personal health information has been our top priority and will continue to be. since we began taking these steps, we have seen a new momentum behind the electronic health record movement. in the past, some providers have expressed skepticism about the standards they would have to meet in order to earn the incentive payments, but in the last few months leading doctor and hospital groups have come out supporting the standards that have been announced and we want to keep the momentum going. when electronic health records are widely adopted, doctors will have better information and more time to focus on patients. patients will have more control over their own health data. employers will have a healthier more productive work force and a stronger bottomline. and as the report we are

releasing today also shows, there will be more jobs for americans and one of the key new industries of the future, the technology itself information. so we are already making great progress, but we've got a long way to go and i want to now ask to come to the podium larry summers, is the chairman of the president's economic council to talk more about the report. dr. summers. [applause] >> thank you. thank you, madame secretary, an? thank you for your ex?traordiny leadership that is the reasonñ? large part why all americans are going to have health care going forward. ? are very fortunate to haveñ?? ????ñ?ñ?ñ????ñ?ñ??ñ?ñ?ñ?i

first, this is good??ñ? jobs and macroeconomic policy.? if you think about economic??? situation, we have got excess? capacity in? many areas.???? there are too many houses that? have? already been built.??? capacity utilization? in???? factories.??ñ??ñ??? consumers are over latter, over? borrowed, relative to their??? assets.ñ???? where can the spending power?? ?at we need to accelerate

recover and come from????ñ?? part of the story is correct?ñ? government actions and that is? why the agreement reached a??? couple days ago on tax policy i? so profoundly? important.??? part of the answer lies in the? international sector and???? exports.?????? that's why the president's free trade agreement with korea is s? profoundly important and much else we are doing to promote?? exports.ñ???ñ????ñ? and part is an investment but at ?e moment when there is so muc? excess capacity we have to??? define the categories of???? investment a little bit more?? carefully.÷? you know, for one reason or??? another our family has a completed more pcs ? ???????

employed resources, which can be put to work providing jobs that? are important in the chart run and providing capacities that are profoundly important in the long-run. long run. that is why health information technology was so crucial part of the recovery act, and this is probably one of the largest efforts government has ever undertaken to spur investment in a particular crucial subsection. second, this is the essential health policy.

i would suggest to you this principle. information technology in the american health care system should be as pervasive in the treatment of patients as it is in the billing of patients. i can assure you that information technology plays a larger role in 20% of doctors offices involved in billing and i can assure you that it is far larger than 10% of hospitals use information technology in assuring that they are compensated. there is no good reason why the average 7-eleven uses more information technology than the average doctors office. it is wrong and it is costly. it is costly at a time when one in 20 prescriptions involve an error. it is wrong at a time when tests

are done and done again and done again, because it is not possible to transmit the results from one doctor's office to another doctor's office, and it is wrong when the average? medicare patient receives care? from seven different positions in four different? organizatios in the average year. this is not a problem that will fix itself. the essence of this problem involves networks. you know the first person who got a fax machine really could do very little with it. the second person who got a fax machine actually could do more. they could fax to the prayers -- first-person but unless they were married to a show that wasn't exciting when there were

two fax machines. when the technology spread, the benefits increased far more than proportionally, because networks were central. so it also is with information, health information technology and that is why government needs to give this a big push. that is why the private sector needs to collaborate. that is why at the center of anything that involves connectivity, is the capacity for connections and that is why the issues of open standards that are stressed in this report are so profoundly important. this is good for the economy. this is essential for the health care system. there is a third reason why this is very important. it is essential for people and

can change their lives. actually it can save their lives as i was driving over here, and this is not in my written text, i was reminded that just about 25 years ago, i had been in the hospital for some time with something fairly serious, and thought that i was leaving at the end of the afternoon. and, at 3:30 someone arrives to tell me that actually i wasn't leaving, because my blood count had deteriorated very sharply and they were going to need to a value with the situation and it was likely a need for several transfusions and this was a very serious problem. as you can imagine, it was a relatively traumatic our until they arrived somewhat sheepishly

at 4:30 with a combination of good news and bad news. the good news was that i was okay. the bad news was that they were a little embarrassed that they have had a certain confusion in reading a handwritten record in distinguishing between the words summers and the words symonds. all that meant for me was an hour as dramatic as any as i have ever spent. one reads that for thousands of other people the consequences? ç?eç? vastly re--- more serious? thanç? that.ç?ç?ç?ç?ç?z?s?z?z? don't we deserve to do better?ç? let's z?never forget as we talk? about the economics, as we talk? about the efficiencies, as we talkç? about the issues facing different providers that doingç?

çisç?ç? faster and better is a? about life and death for thousands of our fellow citizens. thank you very much. [applause] >> maybe i should give our next guest the courtesy of an introduction. professor professor eric lander from m.i.t. and a colleague of mine from the boston community and a really distinguished leader in many many respects but here especially in the area of biomedicine but here today as the cochair of the presidents council of science and technology. welcome, eric. thank you for being here. >> thank you very much. i am here is the cochair of the

presidents council advisers onx science and technology.xwxx i would like to specifically acknowledge two of my colleagues here. christine cassel who is sitting here and craig mundy who is sitting there, whoably cochaired the working group that studied this problem over about nine months. so i want to thank you vote for your extraordinary service here. .. zzçzñzzçç

increasing quality and decreasing costs. there's a huge potential and chris was a more about it to use of information technology, to integrate for example patient data so you can see a big picture of the patients to avoid errors, detect changes in records by comparing over time, provide decision support with the latest information to doctors. but also to larger levels for the overall health care systems to make it a learning system, one that's able to determine side effects earlier or identify what treatments are especially effective for subset of patients, and then also to be able to drive down costs to more efficient business process these. that information technology has indeed transformed so many segments of our economy. portable phones and work processors, things we did before and less efficient ways, and things we never did before. searching all the world's information, for example, or

social networking on a scaleññññ never before imaginable.ññtt byetññ contrast, health informñ technology has lagged behindmç tremendously. as has been diluted to most physicians don't have access to really meaningful, digital, electronic medical records and those who do, well it's often a rather cumbersome, the sort of thing they never tolerate in a word processor for its simple, it doesn't let them into great things, and so has again has been noted, the american recovery and reinvestment act provided a historic investment in incentive payments to physicians and hospitals to acquire and make meaningful use of health information technology. the office of the national health information technology led by david blumenthal and cms have developed meaningful use regulations and starting in this coming year these incentive

payments will begin to transform health information technology. against this background, the president asked his council of advisers about a year ago to look at whether we thought there were any additional components that were needed to fulfill the extraordinary promise. we've identified one majorzç issue: the data that exists in the health information systems that we have today and in the systems that will be acquired by physicians and hospitals with the funding under the era of legislation really contains it's the cut in the incompatible proprietary systems where it's free hard to integrate data across the systems. that's a problem for the patient because the patient can't obtain a coherent picture of all of his or her information. it's a problem for the patients health care providers. in addition, it's a problem

economically because the third party innovator who is the heart of i.t. innovation, the people who compete to write the better word processors and search engines, when they come from the market that is fragmented into hundreds of separateç incompatible pieces, theçç incentive to create a truly innovative tools, the economic incentives, the ability to read the rewards for innovation are so much blunted. now, our question was could this be fundamentally solved in a way that did not require everybody to start over? one tempting solution is just get rid of everything and start over. it was a going an assumption that that was not an acceptable solution nor would it be in mexico solution to say the federal government should write the system for everybody. there's a lot of good reasons i is a terrible idea. and could it be done in a way that protect patients' privacy? that's a very important thing

and central to our discussions along the way. so through the working groupññ? çaired by chris and craigçzç assembled experts from withinñ?? the council and from without an? the short answer to thoseñññ questions was yes.ñññ??ññ it turned out the key to really being able to do this is to hav? the? capability of universalñ? ñchange language.ñññ ?u don't have to go to ensure? universal systems, but if there? is a universal extremely kitchen to any system could write andñ? out of which any system could? read, we could gain most ofñ?? those benefits as technicallyñ? possible to do it it turns out? yes.ñ? it ñturns out that there are t? same sort of technical??? approaches that make it possibl for many different browsers,ñ? proprietary browsers to browse websites in their own wayñññ? because there's universal?ññ exchange language that makes it possible to understand what those elements are and bring them back together. it is a solution that works

elsewhere. you need to have a certain type of approach we referred to as medved data tagging approach. it will be geeky but on the road there has to be geeky stop to make it work. there has to be in infrastructure for la and authorized users and will be authorized users access to the data tags in an appropriately. what it doesn't require, number one, it does not require a central national database of everybody's health information, not a good idea, doesn't require it. what it doesn't require is national patient identify years to make such a system work, not necessary, not even a good idea. but it doesn't require it is for everyone to discard their insisting systems, but rather, to be able to build a layer on top of the systems to translate in and out and over time as the systems are updated and revised, the providers of those systems can build into rather than on top of these types of standards.

what are the kind of teachers? well, it lets privacy be protected and vastly better ways. it can be protected that would avert granular level you want. you could have privacy not just around an entire record but around a particular item within a record. that's extremely important. and you would be able also to make choices about your privacy early and have them be persistent. so it provides a greater flexibility in architecture for? privacy to be indicted withinñ?? healthñ? care systems.ñ? and what it does is it canñ?ñ? unleash creativity of the marke? and market innovation.ñ? now does require something.? to get this done the federal government does have a role,ñ? ñ?use larry summers said, this? is one of the greatñ? collaborations that america is so good at. the vast majority of the business be done in the private-sector.ç?ñ? but if you have a commonñ? universal? exchange language it

does require a coordination, and that is a classic role for theñ? federal government is to be able to bring together industries to? develop such universal exchange language and open standards and? a way that's available to all. and to be able to invent this notion within the meaningful us? regulations.ñ? this is the sort of thing theñ? federal government can do thatñ? is catalytic it is not enormously expensive to do and it benefits all.ñ? everyone would like to have such a thing that no market incumbent is in a position to promulgate such a thing but a federal government is in a position toñ? bring people together to develop such a thing and then read the? benefits that come from it in performance and in competition. so, in closing, and many, manyñ? different ways it is clear this? administration is focused onñ? improving health care.ñ?ñ? the notion of better quality an? lower cost is at the heart ofñ?? many of those historicñ?

legislation, pieces ofññ?ñ?? legislation that have passedñ?ñ already.ñ? it's a part for the president's? council advisers are proposingñ? today. i would like to now turn to myñ? colleague, chrisñ? cassel who ia physician and in a position to really talk about what these types of approaches would mean for medicine, for physicians, hospitals and patients. thanks very much. chris. [applause] >> thank you. i want to thank am i pcast colleague david blumenthal with whom we have worked very closely as well. as you can see, the recommendations of this report really to build on the very important ground breaking work that he and his colleagues atñ? onc have done. but i think it's also important? for us to be able to think abou? how this strategy and vision for health information technology

can leapfrog into the future to? provide much better patient care to reduce the kind of errors that larry summers talked about? and to make health care practice much more affordable and muchz?? more efficient.z? let me just outline fife benefits i see from my perspective and that are written in the report as well. the first is real-time access, real-time access to complete patient data and information and support information support from doctors and nurses in their decision making. so if you have all of the information on a given patient across time as well as across multiple providers and multiple organizations it will improve the process of diagnosis, reducing stakes and save time

but it also will enable doctors to analyze data on their whole population of patients they are taking care of and be able to themselves tell how many of the patients with hypertension have their blood pressure under control or how many patients with diabetes have their blood pressure under control or diabetes have blood sugar measurements within their normal range or getting the the necessary screening test. consider the following for example, we have a number of use cases in the report which i urge you to look at. but let's imagine a 70-year-old woman being treated for cancer who travels to a referral center for more specialized treatment. when she gets there all of her records are now instantly available, avoiding a repetition of painful and expensive diagnostic tests. after she is treated, she truffle's 1200 miles away to stay with her daughter while she

recovers. but in her weakened state, she falls and bricks of hip. she goes to the community hospital the emergency room where immediately all of the relevant information is available to the trading staff and drugs that would have been dangerous with her recent history are avoided. when she recovers and returns home, the information from all of the places where she has bee? seen are available right away to her personal physician. how many americans today can be confident that this is a story that would happen if they orz? their parents were in such añ? situation? very few actually.z? our vision is this becomes a reality and this becomes a standard of care for everyone. the second benefit, and approved clinical practice with information technology and integrated into the workflow minimizes unproductive date entry work.

i have to tell you from thez? perspective of a physician, these days is often three cumbersome and costly demanding the time to report called the measures for accountability and payment for services which are very important. a better health care i.t. strategy could help reduce the timing cost and allow the data to be collected in the actual process of patient care not as an add-on piece of work. these days much of the information is produced for insurance purposes but it's not timely enough or complete enough to drive improved care. yet most physicians and nurses are interested in the responses to the accurate evidence of having the quality-of-care measures produced in the process of the patient care rather than as an additional data entry process and being able to interrogate your own nti and ask questions about certain kinds of drugs, their effect, certain

kind of treatment, a certain kind of patient conditions will lead to significant health care improvement. faired benefit, patients, consumers can't become more involved in their care and able to track their health data. access to both the information and multiple interfaces if you want to think about it that way will the kec for the patient to access information from multiple different sources. the participation of the patient in their own health care will substantially improve not only their care, but their confidence which is especially important, particularly in the management of chronic conditions such as heart disease, diabetes and others. consider this case, this use case. a patient who is taking blood thinner strains his calf muscle during a tennis match and cannot remember which of the over-the-counter medications is

safe to take a given that he's taking this blood thinner. so he types the information into his personal health record list, and it gives him the answers to his questions. indeed, it turns out that there are certain paint hills you should take and certain ones you shouldn't take. ki e-mails the physician the next day though because he has a bit painful bruise appearing in his leg. he sends another e-mail to his physician's office where he is connected to the nurse who manages the blood coagulation test. online he makes an appointment to come and he makes an appointment to see the doctor who responds with electronic information about the result of the test and the medications just as he needs to make before he ever even sees the patient fourth benefit, privacy and security can be embedded into the means of exchanging data to be persistent and accurate.

this approach can improve privacy and security and patient control of the data. the very same mechanism for exchanging can be embedded with the necessary security and privacy precautions attached as metadata. so it is inseparable from that data. all computers offer the touches the data will be legally required to respect the privacy? specifications. and fifth and important, health care research will improve both in terms of public health monitoring and testing and clinical trials. real time identify the data will allow much fasterx?z? identification, cd problems with drugs and medical devices allow early awareness of infections, epidemics and other threats to the public health.÷? this is a benefit to the public?

through hhs agencies like the fda and cdc and state public health authorities as well.z? an example of this is the devotee of the kaiser permanent? a we are going to hear from in a moment with their electronic patient records to identify the? problems of cardiac side effects long before the marketplace studies revealed the spirit also, clinical research studies by the nih will be dramatically enhanced and accelerated by the capabilities. extensive sampling to be randomized clinical trials will not always be needed because an accurate information about patients' conditions can sure which particular groups of patients are more likely to benefit for the treatment which could then rapidly accelerate both the use of treatments where appropriate but also not using them when they are not appropriate. so these five areas really are we to go to improve care and

efficiency for over health care system, and that is what our report is aiming for. utter care, more personalized care, more efficient care and more gains in health. these are all part of the?ç?? problem of the 21st century information technology. it is now my pleasure to turn this over to the two representatives of majorç? companies, businesses that have? used and invested in this kind of resource. one in health care delivery and health care delivery systems, bernard, executive since president of health plan hospital operations for the kaiser permanente a is with us today, and one of information and communications. bill archer, president of advanced solutions will also join. i'm going to call one bernard first. [applause]

>> good morning. it's great to be here today to speak on this topic on behalf of kaiser permanente but also on behalf of a personal story. i was thinking as we were talking through this this is about future but is here now. let me tell you a story quick. september, 2006, i was having fun and less vigorous the custis sixth loss vegas, not that kind of fun, and in that having a heart episode that landed me in the emergency room at one of the community hospitals in which i suffered a cardiac attack. i was placed in an induced coma and told later hospital

contacted through a friend traveling with me, kaiser permanente who in a matter of seconds was able to download all of the information they had on me and had to tax to a hospital in las vegas.ñ?ñ?ñ? fortunately the information isñ? readily available and we did have the facts. this vision will even make that? step. ñ?d will transform it to another level. i was brought of the, and then ? was transferred to my hospital in san francisco with kaiser, where i underwent open-heart surgery. i went back to work in januaryñ? of 2007, and as of today, i hav? not been out ill a single day. but 90% of my care that i get

from a qualified cardiologistsñ? or qualified nurse and a couple of other team givers is provide? to me for the kaiser permanente? health connect.ñ?ñ? i have all the information made availableñ? to me to keep me we? informed about what's going on inside of bernard tyson, and i have the connection to my care team to understand what they need to do next to my overall care and in most cases, that is done over health connect. the future that we are speaking about is here today. this past weekend, i went in fo? my lab test as i am preparing to see my doctor on this friday coming up as i like to say at 3: 40, and i went into one of our last facilities about 9:30 onñ? saturday morning, had my blood drawn and about 12:15, 12:41

blackberry pager went off to give me the message my labñ? results are in it. i got home about 2:00-something and went on line to public my results. everything was looking good with the exception of one particular test that was slightly elevated, still within normal but slightl? elevated. i was able to punch one button to than grass the last nine tests i have taken over the last couple of years to do my own and trend analysis. then i send a note to my care nurse as well as i physician said i will see you next friday but i am curious what might be causing this slight elevation. i got a message back from myñ? nurse that said this is a great result, slight elevation,? nothing to worry about. see you next friday and by the way, we will discuss when you eat over the holiday season.

[laughter]ñ? i think they are getting to know [laughter]w'w'wswswswsvs we believe at kaiser permanente a that what i just described to? you, what is available to 8.7 million members who belong to kaiser permanente should inñ? fact be available to every single person in this country. we believe strongly thatñ? information technology in theñ?? hands of experienced caring physicians and clinical staffñ? makes a difference for ourñ? members and our patients everyñ? day.ñ?ñ? we believe that by having allñ? the information available at an? given time caregivers can makeñ? it more informed decisions about their patient health and the to? help manage their own health more effectively, and by applying the information technology thoughtfully that in efficiencies of tests and treatment redundancies are

unnecessary office visits and costly emergency rooms can be reduced and in some cases eliminated. we achieve better health outcomes as consequence of our extensive investment and information technology. beginning with the kaiser permanente electronic medical record which recall the kaiser permanente health connect. this provides the foundation for our outstanding care. by building on that foundation we are supporting tools and technologies such as care registry's we are able to identify at risk populations and provide care teams with organized consistent per your kristen formation

>> that's our vision, and we know now that we can achieve it with the technology and with the brain power of the wonderful people who work at kaiser permente. they have seen the intersection of technology and research with results not only benefiting members, but also the community at large. our collection of data for very large patient populations enable

us to spot trends in medication effectiveness and care outcomes and studies formally impossible in size and scope. through research assisted by this expensive health data and information technology, we found, for example, that unvaccinated children are 23 times more likely to get whooping cough than children who were vaccinated. extremely obese children have a 40% of reflux disease of the esophagus, and that there is a link between smoking, alzheimer's, and dementia risks. with nearly 4 million members using my health manager, the personal health record available on our website, kp.org, is clear that demand for online health care tools is growing. our members have 24/7 access to

the health information and a communication tool to reach their providers. today, california permente members are on track to send more than 10 million secure e-mails to their physicians through my health manager as well as reveal over 25 million lab results and to make five-plus million appointments online, and that's just with 4.5% of our 8.7 million members currently using our my health manager. these services and overall health portfolio technology tools reduced unnecessary inperson office visits by nearly 26 plgt. 26%, and we reduced emergency room visits by less than 11%. we are using this tool to better understand and capture data that

is allowing us to make better decisions on how the staff can manage our facilities across the united states. a medical record is most effective when it is accessible to both the patients and to their providers. as patients move across geographies, providers, and insurers, port the of their records will be an essential requirement for electronic health records. kaise permente is working on connecting the in addition's emr's beginning with a pilot program to link the largest health record with the largest governmental health record, that of the va. using nhin we share the information of 1,000 of our shared patients proving that more complete information is

possible when shared across different providing organizations. we all agree that we need better health outcomes, and more efficient care nationally. we not only believe that health information technology plays a critical role in achieving better health outcomes. at kaiser permente, rea proving that it actually does. thank you. [applause] >> good morning. i'm pleased to start by saying i don't have anywhere near as dramatic story to begin with as bernard did, but nonetheless, very pleased to be with you this morning, and i want to start by thanking eric and christine and secretary, dr. summers, and

dr. bloomenthal for hosting this great event today. at&t is great to have this chance to collaborate with policymakers on health information technology which we believe holds great potential for improving the u.s. health care system. we believe we have a unique perspective on the promise that information technology holds for improving access to health care in this country. we're large, self-insured employer with more than a million lives under coverage. we are deeply involved in the health information technology and mobile health markets as businesses, and we're also actively engaged with the dosia consortium in developing a personal health record platform for the benefit of our employees. at at&t, we have a firm bleach that the use of mobile technologies and smart networks

can improve the quality of care, reduce costs, and cricket to a -- contribute to a healthier world, and now is the time according to the centers for medicare and medicaid services about $2.5 trillion was spent on health care in the u.s. in 2009 in efficiencies abound, and one of the big problems is a lack of timely access to the critical information that's required to deliver quality care efficiently. ..ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?ñ?

believes it is to drive full nationwide deployment of health information technology. improving the functioning of our health care system we believe it is vital to our economic interests and to our continuing ability to competeñ?ñ?ñ? internationally. now, improving care and reducing costs are vital goals for every? business.ñ? for at&t, in 2190 offered healt? care benefits to some ñ?2 million individuals.ñ?ñ? those are employees, retirees and their dependents. so you can tell ensure we haveñ? serious skin and the game from many angles here. you've already committed to bringing our assets, talent and resources to bear on helping the

healthcare industry to getñ bandages or technologies to solve the challenges it faces. now as any health care professional will attest, healthcare is a highly mobile business. medical information needs to follow the patient, searching for it once the patient is in crisis can hinder the quality-of-care, of course, be very expensive. many of rubber healthcare industry solutions are designed to address exactly how this issue. one of the key challenges for a sample of the hull flighty industry faces is allowing for connectivity among existing electronic medical record deployment, thus protecting much of the investment that's already been made in digitizing and storing medical data.ñ?ñ?ñ? at&t health care community on-line helps with that thez?ñ?? wallen health care providersñ?ñ?

state and federal governmentñ?ñ? agencies to save time and money? by using the existing i.t. infrastructure and integratingñ? it with new services and applications to enable community wide exchange electronic medical records. we also believe mobile and telehealth solutions offer exciting potential to improve the way health care is delivered. take one example from the technology network uses video conferencing and mobility solutions to improve the quality and speed with which they treat patients wounds, and the results are very impressive. they've reduced hospitalizations by 95%, hilda wounds 50% faster than hospital based wound based centers and cost for the paper's of to 85%. now in addition to those quick

examples, they plan to participate in a series of pilot programs and trials that will test some of our key technologies with patients and providers. examples include medicine bottles that remind the patient to take the pills on schedule. devices that monitor patient part or glucose levels from the comfort of their homes, audio and tdo thinks that can replace the need for in person visits to doctors and more. we believe solutions like the ones we are currently delivering and testing as was mentioned before can be transformative technologies, in fact, similar to the way atoms transformed banking transactions or on line booking of travel requirements. now as further evidence of a hour commitment, we just announced that dedicated

practiced call for health, at&t for health will accelerate delivery of wireless network and cloud based solutions specifically for the health care segment. summing it up, we believe it's vital for health information technology to be widely and rapidly adopted across all segments of the health care sector. we are seeing substantial progress has has been mentioned, but there is much skill to be done, so we are very pleased that pcast focused its efforts on driving health information technology adoption nationwide. we believe the goal is vital to improve health outcomes, drive down health care costs, spur investment and create quality high-tech jobs here at home. improving the nation's health care system is truly a goal of generational importance and one that will help ensure our country's competitiveness for

decades and forward. and we at at&t look at the day when the health informationz?z?? technologies are widely deployed and benefiting all americans. we remain committed to improving the quality-of-care, reducing costs and come to a meeting to a healthier world and we are eager to continue working with the administration of these important issues. thank you for your attention this morning. [applause] >> thank you, mr. archer, mr. tyson for being the private sector perspective to this and taking the time and effort to be here with us today. we know you traveled long distances to be here. i also want to thank our pcast colleagues, eric lander, chris cassel, lander for the contribution and laying out a very important challenge for us

in the department of health and human services. and of course i want to add my thanks to secretary sebelius and larry summers for attending and starting off the discussion today. mountain climbers know the feeling of working hard to get to a summit, only to realize there may be three, four, five summits still to climb. as the mashaal coordinator and center for the services in the department of health and human services, we've been working very hard to implement the high-tech agenda laid out for us by the congress of the united states and the president as a part of the stimulus bill of two goals and nine. we felt we were doing a pretty good job. we thought that we were doing okay. the pcast folks have landed on

the next peak and sent to us in effect congratulations on what you have done, would there is a whole lot more still to do. if you set your vision highly enough, if you work harder, if you are nimble, if you're ambitious, if you're quick and decisive. we welcome that vision. this ad ministration is showing you graphically right now through this particular report the importance assigned to the vice of the nation scientists and technologists, and we share that appreciation. we wish it came with a!! helicopter, but we think that will come, too. now what have we been not to for the last 20 months or so implement in the high-tech act? we have been working on two of

the most important priorities of that legislation. the first to promote the adoption of health information technology especially electronic health records. some of the benefits have been discussed by our panelists already here today. and secondly, to accomplish something that is equally important and that is the meaningful use of electronic health records. it has been really bipartisan support for this agenda of promoting health information technology, a widespread recognition that the capacity of its kind of seemingly miraculous things kiser has already put on the table and chris cassel described in her cases. the congress mandated as first to work on adoption. i think the perception was before you could enter operate the need to operate, and we need

to get data, clinical data into electronic form before we can send it shooting around our health care system in a way that our so powerful has described. by the way, in the process of promoting that adoption, we think the federal government leadership has unleashed an enormous amount of innovation, some of which is described to you by mr. archer but is happening throughout our health care system and our i.t. industry. someone once described to me that the day after the ipad was released his company which produced an electronic record had an ipad based solution to the electronic of record already available. kind of explosion of new thinking, the entry of new firms don't think would have been possible without the leadership

shown in the high-tech act. we have also been committed to obtaining meaningful use. the congress was very clear they didn't want computers to be doorstops or paperweights and the nation's and physicians and nurses. they wanted those technologies to be used for self improvement purposes. and that has been a guiding principal of the center for medicare and medicaid services of the office of the national coordinator in our design of the meaningful use from work. the free-market spot health care goals as the absolute priority. there are a series of them bitterly and held in the regulation creating a meaningful use from work and it has put the patient first in terms of patient involvement with care in terms of the leading providers to provide health solutions rather than technology solutions

in order to support a meaningful use capability, we also enacted a series of supporting regulations. one, to create standards and certification of electronic health records that we have actually begun the process we believe of preparing the way for the kinds of solutions that the pcast report has advocated, universal standards that's promote interoperable the and aníbal communications across electronic of records as well as guaranteeing the functionality of the records that were adopted. and we have created a process to certify electronic health records as capable of meaningful use. over 130 electronic health records and electronic modules have been certified in the last two to three months going basically from the dead stop to full speed with the provision of

information to providers of care about the capabilities of electronic health records on the market. we know though that just providing the technology will not be sufficient, so we have been creating the capability to support willing providers to become meaningful users. there are now 62 regional extension centers covering the entire geography of the united states, which are available to providers able to independently about and meaningful use electronic of records. with the help of those electronic -- with all of those extension centers, we have now enrolled already in the first ten months of their existence, 25,000 primary-care physicians to obtain technical support services on the way toward adopting and meaningfully using

electronic of records. we've created a nationwide program of begin communities, whose purpose is to demonstrate what is possible in a community to do with information technology through improving the outcome of care and the efficiency of care. these are community-based activities, collaborative of providers, insurers, health care organizations, local employers, city and state governments that are working together to demonstrate to the fit and in fact to be deacons for the rest of the nation. there's an estimated shortage of 50,000 health it workers, without whose help all with our efforts to get operating electronic health systems up and running will be for naught. we are now spending $120 million through 84 community colleges, training 40,000 health

information technology professionals, 3,000 enrolled in the first cohort in september. and i visited the first graduating class of one of those programs. virtually all of the graduates have jobs either with providers of care or with vendors of health i.t. services or with local governments. the have been successful demonstrating that high-tech stimulus program can develop opportunities for new jobs that have a future in an expanding electronics sector. we've invested in cutting edge research through for a consortium of research institutions that are working on the technologies of the future that can make interoperable the real, but to make privacy and security more effective that can make systems and electronic of records more useful.

.. don't lose track of the huge benefits of interoperability and don't forget to build in that capacity at every step of the way. and we are going to look and incorporate those recommendations as speedily as we possibly can into our work, using our federal history committees which have served as

admirably after this point, looking at a standard and certification criteria to see how they need to be modified, looking for beautiful use framework can assist with the interoperability -- the interoperability capability. we said in our meaningful use regulation published last july, that the next stage of meaningful use would emphasize health information exchange. so the pcast recommendations could not come at a more timely place in our agenda. i want to say as we go forward that throughout this work our commitment to the privacy and security of health information that remains resolute, it is absolutely essential that we have the trust of the american people to create a viable national, interoperable health information system based on modern electronic.

we have to keep patients and consumers in step of the way. they need to also worried about the risk. the technological opportunity created by pat tagging data, checking how to with preferences for its exchange ability and availability is a very important contribution. it needs to be complemented by a range of policies that provide a complete package of solutions to the privacy and security policy challenges that we face. but we are committed to moving forward with a policy agenda as we move forward with the technology agenda. so to reiterate, we welcome the pcast reporter. we think it pushes us forward and set new goals for us.

it provides exactly the kind of external advice of his major policies, we think, to disappoint successful where they have been successful. and we look forward to working with our pcast colleagues as we move forward. i also want to say that the pcast report will be online for the requests for comment from the financial coordinator by the end of the day today. it will be open to comment -- the invitation for comments will be open in the federal register for 30 days till the middle of january. thank you very much for your attention. hot mark [applause] >> at hursley like to thank david blumenthal and his colleagues at the office of national coordinator, to use your metaphor, you have indeed been a sure bet that as part of such great heights already. it's extraordinary what is happening last two years with

respect to health information technology in the spirit with which you take our suggestions of recognizing their even more peaks to climb is exactly the right spirit that we should not forget just how extraordinarily far we have come in the course of the past two years under your leadership in the very hard work of your colleagues, site very much much like to thank you. the floor is open for a couple questions. i know a running mate, relative to the schedule we'd hoped for.? and so we might take five, 10 minute demos for questions, but several of us will be available to stick around and have subsequent conversations. let me throw the chair open to a couple questions if there areñ?? any.ñ?ñ?ñ?ñ? or if not, that's okay, too.ñ?ñ? the question in the back.?ñ?ñ? >> hi, i just wanted to clarify? the congressional quarterly that

she would move as quickly as possible on the recommendations, but they will be certainly challenges and there has been pushed back in the past from hospitals and from additions on interoperability. and i wanted -- this is a question for dr. blumenthal. i wonder how difficult will it be for you to implement this suggestion to the task force. >> we think the technical solutions are very promising and very interesting. we think it the right way to go. we are going to get feedback from our advisory committees to reassure us on that score. we're going to be consulting with the best minds in the country on the technical aspects of the implementation of these recommendations. and of course, and tell you get into the details, you can never know exactly what the problems are. we are reassured by the fact that this is not new tech

knowledge he. it's been implemented in other sectors of the economy, so earnest and strained to catch up with other such are spirit i think the unique thing in health care is for private security insurance is and we think that there are aspects of this set of solutions that would give us new capabilities in that area. so i think that on the whole things like very positive. there are a lot of very detailed activities to undertake common standards to write, implementation specification to write, implementation pilots, demonstration of feasibility and then the publication of all those things as open standards that are accessible to the industry as a whole. we've been doing this with other forms -- to create other forms of connectivity. we have other projects underway than about creating a standards.

so we have a sense of how much it's going to take and we think it's doable. the precise timeline i think one can plan, but we have to be open to the chance -- to the possibility that surprises would hurt. other questions?ñ?ñ? well, if not, let me thank all of you for coming and that mayñ? say that the pcast report itself is already on the pcast website. you can download it today. the request for comments by the onc is out by the end of the day. thank you: i want to thank our two speakers in the private÷? sector for coming and pointing to the future for us what is possible here. i appreciate your taking the time to come and join us. thank you. [applause] [inaudible conversations]

[inaudible conversations] [inaudible conversations]

>> spoke about the strategic arms reduction treaty with russia. president to bomb and russian president dmitry medvedev signing a treaty last april. and now needs the support of 67 of 100 senators for ratification. from the brookings institution, this is about an hour. >> please credit the receipts and let's resume. what we're doing now shifting focus to my think one of the most interesting and important elements of american national security issues which is the big picture of arms control and more

specifically and s.t.a.r.t. treaty. it's one of the administration's high priority in the next session will explain to you, give you some insights why it is so urgent that the senate gave its approval and what some of the key issues are in it and what you really want to know about this significant agreement. and so, the format is i'm going to introduce her to guess now and they'll talk about 15, 20 minutes each animal open it up to you for your questions, comments, issues, responses and reactions. the first i'd like to introduce assistant secretary rose gotemoeller and she is the assistant secretary in the state department of the bureau of arms control verification and compliance and she has served there for a number of years. and she is here. we're really honored to have her because she is the head negotiator for the u.s. delegation with russia in this last negotiation.

she has got an amazingly long experience in this field, served as the head of the carnegie center in moscow. she also served in the department of energy is the deputy undersecretary and energy for defense nuclear non-proliferation and also as the assistant secretary for non-proliferation and national security in the department of energy. she served in the national security council and the white house and she was holding when three countries, ukraine, kazakhstan and belarus all denuclearized, which is i think an amazing and historic thing and she had her hand when that happened in the 90s. it will turn over to dr. john miller at the defense department. and he is the principal deputy undersecretary of defense for policy, where he focuses on all these issues on a much broader portfolio. he's also got a wealth of

experience in the u.s. national security arena, was a senior vice president and director of studies at the center for new american security and other super tedious think tanks in town. at other jobs in the air that he was deputy assistant secretary of defense for requirements plans and proliferation at the end of the clinton administration. and he is also served the hill as a staff member of the house armed services committee. so i'm happy to give assistant secretary gotemoeller the floor here and shall talk 15, 20 minutes and mental hygiene speak and then open it up to your comment. >> well, thank you very much for that kind introduction, peter. and thank you for the opportunity to speak to this afternoon. i saw the brookings institution u.s. seminar i thought this is a

group of people i want to type two about the new s.t.a.r.t. treaty or so really, thank you for the opportunity to be here this afternoon. you know, this seminar which is focused on national security offers an important and timely opportunity to discuss with president obama has called a national security imperative. and that is the ratification of the new s.t.a.r.t. treaty this year. there is no higher national security priority in the lame-duck section of this congress. the new s.t.a.r.t. treaty responsibly reduces the number of nuclear weapons and launchers that the united states and russia deploy, while fully maintaining the u.s. nuclear deterrent. prompt ratification of the new s.t.a.r.t. treaty is strongly in u.s. security interest. this past sunday, december 5th of march 1 full year since the original s.t.a.r.t. treaty, strategical arms reduction treaties started. since we've had no data exchanges on the nuclear forces and no opportunity to inspect russian strategic nuclear

forces. the lack of regular data exchanges and outside verification measures mean that our understanding of russian missile or bomber forces will diminish over time. for more than 20 years, the right of the weapons inspectors to confirm validity of russian provided data by connecting short notice on-site inspections of nuclear weapons facilities is that the core of verification machines and treaties between the united states and soviet union and now the russian federation. if we ratify this treaty, we'll have a verification regime in place to track russia's strategic nuclear weapons, including u.s. inspectors on the ground. if we do not ratify this treaty, we'll have no verification machines, no inspectors in our insight into russia strategic arsenal will be limited. and most importantly, we will have no framework for cooperation between the worlds two nuclear superpowers. once the new s.t.a.r.t. treaty enters into force come will receive extensive decorations

from russia every six months regarding the number, type and location above the strategic offensive forces under the treaty. new s.t.a.r.t. will provide an unprecedented level information about these forces. under the new s.t.a.r.t. treaty a unique identifying number will be assigned to each muslim power which will allow the united states to follow the item throughout the lifetime of the treaty. russia will provide prompt update to that data -- i beg your pardon, so the united states can understand activities in russia's forces and keep track of russia's compliance with treaty central limits. on-site inspections are vital complement to the data that the united states will receive under new s.t.a.r.t. they provide boots on the ground to hide data declarations and that's where confidence and knowledge regarding russian strategic forces located at facilities around the country. under the new s.t.a.r.t. treaty, the united states will have the right to conduct 18 on-site inspections of russian strategic forces annually and without the

treaty there will be zero inspections. i repeat, zero inspections. further delay could mean up to two years without inspections because people say, well, you know, but we don't ratify this treaty in the lame-duck section, we can come back to it in the new year and start quickly and get the treaty ratified in the early new year. well to my mind, that kind of approach calculate because the matter-of-fact with the come back to the senate after the holiday period, we'd have to start over again with the process and the senate foreign relations committee. so that kind of approach simply spelled the lake and i didn't want to make that point clearly to you. the provisions that we put into the new s.t.a.r.t. treaty, particularly with regard to verification and compliance were developed with the concerns and perspectives of the u.s. department of defense and mind. i'm very pleased to be joined today by dr. jim miller will

talk specifically about the interest of the dod overall in the new s.t.a.r.t. treaty. i want to stress that new s.t.a.r.t. has the full endorsement of the military's leadership, six former secretaries of state, five former secretaries of defense and seven former commanders of the u.s. strategic command. the senate foreign relations committee approved the resolution of advice and consent to ratification of the new s.t.a.r.t. treaty back in september -- on september 17 at day 14 to four vote. it was a strong bipartisan vote. the senate foreign relations committee under the leadership of chairman john kerry and ranking member richard lugar undertook a thorough review of the treaty than in many hearings, many briefings and nearly 1000 questions answered for the record. among the senate foreign relations committee comes in a armed services committee and senate select committee on intelligence, we had 18 hearings for this briefing between the period of may when we brought the treaty after the senate and

this past september. so we had a very thorough process and not of that process was developed the resolution of ratification that led to the successful vote in the senate foreign relations committee on the 14 to four in favor of the treaty. new s.t.a.r.t. is the best interest of national security. to reestablish provisions that of seasons the exploration of s.t.a.r.t. a year ago and will continue the international arms control of non-proliferation framework that the united states has worked hard to foster and strengthen over the past 50 years. without it, our knowledge of russian strategic versus will erode over time, increasing risks of misunderstanding, mistrust and worst-case analysis and policymaking. as general chilton, today's commander of the u.s. strategic command has said, without new s.t.a.r.t., would rapidly losing fight to russian strategical forces and our force modernization planning and hedging strategy would be more

complex and more costly. the new s.t.a.r.t. treaty is in our best national security interest and i believe there is every reason for the senate to give it the eighth and consent to ratification this year. with that, i'm going to turn the floor to my colleague, jim miller and will look forward to your questions. thank you very much. >> thank you, rose. i want to provide a few brief remarks after what rose is said and it will open up and have a discussion for your question. as roasted, new s.t.a.r.t. treaty is supported by the senior leadership of dod, including secretary of defense, chairman of vice chairman chief of staff and the commander of general chilton.

sooner or later for the military understand the treaty well because dod focused in detail on what we want from the treaty as we conducted a nuclear posture review and we provided early ongoing input to rose and her negotiate team. dod also had representatives on the team in geneva and i watched on a particular the contributions of dr. ted warner, former assistant secretary of defense, served extremely ably as the secretary of defense has represented to negotiations. dod leadership supports the new s.t.a.r.t. treaty, both for what it does and for what it doesn't do that but to speak rudely about both. three key things that the treaty does -- versus treaty will strengthen stability and help avoid worst-case military planning to its verification measures. second, the treaty provides flexibility that allows the u.s. to retain and modernize a strategic delivery systems. and third, ratifying the treaty

will invest broader number of national security interest, including non-proliferation. i'd also like to talk a little bit about three things that the treaty does not do. first come in the treaty not constrain the u.s. ability to deploy the most effective missile defenses possible. second, and the treaty does not constrain the development of global strike capabilities. we'll talk more about those in a moment. and third, treaty does not in any way inhibit our ability to make necessary investments and our nuclear weapons infrastructure. i like to see if you restart each each of these elements and then go to questions. first, the new s.t.a.r.t. treaty will improve strategic stability in the u.s.-russian relationship. that will impose legal limit on u.s.-russian strategic and those one at our 700 deploy strategic delivery vehicles, 800 combined deployed in undeployed delivery

vehicles in 1550 strategic warheads come equal on both sides. these limits are lower than the previous s.t.a.r.t. treaty and lower than the moscow street by president bush. as rose indicated, the treaty will also reinstitute on-site inspections and other verification that we've been lacking since december 5 of last year. since that time, the united states had no boots on the ground for inspections of the army bases and other facilities. in its data collection provisions in exchange provisions will give us poor insight into russian strategic forces. without these verification measures, we're just going to have much less information about the status of russian strategic forces in the military will have to rely much more on worst-case planning and this will be both expensive and his general chilton said, potentially stabilizing. the second race in the pentagon

strongly supports this treaty is that it allows us to choose our own for snacks and modernize our forces. the department's nuclear posture review, which are connected in parallel with the new s.t.a.r.t. treaty negotiations drover negotiated positions on the key minutes and allows us to maintain a strong triad under the treaty. we have 14 strategic listed missiles every inch a day they will retain a 14 under the new s.t.a.r.t. treaty. summaries of the most survivable of our strategic delivery systems and will carry well over half of the warheads in the new s.t.a.r.t. treaty. we afford a 50 minute men, three icbms today and plan to retain 400 to 420. at the same time, to promote strategic stability, we will emerge, go to a single warhead for each of these missiles. and we have 94 nuclear-capable bombers today, 19 b-2s and the rest b-52s. we intend to retain all the farmers and convert 30 or more

to a conventional liberal, still leaving plenty for a robust nuclear bomber. this robust triad will provide for strong deterrent that any attack on the united states were allied in the administration intends to spend more than $100 billion in the next 10 years to sustain and modernize the triad. this force structure also provides a robust deterrent against any future russian leader who may think of shooting her breakout. we don't believe russia would want to do so, but if a future russian leader gave serious consideration to cheating her breakout to quickly determine the united states has the capability to upload a large number of additional warheads on our bombers, icbm so russia can be no real or perceived advantage. third, ratifying the treaty would fancy number of broader u.s. interests as well. we all recognize that the biggest nuclear threat is not from russia, but in the future

of nuclear proliferation of potential for nuclear terrorism. gratifying new s.t.a.r.t. for make and associated reduction as key an immediate two obligations under the nuclear non-proliferation treaty. this will strengthen the coalition to prevent the capability and prevent proliferation in the future. some of these concerns about the dangers posed by large numbers of russian nuclear weapons, the administration agrees a president to bomb i suppose we address the systems and follow-on negotiations of new s.t.a.r.t. it's highly unlikely wicket to those negotiations if new s.t.a.r.t. is not ratified. gratifying new s.t.a.r.t. will help sustain them momentum in u.s.-russian relations. we've also seen the big important exchanges, including the russian decision not to sell antiaircraft missiles to iran. another example is russia allowing the u.s. to move key materials and supplies for

afghanistan to russian territory. so those are three key things the new s.t.a.r.t. treaty will do. as i said, just important are the things that i won't do. first, new s.t.a.r.t. will not constrain the united states from deploying missile defenses possible or impose additional cost or barriers for most offenses. we've made this clear in our public statements, budgets and plans submitted to congress. the administration is proposing to spend almost $10 billion in missile defense this nuclear year alone. this is a $700 million increase from the previous year. we are continuing to improve both our homeland defense and a regional missile defense. at home -- excuse me, in september we place the 30th ground interceptor to home. as you know, just a few weeks ago nato and costar proposal for the first time nato has taken on this mission. the administration plans to play all four faces of the so-called adaptive approaches for european

missile defense. we understand that future events and elegy or changes in the threat could modify these pages print that's one reason we thought adaptive. we begin to it reiterate and are making investments and plans accordingly. excuse me. second thing the new s.t.a.r.t. treaty does not do is constrain our ability to develop and deploy prop strike communities. they are currently considering what language strike ability are for the future. one of those things were examining is the possible deployment of the global strike capabilities that could strike in the earth in less than an hour. conventional icmbs for sl beyond it at a trajectory this will raise the challenge are issues not least of which is how to tell them from a nuclear missile. in any event, the joint chiefs and secretary gates in general chilton have agreed that any such deployment would play in

this world and so we desire in small numbers if at all. for also currently examining alternative concepts for future prompt over strike systems that would not be limited by the treaty such as hypersonic flight vehicle. the systems have a number of advantages including the ability to avoid overplay. while no decisions have been finally taken, were continuing r&d, research and development on the system we plan to invest well over a billion dollars in r&d and are prompt straight over the next several years. finally, the new s.t.a.r.t. treaty does not in any way impaired her ability to invest in our nuclear weapons complex and infrastructure. the administration have developed an investment plan to sustain our stockpile over the long term. we plan to invest more than $85 billion over the next decade to modernize the weapons complex events of course our turn. this represents a $4.1 billion

increase over the next five years relative to the plan be proposed in may. this level of finding is necessary and it's unprecedented since the end of the cold war. for these reasons, both for the treaty does some of the treaty does not do, is supported by the secretary defends and the commander u.s. strategic. our allies also express report at the lisbon summit a few years ago and finally every president for the last several decades has pursued verifiable arms control agreements in the senate has provided support. the s.t.a.r.t. treaty negotiated by presidents ronald reagan and george h.w. bush was approved in 1992 by 93 votes to six. the moscow treaty negotiated by president george w. bush was approved by 95 to zero in 2003. it's time again in dod and the entire obama administration urging the senate to give its advice and send to ratification of the new s.t.a.r.t. treaty

this year. thank you and alternate back to p. and take your questions. >> okay, thank you very much. [applause] [inaudible] >> could you please identify yourself? >> hello, may miss vince young can i work for the u.s. army active duty retired nationally, did 26 years with the nuclear biological chemical warfare. and having spent time over 10 years in europe, sitting on the border there and having been around the threat of russia, that's what we thought to protect for years. what is different today with the threat? i mean, that than we thought

that, you know, anytime the russians russians and the warsaw countries could come across the border. and he said that it's important to approve this now and it just doesn't seem like there's the third from russia today, like they're going to come across the borders tomorrow and start an attack. in the second part the question and i think that at least what i think some of the thread is -- what i'm more concerned with is the third party, the rogue countries. is there some part of the start agreement that looks at accountability of sources that might somehow escaped to third-party countries to make bombs and things like that? that's what i'm concerned with. >> yes, that is an excellent question and it is actually very true in the nuclear posture review spoke to this when it was completed by spring.

and that is the biggest nuclear threats we face today are the threats of nuclear terrorism, threats of countries who have unpredictable leaderships, that type of thing. that's what we're concerned about today, what could happen, for example, if iran had nuclear weapons, north korea and so forth. so there is no question but that is the focal point nowadays. but i think what is very important to consider about the new s.t.a.r.t. treaty is that it does continue this effort that has been in training now for 40 years to reduce and limit strategic nuclear weapons. there was still quite a few nuclear weapons in the united states and russia still have 90% of the nuclear weapons in the world. so at the end of the cold war, when starr came into force in 1994, we were still deploying on each side upwards of 12,000

operationally deployed weapons. for the s.t.a.r.t. treaty reduce those numbers down. under start do is go to down to 6000, even though her. we went after the s.t.a.r.t. treaty entered into force on the bush administration, president george w. bush negotiated the moscow treaty, which brought those numbers down to 1700 to 2200 operationally deployed nuclear warheads. but we're still in need of reductions to come down even further. and that has been the overall goal that we want to have a stability and predictability in the reduction process. and that's what is so important about having a legally binding and verifiable treaty in place so that we can proceed in a predict the way to bring those numbers down. because at the present time, that is the corporate urn. you're quite right and it's very important i think to point to the lisbon summit a few weeks ago, when we had not only the

lisbon summit of nato ally, but we also had a very important lisbon meeting of the nato russia council with president medvedev paired together with the nato leaders. in the focal point there was some cooperation in working to develop cooperation in some very significant areas, such as missile defense. so that is really the focal point of our relationship with russia now is looking for ways to develop cooperation. so you're quite right. it's a situation were not in the cold war years, not facing the threat of nuclear war between the soviet union and the united states of america anymore, but we still have to deal with the overhang that was left by the cold war and to do that in responsible way. it's important to have these kinds of legally binding agreements. that is my answer, but you're spot on that we really have to focus as the core threat today in the nuclear arena. it's on the unpredictable threats, the nuclear terrorism and perhaps some countries we

can't predict how they're going to act. jim, do it to anything? >> very briefly, thank you for your service. and just to emphasize what rose had to say, the u.s. and russia making reductions under new s.t.a.r.t. is part of our obligation under the nuclear non-proliferation treaty. it will help us be more effective in dealing with the problems that you've rightly identified as a focal point of nuclear proliferation and possible nuclear generation. because russia still has over 90% of weapons and what can we have more than we need an strategic stability still matters. having the kind of visibility into each other's programs at this treaty will provide in the booth on the ground on-site inspections will provide will help us manage the transition. as we look to change the relationship over time. we want to make sure we have a stable way to balance.

>> i have a question. and tina korby and i just wondered as early as may 6th, 6 members of the senate relations requested a copy negotiation records for new start in the administration is only agreed to supply the state department drafted summary of the negotiating history. just give an ambiguity of the treaty's preamble language on missile defense and contradictory interpretations issued by the u.s. and russia. and i just wondered why won't the administration released the complete negotiating records with the abm and inf treaty to the senate? >> well, let me say a few words in detail about the negotiating record matter. in fact, it is not the normal practice to provide negotiating records. the complete story of the negotiations in the complete picture of the negotiations has provided in the article by article analysis that every administration does. in the case of the new s.t.a.r.t. treaty, the article

by article analysis looks across all of the inputs that are provided to the negotiations. everything from instructions that come in to conversations back and forth. and that's really the complete picture of what the delegation how to work with and it is negotiated the treaty. so i think it's very important to recognize that the article by article analysis combined with the testimony that was given. i mentioned 18 hearings that we had on the new s.t.a.r.t. treaty with many, many -- many, many participants in this hearing. the secretary of state secretary of state, my boss hillary clinton, secretary of abnormal limbs and across the. i myself testified for times on behalf of the treaty. so that testimony is part of the complete picture of what the treaty is all about. and finally, we answered a thousand questions for the record that also get the

complete picture of what the treaty is all about. as far as the history of this matter, let me say just a few more words about what happened with the abm treaty. there was a reinterpretation -- an effort to reinterpret the abm treaty back in the 1980s. and pursuant to that, the senate foreign relations committee asked for some information from the negotiation records. and some partial information was provided. i want to underscore that was years after the abm treaty was ratified and entered into force. not the time the inf treaty was also reviewed by the senate for its advice and consent. some limited information was provided. at the time, the senate foreign relations committee put out a very important comment in their report on the inf treaty, where they said that as a part of his, the idea of handing out the

complete negotiating record should not be turned into a habit or a part it's because that would have -- and i think this is very important as the negotiator i can say this is very important. it would have a chilling effect on future negotiations. and overall, have a deleterious effect on u.s. diplomacy. and if you watched what happened with wikileaks over the last couple weeks, you will know exactly what i mean. so i think it is very, very important to bear in mind what the overall practice has been over the years. in fact, the 110th congress ratified 90 treaties and in none of those cases was the negotiating record either asked for or provided. yes, please go ahead. >> hi, i'm arkansan that human rights organization called save

darfur a genocide convention network. i don't have the knowledge and nuclear issues, which is why i'm here. my limited understanding is that previous treaties, especially the moscow treaty have a lot of the key language you are discussing now with new s.t.a.r.t. i'm curious, some of the questions are processed here but are the most sensitive issues that senator kyl or anyone that is trying to delay this or oppose the treaty, what is your response to those substantive arguments? and to come you mentioned before any delay, which you'd have to start from the start. i am just curious, what with that delay look like? is another year, two years, can you paint a picture of a plan b looks like? >> it's a little bit hard to predict. i mentioned during my remarks that we would be lucky not delay as i said. and i will stress once again that the treaty, if it is not ratified in the lame-duck session, by the way, with a

senate that has very much grappled with the treaty, it's been many, many years since the senate had to give its advice and consent to the arms control treaty. i want to stress that i think it's been a very impressive effort, the due diligence the senate has done. it is the senate that is done the due diligence, working very hard with us. a thousand questions i mentioned were serious questions and not only did they give them to us and we had to write the answers, but then they had to read them. that has been a case where i think the senators have really done their homework on the treaty. and that's one of the reasons why we are keen to work with the senate on its ratification. but if it is not ratified in the lame duck session and does go back to senate foreign relations committee in the process starts over again. or for that reason, i believe we are looking at the delay of six, 12, maybe 18 months. it's very difficult to predict. as to the main arguments against

the treaty, i will mention the three of them and speak again briefly to the verification area and then i'm going to ask jim miller to pick up on the other two areas that have been the focal point of criticism because they are very much issues he has been working and working together with the national nuclear security administration, the d.o.e. administration responsible for nuclear weapons. the three main issues that have come up again and again and again have to do with whether or not there is some kind of secret deal on missile defense that is hiding inside the treaty and whether there is some constraint or limitation that will accrue to the u.s. missile defense programs as a result of the treaty. therefore, second major criticism has to do with verification regime. it is not the verification regime of the s.t.a.r.t. treaty, which was negotiated during the court for years. in fact, i worked on the start delegation in geneva in 1990 and 1991, so i'm quite familiar with the process by which the s.t.a.r.t. treaty was

negotiated. the verification regime is different in this treaty. i'll come back to that in a moment. the third big issue does not really have to do it the treaty itself, but it has to do with the modernization of the u.s. weapons infrastructure in the future funding for the stockpile stewardship program. the giving gem fair warning, i'm going to ask them to comment in a moment on those modernization and missile defense issue. but i did want to say a few words about verification. because this treaty is a verification regime that is uniquely suited to the central limitations of this treaty, many of the verification measures in the s.t.a.r.t. treaty were associated with this particular structure in the particular requirements for monitoring that were generated the treaty itself. we've learned a huge amount over the 15 years of implementing the s.t.a.r.t. treaty. the s.t.a.r.t. treaty went into force in 1994 and went out of for us a year ago in december. over those 15 years ago we had

inspectors the ground, conducting inspections across the former soviet union because not only for russia and the united states signatories of the s.t.a.r.t. treaty, but also ukraine, kazakhstan and belarus. it wasn't that the mechanism used to denuclearize those three countries that once the soviet union fell apart, ended up with thousands of nuclear warheads on their territory. so we used to s.t.a.r.t. treaty is the mechanism to remove those weapons from those countries and bring them back to russia for dismantlement or for other deployment. so it is a very, i think, interesting and intense experience that we had in implementing the s.t.a.r.t. treaty and we learned an enormous amount. i had weapons inspectors have been on my delegation, people who had worked on the inspections in the s.t.a.r.t. treaty for all those years and they knew a very great deal

about not only how to conduct on-site inspections, but they really thought through about how to do it better. and so we incorporated some of those experiences and some of those ideas about how to do things better into the new s.t.a.r.t. treaty. and i think that is very, very important, that burning went on, not only on the u.s. side, but they're also inspectors on the russian delegation as well. they too brought their experience to the table. anything for that reason we've ended up with a verification regime and the new s.t.a.r.t. treaty. first of all its uniquely suited to the central limitations of this treaty, but furthermore it has incorporated their improvements which will help us i think to improve the on-site inspection profile in the new s.t.a.r.t. treaty. jim. >> thanks, russ. when they say a few words about missile defense and funding for the nuclear complex. for issues on missile defense, the first is that some have claimed that there is a possible

secret deal as was indicated on missile defense. this is nonsense. there is no secret deal. or if i put it different is secret from the president, vice president, what has -- to menasha scaredy-cat from the secretary of defense, all the people i work at the defense department. secretary of state and the deputy secretary, undersecretary and everybody else there. in other words, if it is secret is secret from the u.s. government. i think it is time to all of the players involved and frankly it's a little difficult to understand what the basis of this claim is. i think the closest we have is as rose indicated earlier, we have had discussions with russia about the possibility for ballistic missile defense cooperation and which would look for people to see a couple of their readers could contribute to the picture for missile defense to help improve our european missile defense capabilities. we frankly haven't gotten very far in those discussions, but we've proposed an umbrella

agreement that would allow us to have those conversations. my best estimate is that somehow taken the discussion of this umbrella agreement to allow the exchange of information as a potential agreement that will limit missile defenses. that is not the case and in fact the agreement that we are discussing is a subset of a defense technical cooperation agreement text that the bush administration opposed to russia. so set aside that issue. within the treaty, the missile defense are noted in two places. one is in the preamble, which simply states there is a relationship between offense and defense. and i think that anyone who understands these issues that all would recognize that. you also have to recognize that we have under the treaty, 1550 weapons allowed on the site.

we currently have 30 ground-based interceptors. her face adaptive adapter for cheerful now have the capacity to go after russia ballistic missiles. so while there is a relationship, there is no possibility that are in the terms of this treaty are sometimes thereafter, that there be any instability caused by our plans on missile defense, which as we said we intend to continue to improve both qualitatively and quantitatively. a second element in the treaty is that it prohibits the future conversion of icbm or slbms launchers. we are committed for farmer a.q. khan at the air force base dpt intercept -- interceptor silos. but we discovered after having done so is that it is a lot more expensive to convertible pilot

than to build a new one. we now have experience building new satellites in fort greeley, alaska. i'm prior to agreeing to this negotiation, we ran the numbers and discovered that if we want to deploy additional bmd interceptors, far cheaper to do so by building new satellites. and in fact, secretary gates has approved putting missile to its work really which will give us the ability to employ interceptors if we choose to do so. the final issue of self-defense is that unilateral statement associated with the treaty made by russia, stipulating that in fact is the u.s. missile defense capabilities grew so large as to begin to create instability or tonight the ability of the russian deterrent, then russia would consider withdrawing from the treaty. this is a provision that was

also present in the previous s.t.a.r.t. treaty. in fact at that time, russia linked it to the abm treaty and in fact when the u.s. withdrew from the abm treaty, russia did not withdraw from s.t.a.r.t. treaty. we made a unilateral statement da silva said the united states intends to continue to improve our missile defenses and we have good reasons for doing so, given threats posed by other countries, including north korea and iran. on the question i was in an essay of the funding for the nuclear weapons complex, senator kyl came to the administration a few months ago and said that the plan we had provided in an essay for the nuclear weapons complex was insufficient. i was frankly a little surprised when he made that statement initially because we had just increased spending for the

nuclear weapons complex dramatically by $600 million in the previous fiscal year and it plans to continue the increase over the coming years. as it turned out, senator carlos ray. we looked into it. there are areas where plants are changed and new estimates have risen an additional name was required. and the administration did a fairly thorough look and decided to add $600 million for fiscal year 12 and $4.1 billion overall for the next five years. in the spot is that over the course of the six or so months since we made the last estimate, things have changed and we meet that adjustments and were perfectly glad to do it in this administration is committed to continuing to fully fund the nuclear weapons complex. those are really the key issues that have been brought up.

>> hi, i'm david hathaway from the u.s. air force here at brookings. you both artfully laid the reasons why he would be good for the u.s. to ratify this treaty. from the other side of it, there must be something in it for the russians to want this as well. could you lay out some of the reasons the russians would want this and when it's a good thing for them? >> well, it is important to recognize and to underscore that this is a bilateral reduction negotiation and so all of the obligations that are placed on the russian side of the treaty are also placed on a tiered so for them, and also provides predictability about what we're doing with our strategic forces and provides visibility into what we are planning with our triad in the years the treaty will be enforced. by the way, treaty will be enforced for tenure smetana

enters into force. so it provides really for both parties core predictability and stability. and i think we've had a huge amount of experience now starting at the strategic arms limitation agreement in the early 70s with developing a kind of increasing amount of predict the ability about what we each have been training with their citrine check forces. as secretary gates has emphasized and also general chilton of strike on, this kind of predict ability really helps with four spanning over time so that you don't end up in the box of having to be worst-case planning all the time and maybe drive up your budget cost in a way you would not otherwise want to do so. so i think for the russians as well as for the united states, the core interest is in the predictability that the treaty provides. >> i agree 100% with a process that. and i would just add that like

us, the russians have a strong interest in non-proliferation and preventing nuclear terrorism. and like a stable benefits and help strengthen the regime by making reductions on both sides of what is necessary. >> is the question back here. [inaudible] question about the plan for the nuclear complex on modernization senator kyl has said that, an nsa, d.o.e. official has come in the course of the negotiations leading up to this discussion now, proposed that modernization funds be requested in a multiyear appropriation and be appropriate for multiyear period is that something the obama administration is embracing at this point? and if not, why does it appear that officials had opposed out to senator kyl? >> the question is whether it is

possible to get some advanced funding for future requirements and in particular for a couple of the larger facilities being built. one that will ensure our ability in the future to continue to work with uranium and the other that will deter ability to continue to work with plutonium. but a look at each of those facilities, it's important to understand there were currently at about the 45% definable. in other words, we have a lot of the work to do still ahead of us for the department of energy does, that will define what these facilities will really look like. but 45% on it will be a couple of years. two and a half years or so before the 90% level of design maturity. and at the 90% level, design maturity and nsa will be a will to make a much more accurate cost estimate of what the

facilities will cost. currently they provide a pretty significant change for those caused. another point also, i think it would be appropriate to consider the possibility for advanced funding. it raises other issues for d.o.e., but it doesn't make sense to do advanced funding would areas such -- today when there's such a wide range of possible cost them in the designs are part down. something i think we should really look at and look out of some and that is a possible option and two to three years. as i said, it will raise other issues in the office of management and budget will have the view. but it is certainly worth considering, but it just where we are right now certainly isn't the right time. >> my name is andrew sadowsky. my question is for secretary

gotemoeller is a rather technical one. do you estimate how many working days to complete the certification process? [inaudible] do you think it is still possible to complete this has to get this done during this timeframe? and what is your plan if you drag over 22011? thank you. >> the answer to your question is yes, we know, for example, that there is a continuing resolution that is time to go through december 17. and about that time there will have to be some additional votes so we know that the congress needs to stay in for the reasons of what will happen with the continuing resolution that keeps the government running, the budget for the government. as we know the congress will be at least here until the 17th of december and it's possible they could stay for more time

after that. so i do think there is time to get the new s.t.a.r.t. treaty finished in that period. i will just say that historically, we have a pretty good feel for how long it takes to do these treaties. the s.t.a.r.t. treaty took five days on the floor. for example the s.t.a.r.t. treaty took two days on the floor. the moscow took two days on the four times. so i think frankly that there is adequate time available. [inaudible] >> well come as i mentioned we will be starting again and it will go back to the committee on foreign relations for consideration and we will be working intensively as before. i do think, as i said, we have an enormous, enormous now stock of both the testimony of the 18 hearings come as i mentioned in

testimony and multiple witnesses on each occasion. so we have a very, very good storehouse of testimony from our top leaders and experts on the treaty. in the 1000 questions for the record won't go away. i suppose we might get asked another thousand questions for the record, but i can't imagine a topic at this moment that we haven't touched on so far. i do think as we have, done our homework with regard to the new s.t.a.r.t. treaty and that it is in a good situation to ratify it in this lame duck session. yes. >> hi, todd jacobson with nuclear weapons deterrence monitor protect the modernization within the essay. and the current draft of the continuing resolution, there is language that would link authorization funding to ratification of the treaty. are you in favor of that language and you think it will apply effective leverage to convince republicans to vote for

the treaty? .. in prague on april 8 with president medvedev. he spoke about proceeding up in our next negotiation to tackling non-deployed nuclear weapons and also non-should teach it or some

people call them tactical nuclear weapons of this has been an issue of great concern to the senate. they have wanted, excuse me, to see us move on to those negotiation tackling nuclear weapons so we will be i hope proceeding in that direction. there are some large multilateral efforts of blood as well. we have been very very keen to proceed with the fissile material treaty cut off on disarmament and very perturbed at the work plan that was agreed on a consensus basis in may a year ago at the conference on disarmament back in 2009. there is a single country standing in the way of us moving forward so we are looking for ways to advance nevertheless a fissile material cutoff negotiation and we will be doing everything we can on a multilateral basis to move that forward whether in the cd or via some other mechanism. the other goals and these are not in the nuclear arena at all

but we have been very very keen to proceed with conventional forces in europe, reductions and controls. back in 2007, we had a situation where russia ceased implementation of the cfe treaty and we wants to move as rapidly as possible now to restore attention to the cfe treaty and we have already some discussions in that regard so it is also on the conventional side of the house that we want to be working and working very busy gristly in the next -- vigorously in the next year. there is are a few of the other areas that we will be looking at for 2011. >> if i could just say briefly to things. first with respect to any future bilateral arms control discussions, it will take some time for this administration to work through the set of issues

that need to be worked through to address tactical tactical and non-deployed weapons, as rose discussed, and it in parallel we will be doing a hard look at potential revisions to guidance associated with nuclear weapons. we expect that we'll take a little bit of time to say the least to work through those issues and we will be consulting with congress and we will be consulting with our allies also because particularly as we begin to talk about the nonstrategic tactical weapons, the interest of the allies are very much in play. we consulted during the new start negotiations as well but it will be critical. the second thing i would say is we think about those potential bilateral negotiations is that there is room on both sides for further reductions. we declassified a few months ago the number of nuclear weapons in our stock pile and so the end of

the previous fiscal year it was 5113 and we said unclassified we had an additional several thousand weapons so you can do the math on our side. on the russian side as well. we believe that there is room for reductions and in particular consolidation of the tactical nuclear weapons and we think this is something that will be very valuable. >> can i get a mic? >> we will give you the last question, peter. >> okay. i am from brookings and i wanted to ask you secretary gottemoeller a little bit about the negotiations and specifically when you start those he sort of had a vague idea, more than a vague idea what some the key issues and challenges are going to be because the two countries have opposing views so my question to you is what might've been

surprising in these negotiations where we didn't expect this issue to become a big deal, contentious and then it was tough to work out and maybe it was one of the last ones to be agreed and resolve. can you give us one or two issues that sort of fit into that were a bit surprising that turned out to be difficult at that were read at the end? >> let me just talk a little bit about the negotiations overall because you are quite right, pete. i mentioned it during my remarks, it has been a long time since we really negotiated such a big deal with the russians, such a big nuclear arms reduction treaty. the last major negotiation of any length was the s.t.a.r.t. treaty negotiations which took place at the end of the 1980s over into the 1990s and we are finally signed by president george h. w. bush and president gorbachev in july of 1991 so you know we are quite a long negotiation but it was a long

time ago also so first of all, call it the concept formulation phase. we had a face that one from the late spring until the presidents met in july in moscow, president medvedev, president obama met in moscow and signed a joint understanding which provided a basic framework or the negotiations but those first couple of months, april, may june we were working in moscow and geneva. we had a meeting in rome as well. basically on the overall concept and you can see the way they sell out if you look at the joint understanding from the july summit of 2009, so we had those basic concepts to go on and then we had to proceed to actually put treaty text out and that is what we did through the end of the summer and worked through into the fall. i think, based on, you know, the way that we put together the treaty text, there were no major surprises. we knew what the issues were.

nothing kind of jumped up but there were a lot of details that have to be worked through because we had again the experience of the s.t.a.r.t. treaty which was an enormous document. the street part -- treaty and its accompanying protocols, about 700 pages long so we had a good basis to work on that as i said we had a new treaty that was really focusing on three particular central limits, the central limit on deployed warheads delivery vehicles and deployed in non-deployed launcher so we were working through particular concepts that would apply to how we would be achieving the reductions in this new treaty, and what particular verification measures had to go along with those central limitations and the obligations in the new treaty. so i can't say it was all smooth sailing. there was a lot of head leading that went on in geneva and we had some very high level help from time to time. admiral mullen and the chairman

of the joint chiefs of staff with his counterpart general a car off played a very important role in the negotiations. president obama himself and president medvedev were very active in the negotiations in my abd at -- immediate loss tauscher came in the endgame of the negotiations to help push it up he'll. we had some considerable headbutting but in terms of unpredictable things arising i can't say i can think of any examples. anyway thank you all very much for this opportunity to talk to you today. it has been a great opportunity for me and i am sure jim would say the same. >> in fact i will say the same and i will say that one thing for me that was totally expected but not typical was the type of open communication and incredibly effective team play by the lead negotiator, assistant secretary gottemoeller and it allowed allowed the department of defense to express its views and to have, to ensure that the treaty was in always

something better senior leadership was aware of and it ends and that had worked through all the issues. i think if you read the history of arms control negotiations on a number of occasions in the past, that was not always the case. and it is something that allowed this to treaty to be accomplished quick weight. the u.s. national security interest so a great credit to you, rose. [applause]

>> up next a conversation on china's economy its energy needs in the country's role on the korean peninsula. we will hear from deputy secretary of state james steinberg from the center for american progress. this is 45 minutes. >> good morning everyone and welcome to american progress. i am the president here at the center. i'm pleased that you could all join us today for this important

and timely discussion of u.s. china relationship. the event is part of a larger dialogue that is hosted this week with china and united states exchange foundation. we are combining forces to have a strong and intense dialogue. last year we visited beijing with a delegation of american policy experts to discuss the path forward for the u.s. china relationship. this year we are pleased to host a high-level delegation of chinese representatives and to continue our ongoing conversation about the critical issues at hand. we hope that our dialogue will facilitate a greater understanding and more strategic trust between our two countries in advance our diplomatic, political and economic relationship. to that end we help the discussion with chairman of the joint chiefs of staff admiral mike mullen here at cap last

week and we are hosting this conversation with secretary jim steinberg today and later today senator john kerry will be back here to give a capitol hill take on the u.s. china relationship. we also spence today and tomorrow, our combined delegation taking deeper into shared concerns and points of friction through detailed dialogues with our counterparts in the chinese delegation. so we are very fortunate to be here this morning and into the afternoon to have two distinguished diplomats to kick off our morning discussion. sandy berger and secretary jim steinberg. first i'm going to introduce sandy berger, of course now chair of the albright stonebridge group and former national security adviser to president bill clinton and national security adviser sandy guided foreign-policy from the

balkans to cosa bow and operation desert fox in iraq on the passage of the historic pnt are, the normal trade relations with china and then with secretary of state madeleine albright who was also in our front row and i think bill cowen is here as well. we are having a little bit of a west wing clinton reunion if you will forgive us here, but together they kept a watchful eye on a strategy of diplomatic engagement to maintain stability of the korean peninsula which is back so much in the news today and i am sure that jim will discuss that. i am going to turn the podium over to sandy in just a second to introduce secretary steinberg who willed deliver remarks. at the end of that our colleague, senior fellow and also a clinton alum, our senior fellow nina hachigian will

moderate a discussion. it is a great privilege of mine to turn over the microphone to a great friend and a great friend of cap's and a great public servant, sandy berger. [applause] >> thank you john. it is a great pleasure for me to introduce deputy secretary of state jim feinberg, u.s.-china dialogue. early in the obama administration the president said that the u.s. china relationship will define the 21st century and there is nobody more engaged in defining the u.s. china relationship in the united states then jim. i had the pleasure of working with jim in the clinton white house as deputy national security adviser for which he did a terrific job. some of you may know the office

of the deputy national security adviser in the white house is -- a very distinguished occupants in that office, but it is -- i would venture to say when jim was there, there was more brainpower per square foot than ever before. jim is well-known for the inexhaustible energy he brings to everything he does, his sweeping knowledge and his intellectual rigor. there is not a single subject that jim tackles that he doesn't bring clarity to. over the last two years jim has traveled the world in pursuit of peace and stability from central europe to asia pacific to the caucasus to columbia. he has particularly been engaged in the u.s. china relationship and an interest that goes back before this assignment come even before he was in the white houst

with china who he knows very well. in march at a very critical time in our relationship when things were rocky, the president sends jim and jeff bader to beijing for high-level meetings to get the relationship back on the right track. and i understand that president obama and president who yesterday decided jim should come back to china next week to try to deal with north korea and others as a testimony to the high regard that jim has held by this president and by the chinese. so it is a great pleasure for me to introduce the deputy secretary of state, jim steinberg. [applause] >> thank you, boss. it is especially meaningful coming from you. at that enormous respect and admiration for sandy who taught me so much and was an extraordinary collie.

it is quite special to be here with so many friends and colleagues who worked so closely together at a very important time in building the u.s. china relationship and i think if we reflect back on to the long road we have traveled is important to keep that perspective and something i'm going to try to touch on in my remarks, which now come just a little over a here since i last had a chance to talk to cap about china. i want to congratulate john and nina and everyone involved in this effort. the exchange that you envy foundation had convened as important under any set of circumstances but especially timely to look at the questions of strategic trust in u.s.-china relations and you have the kind of people here who could have a meaningful dialogue, who understand the opportunities as well as the challenges in this relationship. and it is befitting that brought relationship we have, i'm going to give a broad overview of what i see as both the achievements in our relationship and also

some of the challenges we face going forward. as we continue to build this long trajectory of a relationship which has transcended administrations of both parties for a long period of time. you know, if you were to read the newspapers around here, somehow the u.s. china relationship is experiencing a serious downturn or a freeze or whatever the expressions are but frankly we don't see it that way and i want to explain today and reveal how we look at the overall relationship and see the very concrete areas of ongoing achievement and cooperation that we have as well as some of the areas where we can do even more together to achieve common interest. i think it is important to recall a sandy suggested a broad framework within which we have are sued u.s.-china relations and as i say it is a framework that was established decades ago and has sustained us for a long time. is president and secretary has

said we welcome welcome the rise of since a successful china that plays a role in global affairs and to protect and promote our national interest. we see it to expand our cooperation with china in solving global challenges while fully appreciating the complexities of managing relations with such an important emerging power. we believe it it is in the interest of both the united states and china as well as our responsibility to the rest of the international community to work together to achieve solutions to the most vexing global problems and with each step that we take to promote practical cooperation and support of our common interest we build a foundation and expectations that we can achieve even more in the future. we obviously have a very broad agenda of ranging from regional to international security to global economic crisis and long-term global growth, clean energy and climate and these all formed the elements of our strategic discussions. and continuing our engagement on

these broad range of issues and the numerous initiatives underneath them, are mechanisms that develop mutual assurance and mutual confidence. we develop greater understanding through dialogue which is made concrete by action and achievement. that is the foundation we believe in building strategic trust in the u.s. china relations for the long-term. that is why we place such importance on the establishment of a strategic and economic dialogue between our two countries, the highest level shared i secretary's clinton and geithner and today we are working to lay the groundwork for the third session of the economic dialogue next year. this allows us to have a broad range of discussions with not only the state department and treasury but across the entirety of our government and our chinese counterparts on issues ranging from regional and international issues, security issues and people-to-people exchanges and the like are goes to let me try to review where we are on some of these key topics

today in the steps we see going forward. i want to begin not surprisingly with security. we see the important challenges we face going forward is the need to promote security, peace and stability in east asia. as secretary clinton has laid out, there is a three-prong strategy here starting with our core traditional treaty alliances which are with australia that tie into the philippines but also building strong relationships with with the new emerging powers and particularly in east asia with india, china and indonesia. incorporating these bilateral relationships with comprehensive multilateral cooperation. in this context obviously our relationship with china is really critical and that is why both in building this bilateral relationship but also working with china and regional we see great opportunities to strengthen stability and peace in the region for the long-term.

particularly where police about the opportunity to strengthen our engagement through the east asia summit and appreciate the efforts of china in supporting the decision of the united states and russia to join the east asia summit. this is also part of a broader effort that we have made by expanding our ties with asean and including our participation in the first to two u.s. aussie on summit meetings. in addition to this of course is complemented by her work in apec which is another form for regional cooperation with china plays an important role. this regional cooperation in dealing with security challenges is critical to the long-term future of the region and we are in courage to see recently that china has taken steps along with ozzy on this past october to begin for example to discuss a formal code of conduct to the south china sea where regional stability freedom of navigation, respect for international law and unimpeded commerce under

lawful conditions are essential for all of us for the united states, china and other countries in the region and indeed of the world to be able to achieve our goals of a secure and peaceful commerce in the region. non-proliferation is another key area of security cooperation where our engagement with china has paid substantial dividends. we have been working together in the global context to strengthen the npt and to work towards a world in which proliferation is addressed through effective challenges both regionally and globally. china has played an important role in dealing with the challenge of iran's nuclear program as part of the p5 plus one in discussions that have been taking place in geneva as well as our engagement at with the security council and the adoption of resolution 1929 which impose unprecedented effective and strong sanctions on iran for its noncompliance with this international obligation we will continue to work with china and appreciate china's contribution to making

this process work oath as we pursue our efforts on dialogue and making clear that if iran is not prepared to move forward that there will be substantial costs. of course the second area where non-proliferation is at the forefront is in the context of north korea and a sandy mentioned this is obviously engaging much of our attention over the past month. the recent tensions on the korean peninsula which have been caused by a series of provocations by north korea beginning with the churn on syncing and followed by the revelations of the uranium enrichment program as well as the artillery firing on pyongyang island highlights the need for strengthened regional cooperation and in that context for strong u.s.-china cooperation on this important strategic issue. we want to work with china to address this challenge. we have had successes successes in the past on the presidential statement that the security council issued last year and response to the missile test

followed by resolution 1874 bed later that spring in response to north korea's nuclear test. we have demonstrated we can work together effectively and it is critically important china continue to play a strong role making clear to north korea there are consequences for its actions just as we make clear that if north korea is prepared to move in a different direction that there will be an opportunity for increased and more positive engagement. i think it is critically important to recognize the steps north korea has taken and the consequences that they have for peace and stability in the region. in the context of our interest in a stable and secure in denuclearized korean peninsula china has a critical role to play and we look forward to working together in a way that can demonstrate to all that are hard harder ship is effective in addressing this critical challenge. part of dealing with the security challenges of course requires us to develop a strong bilateral dialogue with china and we are welcoming the

resumption of bilateral military to military dialogue between united states in china something i've talked a lot about. a sustained and substantive military to military relationship is critical to the health of our broader relationship in solving the challenges that i have been discussing. so in this context we are looking forward to the defense consulting that will take place in washington as well as secretary gates planned trip to china next year. these interactions and discussions about substantive issues like defense policies and programs are important for making sure that we enhance transparency and try to avoid the dangers our militaries will become rivals. we need to ensure that this military to military dialogue is sustainable and durable and is not threatened by periods of disagreement when the need for dialogue is all the more important. of course in the region, the one china policy remains to be an

important part of our overall approach to our engagement with china based on the three joint communiqués and the taiwan relations act. our policies aimed at promoting dialogue across the straits. we continue to believe appropriate defensive arms sales to taiwan gives taiwan the confidence to engage the mainland and we are encouraged by the positive steps that have been taken between taipei and beijing and we want them to continue and urge them to continue to take steps that will continue to build trust and contribute to the stability. there has been important progress on the economic front and we want to see further robberies in the future. we are also working hard in our bilateral relationship to strengthen other aspects of security cooperation particularly in some of the nontraditional areas such as counterterrorism, counter piracy and law enforcement. attorney general holder visited beijing in october and provided an opportunity to advance our cooperation in areas like

transnational crime and international are pretty violations. we also need to work together on some of the other great regional challenges outside east asia and pacific and in particular i want to call attention to the need for us to continue our cooperation on sudan and the need to see an implementation of the comprehensive peace agreement, cpa and the importance of moving forward with a referendum in order to secure a stable future for the people of sudan. we also are working together in afghanistan. it is another place where we see opportunities for heightening our cooperation so it is a conference one that is important to both of our countries and as i said as we work together we not only enhance our own interest but we also contribute more broadly to global peace and security. of course the economy is also a critical part of our overall relationship as we work together bilaterally regionally and globally to address the economic challenges of our times. it is clear china's rice in the

global economic power has been swift and it does change international trade and investment market substantially. both the united states and china's long-term prosperity depends on our joint abilities you resolve disagreements about how to best manage are deeply interconnected economies and we are working hard to do so for a number of mechanisms in addition to the snet. the u.s. joint commission on commerce and trade jcc team meets regularly to discuss a wide variety of u.s.-china trade issues. in may we held their first-ever jcc team that you review of trade issues and the jcc t. will convene next week here in washington. meaningful progress through the jcc t. can contribute very significantly to a successful visit for the president early next year. china's domestic economy remains a strong engine for the global economy. we hope increasing domestic consumption china can become a catalyst for growth.

we also have high expectations for continued improvements in china's food and safety enforcement. we believe that stronger and better balanced two-way trade and investment flows will strengthen both our economies and create your jobs in both countries. although as you well know secretary geithner in the treasury are responsible for currency issues. i can note chinese officials have reaffirmed a commitment to enhancing the exchange rate flexibility and we are working to ensure progress in that direction and support of our global rebalancing efforts. the united states supports a greater role for china in global economic institutions to promote global growth including increasing china's voting share of the imf and the world bank. a third area of critical partnership of course is environment and energy. the united states and china share an interest in this stable and energy supplies to fuel our

economies. we are working to encourage china to rely on open and transparent markets to satisfy its growing energy needs. in that respect we continue to encourage china's engagement with the international energy agency and discussion of participation in a collective response to energy supply emergencies. as the world's largest consumers of energy and emitters of greenhouse gases we share responsibility to produce strategies that improve energy efficiency in advance our common interest on climate issues. we we are cooperative together on energy efficiency, civilian nuclear power electric vehicles carbon capture and storage renewable energy and the development of other, china's unconventional natural gas resources especially shell gas. we have also engaged in shared energy and environmental concerns through action plans under the 10 year framework on energy and environment cooperation between our two countries. under this framework the echo

partnerships program have developed energy efficiency and natural resource conservation at a local level. for examples of city of greensburg kansas and the city of neon shoe both of who face grave disasters are sharing green practices on rebuilding infrastructure while tulane university and east china normal are collaborating on research on wetlands conservation. we are also looking forward to constructive engagement with china in the coming days as well as with all other parties in the conference of parties on climate change which is currently convening in cancun. these all of course are matters of high policy but it is important to remember that the diplomatic conversation between our nations has to be enhanced by strong understanding and ties between our people. mutual trust and confidence are not built in a vacuum and they very much involved greater understanding of the people in both of our countries of the steps we are taking together by governments to advance our

mutual national interest as well as the efforts we are taking to engage our citizenry in these issues as well. we have been make great strides in broadening and deepening our government to government engagement with exchanges occurring across nearly all departments and ministries of both our governments but we need to expand that match that at the citizen level by promoting people-to-people exchanges that will help american and chinese people gain a better understanding of our politics, economies, societies and cultures. and it will be surprising hearing from me that we placed particular importance on educational interests to reduce misunderstandings, pre-judgments and to build strategic trust. for example a 10,000 strong initiative sets a specific edge bar for growing the number of american leaders and citizens who understand china to direct experience with the chinese people over the next four years. when we are talking about the

human to human dimension it is important to recognize the importance of the role human rights place in that direction. this is important subject matter between our two countries in the united states continues to be concerned with the chinese government's tight control of activities and the people that authorities deem threatening to the party including internet content including web sites of foreign media outlets. we hope china will take positive steps on human rights including the release of novell laureate wen jiabao and we realize we will continue to have disagreements on these issues but we feel is important to address these responsibly and directly. now all of these developments and this broad ranging relationship can be seen in the context of the deep exchanges taking place at the highest levels between our two governments from the first days in office when president obama and president hu spoke on the phone at the first g20 meeting

the level of exchange and engagement has made an important contribution to building an atmosphere of understanding and trust and helping us find ways to deal with common challenges. president hu's visit in january will be the eighth meeting of our president since president obama took office and follows a few months after the meeting of the two presidents during the g20 and seoul so we have yet another opportunity to continue to build on all the critical issues that i have discussed today and both sides are working hard to try to make that a successful and productive visit. in closing, it's clear from this that we have achieved a lot but there is also important work ahead of us to make sure that our relationship reduces the kinds of results that oath of our countries need and expect for our people. we are actively building relationships defined by common interest in joint efforts to resolve global challenges. as we work together or letter really and regionally and within

our institutions to shape the landscape of the 21st century. as president obama pointed out and sandy made reference to the relationship between china and the united states will be one that will shape profoundly the 21st century so thanks for your attention and i look forward to our conversation. [applause] >> thank you very much for as usual a very insightful and comprehensive comments. let me since i have a microphone take the opportunity to ask the first question and then we will open it up. despite what president obama has said and what secretary clinton has said and what what you upset about welcoming a strong and prosperous china, there is still i found a pervasive sense in china that maybe american people don't appreciate that america really wants to keep kind of weak and that many of our actions are explained by this desire to keep china contained in weak and divided etc. and i'm wondering how you respond to that?

>> i think it goes to the pointed me towards the end about the need to actually go beyond the government to government exchanges. i think these kinds of uncertainties and mistress and doubts are a function of the fact that there is and as much as fancy an they think both sides would like. we have to find ways to communicate. we have to find ways to address and if there are concerns on the part of chinese citizens about u.s. actions that we have a chance to engage and tried to explain our position. i have to say in this respect that is why we play so much importance on media freedom because we think it is important to make sure that all voices can be heard and not just on. it is not because we have designs or negative views about the chinese government that we think in an atmosphere of openness that viewpoint can be heard and debate can take place and not just some voices. i think that dialogue is a critical part in giving people a

chance to understand and air their doubts and have the kind of back-and-forth interaction that can help dispel misunderstandings and build the kind of trust you have been discussing. >> we will start with questions from a number of the press. >> thank you for this opportunity. i am with radio free asia. on north korea a lot of you are talking about the chinese pressure, including you. so, i think this is not a new idea and my question is what kind of real leveraging does the united states have to put pressure on north korea? >> i don't think it is a question of leverage. i think we have a shared interest in making sure that north korea lives up to its past commitments on denuclearization and stops engaging and provocative behavior which

threatens the security of all of the countries in the region so we have a common set of interests and now we have defined a common pathway forward. we believe it is critical for all of us to make it clear to north korea that there are consequences for his actions whether it is the cheonan or the development of nuclear programs in violation of security council resolutions. at the same time that there is an opportunity if north korea moves and they different direction to have a more common perspective. we have worked together to do that in the past as i said last year and a presidential statement after the missile tests and resolution 1874 that demonstrate that we do have is a common view about what the objective is and we are able to work together to communicate their views so i think that is the focus we have right now and that will be the focus of our engagement in discussions with china. to send in an equivocal message that it will not be rewarded for

evocative behavior and their consequences for provocative behavior and if north korea does take seek a more productive engagement with other countries in the region and the other members of the six parties that it needs to take concrete steps to demonstrate its seriousness and purpose. >> we will take one more from the media. sir? >> thank you. at the meeting with the south korean and japanese foreign ministers yesterday, china called for invoice to the six-party talks so what do you think of that and also another question is how would you respond to the decision that the obama administration's policy on north korea is a bit stronger

than that ocean of administrations and to provoke north korea to increased nuclear weapons and increased provocations. thank you. >> well, first i think we made clear that we do not believe it is productive at this time to convene those six parties. what we have seen in the past is that talks for the sake of talks to not produce the kinds of results that we all need to see to move the korean peninsula and a more stable and peaceful direction and in order to create the context for productive discussions when he declared vacation from north korea that it understands this pattern of provoking and hoping people will rewarded to stop the provocations is not one that we are going to sanction so we need to see some evidence that were there to be these kinds of discussions that north korea is ready to move back into implementing its commitments under the 2005 joint declaration and to hault its publication.

we are all basically ready for dialogue if dialogue can be productive but i think it is important in light of what has happened over the last several months to clear indication than concrete indication from north korea that it is prepared to do something significant of the context of discussions rather than just to sit around a table. i'm not sure i understand your question about our policy except to say we are very clear that we have seen a pattern over the past decade or more and which north korea begins to move into dialogue and then doesn't fulfill its commitments and that puts us all and puts the situation in a more dangerous situation than had been before so our policy and i think it has been a shared policy particularly with our south korean and japanese colleagues to make sure that while we welcome the opportunity for dialogue and discussions we need to see evidence north korea is prepared to take irreversible steps to deal with its nuclear program and end its policy provocation.

>> we will move on. >> thank you for the opportunity. i am with chinese media. my question is president hu and obama's phonecall yesterday, they agreed that the security situation on the korean front is not probably hindered to further escalation of tension however the u.s. conducted massive military exercise can be also alarming imprint.-- provocative, and also the second part of the question is it is easy for china to proceed the u.s. using north korea as aids to talk to china. thank you very much. >> first, he will be surprised to hear that i disagree with the characterization of my exercise. what we have demonstrated is is

the united states will stand by its alliance obligations to south korea and if north korea engages in provocative behavior the united states and south korea have the capacity to respond if necessary so we view this is stabilizing and a sends a clear message to north korea that it needs to be sifted its provocations and there will be consequences if it gauges in that kind of behavior and we think this is an element of stability creation rather than the opposite. with respect to the applications for china we have made it clear in all of our discussions from public and private that our responses are being driven by north korea's behavior and not directed at china and this is the reason why believe it's important for china to work with us to restrain north korea and pointed back in a direction of meeting its international obligations with respect to its nuclear program. going back to nina's first question to the extent there are uncertainties about our intent we certainly tried for our public discussions about this but we would welcome more dialogue both on the military to military dialogue on the

political level but also one of people-to-people level because we think it is clear what our purpose and intent are. we are perfectly to enter discussions with those who have questions just why we are doing what we are doing and why we believe what we are doing is driven by the north koreans behavior and which is important and the only way to ensure peace and stability. what we do know is without a clear indication of our determination that the north will feel free to engage in this provocative behavior so we have to make clear that we will stand by her allies in stand by our national security. >> thank you. ralph with the eurasia center. if the u.s. when out on a limb and engaged in a formal recognition of north korea as a sovereign nation similar to what japan and south korea have done how do you think i would change the dynamics and is if that's something your counterparts have

suggested might he a way to move things forward in dealing with the conflict in north korea? >> you know i think we have made clear as previous administrations have made clear that we do not have the hostile intent and we are prepared for dialogue with north korea. north korea's a member of the united nations and so there is no problem with our engaging with north korea if and when the north koreans demonstrate that they are seriously interested in moving forward in a productive direction. this has been, there've been plenty of opportunities for that kind of engagement to take place in what we would like to see under the circumstances are a clear indication from the north than it wants to pursue dialogue for the purpose of achieving concrete results. we are prepared to address concerns that north korea has in the context of a meaningful dialogue so long as we have a clear indication north korea is prepared to meet its own obligations. >> the there are.

>> i know this friday the president is going to meet some chinese dissidents in the white house and it is on the eve of the nobel peace prize laureate ceremony. can you talk more about who the president is going to meet and in what form it is going to be in, which room in the white house is going to have the meeting. thank you. >> as you may have noticed in the introduction i and am the deputy secretary of state so you will have to direct your question to the white house. >> mohamed of reuters. can you shed any light on how you would like china to make clear to north korea that its actions have consequences. this is simply a matter of persuasion or would you like

them to actually consider doing are actually do things that may constrict or affect their trade and economic relations with the north? and secondly do you have any sympathy for these chinese academics say is part of the chinese calculation here. that is to say that undo actions on their part could have a significant effect on north korea at a relatively fragile time in its history and when it is undergoing a succession process? >> i think this is something we look forward to discussing with the chinese. i think we want to share views and get their perspectives on that as well but there are a number of things that may make sense and i think it is important for us to have a conversation with their chinese counterparts. in the fragility and situation there i think our view is quite clear what which is that without a strong message of the

necessity of north koreans to exercise restraint that is what is creating the fragility. the tensions we see in the dangers we see come from the fact that there does not seem to be effective restraints on north korea engaging in these provocations and we have to take steps to make clear that the dangers come from this provocative behavior and rather than sort of stepping back and tolerating it we need to make clear there are consequences for so that is a prospectively have and will share with all our partners in the region as we continue this dialogue. >> thank you mr. secretary. my name is nadia. i have two questions. first of all, during our conversation with chinese counterparts have you ever gotten any implication our message that china will accept a unified korea under the south

korean rule? and the second question is in the relation you say you want to see both sides making progress in economics and other issues. i wonder what other issue means? can you share some light on the context of what you just mentioned? >> on the second, we were very encouraged by china's decision to support taiwan's participation as an observer in the world health assembly. we think there are other opportunities for the two to work together in places where the membership is not membership based on being a sovereign state we have discussed with china some of the particular institutions and organizations for example on climate change there is an opportunity where taiwan can play a constructive role and would be in the interest of all of us to have taiwan engaged in some particular format so i think there are broad range of areas in which there is opportunity for dialogue and progress in the relationship. with respect to the future of korea i think in the end what is

important is that this is a decision that we would like to see the two koreas engage on. that is an appropriate mechanism for resolving that. we have some responsibilities and as signatories of the armistice of course but the right answers for the two sides to engage in one of the things we have strongly encouraged is for north korea to reach out to south korea and to make clear that understands the seriousness of what it has done in his recent provocations and try to move forward on the basis of some of of the past north-south engagements including the north-south declaration which i think is in the right framework in which to think about these problems. >> we have time for only one more question unfortunately. >> thank you. i am with the china press. yesterday the "washington post" reported that one of the -- obama administration accuse

china of enabling north korea to take her pocket of actions and also right now the united states is defining its relationship with south korea and japan and baby created an anti-china block in northeast asia. what is your comments on this report? and secondly, do you think wikileaks documents will have any negative impact on u.s.-china relations? thank you. >> on the latter, we have obviously made our decision on wikileaks clear and i am confident that both sides understand the importance of the strategic interest we have been a relationship and we will move forward on that basis. i don't intend to comment on the newspaper stories in do you have heard my views on what i think is the state between us and china and north korea. thank you all. >> join me and thanking deputy

secretary steinberg. [applause] thank you for all coming. i would like to ask everyone to please remain seated until our speaker has a chance to leave the room. [inaudible conversations] [inaudible conversations]

remarks from india's ambassador to the u.s..

>> earlier earlier india's ambassador to the u.s. discuss how globalization has changed the relationship between the two nations. he spoke at the heritageglobalih foundation. this is 40 minutes. >> now i would like for all of you tom join me in welcoming ambassador meera shankar who can shed some new lights on these issues. she is a great friend of thenk unitedar states. she is very knowledgeable abouta the united states. bou she certainly is a respectedtes. member of the diplomatic corps of the c ity. diplotic c she wasn't that first posted in washington in 1991 o washington in 1991 and while in that position, of course, and later in 1995, she focused a great deal on u.s.-india trade relations. after that shield key positions in india government including the end of south asian cooperation. she was promoted to initial secretary in 2002 and was responsible for the united nations and national security

policy. in 2005, she was named ambassador to germany. so i'm pleased to come along with her deep knowledge of our country here representing india to the united states and also very pleased that she will be started off today with some remarks. ambassador, welcome. [applause] >> thank you, mr. holt. there's a great pleasure for me to have this opportunity to talk to you at this conference. i commend the initiative of the observer research foundation and the heritage foundation to organize this series of conferences and particularly this one, which will focus on indian globalization and the transformation of u.s.-india relations. those who have closely followed

the remark of a successful visit of president obama to india less than a month ago would already be aware of the enormous ground the relationship is covered in recent years. prime minister manmohan singh and president obama, after their recent summit meeting in new delhi, characterized the u.s.-india strategic premiership as indispensable, not only for their two countries, but for global stability and prosperity in the 21st century. our shared democratic values, the emerging international situation and their wide-ranging opportunities have guided our two countries in shaping this relationship. our core operation is broad-based and involve people on both sides from all walks of

life. it draws strength from the enormous public goodwill and popular support that it enjoys in both countries. and of course, as mr. holt said, this is reflected in the bipartisan political support for strengthening the india u.s. relationship across both sides of the political aisle in the united states and across changes in administration. into the broad political spectrum in india, again across changes in government. the world today is undergoing significant long-term changes, which will shape a new world order in this century. the center of gravity of new opportunities and challenges is increasingly shif