[Congressional Record Volume 156, Number 76 (Wednesday, May 19, 2010)]
[Senate]
[Pages S3953-S3955]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           BERWICK NOMINATION

  Mr. ROBERTS. Mr. President, recently, Leader McConnell and Dr. John 
Barrasso, the distinguished Senator from Wyoming, and I engaged in a 
colloquy regarding President Obama's nominee for the head of CMS, the 
Centers for Medicare Services, Dr. Donald Berwick.
  Simply put, Dr. Berwick has a long history of interesting 
statements--pertinent statements--that support government rationing of 
health care, an issue I have vigorously fought against throughout the 
entire health care debate.
  The White House response to our colloquy, it seems to me, was most 
unfortunate, if not rather incredible. Here is what the Obama 
administration had to say:

       No one is surprised that Republicans plan to use this 
     confirmation process to trot out the same arguments and scare 
     tactics they hoped would block health insurance reform.
       The fact is, rationing is rampant in the system today, as 
     insurers make arbitrary decisions about who can get the care 
     that they need. Dr. Don Berwick wants to see a system in 
     which those decisions are transparent--and that the people 
     who make them are held accountable.

  This is a fascinating response. Instead of flatout denials of 
government rationing, we have excuses. If you read between the lines, 
you will notice that for the first time ever in this debate, the Obama 
White House is admitting their health care plan will ration health 
care. It just doesn't make it transparent.

  Remember, when Republicans, such as myself and Jon Kyl and Dr. 
Coburn, the Senator from Oklahoma, tried to warn that health care 
reform would result in government-rationed care, we were dismissed as 
crazy reactionaries or even worse. President Obama accused us of trying 
to scare people, and no less than the American Association of Retired 
Persons, AARP--that organization that purports to represent Medicare 
patients and seniors all across our great Nation--said our rationing 
concerns were a mere ``myth''--that ``none of the health care reforms . 
. . would stand between individuals and their doctors or prevent any 
American from choosing the best possible care.''
  How interesting that now, after the health care bill has become law, 
the President is admitting we were right all along. Here is the quote:

       Don Berwick wants to see a system in which those 
     [rationing] decisions are transparent--and that the people 
     who make them are held accountable.

  That is a complete and utter about-face.
  Although cloaked in the typical straw man arguments that have come to 
characterize this administration,

[[Page S3954]]

the statement is undeniable. The government is going to ration your 
health care.
  To set the record straight, I don't accept rationing, whether it be 
transparent or otherwise. I am opposed to rationing whether it is done 
by the government or by an insurance company. I am not defending any of 
the practices of insurance companies that have unjustly denied claims.
  I am against rationing whether it is proposed by Republicans or 
Democrats or think tanks or the special interest sidelines in this 
city.
  But the Obama administration's response does nothing to address my 
concerns that our government will ration health care. Instead, we 
finally have an admission from the White House that this is what they 
plan to do.
  I am not holding my breath for an apology or a correction from the 
President or the AARP or any of the other organizations that demonized 
our concerns for the past year. But I do intend to ask some very tough 
questions of Dr. Berwick, the President's pick to implement and enforce 
literally thousands of regulations that will soon come pouring out of 
the Department of Health and Human Services, and that will inevitably 
include rationing.
  It is nothing personal, as I have said before. I have met Dr. 
Berwick. He is a very personable, affable, intelligent man. I don't 
doubt that he has support from his peers who know him. I am not 
questioning his honor or his motives or his love for this country.
  As an aside, I would appreciate it--and I know a lot of other Members 
of this body would as well--if the White House extended the same 
courtesy to me and, for that matter, anybody else raising serious 
policy questions.
  But we have a fundamental disagreement about the future of our health 
care delivery system. I happen to think it is important that we have 
this conversation so the American people can understand what is going 
on.
  Please quit attacking my motives and the motives of others. 
Accentuate the policy, eliminate the politics, and don't mess with 
those in between raising reasonable questions. That is an old song that 
rather dates me, but I think it is appropriate. Questions such as this: 
What did Dr. Berwick mean when he said:

       I am a romantic about the [British] National Health 
     Service; I love it. All I need to do to rediscover the 
     romance is to look at the health care in my own country.

  So he is both romantic and supportive of the British National Health 
Service.
  With cancer survival rates for women 10 percentage points higher in 
the United States than in England and over 20 points higher for men, 
why does he think their government-run system is superior to our 
system?
  Please explain this quote:

       If I could wave a magic wand . . . health care [would be] a 
     common good--single payer . . . health care [would be] a 
     human right--universality is a nonnegotiable starting place . 
     . . justice [would be] a prerequisite to health equity as a 
     primary goal.

  While that may sound very nice, very idealistic, the reality is, 
declaring health care to be a human right necessarily places some 
citizens' rights above others--suppressing the rights of some in favor 
of another government-favored group.
  If you are saying health care is a universal right, what you are 
essentially saying is that some people have a right to someone else's 
property, whether that be taxable income or doctor services or their 
health care.
  I disagree with this argument. Health care has become an entitlement 
for some in this country, but it cannot be properly described as a 
right without egregious government coercion and income redistribution 
and patient care consequences.
  But maybe that is OK with Dr. Berwick. After all, he did say that 
``any health care funding plan that is just, equitable, civilized, and 
humane must--must--redistribute wealth from the richer among us to the 
poorest and less fortunate.'' I want to hear more from Dr. Berwick on 
this point.
  Furthermore, what did he mean when he said that ``equity'' is a 
necessary component of ``quality''? Does that mean high-quality care 
should not be available unless it is available to all? This certainly 
seems to square with the United Kingdom's practice of delaying access 
to the latest breakthrough drugs and technologies because of their high 
costs. What does Dr. Berwick think this attitude will do to investments 
and innovations in lifesaving treatments?
  And what about this quote:

       Limited resources require decisions about who will have 
     access to care and the extent of their coverage. The 
     complexity and cost of health care delivery systems may set 
     up a tension between what is good for the society as a whole 
     and what is best for an individual patient . . . Hence, those 
     working in health care delivery may be faced with situations 
     in which it seems that the best course is to manipulate the 
     flawed system for the benefit of a specific patient . . . 
     rather than to work to improve the delivery of care of all.

  Is this a suggestion that it is a doctor's duty to concentrate on the 
good of society or the good of his or her patient? That certainly 
sounds like a proponent of socialized medicine to me. I use that word 
very carefully.
  Finally, this is a question about the following statement by Dr. 
Berwick:

       Most people who have serious pain do not need advanced 
     methods; they just need the morphine and counseling that have 
     been around for centuries.

  That is an amazing statement. I know Dr. Berwick is familiar with the 
Liverpool Care Pathway to death that is employed in the British health 
care system and its reliance on morphine and counseling. He should also 
be aware of the growing concerns of many British doctors that this so-
called pathway to death is being overused for patients who would have 
otherwise recovered, especially stroke patients. Is this what is being 
advocated for the American health care system? For Medicare patients? 
This certainly sounds like the ``death panels'' that became so roundly 
ridiculed and dismissed by ObamaCare supporters during last year's 
debate.
  I know that ``socialized medicine'' and ``death panels'' have become 
loaded terms. I understand that. But if that is what you are for, you 
should just say so. Don't be afraid to have this discussion. Dr. 
Berwick certainly has not been shy about his views in the past.
  Maybe this is a comment more appropriately directed at the 
administration than at Dr. Berwick, but do not hide behind straw men 
and name-calling of those who disagree with you.
  I have legitimate concerns--many of us have legitimate concerns--
about the direction we are taking in this country with particular 
regard to health care. The thousands of people in Kansas who have 
contacted me over the last year have very legitimate concerns, too, and 
if you do not think I deserve some answers, they certainly do.
  The American people are sick and tired of being told that they are 
crazy or racist or that they do not know what they are talking about or 
being misled or that any question raised is simply partisan politics. 
Promise after promise has been broken, from the pledge not to raise 
taxes to the promise that if you like what you have you can keep it, to 
the falsehood that this new law does not cut Medicare. And remember the 
one about lowering premiums. The list goes on and on. Now it is beyond 
a shadow of a doubt that the law will ration health care. I think we 
are duty-bound to hold this administration and its nominees accountable 
for these broken promises and for what lies ahead for patient care. 
That is why I will continue to ask the hard questions that need to be 
asked of this nominee.
  I will continue to fight against what I truly believe is government 
rationing of health care. I did so on the HELP Committee when we 
considered it, the Finance Committee when we considered it, and during 
the reconciliation process when we considered it. All, of course, were 
defeated by party-line votes. And I will continue to maintain that the 
American health care system, with all of its flaws, is the best health 
care system in the world. We need to fix the flaws. We do not need 
rationing.
  In the case of Dr. Berwick, we need answers.
  I yield the floor. It appears to me there is not a quorum, so I 
suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. CARDIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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  Mr. CARDIN. Mr. President, I ask to speak on the Democratic time.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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