11:25 a.m. EST:
And we’re done. Berwick had little challenge with this. An hour of dodging with no major breakdowns and no commitment for return. Major questions remain unanswered regarding his views and conflicts of interest.[Ed -- Very disappointing to read that last update by Ben Domenech.]
11:23 a.m. EST:
Cantwell runs through talking point list of cost controls. So many softballs here where Berwick can dodge questions.
No one has yet asked Berwick about his past quotes regarding NHS or wealth redistribution. The key issues for why he was recess appointed have not been raised.
11:17 a.m. EST:
Ensign asks about healthy behaviors provision he added within legislation and applying it to Medicare and Medicaid population. Berwick talks wellness visits, but doesn’t mention financial benefits included. Ensign notes the Safeway model, which has had great success. Berwick ducks question.
Ensign demands a commitment for more transparency from Berwick on costs. Berwick doesn’t give it.
11:14 a.m. EST:
Grassley back up. Says Berwick recess appointment “violated promises by candidate Obama” regarding transparency.
Everything Berwick cites costs money: Annual physicals, checks for seniors, drug rebates. Wants to talk candy, not about the price.
11:11 a.m. EST:
Wyden cites Gov Kitzhaber’s push for flexibility in Oregon. Another softball, and one where again Berwick plays along with the idea of diversity. He already decried the possibility of Medicaid waivers – Berwick wants demonstration projects, not statewide tests.
Now comes the announcement that a vote has started on the floor. Baucus asks Berwick to begin giving 15 second answers. Laughable.
Roberts absence [he left to vote] means more Democrat questions. Going from Wyden to Stabenow is a major dropoff in health care knowledge and it shows. Stabenow asks a political flack question.
11:03 a.m. EST:
Berwick claims he accepted recess appointment because president asked. Also claims he wants openness and transparency. But Bunning cites his skepticism in blunt terms. He’s retiring, and not holding anything back.
Now Wyden talks about end of life care. Claims he strongly opposes rationing, wants patients to be able to choose between Hospice and Curative care. Of course Berwick will agree, but in so doing he runs against his own comments in the past and the solutions he recommended for the NHS.[Ed -- Heartland friend Marathon Pundit is also watching the hearing. His series of posts on the British Health Care system is worth checking out, too.]
10:57 a.m. EST:
In response to Bingaman, Berwick talks about not wanting “pieces of care” but wants goals of health and comfort and peace of mind. Fine goals all, but does government provide that? Berwick clearly believes it should.
And now Bunning: Right off the bat, warns Berwick that he’ll be spending a lot of time testifying before the House, since the Senate has been “shut out.” Notes absence of a permanent Doc Fix. Blasts “dishonesty,” points out disaster looming on low reimbursement rates for docs as of December 1.
10:48 a.m. EST:
Hatch reads statement blasting process and Obamacare, and decries the limit on time of five minutes per person. Again demands more time for hearings.
Hatch quotes from page 3 of advance testimony from Berwick, notes that Berwick is double counting (as the admin has done) the savings to Medicare. Compares it to using same dollar to pay for groceries and for your mortgage. Quotes CBO to puncture myth, and CMS actuary.
Few people do dogged questioning as well as Hatch: “isn’t this budgetary gimmickry?”
Berwick says his understanding is that they are using “standard accounting practices.”
Berwick says that Medicare Advantage losses are just “normal turnover.” Audible laughter from staff.
Hatch is definitive: “This is pathetic.”
10:40 a.m. EST:
Sen. Roberts says he’s suffering from CMS-induced confusion, and repeats the request for a post Thanksgiving hearing. [Ed -- Nice to see he's got Grassley's back.]
Rockefeller up now, asks regarding states rejecting the system and what will happen to people in those states – Washington, Nevada, Texas and West Virginia are all studying the possibility of dropping out of Medicaid. Two stories on this upcoming in Health Care News, published by The Heartland Institute.
Berwick claims people will have “nowhere to go” if states drop out of Medicaid. But this is inaccurate: states are considering substitute programs which would be run via waiver.
Berwick emphasizes that Medicare is just the endpoint of a journey. More signs of his desire to have government run care which “anticipates needs” and “prioritizes care” from birth to death.
The Senators here seem frustrated, just reading body language. Berwick is giving them talking points, not answers. Very dodgy but also expected.
Hatch’s turn now …
10:37 a.m. EST:
Now the Actuarial clash: Berwick dismisses Richard Foster’s comments as merely “estimates” and dodges the question.
10:34 a.m. EST:
Right to IHI: Grassley leads off with conflict of interest talk. Grassley maintains Berwick has not met his promise to meet and share documentation to illustrate no conflict of interest with his past companies.
Berwick claims he cannot provide financial info because he can no longer request it from his own organization (this strikes me as ridiculous – little precedent for such a barrier). He claims he has asked for no waivers yet.
10:33 a.m. EST:
Grassley demands a second hearing with Berwick considering they only have 70 minutes of questions and a full roster of 11. Baucus smacks him down, saying that’s his prerogative. [Ed - Testy already? Grassley will have to settle for watching House hearings next year.]
10:31 a.m. EST:
Baucus’s first question unintentionally highlights Berwick’s problem – he is being tasked with lowering costs but his solutions tend to increase costs (preventive, chronic care reform, finding waste) in the short term if not the long. He follows up with a question about coordinated care, then cuts Berwick off mid-promotional comments by noting “we’ve heard all that before.”
These questions have been shared, and are expected. Berwick’s trying to run promotion for Obamacare before the Republicans lay into him.
10:28 a.m. EST:
Winding down Berwick’s remarks. He keeps emphasizing a patient who died from medical error. But the patient in question was not covered by Medicare or Medicaid. An indication of how sizable he believes his role to be.
10:25 a.m. EST:
Berwick returns to prepared remarks, emphasizing enforcement against waste. But little he cites, with the exception of the doughnut hole and preventive care (which costs taxpayers more, not less, money), have anything to do with Obamacare.
10:22 a.m. EST:
Berwick notes error rates. A few details on that: The Medicare and Medicaid improper payment rates are issued annually as part of the U.S. Department of Health and Human Services (HHS) Agency Financial Report found at www.hhs.gov/afr. The Medicare fee-for-service error rate dropped to 10.5 percent, or $34.3 billion in estimated improper claims payments. The 2009 error rate was 12.4 percent, or $35.4 billion.
Berwick then talks about health care as a system that “helps people through journeys.” But the key is who directs those journeys — people or government?
10:20 a.m. EST:
Berwick’s testimony begins with emphasizing his family background. He contrasts father’s GP experience with his own. Trying to butter them up before the tough stuff.
10:16 a.m. EST:
Grassley says Berwick recess appointment “violated promises by candidate Obama” regarding transparency.
10:13 a.m. EST:
Chairman Baucus giving a lengthy opening statement – he emphasizes that Obamacare protects Medicare benefits [Ed -- unless you're on Medicare Advantage]. He calls Berwick “point man on new law.”
Ranking member Grassley gives a statement expressing disgust with process, and anger at recess nomination – calls it “incredibly unfortunate.”
Packed house, full of staff and press, also massive overflow.
8:58 a.m. EST: I’ll be blogging from today’s hearing with Donald Berwick, his first before the U.S. Senate. Questioning lines you should expect from Republican Senators at today’s hearing:
- CBO/CMS Actuary vs. Berwick: Several of Berwick’s predictions clash with the expectations of the CBO, particularly in terms of cost savings. They clash even more heavily with Medicare’s own actuary, Richard Foster. Expect both to come up.
- Berwick vs. Berwick: “So, you’ve said your comments have been taken out of context. How so? Please explain the following quote’s context to me…”
- Markets vs. Berwick: Berwick believes CMS can be a change agent which results in improved care for patients and improved outcomes for the system. However, his constant battle against profit as a motive for being involved in medicine, which was advanced under President Obama’s law, has already resulted in negative consequences for doctors and patients, both thanks to new regulations, cut payments, and dropped insurance. Was it so bad for medicine to be a business?
As a preview, after Berwick was recess appointed without a hearing, Senate Republicans put together a hypothetical hearing in which Berwick’s answers on rationing and other issues came from his own public statements and writings. I suspect Berwick’s answers will be different, but many of the questions will be the same.