The power of the forces supporting the Shalala recommendations should not be underestimated. Computer hardware, software, and data management companies stand to garner billion-dollar contracts to create and manage the system. Insurers, managed care companies, and the marketing industry, among others, would love to have access to the data. But the risks are enormous. As one of the advocates of a health information infrastructure admitted, "The sheer number of authorized users, the potential for lawful access without explicit authorization, and the threat of fraudulent access render it virtually impossible to ensure significant levels of privacy for patients under the national information system contemplated."