[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

[[Page S5728]]

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.

                          ____________________