[Congressional Record Volume 156, Number 151 (Thursday, November 18, 2010)]
[Senate]
[Pages S8002-S8003]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. ROBERTS. Madam President, health care--big issue. The health care 
reform bill that is current law--big issue. A lot of talk about repeal, 
fix what is wrong in the bill, what is right in the bill, depending 
upon your personal opinion.
  I think that the Senate--more especially the committees of 
jurisdiction, and I am talking about the Senate Finance Committee--has 
a unique obligation, especially at this time, to conduct its oversight 
responsibility. Unfortunately, that was not the case as of yesterday.
  One of the major problems with the new health care law is the huge 
amount of power and authority it grants to one man, the Administrator, 
perhaps we should call him the czar, of the Centers for Medicare and 
Medicaid Services, CMS. Rest assured, every health care provider in the 
country knows what and who CMS is.
  The Administrator is Dr. Donald Berwick. One of the major problems 
with Dr. Berwick is his longstanding, well-documented support for 
government rationing as a means of controlling health care costs--not 
my words, his.
  Yesterday, the Senate Finance Committee finally had our very first 
chance to question Dr. Berwick. I say finally, because for months my 
colleagues and I have requested this opportunity, a request which was 
denied when President Obama provided a recess appointment for Dr. 
Berwick. So yesterday's hearing was a hollow one of sorts, since Dr. 
Berwick had already been installed at CMS, or maybe parachuted in would 
be the right way to describe it, in that he has made many controversial 
comments about his love for the British health care system and for 
rationing and other comments that certainly deserve a hearing in 
regards to a confirmation process. That did not happen.
  He was also installed pretty much after the debate that we had on 
health care. Now, unfortunately, we were only given 5 minutes each 
yesterday to question the most important man in American health care as 
of today. This was 5 minutes, sandwiched in between lengthy remarks by 
the chairman, the witness, and the floor votes we had yesterday.
  I was not able to question Dr. Berwick on many things. I asked 
unanimous consent of the chairman if I could submit questions for the 
Record. Obviously he agreed and that was it. But when Ranking Member 
Grassley asked Dr. Berwick if he would commit to appearing before the 
committee again--which I think the doctor would; he is a very affable 
and personal man. I do not agree with him, but he is affable and 
personable--so we could continue our oversight, Chairman Baucus 
interrupted his response and refused to make any further commitments.
  How is that for transparency? How is that for finally getting to a 
hearing about the man who is the most important man today in regards to 
the new health care law and implementing it?
  Because I was not able to ask Dr. Berwick my questions yesterday, I 
am forced and am asking them here on the Senate floor. Dr. Berwick 
knows my No. 1 concern with President Obama's health care law is the 
enormous potential for the government to interfere in the treatment 
decisions of the doctor and the patient. Dr. Berwick has a long history 
of statements supporting government control of treatment decisions, or 
what I would call ``rationing.'' I know some would say that is not the 
case. But Dr. Berwick has said that:

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


[[Page S8003]]


  A most unique statement, to say the least. He has publicly stated an 
aversion to new medical technology and health care advances, saying:

       One of the drivers of low value in health care today is the 
     continuous entrance of new technologies, devices, and drugs 
     that add no value to care.

  That is in his eyes. He refers to this as an ``excess supply'' of 
health care. And, of course, we have his infamous quote that ``the 
decision is not whether or not we will ration health care. The decision 
is whether we will ration care with our eyes open.''
  It should then come as no surprise that CMS under Dr. Berwick's 
leadership has embarked upon a path of increasing government control, 
centralized decisionmaking, and top-down mandates that treat doctors as 
nothing more than cooks practicing ``cookbook medicine'' and patients 
as nothing more than numbers, despite their individual needs and 
desires.
  One example: attempts by CMS to restrict the number of times seniors 
with diabetes can test their blood sugar by limiting them to one test 
strip per day, regardless of what the doctor recommends. Doctors 
understand that diabetes care is an exceedingly complex and 
personalized enterprise. My question that I could not ask yesterday: 
Why is CMS replacing the judgment of a doctor on how many times their 
patient should test their blood sugar with a CMS-knows-best approach?
  An even more egregious example of the government getting in between 
patients and doctors is Dr. Berwick's recent investigation into 
Medicare coverage of the life-extending prostate cancer therapy 
Provenge. Provenge is a therapeutic vaccine approved by the Food and 
Drug Administration to treat late-stage prostate cancer through an 
innovative process that removes immune system cells from patients and 
exposes them to cancer cells and an immune system stimulator and then 
injects them back into the patient. Provenge has been shown to increase 
life expectancy by an average of 4 months but sometimes longer, with 
one patient living an additional 7 years. In addition, Provenge is 
special because of its lack of side effects as compared to the 
traditional chemotherapy methods. So not only can patients live longer, 
but their quality of life will be better.
  Medicare coverage for FDA-approved drugs is usually automatic. My 
next question to Dr. Berwick would have been, had I had the opportunity 
in the committee yesterday but was denied because of scheduling: Why 
did you initiate a coverage investigation so soon after Provenge was 
approved? Why is CMS seeking to substitute its judgment for not only 
patients and doctors but for the FDA, the gold standard for drug 
approval worldwide? Are you questioning the FDA's decision? When drug 
companies and research folks produce after many years of research and 
effort and cost, are they going to have to go through two hurdles--
first, the FDA, which can take years, and then CMS--as to whether 
Medicare will approve it? It seems that is where we are headed.
  I know or I think I know the answer as to why Dr. Berwick decided to 
conduct this investigation.
  It is cost--$93,000 for a complete cycle of Provenge was the driving 
factor behind this investigation.
  The good news is that yesterday an advisory committee recommended 
that CMS cover Provenge. But I am very concerned about the precedent 
this sets not only for other cancer regimens such as the promising 
breast cancer drug Avastin but for all new medical innovations.
  Some may say that an extra 4 months of life is not enough to justify 
this high price tag. It is a high price tag. First, the government 
should not be in the business of placing dollar values on life, period. 
That is what Great Britain is trying to move away from. That is why 
David Cameron made the unique statement that maybe we ought to have a 
system that puts the choice between doctors and patients. What a novel 
idea.
  Secondly, the traditional chemo and all of its associated side 
effects costs Medicare upwards of $110,000 per patient per year. So 
Provenge is actually a cost saver when viewed in that context.
  Third, this is exactly the type of innovative approach we need to win 
the fight against cancer. Medical advances don't come in giant leaps; 
they more often occur at the margins. We should not deny patients and 
doctors treatment options simply because they don't offer a complete 
cure. That is shortsighted, not to mention cruel.
  Finally, if we want companies and investors to continue to pour their 
dollars and efforts into developing a cure for cancer, this is the 
wrong approach. The investment into researching and developing Provenge 
approached $1 billion over 15 years, 15 clinical trials. Refusing to 
allow a return on this huge investment will send a chilling effect 
across the health research industry, resulting in less investment, less 
innovation, and worse care for patients. Maybe less innovation is 
actually the goal of this administration and of Dr. Berwick, who has 
targeted the ``entrance of new technologies, drugs, and devices'' as 
``one of the drivers of low value in health care today.'' Value is a 
subjective concept.
  Another question I have for Dr. Berwick: I prefer that the value of 
health care be determined by the patient and doctor, not the 
government. Would you agree?
  Finally, from yesterday's news, I have been shocked by the number of 
ObamaCare waivers coming out of the Department of Health and Human 
Services. According to the New York Times today, 111 waivers have been 
granted to employers to allow them to avoid the new health care 
mandates. The only thing more shocking than the number of waivers is 
who is getting them. Would you believe that they are some of the most 
ardent supporters of health care reform? Unions such as the Service 
Employees International Union, the United Federation of Teachers, and 
the Transport Workers Union have all applied for and been granted 
waivers from the rules. They don't have to follow the rules. They don't 
have to follow the mandates. Guess who are the strongest supporters of 
health care. The fact is, ObamaCare is bad for business, bad for 
workers, bad for seniors, bad for taxpayers.
  My question to Dr. Berwick: When will the American people get a 
waiver from ObamaCare? Of course, that decision would be under the 
purview of the Secretary of the Department of Health and Human 
Services, Kathleen Sebelius, whom I know as a personal friend.
  Kathleen, Kathleen, Kathleen, you are granting all these waivers to 
people in regard to the mandate on health care. When will the American 
people get a waiver from some of the things they choose not to take 
part in? This is, indeed, shocking news.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Missouri.
  Mr. BOND. Madam President, I understand I have 15 minutes.
  The ACTING PRESIDENT pro tempore. The Senator is correct.
  Mr. BOND. Will the Chair advise me when 10 minutes has been used.
  The ACTING PRESIDENT pro tempore. Yes.

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