[Congressional Record (Bound Edition), Volume 156 (2010), Part 9]
[Senate]
[Pages 12804-12805]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           BERWICK NOMINATION

  Mr. WHITEHOUSE. Mr. President, I heard that some of my colleagues on 
the other side were here earlier engaged in a colloquy of condemnation 
of the appointment of Dr. Berwick to run CMS. I wanted to come back and 
respond because I think this body is making a mistake and is taking a 
very wrong path by attacking and criticizing this particular nominee.
  To provide just a moment of context to his appointment, when I was 
here yesterday I had a graph that showed that in 1955, the year that I 
was born, we spent about $12 billion on health care as a nation. Last 
year we spent $2.5 trillion, 200 times as much. The graph showed not 
only the steep curve that took us from $12 billion to $2.5 trillion a 
year, but also the fact that curve was accelerating. It was getting 
steeper. In the last year the year-to-year increase was $134 billion in 
health care expenditures.
  That is the biggest year-to-year increase in the history of the 
Republic. If we kept at it, by 2016 a family of four in Rhode Island 
would be paying $26,000 in premiums for a basic health care policy. 
Medicare Advantage plans jumped 14 percent last year nationally, on 
average. We are in both an unsustainable and an accelerating health 
care cost increase environment. Something absolutely has to be done 
about it. I suspect almost everybody in this Chamber would agree with 
that.
  That is the backdrop--unsustainable, accelerating health care costs 
that now gobble up more than 17 percent of our gross domestic product. 
There is a huge discrepancy between us and every other nation in terms 
of the amount of our economy that we burn on health care. I believe the 
closest to us is now at 12 percent of GDP, and we are at 17 percent, 
and it climbs every year along with that accelerated, unsustainable 
rate of health care cost increase.
  The question is, What are we going to do about it? This is a terrific 
burden on our economy. It is uncompetitive against other nations, it 
hugely depresses our manufacturing sector, and it clobbers families who 
have to pay for health care that is so expensive. It simply has to be 
addressed.
  There are two ways we can do it. We could preserve the status quo and 
simply cut benefits that people receive. We could make Social Security 
health care benefits knocked down. We could make Medicare benefits 
knocked down--disability health care benefits for Social Security. We 
could make Medicaid benefits knocked down. We could spend less, I 
suppose, on TRICARE in the Veterans' Administration and provide fewer 
services, pay for less, or require more copays. That is one way to go 
about doing it, but it is not a very smart way and it is not a very 
humane way.
  A lot of the costs in our health care system is waste; it is waste 
and inefficiency. If we look at the report of the President's Council 
of Economic Advisers, they come at it in two ways, and both ways come 
to the same number, about $700 billion a year--a year--in waste and 
excess costs.
  The New England Healthcare Institute did a study--$850 billion a year 
in waste and excess cost.
  The Lewin Group and former Bush Treasury Secretary O'Neill have both 
arrived at a different number, but they agree the number is $1 trillion 
a year in waste and excess cost.
  So if we have a huge cost problem, and if we have waste and excess 
costs as high as $1 trillion a year--to give us an idea of the scale, 
remember it was about $2.5 trillion last year. It is supposed to be 
$2.7 trillion this year. If the Lewin Group and Secretary O'Neill's 
number is right, that means one-third of the cost, more than one-third 
of the cost is waste in excess care, unnecessary cost. So going after 
that waste and excess cost should be a priority to deal with the cost 
burden that our health care system puts on the country.
  How would we go about doing that? Well, we are actually fortunate in 
one respect. In all of the mess of our health care system we are 
fortunate in one respect; that is, there is a proven correlation in 
many areas between improving the quality of care and lowering the cost 
of care.
  Probably the most famous example is dealing with hospital-acquired 
infections. A hospital-acquired infection costs maybe $60,000 on 
average to treat, and it is avoidable. It is completely preventable. So 
if we crack down on hospital-acquired infections, if we fix the process 
failures that permit hospital-acquired infections to occur, we improve 
the quality of care, we save people's lives, we get them out of the 
hospital sooner and healthier, and we save money, all together. But 
because of the bizarre economics of our health care system, it is not 
in anybody's financial interest to do that who is also in a position to 
do that. So over and over, we have these failures where we could have 
huge win-win situations in which we improve the quality of care for the 
American people while reducing the cost of the health care system.
  It happens with hospital-acquired infections. It happens with 
administrative overhead. Medicare runs about 3 to 5 percent of 
overhead. The private insurance market runs at about 20 to 27 percent 
overhead. It has more than doubled in the last 6 years, from 2000 to 
2006. In 6 years it has more than doubled, just the administrative 
overhead, not health care itself, the administrative overhead of the 
private insurance industry. That is part of the waste and excess costs.
  We can tackle those things. We can drive them down. We can improve, 
for instance, maternal mortality rates in this country. Believe it or 
not, America is 39th in maternal mortality. Maternal mortality is a 
cold, statistical way of describing a mother dying in childbirth, 
giving birth to her baby, and we are 39th in the world; 38 countries do 
better at protecting moms while they are giving birth to their children 
than we do.
  If we can improve that rate, we can save money because the same 
process failures that lead to those deaths lead to expensive 
complications, additional days in the hospital, sometimes lead to 
lifelong injuries to the baby as it is being delivered, which create 
huge cost. So, again, it is a win-win when we improve the quality of 
care to lower the cost of medicine.
  Now, why do I say all of that? Why do I talk about the importance--
first of all, the urgency of the cost problem and the importance of 
pursuing this win-win strategy to reduce the cost of care by improving 
the quality of care for Americans? I mention that because Don Berwick 
is probably the leading pioneer in this area.
  The bible of the quality of improvement movement was a book called 
``To Err is Human,'' written, I believe, by the National Institutes of 
Health. Dr. Berwick was one of the lead authors of that report. It was 
followed by another report called ``Crossing the Quality Chasm.'' Those 
two reports have been the foundation for the quality reform movement.
  I am very familiar with the quality reform movement because I founded 
something in Rhode Island called the Rhode Island Quality Institute 
which has led in this area. The legislation we passed, the health care 
legislation, contains an immense number of reforms of the delivery 
system that are designed to capture this win-win, that are designed to 
improve the quality of care in ways that lower the cost of care.
  One economist has called it the most significant action on medical 
spending ever proposed in the United States. A Noble Prize-winning 
economist has noted that official estimates don't give the plan much 
credit for the cost-saving efforts in the proposed reform, but 
realistically the reform is likely to do much better at controlling 
costs than any of the official projections suggest.
  An MIT professor, who is a leading health economist, said: I cannot 
think of a thing to try that they did not try. They make the best 
effort anyone has ever made. Everything is in here. You could not have 
done better than they are doing.
  So the bill created an array, a portfolio of tools for beginning to 
change

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our broken, dysfunctional health care delivery system and move it more 
in the direction of better patient care that costs less money.
  The lead practitioner of that, the lead advocate of that, the person 
who has thought about this the most and done the most work on it is Dr. 
Don Berwick. So it makes perfect sense he would be the person brought 
over by President Obama to lead CMS and to apply these principles of 
improving the quality of care, to reduce the cost for America. He is an 
expert at it. I think we wrote good legislation on the delivery system 
reform. I think it was actually very good legislation. But it does not 
matter how good the legislation is that we write if the executive 
branch does not get out there and implement it in a dynamic, 
thoughtful, iterative way. We learn something, we move on.
  We have to be creative and continue the pressure on this. We have to 
take what we learn in different projects and bring them together and 
try something now and constantly be in a process of innovation and 
improvement in order to be effective. Nobody will do that better than 
Professor Berwick. That is why both President Bush, H.W. Bush, and 
President Bush, W. Bush, their CMS directors have applauded this 
nomination.
  Gail Wilensky, the Administrator of CMS under President George H.W. 
Bush, said: Berwick has longstanding recognition for expertise and for 
not being a partisan individual.
  George W. Bush's CMS director, Tom Scully, said: You are not going to 
do any better than Don Berwick.
  So from the other side of the aisle, from the partisan side of 
executive management of this, the previous CMS directors know how 
qualified this man is. I know my Republican colleagues want to talk 
about rationing. They would love to paint rationing and socialized 
medicine and death panels all over the health care bill. Obviously they 
cannot resist the opportunity to do that using Dr. Berwick.
  But, frankly, it is not fair, and I think it puts them on the wrong 
side of history. It puts them on the wrong side of reform. It raises 
the question, Whose side are they on? When we have somewhere between 
$700 billion and $1 trillion of waste every year and the person who 
George Bush's CMS director says we are not going to find any better to 
come in and fix that program than the nominee, and they are against the 
solution to that, whose side are they on?
  Well, it is pretty clear they are on the side of the $700 billion to 
$1 trillion a year in waste. That is a choice they can make. But I do 
not think it is a wise choice. When we are dealing with doing things 
such as eliminating hospital-acquired infections in order to save 
money, and they are against the person who is the leading proponent of 
this and who is going to lead us in that direction, who are they for? 
Are they for the families who lose a loved one to a hospital-acquired 
infection? It does not seem that way. It seems like a vote in favor of 
the status quo. It seems like a vote in favor of the status quo and the 
continuing unbelievable number of deaths and casualties from hospital-
acquired infections.
  One of the findings of the ``To Err is Human'' report is that 100,000 
Americans die every year, 100,000 Americans die every year because of 
avoidable medical errors. When we clean up the medical errors, when we 
clean up the process failures that lead to those medical errors, we 
save money. That is Don Berwick's expertise. When they oppose him, 
whose side are they on? Are they on the side of 100,000 Americans who 
lose their lives every year because of avoidable medical errors? I do 
not think so. It sounds as if they are on the side of the 100,000 
medical errors.
  Let this guy have a chance. He has bipartisan support. He is an 
expert in this area. The area he is expert in is the best path to lead 
us to cost savings in health care because it is a win-win path. We do 
not have to take something away from somebody to create the savings; we 
can earn the savings by reforming the delivery system so it provides 
better health care.
  He has founded the Institute for Healthcare Improvement. He has 
worked as a board member on the American Hospital Association on 
Quality Initiatives. He chaired the Advisory Council for the Agency for 
Health Research and Quality. He goes back to the Clinton era, where he 
was on President Clinton's Advisory Commission on Consumer Protection 
and Quality. He is the real deal.
  So I urge my colleagues, as I did yesterday, to step back from the 
partisanship, to step back from the posturing. We have heard enough 
about rationing. There is not rationing in this; this is quality 
reform. We have heard enough about death panels and socialized medicine 
and all of that nonsense.
  We have a serious problem in our health care system. We need to 
address it seriously. There is a path to address it that is a win-win 
for our country, for our people, for our society that reduces costs and 
provides Americans better care. To me, it is embarrassing that we 
should be 39th in maternal mortality. There are 38 countries that keep 
mothers alive through childbirth better than we do. That is the kind of 
thing we should be fixing. That is the kind of quality reform we need. 
That is the kind of quality reform Don Berwick gets behind.
  This should be an area where we can all get behind this. Some of the 
work he has done has been in Republican States, in States with 
Republican Senators. I just know, off the top of my head, that Utah is 
a leading State in the quality reform area. The North Carolina Medicaid 
effort on Medical Home is one of the leading early studies on this 
issue. These people have Republican Senators who can report on how 
successful those have been. Yet they have made the choice not to look 
at Berwick for the person he is, for the expert he is, for the purpose 
he brings to this job, but just as an excuse to try to go back to the 
slogans and try to sloganeer their way through what is a real and 
significant problem for our country.
  So unless you want to wish failure on America in this task, unless 
you want to wish failure on America in reducing the 100,000 deaths 
every year from avoidable medical errors, unless you want to wish 
failure on America in improving our status so we are the best in the 
world on maternal mortality rather than 39th, unless you want to wish 
failure on America in the only win-win path to reducing the terrible 
burden of health care costs, the accelerating burden, unsustainable 
burden of health care costs on our country, unless you want to wish 
America failure in that, you ought to support Don Berwick because he 
knows how to follow this path, this win-win path, toward health care 
savings that come from improving quality. That is a path we should be 
on.
  There is no one better suited to lead CMS down that path than Dr. 
Berwick. So I hope we can find a way in this body to be better than 
that. I think Dr. Berwick gives us the occasion to be better than that. 
At long last, I hope that soon we become better than that.
  I yield the floor, and I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. SANDERS. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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