[Congressional Record Volume 156, Number 102 (Monday, July 12, 2010)]
[Senate]
[Pages S5728-S5729]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            A SECOND OPINION

  Mr. BARRASSO. Mr. President, I come to the floor today, having just 
returned from spending a wonderful week over the Fourth of July in 
Wyoming, visiting with people across the Cowboy State at senior 
centers, Kiwanis clubs, Rotary clubs, and repeatedly the issue came up 
of this appointment of Dr. Berwick to head Medicare and Medicaid.
  My colleague who just left the floor talked about the playbook of 
delay and obstruction. I will tell you that this recess appointment and 
the overall appointment of Donald Berwick is absolutely a page out of 
the playbook of the U.S. President of delay and obstruction.
  Last year I came to this floor and said we should have somebody in 
charge of Medicare and Medicaid. When this body is talking about 
cutting $500 billion from our seniors on Medicare, not to save Medicare 
but to start a whole new government program, there ought to be somebody 
in charge of Medicare in this country who can answer the questions 
about what are the impacts going to be. But the President of the United 
States refused to name anyone.
  At a time when this body was debating how to handle 16 million more 
Americans jammed and crammed into Medicaid, a program where half the 
doctors in the country will not see those patients, it is like giving 
somebody a bus ticket when a bus isn't coming. Those people may have 
coverage but they are not able to get care. There should have been 
somebody in charge of Medicaid. I came to this floor and said: Mr. 
President, it is time to make someone take over the responsibilities, 
to be in charge of Medicare and Medicaid so they can come and explain 
to this Senate and this country what the impacts are going to be of the 
cuts in Medicare and the cramming of more and more people into 
Medicaid. But the President of the United States refused.
  The playbook of delay and obstruction belongs to this administration. 
The playbook of delay and obstruction is what led us here today, to a 
situation where no one was even named to be in charge of Medicare and 
Medicaid for the United States until after an extremely unpopular and 
unwise health care bill was signed by the President of the United 
States. Then and only then did the President of the United States 
decide who he would want to put in charge of Medicare and Medicaid. To 
me, this is an insult to the American people, an insult that the 
American people would never ever have an opportunity of having open 
congressional hearings to have explained to them the positions of this 
man nominated to head Medicare and Medicaid for this country.
  I think the President of the United States has made a mockery of his 
pledge to be accountable as an administration, to be transparent as an 
administration. That is what I heard at senior centers in Rock Springs, 
WY, and in Riverton, WY, at a Kiwanis club, people there as well as at 
a meeting in Powell, WY, at the Rotary club. People all across Wyoming 
and all across the country are very concerned, saying how is this going 
to affect me personally. Seniors know if you take $500 billion away 
from their Medicare, not to help seniors, not to help Medicare, but to 
start a whole new government program--they are very interested how that 
is going to work because that affects each and every one of them 
personally.
  I heard my colleague from Rhode Island talk about coordinated care. I 
am with him. We need to coordinate care. That is why I was surprised to 
see Members of the Democratic side of this Senate vote to kill the 
program of Medicare Advantage for 10 million Americans. These are 
individuals who signed up for Medicare Advantage because there is an 
advantage. It actually helps with preventive medicine and it helps with 
coordinated care. That is going away. Yet the President of the United 
States did not have anybody in charge of Medicare or Medicaid to 
explain what would be the impact of getting rid of Medicare Advantage 
on those 10 million people who need coordinated care and needed 
preventive medicine.
  When I hear my colleague from Rhode Island say if you are against Dr. 
Berwick, then whose side are you on, I would say I am on the side of 
the people of Wyoming, the seniors of this country, the people who are 
seeing $500 billion of Medicare cut from them to start a whole new 
government program. They realize it is not going to help them. That is 
why at town meetings and visits around the State of Wyoming people 
believe ultimately they are going to end up paying more for their care 
and are going to have less care available to them because of this very 
unpopular health care law. That is why, week after week, I come to the 
Senate floor to talk as a practicing physician, someone who has taken 
care of patients for 25 years around the State of Wyoming, to give a 
doctor's second opinion, to talk about what I see, as a physician, with 
this health care law that ultimately I believe is going to be bad for 
patients, bad for payers--the people across this country who are going 
to pay the bill for this--and bad for providers, the nurses and doctors 
who take care of the patients.
  Here we now have appointed, without a hearing, without a debate, 
without this Senate having had a chance to vote, a Director of Medicare 
and Medicaid who has expressed many opinions that do fly in the face of 
and are way out of line with the opinions of the American people. So it 
is not a surprise you see headlines in places such as the New York 
Times that say ``Tough Confirmation Battle Looming For Medicare 
Nominee.'' That is in the New York Times.
  The Boston Globe, the hometown paper where the nominee has been known 
to practice, ``Dangerous To Your Health,'' of Dr. Berwick.
  What is this administration trying to hide? Why is this 
administration unwilling to have hearings? Why is the administration 
not allowing Dr. Berwick to come to Congress to explain to

[[Page S5729]]

the American people his opinions and his views? All we know is what we 
have read, what we have seen from his speeches, the things he has 
written. Likely, it is because if those things were heard by the 
American people this man may absolutely be unconfirmable.
  If that is what the President wants, that is what the President got. 
Because right now I will tell you the President of the United States 
has his own health care rationing czar.
  You say how can you imagine that sort of thing? Let's look at some of 
these quotes from Dr. Berwick.

       The decision is not whether or not we will ration care--the 
     decision is whether we will ration with our eyes open.

  This is not some long-ago quote. This is last year:

       The decision is not whether or not we will ration care--the 
     decision is whether we will ration with our eyes open.

  This is what he says about the British health care system. He says:

       I fell in love with the [national health system] . . . to 
     an American observer, the [National Health Service] is such a 
     seductress.

  Who talks like that? He said:

       The [National Health Service] is not just a national 
     treasure, it is a global treasure. As unabashed fans, we urge 
     a dialogue on possible forms of stabilization to better 
     provide NHS with the time, space, and constancy of purpose to 
     realize its enormous promise.

  I will tell you as a practicing physician that the rates of cancer 
survival in the United States are much higher than in Britain. It is 
not that our doctors are better, it is that people get care sooner--
early detection, prevention, early treatment. Those are the keys to 
cancer survivability. So what we know is that it is not that the 
doctors in the United States are better than those in England, it is 
that the patients in the United States get care where they do not in 
England. But, then again, Dr. Berwick loves the British health care 
system. He actually says:

       I am romantic about the National Health Service; I love it.

  That is what we have. We have a recess appointee who also went on to 
have some ideas about wealth in the United States. He said:

       Any health care funding plan that is just, equitable, 
     civilized and humane must redistribute wealth from the richer 
     among us to the poorer and less fortunate.

  Here we have a recess appointee who will make decisions for hundreds 
and hundreds of billions of dollars, that impact the lives of the 
American people, without ever having a Senate debate, without ever 
having a Senate hearing, without us ever having one word of testimony 
because the President of the United States believes that he knows 
better than the people of this country.
  Dr. Berwick coauthored a book. He talked about one of the primary 
functions of health regulation is to ``constrain decentralized 
individual decisionmaking.'' Let me say that again: ``Constrain 
decentralized individual decisionmaking.'' Individuals? Humans? People 
around the communities. People in our home States. He says we want to 
constrain local people making local decisions. And he says to weigh 
public welfare against the choices of private consumers. For a 
consumer, what is more important to them than their health?
  This is not a one-party-only situation. Even Max Baucus, Senate 
Finance chairman, issued a statement critical of this end-around 
decisionmaking by the President.
  It is interesting how things change. When Barack Obama was a Member 
of the U.S. Senate, as he was not that long ago, the President at the 
time, George W. Bush, made a recess appointment. This is what 
President, then Senator Obama, had to say of John Bolton. He said, 
``He's damaged goods.'' He said, ``He'll have less credibility.''
  Don Berwick is damaged goods. He will have less credibility. I am not 
talking about that with a couple of Senators, I am talking about it 
from the standpoint of the American people. The American people know 
and understand that the President of the United States is trying to 
hide something. That is why there has not been an open hearing. The 
Republicans have been asking for an open hearing. The Republicans have 
been asking for a number of weeks for an open hearing. I have been 
asking that the President name somebody to this position since last 
year but, no, in the playbook of delay and obstruction, the 
administration has decided not to do that--don't name anybody until 
well after the bill is signed into law and then don't allow that person 
to come to the Senate for a confirmation hearing.
  What are they trying to hide from the American people? That is where 
we are today. We are in a situation where the President of the United 
States has made an appointment, a recess appointment without hearings, 
without the American people knowing or being able to ask the questions. 
What exactly are you going to do here, Dr. Berwick, when you cut $500 
billion from our seniors on Medicare? What is that impact going to be 
on their lives when you cut money from hospice, when you cut money from 
nursing homes, when you cut from physical therapy, when you cut from 
rehab, when you cut money from hospitals, when you cut money from 
physicians? We have more and more people becoming Medicare age every 
year. Why is the President of the United States unwilling to have that 
individual come to the Senate and explain to the American people how it 
is going to work? The people have a right to know.
  That is why I am not surprised and was not surprised this past week 
in Wyoming--in Riverton, in Rock Springs, in Powell, as I traveled 
around the State--to have people coming up to me saying: What is going 
to happen to my Medicare, now that the President has made this recess 
appointment over the Fourth of July, when the Members of Congress are 
not in Washington but are at home, visiting with the folks in their 
districts?
  What is this going to mean for my health care or, as many others say, 
what does this mean for my mom or my dad? Those are questions that are 
not going to be answered because the President of the United States has 
decided to make a recess appointment at a time the American people have 
the right to expect and deserve to know from a President who has 
campaigned and promised, promised the American people, transparency and 
openness and accountability, and now the American people realize they 
have received none of those things.
  So, again, as a physician I come to the Senate floor. I spent all day 
Friday at a Wyoming Medical Center visiting with people in Casper. 
Senators around the country went home and talked to people, in fact, 
many back to where they worked. I went back to where I worked at the 
hospital, visited with doctors and nurses and patients as well. All are 
concerned, concerned about this health care law that they believe is 
going to raise the cost of their health care, lower the quality; 
concerned about a health care law that they believe is going to be bad 
for them as patients, bad for the taxpayer because the costs are going 
to go up; bad for the providers, the nurses and doctors who take care 
of them; bad for the American people.
  That is why so many of them, still today, believe this health care 
bill should be repealed and replaced with things that put patients in 
charge, not insurance company bureaucracies, not Washington, DC 
bureaucrats; that would put patients in charge. That is what we need in 
this country. That is the kind of health care the American people need. 
That is what they are asking for. And when my colleague says: If you 
are against Dr. Berwick, then whose side are you on? I am on the side 
of the people I have taken care of all around the State of Wyoming for 
the last 25 years.
  I yield the floor and 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. DURBIN. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. DURBIN. Mr. President, I ask unanimous consent to speak as in 
morning business.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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