principle and its fair information practices. as we look at minimization, there is a collection minimization, and a retention limitation. not just to focus on retention.

i think what we found is, in my opinion, wasted a tremendous amount of time in the past few years with arguments over what qualifies as personal information, what doesn't qualify as personal information. the reason why i think we have done that is because the consequences of something being, falling into the category of personal information, have been tremendously burdened in different regulatory structures. if we can instead focus on what is the information that's potentially going to impact an individual, either beneficially or to their detriment, and then i understand and get a structure in place where we can make sure that companies are appropriately minimizing the amount of damage that they collect, and then had the they do collect, i think that's the direction we need to head in. >> the last question for this person know. jim harper, you are our brandeisian on the panel, one of

several brandeis, both the big government and business and are you worried that centralized government regulation might exacerbate some of the problems that corporate site introduced. so are there some regulations that would be too onerous, some minimization requirements or data retention policies, and if imposed by the government in response to these aol and youtube examples might make the problem more severe? >> thank you for that libertarian saw fall, first of all. [laughter] >> that's my job. >> i prefer not to argue at a level back and forth with too much regular shall be too harmful. is undoubtedly true that moving into early in an area where we don't know well enough what consumers interests are and what the future of technology, that would be damaging. i think everybody recognizes that. but what i'm interested in is maybe moving the conversation to another level. let's ask the people who really have interested in stay, what do consumers want?

how do we figure that out? all of us in this room are very keen the aware of these issues, and unfortunately the public is not. so i think the problem is to let the systems were. let the social systems were. let the market work. to draw out what the real problems are, and then strike the balance is. is this a big enough problem, should it be anonymization? let companies challenged each other's anonymization practices, facilitated, facilitated by advocacy and sometime by regulars. certainly obvious he regulating to stickley too early would be a mistake. but we still have to define the problems, not just as intellectual in washington, d.c., but across the country and forward through the history of the advancing of technology. >> thank so much for a fine first discussion there for our second scenario, chris. >> think you, jeff. the second scenario involves two situations, both in the social networking environment.

in 2007, facebook introduced beacon, a transparent form of online tracking sending news alert about goods and services they buy and view online. one facebook user was furious that his purchase of an engagement ring was broadcast to his fiancée, ruining the surprise. recently after protests from thousands of users, facebook disabled the feature. some have defined privacy in the sense as the ability to control how and when information about ourselves is as close to others. it could be argued that beacon of the retina that sense of control and inspired protests. another incident a bit earlier and bald a woman, 25 euros single mother who began a career as an educator being denied a

degree i millersville university in pennsylvania. she filed a lawsuit alleging the school denied her degree because administrators discovered a photo on her myspace page that showed her wearing a pirates hat in drinking from a plastic cup, with the caption drunken pirate. the court rejected her claim finding the school offered other reasons for denying her degree. that the incident demonstrates the possibility, at least, that public information may affect the provision of benefits without our knowledge. social networking has become extremely popular and i able to consumers. facebook alone has gone from 100 million users in august of 2008, to over 350 million as of this month. obviously, provides it and other services tremendous way to correct and build communities.

but are there concerns about the scope of disclosure, about uses, information that may not be anticipated or well understood by consumers using those tools. david hoffman, do you have any comments on the scope of use or unanticipated use issues that this presents? >> well, i'm struck by a story that i heard from a colleague of mine who's one of i think one of the most world-renowned expert in data protection and new media said they were meeting with some businesspeople, and it took an entire day going through on the whiteboard to understand how the data was flowing from different situation to different situation. i think we've gotten to a point where that's a good thing. it is a good thing that people are innovating and finding new ways to provide business and services. and we don't want to get in the way and would further don't want

to frustrate that. at the same point in time, i don't think we can reasonably expect that the individual to whom the data pertains is going to have an ability to understand that better than world-renowned experts who are trying to figure it out. for that reason, i think we've got a foundation that we can build on. there's been treatment does work over the last couple of years that the center for information policy leadership has been largely leading to get to an understanding of what a system of accountability would look like, where the entity that the individual is engaging with will then take responsibility for how the data is going to be managed. and make sure the reasonable expectations of the individual are going to be realized across -- understand there will be many uses for the data come in many transfers of that data between different entities, to make sure that the individual services are provided like shipping products, and across national boundaries.

>> thank you. you comment on the difficulty that consumers have an understanding the scope of data flows. and that raises a question about whether there are things we can do to increase transparency and make some of these data flows, or at least key aspects of the data flows, more understandable to consumers. leslie, do you have any comments on how that might work? >> well, i mean, i think there have been some green shoots in the privacy enhancing technologies that have to do with transparency. google and then i believe yesterday yahoo both provide i think very robust features that people can look at and see the kind of data that is being collected and the uses, and edit that kind of thing. so certainly, privacy enhancing technologies help, but we have

put so much attention into the notion that notice and consent, and not enough attention into a broader set of more i would call them substantive fair information practices. and we were talking about them, you do, limitations on collection, limitations on use, limitations on retention, transparency. you know, i think that if we would shift the focus, you know, the policy focus, and i think that would include the ftc focus that it is very important for good companies to be thinking about limitations, etc. but i also think there are policy framework needs to expand, because i do not believe, and i'm a great believer in privacy enhancing technologies, that we are ever going to get to the position that simply making all of this more transparent to consumers is going to fix things.

you know, i think these tools are important. which is initiated a campaign to get more of them out there in the marketplace. like that's not a whole answer to this. by any. >> and some of the efforts that he talked about and we discussed earlier, the efforts made by google and yahoo -- >> very important. >> are very important. but i guess it raises the question about other activities in the market place but what about the other companies that exist that may not be engaged in creative efforts, similar to the googles and the yahoos? richard, do you have any views on that? what do we do with the other companies? >> regulate the hell out of them. [laughter] >> that's what i was muttering. [laughter] >> i've been doing this for

quite a long time. in major corporations and with more major corporations. the federal trade commission wants informed consent. i mean, if we had informed consent, we would be a lot happier. and there are serious limits now because of the complexity of the data flows that david mentioned because of the issues that leslie raised, there are serious concerns about how the heck we can use notice and consent and transparency in order to gain informed consent. at the same time, it's personal opinion that companies have been very lazy about doing much work to develop an educated audience. there has been very little expenditure by major corporations or small ones, very little collaboration between the commercial and the public

sector, time out a real public education campaign about online behaviors, advertising, risks, exposures, etc., etc., etc. most companies say my gosh, there are two things. expensive as heck. i just can't afford it. two, lability, liability, liability. i can't do that i would much prefer to take my lawyers their fees to just put up a really complicated and privacy statement, and that way i'm covered. but i'm covered is insufficient. you've got -- my opinion, we've got to encourage companies to start taking on a more courageous role in not only educating their workforce, which is only really just begun in the first place now. but educating their citizens, they're individuals, that people with whom they deal, about the realistic use of the applications that they are

putting forward online. and spend the money on it. really work to do that. and we will hear later today and some of the panels, but jewels and others, how that is beginning to take -- there is some traction in the marketplace for this. but as david mentioned, if it takes informed people an entire day to plot how it works, then how the heck are we going to be able to come and a kind of very short limited time span, individuals who provide to us, how are we going to communicate was the invocations of that are? and the suggested actions that they take. so we get to privacy right defaults, kinds of comments, as well as privacy by design. it's a very, very compensated area. but money has to be spent. time has to be dedicated to this. >> thank you, jim. i want to give you a chance to comment as well. and for those of you on the

panel, if you want to interject, just raise your name tag upward. i will get you any moment. jim, i want to ask you if the concerns, you know, the two scenarios that i have played out are just that, they are two scenarios. you know, is there a larger concern represented here? are these antidotal stories? how do we measure the significance of this issue? >> well, i think a thing to with the senator is it different that we look at them and recognize the role of trial and error, and discovering what problems exist and how to address them. these are two errors of the varying degree that taught various communities of various things. we all know raced to be the first at any meeting about privacy as a deity can be rectified. you know that yahoo case.

and we race at nice to talk about how the deacon and then went. and also broader communities in the public can learn from these errors. those lessons promulgating out across the business community and out across the consuming community help navigate the way forward. and i think it is mistaken for us, much as we like and as much as we're good at it, to intellectualize about what consumers should want. and then decide how to fix the problems that are obviously presented by these elaborate flowcharts. there is a process for figuring out these things, and if we step back and watch it and understand that trial and error is an important role in guiding us, that will be a great help. i do think that we need to look to consumers to decide what they want, rather than cutting short those processes. >> out asunder, you have a comment you wanted to make? >> yes. i would like to raise a slightly

dissenting opinion on the topic of transparency, which are not enough. and i say this knowing that education can work. the studies were doing, lots of work, show that sometimes they can hope. consumers get closer to the state of privacy preferences. however, i see transversely as a necessary condition. but not sufficient. and i say as research, a wealth of behavior of data and critical base showing what are the gaps between them, what consumers want. the terms of privacy and what they will be able to achieve these state of intentions. and there is first of all a

problem of information. we don't know how our data is used in a. and maybe we can fill, we can address the problem with education transparency and reform. but there are other problems that simple transparency and identification doesn't address that there's a problem of rationality, and yet that we are bound to act on information. and there are values that do affect decision-making and sometimes end up making people choose things that the later regrets. that happens often in the case of privacy, because privacy are long-term, we don't fear it mediate loss of real data. nothing bad could happen, but it is usually later in time. sometimes much later in time. and it has been proven again and again by research that we are very bad at making decisions when the benefits are immediate, but the costs are much later in time. then there is a issue that seems i was the costs are coming to

very high. they are very small, but very high frequency probability, spam a for instance. or they are very high and i. very dangerous but very low improbability, such as being arrested for a case of mistaken identity. or other extreme scenarios. in both cases, are difficult for us to deal with because cases where there is really high but low probability, we tend to dismiss them. and obviously made probability. consider even lower than what it is. in cases where instead and event occurs, but the cost of more such as a spam, we tend to understate because we don't understand how this cost actually acutely over time. each of them is small, but over the longer the time, to give an example, many smokers do realize that smoking causes cancer.

they do realism that each cigarette increases by minimal amount of probability of cancer. but the challenges, the next cigarette you're about to smoke will be part of a longer chain of that cigarettes that you'll be smoking over a various long time. in a similar condition we realize that the more and more information can accumulate over time but we don't know to the next step of acting on that concern. >> thank you. i would love to let all of the folks jump in here. we are on a tight time frame. but if you guys find an opportunity to raise point in connection with the next scenario, please do so. thank you. >> so arthur generic comes from the world of lists brokers. imagine this. you are suffering from depression. in the course of your online research about depression, you fill out a survey that includes personal information which you hope will get you to help you

need. soon after, you receive aggressive pages online and through eno promising cures for your mental health problems. you wonder, where did this information come from? it turns out that there is a list that marketers can buy to identify people just like you. here's an excerpt from an actual description list. quote, medevac has brought together this group of individuals with wide-ranging mental health issues. mental health problems can create a significant burden on the afflicted individual making them extremely receptive to any campaign that may be able to offer some existence or release. and depression is not the only category on this list or other marketing categories include anger, antisocial behavior, anxiety, bipolar, depression, eating disorders, lack of sex drive, poor mary, i stress. imagine that you have a weight problem and there are targeted ads that promise to address your situation, so by a niche marketer who promises, or, these

dieters are great prospects for all tightwads and other health petitioner product. these away watching consumers will try anything in the hopes of being healthy. so these are only two examples of niche marketing categories available today on the internet. there are thousands of similar categories available. it easy to raise questions about niche marketing. but are there benefits to niche marking lists? don't people suffering from illnesses benefit from getting information relevant to them? susan, why isn't this a great thing? [laughter] >> well, this is not a new concern. this concern has long existed with the telemarketing and e-mail marketing. i think that the internet heightens the concern because of the increased stability to gather and segment information about consumers. and it's information that

consumers are not knowingly providing for that purpose. they are usually providing it for another purpose entirely. and as you point out, it can be used to take a vantage of extremely vulnerable consumers. in our view, there's some categories of information such as health that are just so sensitive that it shouldn't be collected. and hughes for marketing purposes. i would hope that if a consumer was looking for health related information, it would get advice from their doctor and they would anonymously, if that's possible, search the web to get that kind of information. i don't think that whatever the benefits of this marketing might be. and also the concerns for things like fraud and abuse of a

vulnerable population. >> that's a great. jim, can you give a wholehearted account of what the benefits might be still as i can may be a suitable account. what does illustrate i think is best is advertising is tacky but advertising about advertising is super tacky. [laughter] >> but the question is, isn't that? isn't harmful? and we really should be careful about assuming the results. for a long time, i have been a skeptic or maybe tried to warn our community about opposing advertising of about medical condition. take diabetes for example. is a condition suffered by many people who are lower on the economic spectrum who may not be good about getting to their doctor on time, taking their medications on time. advertising may play an important role in advising them about new treatments that might be easier to take, that might be

cheaper, etc. so i would be very hesitant to stand in the way of allowing advertisers to reach communities like this. their survey, as susan said, there are concerns with a variety of uses. those stand out as obvious. but when people fail to get a new medication because we decided they shouldn't get advertising, that's a sign that harm that could be greater than the risks we know about. >> leslie, harms and benefits, and why don't you advance the plot about whether there's an approach that susan and jim approach, a second approach it in fine particulate vulnerable consumers are particularly sensitive categories of information might be a way of balancing the costs and benefits because i do think we have to look at particularly sensitive information think i think it is hard by looking at sensitive consumers because we are not making rules that are going to get them impose on people out there. not sure that agree with susan that should be banned altogether, but i think this is the kind of circumstance you

have to have the kind of serious robust consent that is rarely provided. i think consumers league and put a lot of information online about their health conditions. and there is a segment of consumers, and if you go to patients just like me and some of these sites, who aggressively believe that it's important to share and get their information out there. and i have been struck by some very interesting conversations between privacy advocates and some of these disease specific advocates about fairly different views on this. but i don't think because there are people who want to share all of this information publicly, you know, that we should somehow -- i think you have got a binary choice here that doesn't make sense to me. i think that some kind of advertising can happen, but it's got to be very serious, often kind of concentric and i have to

do, that i am very, very skeptical about how you make that happen. and i'm particularly worried because even when you do so in certain circumstances, the lack of transparency about making a decision that there's a particular place you would be willing to get offers from, or you are comfortable, you know, hearing about health -- you on a health site and people are advertising. that may not be the same kind of potential harm as that data being collected and advertise over time. i have experienced having an ad served to me after doing substantial research online about a condition and my family that is not diabetes and not likely to show up. and i found it incredibly invasive. and i certainly didn't feel like clicking through and as compared to read the medical literature that i was reading, a parody led to this act, that that was going

to add an enormous value. >> we can imagine that certain kinds of intrusive niche marketing might indeed promote consumer backlash that would be harmful to companies. let me ask michael. are the standards that should apply to businesses to prevent intrusive niche marketing, and if so, what should they be? >> i think the answer is yes. and the discussions around ads and ad targeting have addressed some of those and some of the panel have already suggested, you know, around different categories or vulnerable populations. i think, you know, one thing that occurs to me is that there are just simply responsible practices and a responsible practices in the advertising state. and we all shake our heads that descriptions of the practices that seem to be taken advantage of vulnerable populations. and in the discussions around ad targeting, we talked about restrictions on advertising to children. because they are a particular

vulnerable category of potential consumers. and there are others as well. it's hard to draw a bright line that says, you know, this category of advertising should be off limits for the reason that folks have talked about already. already. and some ways it's hard to say that vulnerable categories of people shouldn't be targeted, because in some ways you can be more responsible by targeting. take it as an example. by targeting then you can make sure they are not seeing the ads are out all are not seeking the ad for products that would be inappropriate for them. and so i think it really comes down to responsible practice versus irresponsible practice. recognized as hard to write down in rule and legislation and regulation. >> so what's not on the trail is this question -- >> we will take you now live to the u.s. senate. the senate is on day 11 of its health care debate. several members have been offered and you are being debated. won by north dakota democrat

byron dorgan to let u.s. citizens buy and import prescription drugs from other countries. idaho republican michael krehbiel also offered a motion to send a bill to committee to deal with middle-class tax liability issues. senators are likely to cause the health care debate today or tomorrow to consider a federal spending package for the rest of this budget year. several federal departments and agencies have been operating on temporary spending authorities since august. live coverage now of the senate health care debate here on c-span2. will lead the senate in prayer. the chaplain: let us pray. gracious and merciful god, you promised never to leave us alone, and we're grateful for

your comforting presence. thank you for your whispers of love and peace. help us to see your face in others and to show them your love. today, give our senators the wisdom to know your will and to choose your way and purpose. when the choice is between honor and self-interest, help them to do right. may they exercise themselves to have a conscience void of offense toward you and humanity. lord, give them strength equal to

their tasks, as you undergird them with your loving providence. we pray in your precious name. amen. the presiding officer: please join me in reciting the pledge of allegiance to the flag. i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. the presiding officer: the clerk will read a communication to the senate. the clerk: washington, d.c, december 10, 2009. to the senate: under the provisions of rule 1, paragraph 3, of the standing rules of the senate, i hereby appoint the honorable mark l. pryor, a senator from the state of arkansas, to perform the duties of the chair. signed: robert c. byrd, president pro tempore.

reid mr. president? the presiding officer: the majority leader. mr. reid: following leader remarks, the senate will resume consideration of 3590, which is the health care reform legislation. the time until 1:00 p.m. today will be equally divided and controlled. it will be for debate only. the time until 11:00 a.m. will be controlled between the two leaders or their designees and then the remaining time will be controlled in 30-minute alternating blocks of tiesm the majority will control the first block, the republicans will control the next. senators will be permitted to speak for up to ten minutes each. i expect the house of representatives to send to the senate this afternoon a conference report. when it arrives, we'll consider it. and if cloture needs to be invoked, then the senate will have to be in session this weekend for a saturday vote and a sunday vote in order to complete action on these bills. this bill is -- includes the

bills that we have tried to complete. as you know, we've been held up by the minority to do these bills. bbut we we've made progress. first would be the transportation bill, commerce, justice, science, financial services and state foreign operations. that would remain the onl leavey remaining bill to be defense. we hope we would get word from the republicans today as to what they want to do. whatever they want to do, it is in their hands. but everyone should understand that procedurally no one can stop us from moving to the appropriations bills. it is bipartisan. we've worked closely with the republicans on this matter. and we automatically go off the health care bill when we get on this. so we're waiting for the score

to come back from the congressional budget office. so there is a lot we can do until we get that done, which will be next week. so no time is lost on health care. and we have to work until the end of the year, so we've got to do this bill. so whenever we hear from the republicans, the senators will know what their schedules will be. we frankly, mr. president, could complete our work today and come back and we could work something out even so that we could have a monday vote. but whatever the republicans want, that's what we will be happy to cooperate with. the presiding officer: under the previous order, the leadership time is reserved. under the previous order, the senate will resume consideration of h.r. 3590, which the clerk will report.

the clerk: calendar number 175, h.r. 3590, an act to amend the internal revenue code to modify the first-time home buyers credit in the case of members of the armed forces and certain other federal employees and for other purposes. the presiding officer: under the previous order, the time until 11 complook shall be equally divide -- until 11:00 shall be equally divided or controlled between the two leaders and their designees. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, for the benefit of all senators, let me lay out today's program. it's been three weeks since the majority leader moved to proceed to the health care reform bill. this is the 11th day of debate. the senate has considered 18 amendments or motions. we've conducted 14 roll call votes. today the senate will continue debating the amendment by the senator from north dakota on prescription drug reimportation. we'll continue debating the motion by the senator from idaho

on taxes, and we'll continue debate on the bill. under the previous order, the time until 1:00 p.m. today will be for debate only, with the time equally divided and controlled between the two leaders or their designees. beginning at 11:00 today, the republicans will control the first half-hour and the majority will control the second half-hour with continued discussions to try to find a way forward. i thank all senators. mr. president, i ask consent that the following staff of the finance committee be allowed on the floor during the debate on the health care bill. the presiding officer: without objection. mr. enzi: mr. president? the presiding officer: the senator from wyoming. mr. enzi: i appreciate the statistics that the senator from montana cited about how long we've been debating this and how many amendments we've done.

actually, that's how few amendments we've done. and right now the majority is filibustering their own bill, and i have no idea why that's happening. we've been calling for votes on both of these amendments that are -- that have been proposed so far, and haven't been able to get the amendments. so i don't understand how they can talk about how many amendments are being done. and i also have to voice some other frustration because i don't know how many times i've heard the exact same speech by the senator from illinois, senator durbin, on this floor talking about the amount of hours that have been spent together working on these bills in the "help" committee, the gang of six, the finance committee. you know, this isn't about how many hours we spend together. it isn't about how many hours we spend on the floor. it's whether we're accepting ideas. and i -- i understand that the other party won the last election. but somehow they're going to stro get over this attitude that they won the election, they get the right to the bill.

they don't have to take any ideas from anybody else. in the "help" committee, i keep pointing out that most of the things we turned in were kind of punctuation corrections and spelling corrections and any ideas that we actually had that appeared to be accepted in the bill were ripped out of the bill before it was actually formally printed, without talking to us. what kind of bipartisan deal is that? another thing with the "help" committee, when we were having -- you know, we've only had 10 days of debate on this. we did more than that on the "help" committee when we were marking up the bill. we're having, in the words of yogi bear are, deja vu all over again. when we were having that markup, the majority withheld a big part of the bill. i think they were maybe still

writing it. that he be that's what's happening right now, too. but we couldn't get the text that we were going to have to write amendments on so that we could deal with the bill. and i think america noticed that. people said, how come everybody isn't reading the bill? you can't read what you don't have. the point i'm trying to make is right now the newspapers are full of information -- well, speculation -- it has to be speculation about what this new medicare expansion does, because i haven't run into anybody that's seen the text of that. i've asked some of the media that have written about it and they didn't see the text; they got a briefing. we haven't even had a briefing. the majority side has had a briefing, but our folks that have talked to those folks said, wow, that was pretty general. how could you make up your mind on whether you're going to support it based on the little bit of information that you got? that's not the way to run any

kind of an organization, especially if you want bipartisan votes. you can't write the bill in secret, which is what was done with this bill. there wasn't a republican involved in the behind-the-doors stuff that leader reid did to put together the bill that we've got now. that's not bipartisan. and there hasn't been a single person from the republican side even briefed on this new proposal that's going to save the world. actually, you know, i noticed that the american medical association suddenly left the bill and said, this will be the worse thing that happens to us. and the hospital association, who have been strong supporters of the bill, have also said, this won't work. particularly the mayo clinic, which we've been holding up as one of the prime examples of the way to do health care in america, saying if this medicare expansion happens, it will cost

us millions. and we won't be able to provide the kind of care that we've been providing. so what's the deal around here? whawhen are we going to actually goat see something? when is the majority going to share with us this marvelous idea that they've had? you know, what -- what kind of way to run a business is that? are we going to recess for the weekend? and i don't want to recess for the weekend. i'm conscious of the 10 days or 11 days that we've had debating and we've only covered 14 amendments. and i got to ticialtio tell yout a lot of important amendments that either will be part of the bill or will help the people in this country to understand what's being thrust on them. there has never been a bill of such importance as this one from the standpoint of how many people it affects. we're talking about reforming health care in america.

that's everybody. that's every single individual, that's every single provider, that's every single business that is going to be affected by this bill. and we talk about 2,074 pages, which seems like a lot. and it would be for a normal bill that you could debate in a limited period of time, which is what we're being asked to do, but 2,074 pages isn't nearly enough to cover health care for america. so why is it only 2,074 pages? well, there are hundreds of references in there to how the secretary of health and human services is going to solve all the problems. the things that we aren't able to put into detail in there, we just assign to her and she will magically be able to solve the problems for american health care. well, after all, it's her department. but that's not going to happen. you can't give that many assignments to any agency, any department, any group of people,

and expect that within a reasonable amount of time, for them to come up with solutions, solutions that ought to be decided on by this body, the elected officials, not just appointed officials but elected officials. and that's not going to happen with this bill. the only way that could happen is if we took significant parts of it and put it up one piece at a time and solved it. and that's what seniors are asking for in this country. they're asking for us to take the medicare part and give them some assurance that when we're through with it, it will work. well, we're not even getting to see a significant part of it. we've been pointing out how it's taking $464 billion out of medicare and will how it will break it, will ruin it. you just can't steal $464 billion out of a bill and have it come out good. -- out of medicare and have it come out good. and the majority recognizes that. that's why they put in the

special commission that's going to come to us etched and every year and suggest -- to us each and every year and suggest the kind of cuts we at ought to mako keep that solved. we ought to take the cuts that are provided and make them apply only to comaimplet but how are you going to fund the expansion of medicare now down age 5? how do you do that? how do you do that? well, i guess you charge a premium to those people. that's the kind. rumor that's out there. how big of a premium? how big of a premium are they going to thrust on those people? i suspect that it's going to be the older or sicker people in that 5-64 age category that are going to want to shift to medicare. if it's a higher premium so the system stays solvent -- having nothing to do with age because we can't do that under the bill, or sickness because we can't do that under the bill. those are good ideas but those

better be in the age of the high-risk pools where people come to me and say you better do something about health care because we can't afford that high-risk pool. it's too expensive. how much more are we going to expect the young people to pitch in in their paycheck -- and that's where the medicare money comes from right now. they deduct a portion of the paycheck from every single working american. that goes into medicare and gets paid out right away to medicare recipients, hardly any of whom are the ones paying into the system. and they're hoping that that system's going to be there when they get older. what i'm asking for is for the majority, is to show us the paper and give us a reasonable time to look at it and give america a reasonable time to look at it. i don't think it's unreasonable for that to be on the internet, you know. that's a significant part of the bill. that would be a significant bill all by itself. it was held from our view when

the "help" committee did it. incidentally, in the "help" committee bill, that was put together in two weeks without our help and put on us, and then parts of it withheld, like this has been withheld, until the last minute and then thrust in. that's what created this enormous outrage across america of "did you read the bill?" how can you read the bill if you havett seen anything on it, if t

choice. because obviously we can't sit there and mandate that from them, although we were promised early on that they would be able to reduce the cost of medicare. that was the original proposal when medicare advantage was adopted many years ago, a number of years ago. mr. president, again, it's anything but medicare and it's anything but an advantage except for the profit-making companies that have done very well off this program. and our bill here merely restrains the overpayments. and i know that may bother these

companies. they'd like to make more if they could, and i respect that from their vantage point. but we should not, as the united states senate, sanction and necessarily to approve a proposal that allows them to make more money out of the pockets of people on fixed incomes to support a fraction of the population at the expense of the overwhelming majority. where the equities in that? why 80% of medicare recipients ought to be writing a check each year to private companies in effect to pay for benefits they never get. and i hope, again, that the organizations across the country -- and i appreciate the position of aarp and certainly the commission to preserve social security and medicare, we thank them for their very strong letters. these major organizations representing 43 million of our he will tkpherl this country -- of our elderly in this country have taken a very strong position against these assaults

on this bill regarding the overpayments that are occurring. and we thank them for it. that may not be enough for some people to appreciate, but i believe that if they look and listen to what's going on haoerbgs they'll understand what is -- here, they'll understand what is at stake. if you're part of the 80% writing those checks and getting none of the benefits, this crowd wants to maintainhahat and probably expand on it in the years ahead. for you out there worried about the cost and solvency of medicare, our bill is a major step in the direction of reducing those payments and providing the options that ought to exist. that is reduce profits or extend benefits. so, mr. president, again, i think it's important to remind our colleagues that under this bill, there's $130 billion in budget reductions in the first ten years. it's the largest single reduction. listen to our colleagues from north dakota and new hampshire talk about deficit reduction. this bill provides $130 billion

in deficit reduction in the first ten years and $650 billion of deficit reduction in the second ten years. we're now told by the congressional budget office that of the millions of people today who are paying insurance and watching the costesque late almost on an hourly basis, even with zero inflation they're watching private companies raise the cost of premiums going up dramatically. on the individual market there are 32 million people, mr. president, on the individual insurance market. according to the congressional budget office, they would pay 14% less in premiums for an equivalent plan under the status quo. that's a huge reduction potentially in the years ahead, for 32 million of our fellow citizens in the individual market. if you're in the small-group market, there are 25 million people in that according to c.b.o.'s analysis. they're eligible for tax credits, would pay 8% to 11%

less in premiums. if you work for a small business and don't qualify for the tax credits, you still get to see a reduction potentially of 2% to 3% ernesto status quo that exists today. if you're in the large group market, and there are 34 million of fellow citizens, according to the congressional budget office, you can see a reduction, 3% to 5% i believe are the numbers. in any category, you've got a choice here to make. and we do in the coming hours. if you want to continue the present process -- when people say status quo, it's such a misnomer, mr. president. the status quo might even be acceptable to people if you could freeze everything. the status quo allows for a dramatic increase in premiums. dramatic increase. we're warned that if we don't take steps to deal with rising costs as we do in this bill, that you're looking at premiums go from $12,000 a year for a

family of four in this country to $24,000 to $35,000 in the next seven to ten years f. this gets defeated, as obviously our republican friends want this bill defeated, then the idea that we're going to jump back into this is a pipe dream. that you will end up with a drastically increase in costs to millions of our fellow citizens that this bill restrains because of the hard work done by the finance committee particularly that had to work on these issues. to those who suggest the status quo is okay, it is anything but okay, mr. president. and so, in terms of cost reduction overall as well as premium reduction, that is so important. and i thank my colleague from indiana, senator bayh, who is the one who insisted that c.b.o. give us an analysis of what the kpwafbgt this bill would be on premiums. the fact is we've seen significant reductionness premium costs. i'll end on this.

in connecticut, mr. president, premiums in the year 2000 in connecticut were about $6,000 a year for a family of four. we're in the year 2009. now that family of four in connecticut is paying around $12,000. that is in nine years, $6,000 to $12,000. those numbers continue to jump and escalate. for those who say no to this bill, prepare to answer the question if you succeed in these efforts, why is it the people you claim to be defending around here with this bill if their premiums for insurance will escalate to the rates we're talking about. that's what we're talking about. mr. president, whether it's so-called medicare advantage or it's cost reduction or premium reduction, this bill, with all of its imperfections is a major, giant, positive step forward for our country. again, i thank the members of the finance committee and members of the "help" committee and both staff and others who

put together and acknowledged and accepted and worked to include many of the ideas that our friends on the other side wisely and thoughtfully made a part of these efforts. with that, i yield the floor. the presiding officer: the senator from montana. mr. baucus: mr. president, i just want to underline the huge bipartisan effort that this side undertook to put this bill together in many, many, many ways. i very much agree with the senator from connecticut on that point. from the beginning, let's go back. over a year ago i held an all-day health care summit at the library of congress for members of the finance committee, republicans and democrats. they were all there, spent the whole day. in addition, i talked to all the groups, called them up. i said we're all in this together, we americans. consumer groups, labor, pw*eug business, small business, pharmaceutical industry, hospital, hospice, all these c.e.o.'s working together to get health care reform passed for our country, for all americans. we kept that process up.

i don't like that word "bipartisan" more accurately so everybody is together, working together. if you don't like something, you take it off -- the presiding officer: the time of the majority has expired. mr. baucus: i was getting wound up, mr. president. i'll continue when the -- when the majority half-hour comes around. mr. mccain: i ask unanimous consent that the senator from montana be given two additional minutes. mr. baucus: i appreciate it very, very much. the presiding officer: is there objection? mr. baucus: this could take a couple more than two minutes. i'll just wait. mr. mccain: thank you. mr. baucus: but i very much appreciate the offer. the presiding officer: the senator from arizona. mr. mccain: i ask unanimous consent to enter into a colloquy with senators tennessee, oklahoma and tennessee. the presiding officer: without objection. mr. mccain: mr. president, we are here obviously, as we are on a daily basis, to discuss the issue of health care reform.

but we are in a rather unusual situation this morning because we don't know what w we're discussing or debating. we find ourselves in an interesting situation, after almost a year of consideration of health care reform, with a measure that has been at least some -- a couple of the outlines of it, weigh know, but frankly we have had no details, except that medicare is going to be extended to -- eligibility for medicare is going to be extended to age 55. i just would quote -- there was a meeting yesterday amongst the senate democrats. "many senate deems emrchled from the meeting sayings -- quote -- "they had learned little from the public option agreement -- senator mary lamp drew called the agreement a very good idea.

senator blanche lincoln said more information is needed and senator ben nelson aid, i just want to know what the costs are." well, know do the rest of us. so dot rest of us. so here we have a proposal after nearly a year that is being -- quote -- "assessed by the congressional budget office" and here we are with no knowledge of what that bill is about with the exception of some bare essentials that have been leake. what's this got to do with change, with bipartisan, with anything? and frankly we have an editorial in "the washington post" this morning that calls it -- quote -- "medicare sausage." and i ask unanimous consent that this editorial from "the washington post" be made part of the record. it says -- quote -- "-- the presiding officer: without objection. mr. mccain: -- "the emerging proposal could have costly unintended consequences." but we don't know what it is. but we know that never before in

this entire year -- i would ask my colleagues -- have we seen a proposal that would increase eligibility -- that would change jibled foeligibility for medicao age 5. never. so the majority leader came to the floor and said, well, if we accept an omnibus millionty trillion-dollar bill by unanimous consent -- by the way, that bill, the omnibus appropriations bill, six bills totaling $450 billion, 1,351 pages long, 4,752 earmarks totaling $3.7 billion, and by the way, spending on domestic programs increased by 14%, except for veterans, which is increased by only 5%. so the majority leader wants us to go out for the weekend, after keeping us in all last weekend and here we have an unspecified

proposal that none of us know the details of the cost. so i'm supposed to go home to arizona this weekend and say, my friends, we've been working on health care for a year and guess what? i can tell you nothing. we need to stay in. we need to know what the proposals are. we need to have voteds o votes d we need to tell the american meme what's going on behind closed doors? mr. mcconnell: will the senator yield? mr. mccain: gladly. mr. mcconnell: i recall our good friend the majority leader telling us on november 30 that we would be here the next two weekends and then i recall my friend telling us that we'd be here this weekend. my assumption is we were here to deal with the important issue that the majority leader has been indicating to everyone is so important, that we must stay here and do t and we're prepared to be here and vote. and vote. in fact we've been trying to vote for a couple of days now and the a been difficult to get votes. mr. mccain: could i ask the republican leader, maybe we -- if we're not going to have a vote, maybe we ought to have a

vote to table the impending imp- pending amendments? i know new orleans is very nice this time of year, but perhaps we ought to stay here and get this job done. mr. alexander: a couple nights ago -- i think it is important to reflecten the season we have here. a couple nights ago the senator from arizona gave an impressive speech in front of the capitol for lighting of the christmas tree. i mean, this is the christmas season coming up. two weeks from tomorrow, very important season. and the majority leader said it is important for us to all to stay -- you know, stay through christmas, if necessary, to debate this bill. we said, all right. that's what we'll do. we'll stay until new year's day, we'll stay until valentine's day. this is indeed an historic bill. we don't want to make an historic mistake because it affects our children, grandchildren, 17% of the economy, all 300 million americans. none of us have ever seen our

constituents more involved in an issue than in this issue. so we're here ready to go to work. so i'm wondering, as i listen to the senator from arizona, not only do we not know what this bill is that we're supposed to enact by two weeks from today, our friends on the other side don't know what it is. they can't tell each other what it is. they come out of their -- they had sort of a rally yesterday. one of the senators described this as sort after "go, team, go" rally. all we've heard they're going to -- and i imagine the senator from oklahoma who is a physician, who has delivered many babies, seen many patients, still continues to do it -, woud have some comment on it. all we've heard is they may try to etion spanned medicare. and we heard yesterday from the executive director of the mayo clinic health policy center -- and i'll ask unanimous consent

to place his letter in the record. the presiding officer: without objection. mr. alexander: and i'll just read one sentence from it. "that expend spanning the current medicare system to persons of 5 to 64 years old would ultimately hurt patients by accelerating the financial ruin of hospitals and doctors across this country." so, i'm very puzzled ideas like this are being cooked up behind closed doors two weeks before christmas and we don't know what they are. and the suggestion is that we don't vote today and go home this weekend. mr. mccain: not only is there questions that need to be -- not only is the oppose significance from the mayo clinic but the american medical association and the american hospital association have come out steadfastly against. i quote from this editorial. here we are going out for the weekend, and the editorial for

"the washington post" says, "presumably, the expanded medicare program would pay medicare rates to providers, raising the question of the spillover effects on a health care system already stressed by a dramatic expansion of medicaid. will providers cut costs or will they shift them to private insurers, driving up premiums? will they stop take medicare patients or go to congress demanding higher rates? once 5-year-olds are in -- once 55-year-olds are in, they're not likely to be kicked out and the pressure will be on to expand the program to make more people eligible. the irony of this late-breaking medicare proposal is that it could be a bigger step toward a single-payer system than the multipublic option plans rejected by senate moderates as too disruptive of the private market." mr. alexander: -- mr. coburn: i would answer my colleague as someone who has practiced medicine for 25 years.

medpac last year sid 29% of medicare beneficiaries it surveyed were looking for a primary care doctor and had great difficulty in finding somebody to treat them. well, that's now. in the state of texas 58% of the state's doctors took new medicare patients but only 38% of the state's primary care doctors took new medicare patients. i would make the case to you that if you delay care, that's denied care. and it's exacerbated in our older population. because an older person with a medical need is much more susceptible to the complications that can come from that initial problem. so if you delay the care, you're denying the cares, and you're actually increasing the cost. so if you add -- there's 15 million people in this population. i have no idea if there are plans to include all of them. but if you add 15 million new

people to medicare, what you'll have is 50% aren't going to find a primary care physician to care for them because the rate of reimbursement doesn't cover the cost of care. so i think the editorial that you quote is exactly right. i'd also note, if i may, that president obama lauds mayo clinic and rightly so. i had a brain tumor removed summer before last by mayo clinic. i'm standing here on the floor because of their expertise. mr. mccain: -- believe the senator from oklahoma could not have a heart attack. mr. coburn: well, i'll ignore that comment. the fact -- the fact is, is what mayo says is we've got to figure out how we create the incentives in terms of how do we get paid cared for at a lower cost? medicare isn't the way to do it. as a matter of fact, i heard our colleagues talk, we've had eight votes since last saturday.

we're ready to vote. this is a 2,074-page vote. i've got 15 amendments in the queue. i want to vote on them. they don't want to vote because they don't want the american people to hear all of the bad things about what's going to happen to their health care if this bill passes. and if we do medicare, what's going to happen is medicare costs are going to skyrocket but access to going to go down. mr. mccain: parntsly, i'd ask my colleague from tennessee, we don't know what we'd be voting on, because there's been a whole rewrite of this health care reform here after a year and we don't even know what the provisions of that bill are, except what has been leaked and apparently my colleagues on the other side of the aisle, with the exception of the majority leader, don't know what it is either. mr. coburn: but the senator, if he would yield, there are some things we could vote on. president obama outlines some very specific things thought to

be in this bill, and we ought to vote to put them in the bill. what he said he wanted and what this bill presents are too different things. so we ought to vote on making sure everybody has access, we ought to vote on making sure we are under the same plan as everybody else that we're going to put into any new expanded health care coverage, we ought to vote in making sure everybody is treated fairly in this country, we ought to vote on your prescription drug reimportation, we ought to vote. but what we're doing is we're getting the slow dowfnlt we heard that we're obstructing the bill. we're not obstructing the bill. any other bill that come before this body that had 2,000 pages on it, we'd allow eight weeks, ten weeks to debate and as our colleague from maine noted, there is not a more complicated subject that will affect more people that this body has ever taken up. and we are trying to squeeze that into three and a half weeks

and the last two weeks we don't know what's in the bill? time out. mr. corker: i'd like to thank the senator from arizona for his great leadership on this issue, and i agree with all here. i'd love for us to continue to discuss this, coul quia's, if you will, and vote. i think that's what we need to do all weekend is talk about this issue and vote. there are numbers of amendments. but, senators, the thing that's interesting to me, you have been for years one of the great champions in this country, as it relates to trying to make sure that we live within our means. you have pointed out waste in government, you've pointed out overspending, and what's happened during this christmas season is for our friends on the other side of the aisle, medicare has become the gift that keys just keeps on giving. -- that just keeps on giving.

i know when talked about during that you are campaign -- and all of us have -- we need to get dmier a point where it is solvent -- we need to get medicare to a point where it is solvent. seniors need to be able to use the benefits lairlt on that now are in -- later on that now are in place. what does the base of this bill do? it takes $464 billion out of medicare to create a whole new entitlement. it doesn't even deal with the doc fix that we've said many times. and so now the reason, by the way we don't know what this says is, the leadership on the other side -- this is another one of those yellow post-its. they're throwing it up on the wall just to see if it works. they're not telling us what the game plan is because they zo dot yet know whether it works. but what they're hoping to do is to solve a major problem they have within their co caucus, ag, by taking from medicare. the mayo clinic won't even take

new medicare patients and yet our friends on the other side of the aisle are trying to throw a whole new decade -- a decade of seniors into the plan. what that means is, less and less seniors are going to have access to care. i mean, that's what -- that's what this means. i will have to say based on history, i am surprised but continue through their policies to throw seniors under the bus. and i don't -- i do not understand what has happened. this must be about a political victory and not about health care reform. let me just say one last thing. i know the senator from texas and south dakota are here. what we would do is more firmly put in place, again, back policy. the problem with medicare today is physicians and providers are paid fees to do more work. so now what we're doing instead of health care reform, which is

what senator coburn and all of us have talked about for some time, we're putting in place in cement something that works poorly, that the mayo clinic says is damaging to them and their patients, we'd be putting it in place for even more people. i want to thank the senator for his leadership. i hope to be with you all weekend discussing amendments that are important, voting on those amendments. i can't imagine a better place for all of us to be. mr. mccain: i thank the senator. could i just ask the republican leader -- the republican leader again to be very clear that it is his view and that of our entire republican members of the senate that we'll stay in for as long as it takes to get this issue resolved, and we are prepared to vote throughout the entire weekend if the majority leader moves to the omnibus appropriations bills. we will have a conference report. we will certainly have discussion about a bill that has

4,072 earmarks totaling $3.7 billion in it. but we really should get off -- mr. mcconnell: you're entirely correct. i can only quote the majority leader himself. he said we would be here this weekend. we expect to be here this week. if he tries to leave, we'll have a vote to adjourn and -p i'm confident every republican will vote against adjourning. it either is or it isn't. as important as the majority may says it is, if it's that important, we need to be here, and more important, equally important to being here, we need to vote. we tried to get all day yesterday an amendment by senator crapo and all we heard was we're working on a side by said, kind of parliamentary talk for delay. we're ready to vote. as several of our colleagues have suggested, we keep hearing about these new iterations of

this bill. it reminds me at the end of a football game trying to throw a hail mary pass. just somehow, some way find a way to pass this bill. i think it's important for everybody to remember what happens to most hail mays. they fall to the -- hail maries. they fall to the ground incomplete. you get the impression they're far less interested in the substance of the bill than just passing something. when the president came up here last sunday he said "make history." make history? the american people are not asking us to make history by passing this bill. they don't believe it's about the president. they believe it's about the substance. and we're out here prepared to talk about the substance of this measure, offer amendments. and we fully intend to do it for as long as it takes, and as the senator from arizona has suggested, if the majority leader pivots to a conference report, which he's able to do

under our process, we'll spend all the time it takes to deal with the conference report. mr. mccain: may i point out again, as the senator from maine, senator snowe, pointed out, it was highlighted in the "wall street journal" today, no major reform in the modern history of this united states senate has been enacted without bipartisan support, a reason for us to go back to the drawing board. i know that the senator from texas has been heavily involved in the issue of hospitalization and the american hospital association's reaction to what appears to be an expansion of medicare. mrs. hutchison: i thank the senator from arizona and am so pleased that our leader is standing strong to say that nothing should take precedence over our handling of this bill and making sure that it's done right. and that's what the republicans are trying to do, is make sure this is done right. we talked about the medicare expansion that is in the

purported bill that we haven't seen yet, but that the democrats appear to be putting forward. and yet, we've been spending the week talking about a $500 billion in cuts to medicare. now we're talking about possibly expanding medicare at the same time we're cutting $500 billion out of the care that medicare patients would get. one of the amendments -- the senator from arizona mentioned -- i mean, excuse me, oklahoma mentioned that he has 15 amendments pending. i have an amendment, and it would stop the cuts to hospitals. $135 billion in the underlying bill that would cut hospitals reimbursements from medicare patients. that's my amendment. now we're talking about possibly expanding medicare, and the american hospital association put out an alarm. it's an action alert. and it says, "medicare pays

hospitals 91 cents for every dollar of care provided. medicaid pays 88 cents for every dollar provided." so the cuts in medicaid, which also have been discussed as an expansion, and the cuts in medicare which we're talking about possibly expanding would go forward, which means what? the hospital association knows what. what is rural hospitals that care for medicare patients are going to go under. so what kind of services can be provided if there is no hospital in a whole county that can provide care to these senior citizens? so i ask the senator from arizona, who's been such a leader on this, we're going to cut $135 billion out of medicare coverage for hospitals. we're going to now talk about

expanding the coverage of more medicare patients which will mean we're going to cut more from the hospitals than is even envisioned in the underlying bill. help me understand this, senator. how would you suggest that that passes the commonsense test? mr. mccain: may i say having stood fifth from the bottom of my class at the naval academy, i'm at an entire loss to explain that to the senator from texas. perhaps before i turn to the senator from south dakota, maybe we could get a response from dr. coburn to that question? mr. coburn: they're going to cut care, which means you're going to have more complications, which means you're going to have worse outcomes. that's what's going to happen. rather than changing the payment formula, which is really what we should do, by rewarding quality and rewarding outcome rather than rewarding, you know, flipping a switch, that's what

needs to happen. but we're going to take the same antiquated system, we're going to cut $465 billion from it, and then we're going to add -- my colleague from tennessee is correct, it's 34 million people if they include everybody from 55 to 64 in the same program. mrs. hutchison: is the senator saying whether you were at the top of your class, like the senator from oklahoma or the senator from tennessee or the senator from south dakota, or the bottom of your class, like the senator from arizona has admitted, he held down the fort, regardless of where you are on the quotient of where you stood in your class, you know what the bottom line is? mr. coburn: if the senator would allow me, real short, here's a survey of 90,000 physicians. that's more than the active practicing physicians in the a.m.a. "more than eight in ten physicians surveyed they think payment reform is best to

improve the system for all americans. only 5% of the physicians surveyed rated current government health care program as effective." 5%. mr. thune: i would just ask my colleague from arizona, if this is what happens when you end up with one-party rule, one party trying to do this going on their own, this seems to be a model of dysfunction in how to come up with a solution to one of the major problems facing the american people. and dysfunctional even by, say, washington's twisted standards. but they just seem to be desperately throwing things at the wall hoping something will stick. but sheerly, surely there has to be a better suggestion coming from the other side than to expand a program that is destined to be bankrupt in the year 2017. i mean, it's the equivalent of a ship that is sinking. it's like the titanic.

you're going to put more people on the deck of a sinking ship. clearly, the overall objective, at least among some -- and i think some have been transparent about it. someone quoted earlier today the congressman from new york in the other body who said that this is the mother of all public options. he went on to say, "never mind the camel's nose. we have his head and neck in the tent on the way to a single-payer system." obviously there are some people here who really want to be to* see a single-payer system. they want to see government-run health care. we don't happen to believe that is the solution for america's health care system. the amazing thing about this proposal is that it takes a program that is destined to be bankrupt in a few short years, cuts $1 trillion out of it over ten years when it is fully implemented and then adds a whole, millions of new people into that program. it's hard to come up with any rational explanation for what's

going on here other than they are left with, in desperation trying to throw something to the wall hoping it will stick. so i would say to my colleague from arizona, is this typically what happens around here when one party tries to go on its own on something that is this consequential to america? one-sixth of our economy is represented by health care in this country, and essentially what they're saying is that we want to expand the part of that economy that isn't working today, that's headed for bankruptcy, that underreimburses doctors and hospitals, put more people into that failed system, exacerbate the cost-shift problem by forcing people in the private payer market to pay myer and higher premiums. it just seems like this creates all sorts of problems that make matters even worse. i would say to my colleague from arizona, i appreciate his leadership on this issue in pointing out what inevitably is going to happen. and when you have, as you noted, "the washington post" editorial this morning even acknowledging

the terrible problems that this creates for health care and the way that this is being conducted, the sausage being made here in washington, d.c. that i would say again, even by washington's twisted standards, this process has become so dysfunctional, i don't know how they can recover. one thing that they could do is decide to sit down with republicans and actually figure out some things that we could do that would drive health care costs down in this country rather than make them go up, i would say to my colleague from arizona. mr. mccain: i thank the senator from south dakota. i have to say that i have never, in the years that i've been here, seen a process like this. i mean, it is incredibly bizarre that after a year, after hundreds of hours in the "help" committee, after how many hundreds of hours in the finance committee, products are here on our desk, it's in front of the senator from tennessee's desk, and yet, there is a meeting yesterday of the democrats, and they come out and they don't

know what the proposal is either. apparently there's only one senator that knows what the proposal is, and that's the majority leader. now, and also then it's okay to go home for the weekend. i honestly say to my colleague from south dakota, i've never seen anything quite like this, especially when we're talking about one-sixth of the gross national product of this country. of course from what they know, doctors, hospitals and others have come out in strong opposition to expansion of a program that, as the senator from south dakota points out, is going broke, is going broke. mr. mcconnell: i say to my friend from arizona, he made reference today to the senior senator from maine and her very insightful and thoughtful and correct speech a couple of weeks ago about how an issue of this magnitude was historically dealt with here and how it was not

being dealt with this way. i mean, she pointed out that the major domestic legislation in modern u.s. history was without exception done on a largely bipartisan basis. and that whole process, as the senator from maine pointed out, has been entirely missing as we moved along here toward development of this 2,074-page monstrosity of a bill designed to entirely restructure one-sixth of our economy on a totally partisan basis. i don't think that's what the american people had in mind. and so they want us here, as we've all indicated, debating, discussing and amending this proposal, and that's what we'd like to do for as long as it takes. mr. alexander: if the republican leader will think back when he first came to the senate as