25. we will reconvene in 15 minutes. thank you.par ♪ >> say you want a revolution. we all want to change the world ♪ \ [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> more now from the nohl labels conference. we will hear from michael bloomberg, charlie crist, and michael castle of delaware. topics include redistricting and election reform. columbia university in new york hosted this >> the press release today about how gerrymandered and non-

competitive a coral process is and why that is. >> the reason that it exists is because people always act rationally and if you were a legislator, you would not want competition. the natural thing is to want to be able to go from alexian cycle to election cycle and move your way to president of the united states and not have to run the risk of being unemployed and going into the private sector which scares them esus out of the. >> there's no jobs. >> because of their actions, there is no jobs. they do what you expect them to do. they make sure that they do not have competitive races. as long as they are the ones that set the standards, i do not think you can expect much change. in new york, ed koch created an

organization, if reelected, you will go and do fair, non partisan redistricting. i hope that they do what' ed force them to commit to, but there is a long history of saying one thing before you get elected and say -- doing something different. >> is there any way you could have a binding contract? >> no. >> at the federal level, you have to change the constitution. that will not happen at the federal level. in some states, you have to change the state constitution. in some places you can do it by referendum -- florida and california. in some places, it would be debated by the courts. when you talk about fair, a nonpartisan elections, it is not clear what your definition of fair is. is it equal opportunity or equal results?

and that is -- the courts are all over the place. >> your fair is in the title of your organization. how are you defining it? if he would not mind sharing, how you define the problem and the successes you have been enjoyed. i want to talk about how some of these changes have altered the nature of the political process. how you dealt with some of the challenges he was discussing? >> florida has the distinction of being pretty much the worse a gerrymandered state in the country right now. we have a situation in florida where we have about 700,000 more registered democrats in florida, but we have 75% now of our legislator is republican. that is a duke to the way the districts are drawn -- that is due to the way the districts are drawn.

our legislators think it is due to the fact that everybody likes them very much, but the districts are drawn in such a way that whoever is drawing the district puts the opposite party, voters in large numbers into a very small number of districts and then puts their voters, spread them out over twice the number of districts. that is the way it has been done in florida for years. this year, 63% of the florida voters in a year that was very unusual in florida for many reasons, said, 63% said, we do not want districts that are drawn for the purpose of favoring or does favoring a political party or an incumbent. that spoke very loudly about the mood of floridians.

these amendments say that districts shall not be drawn with the intent to favor or disfavor political parties or incumbents. we now have and the constitution along with that provision another provision that says that minority voting rights must be maintained. districts will now have to be compact. presently, we have dozens of districts that go for 150-200 miles, splitting counties, splintering cities, and connecting areas that have very little in common. and districts will now have to be compact and it will have to follow geographical and city and county lines to keep communities together, so that voters will be able to vote alongside their neighbors for their representatives instead of finding that their neighbor next door is actually in a district that is totally unrelated to the district they are in. so there are a lot of reasons to

think that, with fairness in redistricting, and this is supposed to take the rating out of redistricting. >> fairness to whose eyes? who is the arbiter? >> it depends. i agree that the legislators think fairness is drawing a district that is going to protect themselves or their political party. this new constitutional provision that we have in florida outlaws that. and it's fairness to the people. >> in his eyes? >> to the people's eyes, obviously, because 63 percent of them for these amendments. in fairness means that the district is not rigged, set up to be a republican or democrat district. if, in fact, if the district is rigged, you know what that

means. if it is a democrat district, the representative or the member of congress is going to be elected essentially in the primary with very little chance of a challenge from across the aisle. in a republican district, the same thing. when you have a situation where there is no real competition of ideas in an election, who gets elected? the person who is either on the far right or the far left and then what happens? when they get to the legislature, they almost did not know how to come together to find solutions that will work for all of florida or all of the united states because they have only had to listen during our elections to people on the extremes of their party, and that is to they have to answer

to. is welln's point os wel takens. . when you have districts that are so student, you get what -- when you have districts that are so skewed, you get what you asked for. as of former republican, now an independent, i can speak with some authority as it relates to florida. ellen is exactly right. we ever -- we are state of 120 million people. we have 75% of legislate doors that are of the republican party. we have 750,000 more registered democrats than we do republicans. what does that tell you? \ >> well gerrymandered. >> they did a good job of that 10 years ago. >> you have been fighting a version of this in california,

more with the actual mechanism of the primary process. tell us what you have been up to? >> if you agree with the redistricting initiatives that have been pushed ford in florida, in california, there is a 40% voter registration -- 14% voter registration. we had arnold schwarzenegger that one in the open primary. it was a special election. arnold schwarzenegger would have never become governor in california under the close primary system we have today. i said along -- all along, how do you reform the system? the fox has redrawn the lines for the hens. i have worked in the open primary. i have worked on that for 14 years. i was a mayor.

we had closed sessions. we discussed potholes, not republican or democrat potholes. when i got to sacramento, it was a call this problem. it was how do we focus, instead of health care or less taxes, how to focus on the republican party? i'm sure the democrats were focused on how to grow the democrat party. no one was focused on how to grow the economy. that is why proposition 14 is very important. >> briefly, how is it that the open primary alters the dynamic you described? >> you say no labels. this is fantastic. it is a giant step forward and i support it. in california, in 19 days, i wrote senate bill six. we amended the constitution. the people voted 55%, starting

in 19 days, the people of california will get to vote for their elected officials whoever they want, everybody is on the same ballot. guess what? you do not have to put an "r" or "d." you put your name, and the top two vote best candidates and vote-getters, get the runoff in the general election. open minded, reasonable, and pragmatic. that is what america needs today. >> how would an open primary be different in your situation, congressman castle? >> i would be sitting next to you as a senator-elect castle today. it is an interesting question. we only have one member of the house of representatives. that eliminates a lot of the federal redistricting issues. we do state redistricting, which is important as well. a democrat from tennessee, and

i introduce legislation to do what we are talking about here -- to have fair redistricting throughout the united states, which i think is essential. there are some incredible this. my staff has been preparing for this and talked about the 17th district in illinois. it apparently was drawn right along a river, and it is in and out, 100 yards wide, houses excluded. that is the way reapportionment occurs across the united states both at the state level and the federal level. i am delighted to be here. what has happened in florida, and i am excited -- the fight for the open primary situation. i was in a primary in delaware. i was in a primary in delaware, and i was heavily favored to win

the general election, and the tea party came in and spent a lot of money. i would have been better suited to an open primary. i had mixed feelings about that. parties exist for a reason. so i can understand the argument that they should be closed primaries. but i can see now much more clearly than i could before september 14. [laughter] i may be on your side. >> two things we are talking about -- open elections and redistricting. a lot of redistricting is there for reasons that copy the u.s. constitution. the constitution has two houses, one is proportional to the population. every state gets two votes, whether the state is populace,

small, urban, what ever the case. a lot of people would argue that is the right way to do it, and the founding fathers had that in mind. when the original route the constitution, it basically was male, white landowners. >> the good ole days. >> not the good ole days. that is where the history is. in america, ethnicity is an important thing. the courts will say repeatedly, if a redistricting takes away the number of seats of ethnicity "a," "b" or "c," then it's not fair. you cannot have it both ways, to say we will not look at everything. >> you bring up an interesting point about the white male landowners, which is the ideals of the constitution that is laid out of originally. over the past few hundred years,

there has been an ongoing moral progression and systematic progression to expand the basic premise of the quality through all people. >> we are much more democratic than we used to be paired >> without question. what i am saying is what is the next layer and the progression? is the next layer, having come as far as we have come, better thought it -- better fought in redistricting or in primary reform? you are talking about the constitutional issue with redistricting. >> when i first came into office, i supported it with a lot of money, an attempt to change new york city's primaries to open election. and we were resoundly beaten. the city is overwhelmingly democratic, so you'd think the republicans were in favor. no. as a matter of fact, it was hard to find anybody in favor of it. since then, a lot of good

government groups have said, yes, we should have done it. i thought to myself, where were you back then? if you want to have something that is totally open, then i do not have a problem if you can display the "r" or "d"next your name, as long as everybody can put the same name on your ballot. in 113 days, close to that, is going to have six, seven can didates. it would be all democrats, because the democrats are so overly democratic. 5% of the people are going to put each of the two candidates in a runoff into the election, and most people are totally disenfranchised. >> how do you avoid that? >> i think redistricting is important.

even if you have a fair redistricting plan, with a close, primary election, which is a midterm election where the voter turnout is low or, you still have to go to the right to win the republican primary and you still love to go to the left to win a democratic primary. that does not take out this partisanship. when you sit in an open primary coupled with fair redistricting, now we are rolling. as the mayor talked about, we have that in california. we had an open primary in 1998, where you have to put an "r" and "d." what we did in california this year, is we asked the voters, given the choice to the candidate to put the "r" or "d," and that will pass constitutional muster with the supreme court. coupled with redistricting, we can move forward. politicians today, think about it, you want to unite the

republicans and democrats, introduced an open primary initiative. they hate it. you are accountable to party proxies. now, every elected official running for office better have a message for november, because of your message is only for june, you will lose, because in california you have two democrats running against each other, and i can tell you which will win -- the one that can get the independents and republicans. that person will be open-minded, reasonable, and pragmatic, and we are on our way. [applause] >> again, from this side of the room, it is interesting to hear that if everybody does not want this, meaning if the incumbent political power structure does not want this, the redistricting, the open primaries, can align like this on a bipartisan plan to make

sure it does not happen, should that not mean that it should be at the absolute top of the list of the problems? they are telling you what is most valuable to them. they are telling you that which is most sacred and must be protected and would truly compromise the power structure. the american people are saying, we believe the power structure does not function in a fair, competitive way. it is almost like a scientific experiment, where you try to figure what the variable is that matters. we found the variable that matters. at what point, and what would it take to organize, not just in florida, not just in california or new york, but using a platform like the one that is being discussed today with no labels, a coalition that can have a very clear, very easy to understand, very easy to understand -- without that

you're doomed -- mechanism to advocate for this? >> you need to do what ellen did in florida. by advocating fairness, that is exactly what she did in terms of redistricting as it relates to state district in florida going for it. over and over and over again, when you market that in an effective way, that talks about the amendments on the ballot, -- you go straight to the people, not to the party bosses, but straight to the people of florida, and then they overwhelmingly passed it by 6 3%. to her great success, she did it. you advocate no labels. you talk about the country before the party. you talk about the people instead of the party bosses. as i travel florida, which is one of the most diverse states and the country, and you talk

about what they want for the future of florida, the future of america, what they talk about is that what people that are fiscally conservative, spend money wisely as the mayor has done in york, but socially moderate. the me along. we are an independent bunch of people, -- leave me alone. if we have a good defense and good education, and you just search for common sense, these things can happen, and america will be stronger for it. >> you know, the governor points out an important thing. we put together in florida a coalition of what used to be called good government groups, and they are almost obsolete today, right? but all of the organizations that fought for fair districts were non-partisan, and the supporters of fair districts were non-partisan, obviously, since we got 63% of the vote in

florida. but the campaign against -- this relates to this no labels concept -- the campaign against these two amendments was to try and label them as left wing, left-leaning, liberal-leaning power grabs. tod this wa -s -- i am pleased report that we had success thereby having a substantive amendment that actually said, in its language which the voters saw when they went to the polls, which actually said, district shall not be drawn to favor or disfavor a political party or an incumbent. voters saw through that, but it was a very, very ugly and powerfully stated campaign against trying to label thse and makeartisan --

them appear to be partisan in nature. >> to the extent that you're able to model any sort of effectiveness, whether in california with open primaries, or in florida with the redistricting, what are the barriers to scaling any sort of effective solution that will exist on a state or county level that can be brought into an adopted into larger spheres? obviously, you are frustrated because he would love to be able to do these things, and you run into barriers. what could be done to celebrate, amplify, or better understand what people are doing that is successful in this regard so that the pressure to scale it into places that are more resistant to it starts to this mdiminish? >> it is not clear that the average voter wants what we are advocating. if you take a look what happened in the u.k., the liberal party

was the darling of the press. everything was focused on the liberal party, but they were the king makers, they got cameron in, but they lost half a dozen seats. in the end, when you have an independent candidate, it is the two major parties that get most of the votes. that may be that the independent candidate cannot win and they want the lesser of two evils. it is not clear that the average person feels themselves disenfranchised or want a lot of the things we advocate. >> at the same time, if you look at the statistics on the american view of politicians, if you look at the statistics on the american view of the incumbent power structure -- >> they say, throw the bums out and then vote for them. i do not like the postal service, but i love my postman. that is a phenomenon that has been there. a lot of it is name recognition.

a lot is ethnic familiarity and solidarity. a lot is lethargy. if you do not bother to vote, you help one or the other. i come back to how far this country has come from what the original framers of the constitution envisioned. the good old days were not always the good old days. things are , a better today where everybody in theory is in franchise. at the margins, no. almost everybody has a vote. >> i would like to change the tone for a moment. as was mentioned earlier by joe scarborough, in terms of the funding of campaigns, or outside money was supporting campaigns then through the two political parties and the candidates themselves. this is become a huge problem in america. i had the pleasure of

introducing something called the disclose act last year. [applause] it got me in a lot of political trouble. it was the case called the citizens united case which said that corporations and labour unions and nonprofits could contribute more directly to advocacy for candidates in this country. so five of us said, fine, and we introduced this legislation. and basically it said, if you are going to make these kinds of contributions, you need to disclose who your chief executive officer is and who you're 10 largest contributors are. politicians do that any out. political parties do that. we felt they should do it. -- politicians do that anyhow. it passed narrowly. there were two republicans that

voted for it. it went to the senate, where it was never taken up. that is a huge problem in america. money in politics is a tremendous issue right now. i think it needs to be addressed. now we have the spread of these outside groups coming in and getting involved with campaigns, not even going to political parties or candidates. and that is a problem. even in this room, we have people who are advocating the public financing of campaigns. that may be multiplied by something -- that is something we need to be considering in america today. we need to clearly deal with that particular problem. while i am on my horse, one quick point made earlier today, and that is that the influence of the political parties and the caucuses in washington, d.c., it's incredible the influence of

the republican and democrat party. they will get you in caucus meetings, and they will say, you have to vote this. it will get republicans elected. they will try to put you in that position. the will to stand up and say i will not vote that way, i will look the other way, is something that is lost. i think both parties -- doing anything that is meaningful. then there is the complete choking when it comes to deficit reduction and some of the major issues of the environment that face this country. there are significant problems in how washington, in particular, operates right now. >> we are talking about reform. congressman castle just talked about it. nothing good could come out for a reasonable, pragmatic person in the republican caucus.

we have to do this or that. no one is talking about the big issues -- the budget. republicans do not want revenues. democrats, they do not want to cut. there are three ways to balance the budget -- you can cut, raise revenues, or you can borrow. you do not want to do any of the three, there is no leadership. they use this labeling to stand behind the leader and say, my leader does not want me to do that. customs and immigration reform. we're getting nowhere. nobody wants to touch it. my father cross the border in 1963. republicans should own that issue. his son is the lieutenant governor. >> i'll leave it on this. you hit this point well. this country is based on a tremendous number of ideals that are tied to fairness and equality that have never, have as yet to completely manifest

themselves. however, if you look at the amount of effort -- i was up in seneca falls on friday, which in in addition to be the town upon which where the women's suffrage movement started in 1848, at that point in time women were considered property. it was ok to whip them. it was a slave country. those people worked against those types of oppressions, which were so much more violent and present in the actual lives of the disenfranchised community, or in it this case, half the population. it took them 70 years from 1848 up through their ability to vote. i really believe that this organization, that this panel and this particular conversation

about electoral fairness and collect w-- electoral reform is the latest chapter in an ongoing conversation between the desire of self preservation and the destructive acts of change that caused those who are trying to preserve themselves to find themselves in a transposition. for that reason, it should not be as frustrating as many of us find it to be, that this is finding resistance. it is natural that this conversation comes into a tremendous amount of resistance. that goes into the civilian narrative around this organization. the resistance to this type of change is a natural occurrence among human beings. then that frustration will not enjoying you to respond with the level of aggression or frustration that might otherwise occur and yourself if you understand those things and understand that as you can see on this panel, and this panel is

a fraction of the people in this country who are very much in favor of the ideas that existed. i cannot think the five of you and of not only for being here today but for giving me the opportunity and honor for being able to manage the conversation with the five of you. rt's cool, and i get to weae my sneakers. thank you very much. [applause] >> are watching public affairs programming on c-span. up next, a discussion on terrorist threats in northern africa and then a look at some

of the challenges and woman in the new health-care law. >> on tomorrow's washington journal, former west virginia gov. bob wise talks about improving the education system to digital learning. after that, on health care rules. then, an author on united states constitution. washington journal each morning at 7:00 a.m. eastern here on c- span. the house comes in at 10:00 a.m. eastern and they will work on a resolution that will fund the federal government for the beginning of 2011. they will also debate reauthorize and science, technology and education programs. live house coverage c-span. >> it is hard to get here. it is also hard to leave here. all of us do leave and the

senate always continues. >> hear from retiring members in both the senate and the house on the c-span video library with every c-span program since 1987, more than 160,000 hours online and friedrich is washington, your way. >> now, a discussion on terrorist threats in northern africa and ways to combat them. from the jamestown foundation, this is about one hour 10 minutes. >> thank-you very much for inviting me here. normally, i used to speak in boring and in the academic gatherings for it is my first time in this kind of conference. if i should die because of the emotion of what is going on, --

actually, i will try to do this the best that i can and explaining in my view the three main developments related to the evolution of al qaeda in the past few years. ok, well, the background, this is, in my view, this is an organization which has been weakened in the past few years from the algerian efforts and counter-terrorism. the algerian government now was far better in preventing the entrance of raw materials. they have been able to get lots of surrenders with the

organization. moreover, this is a development that we have also. there is a sort of consensus in the population because of the effects of 2007 into 2008, and so now, the question is is aqim a normal al qaeda, sort of a and i have some expertise on this. the three main focuses of the presentation are the increasing role of narco trafficking, the creation of the sort of kidnapping industry, and the

salehization and factionalism related to these kinds of activities in the sahel area. these have always been involved in narco traffic. in kidnappings. and they were active in the sahel region, but the new point is that these kinds of activities, they have a far bigger importance for the organization.

and there is a sort of ideological flexibility from this organization. there are the use of narcotics. that disconnection between and think narcotics traffic and groups in latin america in

colombia, which is the most important producer of this kind of thing. also in peru and bolivia. then, the drugs arrive in africa. this is a really small country but it is one of the most important. . mali, all of the countries of the area. then, they go through morocco and algeria towards europe, to spain, which is the main entrance door to drugs in europe. there is the geographical know how. this region is a real complicated area, which is where

harsh to operate their -- which is very harsh. they can sell protection. as we will also see in the kidnapping industry, this is a really important point. at times, aqim works with local groups that have nothing to do with islamic ideology. there are more interested in getting money. therefore, they can sell the

hostages they kidnapped to the organization. in the kidnapping industry, this is nothing new. we had the kidnapping of 32 european terrorists in the area. and there is the increasing presence in this region.

the problem with kidnappings is is getting worse and worse, because european targets, they are really tempting for this organization, because european governments, they are more ready to pay ransom to save the lives of their citizens instead of, for example, america, or china. they do not care what is one line with this kind of -- [laughter] as i said before, there is a sort of multi level action.

this is what i call a win-win situation. the leadership can claim the fact that -- all of the things related to the islamic rhetoric. and they're also instruments of negotiation with local and european governments. for example, nigeria. governments in male. -- mali.

i said there are no opportunities to carry out things they want to do in this area. there is an increasing young population, and there is the spreading of radical messages.

there is a change of the center of gravity towards the southern part of the normal activities. there is increasing internal competition in order to get this ability, and it can lead to increasing level. this is a map of the sahel. we talked about the most important actors.

they are looking for more visibility and more prestige as an organization. these three main developments, there was another one that i decided to keep up from the presentation, because otherwise it would be a bit long and boring, and it is about the new role of nigeria in the region. then, we should discuss which model is in the galaxy of the islamic groups. there are in the islamic groups in the balkans.

an italian-style organization. there is a high degree of conflict with the different families and factions of the organizations. as i said, this is a point that i would like to stress again. this could be very dangerous development for the countries of the area, for the europeans, for the west in general, -- in

spain, there are some groups that are operating as a means to transport the drugs. there are those trying to get illegal documents and bezos and those types of things. there are lots of immigrant

communities where there are some members of these organizations, so it poses a serious risk to the security of europe and in general to the security of the countries of the transatlantic partnership, and the last two remarks involve the coordination. it could be good on one side and then dangerous on the other. they will have a al qaeda, though they may look like a mafia-style group. this is in a different way, other than another type of group because of the brand, because of the fact that if you carry this

out, without any jihadi aims, someone else can claim the attack. this is on a different level rather than on a level of a normal mafia organization. so it is really hard to understand what they want. it is hard to understand who is in charge of the organization, but this is one of the most important developments. these other things which we should keep on discussing. so thank you. [applause] >> thank you, dario.

it is very interesting. i want to welcome now jean-luc marret. it is a particularly silly and talk big. president sarkozy declared war on al qaeda, which obviously led them to declare war on france -- it is particularly salient. >> good afternoon, ladies and gentlemen. the foundation has invited me here, and thank you for that, to make a presentation on some elements of french counter- terrorism. i am going to say "ct" operations. i have been currently living in at d.c. four 3.5 years, and i am a fellow at a think tank. dan wheeler a non-partisan think

tank, -- and i am in a non- partisan think tank. i would like to state at the outset that the views presented here are subjective, and i only speak for myself. the subject of french counter- terrorism is not an easy one, and i say this for several reasons. number one, by tradition, there is a whole lot of tradition that surrounds this type of activity then, there is also this issue of transparency. it is far different from the american one. public relations and public diplomacy. very recently, one service required a spokesman -- acquired

a spokesman. number two, but i do not have time to work too much on that, i think here in the u.s. and there in europe or in france, we have a different view to represent the threat. it seems to be they hear, you are more inclined to talk about al qaeda, al qaeda central, and now, more recently, homegrown terrorism, while in europe, especially in france, we are mostly focused on this global- local nexus. let's a global, which means we are mostly working on the made in france or made in german terrorism in connection with countries of origin and diaspora. having said that, i think we need to talk about the threats.

i should start to say that almost every week, france received threats from networks or individuals. some are very explicit. such as a fatwa to identify a radical here or there, or a radical from aqim, and there is intelligence gathered from some in africa. this has to be evaluated. french territory, which is not a big secret, managed to work against anti-terrorism since 1996, but it is feared that an attack will successfully do something one of these days.

like the u.s. counter-terrorism, it can only delay the moment. this is inevitable one of these days. so french specialized services are announcing their readiness with counter-terrorism. the french city swat teams, we have two national swat teams in france. there are a number of trained officers simply preparing to manage the big scale terrorist attack, like in mumbai, or massive takings, and we aren't doing this with other european swat teams. similar to the u.s., i think, france seems to be much more of

a target in africa or overseas, where we have roughly around 90,000 nationals, citizens, north africa, even though it is declining in algeria, and we have around 110,000 french speaking, and we should also mention the economic activity in french-speaking africa. i think is more less in the

basement. the next time one man moves, he will be arrested. i think the aqim are using the sahel as an opportunity. having said that, i think we need to have a memory about the field, because many of these things are not new. the regular army were mostly shape for a big, conventional

situation in europe. cold war oriented. we have a lot of stuff about intelligence now. we have made some progress on that. that is not so old, actually. this is not pc anymore, and among my students, i have some officers, and it must be said that what we're talking about, in often stands for various origins.

there is a dedicated military program that started in 1920. one from the south met another one coming from the north. there is a payment of ransom in exchange for a captive. you can read papers and books from many journalists and lecturers.

in the 19th century, it was practiced. in the french side, a lack of compound closure of companies working the fields. and the traditional factors that i have mentioned. we should not forget that the french military has had an event from 1881 and ask for military intervention against these tribes because since roman times, they have been known to openly welcome those into the

fold. there is nothing new. and there was a very recent example. we have a bunch of guys who were affiliated with the capacity. the name was typically local. from the western view, you can see that with aqim. there was a very prestigious city with a lot of culture and a lot of cultural of activity -- cultural activity. this is a very specific and militant reference to the local

past. there is nothing local year. it must be noted that every comparison with the u.s. has its limitations. for example, there was a coordinator created. there is mostly around 15 people.

this is summing up the french fbi. this is an intelligence agency which reports directly to the minister of the interior. it was effective in july 2008. dcrg. the french national police services. there was a rise of islamic insurgency.

while the service is very active, -- for the external we have the general external security, comprising roughly a 4500 people. this is the france external intelligence agency.

there was an increase in capacity. in order to analyze various pieces of data. overall, this is not jack bauer. it can be very basic. at the same time, high-tech, too. it mostly comprises of inputs from paid or unpaid conformance from local tribes and looking at sensitive areas to check aqim moves.

i would not be surprised if the u.s. side is doing its at the same thing at the same time. i hope, actually. the technical choice in the program announcements the strategic priority. ok, so this is supposed to provide for capacity, but it is partly a good size for africa.

we have a branch, but we also of special forces from the military side better able to intervene. this is what we call special ops, c.o.s., and there is a fairly long field experience in africa, which is significant. we also have the french police cooperation, and now, this has been brought up since it was in 1961 but also ordering drug trafficking.

there is the lack of compound culture, the number of citizens we have there. and with the money they receive, they can increase their capacity. this is around 50 million. this is a lot of capacity. so there is some worrying situation. in northern mali. the french purpose is to avoid a situation like iraq and afghanistan. this means we went to be

supporting others, and the big thing for us is that we have a few hostages, and we need to have actual intelligence, and this is not so easy to do. i would be surprised if they did not try to enhance the capacity is, like multiple bombing attacks, or things like that with a massive impact, and it

could potentially change the format in the field. especially if this is a worst- case scenario. thank you. [applause] >> i hope you often on the presentation as fascinating as i did. it was a very interesting expose on what is taking place in france, particularly within the ct community. i found it particularly instructive. he has laryngitis, so please bear with him, and please keep the rustling of papers down, because he is not going to be speaking very loud. please join me in welcoming andrew mcgregor. >> thank you, geoff.

bear with me as i do this in my best very wide imitation. may i have the slides, please? thank you. the january 9, 2011 referendum will mark either the creation of a new african nation or the beginning of a third civil war. both north and south have been farming in preparation of such conflicts. both sides might be expected to use proxy's or to create alliances with neighboring countries, raising the possibility the entire region could be drawn into the conflict. a breakdown in regional security might allow entry into the region of non state terrorist groups, such as al qaeda and its

affiliates. sudan currently possesses an oil reserves estimated at 6 billion barrels. production provides 60% of the total no. revenues and 98% of the south revenue stream. sedan's growing oil industry has funded the rearmament of both north and south, but it has also added a new geopolitical dimension to a potential conflict. china's continued economic growth with eyes on securing oil supplies from nations like sudan, supplies that will be immediately threatened by a conflict that would be largely fought in the oil fields of south sudan, and united states is expected to become a player in the south sudan oil industry, and the development could only be made possible by southern independence, as current

sanctions prevent this. american investment groups are already buying up large tracts of agricultural land in south sudan. their interest is in untapped oil reserves rather than farming. oil currently represents nearly 20% of the cidoni is gdp. an interruption -- 20% of the sudan gdp. this is a significant sum to a developing country. neighboring countries would also secure cost be to trade. -- costs to trade. if they block oil shipments to the pipeline, the result would be the loss of all development gains made in the last five years and possibly even starvation. the south however cannot just live happily ever after.

the refineries are all located in the northcom and the only pipeline for export in the landlocked self runs through the north at the red sea -- the refineries are all located in the north, and the only pipeline for export in the landlocked south runs through the north at the red sea. an important oil producer like sudan, it would have immediately -- it would immediately produce an effect. unless we forgive, there it be terrible loss of life in a renewed conflict. in the other civil war, roughly 2 million people lost their lives with twice as many displaced, many permanently. the failure of sudanese politicians to reach agreement on the citizenship issue will directly affect the many southerners who've unit -- who left the north.

the ruling national congress party has indicated that these seven cities will lose their right to work or receive health care in the north. the sudanese president still wanted on international criminal court indictment for war crimes in darfur, has at times said nothing other than a vote for unity would be acceptable. but other times, he will except whatever outcome is reached. the south has made some of the in strides -- has made significant strides. the peace agreement gave the south the right to maintain its

own army. with south sudan spending 50% of its budget on arms since 2005, and you conflict will look different than the one before. battle tanks from ukraine have been obtained, making the south at least equal to the north in terms of armor. this preparation for war has, however, , and a great cost in the oil-producing areas, which obscene little money while there is environmental degradation for the facilities. this could easily lead to internal struggles with in the south. the 10,000 man united nations -- it cannot increase the size of its force without getting the permission of cartoon.

they have proven in a sexual -- .roving ineffectual wil it would take a massive increase in the size and power of the force along the 1,250 mile border. independece in south sudan would also boost the independence in darfur. especially if there is another opening. perhaps, with this in mind, this of sudanese president has made extensive efforts -- the south sudan president has made extensive efforts. the most powerful of these groups, the justice and equality movement, which launched a raid

on the capitol itself, something previously thought impossible. the dispute over a border region, lying along the north- south and border, also has the potential to spike into a civil war. hundreds of local residents were killed in 2008 between forces of the north and south. a separate referendum to be held separately with an independence vote will determine whether abyei joins the north or the south. most are expected to join. the arabs, who pasture there herd's there for most of the year, will be included in the voting. there are few signs the referendum will take place on time. khartoum has said it is necessary.

there is new violence in the already war ravaged territory. officials now speak of annexing abyei, but only after making significant financial considerations to -- concessions to khartoum. there is an accusation of widespread atrocities against civilians during the civil war. complicating the whole issue of war and peace in the nile valley is a growing and deadly serious dispute over use of the nile waters. the white nile begins in sub- saharan africa, some 400 miles south of the mediterranean. much of this water is lost in massive swamps of the south sudan. more important in terms of water is the blue nile, which begins in the mountains of ethiopia before joining the white nile in

khartoum. unlike egypt, ethiopia enjoys a fairly abundant rainy season. in recent years though, the rains have become less dependable, and ethiopia is determined to build a huge irrigation system to avoid further famine. ethiopia is also in the midst of bought a rebuilding an ambitious series of dams for hydroelectric polysemy -- hydroelectric power. the egyptians say that this and others is like asking them to abandon their nile culture and go live in the desert. the inflexible attitude is based on two unchangeable facts, and the population has reached unprecedented numbers one of the

land is confined to a narrow strip. both food and energy supplies are inextricably tied to nile water. agriculture represents one- third of egypt's economy. all of it is dependent on nine water. rhetoric over the water issue is growing extremely heated. -- all of it is dependent on the nile water. they talk about not being able to win a war with ethiopia over the nile waters. the current treaty was signed during the 1920's during the british occupation. over 55entitled to billion cubic meters of nine water -- nigeln -- ile water. it is almost 100%.

other countries of spent over 10 years trying to modify this agreement to no avail. a new deal to share the nile waters was sound by ethiopia, kenya, uganda, rwanda, and tanzania, in giving the other nile basin countries one year to sign on. some have promised to sign the pact, but others have rejected it. with egypt, their self-described gift of the nile, calling it a national security issue, challenging their sacred control of the nile. however, each of refusal to negotiate new terms is not sustainable. besides ethiopia's massive energy skiing, -- energy scheme, they are building more power

plants. as the prime minister says, the egyptians have yet to make up their minds as to whether they want to live in the 21st or the 19th century. a political struggle over oil and water in the region could also result in a new wave of proxy warfare. a good example of this type of proxy conflict can be found in the resistance army, eight wild weill group, the survival for decades was solely based on sudanese support as a proxy against uganda and retaliation for the uganda support for the south. the renewed conflict would undoubtedly see shartoum -- khartoum involved. al qaeda would also like to return to sudan, where they're

generally unwanted by any party today without even a fish or even covert support by any group. the sudan security service has been largely effective in preventing an al qaeda return to sudan, but a general breakdown in security could create conditions favorable to infiltration and the formation of new al qaeda cells. a renewed conflict in sudan would quickly bring uganda, ethiopia, and egypt as sponsors or even military partners of one side or another. uganda, especially, with an experienced, well-trained, well- equipped military has said it is willing to protect south sudan independence. a new civil war in sudan can

also easily spark the first major water war, a costly harbinger of future global struggles over increasingly scarce resources. the south sudan president has warned of a return to violence on a massive scale if the referendum does not go ahead as scheduled. no amount of military measures will convince most southerners that their future lies in a united sudan under the rule of tribes. failure to conduct this on time could lead to a unilateral declaration of independence. as the south sudan president says, -- of course, it must be recognized that even a vote for unity would not be a guarantee against new conflict without resolution of many outstanding issues. none of which were resolved in the five years that have passed since the conclusion of the 2005 comprehensive peace agreement.

should china perceive that its energy sources are being compromised by american support for southern independence, there is a very good chance that this could drive a downward spiral in chinese-american relations. given the wide ranging economic, political, and security ramifications of a new conflict in the sudan, current concessions over poorly made cargo bombs emanating from yemen and airport pat-downs, these pale as security issues compared to the ticking time bomb in the nile basin. thank you. [applause] >> that was certainly scary. we have time for only a couple of questions. i want to be mindful of the next panel at 3:00 on yemen. perhaps we could take one or two

questions and i also encourage you, if you do not get a chance to ask your question, i get in touch with the analyst directly. it will be here for the afternoon. the first question from this gentleman here. >> thank you. i'm from the canadian government and thank you for your excellent presentation. i think my question is for jean- luc about the recent statement from aqim in which they informed the french public, they are often the cozy 84 hostages with osama bin laden directly. to me -- could you give your assessment on whether this is a sea change in aqim strategy moving to hostage-taking in support of global jihad? and could this lead to further tensions within the groups, those more focused on the regional agenda versus at those

on the global jihadi agenda, and what does this tell us about the relationship between al qaeda and aqim, and the level of difference? >> the french mind -- prime minister has made a very strong statements. he said there is no way that the front of our do you will do that. it is almost impossible to negotiate with osama bin laden since we do not have a way to have a communication with him. i think that was mostly rhetoric coming from aqim. after that, i think one lady has

cancer, so negotiators have been able to provide for some medication. which means that there is a sort of direct connection. but frankly, i do not know anything about that and i do not want to know too much about it, actually. but at the political level, that is a stupid demand, and none since demand. -- and nonsense demand. >> it seems to me a sort of desperate attempt to grain of bit -- to regain -- it seems that there is a central leadership but they are no more in control of the factions in the south, and moreover, if you want to, you should provide

that telephone number for osama bin laden. [laughter] >> this gentleman over here. >> this is for them again. any indication of aqim connected cells or individual inside europe engaging in lower level distribution on a consistent basis? >> frankly, there is a lot. a few weeks ago, a few days ago, there is an american citizen arrested in barcelona for doing some stuff for aqim. again, there is no membership card. we're not talking about the scandinavian political party

either. that is fussy and hard, that connection that can be for sure is who has contacted to, and to intelligence thinks. but in many ways, the old name of the group in europe in the 1990's is still more or less there. there is still remaining at work, more central than the guys who had been freed, and some of these guys can have connections. that is moving, but by definition they are there. they were in canada a few years ago. in the u.s., actually, i do not know. you have an algerian community in the u.s., so maybe that is also here. that does not mean that they have a threat capacity.

you also have this -- i do not believe in the concept -- but guys who are particularly sensitive to the aqim, everything is moving, and there is a continuing between then and now. there is a guy, mathematician, ph.d., if he was from the old group in jail, now he is out, so he is probably under scrutiny by the french intel, but he was freed and he is working in a french public library. that is gray and moving. >> i think that he hits it. there is no membership card. i can talk about what is going on in italy.

in the past three months, there have been different allegations about the presence of cells collaborating in my city with local criminal gangs. but still, the amount of the affirmation released from the , it has notrities been really high. i think again -- if i decide to turn jihadi and i tried to carry out an attack in naples, they will say, ", he has been trained, and does it mean there is a sort of connection?

i do not know, liquid or defined? >> fluid. >> yes, that you cannot say the border between membership and who is part of a group or not. there are some self-reminding of the heritage in europe, that is sure. but still, they can be dangerous and there can be a sort of -- someone who can tell them what they should do, but i do not think there is this kind of problem right now in europe. >> thank you very much. we are out of time. it is her coffee care reform.

we are live at the center for american progress here in washington. >> welcome to the center for american progress. i am neera tanden, the chief operating officer. i was thinking of for coming. today's events and how to make

health care organizations to make more rigid work more effectively have kicked off the center's work on lowering costs and discussions about payment reform. we believe strongly that to fulfill the profit -- to restore the process of the affordable health care act, we need to ensure we are lowering costs over the long term. that is why we have today's panel as well as a series of discussions taking place of the next several months and the year to really illustrate how we can talk about the promise of payment reform most effectively. howy's panel will discuss to make the affordable care act work in terms of accountable care organizations. we have a great panel. leading off the panel is nancy- ann deparle. we are honored to have her as

the president's counselor and the director of the white house office of health-care reform. she really led the effort. when i worked in the obama administration, i served on the health-care team under nancy- ann. she was a fantastic general leading the efforts and we are glad to have her. most importantly, she has a history of reform in these efforts because she was, as many of you know, the director of cms. she brought that expertise to the discussion of lowering costs, increasing quality, and making care better for all americans in the lead up to the legislation. we are honored to have her here today, my friend nancy-ann deparle. [applause] >> thank you, neera. i am glad to be here today and i

would think the center for american progress to bring this together to talk about the implementation of the affordable health care act and in particular affordable care organizations. neera and her team have been busy working on some of these issues including how to really make sure we are lowering costs in a way that makes health care more efficient and effective for patients. that includes the work you have done on collapse and other areas -- on co-ops. i want to think many of the people here today including some of those on the panel and my colleague john blum. they have created ideas to make this more efficient and effective for patients. our goal is to make sure that health care is high quality and high value. the affordable care -- the affordable health care act have deliver the provisions. this is the nine month anniversary of president obama

signing the affordable health care act. it seems like just yesterday in some ways. 2010 has been a remarkable nine months. on sunday morning before the bill passed in the house, president obama was already focused on implementation and made clear that he wanted the process to be careful and expeditious. our administration team has tried to achieve his vision. it is an incredible honor to work with many of you in this room on the president's vision making health care more affordable and accessible for americans. as we approach the waning days of 2010, we are finishing up the last pieces of what i call phase one of the implementation of the affordable health care act which really has two parts. one is setting new rules of the road for insurance companies and gives consumers more control over their health insurance and, more importantly, more transparency over what is happening in the health insurance market.

secondly is expanding in stabilizing coverage for some americans, especially early retirees, people with pre- existing conditions, and young people have been most at risk losing coverage. it has been a very busy nine months working on those two areas of phase one. we have implemented a patient's bill of rights that will give consumers an unprecedented protections. under the new law, americans in the new insurance plans of preventive services without additional out-of-pocket costs. nine adults will be able to stay on their parents plans until they turn 26. already, this change has brought relief to americans and their parents used to worry about how they would get coverage first starting out. consumers in new plans will have the freedom to choose their primary-care providers within their network without having to get a referral. patients in the new plan to receive less services in an emergency room of a hospital -- who receive services in the

emergency room of a hospital who are not covered. insurance companies will not be able to discriminate against children with pre-existing conditions. insurers cannot impose a lifetime limit on the care and annual limits are restricted until 2014 when they will be eliminated. consumers will have the right to appeal a decision made by their insurance company to an independent third party. these are just some of the new rights that americans have received and consumers have received as a result of the affordable care act that we have been rolling out over the course of the last nine months. importantly, we are also easing the burden on seniors by providing medicare enrollees have hit the construction drug coverage, called the doughnut hole, a $250 rebate to help defray costs. by 2020, we intend to close the hole completely. starting this january, the prescription drugs that seniors

purchase will give a 50% discount. over time, the doughnut hole will close. in 2014, the law will not only prevent insurance companies from denying coverage for pre- existing conditions, but it will ban insurers from charging people more based on their gender or healthcare status. i do not need it to you what news is that change will bring to the marketplace. all of these protections are key to ensuring that americans have access to quality coverage and can take advantage of the delivery system along with the private sector efforts helped to boost. if you look forward to 2011, we are now beginning to work in earnest on phase two of the implementation. again, this has two pieces as well. one, working with the state's deceptive changes for marketplaces where there will be affordable health care choices for consumers and small businesses to have not had them before. we just had a meeting at hhs last week were 44 states and the

district of columbia came to washington to work on the planning for setting up these exchanges. the second piece of the work we are beginning now is what we call a delivery system reforms, working with employers, hospitals, doctors, nurses, consumers, leaders in the health-care community and system to implement reform to our delivery system to make the health care system work better for patients and over the long run lower-cost. this is crucial work and it is why the timing of this conference and discussion today are sold important. i think everyone in this room agrees that while we have a very good health care system in the united states that we can improve it. we can improve the quality of care we provide. in a paper released today from the center of american progress points out, our health care system does not reward doctors and hospitals today to keep patients healthy. in fact, it does the opposite.

we pay more for more care regardless of the outcome which does not make sense. we all know that delivery system reforms need to happen to recruit patients safety and quality, to save lives, lower costs. in many instances, the good news is there are proven strategies we can implement to improve the strategies. that is why the affordable health care act makes delivery system reform that will take critical steps in keeping patients healthier and better preventing and manage elises. one delivery system reform is accountable care organizations. glenn hackbarth, i remember the discussion we had when we served together on medpac. it is kind of a wonky name. it can make it easier for doctors, nurses, and other members to coordinate provided care. the council care organization program goes beyond the direct provision of care.

it is a shared savings incentives aligned so the medicare accountable care organization program will encourage investment in the health information technology and innovative ways of delivering care that will improve the quality of care for patients. caner the new law, aco's deliver all the care beneficiaries need in a court did way to provide value to the medicare program and deliver improved quality of care to the patients. another aspect of the reform implementation efforts of interest to the people here today is a national pilot program on payment bundling. the law calls for a national volunteer pilot program that will encourage providers and hospitals to better coordinate patient care and paper of the health-care services a patient receives during hospitalization in a bundle the payment. in makes a lot of sense but it is a significant departure from the existing medicare payment methods right now.

under the rules of this pilot, providers of able to distribute payments they deem fit among members of the team instead of in compliance with medicare's existing administrative pricing system. there are a number of other provisions in the affordable care at that are excellent opportunities to innovate and provide care more efficiently. the payment changes to address hospital-acquired ellises and unnecessary. missions. two areas of unnecessary expense that are so costly to patients as well as the medicare cost medicare, patience, and payers millions of dollars each year and these avoidable situations where people get an infection in the hospital or they are readmitted just because the care the first time was not what was needed, they lead to tens of thousands of avoidable deaths and illnesses that are a real burden on the parents that we're supposed -- the patience with her supposed to be serving. through the newly established

cms innovation center, we have both the authority and resources to take bold, innovative steps right now. the innovation center will test models and include establishing an open innovation community that serves as an innovation clearing house for best practices in the health-care renovation. as i said, there are lots of things going on that can show you can serve patients effectively, save money, and also create a better, high- quality health care systems for the patients. we need to get that information out of the places around the country. the innovation center will work with stakeholders to create learning communities to help other clinicians, doctors, and nurses to rapidly implement these new care models. i am proud of what we have accomplished so far and what we have in the pipeline, especially many of the delivery system reforms which we believe will make patient care safer, improve quality, efficiency come and save money for employers, the government, everyone.

as you know, as we convene here in washington, some people want to go back to the days when insurance companies, instead of patients and their providers were in control of our health- care system. frankly, on the of the defenders of the status quo can produce a plan that will meaningfully help people and meaningfully improve the health care system the way the affordable health care act does. repealing the law would mean that 32 million americans who would have gained coverage and the affordable care act would remain uninsured. it would mean insurance companies can once again in pose double-digit premium increases on americans that we've been seeing for the past decade with no real oversight, transparency, or accountability. all of the landmark consumer protections i mentioned in the new bill of rights will evaporate. these new promising efforts to help doctors and hospitals improve the way they deliver

care, such as the council care organizations we will talk about today would come to a screeching halt the law were to be appealed. it would eliminate a significant debt reductions and over $1 trillion over the following decade of the affordable care act were to be brought about. digester feeling some of the key cost-saving measures in the medicare, medicaid, and schip would it reduce the deficit. i could go on and on about the countless benefits that the law has already, and will continue, to deliver to americans in this country that will go out the window at this is repealed. i think all of you here get the picture. one thing that you can all do it helps is to educate your patience, friends, and neighbors about what is in the affordable care act and how can benefit them. there has been enormous disinformation and the public has been evenly split four months about those who favor maintaining the affordable care

act, expanding it, strengthening and, as opposed to those who think that the law should go away. there is a lot of cognitive dissonance. people hear one thing, here that the law is bad, then they experience getting a very different thing. a friend who is helped by the pre-existing condition insurance plan, a person who has not been able to get insurance on their home -- on their own and then they are assisted. a child who does not have coverage and graduated from college, has an internship that does not provide health insurance, and now they can stay on their parents' plan. it is not surprising that a lot of people do not quite know what to think. you can help them. many of the people here today have played and continue to play a vital role in the successful implementation of the affordable care act. that does not mean that we all agree. people are playing a successful role by helping us address the

questions that they have and work on the regulations that we need to implement lot and make sure that we do so in a way that is not disruptive. i want to thank them as well. moving forward, the president and their team in the administration is focused on implementing this new law to me this and make it able to all americans. thank you for having me here today, and again, good luck on your discussion and overlooking forward to hearing your ideas. thank you. [applause] >> the afternoon, everyone. i am judy feder from the center for american progress and a fellow at georgetown.

i am very pleased that nancy-ann was able to join us. i am sure this will be an interesting discussion on payment reform in a particular the affordable health care act. we know that whether the issue is a success of health reform, the sustainability of our existing coverage, or the fiscal health of the nation that the key to future success is slowing the growth in health-care costs. key to our success in that effort are decisions that hhs and the center for medicaid /medicare services is now making in implementing the tools provided by the affordable care act. it is these decisions that we are here to discuss today in will belar how aco's defined. broadly speaking, they are i'm -- date delivering coordinate care needed by a specific set of patience.

under terms, and allows them to benefit financially as long as they inshore and improve the quality of care that patients get. when these will really be in practice and whether they will truly deliberate from the emphasis on volume to the emphasis on value, as we typically same, depends on the kind of decisions we turn to now. i will give you a quick overview of recommendations that my senior fellow, a harvard economics professor, who is not able to be here today, made in a paper that we have just put out and we will discuss the issue we raised along with other issues that will come up. glenn heart -- glenn hackbarth, steven lieberman, and debra

ness, leader of the consumer coalition campaign for better care. first, my two cents with david, the paper is available to you and available online and i will start with the issue of who becomes an accountable health care organizations. the law allows many to form and hospitals seem to be leading the charge. they are actively engaged in connecting to other providers, acquiring physicians, practices, or hiring physicians hopefully to work with the broad set of providers engaged in in the delivery of care to better coordinate. more needed is a reduction of hospital years. hospitals working with ever providers can and have achieved that goal. and hand, they can share in the savings.

what they actually do is an open question. it raises some concerns about whether instead hospitals can use this as an opportunity to enhance their domination of local markets and use their market power to protect existing patterns of care rather than promote change. if, alternatively, physicians take the lead, they can gain rather than lose revenue in the process in making hospitals compete for a set of count on the referrals they provide in order -- compete for instead of counting on the referrals they provide. john, i will keep looking at you, on this recommendation to recommend that cms works alongside hospital-led aco's to

emphasize when it takes good physician care to deliver. for example, reductions in preventable we admissions and emergency room years -- readmissions and emergency room use. managing in coordinating patient care and to the range of tools made available to the affordable care act, encouraging better primary care especially if your innovations. the second issue is how to pay account will care organizations, which we hope will also be affordable. the aco concept aimed to entice physicians and hospitals to produce a paid in the new behavior primarily by offering financial benefits if they reduce spending relative to projections while achieving benchmarks for quality of care.

in a section of the law that establishes accountable care organizations, it is called the shared savings provision. it's specifically allows the secretary t as other payment models to improve quality and efficiency -- to use other payment models. first asto offer aco's a choice and after three years, payment share with the aco's some of the risks. we give them the option of saying it -- taking some of their payments in a lump sum rather than a fee-for-service to give them up front support to invest in technology, staff, and other mechanisms to truly to be able to manage the care they provide. so why a share of risks as well as savings? evidence suggests simply allowing rewards to lower

savings without some responsibility in our over- spending is likely to be too limited of an incentive to overcome the benefit of providing more and more services under the fee-for-service system and is unlikely to be as effective as we help in changing provider behavior. from the get go, we want providers to not only participate in the arrangements aimed at better delivery, but we want to make sure the arrangements will achieve the delivery reforms that we want to produce which requires an alternative payment arrangement simultaneous and on the same scale as the shared savings approach. also is the role of consumers. the emphasis in aco development on measuring and assuring patient-centered care as a position for financial benefits and on sharing risk and not delegating to the providers, we

show a strong commitment to truly changing patterns of care and not generating the backlash that met hmos years ago. to that and the coming in even more importantly, to promote the shared decision making that leads to better care, we recommend a strong focus on consumers in implementation, specifically that consumers know the rules through which their positions are playing in have a choice to participate as well as a choice to continue to use providers as they see fit, that they get a share in the financial rewards derived from using care more efficiently as their providers recommend, they have someplace to go for recourse if they question their aco. and physician-led aco's consumer engagement and protection, david and i argued

that cms cannot launch the medical care system that the affordable care act has in mind. that is our defense for the administration and it is food for thought. i am delighted to have the others with expertise. john should go first, but as we discussed, we will have others speak first then we will turn to john to discuss a little a monster ourselves that we will open the floor for conversation. -- to discuss a little amongst ourselves. as nancy-and referred to, we have been working on this at medpac for some time. you have offered comments to cms on the issues we addressed as well as other issues. i was wondering if you would speak on where the commission is

and what they recommend. >> thank you, judy. i appreciate the opportunity. the point there recommend will overlap with what judy and david presented in their paper. i will try to add in a few different things as well. let me begin by saying that we are an organization that agrees with the basic premise of the aco provision and many others namely that if we are going to have a better performing, high- value health-care system we need to change how we pay for services, and encourage more effective forms of health care delivery. of course, the aco is one such provision but it is not the only one in the law.

nancy-ann mentioned the following provision, and the like, which we think are also very important. the provision with the basic sharron model, we think it is a good starting point towards creating organizations that and great care across the full range of services. we are concerned that the gain- sharing a model may be too weak and model, but it is an inviting starting model for new organizations that are just beginning to coalesce, having a model where they can gain without being at risk i think will attract people who may otherwise be discouraged from for dissipation. in that sense, it is a good

thing. -- otherwise would be discouraged from participation. it would be good to see the gain-sharing model as the starting model from which organizations must eventually graduate. this does not provide for graduation. it is viewed as an enduring model. if we were to seek to require organizations to move on from gain-sharing, at some point that would require a legislative change. that is not something john could be expected to do on his own. something that cms may be able to do on their own is think about adding other models, two- sided models, that have but the gain-sharing and downsize risk and create incentives for organizations to move down the continue on overtime as the

gaining experience in better managing care. one variable that may be used to encourage that migration is the percentage of savings that the organization gets to keep the. as i read the statute, there is much in that dimension. you could say if you go into a two-sided model where the organization, they would get a higher percentage of the savings on the upside if they are successful. another issue we have spent time talking about is how to set the targets. specifically whether the targets and the aggressiveness should vary based on the historical cost level of the organization. let's take the example of an organization that has been a very efficient in the past but

it is a market that has a low per-capita medicare costs. if you set the target based on the historical experience, it becomes more difficult for them to achieve additional gains and rewards them for reorganization that is created in a very high cost area where there is a lot of wasted to be eliminated. on the face of it, that seems inequitable. having said that, it is a tricky issue once we start to think about it. the natural instincts may be to say to set more generous targets for their organizations operating in low-cost areas and set more aggressive targets for those who operate in and high- cost areas. the rescue reinecke go too far down that path is now one participates in the high cost areas -- the risk you run if you go too far down that path is that the risks are too aggressive.

everyone is participating in the low-cost areas because they offer more money than what has historically been in the area. then you have the aco's were you do not need them and none of where you need them in the historically high cost areas. make -- you have a potential tensions situation between equity and what makes sense in encouraging the long-term evolution of the medicare program. >> you came out where on that one? >> we came out on encouraging cms to make modest changes in the name of equity to make targets more generous in the lower cost areas and a little bit more aggressive in the high cost areas but do not go too far. >> a balancing of participation? >> yes. my last point to emphasize is

one that judy has already mentioned which is the role of beneficiaries. it seems to us very important that beneficiaries been notified, at a minimum, that the providers caring for them are adopting the new payment model. indeed it to the extent that we are moving away from gain- sharing to a more aggressive modeled that have upside and downside risks, the importance of the notification, we think, gets more important. we are very concerned that if we are not careful that we could end up with a replay of the managed care backlash of the 1990's which seems to have resulted from patients feeling like their care was being changed without their consent and that others were benefiting from the change, providers,

insurers, employers, and they were not. it was the carsten aspect of it that caused concern -- it was deemed the coercive aspect. there were more than happy to be that concerned. the same set of ingredients could exist if we are not careful. it is critically important that patients buy into this, be informed, be educated, and now with the benefits of aco's are for them. >> thank you and we will turn to deborah to talk about the patient's side. first, i want to turn to steve it is working on the delivery system is provided on the ground trying to build new organizations. what are you hearing? what do you want to tell cms to

do? >> thank you, judy. a pleasure to be here. i congratulate you and david on a really terrific paper that captures in a nice way some of the critical issues and some of the issues that need to be grappled with. i think that i am struck by not only the thoughtfulness of glenn's comments but a lot of the trade-offs. there are a lot of nuanced choices. it is important to differentiate points where people have agreements of being left of the decimal point and how best to deal with the deficit. they are important issues, but they are to the right to the decimal point. in exploring this concept, it is

important to distinguish when we are talking about alternative ways to improve the concept of verses fundamental questions of principle and how to design aco's and how they should work. my second introductory comment is i want to apologize and recognize how hard the job that john and his colleagues have at the cms. they are being asked to regulate something that is basically never existed. we have analogues, but we do not have aco's. there are two dozen sections where it says there is a discussion with the secretary of how to implement these things. there is a lot of punting the ball down the road a little bit and hoping cms figures it out. i think it is a very challenging

task for them, and this is a bit obama article coming out, but i would like to cover four quick topics. aco's are creating systems of care. the fundamental belief is systems are better than non- systems. the empirical literature shows that and partially because we do not have systems of care than you cannot have a large enough to lift patients to either do meaningful projections of budget and a measurement of financial performance. equally importantly, you cannot do meaningful measures of quality and outcomes. the need to have size and someone saying, i, as a provider, and taking -- "i, as a

provider, and taking responsibility." you mostly to bundle the payments anyways. building systems is important. try to think about howaco's -- how aco's differ from hmo's, they have structural features to lock people and leaving the you have to be enrolled, part of a prison that work, there are benefits differentials if you got out of network, them prior authorization and relatively strong ability to influence what patients a day. the second mention of hmo's what type of the delivery systems, but what systems of care? how do i improve care? disciplinary teams, mrsa mines, going through a list of things that people have done. -- disciplinary teams, nurse hotlines, going through a list.

i look forward to debra's comments on how best to engage the beneficiary. the second point i want to go to be on the importance of systems is the notion of shared savings. glenn and judy both covered that well. it is somewhere between fee-for- service and as an anti-and said it is a system, from an economist's perspective, that says you are a revenue center. the more you do, the more you get paid, and the incentive is maximize revenue. providers become cost centers. therefore, what we want to do with share savings is to have a moderate balance between the two. jim house suggested the idea of payment system was to pay on average and to have equal margin, marginal cost.

they had an incentive to do one thing or the other, what would drive them would be what is clinically appropriate. as the lead noted, and as you noted in your paper -- as you and glenn noted, it has very weak incentives. as we start to move towards an arrangement where providers will get more of the rewards if they do better than budget but will be financially responsible with lower fees, if they exceed budget, there is partial capitation to build stronger incentives so the requirements on a system in terms of fiscal solvency, licensure, beneficiary protections, becomes very important. i just want to take a minute to follow the money. if an aco has a 5% savings, which many people would say is a significant reduction, and would

be 5% net savings and it typically it costs a fair amount of money to achieve these things in the upfront investment. just for the purposes of this discussion, my target is 100 and i achieve 95. the first 2% and the formulations would go to the pair because the statistical matter of projecting budgets is very noisy and there will be random winnings were people win by chance. if i go from 100% down to 98%, the remaining 3% in many formulations would get split 50% to the pair and 50% to the provider. for every $5 i caut, the aco ges which is 15%-20% of what

you would normally spend on primary care. it is more like 4%-5% spent on physician care and a 2% on what is spent on physician and hospital care. the savings start to get watered. that is one of the reasons that i think i agree with your recommendation to build in a ladder of escalation said the system can start with training wheels where it is a bonus on the system and then progress -- bonus only system. as they get licensed and then can move to partial capitation. one of the ways we would suggest cms use its authority is to limit the number of initially type ofaco's, not the but the number, but this is an explicitly experimental system where we do not know what works

and this is somewhat unorthodox in a medical context. use the secretary's discretion to limit the numbers of providers to make sure that we get a real representative sampling because what is possible in california, where there is lots of experience with delegated experience, is very different than what would be possible in parts of the country without that infrastructure. just to quickly windup, the last thing is who forms aco's? this is a critically important issue. if i am a hospital cfo, most of the low hanging fruit in terms of the 5% of savings will come out of the hospitals. if i have high fixed costs, that means a reduction in my top line revenue translates into a worse off the bottom line which means as a responsible hospitals cfo

that i want to avoid that. you say hospitals are already a major force that will be likely to be forming systems. unfortunately, that may undermine the degree of competitiveness in many markets. physicians had shown themselves historically to not be very good at either organizing or having capital to fund the organizations. the returns to not look attractive enough for venture- capital money. where i think that leaves us are with two non-hospital alternatives which are existing systems of care where you have delivery systems that have the infrastructure that can expand from capitated patients to a fee-for-service patients or pco's. it is an interesting question of trying to a line and short sentences with delivery system incentives. let me stop there. how that gets done is a really

interesting question. i will just leave as a conclusion the point that, which i think is consistent with what you were saying, that if the problem will just be a lack of capital at least to start these things, working capital, the question is whether this is an attractive play for insurers and try to avoid hospital-dominated aco's. >> thank you. a lot of food for thought. i want to turn to you, debra, because you are engaged actively in this discussion. we talked about not wanting to receive a backlash about deliberate and operating responsibly there. we also talked about the initiative of payments--- patient-centered care. we look to you to tell us how best to have patience engaged in the process and the public engaged in its success.

>> a great. thank you very much. i want to add my compliments to you and david for your wonderful paper. let me say a word about the campaign for better care. it is a growing coalition of more than 160 organizations, state and national, that of come together to work on payment and delivery system reformed in ways that will make care more coordinated, patient-centered, comprehensive for those who need it the most especially older adults and people with multiple chronic conditions, those who are the most vulnerable, highest users, highest risk, and generating the highest costs in the system. your paper is actually quite exciting and quite in sync with the consumer coalition is. he asked me to talk about specifically about our reaction to the payment recommendation and the patient recommendation. first, i will say i could not

agree more that this is an evolutionary process and we are walking a careful line for both providers and patients. at the end of the day, we need them both to make very significant changes in their behavior. at the same time, we needed to work so we needed to build aniline enough accountability -- we need to build in and accountability and incentive to participate to patients see enough in and to feel like they are betting -- they are getting better care, better costs. given that, i think your proposal that we need to transition from a system of that yearly bonus or share the savings to one which would include a share risk and moves away from fee-for-service is absolutely essential. the people who are getting hurt the most by fee-for-service our patients who suffer from the

fragmented and overly expensive care that it produces. there are a few things i want to add. the accountability issue is critical. at the end of the day, whenever the payments incentives are, we need to make sure we are holding this accountable at the end. you propose in your paper one of the most powerful measures of accountability, one of the major cost centers, which is reducing unnecessary hospitalizations, preventing unnecessary readmissions and e.r. use. we agree with that. we think most of the costs in the system are generated by people with multiple chronic conditions. we need to look hard and good coordination measures. it seems -- and things like medication management as well which can cause a huge problem for the elderly and those with multiple chronic conditions.

finally, the law does a pretty good job of saying this and we will do everything we can to push the fact that one of the major ways to hold these models accountable has to be with patient-centered metrics. that means coming to me, collecting patients reported data about their experience of care and their outcomes of care. at the end of the day, whether the care is better, better coordinated, whether you are getting better is proceed through the eyes of the patient rather than through the eyes of the provider. strong accountability for both cost and quality is critical. the second thing i want to say is when it comes to the financial incentives and the protections we build in is that we need to make sure that these models really serve our highest risk population. when a deep worries that the consumer community has is that to get these savings -- one of the deep worries the consumers have is that they will either

skimp on care or cherry pick their populations. we need to build in payments incentives and support to not allow that to happen. one thing that is very important is to make sure we have risk- adjusted payment to that complement's the complexity of the patients that are being carob. we need to make sure there are adequate resources for those providing the care management for those manage patients. finally, we need to make sure that we are monitoring this populations that are most at risk. i mean making sure that we are not exacerbating but rather that we are reducing the disparities that riddle the system today. to do that, we need, from the ghetto -- get go, built into the language these types of things so we can track the population

and now at the end of the day if we are making care better for those who are the most expensive and hardest to cure or making it worse. it is also another safeguard against stinting on care. i agree very much with one plan had to say about looking at baseline targets -- agree with what glenn had to say. on the payment front, some of those shared savings going back to the consumers. this is about getting consumers to engage differently and they need to seek care getting better and costs getting lower. one way to do that is to give them a share of the savings just like we are talking about giving the payers and providers a share of the savings. there are many ways to do that. now, you asked me to talk about the patient's engagement peacie. you talk about about patient

protections and engagement. they are related, but they are different. from the get go, if you want patience to embrace this new model of care, than patients and consumers need to be at the table from the beginning helping to shape, implement, monitor, assess, and determine what should and should not be expanded. too often we make the mistake of thinking, "if we build it, they will come." what we really need to do is build this the way patients needed to be built to meet their needs. that takes me to a major paradigm shift that needs to happen across the board which is that we really have to start believing that it is important to listen to what patients say they need and want. one of the reasons we think it is so important to do patients

experience surveys and get patient-reported data is that the work we have done when we ask patients what they need and want from these new models of care, they tell us the very things that will help us to get the better outcomes. they tell us the very things that will help them be more engaged in their care, to be better partners, to be more adherents in their medication years, better manage their chronic conditions. it is not just patient satisfaction. it is not just the nice thing to do. and it is an essential thing to do if we want to build these new ways that results in better care for patients and get us to better clinical outcomes. plus, again, if we're talking about people with multiple chronic conditions, if we are not talking about asking them about their experience with care coordination then my guess is that we will not, for a very long time, have condition- specific clinical measures to ever tell us if someone has five different clinical conditions is getting good care.

we will never get to that population if we did not take seriously asking patients to report on their experience and outcomes. finally, on the patient protection front, i think we are all in agreement from what i have heard that the idea of not telling patients they are enrolled in these things up front makes no sense. if we want patient engagement, they have to know and they have to be clear about what it is, have a clear understanding, clear expectations, clear in creating and buying and to those expectations. there needs to be complete transparency about financial incentives that the providers are operating under. patients need that because they have had a bad experience in the past and because this model does have a risk of cherry picking and skimping on care. we need to make sure that there

will be experimentation that there needs to be network adequacy. we need to figure out what that looks like. until we know what that looks like, how could you not have that choice is and flexibility for beneficiaries? the idea of the lock-ins or requiring people to stay in an aco, not one of us would want that arrangement foisted on us. network adequacy, flexibility, choice, we needed to build these systems into something that consumers embrace and want to be a part of. finally, you mentioned in your paper an omnibus or an appeals process. again, during this evolutionary time, we are trying to figure out what works and what does not, how could we not build that in? patients need to know that this will be something, the part of

patients engagement where they feel if they are not getting the care that they need, that have somewhere to go. >> i think you are, in large part, determining what this is and how it will go forward. i would love >> thank you for the opportunity and the paper. the one thing we need to think about with the atl program is how it ties into other changes that are happening to the overall medicaid program. the affordable care act puts in place tremendous changes to the medicare program to help we think about paying for and financing services. the aco program only applies to the fee-for-service program which applies to the -- applies to the 80% of people today.

at the same time, cms is putting in place a stronger pension program trout -- for the private side of managed care and a five- start bonus payment system that will start in 2012. we are putting in other pimmit reforms for hospital services, physician services, the full gamut. while we think about the aco program , we're putting in other delivery reforms to approve the overall system. it is important to keep in mind that the aco program is to demonstrate something better than regular fee-for-service medicare it needs to be on top of the other pension reform changes that are going into place, payment pressures that are going into place to the affordable care act. we are seeing the aco program as the overall baseline of service when all of these changes take

effect. the statute contemplates a very flexible model to the aco program. we are going into this notion with the premise that we have to create a program that can serve multiple aco models, meaning hospital-based models, physician-based models, and a combination of the two. clearly, the statute does not have a one size fits all model. that is very much our premise. right now, we are in a phase of the kind of pre-decisionmaking for aco. we anticipate having proposed rules sometime out next year. the notion is that we are all starting from scratch. we are trying to figure out the program together. cms will go in with a true proposal wanting comments back from all perspectives. consumers, providers,

physicians, health plans will help inform our decision making. the statute requires that the program starts january 1, 2012 very we are very much committed to seeing this program up and running. as all cms leadership talks about talksthe aco program has the promise to think about how we think of patients and health- care journey. today we have physician, hospital, a post-acute -- if this works well, patients will have journeys of care with a well coordinated handoffs. it will be very well coordinated handoffs of care, not the current solo approach that we have within the medicare program. we are grappling with hard decisions that have been raised here today. several hard decisions that we

are grappling with, is how we think about risk. do we think about -- we as organizations to take upon these risks. some organizations have come to cms and have said they are ready to stick on more risk. they want two-sided rest are we have to think carefully because some organizations are coming to us with clear intent to roads to dominate market places. those who are coming to attend to the organization's that currently dominate the marketplace or want to dominate their health care marketplace. we have to think carefully what it does it means to take on risk and what the implications are when organizations asked to take on risk. the second part issue we are grappling with is how do you assign patients to an aco model? this is not where the beneficiary chooses to sign up with an aco.

rather, the cms pass to a side benefit to n aco model. do we do it after the factor before? we have heard arguments on both sides of the issue. that will be a hard decision that cms has to make. how do we think about data? organizations that come to cms wanting to be in aco talk about payment data that cms holds. physician organizations come to cms and said they don't have data on hospital use or drug use and for us to be able to manage patient care, we have to have access to the data that you have within your fee-for-service payment systems. that is very protected, confidential the data. we are thinking about what it

means to provide more organizations than organizations currently have. it is a very hard issue. how you notify beneficiaries that they are being signed to a aco? the private side of medicare, cms has a tremendous oversight capability to see how plants market and communicate to beneficiaries. do we have to think about those process ceased to ensure that aco organizations do not mislead beneficiaries and over- promise. ? they have to understand their physician might be part of than aco and might have incentives to change care hopefully to best manage care. a real tricky issue is how we think about communicating and informing beneficiaries that

there is a physician or hospital is part of an aco organization. with that, i will stop. let me say in conclusion that cms believes they aco program has a way to better manage care. all things go well, the aco's will do better on cost and clinical management for beneficiaries. we are going into this notion with a full understanding that we need to hear from the community to help inform our roules. this will be best response and best ideas. we will not go into this having all the answers but we expect lots of comments coming to us that will inform our final rules. we will issue them sometime next summer. thank you for the opportunity and i am happy to answer any >>

>> thank you. you write that the issue of market dominance which we have been talking about and did talk about the concerns of who is coming in. does somebody want to -- go ahead >> i think this is a very important issue. i think the decisions that cms makes, at the margin, could make the problem worse. it is worth remembering that there is a problem regardless of what cms does. we have many markets where today already, there is an extreme concentration of market power and it is having a large impact on the rates paid by private pay yours. --payers.

the implication is not just high rates relative to others but variation within the markets for the exact same service. there are huge variations for the price of a given service within a single market. that is an indication that you do not have a competitive marketplace. all that the exists today regardless of what happens on aco's. one of the risks when you say we will factor this in and do our decision making process -- for example, cms could say you ifnot qualify if yoas an aco you already have a certain share of the marketplace. if they are negotiating with private insurers or exists under medicare advantage, to say that you can't do it in aco but you can do it in the private

marketplace could end up having a distorting effect on the mark of a different sort. i think we need to deal with the market power issue. will notdo on aco's solve the problem and it will not create a problem where one does not exist today. i think we need to be careful and put it in context. >> that is very helpful. let me pick up on one other issue which talks about informing consumers. what do you think about whether consumers know in advance or find out after the fact? should we let them know in advance? john is raising issues about how we ensure that consumers are getting appropriate information about what they are getting into. >> obviously, you can't expect consumers to engage effectively

and change their behavior is to come -- to become more involved and better partners in their care if they are not informed. it is not impossible to imagine creating upfront information that makes clear what being in means.an aco that would probably be best delivered by their individual provider in the context of a trusted relationship. it is almost a two-way agreement. here is what you can expect from me in terms of better care, and here is what we hope you will do to support us in providing better care. that is not impossible to do. there are examples of programs out there that have done it with great success.

soft social contract -- i think it starts with us making sure that the thing we are offering actually response to what patients say they want and need. building in the right thing, patients what the things we actually believe will make for better care for the one whole person care, they want better communication, they want their information at their fingertips, if they want their doctors to talk to each other. those are the very things that we think will make for better care. those are also extremely compelling to patients. understanding that is what this is about should not be impossible to convey. let me go on for one more second -- this points up something else which is that, for this to really work particularly for the most high-risk patients, we have to build this on a basis of primary care, on a strong

primary care foundation. it is only with a strong primary care foundation that you can have that kind of trusted relationship, that kind of coordination, that kind of communication, that kind of engagement of patience, shared a decision making, linking people to the right support services in their community. none of that can happen without a real strong foundation of primary care of. >> which takes us back to what john was saying that this was one of the tools in blog and one of the areas where we also need attention to make sure that we have a stronger primary care. thank you. let me open the floor for questions. yes? >> i am with a politico. you have talked about the importance of physician- organizer aco's. could you speak about how you

would best to encourage those? >> we talk about that a little. others were indicating that it is a challenge. we do have examples of a physician organizations particularly in california that can successfully and have demonstrated their ability to deliver care and take responsibility for all the patient care. as we move from a system in which we have many, many small practices of the physicians to a system more integrated, we see lots of physicians being hired by hospitals which is one way to go. we suggested that there are alternatives in terms of providing organizational support perhaps with certified management organizations which does exist in the real world. it would be a new initiative for cms to take on to provide an

external support to physicians' organizations and not expect them to take this on themselves all the patient management tasks and health information technology that they would need to manage patient care. we want them to work with other organizations to bring them together. we talked about providing them loans up front to be able to invest themselves in the kind of practices or the kind of practice redesign that enables them to have battle -- better management systems to achieve their goals. we also recommend that we think about the criteria for aco certification so there is an emphasis on being able to demonstrate that these organizations can do what we need physicians to do which is

to provide the appropriate care and the coordination to really manage their care. we think it is a challenge but we are calling attention to addressing that challenge so the we don't exacerbate concentration that already eggs zests. we don't want to fall into a situation in which we cede the ground to hospitals. >> i will echo what you said it emphasize what glenn saidif aco's are a revolutionary change with incentives, in this sea of the very 15-year, maybe 20-year provider consolidation, it has to be seen in that context. when i worry about the caloric effect of meat eating a hot

fudge sundae and eating the cherry on top. --that is what i think about. [laughter] one of the key questions is trying too's are improve the delivery system but there is a statutory requirement which is they have to save money or not increase costs. as far as i can tell, i spend most of my career doing but it's tough, there are multiple payments for every dollar of savings. the question of creating an up- front care management fee that cms pays to be recovered from future savings? there is a pretty basic bookkeeping question. this requires up-front money. the question of what a source of that money is becomes a very

important question and it becomes a difficult policy call for cms. the last quick point about this is diversity. there is enormous heterogeneity within every market was certainly across markets. the way care is delivered in bend, oregon is different than salem which is different than phoenix which is vastly different than this area. about letting 1000 flowers bloom, letter later it is tougher regulator to create a program good things happen but it is difficult not to have bad things happen. this has to do with allowing for diversity while still having suncor is essential protections. that is an extraordinarily tough balancing act. >> sure.

one thing that has not come up is that over time, one of our objectives should be to move toward multi-payer models and alignment of the public and private sector. i don't know how we can expect to transform the way care is delivered in individual practices if there are a million different kind of incentives programs, etc. we need to move to a place where you cannot have the kind of cost shifting but goes on between the public and the private sector and all the incentives and the measures and data collection gets aligned. that will make it so much easier for these primary care and physician practices to actually make the transformation that they need. >> yes, sir? >> mike miller, i'm a public

consultant.airs i want to talk about dealing with market-dominating organizations. areseems that the wayaco's implemented could be to get a changing the dominant nature of those organizations particularly since there is a provision law that is supposed to give preference, i think, for private payers. from my experience, the employers like nothing better than partnering with medicare to say that they are market- dominating organization and we will not go against you. a toolthink there's there?

>> with the medicare context, we don't have to worry about market consolidation. for hospital and physician services, cms as ic-schedule. there also were about private payers. they have to worry about consolidation. it is easy for cms to say to bring in organizations and we don't care whether they consult it marketplaces. doesre mindful of the cmjs downstream to private payers. they don't want to have to negotiate their own payment rates. we are mindful of what cms does could have downstream and back to private payers such as market consolidation and higher price points. it is not as big of a worry for

cms/medicare but we have to know that we are saving the entire health-care system, not just cms. >> you'll also want to be protected on the price side. >> i agree what -- with what a democrat has said. our goal is to change health care as delivered. we are using payment policies leveraged to change in the care delivery. the power of lever will be a function of how many papers you choose to use this particular lever and whether they do and a well synchronized way. i am all in favor of the idea that would need be great if we could get medicare to aco's but also get important private

payers using the same tool. it is easy to say that and hard to do because of the diversity of u.s. healthcare in different markets and how many different players. it would drive john crazy to try to coordinate with all the idiosyncrasies of different players and a different markets. i don't think it has to be the exact same payment system to have some of the synergistic effect we seek. if there was coordination at a higher level in terms of payment methods and the metric, i think we can get considerable benefit from that. there are two distinct issues here. one is coordination of the payment methods and the other is the payment rates. you can imagine a system where we coordinated the methods and matrix with private payers but still continue to pay markedly

different rates. or you can imagine a system whereby over time you reduce the differential in payment rates but when you start to do the latter, you have implications in terms of budget impact whether you are leveling off on the rights or down on the red. ates. short run, i would say let's focus on trying to get coordination on the payment methods and leave the more difficult task of synchronizing rates somehow down the road. let's walk before we run. >> that is helpful. yes, sir? >> cq health beat. what difficulties do you anticipate under the pen ding cr?

>> i haven't had a chance to read cr yet. we are a c rightms regulations -- we are writing cms regulations at the moment. the aco program is one of our highest priorities. as the program has been spoken about, it as one of the biggest potentials in the affordable care act to improve quality, to reduce costs. it is one of our highest priorities. we are very much committed to the program. >> questions? >> i am a primary-care

physician. if you want to know how an aco looks to a primary-care physician because we are on the bottom, they will publish something of ahealth fair website in a couple of weeks. in europe, they deliver better care to more people for a lower price with a outco's. aco's. this will be very disruptive and expensive. complication breeds transition -- makes for transaction costs. >> to you want to take that? >> our observation with cms is the greatest faults we have within the service of the

medicare system is that we have a system that gives a strong incentives to sometimes provide more services than necessary or are under-provide services that focus on prevention or focus unwellness. if the aco program is done well and rights, that will change the incentive isth. e aco statute as primary care meaning an aco has to demonstrate they are a primary- care based organization and have the capacity to serve at least 5000 medicare beneficiaries. the aco program transforms the mindset of how we think about the fee-for-service medicare program by being focused on services, focused on primary- care wellness and -- prevention. how we set the target and

clinical requirements, we will be very aggressive. babel said strong incentives and better -- better patient care. handoffs will be well afford it and not just left to the position to navigate by himself or herself. >> which takes us back to the patients and this is about the patients. we have to the -- we have to use the tools we have to move this system forward. i think everybody knew before we had this conversation that you have an extremely challenging job. it is not easy to change the inefficiencies and shortcomings of the american health-care system. i have long talk c aboutms --

i've long talk about cms as the engine of reform the white house is committed to moving this forward. we very much value your participation, all our panelists, in this conversation. thank you all for coming. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010]

>> up next on c-span, a discussion on the release of the classified wikileaks documents and what it means for u.s. diplomacy. after that, we'll hear from the group "no labels" which that has the goal of reducing partisanship in politics. the senate continues work on the arms treaty with russia known as start. they will also take up a government funding measure. live senate coverage begins at 9:30 eastern on c-span 2. the cren us is determines -- census determines how many lawmakers we will have in each

state. live coverage of the census results at 11:00 a.m. we'll hear from a panel of former u.s. government officials. this is an hour and 25 minutes. >> the first wonderful snowy day of washington, d.c. as our radio personalities are probably already hearing, it is time to abandon cars now. we welcome everyone to our auditorium and especially those who are joining us on our heritage.org website as well as those who'll be viewing us on a future occasion on a c-span network. we would ask everyone inthousands make sure cell phones are turned off as a courtesy to our presenters and we will of course post the program for everyone's future reference.

hosting our discussion, terry miller. prior to joining heritage, he was a diplomat and public servant. in 2006, president george w. bush pinted him as ambassador to the united nation's economic and social sounl and before that he served as deputy secretary of state. he has served in it lay, france, barbados and new zealand. he also headed the u.s. delegations for to the u.n. conference in 2004. please join me in welcoming my

cleerks ambassador terry miller. terry? [applause] as you will hear during our discussion today, the theft and disclosure of a large amount of u.s. government classified information through wikileaks gives challenges to our legal bliments. we're going to have to rethink what we communicate within the u.s. government and how we communicate. we're going to have to prepare breaches of faith with foreigners who have shared information with us in the past but will be more reluctant to do so in the future. we're going to have to restore, and this may be the hardest

part of all, our reputation for competence. first i would like to say this was a predictable and pri eventable occurrence. predictable because of the growth in both the quantity si and the dissemination of the information of classified information throughout the u.s. government. tens of thousands of people had access to this information. legitimate access to this information. unless you believe in a world without sin or error, then you must be prepared for treason or treachery or indeed, accidental disclosure.

catastrophic failure representeded by the wikileaks disclosures. the first design in our system involves the erosion of hierarchy within our foreign policy, defense and intelligence establishment. the erosion of hierarchy, the diffusion of power and responsibility requires the same kind of increase in diffusion ofnformation throughout the system. that leads to the violation of what is probably the most important principle of secrecy, which is to limit the number of people who have access to the secret information. to be blunt, there are too many people in the loop. the basic question that must be asked and emphasized is who has a need to know? those people, and no others,

should have access to secret information. and with very few exceptions, that access should be granted on a case-by-case basis. not general access to all issues at all times. the second principle is not to treat as secret, which is trivial or unimportant. we have communication systems and procedures in which it is too easy to classify information. far too much information gets classified as a result. things that don't need to be secret are treated as such. this leads the a certain casualness of mind about what to write and how to write it. the reaction of some of my foreign colleagues to the recent leaks has been i can't believe you guys put that on paper. well, i agree. we also have too many levels of

secrecy. individuals classifying information for the u.s. government get to ask themselves questions like will this do just a little bit of harm if it is released or will it do massive amounts of harm? can it be released next year or five years or never? we need to be asking one question only. is something a secret or not? is there a compelling public reason to hide something from the general public? if so, then we need to hide it. don't make it available to thousands of people who may not understand its significance. finally, there are technical, systemic failures. the u.s. government data runs primarily on closed systems with nodes of interaction, some technical and some personal,

with public systems. we need to do a much better job of guarding those connections. now, the subjects of our conference today is the black eye to u.s. diplomacy from these leaks. fortunately, i don't think that the reputation of u.s. diplomats has suffered much, at least not with the u.s. public, as a result of these disclosures. for the most port, we -- part, we found out that u.s. officials are saying the same things in public as they are in private. we found no conspiracies of diplomats or officials. the same, of course, cannot be said of foreign officials, whom we have found saying different things in private than they are saying in public. those revelations have caused embarrassment and perhaps worse to those people and they are

certainly going to reduce free flow of information to u.s. diplomats in the future. now, about that flow of information. the first question i would ask is who is reading this material? most embassy reporting is read by a very small number of people in washington. for some b sis there may only be two or three people throughout u.s. government that actually read an embassy's cables. the materials disclosed by wikileaks is probably getting far more attention now than it ever got in its initial formal distribution within the u.s. government. the information that our senior decision makers need is not raw data. it is not thinly disguised gossip but rather information and analysis that has a direct bearing on our abilities to defend ourselves.

our interests or diplomats are still capable of providing such information and analysis but now floats in a sea of information of often uncertain -- are meaning. we'll need much more information in separating the weak from the -- and more of that attention needs to be in the field. the basic question before committing any communication should be what value does this add to our understanding of any real issue? what are the government's interests or positions. even a way in which a foreign individual or leading might act in a crisis. if the answer is, well, it doesn't add much, then it probably shouldn't be put in or written in the first place. as government expands and information becomes more diffuse, there is a tendency to

substitute information exchange for judgment. there was a time when individuals were given substantial authority and held accountable for results. in today's greatly expanded state department, individual authority, responsibility and accountability are all greatly reduced, and they have been replaced in part by bureaucracy. bureaucratic systems and processes. wikileaks disclosures came about as a result of a breakdown within those bureaucratic procedures. given size and complexity of the systems and information flow in question, such breakdowns are inevitable. surely step one should be to reduce size of the flow of information and the number of people who have access to it. there by reducing the risks when a disclosure does take place.

i would like to close with just a few recommendations. first, i think we need to clamp down on the use of classification authority. we need to reeducate our employees and our diplomats to the idea of working in an environment in which you can count on nothing being secret or secure. we need to train people to think before they write. we need to rethink the concept that there are different levels of secrecy. something should either be secret or not. and handling secret material, we need to reinvigorate the concept of limiting access to those with a need to know. we need to redesign our systems to eliminate the nose of connection between secret and nonsecret channels of communication. and finally, we need to make it hard to classify information and also hard to access it.

i'm going to end with just one sort of extraneous thought almost. that is why do we save everything within the u.s. government? in my view, we benefit greatly from a type of secret communication, in which information is transmitted and then destroyed. the written equivalent in effect to an oral-private conversation. i know that historians and lawyers love a written record, and i understand that that can be useful when we have questions of accountability. but, an obsessive devotion to archiving everything, that's what we do in the u.s. government now. that obsessive devotion is increasingly debilitating to communication and will be even more so following disclosures

of wikileaks. we have put together an outstanding panel to discuss these issues in greater depth here this afternoon and i want to introduce them to you now. lisa curtis, a senior research fellow in the heritage foundation studies center focusing on america's relations with india, pakistan and other south asian countries. before joining heritage in august, 2006, lisa was a member of the professional staff of the senate foreign relations committee where she was in charge of south asia issues for then senator lugar. she served as a senior advisor, an analyst in the foreign service where she was assigned embassies in pakistan and india. paul rosenweig work at the

allison center for foreign policy studies. he provides legal and strategic advice on national security to individuals, companies and governments. from 2002 to 2005, he was senior legal research fellow for legal and traditional studies where he specialized in civil liberties, national security and criminal law. he also served as deputy si zeant secretary for policy and homeland security and is acting as accident secretary for international affairs, and last, cully stimson, the senior legal portfolio at the center for legal studies here at the heritage foundation. before joining heritage in 2007, cully served as the deputy assistant secretary for defense for detainee affairs

where he advised the secretary on detainee issues worldwide including at goib, iraq and afghanistan -- including guantanamo bay, iraq and afghanistan. he co-chairs the defense senior leadership oversight ke. -- committee. he is is criminal prosecutor, defense earn -- was a criminal prosecutor, defense attorney and la professor. we're going to start with lisa curtis. >> what i said in another panel, which was basically focused on the afghanistan and iraq war archives that were released in july and then subsequently a few months later

in afghanistan, was that most americans were already aware of the general thrust of the information released in the documents. i also noted that these reports were not necessarily the crown jewels of u.s. intelligence. meaning they did not contain the most highly guarded secrets on which sensitive u.s. policy decisions are made. that said, the release of the reports as the most recently released diplomatic cables clearly compromises u.s. national security and you know, i want to differentiate between the afghanistan-iraq war cables that were released, reveal that u.s. battlefield techniques, ways of communicating, intelligence gaffes and all of this information that our enemy on the battlefield can exploit. and even groups like amnesty

international faulted wikileaks for we veeling the names of iraqi and -- for revealing the names of iraqi and afghan civilians and put people's lives in jeopardy. also, with the previous releases of information, i notice that -- called into question, their willingness to share sensitive information with u.s. officials. unfortunately, after this latest release, i think this point will only be reinforced to them. so while the release of the iraq and afghanistan war archives seem to indicate the that julian assange had a strong anti-war agenda, and he may have helped dispurse a broad anti-war movement in the u.s., the release to have

diplomatic cable shows that assange has an even larger u.s. agenda which means sabotaging the u.s. government's ability to conduct relations with foreign governments. this is ironic. diplomacy allows nations to communicate effectively, to cooperate and negotiate and to avoid wars. is it mind-boggling that julian assange thinks he is doing the right thing simply makes no sense. no one is disagreeing with the obvious need to be able to expose government corruption and misguided policies but this massive dumping of classified information on to the internet is not the way to go about it. now since the reports were only recently released about two weeks ago and only about 2,000 of the apparently quarter of a

million reports they intend to release, have actually been posted on wikileaks, we cannot yet predict what the full impact of the situation will be. the media has reported some countries are already limiting the number of american diplomats who can attend meetings and they are not allowing them to take notes, yet other embassies are seeing no changes. so the impact is likely to be felt differently in different countries. secretary clinton went to great lengths to make clear that the opinions that were expressed in many of these cables don't reflect official u.s. policy. field reporting coming from officials in the field. now interestingly, some of the commentary in the u.s. media has noted how professional and well written many of the cables are, which means the release of

the cables may have actually lifted the opinions of some about the work of diplomats. i think people often think of diplomats as attending lavish parties, signing treaties, however these cables reveal these diplomats are working hard under difficult circumstances to achieve worthy goals. to keep the weapons out of the hands oven terrorists and reduce conflict and promote democracy and human rights. now every government, not just the u.s., requires the ability to have conversations with both foreign officials and human rights activists, democracy workers and journalists. because of the wikileaks fiasco, people would simply not trust their american counterparts or be willing to share information that could help solve many of these local

problems. there is also concern about the safety and security of the foreign nationals, the local nationals of the host country, who work in the embassy, they help set up meetings and gather information so they are often referenced in the diplomatic cable. so there is concern about their safety since living in these cups. now i agree with terry, that the wikileaks phenomenal is likely to create a shift back to more traditional policy of sharing information on a strict need to know basis. there is likely to be a backlash against concept of broad information sharing, which we have seen in the post 911 world in both intelligence and policy making community. i would say with regard to information sharing, interagency information sharing, we're now the post wick lesion world. -- wikileaks world.

clearly breaking down barriers to information sharing has helped secure the u.s. homeland. so my hope is that people are -- use discretion, certainly, there will have to be more scrutiny in deciding who gets access to information and terry explained very well, why that is the case, but at the same time, i think that we have all benefited from the increased information sharing when it comes specifically to threats to the homeland. so it is clearly a balancing act that we have here. now, my specialty is south asia, so i focused particularly on the impact of u.s. policy in south asia. there have been some interesting developments, one was the reporting of wikileaks in pakistan to create propaganda against its arch enemy, india. there was a fabricated report saying there were cables

reporting on indian meddling in pakistan. when it was out that that was fabrication, the newspapers were forced to report a retraction to maintain their credibility. they said they regretted the release of the story and noted the erosion of its public credibility, but i think this was a rather bizarre case and it is unlikely to happen again. so the wikileaks rrks when it comes to the cable tharps released, are most unhelpful when they involve sensitive relations like the one between the u.s. and pakistan. interestingly, i think pakistan cables, though, represent a case in which people, the public, can see how complicated and difficult it is to pursue diplomacy in a country in which the leadership is so fragmented.

and this is the kind of thing people know already but seeing it in black and white i think certainly brings the issue home. and another interesting point is some have pointed out that the wikileaks shows that the americans really don't have such awful intentions toward their country and that perhaps the pakistani media needs to cut its bombast against the american government. one wrote wikileaks provided the pakistani nation another chance to reconsider and revisit so many disconnectses that upholds between the realities and the perception about the way the world is to be shaped. so i'm not saying that the wikileaks will contribute to lessening anti-americans in pakistan. i'm merely noting that the impact has been unpredictable in some cases. in conclusion, i doubt julian

assange will be perceived by most americans as a hero. i think many americans view him as someone who does not have the best interests of the american people at heart. and is playing fast and loose with u.s. national security. thank you. >> thank you, lisa. paul? >> thank you for braving the weather and making it out here. i want to talk about wikileaks from a cybersecurity internet. i confess that leads me to some places that are a little different than from where i think terry and lisa are in terms of their thoughts going forward. to my mind, a fundamental

takeaway lesson from wikileaks is that the depth of secrecy is inevitable. or to put it in a more technical frame, the half-life is decreasing as we go forward. that is not to say that there will not be secrets in the world ahead of us. so long as there is value in the secrecy of the information, there will be incentives where people can main taint, but -- maintain it. the virtue is that it serves as an open architecture for conveying information. it has reduced all of the good things we have dom expect in our lives, -- come to expect in our lives, whether it is purchasing on amazon or the

facebook phenomenal but because of the unique open, architecture nature of the internet, it is inevitable that it is as readily usable by those who would do -- as it is by those who would make good of it and that is true whether it is cybercriminals seeking to steal identity or money or people like assange who seek to use it to destroy some of the fundamental purposes of american diplomacy and national security. so with that it is a kind of background to what i see as the reality that no amount of american policymaking or any country's policymaking is going to change, what lessons about cybersecurity or keeping secrets within that context do i think we can learn from wikileaks. for me, the first and foremost lesson is one that everybody in the domain tends to forget,

which is that most of the problem, the human factors, which is to say notwithstanding the fact that we live in a world -- outside of the system, things that are extremism, often, most of the time, the threats to the security stomach the information -- data that you're holding, often insiders, either by mistake as when people mistakely give away their passport to a friend, trugs them. or in the case, if reports are to be -- i'm going to assume the truth of public reports about how the cables were exfiltrated from the american system. he has been charged and not convicted so he is entitled to

a pludges of innocence. if -- presumption of innocence. if the reports are accurate, until we outlaw sin, we're going to experience that. so the first side of things that i think we should take away from an event like this, is that we need to do a better job of securing. which is really pretty simple. we need to define who gets access. i'm not sure that means we need to cut back on the number so much as we need to make sure that people who are granted access to america's secrets are deservingly. more importantly, one of the lessons that gets lost, all too often is -- the need for -- which is to say that as i understand the history, there is -- there are indications in that person's past that might have indicated that he was

growing more frustrated with his lot in life that would have been indicators of a change in attitude. one of the pieces that we want to deal with is not just granting people access but a constant vetting of who gets access over time. but a second piece that i think we need to learn from this is that america needs to upgrade the systems insurance utility of its programs. that we have a system that does not alert on the downloading of 250,000 files at a time, is not s a remarkable thing. granted, it required -- this is not like you flip a light switch and the system is upgraded recall that systems worldwide overnight. you can't. and i certainly understand that it will be a process that needs

to be rolled out in a way that doesn't interfere with long going operations. but at the same time, that is a common place in the operating systems of, you know, major companies throughout the united states. when people do engage. people -- engage in an unusual pattern of download ing -- it trips an alarm and somebody has a security function that needs to be performed. likewise, within america's systems there needs to be programs that monitor unusual patterns of access to information. it makes to me perfect sense that a private in an intelligence unit might need access to cable s that arederived from iraq. you could say yes, as well to iran and maybe afghanistan and

jordan and israel. but when he is accessing information in cables from holland or venezuela or mexico or north korea, that suggests somebody who is engaging in a pattern of activity that is outside the zone of the types of things that one would expect for a person in that situation. and it is, again, it is not trivial to design alerts that monitor that kind of information access and provide that kind of analysis of the activities. but at the same time, it isn't impossible. indeed, it is also the type of system that is in place in many companies in the united states and some of our more highly classified regimes in u.s. government agencies.

so that is a perfectly reasonable exer tation, i would think. i disagree with, gently, with some of what terry said about the third possibility, which is that we need to clamp down on the information sharing and go back to a need to know mechanism and we need to start limiting the amount of information that we collect and exercise some filtering before information becomes part of the collection of u.s. data. i think that that would be the wrong way. for one thing, i think that a lesson we learned from 911 is that we need to break down the need to know paradigm and make it a need share paradigm.

i would be reluctant to see or welcome back the idea of a need to know paradigm because, inevitably, in a u.s. -- where agencies protect their -- that would be seen as a signal to, you know, return to pre9/11. so i wouldn't go in that direction. but the other piece is that, you know, the thing that we learned not just from september 11 but from all formors internet data and analysis that have occurred in the last 20 years is that you never know what the relevant factoid is going to be to a piece of analysis going forward and we shouldn't be editing ourselves at the front end and purging from our data that things that

we can't possibly know might well be relevant going down the line. right? what we have in the internet is a system with a much greater capacity for data integration and analysis than we ever had in the past. it is a system that is allowing us to discover new patterns of human activity, whether it is social activity on facebook or criminal activity in -- or terrorist activity or patterns of activity among insurgents in iraq. that comes not by limiting your data intake but rather by using better analytical tools. significant data in the midst of the process never knowing what the right piece of data would be in the end. who would have known that the

travel patterns to afghanistan, of david headley, were going to be -- that happened before 9/11 were going to be relevant to a post 9/11 investigation? we wouldn't have. we might well have discarded that information. now we have a better sense that we can't know what the sanctions are going to be. so on that one little piece, i think i can say that the promise of data analytics is not meant by cutting back on sharing and that intake but is better met as a threat -- by ensuring that only the right people have access to the data and ensuring that people inside the system are monitored. one of the things people say about the internet is that everybody has lost their privacy on it.

that is not necessarily true but if there is one set of people who should lose all of their privacy are systems users inside the u.s. government. i think i have done my 10 minutes. i'll pass it on. >> thanks a lot, paul. terry? >> thank you for hosting this. in washington, one flake turns into gridlock on the roads, as you all know. my path is to scuzz the legal parameters here, namely whether or not assange or wikileaks or both can be held criminally liable. i would say at the outset, because i'm a commander in the united states navy reserves, i'm under order by the

secretary of defense not to read the wikileaks leaks. i have it so my remarks are based generally on the law as i know it and certain recordings. i think paul had the same structure as well. because of the security demreerns his capacity as a business owner. -- clearance in his capacity as a business owner. wikileaks, the intentional dissemination of hundreds of thousands of war-related classified sensitive u.s. cable, while we are engaged in two tiers of war and operation, has no doubts, as you know, opened a vigorous debate about whether wikileaks or its founder julian assange can be held criminally liable. some see him as a traitor or a spy. as a legal matter, traitors are

usually citizens attempting to harm the country so they can't be tried for treason. the espionage act, the discussion du jour, today on capitol hill, there was a hearing in the house judiciary committee on this very topic, or other laws which have been much the debate in the law, especially the legal laws. others, i want to characterize more as a smaller group, see wikileaks and assange as a hero. a courageous person who should be applauded for his actions in making transparent which should never have been hidden from the public in the first place. i certainly don't subscribe to the second category. there is no doubt in my mind, from the various positions i've held, that the information disseminated by wikileaks has

damaged our national security. i would associate myself that with all the panelists remarks but specifically the concerns that lisa eloquently laid out and talked about in the past, it certainly harmed our diplomatic efforts. imagine if you were deployed in an embassy somewhere, certainly in the middle east or in a sensitive area and your jorks among other things, was to report back on the day-to-day happenings around you, you would take -- i think so, your natural instinct in terms of carrying out your functions and reporting exactly what you're seeing, given this disclosure. and no doubt, caused other negative collateral consequences to the united states and our allies. some of which we probably vant encountered yet or gone through or has become obvious to us. i believe the primary

beneficiary of the wikileaks -- however you want to defiant. al qaeda and those associated with it but those who want to see the degradeation of the united states -- see the united states be harmed in the eyes of the world. that seems sad, this saga, which i believe will continue, because as we all read, wikileaks has not only promised to disseminate more information, but according to what i have read, pushed out their information to various co-conspirators. so if something bad happened to assange, they would push out the information. this saga highlights what i think is the natural -- in a free society, as my olds boss

testified earlier today before the house judiciary committee where he said "on the one hand, you have protected government secrets and on the other hand you have upheld protection for the press." whether wick vehicles a traditional media outlet, i think is certainly open the debate. but there can be no doubt if it or julian assange will be prosecuted in the united states and wrap themselves in the protection to have first amendment saying they are a media outlet, however broadly defined. let's begin our legal analysis with a known no and then move into somewhat murkier territory. first, as we all know, the army has charged u.s. army first

class prives for willfully delivering and transmitting classified information to an individual not authorized to se it. he received the classified information wikileaks. i have a copy of the charge sheet here. as we all know, it -- bradley manning. is presumed innocent and he is -- presumed innocent unless he is proved guilty -- beyond a reasonable doubt and what about assange and wikileaks? the fact that he can be prosecuted -- he was on active duty during the time he allegedly committed the acts. how that turns out, nobody

knows how the case will turn out. but assange, a non-registered entity, an entity, not registered in the united states, can it be prosecuted? let's -- before we try to peel that back a little bit, let's put some indisputable facts on the table. first, it is a given, and i think, my colleagues have touched on this quite well, but i want to talk about it in a legal context. it is a given that there is and has been for sometime, overclassification of information in our government. no doubt about it. when i was the deputy zeant secretary, i'm sure that has happened to you, paul, you have your classified and when you get ready to use that, i'm sure -- your cybernet screening here, when you wanted to send

an email, you had no choice but to classify it at one level or another and you and you alone made that decision and it wasn't black or white. you decided based on your training experience how to classify it. i have no doubt some of the things may be -- should have been on the regular internet. but that's neither here nor there. that said, it is not necessarily a legal problem. it is a policy challenge.overas dubious legal defense for manning, i believe r, or anyone else charged with leaking classified information. two, some, including paul and the others have argued that congress may find it necessary in the age of the internet to update the espionage act of 1970. our recent brief but hopefully

helpful web memo is available outside. and revisions, will not cover prior conduct unless you charged it under what we talked about in our paper, a continuing course of conduct, which may be a stretch. may be not. let's focus on a little bit more closely on the espionage act, because i want you to think through and hear the language of it because the language matters before i wrap up my thoughts. the act, remember, the 1917 act, has been updated over the years. the crux of the act says "whoever, for the purpose, not specific intent, language, ob take information or reason to believe that the information is to be used to the injury of the united states, receives or agrees or -- whoever source

blah blah blah is guilty of espionage. all right, now, congress today, started, actually continued this debate about whether to act -- all the right language for this age that we live in. i would caution congress not to rush into anything without knowing all the facts in this country. it is a saying goes, i would suggest -- would make that law as well. third, there is a danger in trourk a legal judgment as the stakes of this case are too high. let me illustrate why i say that. commentators and politicians including senator dianne feinstein have concluded it is clear cut, cut and dry. they have said so in cares

publications. other folks like former bush administration, attorney, jack goldsmith are not so sure, as they have recently written about. why, says jack, are we still angry at assange for violating the espionage act? why are we just angry and intent on getting bob woodward for obtaining the classified information he so liss ited and published in his book "obama war." prosecuting assange from manning and then publishing it is not much different than a newspaper reporter or authors soliciting classified information and then publishing

it. these are a few of the arblingts for and against prosecuting assange. but rather than engage in a very rushed judgment, legal judgment, allow me to suggest the way forward. this is where i'll conclude. it seems to me, and maybe i'm old fashioned, that there is simply no substitute for a thorough and unpenetrating and exhaustive investigation into all the facts and circumstances around this entire affair. oftentimes it cannot be accomplished without the usor a grand jury and the subpoena power. because of these exact concerns regarding the first amendment protections for the media, however broadly defined, the department of justice, our top prosecutor, had internal rules for press-related cases, and

those rules, i would argue serve as vital interests, which in the long run are more important than any of the julian assanges out there. freedom of the press. those facts may lead prosecutors to conclude that any number of statutes have been violated. that may or may not include espionage or obstruction of justice or conspiracy. they may conclude, however, that there is simply no way of prosecuting assange under current law. thank you. >> thank you very much, cully. now, it is your turn in the audience to ask questions of our panelists or to make comments as you would see fit. if you have a question or comment, please raise your hand and wait until we bring you a microphone so our participants who are online, in the media watching us, can also hear your

question and please also identify yourself and then ask your question. >> you talked about -- people would be in the united states. >> they are not going to be living in pakistan, as you know. one of the things -- what is the conspiracy that people have been talking about is the united states trying to -- all of the nuclear weapons, taking control of -- the united states, trying to take out

particular nuclear material from -- and i think the people -- the united states. the conspiracy that the united states wants to take control of nuclear weapons or -- you talked about different aspect of -- >> just to clarify that i'm not with the u.s. government anymore. i'm not under the same restrictions that these gentlemen are but i decideded a a research analyst in the public realm against facts that these wikileaks cables have been released, i'm not going to certainly -- the information or exploit or take advantage of it but at the same time, i am commenting on some of the things that are making it into the press and so i am familiar with the cable that you raised.

and i would say that i think you're right. i think it has reinforced skepticism from a large part of the pakistani public on the nuclear issues. that is a particularly sensitive issue for pakistanis. and unfortunately, i think, the u.s. media has fed some of that suspicion. unfortunately, i think there has been a lot of hype surrounding this decision. i will look at it as a low probability, high-risk scenario of terrorists actually accessing pakistani -- it was something that we had to pay attention to but at the same time, it is not -- tough on -- are going to take over the -- and all of a sudden have their finger on the button. i think the threat is more an insidious threat. aggressively over time, people will -- with sympathies to some

of these militant groups will gain access over time with technology and these issues, but that said, the cable in question talks very much about cooperation. there is nothing said about the u.s. trying to steal the uranium. it is a negotiation that is taking place between the u.s. government and the pakistan government about safeguarding nuclear assets. so unfortunately, i think the reality is yes, it will reinforce concerns in pakistan that the u.s. is trying to denuclearize pakistan, but if you really read it closely, you know, it would be seen that this is a cooperative effort between the u.s. and pakistan to simply safeguard those materials so they don't fall into the hands of terrorists.

the goal is not to denuclearize pakistan. it is simply to make sure that that nuclear material stays out of the hands of terrorists. >> thank you. >> my name is -- and my question, i just -- for mr. stimson. the senator lieberman shield argument which wasn't really brouppingt, show how that goes to the heart of problem. i would like to hear your thoughts and comments on that. >> we don't endorse specific aspects of legislation or pieces of legislation but let me comment generally on that. i read it. i have a copy of it right here.

the espionage act has been held to cover non-citizens. the shield act as currently drafted, the draft i have, does not. so it is questionable whether assange, whether the shield act would in fact, reach assange or people associated with wikileaks. i believe that the extent to which the investigation is thorough, could show that, based on actual facts, communication between wikileaks, assange, and the mannings of the world, whether it is manning or other people, that wikileaks, is not at all like a media organization.

the more likely it is that assange or wikileaks or people associated with wikileaks, investigating criminal law for united states, the further away it looks like it is, the more likely the first amendment touched on, will come to pass as a viable defense and the more likely it is the prosecutors will move forward with traditional criminal charges and that would involve the shield act as currently read. >> i tend to agree with all of that. i also tend to think that, the section the espionage act was narrowly and carefully drawn. it h