[Congressional Record Volume 156, Number 102 (Monday, July 12, 2010)]
[Senate]
[Pages S5723-S5728]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE APPOINTMENT
Mr. DURBIN. Mr. President, the speech which the Senate just heard
from the minority leader on the Republican side is consistent with the
Republican position on health care reform. They opposed it. They voted
against it. They want it to fail. They do not want to give this health
care reform a chance.
It is interesting that although they oppose health care reform, I
have yet to hear the first Republican Senator come to the floor and
suggest: Well, the first thing we need to do is to make sure we
eliminate--eliminate--the tax credits and deductions for America's
small businesses to help pay for health insurance that were part of the
health care reform plan.
I have never heard them say that. They opposed the plan. Do they
oppose the help we are going to give small businesses across America to
afford health insurance for their employees? That is what repeal is all
about.
Secondly, I have never heard a Republican Senator come to the floor
and say: We want to repeal the $250 check which will be sent to
thousands of Americans currently under Social Security, Medicare
prescription Part D, to help pay for the gap in coverage in the so-
called doughnut hole. That was part of the health care reform plan. So
those who come to the floor asking for repeal of health care reform
obviously want to repeal this check for senior citizens. I have not
heard that said one time.
I have also been waiting for the Republicans who want to repeal
health care reform to stand before the Senate and say, honestly,
openly: We want to eliminate health care insurance coverage for 30
million Americans who will have it for the first time in their lives--
30 million uninsured Americans who will have health care insurance
coverage because of health care reform. To repeal health care reform is
to repeal that coverage for 30 million Americans.
I have yet to hear the first Republican come to the floor and say
they want to repeal extending health insurance coverage and the peace
of mind that comes with it. I am waiting for the first Republican who
wants to repeal health care reform to stand before the Senate and say:
We want to take away the power given in this health care reform to
individuals so they can fight health care insurance companies that turn
down coverage for families because of preexisting conditions. It
happens every day in Illinois, in Oregon, in Arizona, in Kentucky.
The bill we passed gives American families a fighting chance against
those health insurance companies. Those who are calling for repeal want
to take away the power of families to fight for health insurance
coverage when they need it the most.
I have yet to hear the first Republican who calls for repeal of
health care reform go to families with kids in college and tell them:
We oppose that provision in health care reform which extends family
health insurance coverage for young people until they reach the age of
26. Those of us who have raised college-aged students know that is a
blessing to have those kids--I call them kids--those young people under
your family health care plan after they graduate from college until
they reach the age of 26--a period of time when some of them are off
taking a trip of a lifetime after graduation or looking for a job and
do not have health insurance coverage.
I can recall calling my daughter Jennifer: ``This is Dad. I am so
happy you graduated from college. Do you have health insurance?'' ``Oh,
Dad, I feel fine. You know, I'm healthy and strong.'' ``No, Jennifer.
You need health insurance.''
The law we passed, the health insurance we passed, is going to give a
family coverage to protect their kids until the age of 26. Those who
want to repeal it want to undo that provision. But I have yet to hear
them say that on the floor.
They have a different strategy. Senator DeMint of South Carolina made
it clear when the health care reform debate started that the purpose of
the Republican effort was to defeat health care reform. In his words:
We want health care reform to be Barack Obama's Waterloo in politics.
He was very clear. They wanted the President to fail, they wanted
health care reform to fail, and they still do. Their latest strategy
was to stop the President from putting in place a person to run the
program--someone who would try to make it work, someone who would look
at the things we have done in Congress and make sure they work in the
real world.
Last week, President Obama made a very sensible move, after waiting
patiently for the Republicans to give us a chance to vote on a man to
serve and to oversee Medicare and Medicaid as Administrator of CMS. His
name is Dr. Donald Berwick.
CMS has been without a permanent Administrator since 2006, and it is
time this important position be held and filled for the good of
American families. This man, Dr. Berwick, is eminently qualified for
this role. He is a Harvard pediatrician and policy expert who was
committed to improving health care long before our debate started and
who today is one of the foremost experts and leaders in health care
quality and patient safety. The President appointed him last week when
we were gone because my colleagues on the other side of the aisle, the
Republicans, had made it clear they intended to elongate this debate on
his appointment as long as possible, to rehash argument after argument
instead of just giving us an up-or-down vote to let this man serve the
Nation
[[Page S5724]]
and serve all of us who want quality health care.
Rather than work in a bipartisan way to get things right, to make
sure we implement the health care reform that is decades overdue, the
Republicans took a political position and held to it. The President was
right to come down on the side of helping American families deal with
health care rather than to engage in this never-ending political
battle.
The Republicans delayed Dr. Berwick's nomination by bringing up the
same talking points and the same Republican arguments we have heard
again today and over and over again. They are entitled to their point
of view, but Dr. Berwick is entitled to an up-or-down vote. The
President decided he couldn't wait any longer and made this recess
appointment.
By blocking nominees such as Dr. Berwick, the Republicans are
blocking progress on improving health care in America. According to
RollCall, a publication on Capitol Hill, the coordinated Republican
message is called second opinion. I have seen some of my friends on the
Republican side of the aisle come to the floor with large posters that
say ``Second Opinion.'' A Republican Senate aide says the effort is
intended ``to draw attention to the consequences of the health care law
that the White House hopes people miss.''
Well, whose second opinion is this? It is the same opinion we have
heard from Republicans from the start who consistently voted against
health care reform and refused--refused during the course of the
debate--to put on the table any proposal which would extend health care
coverage to 52 million uninsured Americans, help to hold down the
costs, and give people a fighting chance against health insurance
companies. Time and again, they criticized our efforts and never
proposed a viable, comprehensive alternative.
Starting this year, we know children will never again be excluded
from health insurance because of a preexisting condition. That is in
health care reform. Adults will no longer be dropped just because they
get sick. Young adults will be allowed to stay on their parents' plan,
as I said earlier, until age 26. These are real changes we are going to
see this year. That is the way it should be--health insurance that is
there when you need it, not the kind of health insurance where you pay
premiums for a lifetime and pray to God you don't go to the hospital
and get a diagnosis that says you are headed in for a surgery or a
long-term illness and you are not going to have health insurance
coverage. That is the reality for too many American families.
The Republicans have never offered an alternative. They have voted
against this consistently, and now they want to stop President Obama in
every effort to try to make this work for America.
I believe most Americans, even those who have questions about health
care reform, believe it deserves a chance. They believe we ought to
give it our best human efforts to make it work for America. They want
to see us work together. They don't want to see these filibusters, they
don't want to see these blockages, and they don't want to see the
consistent policy of saying no to everything.
Don Berwick is a well-respected, accomplished, leading authority in
health care. We are fortunate to have his expertise at the forefront of
the agency charged with making many of the changes in health care
delivery. He has the respect of Democratic and Republican leaders,
including Mark McClellan, the CMS Administrator under President George
W. Bush; Gail Wilensky, the CMS Administrator under President George
H.W. Bush; Nancy Nielsen, immediate past president of the American
Medical Association; Rich Umbdenstock, president and CEO of the
American Hospital Association; John Rother, executive vice president of
the AARP; and Ron Pollack, executive director of Families USA. The list
goes on and on. He deserved a vote. The President deserves a team to
make the law work. The American people deserve something more from the
Republicans than the word ``no.'' That is all we have heard in this
session.
Now comes an election in just a few months, and the party of no is
asking for another chance. This is the same party whose economic
policies drove us into this economic recession under the previous
President. After driving that car in the ditch, as the President has
said, they are asking in November for the American people to give them
the keys again and let them start it up all over. Well, we have learned
a bitter lesson, and we are not going to repeat it. With so many
millions of Americans out of work, with this economy struggling to
survive, we cannot and should not return to the policies of the past.
We cannot accept no for an answer when it comes to moving America
forward.
I am glad the President made this decision to make a recess
appointment of Dr. Berwick. He deserved a vote on this floor. He
deserved a chance to have his day of service to our country. Sadly and
unfortunately, the Republican policy of voting no and saying no to the
President has led him to this conclusion and this interim appointment.
I wish Dr. Berwick the best. We should now try to work with him to make
this policy even better, to make sure more Americans have the peace of
mind of having affordable health insurance when their family needs it
the most.
Mr. President, I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Arizona.
Mr. KYL. Thank you, Mr. President.
Now let me set the record straight. Republicans have never said no to
Dr. Berwick. We have never blocked a vote on Dr. Berwick. There has
never been a vote called on Dr. Berwick. In fact, there has never even
been a hearing on Dr. Berwick. Republicans have not stopped his
nomination.
It is true there hasn't been a permanent director of the agency that
Dr. Berwick will now head since 2006. When Barack Obama became
President on January 20, he could have corrected that problem. But I
suspect the reason he didn't nominate anyone to head CMS during the
debate on the health care bill is because if Dr. Berwick was his
nominee, the last thing the President wanted was a discussion of Dr.
Berwick's views on health care. His views are antithetical to the views
of the majority of the American people, supporting rationing, as he
does, and his love affair with the British single payer system, as he
has described it. This is not something the American people would have
countenanced. So Barack Obama, the President, rather than filling the
position, decided to hold off on nominating a person to head CMS until
after the health care debate was over.
Now, this is bait and switch. This is not the transparency that
Barack Obama promised when he campaigned for the job of President.
Instead, in my view, it is hiding the ball: Let's get health care
passed, not tell anybody we are going to nominate Dr. Berwick to head
CMS, and then, after the bill is passed--in fact, I think about 4
months after the bill is passed--nominate Dr. Berwick, and then have
the gall to say Republicans stopped his nomination. We haven't stopped
his nomination. There has been nothing for us to stop. There has been
no vote.
I am on the Finance Committee. The chairman of the Finance Committee,
a Democrat, Max Baucus from Montana, was very upset about the fact that
the President appointed Dr. Berwick because he said: I haven't even had
a chance to call a hearing yet.
Republicans stopped the nomination? No, we didn't stop it. Has there
been a vote on the floor of the Senate? No. Has there been an attempt
to have a vote? No. So how could we have filibustered a nominee who
hasn't had a hearing, when his name hasn't even been brought up in
committee, and who hasn't been sent to the Senate floor for action?
Well, they say: We anticipated you would have objected to him. Yes,
that is true. Knowing all we know about him, you are right; a lot of us
would have objected to him. So bring him up for a vote, and let's have
the vote, up or down. If he has the votes to pass, he passes. If he
doesn't, then perhaps the American people's will has been expressed.
I wish to remind my colleagues that the ranking Republican on the
Senate Finance Committee, Chuck Grassley, requested a hearing for Dr.
Berwick. He requested that it take place the week of June 21. Why? That
was before the hearings for the Supreme Court nominee, Elena Kagan. The
reason Senator
[[Page S5725]]
Grassley did that was because he wanted to make sure for the several of
us--there are three Republicans and I know at least one Democrat who
serve on both the Judiciary Committee and the Finance Committee. He
wanted to make sure we would have an opportunity to attend both
hearings because we knew the time the Elena Kagan hearings were going
to be held in the Judiciary Committee. He specifically requested that
Senator Baucus schedule the hearing for Dr. Berwick the week of June
21. He would have been happy to be there. I would have been happy to be
there.
For anybody to suggest that Republicans are to blame for the fact
that Dr. Berwick's nomination didn't come to a vote or wasn't brought
to the Senate floor is sheer fantasy. We have not held up the
nomination. We have not prevented a vote. We have not blocked the vote.
Yes, we have been critical of Dr. Berwick. Since when is that a crime?
Since when is that the party of no?
Let me mention a few of the reasons we are critical of Dr. Berwick
and why the American people are going to rue the day that the
President, while we were gone from Washington over the July 4 recess,
recess-appointed Dr. Berwick. He didn't go through the regular Senate
process. He made a recess appointment before Senators had an
opportunity to have a hearing or to have a vote.
Well, I think I know some of the reasons. First of all, his radical
views on health care policy. I am not going to quote all of the things
he has said, but he did describe his love of the British single payer
system in very poetic terms. He said he was in love with it. He has
described it in the most glowing terms. He said his preference is for
absolute caps on health care expenditures in the United States. He says
competition is one of the biggest problems in American health care. He
says he believes in one-size-fits-all care. That is a direct quotation.
Everything I have said here are quotations from different things he has
written, all the way from 1992 through 2008.
We wanted to hear more about some of these views, especially since
the CMS, or Center for Medicare and Medicaid Services of the Department
of Health Care that he will head up, is in charge of administering the
health care law we passed, a law that does--let me just mention four
specific things it does, with a budget, as I said, larger than the
Pentagon budget. I think he has something like $803 billion in benefits
this fiscal year that he has the opportunity to dole out. So there is a
great deal of power.
First of all, we know the bill establishes a Medicare commission
which is given the responsibility of finding sources of excess cost
growth, meaning tests and treatments that are too expensive or whose
coverage would mean too much government spending on seniors. There is
an opportunity for rationing.
The law will redistribute Medicare payments to physicians based on
how much they spend treating seniors.
That is a way they can adjust the payments and, therefore, determine
care.
Third, it will rely on recommendations from the U.S. Preventive
Services Task Force--that is the entity that last year recommended
against mammograms for women under the age of 50--in order to set
preventive health care benefits, which is another form of rationing.
Finally, it will authorize the Federal Government to use comparative
effectiveness research, or CER, when making Medicare determinations.
Republicans tried to get on a simple amendment to that to say: OK, you
can compare effectiveness research but not to deny coverage based on
cost. Our attempts to get that amendment passed were defeated. Why?
Because they wanted to leave the flexibility in the law for the head of
CMS, now Dr. Berwick, to ration care.
What is done in Great Britain is what he says is good policy. He
said:
It's not a formula for comfort; it's a formula for
constructive discomfort.
He described in several other ways the fact that this would be
something people would not like but they would get used to it and have
to abide by it. He said:
The decision is not whether or not we will ration care; the
decision is whether we will ration with our eyes open.
Indeed, at least his eyes will be open--the people who make the
decisions on whether we can get health care for our families and what
it is. He will know what is happening, but will we know until it is too
late? We didn't even have a chance to ask Dr. Berwick questions about
this because he never was given a hearing. We weren't given that
opportunity. Instead, the President waits until we are out of town over
the Fourth of July recess and recess-appoints the individual so that he
doesn't have to have a hearing or a Senate vote.
Here is another comment from Dr. Berwick:
I would place a commitment to excellence--standardization
to the best-known method--above clinician autonomy as a rule
for care.
That means the doctor gets to decide what happens to the patient,
along with the patient, as opposed to standardization of the best known
method, with a bunch of bureaucrats figuring out in a cookie-cutter way
what kind of treatment is less costly and therefore best for people who
receive government-paid health care. True, this is the way it is done
in some other countries that he thinks are great in terms of their
health care system. That is not the way it ought to be in the United
States. By this individual now receiving this nomination and this
appointment, he now will be the person who helps to determine that
standardization rather than the clinician autonomy we have today.
Again, Dr. Berwick will head the agency in charge of implementing
much of the new health care law. He will have the responsibility to
determine what your health care coverage entails. He is the person whom
the President appointed to reduce the government's health care costs. I
can guarantee you how that reduction will occur: it will occur when
they decide that standardization requires that the government only
approve the following kinds of treatment or drugs or services, and too
bad if you expected something greater than that.
Given Dr. Berwick's philosophy, public comments, and writings about
rationing, I think we have a pretty clear picture of where he will look
to achieve those savings.
In 1996, he wrote a book entitled ``New Rules.'' He and his coauthor
recommended ``protocols, guidelines, and algorithms for care,'' with
the ``common underlying notion that someone knows or can discover the
best way to carry out a task to reach a decision, and that improvement
can come from standardizing processes and behaviors to conform to this
ideal model.''
This is extraordinarily distressing when we are learning every day of
innovative ways physicians and scientists have come up with to treat
diseases and chronic conditions and illnesses--with new kinds of drugs,
with other kinds of treatment, avoiding surgery in many cases, and now,
importantly, using genomic research. The TGEN Institute in Phoenix, AZ,
for example, is pioneering work involving the human genome so that
ultimately we can determine what is best for each individual person in
terms of a treatment. You may have breast cancer, for example, but
physicians know all breast cancers are not the same and they are not
all treated the same way. One woman can be treated with a particular
form of radiation or chemotherapy or surgery, and yet for another
person who seemingly has the same cancer, that treatment doesn't seem
to work. Through human genome research, they basically map out each
person's gene history, family history, and gene makeup in such a way as
to know whether various kinds of treatment will be accepted or
tolerated or successfully completed for each patient. They can tailor
the treatments or the drugs for each particular patient.
If you have standardization of processes and behaviors to conform to
this ``ideal model,'' to quote Dr. Berwick, you are going to get away
from the kinds of treatments that could really be breathtakingly
innovative for the future and could save many lives and improve our
quality of life for as long as we live. This is the future. The future
isn't cookie-cutter medicine where the doctor has to do exactly what
some group of bureaucrats says because they performed a test someplace
and that was the most efficient way to treat the particular patient.
[[Page S5726]]
Another couple of things.
Dr. Berwick expressed his disapproval for costly cutting-edge medical
technologies and has said prevention services such as ``annual
physicals, screening tests, and other measures'' are ``over-demanded.''
One of the things we did in the health care legislation was provide a
lot of different incentives for preventive care, for screening, to try
to help people avoid illnesses on the theory that it would be a lot
cheaper if we didn't do a lot of treatment that was unnecessary. If you
could identify in advance that an individual had a need for some
treatment, maybe you could catch the disease, say, the cancer, early
and not have the expensive treatment, the end-of-life kind of care that
is frequently very expensive.
Let me close with a couple of things. The Wall Street Journal
editorialized about Dr. Berwick's vision, saying this:
Such a command-and-control vision is widespread among
America's technocratic medical left, but it is also
increasingly anachronistic amid today's breakneck medical
progress. There isn't a single ``ideal model'' in a world of
treatments tailored to the genetic patterns of specific
cancers, or for the artificial pancreas for individual
diabetics, or other innovations that are increasingly common.
This is nonetheless where Dr. Berwick . . . will look for his
``savings.''
As CMS Administrator, Dr. Berwick will not only oversee billions in
Federal spending but will be responsible for programs that cover
millions of lives. It is perplexing, to say the least, that such an
important position would bypass Senate consideration, without even so
much as holding a hearing.
Moreover, this appointment is just the latest self-contradiction of
an administration that claimed it would be the most transparent in
history. We now have another example of the lack of transparency--the
President recess-appointing someone, I believe, in order to avoid
having a hearing and to avoid having a debate that would inform the
American people of the kind of person the President was putting into
this enormously important position.
Mr. President, I express the same concern Leader McConnell expressed.
We regret that the President has seen fit to do this. I understand he
can appoint anybody he wants, but what I really resent is turning
around and having a spokesman for the President say that somehow or
other the fact that he didn't have a hearing or the fact that he never
was voted on is somehow the Republicans' fault. We had nothing to do
with the fact that he didn't have a hearing. We asked for a hearing. We
had nothing to do with the fact that he never had a vote. We never
objected to any vote. There has never been a question of having a vote.
Nobody ever said, in the Finance Committee or on the Senate floor,
let's vote on Dr. Berwick. We had nothing to object to. The President
can make the appointment if he wants to. We can still debate his
qualifications even though he will now serve in this position. But to
blame Republicans for having to do it in this nontransparent way is
wrong, and I think Republicans are going to continue to demonstrate to
the American people why this is a nominee who should have been aired
out in public rather than appointed during the July 4 recess.
The ACTING PRESIDENT pro tempore. The Senator from Rhode Island is
recognized.
Mr. WHITEHOUSE. Mr. President, I rise to discuss the appointment by
President Obama of Dr. Donald Berwick as Administrator of the Center
for Medicare and Medicaid Services.
I disagree, respectfully, with my distinguished colleague from
Arizona. I guess I agree that it is regrettable that this was a recess
appointment, but I believe that on the part of the President it was
both prudent and necessary to make this a recess appointment, given, A,
the urgency of moving forward with health care reform and, B, the
relentless blockade the Republicans have maintained.
Dr. Berwick is perhaps the most qualified person in the country to
wield the vast apparatus of the Federal health care bureaucracy toward
the comprehensive change we need, to lower the cost of health care,
while improving the quality of health care.
In evaluating this urgency, I ask my colleague to consider the
situation we are in right now. We are in the midst of an accelerating
and unsustainable rise in health care expenditures in America. In
1955--the year I was born--we spent a little bit over $12 billion a
year on health care. That was the annual health care expenditure in the
United States in 1955--$12 billion. Last year, we spent more than $2.5
trillion. The increase over the previous year was $134 billion--from
2008 to 2009, an increase of $134 billion, which is the largest year-
to-year increase in history, by the way, and 200 times what we spent in
1955--200 times. Anybody who is looking at this can see both the trend
and the increasing acceleration of this curve. It is accelerating, it
is unsustainable, and it adds up to, at this point, a stunning 17.3
percent of our national domestic product, our GDP, spent on health care
every year. No other nation even comes close to spending that much of
its annual domestic product on health care.
In my home State of Rhode Island, had we done nothing on health care,
by 2016 a family of four would have faced more than $26,000 in premiums
for family health insurance--$26,000 per year in 2016 average costs.
Last year, premiums for Medicare Advantage plans jumped an average of
14.2 percent nationally--just in 1 year. So there is a clearly
unmistakable case that our health care costs are out of control and we
have to do something about it.
The escalation, as I pointed out, is unsustainable and accelerating,
but it is not inevitable. Indeed, experts from across the ideological
spectrum agree that a great deal of health care cost is simply waste--
waste resulting from an irrational, disorganized status quo that too
often encourages the wrong choices by patients, payers, and by
providers of health care services. That status quo has to change.
As you consider our health care system, set aside for a moment the
problem of duplicative tests, the problem of lost medical records, the
problem of unnecessary treatments, and the problem of uncoordinated
care for patients working between multiple doctors. Set aside all those
problems and look just at the administrative overhead of our private
insurance market.
By way of reference, administrative costs for Medicare run about 3 to
5 percent. Overhead for private insurers is an astounding 20 to 27
percent. A Commonwealth Fund report indicates that the private insurer
administrative costs more than doubled from just 2000 to 2006. In those
6 years, the overhead, the administrative costs of the private
insurance industry, more than doubled, up 109 percent. The McKinsey
Global Institute estimates that Americans spend roughly $128 billion
annually just on what the report called ``excess administrative
overhead.'' There is $128 billion that we pay for every year in excess
administrative overhead--not health care but administrative overhead--
in our health care system in the private health insurance market.
On top of that, you have the duplicative tests, lost medical records,
unnecessary treatment, and the uncoordinated care for patients with
multiple and chronic conditions. I won't dwell on those particular
topics because I have spoken about them so often on the Senate floor in
the past. My point is that because of all this waste in the system, the
President's Council of Economic Advisers concludes that it should be
possible to cut total health expenditures about 30 percent. Let me
repeat that quote.
It should be possible to cut total health expenditures
about 30 percent without worsening outcomes . . . which would
suggest that savings on the order of 5 percent of GDP could
be feasible.
Five percent of GDP is over $700 billion a year, and other experts
agree. The New England Healthcare Institute reports as much as $850
billion a year in excess cost ``can be eliminated without reducing the
quality of care.'' Former Bush administration Treasury Secretary
O'Neill has written that the excess cost is $1 trillion a year in our
health care system. The Lewin Group, which is often cited in this
Chamber on both sides of the aisle as a respectable organization that
does authoritative work in this area, finds that we burn over $1
trillion a year through excess cost and waste.
So is it $700 billion a year in excess cost and waste, is it $850
billion a year, is it $1 trillion or over a year in excess cost and
waste? Whatever it is, it is a big number, and we needed to do
something about it. This Congress rose to the challenge in the health
care reform
[[Page S5727]]
bill and passed what health economist David Cutler has called ``the
most significant action on medical spending ever proposed in the United
States.''
This isn't just a partisan view. Analysts of all stripes agree the
reform law does more than any previous measure to begin to lift the
dead weight of all this wasteful health care cost off our economy. The
Commonwealth Fund has projected that the law will reduce the annual
growth of national health expenditures--that is the amount that private
and public sectors would otherwise spend on health care every year--by
0.6 percentage points annually and nearly $600 billion over the next 10
years. The Council of Economic Advisers writes that ``total slowing of
private-sector cost growth'' will be approximately 1 percentage point
per year--more than $1 trillion over the next 10 years. That is just
what they can prognosticate, what they can anticipate, what they can
project.
Here is something that is interesting. Nobel laureate Paul Krugman
writes:
There are many cost-saving efforts in the proposed reform,
but nobody knows how well any one of these efforts will work.
And as a result, official estimates don't give the plan much
credit for any of them. Realistically, health reform is
likely to do much better at controlling costs than any of the
official projections suggest.
Health reform is likely to do much better at controlling costs than
any of the official projections suggest.
He is not alone. Other respected health economists--Len Nichols of
George Mason, Ken Thorpe of Emory, and Alan Garber of Stanford,
described the bill's cost controls as vital, a significant improvement
on the status quo. And MIT Professor Jonathan Gruber, one of our
leading health economists, said of the bill's cost control measures:
I can't think of a thing to try that they didn't try. They
really make the best effort anyone has ever made. Everything
is in here. You couldn't have done better than they are
doing.
So that frames the picture for the appointment of Dr. Berwick because
the President's signature of our health care law was just the beginning
of the reform project that lies ahead. This law gives those
unprecedented tools to fight health care waste and inefficiency, but
those tools are meaningless, they are useless unless they are applied
both vigorously and wisely. Don Berwick is simply, hands down, the best
person to do that. He has vast experience, proven expertise, and he has
earned the respect of colleagues in the public and private sectors and
on all sides of the ideological spectrum.
For instance, Dr. Nancy Nielsen, immediate past president of the
American Medical Association, said Dr. Berwick is ``widely known and
well-respected for his visionary leadership efforts that focus on
optimizing the quality and safety of patient care in hospitals and
across health care settings.''
Gail Wilensky, the Administrator of CMS under President George H.W.
Bush, said Dr. Berwick ``has long-standing recognition for expertise
and for not being a partisan individual, so I think that will assist
him in his dealings with Congress, both with the majority and hopefully
the minority, as well.''
Tom Scully, George W. Bush's CMS chief said:
You're not going to do any better than Don Berwick.
And Steven D. Findlay, health policy analyst at Consumers Union, has
applauded what he calls ``a spectacular appointment.''
Don has been an intellectual force in health care for
decades. He helped forge many ideas incorporated in the new
health care law.
So given this chorus of praise from across the ideological spectrum
and the urgency of the task at hand to control those costs, one might
think that bipartisan support for Dr. Berwick's nomination would be
strong and swift.
Well, you heard the Senator from Arizona. Unfortunately, my
Republican colleagues, regrettably, threaten the familiar old
Washington playbook of delay and obstruction.
I have spoken many times about how the Republican minority has
delayed without substantive justification far too many of the
President's executive branch nominees, jamming up the administration's
ability to administer the government; usually not because they have any
objection to the nominee but just to jam up the administration's
ability to administer the government.
On our Executive Calendar right here we have the names of everybody
who is waiting on the Senate floor languishing, waiting for a vote.
That doesn't even count all the names that are stuck in committees.
These are the people on the Senate floor waiting for a vote. Some have
been on for months. Some of them have cleared committee unanimously
with full Republican support in the committee. Yet they are jammed up
here. That is the quagmire into which they were going to stick Dr.
Berwick, notwithstanding the urgency of the need.
Since his nomination was first announced, the Republicans made clear
they would subject Dr. Berwick to this treatment. There is no doubt
about that. It was confirmed just now by the Senator from Arizona. A
recess appointment was the only way for the President to ensure that
CMS is fully equipped to handle the vital and voluminous and immediate
tasks that we have asked CMS to perform.
So why do my colleagues on the other side of the aisle clamor in
opposition to Dr. Berwick, the foremost expert in the field of reducing
cost by improving quality of care? There are innumerable ways to reduce
health care costs by improving quality. Reducing and eliminating
hospital-acquired infections is a perfect example. The North Carolina
Medicaid effort to provide coordinated care of a medical home for
people who are high users of the health care system is another example.
My Republican colleagues, who so loudly championed cost control, now
claim this reducing cost by improving quality is rationing--rationing.
Well, here is my question: Whose side are they on? One trillion dollars
a year in waste, and they are lining up to defend the waste and call
efforts to restrain it rationing? Protecting you and your family from
expensive and dangerous hospital-acquired infections, that is
rationing? Organizing complex care of people who have multiple
diagnoses and chronic conditions into coordinated medical homes,
rationing? Whose side are they on when they attack the reforms, the
quality improvement, cost-reducing reforms that are Dr. Berwick's
signature expertise?
One Senator even stood in this Chamber and said Dr. Berwick endorsed
an end-of-life pathway to death. Oh boy, looks like the death panels
are back. Dr. Berwick is not just a pioneer in health care quality
improvement, he is the pioneer. He was a lead author of the Institute
of Medicine's watershed report, ``To Err Is Human,'' and the follow-on
report, ``Crossing the Quality Chasm.'' ``To Err Is Human'' launched
the quality movement in this country. That report exposed the
breathtaking fact that 100,000 Americans die needlessly in this country
every year from medical errors--100,000 Americans dead every year in
this country because of needless medical errors. Is getting rid of the
errors that killed those 100,000 Americans rationing? Don Berwick has
devoted his life to saving those lives. Whose side are my colleagues on
when they oppose Dr. Berwick?
The connection between quality improvement and cost savings which Don
Berwick has spent his career exploring is demonstrated by global
maternal mortality figures. Maternal mortality is a cold and
statistical way of saying moms who die in childbirth. We in the United
States are 39th in the world. Thirty-eight countries, including most of
Europe, do a better job of keeping moms alive through childbirth. We
would be willing to spend money to get better at that, I would bet. But
the strange thing is the many medical errors and the process failures
that cause those deaths--and that cause us to be 39th in the world at
maternal mortality--also cause a lot of other complications which cost
lots of money to treat and recover from. So if you make those quality
improvements, you save money. That is the win-win connection between
cost saving and quality reform.
That is the area where Don Berwick specializes and has specialized
for years--improving care, eliminating process failures, and saving
cost. But my Republican colleagues are standing against him and want to
talk about rationing. When it improves care, when it lowers maternal
mortality, that is the kind of reform I think we could use. If
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you are against that, and if you are against Dr. Berwick, whose side
are you on?
Dr. Berwick founded the Institute for Healthcare Improvement, one of
the first organizations to promote systematic and sustainable health
care quality improvement. He has worked on quality initiatives as a
board member of the American Hospital Association, as chair of the
Advisory Council for the Agency for Healthcare Research and Quality,
and as a member of President Clinton's Advisory Commission on Consumer
Protection and Quality. That is his work.
That is probably why Tom Scully, CMS Administrator under President
George W. Bush, said:
You are not going to do any better than Don Berwick.
So I ask my colleagues: Do we really need to raise the phony
scarecrows of rationing, of death panels, of socialized medicine?
Do we really need to go there against $1 trillion in waste and
inefficiency every year? Do you really want reform efforts to fail
against 100,000 American lives lost every year due to avoidable medical
errors?
Do you really want reform efforts to fail against eliminating
hospital-acquired infections and providing better coordinated care for
patients who have multiple doctors and multiple conditions? Do you
really want the reform effort to fail? Is this how far we have fallen?
There is a huge window where we could work together on a win-win
path, where we could improve the quality of health care for Americans
while reducing its cost by coordinating the care better, by
coordinating electronic health records better, by avoiding hospital-
acquired infections, by avoiding unnecessary care, by making sure
doctors know what the best evidence is for treatment as they have to
take on patients with multiple difficulties and symptoms. We could do
this together. This is a win-win, and Dr. Berwick is an expert with
bipartisan public/private--or Republican and Democratic support and
recognition of his particular expertise in this area. I urge my
colleagues to treat Dr. Berwick as the highly qualified individual he
is, not as an opportunity for political grandstanding--we do enough of
that around here--not as a way to wish failure on America in this vital
task that lies before us. At long last, my friends and colleagues, are
we not better than that?
Mr. President, I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Wyoming.
____________________