UNITED STATES OF AMERICA

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

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CITIZEN'S HEALTHCARE WORKING GROUP

PUBLIC MEETING

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Tuesday, August 16, 2005

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Conference Center at Harvard Institute of Medicine

77th Avenue Louis Pasteur, Room 138

Boston, Massachusetts

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1:00 p.m. - 4:15 p.m.

MEMBERS PRESENT:

MR. RANDALL L. JOHNSON, Chair
MS. CATHERINE G. MCLAUGHLIN, Vice Chair
DR. FRANK J. BAUMEISTER, JR., Member
MS. DOROTHY A. BAZOS, Member
MS. MONTYE S. CONLAN, Member
MR. RICHARD G. FRANK, Member
MR. JOSEPH HANSEN, Member
MS. THERESE A. HUGHES, Member
MS. PATRICIA A. MARYLAND, Member
MR. MICHAEL O'GRADY, representing Mr. Michael Leavitt, Secretary, Department of Health and Human Services
MS. ROSARIO PEREZ, Member
DR. AARON SHIRLEY, Member
MS. DEBORAH R. STEHR, Member
MS. CHRISTINE L. WRIGHT, Member



STAFF PRESENT:

MR. GEORGE GROB, Executive Director
MS. JILL BERNSTEIN, Research Director
MS. JESSICA FEDERER, Program Analyst
MR. ANDY ROCK, Senior Program Analyst
MS. CONNIE CHIC SMITH, Communications Director
MS. CAROLINE TAPLIN, Senior Program Analyst
MS. RACHEL TYREE, Program Analyst

OTHER PARTICIPANTS:

MR. LARRY PATTON, Designated Federal Official
MS. NANCY REAGAN, Associate of Joseph Hansen



I-N-D-E-X

AGENDA PAGE

General Committee Meeting 4

Committee Reports

Community Meetings Committee 5

Communications Committee 71

Report Committee 124

P-R-O-C-E-E-D-I-N-G-S

1:07 p.m.

CHAIR JOHNSON: We'd like to welcome you all to our meeting this afternoon, and if we look at our agenda, we have three primary sections of our meeting.

The first will go from 1:00 until approximately 2:15 will be our Community Meetings Committee, and information from them and discussion regarding some of their matters.

The second will be from 2:15 until 3:30, in which we will discuss some of the activities that relate to the communications of our projects. We expect to take break at 3:00 and then reconvene at 3:15 for comments and input and questions of the Report Committee. We'll have some discussion of budget at 4:00 and then adjourn at 4:15.

We have a public forum that will convene at 5:30 p.m., and we ask that you, as Working Group members, be in the amphitheater at 5:00 for program instructions.

So that's our agenda. Any questions regarding the agenda? Okay. If not, we'll turn our discussion regarding community meetings over to Dr. Aaron Shirley and George Grob.

DR. SHIRLEY: Mr. Chairman, if it's okay with you, I would like to ask George if you would kindly summarize our deliberations for the Group.

MR. GROB: Our committee met to discuss concepts of our healthcare program. The general agreement we reached was on two fronts. Part of it has to do with the sense of strategy that we would have, and part of it had to do with the agreement on the numbers and the kinds of meetings that we had.

Then we left questions open for further staff work, to bring back ideas for the committee and the Working Group.

With regard to the kind of views we have, we agreed that we would have a mix of different types of meetings.

At the core of it would be ten meetings we're calling standard meetings, which would afternoon long meetings, involving up to 250 or even 500 people, of which a core of about 150 would be selected to be representative of the population in the captured area of the metropolitan area in which people live. The others would be walk-ins or others who come.

The meetings would be highly structured, would be facilitated, and would use modern technology in order to allow people to weigh in on issues that would be raised, and it would be possible to distinguish the answers of those questions from those who were selected to be representative, but others would also be able to participate in the meeting.

When those meetings were over, there would be a summary of results that would be available and accumulated over the life of our projects so those could be used. We're estimating ten of those meetings I'll call standard meetings.

We also have the option to have up to two very large meetings, which would be 1,000 people each, or a combination of four meetings of 500 people each, that could be used primarily at times when we wanted to draw a lot of attention to what we're doing to make that a very prominent national event, because of the size of the turnout of those meetings.

We tentatively thought that one of those meetings would be used for the opening meeting, because of the news attention that we want to gather for that purpose. We made no decision about the second of the large meetings that we're going to have.

Coupled with that is another series of meetings, which would be less structured, but still would be formalized meetings, and they would be more typical of the kind of community meetings, the open mike meetings that people are accustomed to when they think of community meetings.

An introduction to material, with a facilitated discussion involving the audience. They would be allowed to ask questions and make statements, and that we've made arrangements for being able to do up to 30 of those meetings in different locations.

Another option for meetings that we agreed to would be what's called invited meetings, and I'm sorry I didn't say this, but self-initiated meetings where organizations around the country would be able to hold their own meetings, but we would provide a kit that they could use. It would be on the website, so they could have an organized meeting, and they would be able to hold their own meetings.

These meetings would be supplemented with electronic meetings, two very large webcasts, live webcasts, probably associated with some companies that have offered to help draw a group of people to those.

Another one, we didn't decide this for sure, but another option that was discussed was a meeting that would be associated with a large rural area, perhaps working out of South Dakota, and connected with other states, and using as well facilities from the Department of Agriculture's Outreach Service, who have offered to give us some assistance in that regard.

Then our website would be very active. It would include the opportunity for maybe one blog, a blog discussion for those who want to participate and allowed to chat. If we want to, an expert session if we want to do that.

We would be able to keep our website updated with current news and different things that could be prepared, that would be current and available at the website.

All those things that I mentioned would be facilitated by two large contractors. One of them would be AmericaSpeaks, and the other one would be the Public Forum Institute.

Each of those would be set aside in the budget of up to one million dollars each for those activities, and they would be responsible for preparing and carrying those out. We would be able to buy the items I just discussed.

Those are the meetings. Now connected to that was a strategy, and the idea of the strategy was that we would think of using two groups. One would be a highly formalized and to some extent scientific as we could make the results.

So that would be the ten meetings. The two large ones, and perhaps the webcast meetings. For those meetings, we would be able to draw information that could be compared when we were done. We would have representative audiences. We would select sites that would capture a good cross-section of the nation, so that when we were done, through analytic means, we could make a statement about what we found using scientific or nearly scientific methods.

On the other hand, up to 30 meetings, which should be more of an open-type discussion. We are trying to provide a great deal of variety for different purposes, such as reaching groups that are hard to reach, or people that like to volunteer to have certain kind of meetings.

The style of those meetings could be adapted to whatever the purpose for them was. So we'd have that option. So that when we were done, we'd be able to draw our results from a combination of what I would call analytic information, but also information from being very present in the communities, and talking with a variety of formats, combining basically qualitative and intense personal contact along with the more analytic things.

Supplementing the analytic side of that strategy would be a national, a representative of SEM, of a thousand individuals, answering the same questions that we can use as a basis of analysis. So that was the overall concept and strategy behind the meetings.

The final stage that was that we agreed that we need to select the cities or the sites, rather, and the schedules for the ten standard meetings at this one large meeting, and then the two webcast meetings, and that we needed to do that very soon. We agreed that we would discuss a process that would be used in order to make those decisions.

That process would include that our staff, using the help of consultants, and by discussing with those contractors I mentioned as well as a PR firm, that we hope to have reporting to us, would come back to this committee with options for our consideration, about where those meetings would be located and when the meetings would be held.

So when we agreed to that, what we agreed we needed was to consider what process would we use, in order to get those options considered by the working group as a whole, since we can't wait until a month from now, when we need it, in order to make those decisions.

So that brings us to the end result of what that process is. That's my summary of all this. Thank you again.

CHAIR JOHNSON: Thank you. Questions or comments for Aaron or George or anybody would like to build on those comments?

MS. STEHR: I guess I have a question, and maybe our chat expert could weigh on this. What's the optimum size of the meetings for the chat thing?

MS. GOOLD: The exercise was designed for between nine and 15 people, but it's been used in the caller and, more to the point here I think probably, larger groups. The range --

CHAIR JOHNSON: Can I interrupt you for just a second?

MS. GOOLD: Yes.

CHAIR JOHNSON: Sir, are you able to -- you're transcribing. Are you able to pick up her comments?

COURT REPORTER: I have a second mike here that's picking it up, yes.

CHAIR JOHNSON: It's picking it up. Okay, thank you.

MS. GOOLD: Okay. The size of the group nine to 15 is considered to be ideal for group decision making, group interaction, small group conversations. But you can go bigger, you know. We've done it with 50. Five hundred would probably be a stretch.

On the other hand there is the web version. It can take larger numbers, both in a group and I think, importantly, you could have individuals participating in the web version and complement that with some face-to-face group meetings.

CHAIR JOHNSON: It's my understanding that you want to take some time on our agenda to talk about the chat process. Is this the time you'd like to -- well, Aaron, I'm looking at you. Is this the time you and George would like to do that, or a little bit later in our allocated time for a community meeting?

DR. SHIRLEY: Probably now, while it's still fresh.

MR. GROB: Yes, because Susan agreed to stay. She has to travel shortly, but she agreed to stay for our discussion here, if there are any questions that people would like to ask.

MS. CONLAN: And move up to where everybody can hear you.

CHAIR JOHNSON: That would be good. Thank you.

MS. STEHR: So I guess I'm wondering, is this more appropriate for self-initiated meetings, or where does chat fit into this --

MS. GOOLD: What he was talking about?

MS. STEHR: Yes.

MS. GOOLD: Yes. I would think it could be used for both. Again, I don't think this applies to very large meetings. It applies only to those small meetings. It isn't really workable in that large group context. But I think for self-initiated meetings --

(Phone ringing.)

MS. GOOLD: There are a number of focus groups who are either using or planning to use Chat, and it would be possible to sort of leverage this group's community meetings with their activities. They want to start probably a domain using the chats. She knows about those groups.

It would be, I think, a relatively straightforward matter to say well whatever your plans are using chat with the working groups, you could use it to share with them, so they could have more groups perhaps and they could potentially sort of build in your own efforts by letting people use your tools and what-not. It's self-directed.

CHAIR JOHNSON: A related question. How long -- can you describe the length of each of these meetings, text, and how long your involvement would have to be in order to be effective?

MR. GROB: Okay. The ten so-called standard meetings will generally last either the morning or an afternoon, about four hours. The large meetings would basically cover either a day or four hours. You could organize it either way.

The meeting, the 30 meetings that would be adaptable could be any bit of time. It could be as short as an hour. That might be made available at a national conference. But they could also be extended out to, you know, two or three hours, probably though, not a whole lot longer.

MS. GOOLD: But that could be done, including the survey and the questionnaire.

MR. O'GRADY: Susan, a question about the process, and I can see how that tool could work. I work for unions, and when we do a bargaining we have a big group and we have a finite amount of money that we can spend for the next three years on that. So we make our choices.

But for this group and for what we're trying to do, how does that all relate when we don't know what a finite amount of money is? Do you have public programs, do you have private sector and you have individual. I'm struggling with how this process, with all these different varieties, might lead us to any conclusions that we could use.

MS. GOOLD: Well, I think there are a couple of ways you could do it. I think probably the most straightforward way would be to have one version of the exercise, and you could choose that finite amount of resources or something else, the average cost of a commercial health insurance plan across the country. You could choose a number of things that some time after we looked at it would be reasonably relevant.

Then people use -- everyone uses that version. One of the possibilities would be that for senior citizens, the relevant costs are very, very different, potentially. In our North Carolina project, we had Medicaid version, a sort of general version, and a senior citizen version. It turned out that the Medicaid version's relative costs were very close to the general version. So we used one for that.

But senior citizen was very different, very different. So if you like -- if you want to include 55 and over, there are two versions.

CHAIR JOHNSON: Mike.

MR. O'GRADY: Might I suggest that, you know, and along the lines of what you said, in terms of thinking about this and really where it would be the most effective, I am thinking along the web. People can play, people can't.

If we bought 500 people or 1,000 people together some place and said that you know, this may not be for everybody. So you wouldn't want it if they came down for a regular full meeting and all of the sudden they were told it's time to play a game.

I mean, you know, we're supposed to be kind of a not one-size-fit-all group. But the idea of, this seems to me, have a lot of value-added to kind of a website, where people are going. They can do it. They can do it when they want to, you know, in the privacy of their own home.

Then you could have that ability to do just what you said. You might want to have that caveat that says, you know, if you're a senior citizen thinking about Medigap coverage, this really isn't for you. Either these are another product or a whole --

MS. GOOLD: The numbers don't come out right.

MR. O'GRADY: Right, right. The long-term care switch is a little different here than it is for others. So, I mean, some of that kind of stuff. But I can see, you know, a very productive role for it. But I would hesitate to go full-scale in a big meeting of 1,000. Like you said, that's not what the design was for.

MS. GOOLD: Really, the face-to-face group activity, the sort of course training format frequently used is where a lot of action happens. A lot of what people find enjoyable, a lot of what you learned is from that group dialogue.

A group of 500 is not going to -- you're not going to it. So there is -- I mean the web version has both an individual version, just for individuals can do it, design their own plan, go through the help desk and get assistance, and then design it again.

You could also have a group exercise that takes place over time, and that time frame can be set for two, whatever. They can send it all in over the course of two weeks. People can play with it, they actually can read and suggest the decisions for the rest of the group.

There's a whole section for group dialogue. I don't think the dialogue is going to have quite the same effect as a face-to-face version. So but, you know, it's --

CHAIR JOHNSON: Catherine.

VICE CHAIR McLAUGHLIN: I wanted to capitalize on your remarks just now. I don't see this as mutually exclusive. I think the large group had a particular point, a particular goal. The web has a particular goal, reaching a lot of people. People can go where it's convenient for them.

But I -- when I read the legislation that created this group, and when I think about what we heard from Senator Hatch when he came to meet with us, and then again in Salt Lake City, they want us to go and talk to people.

As you said, the face-to-face is what we do. The 500 is not going to have us talking to people. One hundred and fifty is not even going to have us talking to people. I think that the members of this group have a fiduciary responsibility to going out and talking to people.

Whether it's ten people or 20 people or 40 people, it is our responsibility. That's what we were charged with doing. We were supposed to go and talk to people and listen to them, learn from them, have an exchange, and we hope in the process alter their view about tradeoffs and about sacrifice and gains, which is part of what this particular project is about. There are other ways to do it like this one.

So I think that in this laundry list, it's not enough just to call self-initiate. I think personally that the members of the working group should step up to the plate, so to speak, and we should all be willing to go out and listen to people and talk to people.

It may be painful sometimes. It may be scary. You may feel as though, ?Oh my gosh, they're going to ask me all these questions I don't have the answers to,' or ?Oh my gosh, they're going to start ranting and railing at me about the horrors of the medical care system.'

I think that it's frightening for some of us to do this, but it is our responsibility. When we agreed to be on this group, we agreed to do that. That's part of our job.

What I like about chat or something like chat is that it gives me a crutch, if you will, a kiss me -- I feel like I have a structure. I can go and meet with 20 people in a nursing home, or meet with 40 students at the University, or meet with people in inner city Detroit or in downtown Flint who have been uninsured for 30 years.

I have a structure. I have something that I can move along, and it will make me personally feel much more comfortable about going out and engaging in these kinds of discussions with the American people.

So with all due respect, the web is great. The 500 exciting, but I think there's an in-between where we sit and we listen to people that we agreed to do. It's time to step up to the plate and do it. I, for one, would feel much more comfortable if I had something like this, that gave me structure.

You know, I was talking to Joe earlier. You know, let's say I go into Detroit and I'm meeting with a lot of union guys, and we start on the game, and then they just say ?You know, we want to talk about' -- if I feel comfortable and confident by then, I can abandon the game. But a game is something to start with.

My guess is I don't know what your experience has been; I'd like to ask you. A large percent of the time, they get into the game and want to finish it, and then we'll get the good data that George can use and that Richard can use to analyze.

But sometimes, you know, you can abandon it. But I, for one, feel much more comfortable and confident if I have some structure, and at the same time, the working group would benefit because we have data. For all the ones that we get all the way through the game, we actually have data.

MS. GOOLD: Well, one of the ways is the game structure, and the other group members will moderate some of what they're talking about, where someone's coming in and they have one particular issue that they want to pick on, their particular feeling of a friend or themselves or whatever.

The structure of chat can be used to moderate some of that. They have to talk to other persons, not just you. You don't have to be tied down that way. They get to talk to each other and say, you know, well that's well and go, but what about this over here --

MS. CONLAN: I saw somewhere that this is a particularly good medium for working with the disabled community. But then when I looked at the things that we didn't really get to explore, it seemed very dependent on visual and eye-hand coordination skills. So what does that mean that it's good for the disabled community?

MS. GOOLD: Well, let's -- some of them have a different version. In the original, actually not as dependent on those skills. You do need to be able to read at about a sixth grade level, or someone who couldn't read, they would be offered the services of an assistant for the exercise, and have some visual skills.

Although we have, with the software, a program called, let's see -- something that enables them to have the larger computer screen software, it enables people with low vision skills to do it, on a special computer. Also we need to identify people who need that.

But by knowing this, we can accommodate all types of people. You know, you have the low vision that can be accommodated, some difficulties with fine motor integration.

MS. CONLAN: So then what does that mean when it says this works particularly well with the disabled?

MS. GOOLD: I'm sure what --

MS. CONLAN: Oh. I guess I thought --

MS. GOOLD: But we developed it to be --

MS. STEHR: Well that's something George sent to people.

MS. CONLAN: Okay. I guess I just saw it in writing, so I thought it was -- okay.

CHAIR JOHNSON: Okay. Frank and then Bill.

DR. BAUMEISTER: I just had a question about the cost of the materials in this program. You see where it says at self-initiated community meetings, that we want to encourage the use of this program. What kind of expenses would they incur?

MS. GOOLD: Well, they have to spend a little bit. I mean, the software itself is cheap. Usually you can get it for laptops, which is not as cheap, although you can rent them, so it's pretty useable.

Actually, in most of the projects we've done, the major expense has been in recruiting and assembling the groups, and not so much in the user materials. So that tends to be the bigger obstacle. So that's going to be an obstacle --

CHAIR JOHNSON: Can we assume that -- I'm amending his question. Can we assume that the software can be downloaded on anybody's computer?

MS. GOOLD: Yes, yes, and there are cheaper ways of doing it. You have a computer lab at the public library as a source rather than laptops.

DR. BAUMEISTER: How about this little board game in the pamphlet?

MS. GOOLD: Yes. This version is relatively cheap for use. We have educators who are using it. The difficulty is in first creating it with a different content, you know, just make a new one. If you want to change the content, you have to make new one. It's not that big a deal.

Data collection, if you want to collect data. For self-initiated groups, that may not be an issue, if you don't care about what data is coming out. But data collection with this can be trickier. You have to find paper of some kind that you track it, enter it.

What I found in research projects is that it tends to be the loss between running laptops for a week to do, you know, eight or ten groups or whatever some place, and paying someone to enter data.

CHAIR JOHNSON: Can I ask a question before I go to you, Joe.

MR. HANSEN: Go ahead.

MS. GOOLD: Yes.

CHAIR JOHNSON: I still need a meeting of, let's say, 50 to 100 people, and the working group gets the people there. What's the cost?

MS. GOOLD: What's the cost? Who's facilitating it?

CHAIR JOHNSON: You tell us. What's your recommendation?

MS. GOOLD: Well, I think when I talked to Theresa on the phone the other day, I said probably the simplest, most convenient and most consistent way of doing this would be to hire someone familiar with Chat, to go to all those places and facilitate.

I say it for a couple of reasons. One is, that way, whoever's there from the working group can listen, because facilitating is -- you know, you have to be --

CHAIR JOHNSON: Okay. I'm going to ask you to move on and answer the question because of our time.

MS. GOOLD: Okay.

CHAIR JOHNSON: So what's the cost?

MS. GOOLD: What's the cost?

CHAIR JOHNSON: Yes.

MS. GOOLD: I don't think I can answer that accurately. I did get something from a group in Minnesota that has a lot of experience with Chat. They've taken it to a lot of the National Education Association conferences.

I've got some figures in my briefcase. They are interested in doing this and willing to discount their prices substantially, because they think it's important and that it will generate a lot of interest in Chat, and they use that in their work.

But I can't answer off the top of my head here.

DR. SHIRLEY: I'm curious about the contradiction that both Mike and Catherine raised, and you actually said it, if we don't care about the data. Because in Catherine's example, she talked about meeting with a group of uninsured. That's going to skew it to their interest, as opposed to this. So how do you deal with that?

Because I think it could be a useful tool, but how do you make it so that it really applies to what we're doing here?

MS. GOOLD: As a researcher, I can tell you that any time you gather data from groups of people who you convene to meet in groups, your data will be skewed, period. Well, that's not fatal, because all data has bias in it of one sort or another.

So the more you can use representative sampling, the more something I call substantive representation, and that is you can gather groups, such that all the relevant interests are at the table, or at different tables.

I think you can overcome some of the weaknesses of that. You can't eliminate it completely, but I think you can ensure that you include enough a representation of folks in groups, so it overcomes all that. But can you get perfectly statistically generalizable information? No.

I'm not sure you can do anything, but the group exercise overcomes some of the weaknesses of surveys, for instance, where people answer things off the top of their head that they may not have thought about that much.

In this case, they have to think about it, and that overcomes some of the known weaknesses of surveys. However, it has weaknesses of its own. That's one thing.

DR. SHIRLEY: I like the exercise. I was just trying to figure out what we do with it after.

MS. GOOLD: Yes.

CHAIR JOHNSON: Joe.

MR. HANSEN: Just 30 seconds. Having done -- I've done a bunch of these for senior citizens with the new Medicare bill, 150, 200 people at a senior center, and I would just really caution you to go into a group like that with this.

You know, they say the Citizens Working Group is coming to town and you've got an hour and a half to meet them at wherever, and you bring out something -- and the reporters stay for the first 15 minutes, and the report is going to be ?You brought out a game.'

I think you do what you want in terms of this one. I would much rather go into that sort of an environment with a well thought-out, pre-tested PowerPoint that sort of lays out the major things out there and do it.

I just think that -- I think this is a great tool in the right context. I would just -- I mean, you should do what you want, if this gives you a tool to move forward in this. But just be careful. Be ready to --

MS. HUGHES: But you do overlay on the game. Yes, and in California the press was --

MS. GOOLD: Plus there's a lot of simulation.

VICE CHAIR McLAUGHLIN: Simulation. So now how did the press respond to it in California? Theresa, you were of it from, through the press in California or when --

MS. HUGHES: Well, in California, I witnessed it at an ABD, blind and disabled population, get together with a stakeholders' meeting that the administration had called together, in conjunction with several foundations.

It was -- how it was received, the issue was managed care, the ABD population going into managed care, and the fear that the ABD population had, was very high, because they have specific providers that they've fought very long and hard to, you know, attach themselves with, and how would they have any control over anything.

So I believe your tool was used to give them some element of control, so that they could make recommendations off of it to the administration, in terms of how to serve these populations well and meet the goals of the administration.

The press that was received from it, the press that I remember is that, one was that something to the extent that it took the sting out of making a move. I don't know that that's pertinent to every population, but I do know that the ABD population that then attended subsequent stakeholder meetings referred back to this exercise and -- as something ?Well, I have more confidence if you use this thing that we did.'

MS. GOOLD: That's true, but -- so generally speaking, the feedback from the adult disabled MediCal who was participating in that project was favorable, especially at the time and right afterwards, and to some extent later on when the report was submitted to the administration.

But there was also some feedback, and I think it's important to note that they had started with their total pile of resources was starting with 15 percent private funds, the state portion of what costs were.

So they were starting with the part that was actually 50 percent below what they have had before. So there was some -- some treat it like your games are making us do away with the system. This is an excuse for you to cut back on our programs.

There was some negative, there was some negative press associated with that particular context.

MS. HUGHES: Right, and that there was -- yes, I apologize for getting that wrong. But yes, because there was negative press associated with the ABD population thinking they had to make the decisions for the administration.

MS. GOOLD: I don't know that that would be as applicable to this sort of a plan, however, because you're not starting Medicare benefits --

VICE CHAIR McLAUGHLIN: --the presentation this morning is why is it up to privately insured workers to trade two percent, four percent of their premium dollar for the uninsured?

If the game is set up that way, there may be some anger and frustration, right, that the game, you know, that in fact you may be -- wait. ?You're making us do your dirty work for you.' The same idea, that ?You're making us give up something to pay for the uninsured. Why doesn't the federal government give up money for B-1 bombers for the uninsured.' I just said that --

MS. HUGHES: In fact, that's one area that they --

VICE CHAIR McLAUGHLIN: Do we even have B-1 bombers any more?

MS. HUGHES: Yes. Was this isn't our responsibility; it should be somebody else's responsibility. Why should it be coming from us?

CHAIR JOHNSON: Susan, another question, if I could. Let's say that we had different working group members that wanted to use it. We're going to conduct a meeting, one of the self-initiated meetings and let's see they're two hours each.

Let's say that Joe would like to use this as a tool for doing that, but let's say Pat doesn't. Pat feels more comfortable using a PowerPoint presentation, and asking questions and getting the dialogue going, or with the flow kind of a discussion.

To what extent is there flexibility in your mind to do that, and the other area of flexibility is, would be around lengths of time. You said two hours would be the ideal. Is it possible that Pat might use this for an hour and Joe might use it for two or anybody else's same questions? Just examples.

MS. GOOLD: Okay. So I'll take the second question first, time-wise. I think it can be done in an hour. There's a couple of ways you can vary it. You can drop the second round; there are three rounds. You can drop the final individual round. Obviously, you don't do data then, but from the -- especially that final individual round.

But the caution has to be not to, as much as possible, to constrain the amount of time for the group dialogue about the tradeoffs for the meetings. You can do it in an hour, as others have done it. You can do it two hours. An hour and a half is fine.

So that's the second question. That's pretty easy. How flexible is it in terms of-- and I think Catherine was alluding to this earlier. You start out with this, and then the conversation moves on to something else all together.

Or don't use it at all, in which case you just leave it at home. But if you wanted to use it as sort of a starting point, jumping off point and then have, drop the last two rounds, fine. I mean, it's going to affect -- there is going to be a tradeoff there in terms of there can only be collection of certain data.

But other that, I don't see why we can't do that. Did I answer it.

CHAIR JOHNSON: Aaron.

DR. SHIRLEY: Yes. But we've talked about the legitimacy or non-legitimacy of data. But on the other hand, Catherine talked about going out and listening to people. I hope we're not assuming that when we go out and listen to the people, that everything, you know, what we collect is going to be so, you know, legitimate for scientific purposes.

But I can see --

CHAIR JOHNSON: I think that's the reason for the thousand-person survey that George mentioned this morning.

DR. SHIRLEY: Okay. But I can see this instrument, some of the questions or activities being used to stimulate some very interesting discussions among the small, self-initiated meetings.

MS. GOOLD: And in fact, I think I've done some analysis, not only analysis but dialogue, which is data of a different sort than a survey or that quantitative stuff on conclusions is what data we are trying collect.

I think it's going to be very illuminating to learn, for instance, why people are arguing for and against the uninsured category or to the paper that will set deliberations about mental health parity and mental health and substance abuse services and arguments about coverage for those categories.

I think that can compliment the other categories. If you look and see, for instance, that people change. Individuals are more likely to choose mental health coverage after the group dialogue than before.

But I want to know what's going on? What are they -- are they learning something? Are they feeling more that there's a responsibility to the community to take care of those who are uninsured? What is it that's going on? I want to know, so that that data is complimentary to the other.

MS. HUGHES: So you can work on the press as a --

(Laughter.)

MS. GOOLD: Basically, right.

MR. HANSEN: Well, I have one -- Pat, go ahead.

MS. MARYLAND: I was just going to ask a question. Actually, you stimulated a thought regarding we have an opportunity at these different forums to touch hopefully the hearts and minds of quite a few people from across the country.

During that time, and this is not necessarily a question directed to you but to the committee, but would we be using this as an opportunity to perhaps develop a standardized survey tool of some kind, that could be completed by those in attendance, whether those are the small meetings or the standard meetings or the larger meetings, where we try to elicit specific information about their thoughts?

It's very targeted questions that might feed back into helping us at least put together recommendations. Could we use this as an opportunity? I'm sort of throwing that out, based on what you said, because I think we need something more structured to have some --

MS. GOOLD: You can add that. I mean, you could have that. We have a pre- and post-survey there to ask questions on that. But maybe you may not want to add to that.

MS. MARYLAND: It just was a thought.

CHAIR JOHNSON: Dottie.

MS. BAZOS: Well, I just wanted to address your question. I believe that one thing we were thinking is that when we did meet with the public, we would be focusing on the four questions that we've been charged to focus on, and that a survey would be developed, and we would be collecting standardized data in that way.

What I'm trying to come to terms with is I think Chat sounds great, and I've been concerned about how we would have discussions about tradeoffs. So this seems to be very interesting for that piece.

What I'm struggling with is how to marry sort of that discussion that Chat facilitates with some of the broader questions that we need to have answered, without overwhelming the public and getting off track.

MS. GOOLD: Well, your question about financing. Chat really does not do much for that. The only piece of that might be for the uninsured category. But it really --

MS. BAZOS: And the tradeoff piece, if I understand correctly -- but that's specifically around plans.

MS. GOOLD: Right.

MS. BAZOS: Or services in plans that you find in benefits.

MR. FRANK: It's not even services. It's benefit design.

MS. BAZOS: It's benefit design. So it's a little more narrow than I had been thinking would approach --

MS. GOOLD: Well, I think that the benefit design is what they start with, we all start with, and they then as they talk about it though, is what that means when you get sick, and what services are and are not available, restrictions on access, and not just for yourself but also on the members of the group.

So I think the tradeoffs are not just about sort of having this coverage versus that coverage, as it translates through the feedback mechanism and through the group dialogue into sort of the consequences and the tradeoff would happen at a personal level.

You can also set up the exercise, and this is what the meeting in California was about, in a different way completely, where categories can be not service categories but in, for instance, California, they're looking at different kind of health care needs.

I think it's a little harder for ordinary folks to grasp. It's a little more abstract. The other is more concrete and then they get a hospital and say ?Oh yes. So that means I can't see a doctor for X number of days.'

CHAIR JOHNSON: Can I pick up and ask a similar question using different words?

MS. GOOLD: Yes.

CHAIR JOHNSON: Because I'm trying to get my arms around this as well. Let's say that Deb, in the rural areas, finds a lack of physicians of certain types, pediatricians, oncologists, whatever, and let's say that that's a subject that those people want to talk about.

Let's say she also feels that end of life, ?How do we treat end of life is another subject that they want to talk about. That's not a big issue in the game. So how would Deb incorporate, let's say, those two discussions, and maybe mental health care on top of all of those, and do all of those that are important in her location with the Chat game?

MS. GOOLD: Well, a couple of things. One is you can have -- you can tailor your categories. So you can have that in other projects. The end of life point is a little trickier.

If you have specific category of hospice care, but how would you, if you want to talk about any tradeoffs in terms of, you know, limiting life-sustaining treatment or what have-you, that would be, I think, more difficult to do, and I don't know if that is in there already.

One of the reasons we developed a Chat exercise is that I was struggling to think about how to talk to citizens, groups of citizens about limited resources and tradeoffs. The problem was that if you talk about just one thing or two things or three things, people always want to spend more money on those.

The whole idea was that if you're, you know, if you sort of include everything in order to realize that, if you want to increase access to obstetricians in rural areas, that might mean something else is not as good, or not as available or something.

CHAIR JOHNSON: Aaron?

DR. SHIRLEY: I'd like to proceed with our evaluation of the extent to which we ask Chat to work with us. Give some thought to how Chat could be used in prioritizing, if we were going to use this process. Prioritizing, determining where Chat could best fit, which category of meeting, which geographic area, which population group.

CHAIR JOHNSON: Do you want to try to get a sense from the committee of whether or not we want to use them? Is that something that's on your agenda today? Do we need to do that from a budget perspective and planning perspective?

MR. GROB: If it's possible to quickly determine what the boundaries are, whether they were -- I don't know how to put it. Is there a lot, is there a little. If any additional costs will come out of our other budget, but we get some immediate funds to use this for some of the costs.

I'm trying to think of way to quantify your question, because I think it would be --

CHAIR JOHNSON: Rosie has a comment she'd like to make.

MS. PEREZ: Yes. I just have maybe a follow-up question on where it would work. Has this been used in communities that don't speak English?

MS. GOOLD: Not yet, but it will be. Probably we need to plan for additional meetings, because the translators are not available yet.

CHAIR JOHNSON: To what extent, how many of you would like to see is pursue this further, explore it further, getting the cost and then a sense from the Working Group members of how we might use it? May I see your hands?

(Show of hands.)

CHAIR JOHNSON: Okay. We have a sizeable number who would like to do that, although not everybody. So you would like to see how close we can come to a conclusion today, regarding --

MR. GROB: Well, about how much effort do we put into this compared to the other things that we're doing? That's a very general way of saying will we have the staff time and money? We have all those meetings we have to plan.

DR. SHIRLEY: I would suggest that we not try to do that here, that within the next X number of days, we come up with some suggestions.

CHAIR JOHNSON: Okay. You as a committee want to come back to the Working Group with some thoughts regarding that, and in the interim, people get their feedback to you as a committee?

And would we have a deadline to get the information back to you by what date, Friday? I don't want to put words in your mouth --

DR. SHIRLEY: I had suggested earlier today that it would be good if our Community Meetings Committee could find 30 or 40 minutes while we're here, okay.

CHAIR JOHNSON: Okay.

DR. SHIRLEY: And if we can carve that out, I hope we might be able to come up with some recommendations.

CHAIR JOHNSON: Okay, thank you. And Dottie and -- Montye is first, and then Dottie.

MS. BAZOS: Okay. I would just like to ask that the Community Committee make their recommendation in light of what we've already talked about that might happen at the community meetings.

So that if you think about it, I know we've talked about developing a study guide that would sort of march through some of the things we've talked about in our report, and having surveys. So I think it's difficult for me to think about a decision about Chat separate from anything else.

So I'd like it within the context of what else we've thought about. Or, if it's a separate activity, that too. But I'd like that to be considered and weighed. Thank you.

CHAIR JOHNSON: Okay. Montye, and then Mike.

MS. CONLAN: I was wondering if it's a good use of your facilitator to maybe come, but I'm just going to use my own example. I have a support group, and I know other support group leaders.

Let's say we had a facilitator come, do the simulation with us, train us so that then we could go to our support groups and do it in those small groups. Is that a good way to operate or --

MS. GOOLD: Yes. In fact, we designed the exercise so that we should be able to have facilitators trained beforehand, and participate and want to be able to facilitate the meetings.

MS. CONLAN: So then we would just pay for a facilitator, maybe, to come to my area, work with maybe a group this size or a little bigger, and then we could spread out and multiply that?

MS. GOOLD: We could, and one thing I discovered is that the facilitator is busy during the exercise. If you want to listen --

MS. CONLAN: I'm just talking about as a compromise, to save costs.

MS. GOOLD: But yes. Certainly for self-directed meetings.

CHAIR JOHNSON: Richard.

MR. FRANK: It's easy to confuse us. The hairline's the same, nose, skin color. You don't know what a burden it is.

(Laughter.)

MR. FRANK: The question I have is -- I think you've given us a really good idea on really the thing that this technology does really well, which is it seems to focus really on tradeoffs and benefits to society. That's really what it's built to do.

My question to the subcommittee, which I'm a member of, is that the most important tradeoff that we need to wrestle with as a working group? I don't know the answer, but I think that unless we answer that big picture question, getting into all the details about, you know, cost and stuff isn't going to be all that useful.

So I think that's the first question we have to ask, because you know, you've given us a really good idea of what the capability is in this area, and the question we have to ask ourselves is where does this fit into what we really need to find out from the American people, in order to do our work.

VICE CHAIR McLAUGHLIN: I was just going to say, Richard, the four questions, the very first one is what services do you want to be delivered? It seems that that's directly what this is about.

MR. FRANK: No, that's not -- I would say that's absolutely not true.

VICE CHAIR McLAUGHLIN: Well, it can be -- it can be absolutely designed to get, to elicit responses to that question.

MR. FRANK: Well, yes. I think we differ, and that's why I think we should have a discussion in the subcommittee about it.

CHAIR JOHNSON: Okay, thank you. Any other comments before we adjourn this discussion with Sue? Well, we want to thank you for coming in today, traveling from Ann Arbor.

CHAIR JOHNSON: Okay. George has some other things that he would like to go over with us with respect to decision processing.

MR. GROB: Well, this is the agenda item that we left our committee meeting this morning with, which is we need to now make decisions quickly about the skeleton meeting, the 10, the 1, and the 2 webcasts, as to what the sites should be for those, and the dates we're doing them.

We were asked to provide some options for the consideration of the Working Group. That would be premised upon some discussions we had this morning about where members would be interested. But, actually, I think that the sentiment was really to have a strategy for it as well, and to give you more than option for that.

But we also said that we need to do this quickly, because we need to post those dates and sites on a website on October 6th. So the question is, what process would the Working Group like to use, in order to make that decision?

I'm talking about do you want the telephone meeting? Do you want the memos? Do you have a preference for how you all say yes or no to what we're going to do? We do need to do it long before we'll all meet again.

MR. HANSEN: George, is a place to start, was there some sites that are being discussed in committee that are with staff, that maybe you could just put out there as a place to start, on at least locations?

MR. GROB: Well, I took it and -- when I took it as a list to you before, I didn't know how to ask you whether it was everything that was -- I was assuming from the last meeting that we had, that if members wanted to have a meeting in their city, you know, one of these kind of meetings, that we would do it.

Now there are very few members that weighed in, that they would like to have one of these kind of meetings in their city. Most members said that their city wasn't as special as just trying to decide what a good group would be for the meetings.

So the only set of places that -- for which there had been any pre-decision made that was principle, that if members wanted to have one in their city, we would try to honor that.

So other than that, while we have ideas, we haven't come -- but it wouldn't take us long to come up with suggestions, based on a variety of principles. You know, you want to do north, south, east, west, rural, urban, this kind of group, that.

You know, there are a number of the usual analytic techniques, and you try them out and see what it gets you. We know, for example, if you use border cities, you know, in border states, you pick up two states that way, you know, to the extent to which you said you were in those states.

That's just the usual set of analytic things. So we could give you four mixes of the principles that we used.

CHAIR JOHNSON: So let me clarify. Your assumption earlier was that Working Group, most of the Working Group members would want to do one of the 30 conventional small meetings. Is that correct, or you were thinking most would like to do some of the standard meetings, which are larger?

MR. GROB: No. My view, from you know, talking to people, that the mix that revealed itself in our meeting, that's what I was getting back from this. Some wanted, you know, a big one, but others wanted something more intimate.

But the principle I was using is that if a member wanted to have one of these big meetings in the city in which they live, then we would put that one on the list. Then all of the rest of the cities would be selected on an analytic basis. But again, I'm not held to that. That's what I thought you wanted to do.

CHAIR JOHNSON: Mike, and then Deb.

MR. O'GRADY: I guess I just had one thing in terms of, because of the way that we've operated over the last hour. You sort of laid out a number of different things as we were walking through the budget, and how many meetings and how much and things like that.

There's only one thing that caused me some discomfort, or at least some concern, and that was the idea that it was laid out that we might let groups sort of go it alone or that there'd be outside groups, you know. Senator Wyden has talked about different things, you know, Starbucks.

That caused some concern from Brent, Mary, whatever. My experience has been that if we want to do things with groups we should. We should make sure they're balanced, but we need to control that process.

We do not want a runaway, that somehow, and I don't want to pick on a particular group, but it's sort of a little industry capture there, that they're saying it's the Citizens Working Group, when really no, it's a particular interest being represented, and they're sort of saying that.

So I mean, I think partnering with groups. I think we balance it to meet someone like Brent's concerns, and then we move forward. But I think on any of that, just it still requires that threshold of our own involvement, to make sure it's still our meeting, that we haven't been captured by somebody else out there.

MR. GROB: Let me clarify. It's exactly what you're suggesting, that if we had the live webcast, it would be entirely under our control, the content and how it would be done. We would be getting assistance from those who want to participate, in terms of announcing the meeting, of promoting it in their place of business, you know, and things like that. But it would be under our control.

That would be true of all of the meetings that I've called the skeleton meetings, the fundamental ones. Where the groups could come in would be in two ways. One is, some organizations might make a request that we come and a make a presentation and their meeting, in which case it's still us agreeing to go there. That would be like one of the 30 ones could be done that way, for example. That would be one way to get at some of those.

Then the other way would be if groups would simply flat-out like to hold their own meeting, they would -- we can't stop them anyway. So we would give them a kit on the Internet that anyone could pull down, should they simply want to --

MR. O'GRADY: I don't think they get to have our name associated with it.

VICE CHAIR McLAUGHLIN: Yes, because then it has our name on it. That's what he's getting at.

MR. GROB: Oh, okay. So you are --

MR. O'GRADY: Yes. I don't think you want to do that. I don't think you want to do a very particular group with a very particular policy they're pushing, somehow makes it appear that the Citizens Working Group is 100 percent behind their position. I think you just need to buffer it.

CHAIR JOHNSON: Okay. Deb?

MS. STEHR: George, could you get us like a list of those key members of Congress that are on those committees, and what states they're from, as a way to help determine where we will be, and then we could also, you know, we could group regionally, whatever, according to those key people. I think that would be real helpful.

MR. GROB: That's an excellent idea. That will be one of the criteria that we'll use. That's an excellent idea.

CHAIR JOHNSON: And Montye?

MS. CONLAN: I guess I'm looking at this still, and I know Dr. Shirley has done some work, and I was kind of interested in working through the extension agents for the distance learning. I don't see that on here, and how does that fit in?

I guess I would be interested in having Dr. Shirley tell us some more about that.

DR. SHIRLEY: Most states have a land grant college, and along with that goes, it used to be agricultural extension. They have considerable distant learning capabilities. The extension service in my state has offered their resources and assistance in whatever way we want to use them, as part of our getting out work and ideas out.

They have agreed that they would work to assist the states of Florida, Louisiana and Arkansas, in doing the same thing. They suggested that there's probably an extension service in every state. So that's an idea that we would like to pursue.

VICE CHAIR McLAUGHLIN: On television? Is that what --

DR. SHIRLEY: No, interactive. Interactive

VICE CHAIR McLAUGHLIN: Computer.

MS. CONLAN: Like in a classroom, but the professor is somewhere else.

DR. SHIRLEY: They can set up --

VICE CHAIR McLAUGHLIN: Oh, so it's through a computer.

MS. CONLAN: It's like teleconference.

DR. SHIRLEY: T-1 lines.

VICE CHAIR McLAUGHLIN: Yes, teleconference.

DR. SHIRLEY: Something like that. They do distant learning. It's geared towards distant learning, but it's interactive videoconferencing.

MS. CONLAN: And they usually have sites at all the community colleges. It's called TWIV.

DR. SHIRLEY: They suggested that in Mississippi, they should traditionally do 100 to 200 in a setting, like a typical classroom, and the instructors are someplace in a studio. There's a two-way interactive video.

But they say they could, after we described what we're trying to accomplish, that they could accommodate a facilitator at one spot, and the satellites around the state, and dialogue going between the facilitator at the site and the satellite sites.

VICE CHAIR McLAUGHLIN: Could you use that with Chat? If you had the facilitator in one central spot, but then all the materials went out to all the distance learning centers, that way you can save money on the facilitator but still let all of those people participate in that.

DR. SHIRLEY: That's a thought.

MS. CONLAN: It actually may be what you could do is dialogue scenario.

MR. GROB: In essence, that is -- the two models we had were we were thinking of -- there's two ways in which the facilities of the agricultural research center can be used. One of them is, as you're saying, as another version of the Starbucks kind of a version of a meeting.

In that case, we were thinking of combining it with the needs of Chris' group, that that would be an extension of a meeting there, using live webcam system extension to a meeting centered on Chris' area.

Now the other way that we could use it is simply as one of the 30 meetings with a meeting coordinator, you know, directing the meeting separately, and the other people would be participating from a distance through the usual learning thing.

So for that, you could use any variety of formats that you wanted. Whether Chat would work that best, we don't know if that will work.

VICE CHAIR McLAUGHLIN: I think had one more thing, Mike, that I heard about two weeks ago that in addition to Starbucks and Marriott, Borders is a potential, which Brent was happy about too, because there are a lot of readers, you know, and Borders has hot spots in odd places.

The Borders headquarters is in Ann Arbor, which is how I heard about this, that there's some possibility of that participation. So I think your point was we need to have several employers that are amenable to different populations, and it doesn't give an impression.

So I just thought I need to ask that, because I'm not sure George has informed the Community Meetings Committee that Borders is now on the table, too, as a possibility along with Starbucks and Marriott.

CHAIR JOHNSON: Whatever you heard regarding the process. We started this discussion 15 minutes ago on what's the process going to be.

MR. GROB: Again, what I've focused on is to choose those ten regular, one big one, and two webcast meetings. I think the webcast was going to just be a small meeting. But for the 11 others, we've received instructions to give you options that provide an analytic basis.

So let's suppose that there comes a day in which we have a paper that shows four options, the basis, the pros and cons. I now need to get a decision from all of you in terms of how would you, what process do you want in order to discuss and consider the options we present to you, and then to say "Yes, we agree. We've all chosen this one"?

MR. O'GRADY: May I make a recommendation on that? If you took -- we're shooting, our target is like ten, for this sort of --

MR. GROB: Ten and one big one, yes.

MR. O'GRADY: Ten and one big one. If the staff could go through, lay out for various pros and cons 20, and then just e-mail it out to us and we rank order, and you can see sort of how different people are kind of voting for what they think.

I would say with a little, at least a paragraph or two of why the staff, sort of the pros and cons and lay it out. Some of them may even be logistical. We'd like to go to Kansas City because there's a big regional office and that means we've got infrastructure there that we can work off of and do our advance work.

I mean, it can be like -- or your point about let's a pick a place where it's a couple of different states or a Four Corners sort of arrangement and do that.

MR. GROB: Right, right.

MR. O'GRADY: So, I mean, that would at least allow us all to sort of see the list, not just see ten, but see a number of them, see the pros and cons, what the staff was thinking about, and that would give me enough information, I think, to be able to start saying ?Well, this looks like the first pick. This is number three,' you know, things like that.

MR. GROB: Then when we hear back from you all --

MR. O'GRADY: And of course, the chair heads the deal.

VICE CHAIR McLAUGHLIN: And this is just for the ten?

MR. GROB: The ten, and -- but I keep saying 11, because I want to come back to that 11th one, which is a big one, because it's a much bigger decision. But of all things, that's probably what I would make more than the others. But let's stick with the ten for a moment.

So then we hear back. So my problem is, the question I'm raising is, how do I get a decision from the Working Group, if we're not convened here face to face?

MR. O'GRADY: But don't you -- well, I guess what I'm -- well, I think, I shouldn't put it that way. What I think is if you said, if I got an e-mail and it's on Tuesday, and it said ?By Thursday, I need you to get back to me and give me your ranking, 1 through 20, of these 20 sites.'

I could read a little blurb that said ?This one, but this one has webcast facilities and we're not going to hit that anyplace else,' whatever the staff thinks is their sort of pros and cons here, for me to take the time and go through this and just rank order, and shoot it back to you, and then you can sort of see where the Working Group comes out.

VICE CHAIR McLAUGHLIN: Except we know you have to call Aaron and let him know that's coming. He told us that a couple of months ago.

MR. O'GRADY: Oh, I see.

VICE CHAIR McLAUGHLIN: If you're sending an e-mail, you have to call and let me know.

DR. SHIRLEY: There are some weeks I don't go down to the country.

(Laughter.)

MR. O'GRADY: Oh, all right. Special accommodation.

CHAIR JOHNSON: Okay. So what I'm hearing your suggestion is, Mike, is staff puts this together, and by X date they send this out. They give us two days, three days, whatever they feel comfortable with, so that they can get sufficient feedback from us regarding their recommendations.

If the feedback is strong enough and uniform enough, we'll move in that direction. But on the other hand, if there's disparity between the responses, then we have to --

MR. O'GRADY: Yes. That's the way -- I'm seeing this as an options paper with a decision memo at the end, in effect. So if you find that we've got eight people here who all want to go to Detroit, take us to Detroit.

If you now find that there's something where we all want to go our hometown or wherever our little girlfriend's from something like that, well then you don't have a consensus.

(Laughter.)

MR. HANSEN: Or boyfriend.

MR. O'GRADY: Or boyfriend.

CHAIR JOHNSON: Okay. Montye, you had a comment?

MS. CONLAN: I just wondered, does that circumvent the committee? Are we, is the committee in there in the line of --

CHAIR JOHNSON: Yes. I think it does. It does mean the committee's going to be involved. Won't you be sharing that with the committee?

MR. GROB: Yes, if that would be a good way to do it.

MS. CONLAN: I'm sorry. I didn't understand.

MR. GROB: I said I think yes, I think that's the proper thing to do.

CHAIR JOHNSON: So it is amending your comment, but you would share this with the committee first.

MR. O'GRADY: Well, and seek committee input, in terms of what --

MS. CONLAN: Well, that's what I'm saying. Wouldn't you seek committee input first, or maybe have the group kind of, and all that information that came in from the entire group, go to the committee? The committee could say, you know, this is what we see. This is what we think and recommend, and then -- just acknowledging the fact that we have a committee.

VICE CHAIR McLAUGHLIN: I think this goes back to what I said earlier, in that we have to rely on people to do the work for us. I don't know anybody here, and maybe I'm speaking out of turn, that this is their full-time job.

We have staff. We need to utilize them. They need to do the background work for us. They need to bring it back to the committee and make the decision, like Mike said. I don't have the time, you know, even if I was on that committee, to sit and look and investigate.

CHAIR JOHNSON: So am I hearing you say that you think the staff ought to get to the committee, get their feedback and then out to the Working Group?

VICE CHAIR McLAUGHLIN: Yes.

CHAIR JOHNSON: Are you all comfortable with that?

VICE CHAIR McLAUGHLIN: Yes.

MS. CONLAN: Yes.

CHAIR JOHNSON: Okay.

MR. GROB: I have one other thing.

CHAIR JOHNSON: Yes. We're just about done with this committee.

(Laughter.)

CHAIR JOHNSON: We have two more minutes.

MR. GROB: On that, I will also include the discussion of the choice of the one big one, on the assumption that that would be the first one, and that will part of our analysis.

CHAIR JOHNSON: And you want to talk about contracts, where we're at?

MR. GROB: Okay, and the contracts. That's the other thing --

DR. BAUMEISTER: Can I ask one question? If George is going to do all the work with staff, to narrow this group down to 20 or so, and you're going to send it out, why are you going to send it through committee, if everybody else is going to have to vote on it yeah or nay, and you're going to get input from everybody?

I just see a middle man here that's unnecessary, from my standpoint. This is a question I raised this morning. I think that --

MS. BAZOS: I've got one question. Richard sits on that committee and has brought up, I'm sorry Richard, several times that, you know, we need to know what we want as an outcome.

We need to make certain -- I'm a little uncertain, but I'm sure you've got it figured out, how you can take 50 sites, narrow it down to 20, and get to the outcome that we want, that's stratified the way we want it, that has the sample that we wanted.

So as long as I'm sure that Richard's weighed in, that he's going to get the outcome he wants, then I don't know what other role the committee would be playing. But I know that Richard sits on that committee and is responsible to make certain that the input we get from the community meetings gets us the output we want.

VICE CHAIR McLAUGHLIN: And Richard's asked the experts, so --

MR. O'GRADY: To answer Frank's question, I think the idea it is identifying that the committee has expertise beyond what the staff has, and that it should be -- I mean, I would -- I don't know that you need to be staff does all their work, stops, has a final product, turns it over to the committee. I would think it added some fungibility between them.

But this committee is focused on this. So I think that in terms of they've been thinking about this, exactly what we were talking about before with Christine, way more than I have. So I mean, you know, you want that value, you want that improvement in the product, and then it comes out and then people can sort of say --

But it might take you a couple of -- it might take more than one round, if all of the sudden you found they're all in, you know, Florida and Georgia. You'd go ?Wait a second, guys. This is great, but you haven't balanced it the way you need to.'

CHAIR JOHNSON: Okay. This will be all. Richard's comment will be the amen to this session, and then we're going to go to Dottie and the Communications Committee.

MR. FRANK: I just had a suggestion on how you might use the committee, which was maybe that -- I mean, I've heard a lot of suggestions about the criteria that go into making up the list, some of which I think are a great idea and obvious, and some of which I think are really bad ideas.

It might be good to have the committee help you narrow the criteria upon which the staff will put together the list. Then go back and make sure -- the committee can make sure that it went that way before it goes out to the Working Group, and tweak it a little bit, as Mike suggested.

Because I think that we've now got -- you've probably got a list now of people who have been taking notes, of 47 items, you know, and it's hard to pick when you've got 47 criteria 20 places.

CHAIR JOHNSON: Okay, thank you Richard and George, and thank you, Aaron. I appreciate your initiative here.

(Simultaneous discussion.)

CHAIR JOHNSON: Okay. Dottie, ready to go?

MS. BAZOS: I'm ready. Okay. Communications Committee. First, I think it's in order that we thank Rachel for all the work that she's done on the Communications Committee.

(Applause.)

VICE CHAIR McLAUGHLIN: When's your last day, Rachel?

MS. BAZOS: Thursday, and we're not leaving her seat empty for long. I'd like to welcome Connie Smith, who's going to be the Director of Communications. So welcome.

(Applause.)

MS. BAZOS: I think everyone met Connie today, so poor Connie. Okay. I'm going to have to change this agenda a little bit, so I'm just going to do it my own way.

First of all, I'd like to make a request of the Communications Committee members that we meet tomorrow morning for breakfast, to do some of the work we didn't get to do today. So I'd like to meet at 6:30 at the gym, ready to roll.

(Laughter.)

MS. BAZOS: We can meet tomorrow morning what time is our meeting, 8:30?

MS. HUGHES: The hearing starts at 8:30.

MS. BAZOS: So I'd like to meet at 7:00.

MS. HUGHES: Where?

MS. BAZOS: Wherever the breakfast -- right around in the lobby, and we'll find a place right there. We'll meet for one hour and then we'll be over here for 8:30. So let's say 7:15, 7:15, so that we can get some decisions made.

Okay. In the lobby at 7:15, so Catherine and I don't get lost, and we'll come over here and have bagels and juice and coffee. Finish up our meeting.

Okay. What we have for a report today -- tomorrow, what our agenda will be is we need to talk about upcoming events that we have. We have our report that Catherine's going to talk about today, and we're going to actually publicize that the report is done some time early in October. A tentative date's been set, October 6th, and that still is tentative as far as I understand, unless it's changed in the last week.

What I understand is that Senator Wyden is confirmed, that he can come to that rollout, but we're waiting to hear from Senator Hatch. George, is that still true?

MR. GROB: That's still true.

MS. BAZOS: Okay, that's still true. So the date might change. So we need to make a lot of decisions about what that day is actually going to look like, who's going to attend that meeting, what are we going to do at that event, if our website's going to be up on that event, how are we going to bring people to the website?

So those are the kind of discussions we're going to have tomorrow. We're going to make decisions on that. We're going to at least make the list of work, meaning for the staff to get working on, to get ready for that day.

All right. So that takes care of that one big thing. George, I'd like you to talk a little bit about -- I missed the last phone call, so I'm a little bit behind.

But on the last phone call when you redid the budget, we made an agreement that you would contact the PR firms, write some contracts, and actually make it possible for us to contract with PR firms to do some work around getting the ten-pager done, around getting the website looking really good.

Can you just tell us what's happened with that and what your time line is for that?

MR. GROB: Yes. We put out bids using the expedited bid process to three firms. They were Edelman, Oglesby and I forget the initials, GMMP? GMMB. We are awaiting their response.

MS. BAZOS: And when are we supposed to hear from them?

MR. GROB: We are supposed to get their responses, I think, by Thursday. We received a call from our contract officer, that suggested a couple of them would have difficulty meeting that date, and we're talking about giving them a few more days, or clarifying whether we've received correct information from them.

So we're certainly hoping to receive their proposals by the end of the week or Monday. We're pursuing this one, so that we hope we can able to select very quickly. That's our plan.

MS. BAZOS: All right, that's great. So does anybody have any questions about that or need to be brought up to speed about that? Okay.

The other things, the one big piece that the Communications Committee has been working on is getting our website ready, and Andy's done a lot of work on that. We've looked at a couple of things on the website using GPO, and one is the logo that we will use.

Our committee has looked at the logo. We actually found one that we think that we really like. We were going to approve it for the committee to look at today, and I think Andy, what do we make -- we decided to wait until -- we'll wait until the committee sees it tomorrow and then send it around. I think that's probably the best thing to do, because we haven't seen it.

At the same time, we've got another draft of a website page completed. We've all -- our committee members have all put input into the page that GPO's been working on. We're getting closer to what we like. So Andy's brought another draft page for us to look at. We'll look at that tomorrow as well.

In addition to the logo and the website front page that we're looking at, the GPOs developed, we are going to ask and we all agreed that we would ask one of the PR firms to also give us, to look at that and kind of see if they can even make it a little bit better for us. So to give us a couple of other options that we could review.

So that's where we are with the website and the logo. The committee -- yes, Pat. Okay.

MS. MARYLAND: The front page that we talked about, the slide show specifically, did we -- was there any opportunity to make that slide show interactive, in terms of with the music and just a little bit about, you know, the conditions facing people of all ages, health conditions facing individuals of all ages? Remember the slide show?

MS. BAZOS: Well, we were talking about within the

MS. MARYLAND: Yes, yes.

MS. BAZOS: The face page that changes.

MS. MARYLAND: Within the face page, exactly.

MS. BAZOS: Andy, do you know?

MR. ROCK: Yes. I don't know if interactive was the right word, but it would be a revolving. So we'd have words and pictures. What those pictures and words are still would have to be done. We haven't done that yet, but that can be done.

MS. MARYLAND: The audio piece is not there.

MR. ROCK: The audio is the tricky part. It was pointed out by a member of the work group, as well as the technical people, that you start limiting the number of people who can access it.

So if you look at it further, there's sort of a technical issue about whether we have really a small audience at that point.

MS. BAZOS: Okay. All right. So we're getting closer to having a website page, and I would hope that we would have one. Why don't we just talk right now about when we get this website page and logo from Andy and look at it tomorrow, should we send it to the whole committee, so you can look at and just weigh in, give us your comments?

Those comments, then, will probably go to the PR firm. So does that make sense to everyone in the group as a process? Yes.

MR. O'GRADY: Can I ask one little clarifying question?

MS. BAZOS: Yes.

MR. O'GRADY: Andy, in terms of this, and as Andy knows, we spent a lot of time working on our web page back at ASPE (phonetic). One of the things, he's absolutely right in terms of if you want to go the full kind of Media Player. You limit your people.

Would you just explore a little bit, to see if there are -- I mean, a more generic .wav file, that will allow some of the things that Pat's trying to get to, but again, we stay at the same level of technology of anybody who really has a good web browser, can sort of, you know, if they have Netscape or whatever the Microsoft product is called, that they can get to.

Because that may be able to give you -- I mean it won't be full symphony, but it will at least do an intro.

MR. ROCK: Sure.

MS. BAZOS: Oh, okay. Anything else for the process to the website, or the PR firms, sorry? Okay.

The other piece of work that we have been working on is lots of members have been going out and talking to folks in their own communities and with their own organizations. So they've asked us, through Jessica actually, to put together packets, introductory packets of who we are, what we're doing, how to get hold of us, those types of things.

Jessica's done a wonderful job. We have those packets. They are in draft. I think that what I will do is Jessica, do we have enough for everybody?

MS. FEDERER: Yes, we have them.

MS. BAZOS: I'd like to hand them out to the whole Working Group as drafts, for your input. Once we agree on what should be in the packets, and I'll tell you what's in them now.

Let's see. There's a letter from the Working Group members. There's a little fact sheet about who we are, what is the Citizens' Working Group, a chart, a little page about how you can make your voice heard, and then there's our bios.

So that's what's in the package. Jessica can make these available to everyone. She's also been working on developing, once we get the logos, we'd all be able to have thank-you notes for people, business cards and what else are we working on putting together, so that it would all go in a little package, so that you could just hand --

You know, if you met with somebody, you gave them a package and they wanted something, you can give them your business card and you'd write them a thank-you note if you had a meeting with their organization.

So it would all be pretty standard with our new logo on it. This is sort of the basic of what I think a lot of us need to have in our offices, if we're going out and someone asks us who we are and how we can get in contact with you. We'd just hand them this package of information.

So the process for you getting back to us on this should be -- got a suggestion, Mike?

MR. O'GRADY: No, not me. I've already spoken enough. Richard has a suggestion.

MS. BAZOS: Richard has a suggestion?

MR. FRANK: Ask Mike.

MS. BAZOS: Ask Mike. I think that Jessica, you can send everyone these electronically, right?

MS. FEDERER: And if you also have edits, just to write them out and give them back to me, and I'll make them. Or if you'd like, I'll send out the e-file and we'll offer this on our internal Intranet, where you can access this and do track changes and send that back to me.

MS. BAZOS: Okay. Let's agree that we need input. If you're going to give input, we need it by next Friday. If we don't hear from you, we're going to assume that it's fine. We'll send an e-mail out that says that. So if you're late, you're late.

MS. FEDERER: And once I do the final edits, that's that.

MS. BAZOS: Then once we get input from everyone and we've redrafted these so that it's the wording and the language is what you like, then we will send you in hard copy as many packets as you request, so that you can have them in your office. We'll also put them up electronically if you just want to download them. All right. So this is meant as a tool for you.

VICE CHAIR McLAUGHLIN: By Friday, is that this coming Friday?

MS. BAZOS: Yes. What is today? Today is -- so next Friday.

VICE CHAIR McLAUGHLIN: By next Friday?

MS. BAZOS: By next Friday.

MS. WRIGHT: The 19th or the 26th, Dottie? 26th?

MS. FEDERER: The 26th.

MS. BAZOS: Okay, by the 26th.

VICE CHAIR McLAUGHLIN: Okay. I have a general question. On the letter from the Working Group and the "Health Care in the United States," and I guess that's it, how much do you think that should coincide with the report? Are these considered separate documents, or should the language and the information and the -- given in the letter and the health care go with the report?

MS. BAZOS: It should coincide, and it doesn't.

VICE CHAIR McLAUGHLIN: Well, I want to know whether -- yes. I want to know whether the Working Group thinks that that should be the case, and if it is, then the Report Committee needs to get back to you, because it doesn't coincide.

MS. BAZOS: So using those same numbers?

MS. WRIGHT: It should coincide.

MS. BAZOS: I should coincide.

VICE CHAIR McLAUGHLIN: I mean, if people think that's the case, then I will intervene and try to make sure that that's the case, because it's not the case now.

MS. BAZOS: Okay. So let's hear from everyone. I agree that it should coincide. All right. So Catherine, send us the right information --

VICE CHAIR McLAUGHLIN: It's just not the numbers. It's the wording, it's the tone, it's the ordering. I mean, the report is set up differently. So to the extent we want it to be the same, then we have to have sign-off from the Working Group on the report, to then do this, right?

CHAIR JOHNSON: Who is this to be used for?

MR. HANSEN: It's kind of a press kit, right?

MS. BAZOS: Right.

MS. FEDERER: Well, we have it as a separate press kit. It was a request of the Community Committee, meeting with organizations like their alumni associations to their schools, their history teacher for their child. But when people ask what is the -- what is the Citizens' Health Care Working Group do, just so that you have something to give them at this point. Because at this point --

VICE CHAIR McLAUGHLIN: Well, in that case, I think we can't do it by next Friday, unless the Working Group moves real quickly on the report and we have a sign-off from everybody on the Working Group by next Friday for the report.

I think it's the chicken or the egg thing. I think what you have in here, I mean, it's not time-sensitive. Next Friday is sort of an arbitrary deadline, I gather, or --

MS. FEDERER: Are you asking me?

MS. BAZOS: Yes, it's arbitrary.

VICE CHAIR McLAUGHLIN: So can I request that you wait until the report is done?

MR. O'GRADY: Or do you want to simply remove those things that you think are report-dependent?

MS. BAZOS: Well, this is what I'm thinking --

VICE CHAIR McLAUGHLIN: Remove the letter and those two pages.

MS. BAZOS: Well, those are the two things that we were going to look at in the committee, that all of us looked at quickly. So why don't we --

CHAIR JOHNSON: I'm wondering if this kind of information should be part of the review with the public relations firm, and that's more where we might want to more closely align our language with the --

MS. BAZOS: And just put everything through them.

CHAIR JOHNSON: Pardon me?

MS. BAZOS: And just put everything through them, like the ten-pager and this?

CHAIR JOHNSON: Yes. So we have similar language, similar messaging.

MS. BAZOS: Well, I agree. I think what happens, though. Okay, here's the immediate problem, is we've got committee members that have said "I'm already being asked by a lot of people to give them information."

So is there some -- are one of thee fact sheets okay? I mean, could we look at one of these fact sheets, like "What is the Citizens' Health Care Working Group?"

VICE CHAIR McLAUGHLIN: Right.

MS. BAZOS: Could something like that be given out to people?

VICE CHAIR McLAUGHLIN: Right, right.

MS. BAZOS: And nothing else yet? Could we agree on one?

VICE CHAIR McLAUGHLIN: And "Make Your Voice Heard." I mean I think those we could get back to you on. And the bios. Make sure you read your bios. I'm not a math teacher.

MS. BAZOS: Well, I think that there's a mistake in your bio --

(Laughter.)

MS. BAZOS: So okay. Then I think that's a good compromise, because that would then get people something. Is that fine, or do you think we should wait until we have the final logo?

CHAIR JOHNSON: What is it that our people are looking for?

MS. FEDERER: The concern that I've heard a number of times is the individual members are going out and seeing people or people are approaching individual members, or organizations are calling me in the office or individuals are calling us.

That is everything that we want to give to someone that is not through a PR firm. We essentially have to say "I'm sorry, I don't have anything to give you until we get lot of this." I know it's a process to get all of that.

If there was something that we could just agree on to have and perhaps it's a preliminary, that we can give to the organizations that calls up to the office every single day and they say "Who are you, what are you doing, how can I get involved."

Things like that, we really need to have something to hand out. I know a lot of them are probably going to ask us, and they're going to say "What can I do to help," and we don't have really anything that we can provide.

It's frustrating on our part, because then if they go away with this negative impression, and it may be months again before they want to be interested. So it would be helpful if we have something of this length.

VICE CHAIR McLAUGHLIN: Right. But I guess, then, what Dottie was asking is from your perspective, Jessica, and the staff, when you get these calls, "What is the Citizens' Health Care Working Group," "Make Your Voice Heard," and then the bios. Would that be --

MS. FEDERER: That would suffice. I could take out the first two pages, no problem.

MS. BAZOS: All right, and then why don't we take the first two pages and take a shot at them tomorrow in the committee meeting?

VICE CHAIR McLAUGHLIN: You want to wait until the report, right?

MS. BAZOS: Wait until the report is done?

VICE CHAIR McLAUGHLIN: Right.

DR. BAUMEISTER: Yes, yes, so it's clear.

VICE CHAIR McLAUGHLIN: Right.

DR. BAUMEISTER: I mean, you're quoting figures we may change, and then they'll be this inconsistency.

MS. BAZOS: Oh yes, you're right.

DR. BAUMEISTER: So let's just go ahead with it. You get your product out, with a review by Friday, and you've got what you need, and the report is consistent.

VICE CHAIR McLAUGHLIN: Right, right.

MS. BAZOS: Okay.

VICE CHAIR McLAUGHLIN: Okay.

MS. BAZOS: Okay. A decision is made. I'm happy about that. The other thing that Jessica has done is she put together press packets. This is just all the press that we've been able to garner since we started. So since 7/15 until 8/11, and she has a package for everyone.

She said she'd be handing these out on a monthly basis, just so that we can all see what we look like in the press. No decision to be made about that.

(Simultaneous discussion.)

CHAIR JOHNSON: Dottie, while you're talking, I'd like to -- Connie, do you -- we'd like to have you come and participate here a little bit, so you're not sitting like you're in the back row, but you're -- if you're going to assume Rachel's responsibilities, I'd like to have your active participation.

VICE CHAIR McLAUGHLIN: Maybe she wanted to stay back there.

(Laughter.)

CHAIR JOHNSON: I don't think so, right? I don't think so.

(Simultaneous discussion.)

CHAIR JOHNSON: Okay.

MS. BAZOS: All right. I am most anyone -- Frank? I'd like to ask Frank to give us an update on Oregon.

DR. BAUMEISTER: We have a program planned. The date of the presentations will be on the 23rd, which is on a Friday, and unfortunately, Randy is not going to be there. Randy had a previous commitment. He's going to go to China for a conference. Randy is going to be there on the 20th, to participate in another conference.

So we've got two days there in between for a Working Group meeting, a committee meeting, whatever. I've put together or we're in the process of putting together a presentation with the original authors of the Oregon Health Plan, some of the instrumental players in the development of it, some people who have edited the piece and who are organizing and structuring and carrying out community meetings.

They can, I think, give us some insight into the difficulties inherent in the process. That's basically it. I think it will be enlightening, educational, stimulating and Portland, of course, in the fall is a beautiful setting.

MS. BAZOS: Is there any help that you need from staff that you're -- do you want to ask for right now?

DR. BAUMEISTER: I think we'll need significant help from staff.

MS. BAZOS: So are you able to take the lead on it? You'll be working with Carolyn and Connie?

DR. BAUMEISTER: Right.

CHAIR JOHNSON: For people to plan their schedules, when are you thinking that the listening event will end on Friday, the 23rd?

DR. BAUMEISTER: Early afternoon.

CHAIR JOHNSON: Which means that some of you, if you have to get back to the East Coast or your locations, may have to leave before the meeting is ended. Or if you're going to -- an alternative might be for you to stay over that night and go back the next day.

So just kind of an alert to you, to sensitize you to the nature of that, because if you're coming from a time schedule that's three hours behind the East coast time.

As I looked at even returns from the Midwest, the last flight for me to return to the Midwest is at 1:19 in the afternoon, which means in order for me to catch a flight, I've got to leave at 11:30, at the latest.

DR. BAUMEISTER: And that would be the 22nd.

CHAIR JOHNSON: Yes. If you wanted to return to the Midwest or East coast, you'd probably have to leave at the same time on Friday, if you need to be back by Friday. The alternative, of course, is to stay over and maybe those who are in the West coast and Midwest, maybe down in Houston.

MS. BAZOS: Another question is, we have those two days. We have September --

DR. BAUMEISTER: 21st and 22nd.

MS. BAZOS: 21st and 22nd. So the agenda for those two days, have we thought about those and what we want on what do we want, as committee members, for those two days? What were we --

CHAIR JOHNSON: Tentatively, what we had thought of in a call that Frank and Dottie and George and I have had, Catherine, is to have the meeting begin in early afternoon on the 21st, which would give some travel time for those of you who want to come out in the morning of the 21st, understanding that it will be a long time to continue much into the late or even early evening.

But that would give us a start on the 21st. Then we'd have all of the 22nd to meet, all day long. We had earlier been contemplating committees meeting, as I recall, on the 21st, but is that in concrete?

VICE CHAIR McLAUGHLIN: Well actually Randy, I remember that call. You have to leave like 11:30 on the 22nd on Thursday, and so I was recommending that we have a full Working Group meeting or at least part of Wednesday afternoon while you're still there.

The committees can meet Thursday afternoon when you're not there. But I personally would prefer that you're there for the full Working Group meeting. So I think it would be better to have a couple of hours Wednesday afternoon for the full Working Group meeting.

CHAIR JOHNSON: Okay. Okay. So that's the Oregon event.

MS. BAZOS: All right. Committee members, is there anything else that we need to talk about?

MS. WRIGHT: So you're going to back the travel day up to the 20th?

CHAIR JOHNSON: Travel day would be probably the 21st, in the morning. But if you can't make the start of the meeting, you'd have to figure out --

VICE CHAIR McLAUGHLIN: Well, there's a three hour or maybe two hour time.

(Simultaneous discussion.)

MS. WRIGHT: Yes, I was lucky. There's a morning flight. I think Chicago east, there's a morning flight.

MS. BAZOS: Pat has something from our committee.

MS. MARYLAND: Yes. I'd like to just commend you, Dottie, for great leadership. I think you have really stepped up to the plate and provided great leadership for this committee. So thank you for that.

VICE CHAIR McLAUGHLIN: Pat, you took the words right out of my mouth. That's what I was going to say too. Thank you. Thank you, Dottie.

MS. BAZOS: Thank you very much. I'm honored.

MS. CONLAN: I want to just say to you and Jessica thank you for this packet. That was some discussion. I think it really fills a need and I'm glad you went ahead and worked on that.

MS. BAZOS: Okay, we're trying and we'll get there. It is a little slow, but that's okay. That's what committee process is all about.

CHAIR JOHNSON: Okay. Anything else for the Communications Committee? If I can, then, what I'd like to do is take you to the schedule that each of you should have received. This is a little bit off our agenda time, but some questions that we got into a little bit this morning, and would like to proceed to have some further discussion on it right now.

MS. HUGHES: Is there a paper copy of that?

(Pause; simultaneous discussion.)

CHAIR JOHNSON: Here are some questions that we're going to ask you. We're going to ask you about the possibility of moving the first community meeting to some different dates, and then the possibility of adding a full Working Group meeting in October.

The third question is many of the meetings are on Thursdays and Fridays, where we meet in the future. For those of us who have traveled on Thursdays and Fridays, that raised the question, is that a wonderful two days to plan our meetings, or should we make them other than a Friday, so we're not getting into Friday afternoon air traffic and potential cancellations and so forth? So those are the questions.

MR. GROB: Could we start with that last one first?

VICE CHAIR McLAUGHLIN: Is it possible to stagger the days? I know that I'm teaching a course that meets every Friday morning this fall, and I suspect that there may be people who clinic every Friday. But then there's, on the other hand, we'll meet every Wednesday. So I was wondering if we can vary it? Does it always have to be on the same day?

MR. GROB: The answer was that we had set -- it's so hard to find out when everybody is available. So we had sent out to everyone. So in the near term, in the meantime, we said "Please, just put these meetings on your schedule so that you begin turning other people down."

So the question you're asking is whether we should try in the future to try to recognize planned events by the members, so they know and see if we can accommodate them. So when you were asking sort of like some on one end, some the other, we need to actually try to get a sense of members who have immediate commitments.

CHAIR JOHNSON: Let me test something. Catherine's indicated a Friday conflict, and I've also indicated traveling on Friday kind of a conflict or potential conflict, because of the air travel.

To what extent would you all feel comfortable to avoid that, of trying to do a Thursday or Wednesday and Thursday types of meetings, or Tuesday and Wednesday? Mike is shaking his head. Yes, he likes that idea. How about the rest of you? Is that okay? What are your thoughts? Joe, do you have comments?

MR. HANSEN: Yes. Anything you can do to avoid Sunday night or Friday is good. I fly a lot. Those are the two worse times.

CHAIR JOHNSON: Yes, Catherine.

VICE CHAIR McLAUGHLIN: The only thing I want to make sure we remember is at the beginning of this, when we started the committee, you asked us to provide you with our calendars, scheduled dates, and some of us have board meetings on certain dates that we have to attend.

So I am a little concerned that if we change it, I may not be cognizant of some commitments that we just have to make, and that we've already so notified the committee early on our blackout dates for us. So I think that's the only challenge that we'll have for some of us.

MS. BAZOS: Yes. I think the blackout dates, that's why I'm saying they varied. They were sometimes Friday, sometimes Monday, sometimes -- I mean, it varied, according to issues, different issues.

MR. GROB: I'd like to remind all of you of the experience we were having with that, which is we did try to get the blackout dates, and then of course, the fact that life is so uncertain and even that would change. So we did do that.

Then the idea that you presented to us was instead of blacking out dates, go the other way, that mark these dates on your calendar, and then when other people are asking if you're available, you'd say "No. I've got a meeting of the Working Group."

So by putting this all in advance, we went away from that blackout date to a more proactive way of setting those meeting dates. But I think what you're saying is that, and I'd be glad to do this, I could send out a schedule in which we now use Wednesday and Thursday, or Tuesday and Wednesday, and send that to all of you.

Then you could see whether you have standing commitments, like you always have a meeting on the first Wednesday of every month or something like that.

Then if I did that, then we could also do that. I'll lose one meeting time. I'll miss that one. But as a general rule, I'm going to miss them all, so could you try the other one or something like that. If you want to, I'll send you out two. I'll send you one where we go Tuesday-Wednesday, and one where we go Thursday-Friday.

(Simultaneous discussion.)

VICE CHAIR McLAUGHLIN: Aaron was saying that the ones that you sent up here, he just checked his calendar, were all Thursday-Friday dates.

MR. GROB: Yes, that's right.

VICE CHAIR McLAUGHLIN: So that's how you're --

MR. GROB: Shall we change that? That's the question. Should we change that? Tuesday-Wednesday, or Wednesday-Thursday. So to avoid that Friday problem, basically. So if you want me to send you two schedules out, or you want me to just try one and see what happens? What would you prefer to do that?

VICE CHAIR McLAUGHLIN: I think you just try one and just let us know. If we have standing meetings, we'll let you know.

MR. GROB: Yes. You'd say "Oh, this one's not working. Maybe try the other one." How about a simple preference? Do you want Tuesday-Wednesday or do you want Wednesday-Thursday? You don't care?

CHAIR JOHNSON: Flip a coin.

MR. GROB: Okay. I'll pick one. I'll send you one out; we'll see how it flies. Then if we -- it turns out that we're locking somebody out pretty regularly, we'll then try the other one.

CHAIR JOHNSON: What is the planning period we're talking about?

MR. GROB: The rest of the project. That was the idea. Let's lock our dates in now, rather than always trying to go the other way with it.

VICE CHAIR McLAUGHLIN: Right, right.

CHAIR JOHNSON: Okay.

MR. GROB: Then the next question is more particular one, and that refers to two things, is the need for a meeting during October, because what's going on here, what's driving this question is that we're tentatively, in our planning against October 6th, as the rollout of the report.

Don't forget that we will have just come off of a meeting in Oregon, the 20th of September. The next thing we were going to do was rollout the first community meeting on November the 1st.

So what that left us was a long period, assuming that the whole Work Group would be there for the community meeting, especially the first one. That left us with about five or six weeks with no meeting, and then on the other hand, if we tried to stick one in much sooner, then we'd have meetings one on top of the other.

So we tried to, you know, come up with -- I mean, what we come up with is the following proposal, is that we have a working group meeting on the 18th and 19th, and then move our first community meeting back to November 8th and 9th.

So the purpose there was to put them about, you know, put them almost a month, not a little shy of a month, between the two meetings, and then roll that back a little bit. That was a suggestion.

CHAIR JOHNSON: Can I build on that a little bit? What was the October date?

MR. GROB: October the 18th and 19th, and then November the 8th and 9th for the first community meeting.

CHAIR JOHNSON: Now we had also talked about this, in full disclosure so we can see if you're all on board. We had contemplated the possibility of having a Working Group meeting at the time right around the rollout of the report, which was October 6th.

Initially, in just George's discussions with myself, we had thought it's too early to do a -- potentially too early to do a community meeting right after the September 20th, 22nd and 23rd meetings.

That's why we contemplated having that meeting be on the 18th and 19th, and it would only then assume that maybe the Report Committee participated in the press event, that the whole Working Group would not come to the press event on the 6th of October, just from an expense perspective and so forth.

So let's test that with you all, and see how you feel about that as well.

MS. STEHR: I think it's more important for all of us to be at that report, at the report launch. I think it is anyway, don't you?

CHAIR JOHNSON: And share your rationale on that?

MS. STEHR: Just because we're doing the report, and we're literally being introduced, pretty well being introduced to the country. I think it's important that we're there.

MS. CONLAN: I think Deb's right, and I think it's important to be there as an entire group.

CHAIR JOHNSON: Would you want to -- if we vote on it, amend your comments then, with if we have a Working Group then instead of later in October? You want to comment on that?

MS. CONLAN: I'm open for any date. I have no job, so I have no conflict.

CHAIR JOHNSON: Were you going to comment, Rosie?

MS. PEREZ: I stepped out to the bathroom, so I missed this. Where is the launch going to take place?

CHAIR JOHNSON: In D.C.

MS. PEREZ: Okay.

VICE CHAIR McLAUGHLIN: But it's still before the launch of the community meeting.

MS. PEREZ: Yes, the report. So it's going to take place in D.C.?

VICE CHAIR McLAUGHLIN: Its schedule now would be October 6th. That's what Dottie was saying, that we haven't heard from Senator Hatch's office yet, but that's when it's now scheduled. That's a Thursday, correct?

MS. BAZOS: A Thursday morning was what --

CHAIR JOHNSON: Correct.

MS. BAZOS: Thursday morning on October 6th was what was being proposed for the report launch. Well, the one thing that we really haven't talked too much about that I wanted to talk to the committee about tomorrow, with help from the staff, is what does it really look like to launch a report and is it important?

I mean, I think we need to ask the question. Is it important for all of the members to be there, or I mean, I know that at one time -- sorry Rosie. I can only think on this very linear path.

One time we had talked about the biggest event for us truly is when we go out to communities. I mean, I would like to see all of us there on that big event, where we're really listening, and that the report is sort of lead-in to that.

So it this a tradeoff we have to make, I guess, is a question? We need to get used to the word tradeoff, much as I don't like it. But is there a tradeoff, and Mike, maybe you could tell us a little bit about this politically.

What does it look like? What do people usually do? Should we all be there? Or is it something where, you know, it's like a press release and doesn't really matter?

MR. O'GRADY: Yes, except the Capitol, Washington Monument. I think it varies quite a bit, in terms of what you think it is. It will be an important time. Hopefully, we will have the contract with whoever is going to handle our broader messaging in place then, because it's important how you roll something out.

I think the report is -- the report is important because you have something tangible, where actually it's a deliverable, if you want to think of it that way.

It gives then, if you're talking about the media, you're talking about they have something to then write a story around. So I think the report can be fairly important, especially if you're going to have -- if you think you will be able to get both Senators there. That also makes it certainly more of an event than if it's just us.

I mean, it's hard to know -- I mean, this kind of a group, this sort of -- you know, I've been involved with a number of different commissions and what-not. It's extremely hard to predict.

I've been on ones that we thought, you know, we were crying in our beer at the end. We thought we had failed. It turned out we changed legislation for the next five years. And other ones where we thought we had a great, you know, outcome and it was wonderful, and nobody did anything with it.

So it's very hard to predict what will be the pivotal, you know, what is the real essential one? I think you should probably if there's the money to do it, you should try and have as many as the people who can there, with the notion, though, you want a real, clear message, and therefore it may be people sitting on the stage or whatever we have as a venue. But it may just be one or two people talking.

So it's worth your while to make the kind of, you know, when we talk about these logistics and trying to catch a flight in Sioux City and make it over to whatever, I think we should just be -- it should be planned out enough, that people know "Boy, am I coming all the way across the country for a half hour event, and I smile and get my picture taken, and then I go back to the airport."

CHAIR JOHNSON: But there's -- build on your comments a little bit, Mike. I think the question wouldn't necessarily be do we come across the country for a half hour event, because potentially we could build in a Working Group meeting around that time.

If we do that, then the tradeoff is we've juts had a Working Group meeting a week and a half before that, or two weeks before that, and is that -- is there more value in having the full Working Group meeting along or around the 15th or 18th of October, where we've had more developments.

That may be a tradeoff that we're asking the Working Group to make.

MR. O'GRADY: Right, and I think as a general rule on any of these meetings, it is that you want enough content and what-not that people, if they're going to do these kind of logistics, that it's really pretty, you know, it's pretty packed full of stuff.

VICE CHAIR McLAUGHLIN: Yes. It really is two weeks later.

DR. SHIRLEY: I don't have a calendar, so I don't know about that. Two things. If all of us were present at the rollout, is it possible that this will have more impact and once it goes out, folks say "Oh, that's what they were talking about?" You know, once we start distributing this, something would have preceded this, that got some national attention, number one.

Number two, even if we didn't have a formal meeting if we were all here, it might be a good time for us to have some time together under a less stressful environment and get to know each other.

CHAIR JOHNSON: Are you bringing in the catfish again?

DR. SHIRLEY: I'll bring catfish, watermelon, the whole works. But it might be an opportunity to be here, be there all together without the stress of having to go through this. You know, just a little R&R together.

CHAIR JOHNSON: Well first, Debbie has her thing up.

MS. STEHR: Yes. I've had my thing up for a long time.

CHAIR JOHNSON: Go ahead, and then Dottie.

MS. STEHR: Well, I'm going to stress again, I think, the importance of the whole group being there, because number one, it's being held at the National Press Club. It's an opportunity for many of us to meet with our Washington bureau staff of our papers from back home, of our major papers back home. It's just an opportunity, really, for every one of us to get introduced to the media.

I'm questioning do we really need to have the big, formal Working Group meeting mid-October and just do a short meeting after -- you know, do an after the report release and do a revamp, was it worth it, that kind of thing, you know, something and skip the mid-October meeting, and maybe just do a conference call that week or something.

I think it would be kind of nice to have a little break in between meetings.

CHAIR JOHNSON: Okay. Dottie.

MS. BAZOS: No, that's okay. I wasn't -- it's not important.

CHAIR JOHNSON: Okay. Any other comments?

MS. HUGHES: Yes. I would just like to say that we're going to have the community meetings all done, everything's going to be done before they, you know, by the time this October 6th meeting happens? Because if it's not and there's all this lead time that's been needed to get these meetings on board, then when is that going to be done? Is that going to just fall on the staff, so that nobody else has to worry about doing it? So you're just all busy, and then I don't -- all's I have to do is show up, or is that going to be a parallel track, where -- or is that going to be a sequential track?

I mean, I don't see this first community meeting coming off on the 1st or the 9th or the 8th, without any -- some type of interaction. I mean, I think that there's as much work going into the community meetings, that went into the hearings and that went into the communications, unless I have missed something today.

CHAIR JOHNSON: Probably more, probably more.

MS. STEHR: So when is that going to be done?

VICE CHAIR McLAUGHLIN: I heard George talk about swallowing the pillows.

MS. STEHR: Well, that's what I mean. If we're talking about -- maybe I think I'm missing something here.

MR. GROB: See if I can say something that makes sense. This is simply done kind of on logistics, but the advantage of, and this is not the kind of reasoning, Debbie's reasoning, which has a different, I think, to look at the value of the members being here for other reasons you mentioned.

If one looks at it from a narrower perspective, and I don't know that that's a legitimate way to look at it, from the point of view of money and the point of view of planning and work, it would be more logical to have a work group meeting in the middle of October, you know, a little bit before the community meeting's done, than one at the very beginning of October, since we're just a week or two away from having had a meeting.

So that is exactly what the dilemma is, is the choice between what you want to invest in the opportunity and value of a mid-October meeting, to nail down and make the crucial decisions about this event that will occur with the community meetings?

Or do you want to associate it, sort of give that up, if you will, and then have everyone here for many other reasons? I think the symbolic importance, the getting together at the early meeting.

Right now, it would be difficult from a logistical point of view to do both the forward rolls, you know, to do both, and just from the point of view of doing it twice. You have a meeting on September 20th, then a meeting October 6th, then coming back and meeting the 18th and then coming back and meeting on the 8th and 9th. That's exactly what we're talking about.

MS. HUGHES: Then I guess that what occurs to me is that because we don't know what -- October 6th was chosen as the date, so that is a given that we have to work around.

If that is the given that we have to work around, I just have a feeling that, and it's just a hunch and, you know, take it for what it is, that it is important for us as a working group to be in D.C. when the report's kicked off.

I can't -- I mean, to me, it -- you just look at it publicly. If we had the Report Committee there, I mean they've done all the work and I certainly am not going to take center stage for any of that, because they've all done that.

I just -- but I think that if we're a collaborative group, then we're working collaboratively, even if it's just to support them. If we want the media to have four people there representing the whole group, I don't think -- my hunch is it's not going to look good.

CHAIR JOHNSON: Okay. Let me see if I can summarize what I've heard. Joe, I'm sorry.

MR. HANSEN: I'm concerned what Therese says, that you know, more than just October 6th, are we going to be ready for the community meetings and everything else like that. I'm not even sure we're going to be ready for October 6th.

But also what Mike said, I think Mike is very and I've had some experience with this too, about the photo op piece and all that. You know, it can make a difference or not.

But have we heard from -- we don't have a PR consultant on board yet, do we? We just picked the October 6th date because it was a good date? I guess I'm asking you, George. Have you got any professional advice on this?

MR. GROB: Well, I'll tell you why the date was picked and I'll tell you what work we've done around the PR aspects of it. The origin of the date had more to do with their overall schedule. This was at the Mississippi meeting that we had this, the origins of it.

Because we need to have about six months of community meetings, which have to end like mid-April, so we can prepare sort of preliminary information. So basically it was driving backward, and the fact that we have to have it all wrapped up by September 30th, and there are some periods of time that we must respect.

So when we began to move that back, there was an extremely strong sentiment, among all the Working Group members, that the community meetings would be the really big important stretch, and they asked me to redo the schedule so that we allowed six months in there for that.

So you do that, and you end up then getting pushed back, basically, to October, the early parts of October, to get that report out. So once just the logistics of just getting all this activity in the period we had for it, you ended up basically with about the 1st of October as a kind of, you know, the dates that we needed to get the report out.

From that point, then it became a day at a time, trying to find out well, on what day could we both get Senator Hatch and Senator Wyden? On what day could we get a prestigious site for it, mainly the reporter's building. So that began driving that, and that's how we ended up with October 6th. It was the only day that we could find both Senators available, I think the symbolic thing.

So that's where that came from. Now in terms of the current thinking of the PR for that, that of course is a real good start, having that location, and I think Deb got that right. All the reporters from around the county are there basically. It's a prestigious location.

Having the two Senators there, that's really a very good thing. We began then to think of other supplementary kinds of things, and we had some ideas about it. For example, we might be able to get on some do a TV round and have a few places where there's some other TV.

But that's what we also said. Well, let's get a firm in here as well, to give us other advice as to how to roll that report out. In addition to that, there is the question of how do we tell the world in advance that it's going to happen, not that they wake up that morning and find out that it's there. But how do we queue other players? Again, a firm would be needed. Then that got us back from this date on.

How can you get a firm to work for you in a few weeks, when the bidding process usually takes much longer than that? So you've basically got the squeeze at both ends. That explains why the dates are the way they are.

MR. HANSEN: There's a follow-up, and maybe I misunderstood. But originally, it was, when this discussion started, it talked about the Report Committee and the Chairman. I'm assuming that others will be in there, and then now let's include everybody else.

Has any thought been given to maybe just doing the Report Committee in Washington and having other, and maybe eight or ten other sites, wherever the committee could be, so we don't have to --

I'm in Washington, you know, so it doesn't make a difference to me, so Frank doesn't have to come from Oregon for that, or stuff like?

MR. GROB: We did give some thought to that, and we found that that was extremely difficult to do, logistically intense, just very, very hard to do. Originally, one of the ideas that was proposed would be to do a three-city event that would be more or less simultaneous.

But then as we began to work our way through the logistics, it just became near-impossible. That's why we began to substitute the idea of maybe getting, or paying our way onto some of the morning TV programs, you know, that kind of thing. But that again was considered.

So it just seemed, when we began to work with some of the details, that that really wouldn't work very well. With them, it all conspired to present us with a dilemma that we're now facing.

MS. BAZOS: And that is one question that we did already go, unofficially or informally to a PR firm to ask. Does it make sense to have a rollout of the report in multiple cities, and they said no. We went to Peter --

MR. GROB: We went to five firms and asked them that question. They said don't do it.

MR. HANSEN: My concern is that, you know, in Washington, you know, if there's a bomb scare, you're dead. You're going to lose it all.

CHAIR JOHNSON: One more comment, and then I'd like to kind of summarize what I've heard and see if I'm hearing correctly. There's one hitch to George's just-now discussion, and that is Senator Hatch will be hearings, and is reluctant to come to the Press Club.

So they would like to suggest we actually do the press conference on Capitol Hill, which would also be similarly prestigious. It might be an opportunity for Deb or me to invite our local staffers, staffers for our Senators from our state, to come to the rollout as well. But just an alert to that as a change.

What I've heard, I think, is that at least a good number of us would like to participate in the press conference, rolling out the report. So I'm hearing that we think that that's really important, and that there's sufficient substance to have a meeting at that same time.

In fact, we'd almost prefer to have a meeting at that time, as opposed to later in October, because of the challenges of going in October. We'll have sufficient content related to the community meetings at that time.

So then if we were to consider that, well, before we do that. Is that a correct sense of you as a working group?

VICE CHAIR McLAUGHLIN: Yes.

CHAIR JOHNSON: Okay. Then if I can go one step further, then would it be our preference to have a meeting on the 5th and the 6th, or the 6th and 7th, keeping in mind that the 7th is a Friday?

VICE CHAIR McLAUGHLIN: Also, when we talked about the rollout and we were discussing the 5th, 6th or 7th, I'd let you know that on the 7th at 11:00 a.m., I have to be in Ann Arbor to introduce the president of the university.

CHAIR JOHNSON: Okay. So from Catherine's perspective and the earlier comments perspective on traveling on Friday, the 5th and 6th would probably be better than the 6th and 7th. Is there anybody who could not do that, based on what you know right now?

MR. FRANK: I can only be there for the 5th. I won't be there on the 6th.

CHAIR JOHNSON: You will not be there on the --

MR. FRANK: The 6th.

VICE CHAIR McLAUGHLIN: I think it's critical that you're there on the 5th.

MR. FRANK: I just can't. I have to teach. My day job.

MS. CONLAN: Well, it's like Friday's my day job.

(Simultaneous discussion.)

CHAIR JOHNSON: Okay. Any further comments? Richard, are you comfortable with us going ahead and having the launch without you being there?

MR. FRANK: Oh, absolutely. Yes. I mean, I just -- I don't -- I think Senators Wyden and Hatch are a lot more important to this than any one of us.

CHAIR JOHNSON: Okay. Thank you. Okay, and then should we leave the 1st, George, and Working Group. Should we leave the November 1st date in place, then, for the first community meeting, and look to have a Working Group meeting on the 2nd as well?

Community meeting on the 1st and then we can digest that and have some discussion regarding that and think about --

MS. HUGHES: How the other ones are going to proceed?

(Simultaneous discussion.)

VICE CHAIR McLAUGHLIN: I didn't know we were going to start with dates for this, and my calendar is back at my hotel. So I can't -- I don't know about my dates.

CHAIR JOHNSON: Okay. So part of what we'll do, George, is grab our calendars, look around those dates as well.

MR. FRANK: You know, a lot of it depends on where it is.

VICE CHAIR McLAUGHLIN: You have to speak forcefully. Yes, exactly.

MR. FRANK: We don't need to get into individual calendar issues.

CHAIR JOHNSON: Okay, thank you. We've gone over our time for the Communications, but a good discussion. Thank you. Why don't we take 15 minutes, and then we'll reconvene on the report.

(Whereupon, a short recess was taken.)

CHAIR JOHNSON: We're reconvening the committee, and our objectives for the next several minutes, actually the next 45 minutes, will be hear Catherine's comments on the report. So let's proceed with that.

VICE CHAIR McLAUGHLIN: Okay, guys. We need your help on the report. We need to come back. All right. I know that we had scheduled a discussion about the report content, and about issues to be resolved.

Unfortunately, none of us got the hard copy of the report until a couple of hours ago. So that conversation is obviously not going to take place. We do need to come to some kind of agreement about the actual content of the report, and we need to come to agreement soon.

We have got to have this report pass through Senator Wyden and Hatch's office; we need to have it read by other people to do like what's called a GAO or CRS kind of check, to make sure every fact is correct, that we haven't referenced something incorrectly.

It needs to be translated into Spanish. There are a lot of things that need to be done before we can put this on the website. We are behind, for a variety of reasons.

Let me update you just a little bit of what we've done since Salt Lake City. In Salt Lake City, I got comments from about a third of you on the previous version of the report. The Report Committee, well me; I was the only one who spent the weekend in Salt Lake City, so I represented the Report Committee and the staff, spent 11 hours on Saturday and 12 hours on Sunday in one room, and we still talked to each other Sunday night. That's really remarkable.

MS. CONLAN: Some of us were there.

VICE CHAIR McLAUGHLIN: I haven't gone there yet, Montye. Going through line by line, literally line by line, and saying "Okay, this sentence, did George have any comments on this? Did Randy have any comments? Did Mike have comments? Did Don have comments? Did Richard have comments," etcetera.

For about three hours, Montye and Therese were there representing their own comments on it, and they can tell you that we did sit around and faithfully consider every single person's comment on every single sentence that was handed to us, either in an e-mail or in written comments or oral comments the day before, and try to be responsive to those comments and check for new data on the Internet. We were all working on the Internet and making changes.

We then went back to Houston, some of us went to Houston. Jill went back to Washington and during that next week tried to get some new examples to satisfy some members' concerns to reorganize some things and make some changes.

We then sent the revised version of that report to all the members of the Report Committee. The members of the Report Committee then got back to us with, and Randy also at that time, with "Gee, this looks a lot better. I like it. Here are a few more comments."

So Jill by now is in Spain. Page had left to go back to Houston, but Rebecca and I toiled away, trying to respond to that set of comments. Simultaneously, George talked to some woman named Joy to look at it for editing, and was reading it himself, and said "You know, it really doesn't grab us. It doesn't really tell a story. I think it needs to be reorganized."

So Monday a week ago, George and Rebecca proposed a new organization. So this is not changing the content of any of the paragraphs, but it is changing the tone. It's changing how it's organized.

So last Wednesday, we sent the third version of the report, the original report that you guys saw, the 25 pager in Salt Lake City to the Report Committee, asking for their feedback by Friday. We heard from two people and we're working on those comments, in the hopes of sending that to you Friday night.

In the meantime, Jill got back from Spain, and Jill and George had a conversation, and we decided that we really need to plot the graph into the proper place. You may remember in the report in Salt Lake City, a lot of people got confused, because it was in a Word document and some of the text boxes were on the wrong page. Some of the graphs weren't even there.

I mean, there were a lot of problems. So we needed someone with some expertise to do that, and that person started doing it, but did it on the reorganized report, not the other one.

So Friday afternoon when Jill came back and we started talking, we realized that no one was working on the report that the Report Committee had seen and had made recommendations, and that instead, the staff was working on the reorganized report. That took a lot of time.

So Jill, I actually worked until 1:30 Saturday morning and 2:30 Sunday morning, and Jill worked all weekend, even though she was taking care of six parrots and two cats. It just didn't happen, because of technical difficulties.

So I'm apologizing for the fact that the report that you see before you arrived at such a late date. It's also the case that this report has not been seen by the Report Committee, because the Report Committee saw the other organized version last Wednesday night, and gave me comments.

They have not seen this report at all. This is the first time they have seen it as well. So with that caveat, we can't really -- I guess we're going to ask you to read this version of the report, which is, as I said, organized differently, and give us your feedback.

I'm going to have to get feedback, obviously, from the Report Committee as well, whether you even like this reorganized format, or whether you prefer the other format, which you guys saw last Thursday, and try to come kind of consensus.

It's gone very awkward, because of these two organizational structures. But what I can tell you is that the actual paragraphs are the same. It's just that the opening sentences, sometimes, are different, because when the plop the paragraphs in a different order, you know, you have to change.

MR. O'GRADY: Uh-huh, the flow.

VICE CHAIR McLAUGHLIN: The flow. So if you do read the one that's been given to you, which is the only one that has the text boxes and the graphs embedded, you will be able to respond to us with all of your concerns about numbers being used, examples being used, references being made, the ideas.

What you won't be able to do is say whether you like this organization better than the other one. But I'm hopeful that the Report Committee can assume that responsibility, because now to get the staff to do all of this on the other version is going to take days.

So please read this version and give us feedback.

MR. O'GRADY: Do you have an electronic version of that too?

VICE CHAIR McLAUGHLIN: Excuse me?

MR. O'GRADY: Do we have an electronic version of that too?

VICE CHAIR McLAUGHLIN: We can get --

MR. FRANK: Jill?

VICE CHAIR McLAUGHLIN: Jill can send you an electronic version. Yes, it's a PDF file. That's the other thing. We had to wait for Will to show up because he --

MR. O'GRADY: It's a little tough to do track changes and edits on a PDF.

VICE CHAIR McLAUGHLIN: You cannot do track changes in a PDF file. Now she sent me a Word version of it that I got this morning, and I haven't experimented yet with how to do it. The problem is, Mike, whenever you make changes, the graphs pop and they just -- they show up on another page or they're not even visible any more.

So electronic versions, tracking changes, it's just not going to work. So I hate to say, we need you to work on the hard copy, or save -- and this is what I did with Jill -- I saved the Word document Friday without any of the graphs and texts in it, and then made comments on the text.

If you want to do that, that's cool too.

CHAIR JOHNSON: Can I clarify my understanding of that?

VICE CHAIR McLAUGHLIN: Yes.

CHAIR JOHNSON: Is your last statement to suggest that the Word document that you had on Friday includes everything that's here except for the text?

VICE CHAIR McLAUGHLIN: No, no.

CHAIR JOHNSON: Is there a document that does include --

VICE CHAIR McLAUGHLIN: I just got a Word document this morning that includes everything, right.

CHAIR JOHNSON: Without the graphs?

VICE CHAIR McLAUGHLIN: Yes. I should tell you that unless you have a pretty powerful computer, it's going to take a very, very long time to download this.

MS. CONLAN: In PDF?

VICE CHAIR McLAUGHLIN: In PDF or Word. I actually went and brushed my teeth, washed and brushed my hair, everything lese this morning while it was downloading on my laptop, and I have a pretty big laptop. So it's just not -- yes. It's the nature of the best, because of all those graphs.

CHAIR JOHNSON: Let me clarify again. Going to the tracking changes.

VICE CHAIR McLAUGHLIN: Yes.

CHAIR JOHNSON: Is there a way that we could get an electronic copy, even if it didn't include the graphs, so that we could give you tracked changes?

VICE CHAIR McLAUGHLIN: I could ask them. They don't have that now. I can ask Jill to try to create a Word document without any of the tables or text boxes in that document.

MR. GROB: Could I make a technical suggestion for you?

VICE CHAIR McLAUGHLIN: Yes.

MR. GROB: I've been following what Jill has been doing very carefully every day, looking at where we were. At the time that I received this PDF file, she also sent me a Word version that is probably the same on you have. You might have a more recent one.

When I compared the Word version to this one, the PDF was better. For the Word, they still had -- it was largely okay, but it did have a couple of pages where, you know, a text box was on top of the text.

VICE CHAIR McLAUGHLIN: Yes, right.

MR. GROB: So I figured if we got you this, when you could really see what it looks like, and see how it goes, that it occurred to me that Jill is probably still working on it.

So it would be easier for us to send, if you would like to do the track changes, I'm thinking that it would be easier for us to send you the one with the graphics that looks like this, just realizing that when you do track changes, you're going to screw the graphics up.

VICE CHAIR McLAUGHLIN: Right. No, no, I know. Actually George, what I was going to say, is this will give you the visual of what goes with what, and what we should send you is a Word document without any of the graphics, so that it doesn't become so hard --

(Simultaneous discussion.)

MR. GROB: That's fine. My technique in this was I had the Word document open and I had the PDF open and for the look, I look at the PDF and for the track changes I look at the Word.

VICE CHAIR McLAUGHLIN: Exactly, exactly. So what I'm going to ask Joe to do is to send everybody to create, because she doesn't have it, to create a Word document without any of the graphics and text boxes, to send to all of you, so you can track changes.

MR. GROB: If it's goofy and moves around --

VICE CHAIR McLAUGHLIN: No. Also just a downloadable problem. There may be people who aren't -- literally are not going to be able to download this on their computer. It's huge. It's just huge.

MR. GROB: Okay.

VICE CHAIR McLAUGHLIN: So then the question is, how much time to give you? When George and Randy and I talked last week about the process, we thought we were going to have gotten this Friday night. We would have had the weekend. We were going to give you until this Friday.

At lunch I grabbed Randy and said, you know, George and I have to do the working backwards in time, in order for us to be ready for the launch, da-da, da-da, the Spanish, the Joy, editing. I throw that back to you. What deadline?

MR. GROB: Here's what I did? So I worked on that, you know, in the light of this, and let me tell you some principles I used and then let me sketch out. I didn't even have a chance to type it up it was so hot. But let me tell you the principles I used first.

The principle I'd like to use is to still aim to have it ready to go on the 29th. Now as outrageous as it seems, let me explain the technique for it. I think I can trade staff time, having them work weekends, and giving them days off while you're on your cycle of the review. Because they just truly can't keep it up forever.

MR. O'GRADY: Sure.

MR. GROB: So that was one solution I came up with, is that having -- basically getting comments from you at two and three-day intervals, and then letting them rework it on the weekends while they take those couple of days off, taking their weekends in the middle of the week.

The reason for aiming for the 29th is because of what Catherine has said, that I think that if we do not have something that what we say it is by the 29th, I don't think I can get the Spanish done and get it reformatted to fit the new style --

You know, we'll have a report style that will go with the website. That will take a bit. We'll actually have to have some copies printed. You know, we can't just say "Well, Mr. Senator, it's on the web."

You know, we'll probably have to send some sets out to some people. That's a decision we have to make as to, out of courtesy, who do we send things to. So there will be a bit of that.

So that forced me back to the 29th. Let me lay out, and if you could take notes, I'll be happy to you know, after we discuss this, then I'll be happy to send you a schedule for review for everybody, to see if this would work for you.

I'm going to try to keep a calendar in front of me, to make sure that it is saying that, but here's what we came up with. Okay. Well, today is the 16th, right? So today what we would do is begin our review, and give you until the 19th to respond back. Now the 19th is Friday.

VICE CHAIR McLAUGHLIN: What I was told we were ask them to do when they were going to get this last Friday. That cannot work. We're going to be here all day tomorrow on hearings. That gives them Thursday, and they have jobs.

That's just not feasible.

MS. STEHR: How about Wednesday of next week?

MS. WRIGHT: Yes. Give us the weekend at least.

CHAIR JOHNSON: There is an issue that we have. We will need to get your feedback back, and have the Report Committee and staff work on your feedback, and then another copy back to you, for you to say "I'm okay with this."

And so if in fact you're going to have two reviews of this, that's the reason for pushing those dates.

VICE CHAIR McLAUGHLIN: Let me talk a little bit about the responses. One response is in fact things that you're uncomfortable with, things that you want changed, as input. The other thing that we need from you is sign-off.

All along we've been talking about this is a consensus-building format, and the Report Committee in Salt Lake City, and Brent's not here but three or four members are here, agreed quite strongly and told Randy and George this afterwards, and told all of you that we believe that people need to sign off on this.

Just like we personally believe that people need to sign off on the communications strategy and on the community meeting strategy.

But as the first thing out of the block, that's the report, for this consensus-building process. We have had discussions about what that means you are signing off on.

If it means you're signing off on every word, this won't be finished for ten years. If it means you're signing off for every sentence, five years. Every paragraph, one year.

I mean, it cannot be at that level of detail. It just cannot be. So when we ask you to give us feedback, it has to be at higher level. It cannot be at that level or we will not do it.

There are several things that we have talked about -- well, not Mike, but Richard and I talked about a little bit with Brent, of overall issues to sign off on.

One clearly, and I was hoping to have a discussion about this today, but we've gotten a lot of time scrunched significantly. But one is the overall tone.

You'll see right away that the report, the whole beginning, is different from what you saw in Salt Lake City, and that's responding to the concerns of some members of the Working Group about the overall tone. To simplify things greatly, let me tell you the spectrum.

On one end of the spectrum is Chicken Little. The sky is falling, we've got to grab the public by the throat, shake them. If we don't do something now, the world as you know it will end, and it's going to end soon. All right? That's at one end.

The other end is you know, we're the envy of the world. Our system looks really great. We just need to tinker around a little bit, for 15 percent of the coverage, and even some of them don't really need coverage. They're healthy and young. Just a few of them.

We have a few people that don't get what they need. We have some, you know, unhappy people, but most people are happy, and we have some medical errors, but most people, you know, we're living longer, we're doing great.

So I'm deliberately having two polar opposites. Where do we want to be on that spectrum, in terms of the overall tone? It's a very important decision that this Working Group has to make.

The Report Committee has been juggling back and forth about this, and responding to comments made by individuals. But the Working Group has never talked about this as a full group. What is the tone that you think we need to strike?

Now I will tell you the 25-pager is only one version, remember? We talked about the ten-pager, which was what was going to be at the big rollout in October. That was going to be mass produced. In that, the tone can be slightly different. But they have to at least be compatible with each other.

It also will influence the communications strategy. It will influence the community meetings, what we do -- do we go out to the community meetings and say "Chicken Little," or do we go out and say "Everything's pretty good, but what do we see changed?" Where are we on that spectrum?

The second is the focus of the report, the main focus of the report. Is it high and rising costs? Is it quality problems? Is it lack of coverage, whether it's uninsured or underinsured?

We've been talking about those three things, but as you read the report, you'll see what is your opening salvo? What do you -- you know, you can't do justice to all three of those topics. So again, where do you want to be in terms of that mixture? What emphasis do we want?

Do we want to have the Dave Walker emphasis on costs? Do we want to have the Brent James emphasis on quality? Do we want to have the Mississippi emphasis on the uninsured? Where do we go? And do we treat them all equally?

That's what we've sort of done now, but some people aren't happy about that. Some people want the balance changed. I need your feedback on that.

The third is the whole issue of tradeoffs. We talked a little bit with Chat today with tradeoffs for benefit design. What tradeoffs conceptually do we want to put into the report? Do we want to put anything about tradeoffs so far?

How explicit do we want to be about tradeoffs? Do we have to introduce this, or is that really what we introduce in the community meetings? That the report just says "This is the state of the world," and you know, you've got to know if we keep going the way we're going, there are going to be some problems, and we're going to have to make some hard choices.

So I need feedback from you. The committee needs feedback from you. How explicit do we want to get about tradeoffs? Right now, it says "Where does the money come from, where does it go, what does it buy, who's using those services, where are they using them, you know, how well is the system working?"

It doesn't really do a lot about tradeoffs. Is that okay, or do we need to put more of that in?

The fourth thing is criteria for inclusion, and we have gone around the bush about this several times, and it is really very difficult.

One way to treat all of this is just to be very much at the conceptual level, the 15,000 foot level, and talk about, you know, "Boy this is happening and that's happening, and if we do this, then it is likely that," and talk about what's likely to happen, what is probably happening now.

Then do we talk about relationships just in the positive-negative? Do these two things, will this have a positive effect on coverage? Will this have a negative effect on quality? Will this -- all right. Talk about it at a very broad level. Or do we actually bring in numbers, you know, data and numbers.

If we do data and numbers, what standards do we use for inclusion? What are the standards of evidence? The committee's talked about this a bunch. How do we decide on what numbers to put in that report, what evidence is sufficient to make it in the report?

We have had this discussion as a working group from the very beginning, back in April, that we have to be careful, and we have to make sure we can stand behind every single number. There was a lot of agreement to that back in April, in our very first group meeting.

But when you read this report, I want to hear from you, are there numbers in here that you go "Wait a second. Where does that come from?" Or "Why can't we have some numbers? We had hearings about this. We heard from experts here, experts there."

I want you to start thinking about that. But I will tell you that to date, what the Report Committee has done, and it's a blending of Mike's experience with CRS and in the government, and Richard and my experience and Brent's experience as part of the peer review process, we have decided to only include numbers that have been really through a peer review process, and that there is general agreement among the experts that this is these are legitimate numbers.

Those are very high standards, and even though, there are some numbers in there that not all members of the Working Group feel comfortable about. I mean that the Report Committee feel comfortable about. So how loose can we get? I'd like some feedback from you on that.

The fifth one that I want feedback on is this solutions, what's being done now. We heard a lot in hearings about different solutions, different things done in Jackson, things done in Salt Lake City, things done in Houston, things done -- well, here are things that come tomorrow.

Do we want to have again, the 15,000-foot level here are things that are being tried, that are conceptual, or do we want actual examples of things? If we want actual examples of things, again, what are the criteria for inclusion? Do we need to have evidence, good, solid evidence that those examples are doing something, that they're accomplishing something?

It's one thing to hear about a program that people are doing, but as someone who's done a lot of evaluations, I can tell you it's often not until five or ten years later that you know whether it did any good, whether there was any effect. Not just long-term effect, but any effect at all.

So what are the criteria for including specific examples? You know, does it have to be something that's done for a large group of people? If it helps ten people, do we put it in? Where are the cutoffs if we're going to include actual examples, rather than more generic, these are the kinds of things that people are trying, experimenting with or doing.

So those were the five issues that we thought of, that we would like feedback from you on, and want to have consensus on and some kind of sign-off.

Now how far below that we go for sign-off is the discussion that we need to have, but the Report Committee wanted sign-off on those five things. If the Working Group feels as though the sign-off has to go even at a lower level, paragraph by paragraph, we can talk about it.

But that was the level that we thought, at a minimum, we would like consensus on. That's where we are.

CHAIR JOHNSON: May I assume that either you or George will get out the five questions, so that those of us who

VICE CHAIR McLAUGHLIN: Sure. I wrote these on the plane yesterday, so George hasn't seen them yet. I'm sorry, George.

CHAIR JOHNSON: Maybe the committee has. If you've just written them on --

VICE CHAIR McLAUGHLIN: Richard and I talked about it at length, and these reflected the conversations we had in Salt Lake City, over a three hour dinner.

MR. FRANK: With some additions. There's one -- can I just weigh in for a second on this? The first one you cited about the sky is falling versus everything's great, I don't know that we have a lot of leeway on that. I've seen people go in both directions.

Oh, to really motivate these people -- it hurts your credibility. Oh, everything's great, when we know everything's not great. It hurts your credibility. Credibility is very, very important to this group, and therefore how -- now we may disagree. You know, every group has its Eeyore, but we may disagree on that.

VICE CHAIR McLAUGHLIN: Don't worry about me.

MR. O'GRADY: But I think in terms of it's got to be someplace in that middle, to just protect the integrity of this group, that we're not, you know, advocates on one side or the other, that we're looking at these hard problems and taking a very even-handed approach.

VICE CHAIR McLAUGHLIN: That's what we've tried. Now I should tell you -- I mean, when you read it that's the current tone, and this is the fourth iteration for us, those of us who have been doing all the writing, and Don, who also for Mike. So there have been five of us actually, and that is tone now of this report.

But I should tell you that it was hammered out with some agreement between us, and there are people who aren't happy with that. They want it further on one end or the other.

The communications -- not the Communications Committee -- but we've heard from some communications people that the press will ignore this, because it's so even-handed.

Well, at what point do we want to get the press's attention? With the 25-pager, or with something else? So that's something that we as a group -- the Report Committee made its value judgment about what it thought the role of the report should be. It did not think the role of the 25-pager was to grab the reporters by the throat and get them all excited.

It thought it was the opening salvo for the debate, the discussion with the public. Sort of these are the facts, this is what we know. That it was not meant to grab reporters. It was meant to provide information for the public.

But that's the Report Committee and that's what we're doing. It's not our job to worry about communications.

CHAIR JOHNSON: Mike, I don't think most of us would be here if everything was even-handed. I mean, that's a wrong word and it's not intended to reflect on Catherine's comment. We're here because we think the system is broken, I think.

If the public's not aware of that, if we don't believe that, obviously it reflects my own bias here, but if people don't understand we have a problem, then we don't have to tradeoff anything. We can continue going as we're going.

MR. O'GRADY: But I think the best, one of the nice parts about this to your other point there, about you know, there's three main themes here, and they ought to treat it, I think, pretty even-handedly at this point.

But they are sort of the three aspects of that if everything was peaches and cream, we wouldn't be doing this. There's no doubt about that. Those are three they're sort of my top three of concerns.

So, I mean, different people will weigh in on different things and feel the whole report should be on the uninsured or the whole report should be on, you know.

I think if you put Frank alone in the room, you'd probably have the whole report on kind of quality and the whole health information technology.

VICE CHAIR McLAUGHLIN: Right, right.

MR. O'GRADY: But I mean it's -- right now, there's a nice balance between different issues that are pretty important to the American people.

CHAIR JOHNSON: I'd like to ask a question of the Report Committee, based on Catherine's comments.

(Tape change.)

VICE CHAIR McLAUGHLIN: You know, the suggestion is that they might begin to sort through it or that we're promoting it. We don't leave any space for the real work that I think we have to do, which is to listen.

And you know, I think at the end of the day, it is very hard for people to leave space to actually listen. I think that's what we have to do, is leave space.

CHAIR JOHNSON: I know that we, at least a bunch of us, including Montye and me, would like to comment more on this. If you can hold your comment, Montye, we have to break at 4:15, and we need to talk about the schedule, okay.

So George has recommended that we get back to him on the 19th. Let me go back to that and make sure we're all hearing his proposal. Then what would happen after the 19th?

MR. GROB: Again, a schedule for the report versions. On the 19th, then, we'd get it from you. On the 23rd, we would then get you the next version. That would be the 23rd, Tuesday.

MR. O'GRADY: George, this is comments on the report we're talking about, by the 19th, or --

MR. GROB: Yes, it was.

MR. FRANK: This Friday.

MR. GROB: This Friday, that's right. That can't be done?

VICE CHAIR McLAUGHLIN: It's impracticable.

MR. FRANK: They need a little more time.

MR. GROB: Yes, okay. I tried to -- what I tried to do was to work in two whole reviews and time the process. So if we -- the alternative is to work in one full review of the report.

MR. FRANK: I just think that if you want a thoughtful job done, people have to be able to sit for two hours, and after being here through Wednesday --

CHAIR JOHNSON: We don't go home until Wednesday.

MR. FRANK: Right. We don't go home until Wednesday night. So that would mean Thursday you're digging out half the day anyway, and so you'll have no time. So you need at least a weekend, so you can have a couple of hours to --

CHAIR JOHNSON: So if we do that, if we think that we -- if we play that out, then what would be your suggestion of the staff working on it, and getting another copy to us for review?

MR. FRANK: Well, I mean, I guess my reaction would be, and I'm just talking about myself, and so assuming that I'm not that much different from anybody else except in appearance, would be --

(Simultaneous discussion.)

MR. FRANK: I'm trying to lighten it up here anyhow. But I would say that, you know, I would be ready to get written comments back Monday, by COB.

VICE CHAIR McLAUGHLIN: But then when does it get revised?

MR. FRANK: Well, I'm just telling you, I'm just telling you when I can get a thoughtful job done to you, and I'm not worrying about the other thing, because I'm trying to at least tell you what I think I can do, and we can --

CHAIR JOHNSON: Richard, play that out then. When would you expect to hear from staff regarding their feedback or their consolidation of the information, feedback and so forth, and out to us with -- okay, here's what we heard, and this is the next rendition.

MR. FRANK: Well, I mean I'll make a statement based on the last version of the report that I saw, which was the Word version last Wednesday or Thursday.

VICE CHAIR McLAUGHLIN: Wednesday night.

MR. FRANK: Yes, Wednesday night. I thought that I had some comments, but I thought it was not even a day's worth of work fixing what I needed to fix.

VICE CHAIR McLAUGHLIN: Yes, but everybody should --

CHAIR JOHNSON: But you have 14 people and there are different comments.

(Simultaneous discussion.)

MR. FRANK: Right, right. No, no, that's right. But on the other hand, if the past is any indication of what the future's going to be, then I think that I tend to be on the high end of comments, in the distribution, and that therefore there's maybe 2-1/2 days of work to do or, you know, because I assume that a lot of my comments that also overlap with the comments that other people had made.

CHAIR JOHNSON: Can you turn that around by the 24th?

MR. FRANK: I mean, this is just -- this is my guess, based on what I saw last Wednesday night.

CHAIR JOHNSON: Can we look for a compromise that you have your comments in by the start of the day on the 22nd, not the close of the day, so that the staff can have that day to work through their comments.

MR. FRANK: Well, you can ask everybody else. I can accommodate you on that.

MS. HUGHES: I can't accommodate that. I go back. I have a report that's due in Sacramento at close of business on the 22nd, and I'm working through the weekend on that report. So you know, I trust what the report -- I trust what you've done and what you've done.

I mean, I'll be real honest and say I trust that. I do believe that there should be -- what?

MR. FRANK: A big mistake.

MS. HUGHES: Big mistake. Except for the fact that you tried to balance it, you tried to keep a balance in the report. I appreciate the efforts for the balance, and that's what I trust. My only comment would be, because I can't give any other comment on it, is that we have a balance of the three issues that are there, if we have three issues that are of importance, in my opinion is they need to be equally balanced.

That's all I can give, because I cannot meet any of the time lines for this.

CHAIR JOHNSON: Okay. If we were to do that, could the staff turn it around by the 24th?

MR. GROB: Yes.

CHAIR JOHNSON: Okay. If the staff turns it around by the 24th, then Richard and Mike and everybody else --

(Simultaneous discussion.)

CHAIR JOHNSON: When will we have our feedback to the staff again?

MR. FRANK: So they turn it back around to us on the 24th, which is what date?

CHAIR JOHNSON: It's a Wednesday.

VICE CHAIR McLAUGHLIN: Wednesday.

(Simultaneous discussion.)

MR. GROB: We can get them back to in two days.

VICE CHAIR McLAUGHLIN: All right. You're saying comments back by Monday morning, the 22nd?

MR. FRANK: Staff gets back to us by close of business the 24th, and then you want -- you're proposing that we get back to you the night of the 26th?

MR. GROB: I'm wondering whether by that time, we could be asking you for your concurrence at that time?

VICE CHAIR McLAUGHLIN: I just will tell you that, I mean, Dottie's going on vacation. Next Wednesday through Friday are my only three days of vacation this entire summer, and I'm going to Canada and I'm not taking my laptop and I'm not taking my cell phone.

We have expensive theater tickets, every matinee every evening with our children. I'm not doing it. So I'm just letting you know. I just want to get out there. We originally thought, and I bought those last February.

We originally thought that this was going to resolve by next Wednesday, and for a whole bunch of before I left for vacation, my three days. For a whole bunch of reasons, that's not going to happen, you know. I'm just saying I get back late Friday night, next Friday night. I can look at it Saturday. But you will not hear from me by close of business Friday, because I'm going to be in Stratford, Ontario. Dottie's going to be her only vacation next week too.

MR. FRANK: We trust you. Can you trust us?

VICE CHAIR McLAUGHLIN: No.

(Laughter.)

VICE CHAIR McLAUGHLIN: If you trusted me, you would sign off right now. That's not true. If you trusted me, you would just sign off right now.

CHAIR JOHNSON: So let's push that to the 29th.

VICE CHAIR McLAUGHLIN: The 29th. That's fine.

CHAIR JOHNSON: Can we test with you the 29th? Can we get your concurrence by the 29th? Okay.

MS. HUGHES: So we can -- all of our editorial changes, not editorial, but comments, at the 50,000-foot or 15,000-foot level, to you by the 29th or 22nd?

MR. FRANK: 26th, right? The final ones are the 26th. There are two rounds.

VICE CHAIR McLAUGHLIN: The things that would prevent you from signing off we need by first thing next Monday morning. By what we need by first thing the following Monday morning is I'm willing to sign off.

MS. HUGHES: Okay.

MR. FRANK: Or I don't.

MS. HUGHES: Okay, very good.

VICE CHAIR McLAUGHLIN: Right.

CHAIR JOHNSON: Hopefully, it's yes. Okay, and the staff will get their version out to us by the 26th.

MR. FRANK: We need an explicit vote, right? I mean, the staff will --

VICE CHAIR McLAUGHLIN: By Monday morning the 22nd --

MR. FRANK: But what I'm saying is that if you don't hear from us, because our computers are turned off or because whatever, the staff will have to start and make us give them an answer; is that right?

Well, I just don't want -- what I'm -- the question I'm raising explicitly is that silence, what does silence imply?

CHAIR JOHNSON: Concurrence.

MR. FRANK: Yes. Well, what I'm saying is I'm uncomfortable with that, I think.

CHAIR JOHNSON: Let's say that you've sent -- the staff has sent it out, and let's say the follow it up with a telephone call on Monday. We need to have yours here, and still there's no response, and on Tuesday there's no response, and on Wednesday there's no response.

MR. FRANK: Well, here's my dilemma. I'm very sympathetic to that, and it would piss me off too. But here's my dilemma, is that it's hard for us to go dancing out to the American people, saying we really want to hear from you and we're here to listen, when we haven't fully made -- when we haven't gone, you know, 110 percent of the road listening to each other, right?

Because it seems to me that what you've got to be able to do is say "Everybody had a chance, everybody had a vote. We did this based on votes, you know, and everybody's voice and weighed in here." There's no room for ambiguity.

I'm saying that just because I totally understand --

CHAIR JOHNSON: Yes, and I don't think this is going to happen, but I'll think on it, what Richard said. He turns off the computer and he turns off his telephone calls, and he's at this highfalutin meeting out in Las Vegas, or wherever it is, and he just doesn't respond.

So maybe what we're saying here is we need to have every one of you respond, be purposeful about doing that.

MR. FRANK: Right. It has to be both ways that the staff and everybody will make a super effort, but we have to make super efforts too.

CHAIR JOHNSON: Right. Are you okay with that? How do the rest of you feel about that? At this point, it's kind of quiet.

MR. O'GRADY: One thing, just a slight exception to that, would be my somewhat odd rule on this working group.

(Simultaneous discussion.)

VICE CHAIR McLAUGHLIN: It's every appointed member.

MR. FRANK: It's every appointed member.

VICE CHAIR McLAUGHLIN: You don't count anyway.

MR. O'GRADY: Okay, thank you.

MS. HUGHES: That's fair enough.

MR. FRANK: Yes. I think you want to wait for the

(Simultaneous discussion.)

VICE CHAIR McLAUGHLIN: But I do want your comment.

MR. O'GRADY: Yes. Oh, I can comment.

VICE CHAIR McLAUGHLIN: But only appointed members sign off.

CHAIR JOHNSON: I have one other thing on the report, and that is that I'd just personally like to thank both George and Catherine for their work on this. Both of them worked really hard, and the hours that they've put in, the several versions that they've looked at.

You've looked at and shared your perspective. You've listened and you responded, and you responded by e-mail to each of us who responded with our thoughts, and so I think we owe you a debt of gratitude on this, both of you and others from the staff.

(Applause.)

CHAIR JOHNSON: Having said that, we still need to have your comments, and as objective comments as we can. So okay.

One last thing, and then we're going to close. George prepared a budget. We have reviewed that budget on a telephone call five weeks or on the 5th of August, and what we said is we wanted to bring it to you at the full working group to either express formal approval or get your feedback. So I'd like to ask if in fact first, George, you have any other comments regarding that.

We'd like to get it formally approved or formal feedback that we not approve it.

MR. GROB: I'll just leave it at that.

CHAIR JOHNSON: Is there anybody here who would have heartburn and resist approving that budget that was presented on the 5th?

VICE CHAIR McLAUGHLIN: What are the implications of some of the community meetings? I mean are we -- is the budget flexible enough to adjust to --

MR. O'GRADY: That would be my solution, and my solution was to make it flexible within the framework.

MS. WRIGHT: So I so move that we accept the budget as presented.

CHAIR JOHNSON: Thank you.

MS. HUGHES: I second the motion.

CHAIR JOHNSON: Any discussion?

(No response.)

CHAIR JOHNSON: All in favor say aye?

(Chorus of ayes.)

CHAIR JOHNSON: Opposed?

(No response.)

CHAIR JOHNSON: Thank you. Okay. We'll adjourn our meeting. We'd like to reconvene at 5:00 in the Amphitheater, and y'all have instructions where to go for that. Any other comments?

(Whereupon, at 4:25 p.m., the meeting was adjourned.)