[Congressional Record (Bound Edition), Volume 156 (2010), Part 9]
[Senate]
[Pages 12797-12802]
[From the U.S. 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.

[[Page 12798]]

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 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,

[[Page 12799]]

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?
  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

[[Page 12800]]

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 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

[[Page 12801]]

     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.
  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

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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.

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