[Congressional Record Volume 156, Number 103 (Tuesday, July 13, 2010)]
[Senate]
[Pages S5754-S5758]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
APPOINTMENT OF DR. DONALD BERWICK
Mr. BARRASSO. Madam President, I rise to discuss a recess appointment
made last week when many of us were traveling to visit with
constituents to talk about the issues of the day.
During that time, I was in Wyoming, and one of the main issues
brought up at senior centers was the appointment by the President of
Dr. Donald Berwick to be the head of Medicare and Medicaid. I heard the
concerns of these folks because of statements Dr. Berwick had made
about the British health care system and his love of the National
Health Service in England. They are concerned as to how this gentleman,
who has taken positions and made a number of statements, would run
Medicare and Medicaid. Specifically, they had concerns because they had
heard his statement:
The decision is not whether or not we will ration. The
decision is whether we will ration with our eyes open.
Seniors around the State were concerned about what this means. Then
to hear that the President made a decision to do a recess appointment
of this very individual, without hearings in the Congress, without an
opportunity for the American people to hear specifically his response
to questions we might have--is this what the American people want?
Absolutely not. We have a President who campaigned on a pledge of
accountability and transparency. To me, this makes a mockery of that
pledge because this nominee will not have to answer questions about
statements he has made.
I see my colleague from Arizona, a State where people on Medicare are
concerned, where we have many seniors, a State with a Medicaid
population that will be impacted. Yet we now have a director of
Medicaid and Medicare, finally named by the President after a full year
of debate on a health care law that cut $500 billion from seniors on
Medicare and crammed 16 million more Americans onto Medicaid, a program
that is currently very broken. I say to my colleague from Arizona, my
goodness, the impact on the folks in Arizona is astonishing.
There was an article today in one of the papers that talks about a
Medicaid stalemate. They talk about his home State of Arizona. They say
Arizona has had to cut about a dozen benefits from its Medicaid
Program, including hearing aids, podiatrist services, capped physical
therapy visits. Yet there was nobody in charge of Medicaid when the
President and the Democrats in this body said: Hey, don't worry. We are
going the cram another 16 million more Americans onto Medicaid--a
system we know is broken.
So I turn to my colleague from Arizona and ask him his thoughts on
this recess appointment at a time when seniors and folks around the
country are concerned about the debt, the deficit, the economy, and now
we are seeing the President making a mockery of his previous comments
about accountability and transparency.
Mr. McCAIN. Could I say to my friend, I think this issue is an
alarming and disturbing one--perhaps one of the most disturbing, for
two reasons: One is that this nomination had not even gone through the
earliest stages of scrutiny by the relevant committee, not to mention
the entire Senate; and the other, of course, is the individual himself
who was being nominated, who could only be viewed as extreme,
especially concerning many of his comments. One of his greatest
rhetorical hits is: ``any health-care funding plan that is just,
equitable, civilized and humane must--must--redistribute wealth from
the richer among us to the poorer and less fortunate.'' That in itself
is a remarkable statement.
But I wish to, for a second, with my friend, Dr. Barrasso, go back to
this process. The fact is, our colleagues on the other side of the
aisle blocked for over 2 years the nomination for this position by
President Bush, and this nomination was barely 3 months old. He had not
even filled out the questionnaire, much less attend a hearing. So the
rationale used by the administration was: Well, the Republicans are
going to block it. Well, we may have. And given the comments and record
of Sir Donald--he is a knight, I understand, knighted by Queen
Elizabeth--well, the comments by Sir Donald certainly do give one
extreme pause. But shouldn't we at least go through the process of the
hearing?
I have been around here a long time, and I have not paid attention to
every nominee and the process they have been through, but I cannot
remember a time where blocking the nomination took place--or
announcement of preventing the nomination from moving forward was done
before a hearing took place, or even the questionnaire.
In fact, I was very interested to see the comment of the chairman of
the Finance Committee, under whose supervision in his committee this
nomination would go through. I quote Senator Baucus:
I'm troubled that, rather than going through the standard
nomination process, Dr. Berwick was recess appointed. Senate
confirmation of presidential appointees is an essential
process prescribed by the Constitution that serves as a check
on executive power and protects Montanans and all Americans
by ensuring that crucial questions are asked of the nominee--
and answered.
So not a single question was asked of the nominee, much less
answered. And, of course, I understand. Having been a committee
chairman myself, I will take great umbrage of my party, the President,
or the other party that the process was completely bypassed. Because
the Senate has the responsibility of advice and consent. And over time,
I must admit that both Republican and Democrat administrations have
abused the recess appointment process. Yes, they have abused it. But I
must say, this takes it to a new high or low depending on which way you
view it.
We have now seen in this administration the appointment of various
``czars,'' people given responsibilities over vast areas of government
as ``czars.'' They have got more czars than the Romanoffs. So this is
another step, in my view, of incursion and encroachment by the
executive branch on the legislative branch, a coequal branch of
government. So that in itself is extremely disturbing.
Are we going to have nominations made--an announcement of those
nominations, and then automatically are we going to have ``recess''
appointments made? What was the hurry? There is going to be another
recess in August. There is going to be another recess in October,
unless we go out for elections. But yet in their zeal and haste, they
had to do it over the Fourth of July recess.
I tell you, my friends, this is more than just one individual. This
is a gradual and steady erosion of the responsibilities of the Senate
of the United States called advice and consent, which can set dangerous
precedence for the future. I say to this administration, and my friends
on the other side of the aisle--and I appreciate the comments of the
chairman of the Finance Committee--if we allow this to go on, it will
hurt the Senate as an institution, not just Republicans, not just
Democrats, but it will hurt this institution, if we allow, unresponded
to, a situation where a nominee--his name comes over, and not even a
hearing, not even a question is asked--and immediately that nominee is
recess appointed, which means they are in a position of enormous power
and authority for a long period of time. And this appointment--this
appointment--has enormous consequences in light of the passage of the
most sweeping overhaul of
[[Page S5755]]
the health care system in America, having just taken place over our
obviously strenuous objections.
But it happened. Now the individual in charge, the individual who
will bear great responsibilities, has not answered a single question
posed by Members of this body on either side.
I say to my colleagues, this is a dangerous precedent and one that
should not go unresponded to by either Democrat or Republican because
of our responsibilities as a coequal branch of government. I see my
colleague, the Republican leader.
Mr. McCONNELL. I say to my colleague from Arizona, I just came on to
the floor and am not quite certain what happened earlier in this
colloquy, but there is no doubt about it that they did not want Dr.
Berwick's name to surface during the health care debate. They did not
want any questions asked of him in public. We have had recess
appointments, of course, by Presidents of both parties. Typically, they
have gone through a hearing, a committee vote, and end up out here on
the calendar so that at least there was some exposure to the nominee's
views.
What we do know about this nominee is what he has said in the past
about the British health care system. It is stunning that anybody in
this country could look at the national health service in England and
decide they were in love with it. So I would say to my friend from
Arizona, and my friends from Wyoming and South Dakota, there is
no question what they were up to here. They wanted to sneak this guy
through with a minimum amount of exposure.
Mr. McCAIN. Could I mention to my friend that even one of our not so
strong allies from the Washington Post, Ruth Marcus, wrote a column
saying:
There are legitimate explanations for Berwick's more
incendiary comments on health care. It's too bad he didn't
get to offer them. A cynic--who, me?--might think that the
administration simply preferred not to suffer the political
downside of a public airing.
A cynic might wonder, with Arkansas Democrat Blanche
Lincoln facing a tough re-election fight, whether Berwick
could even get through committee on a party-line vote. A
cynic might think that the last thing Senate Majority Leader
Harry Reid wanted before the election was a floor fight about
rationing health care.
A cynic might look at the White House explanation--that it
was urgent for CMS, without a confirmed administrator since
2006, to have a leader--and ask: Then why did you dither for
15 months before nominating someone?
In announcing the appointment, the president complained
that ``many in Congress have decided to delay critical
nominations for political purposes.'' True, but where's the
evidence of delay in Berwick's case? You can't fairly accuse
the other side of political gamesmanship when you short-
circuit the process and storm off the court before the first
set.
``To some degree, he's damaged goods,'' then-Sen. Barack
Obama said in 2005 about John Bolton's recess appointment as
United Nations ambassador.
Would the president say the same about Berwick?
An excellent column.
Mr. McCONNELL And that was Ruth Marcus.
Mr. McCAIN. I think it puts it pretty well. But none of us, of
course, being cynics, would accept such an explanation by a columnist
from the Washington Post.
I see my colleague from South Dakota.
Mr. THUNE. I would say to my friend from Arizona and to the leader
that a cynic might also raise the issue of why it took the President
454 days to nominate Donald Berwick and then have a lot of his
surrogates go on in front of the media and say: We had to do this
because we needed to get this position filled. Madam President, 454
days--if this position was so critical and so important to this
country, you would think they would have moved in a more expeditious
fashion to get a nominee out there. They did not even have a hearing in
front of the committee.
They could have had a hearing. They could have had a vote at the
committee level. They could have brought him to the floor. They did not
do any of those things that would be called for in the regular order
because, as I think the Senator from Kentucky has pointed out, they did
not want to take a tough political vote.
When you look at this man's record and the things he has said about
the British health care system and some of the other comments he has
made--I want to point out something here too which I thought was sort
of interesting because he is going to be called upon to implement a
2,700-page bill, which, when the regulations are written, is going to
be thousands and thousands of pages, not to mention the fact that as we
debated this on the floor of the Senate, it ended up being about $1
trillion, and when fully implemented $2.5 trillion. So he has trillions
of dollars under his jurisdiction. He has a 2,700-page bill that he is
going to implement. And he came out and said:
I don't feel like a leader, so it's very hard for me to
project myself into that situation. But inattention to detail
is my biggest defect. I'm always leaning forward into
something new. I can create a mess. Luckily, I have people
who are willing to create the detail around the idea or, if
they're really smart, know which ideas to ignore.
He is basically saying he is not a detail guy, and yet this massive
new health care program, which is literally going to be thousands of
pages, including regulations--and 2,700 pages, as I mentioned, in terms
of the legislation itself--he will be called upon to implement it. And
he has a vision clearly that the model he supports is the British
health care system, the national health care system, which, as we all
know, countries in Europe are moving away from. Why we would be moving
in that direction, and why they would appoint somebody like this to
this important position defies explanation.
But, more importantly, I think, as well, is they could have done this
in the regular way. He could have come before the Senate and answered
questions as any other nominee would. He should have had a hearing
where he was able to respond to some of these statements he has made in
the past. Yet they chose to do it in this way, with a recess
appointment, notwithstanding the fact that it was 454 days before they
put his name forward for nomination, and since that time 79 days, and
they are blaming the Congress, and they are blaming the Republicans
specifically for not moving this nomination, when, in fact, it was the
President and his administration who waited that long to put somebody
in this position.
Mr. McCAIN. Could I ask the Republican leader a question. He has been
around here a fair amount of time, as I have. I ask the Republican
leader, has he ever heard of or recalled of a nominee who was recess
appointed without even the questionnaire from the relevant committee of
oversight being responded to or a hearing before that committee? For
the life of me, I cannot recall that.
Mr. McCONNELL. I say to my friend from Arizona, I do not know the
answer to that. But we do know it was a curious, maybe not totally
unprecedented but certainly unusual situation where a nominee is
subjected to so little scrutiny and oversight--no questions, no
opportunity to testify. This is a truly unusual situation. I think we
know the answer as to why. This guy is in favor of rationing health
care--openly, unabashedly, an advocate of rationing health care. I do
not think they wanted to have him have to answer the questions. He may
not have been very good at details, I say to my friend from South
Dakota, but he got the big picture. And the big picture in his mind is:
The decision is not whether or not we will ration care--the
decision is whether we will ration with our eyes [wide] open.
That is what he intends to do.
Mr. McCAIN. So a nominee whose clear philosophy of record indicates
redistribution of wealth, as he describes it, and a use of health care
in a way that includes greater and greater ``leveling of the small
distribution of income in America''--does that give us some indication
of the real intentions of the administration when they proposed health
care reform in this package, despite the statements made by the
President that if you like the health insurance policy you have, you
can keep it; there will be no tax increases for people below $250,000,
et cetera? Does this appointment of an individual with a clear-cut
philosophy that this is a way to redistribute wealth in America
indicate that maybe the real--again, not being a cynic, but would give
us some idea of a real intent of this ``health care reform'' we
resisted so strenuously for more than a year?
[[Page S5756]]
Mr. McCONNELL. I think my friend from Arizona has it exactly right.
Every single Member of the Democratic Party in the Senate voted for a
bill that is going to impose $500 billion of Medicare cuts over the
next 10 years.
We have a physician, fortunately, in the Senate: Dr. Barrasso. He
intends to reach that target, does he not, I would inquire of my friend
from Wyoming, by rationing health care?
Mr. BARRASSO. Madam President, I believe the President of the United
States, I say to my colleague and friend, now has what he wants: his
health care rationing czar--not someone approved by the Senate but
someone he has appointed and put into place without an open hearing.
It is so interesting, as my colleagues from Arizona and South Dakota
talk about, that the failings of the British health care system--a
system that Dr. Berwick says, ``I am romantic about; I love it; it is a
national treasure, a global treasure,'' but then the headline today is:
``U.K. Will Revamp Its Health Service.'' It says: Health care experts
called the plan one of the biggest shakeups in the national health
service's 62-year history. Its new coalition government in Britain,
grappling with weak public finances and rising health care costs,
announced an overhaul of the state-funded health system that it said
would put more power in the hands of the doctors and involves cutting
huge swaths of bureaucracy.
This is at a time when we have just in this country passed not what
we voted for but what the Democrats and the President voted for: a bill
that increases the bureaucracy, including $10 billion for Internal
Revenue Service agents and higher and higher numbers of government
workers and bureaucrats taking power away from the doctors, away from
the patients. Now it is government-centered health care at a time when
Britain is moving away from it, and the person the President of the
United States has put in as his health care rationing czar is someone
who calls that approach a national treasure; cutting $500 billion from
our seniors depending on that for Medicare, not to save Medicare but to
start a whole new government program.
Britain is trying to revamp because they know that someone with
cancer in the United States has a much better chance of survival than
somebody in Britain. It is not because our doctors are better in the
United States--and I have practiced medicine in Wyoming for 25 years--
it is because people get care in the United States that is delayed and
therefore denied in Britain. But Dr. Berwick is romantic. He has fallen
in love with that national health service, a service that is not good
for patients, and it is not good for providers.
I see my friend from South Dakota, another rural community and State.
I am sure he is seeing and hearing the same things from his seniors
there, their concerns about what is going to happen to the cost of
their care, the quality of their care, and the availability of the
care, especially with Dr. Berwick now in charge.
Mr. THUNE. The Senator from Wyoming knows full well how difficult it
is to deliver health care in rural areas. Being a physician himself, he
knows the challenges we face.
It seems to me that notwithstanding the comments to the contrary, we
have to look at what people do. In this case, what the administration
has done is appointed somebody to run this massive new health care
program who clearly is on the record by his previous statements in
favor of redistribution of wealth, in favor of rationing of health
care, in favor of government-run health care. He is romantic about the
British national health system, which, as the Senator from Wyoming
mentioned, is having all kinds of complications and problems, including
runaway costs, and now they are trying to figure out how to move away
from it. The problem they have is that 1.6 million people are employed
by the British national health system, a huge employer in their
country, so the economic impact, the political impact of making changes
in that system is very difficult. That being said, it doesn't seem as
though they have any choice because they are facing such difficult
fiscal circumstances in their country and they are seeing these runaway
health care costs contributing in a very significant way to that.
So it seems to me, at least, that what we have done here with this
massive health care bill passing in the U.S. Congress--$2.5 trillion
when it is fully implemented over a 10-year period--what we are already
seeing now is the Actuary at CMS coming out and saying it is going to
bend the cost curve up and it is going to cost considerably more above
and beyond the normal year-over-year inflationary increases in health
care Americans have already been seeing. Then we also have the CBO now
coming out and saying it is not going to achieve the deficit savings
that were advertised here on the floor when we had the debate. There is
all this information coming out which validates the argument we were
making at the time, and that is that we don't want to move toward the
government-run health care system that rations care. Then they put
somebody in charge who believes in redistribution of wealth, rationing
of health care, government-run health care--all things we argue this
would lead us toward. Clearly, the administration really shows their
hand when they appoint someone such as this to run this important,
comprehensive, wide-reaching, and expensive bureaucratic program that
very much will resemble, in terms of the model, what they are doing in
Britain, which Britain is moving away from.
Mr. McCAIN. Madam President, I ask unanimous consent to have printed
in the Record the Wall Street Journal editorial of July 12, 2010,
entitled ``Who Pays for ObamaCare? What Donald Berwick and Joe the
Plumber both understand.''
I have some relationship to Joe the Plumber, not to Donald Berwick.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From the Wall Street Journal, Editorial July 12, 2010]
Who Pays for ObamaCare?
What Donald Berwick and Joe the Plumber both understand
Among Donald Berwick's greatest rhetorical hits is this
one: ``any health-care funding plan that is just, equitable,
civilized and humane must--must--redistribute wealth from the
richer among us to the poorer and less fortunate.'' Count
that as one more reason that President Obama made Dr. Berwick
a recess appointee to run Medicare and Medicaid rather than
have this philosophy debated in the Senate.
We are also learning that ``spreading the wealth,'' as Mr.
Obama famously told Joe the Plumber in 2008, is the silent
intellectual and political foundation of ObamaCare. We say
silent because Democrats never admitted this while the bill
was moving through Congress.
But only days after the bill passed, Senate Finance
Chairman Max Baucus exulted that it would result in ``a
leveling'' of the ``maldistribution of income in America,''
adding that ``The wealthy are getting way, way too wealthy,
and the middle-income class is left behind.'' David Leonhardt
of the New York Times, who channels White House budget
director Peter Orszag, also cheered after the bill passed
that ObamaCare is ``the federal government's biggest attack
on economic inequality'' in generations.
An April analysis by Patrick Fleenor and Gerald Prante of
the Tax Foundation reveals how right they are. ObamaCare's
new ``health-care funding plan'' will shift some $104 billion
in 2016 to Americans in the bottom half of the income
distribution from those in the top half. The wealth transfer
will be even larger in future years. While every income group
sees a direct or indirect tax increase, everyone below the
50th income percentile comes out a net beneficiary.
At least at the start, Americans in the 50th through 80th
income percentiles--or those earning between $99,000 to
$158,000--are nearly beneficiaries too, if not for the taxes
on insurers, drug makers and other businesses that will be
passed on to everyone as higher health costs. This group will
eventually get soaked even more--probably through a value-
added tax--once ObamaCare's costs explode. But at the
beginning the biggest losers are the upper middle class,
especially the top 10% of income earners, mainly because a
3.8% Medicare ``payroll'' tax surcharge will now apply to
investment income. ObamaCare, in short, is almost certainly
the largest wealth transfer in American history.
Distributional analyses like the Tax Foundation's are
usually staples in any Beltway policy debate, especially when
Republicans want to cut taxes. Yet aside from this or that
provision, none of the outfits that usually report for this
duty--the Tax Policy Center of the Brookings Institution and
Urban Institute, the Center for Budget and Policy
Priorities--have attempted to estimate the full incidence of
ObamaCare's taxes and subsidies.
In part this may be because ObamaCare is such a complex
rewrite of health, tax, welfare and labor laws. But it's also
embarrassing to liberals that much of ObamaCare's
redistribution will merely move income to
[[Page S5757]]
the lower middle class from the upper middle class, and the
President habitually promises that people earning under
$200,000 will be exempt from his tax increases. We now know
they won't be.
With his vast new powers over what government spends, Dr.
Berwick will be well situated to equalize outcomes even more,
and he certainly seems inclined to do so. The most charitable
reading of his redistribution remarks, delivered in a 2008
London speech, is that any health insurance system will
involve some degree of redistribution to the ``less
fortunate,'' that is, to the sick from the healthy.
Yet Dr. Berwick made those comments in the context of a
larger, and bitter, indictment of the U.S. health system,
even though the huge public programs he will run already
account for about half of all national health spending. From
his point of view this isn't enough. And his main stance was
that individual clinical choices must be subordinated to
government central planning to serve his view of social
justice and health care guaranteed by the state.
The great irony is that this sort of enforced
egalitarianism imposes higher taxes and other policies that
reduce the total stock of wealth and leave less for Dr.
Berwick to redistribute. Economic growth has been by far the
most important factor in improving health and longevity,
especially for those whom Dr. Berwick calls ``the poorer and
less fortunate.''
Americans have learned the hard way over the past two years
that this Administration believes in wealth redistribution
first, economic growth second. Or as Dr. Berwick also put it
in his wealth-redistribution speech, it is crucial not to
have to rely on ``the darkness of private enterprise.''
Mr. McCAIN. Madam President, I will quote the important part of the
Wall Street Journal editorial, speaking of Dr. Berwick, Sir Donald:
With his vast new powers over what government spends, Dr.
Berwick will be well situated to equalize outcomes even more,
and he certainly seems inclined to do so. The most charitable
reading of his redistribution remarks, delivered in a 2008
London speech, is that any health insurance system will
involve some degree of redistribution to the ``less
fortunate,'' that is, to the sick from the healthy.
Yet Dr. Berwick made those comments in the context of a
larger, and bitter, indictment of the U.S. health system,
even though the huge public programs he will run already
account for about half of all national health spending. From
his point of view this isn't enough. His main stance was that
individual clinical choices must be subordinated to
government central planning to serve his view of social
justice and health care guaranteed by the state.
The great irony is that this sort of enforced
egalitarianism imposes higher taxes and other policies that
reduce the total stock of wealth and leave less for Dr.
Berwick to redistribute. Economic growth has been by far the
most important factor for improving health and longevity,
especially for those whom Dr. Berwick calls ``the poorer and
less fortunate.''
Americans have learned the hard way over the past two years
that this administration believes in wealth redistribution
first, economic growth second. Or as Dr. Berwick also put it
in his wealth-redistribution speech, it is crucial not to
have to rely on ``the darkness of private enterprise.''
That is an individual who is now going to oversee over half the
health care provided in America who believes that ``the darkness of
private enterprise'' should not be relied on.
So I wish to say to my friends again, there are two issues here of
great concern: the individual himself, his record, and what he clearly
intends for the finest health care system in America--not on
restraining costs but obviously a redistribution of wealth; second,
this entire process of an individual not even filling out a
questionnaire--a nominee--or any semblance of a hearing before the
relevant committee before a ``recess'' appointment is made. This is an
erosion of the constitutional responsibilities of advice and consent of
the Senate.
Mr. THUNE. Madam President, if the Senator from Arizona will yield,
just to put a final point on that, again, 454 days before the
administration put forward this nominee, there have been 79 days since,
and they are blaming Republicans for holding up this nominee--again,
notwithstanding the fact that it was 454 days before they ever put it
forward. If we don't have a hearing and he doesn't have to come in and
answer questions about these at least what I would characterize as
outlandish statements, again, it is an abrogation of the responsibility
the administration has of working with the Senate, the Senate's power
of advise and consent, to at least have a hearing, to at least have a
vote, to at least have some public discussion about this gentleman's
qualifications and his attributes with regard to this important
position to which they are going to appoint him.
I wish to point out as well that there is one other example of this.
The TSA Administrator, which is another very important job, by the time
they actually got somebody submitted who could be acted upon here in
the Senate, 482 days had lapsed. It was 521 days when the new TSA
Administrator was finally approved, but we went 240 days when the post
was vacant, from the time the post was vacated in January of 2009 until
they appointed their first nominee, who then had to withdraw because of
problems. Then they appointed somebody else who withdrew because of
problems. They finally submitted somebody who was actually approved,
but it took 521 days. That is not us. That is not the Republicans in
the Senate holding things up, nor is it the case with Berwick's
nomination where 454 days lapsed before the administration put his name
forward. Then they just quickly, without giving us an opportunity--the
Senate an opportunity--to do our job recess-appointed him to a position
where he is going to be responsible for thousands of employees,
obviously billions and trillions of dollars when it comes to the health
care delivery in this country, and that is very unfortunate.
So, as the Senator from Arizona has pointed out, it is partly about
this gentleman and what he stands for and what he intends to do with
this position, but it is also the process by which he was actually put
into this position and how it completely short-circuited and bypassed
what is regular order and what should be under our Constitution the
responsibility of the Senate to provide advice and consent.
Mr. BARRASSO. Madam President, if I could just ask my colleague,
talking about the Constitution and how we as Americans see ourselves,
Senator McCain just quoted a comment made by Dr. Berwick about the
darkness of private enterprise. Dr. Berwick coauthored a book called
``New Rules.'' In it, he argues that one of the primary functions of
health regulation is to constrain decentralized, individual
decisionmaking--constrain individual decisionmaking--and to weigh
public welfare against the choices of private consumers. I mean, could
anything fly further in the face of what Americans believe? The
decisions, the choices of private consumers--that is how we make
decisions in America. That is what I recommend for patients: Make your
individual choice. What is best for you? How to help keep down the cost
of your care; prevention, coordinating care; working and making smart
choices for you as an individual. Who knows better? Who knows better
how to spend your money? You do. Who knows better how to make choices
for your life? You do.
That is not what Dr. Berwick is saying in this book, ``New Rules.''
It is to weigh public welfare against the choices of private consumers.
So I inquire of my colleague from South Dakota, what would people
from South Dakota think about that? This is somebody who is saying:
Government knows better than you do. People of Wyoming have never felt
that way, and I would imagine the people from South Dakota have never
felt that way either.
Mr. THUNE. I say to my neighbor from Wyoming, he understands his
constituents very well, and we share a border, but we also share a lot
of other things, including a common set of values and a sense of
individual responsibility and belief in freedom.
I think what this gentleman represents in terms of his view is
completely contradictory to what the majority of my constituents and I
am sure the majority of the constituents of the Senator from Wyoming
would say with regard to how you ought to approach issues. The American
individual, the American consumer is in a much better position to make
decisions about their own health care than some government bureaucracy
here in Washington, DC.
Essentially what Mr. Berwick has concluded over time--and he has had
a long career analyzing and studying many of these issues--is that a
government-run system where some government bureaucrat is in a position
of making these decisions that are important to an individual--in this
case, his health care or her health care--that is clearly a model he
endorses and supports.
[[Page S5758]]
It is very contradictory, I would say, to what I think is the view of
a majority of Americans. Frankly, one of the reasons I think many of us
opposed the health care bill when it was under consideration in the
Senate--and the Senator from Wyoming made some excellent comments
during the course of that debate about his experience with health care
as a practicing physician--is that clearly the American model is one
that is very different from the European model.
What we have with Mr. Berwick is somebody who wants to remake the
American health care system in the image of the model that we see in
places such as Europe. His example of the British health care system,
about which he is romantic, is a good example of how he intends to
implement the health care bill passed in the Senate.
We have argued all along that the intention of those behind it is to
move us in the direction of a more single-payer, European-type system
as opposed to what we have experienced in this country and have enjoyed
for such a long time, and that is one that has its basis at least in
the market where we have individuals who are in charge of making many
of the decisions, as opposed to some government bureaucrat.
This is very unfortunate in terms of the fact that this was an
appointment that was made in the recess without the normal process
being adhered to, with this gentleman coming in front of the Senate to
answer questions and actually having a vote in the Senate.
For our colleagues on the other side to argue that the reason they
had to do this was because Republicans were slowing or somehow delaying
this process is completely inconsistent with any of the facts. As I
said before, 454 days before the President put his nomination forward.
Certainly, it is not the Republicans' fault they did not have a nominee
up here. Then the fact that they did not have a hearing and there has
not been a vote in the committee and now not a vote on the floor of the
Senate is unfortunate, given the consequences and the impact the person
who occupies this position is going to have with regard to delivery of
this new health care reform legislation.
Mr. BARRASSO. It was interesting, on this floor someone on the other
side of the aisle stood and said: If you are against Dr. Berwick, then
whose side are you on? As I see my colleague from South Dakota, I can
answer that question, and he can answer that question. If you are
against Dr. Berwick, then whose side are you on? I am on the side of
the American people--the American people who are concerned about $500
billion in cuts to their Medicare, not to help Medicare, not to
strengthen Medicare, but to start a whole new government program.
I am on the side of the people who believe we should not redistribute
wealth in this country. I am on the side of my patients and friends in
Wyoming who do not want the rationing of care. I am on the side of my
friends and patients in Wyoming who do not want government-run health
care. But that is what we have now.
We have a President-appointed czar, essentially--a czar--to ration
health care. That is not what the American people want. It may be what
the Democrats in Congress want. It may be what the President of the
United States wants. I view this as an arrogant use of Presidential
power at a time when I think the American people were intentionally
misled all during the fall because the President refused to appoint
somebody, would not name anybody to be in charge of Medicare and
Medicaid when the whole debate was going on. Only after the bill was
signed into law--only then--would he announce to the country his choice
was somebody way outside the mainstream of how we in America deliver
health care, want our health care, how we care as patients, how we care
as physicians--way out of that mainstream, someone whose approach is a
very different one, who loves a system where we know people with
diseases are denied care, where care is delayed, and where today the
whole country is saying: I think we got it wrong. We need to relook at
this. They see what is happening, and I think the American people will
know what will happen to us as a nation if we go down the path of a
nationalized health system where we redistribute wealth, ration care,
and government runs the health care system of our Nation.
It is the wrong decision by the President. It is the wrong direction
to go. The American people know it, and they do not like it.
Once again, the American people are not going to have their voices
heard because the American people are going to be denied an opportunity
to voice their opposition to this nominee to their elected
representatives because the President decided he knew better than this
Congress and made a decision to appoint someone at a time when the
American people wanted their voices heard.
Madam President, I yield the floor, and I suggest the absence of a
quorum.
The ACTING PRESIDENT pro tempore. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. KAUFMAN. Madam President, I ask unanimous consent that the order
for the quorum call be rescinded.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
____________________