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Public Statements

Appointment Of Dr. Donald Berwick

Floor Speech

Location: Washington, DC


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, 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.


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.


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