Gibbs Evades Question of Whether Obama Agrees With His Medicare Director That Health-Care System Must Redistribute Wealth

White House Press Secretary Robert Gibbs (AP photo)White House spokesman Robert Gibbs has evaded answering the question of whether President Barack Obama agrees with Dr. Donald Berwick, his newly appointed administrator of Medicare and Medicaid, who has insisted that health-care systems must redistribute wealth.

"Excellent health care is by definition redistributional," Berwick said in a speech delivered on July 1, 2008.

When asked directly at the July 7 White House press briefing whether Obama agreed with this, Gibbs would not answer the question. Instead, he parried it with jocular statements about the provenance of the quote.


On July 8, sent Gibbs an email that included a link to a YouTube page on which is posted a video of the portion of Berwick's July 1, 2008 speech in which Berwick made the comment. Gibbs was also provided with a transcript of the relevant segment of the video and a copy of the July 26, 2008 edition of the British Medical Journal (BMJ) which published a written adaptation of Berwick's speech.

Berwick gave the July 1, 2008 speech to honor the 60th anniversary of the National Health Service, Britain's government-run single-payer health care system.

"You could have had a monstrous insurance industry of claims and rules and paper-pushing instead of using your tax base to provide a single route of finance," said Berwick in the video recording of the speech that provided to Gibbs. "You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker. And that 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 the less fortunate. Excellent health care is by definition redistributional. Britain, you chose well."

Gibbs was again asked--in the July 8 email--whether President Obama agreed with Dr. Berwick that "excellent health care is by definition redistributional"?

Gibbs again did not answer.

On Wednesday, Obama made Berwick the director of the Centers for Medicare and Medicaid Services (CMS) through a recess appointment.

Obama had sent Berwick's nomination in April to a Senate that has a 59-seat Democratic majority. Senate Finance Chairman Max Baucus, a Montana Democrat whose committee had jurisdiction over Berwick's nomination, had not yet scheduled a confirmation hearing on the nomination.

Senate Majority Leader Harry Reid, a Nevada Democrat, has control over scheduling floor votes on presidential nominations.

In a White House statement announcing the recess appointment, Obama charged that the confirmation of Berwick and two other nominees he was naming by recess appointment at the same time had been delayed in the Democrat-controlled Senate by unnamed persons for "political purposes." "It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes," he said.

Because Obama's made this recess appointment while Congress was out for the July 4th holiday, the Democrat-controlled Finance Committee no longer needs to hold a confirmation hearing on Berwick before the November elections and Senate Majority Leader Reid does not need to schedule a vote on the nomination this year. But, under the express language of Article 2, Section 2, Clause 3 of the Constitution, Berwick's recess appointment must "expire by the end of the next session"-meaning Berwick must leave office by the end of 2011 unless the Senate puts him through the constitutionally required confirmation process in the intervening time.

On July 1, 2008, Berwick gave his speech at Wembley stadium in England celebrating England's single-payer health care system which was then in its 60th year. In the speech, Berwick praised Britain for choosing to have a government-run health care system and made his remarks that to be "just, equitable, civilized and humane" a health care system "must" redistribute wealth, and that "excellent health care is by definition redistributional."

The portion of Berwick's speech that includes this statement was posted on YouTube by the Heartland Institute on May 12, and that same day nationally syndicated radio host Mark Levin played the audio of the relevant portion of the speech on his program. Berwick's statement that "excellent health care is by definition redistributional" has been available online in both video and audio form ever since then.

A few weeks after Berwick delivered the speech in 2008, a written adaptation of it was published in the British Medical Journal (BMJ) in its July 26, 2008 edition. In the written version, Berwick repeated his praise of Britain's government-run, single-payer health-care system as well as his assertion that a "just" health-care system must redistribute wealth. The language of the written version that Berwick published in BMJ, however, was somewhat streamlined from the spoken words he used at Wembley.

"You could have a giant insurance industry of claims, rules, and paper pushing instead of using your tax base to provide a single route of finance," wrote Berwick. "You could have protected the wealthy and the well instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any healthcare funding plan that is just must redistribute wealth. Britain, you chose well."

On Wednesday, July 7, 2010, the day that the White House announced that President Obama was bypassing the Senate confirmation process and giving Berwick a recess appointment to run Medicare, asked White House Spokesman Gibbs during the White House press briefing whether the president agreed with what Berwick said about redistribution at Wembley.

"Among the controversial comments that he's made in the past that would have come out in a Senate confirmation hearing are that ‘excellent health care is'-‘excellent health care by definition is redistribution," said "Some of the others were mentioned. Does the president actually agree with that comment?"

In response, Gibbs noted that two past Republican CMS directors supported Berwick's nomination.

"Look, this is somebody who is uniquely and supremely qualified to run an agency that is important to our government, it's important to seniors, it's important to implementation of the new health care law," said Gibbs. "And this is somebody supported not just by Democrats but by, as I said earlier, Tom Scully and Mark McClellan, who ran this agency--both of whom ran this agency for George Bush.

"But does the President agree with the previous statement?" asked

Gibbs then remarked that the question of whether Obama agreed with his Medicare director was a political game.

"I know that this is the exact type of political game that the American people have come to understand dominates Washington and doesn't actually make their health care more affordable," he said.

Gibbs then declined to say whether comments by Berwick about rationing and redistribution would be troublesome in an election year if they were aired during a Senate hearing.

"You just read comments," said Gibbs. "Is there like a secret comment book that somehow you got that nobody else got, and you just read a couple of them to me--and somehow they wouldn't have come out? Did he say things like, 'rationing happens today; the question is who will do it'? Did he say that? Did he say that?"

Gibbs said that that comment was actually made by Rep. Paul Ryan of Wisconsin, the ranking Republican on the House Budget Committee, who was a fierce critic of the health-care law that President Obama signed in March.

"Actually, that was Paul Ryan. That was Paul Ryan," said Gibbs.

In fact, in an interview published on Feb. 2, 2010, Ryan told Ezra Klein of The Washington Post: "Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?"

In June 2009, in an interview with Biotechnology Healthcare, Dr. Berwick made his own remark about rationing--in the context of government-funded health-care.

"We can make a sensible social decision and say, ‘Well, at this point, to have access to a particular additional benefit [new drug or medical intervention] is so expensive that our taxpayers have better use for those funds,'" said Berwick. "We make those decisions all the time. The decision is not whether or not we will ration care--the decision is whether we will ration with our eyes open. And right now, we are doing it blindly."

Under the health-care law signed by President Obama, American earning up to 400 percent of the poverty level ($88,200 for a family of four in 2010) will receive federal subsidies to buy health insurance, but they will be required to buy a government-approved plan in a government-regulated exchange.

Senate Finance Chairman Baucus was critical of Obama's use of a recess appointment to circumvent the Senate confirmmation process for Berwick. "I'm troubled that, rather than going through the standard nomination process, Dr. Berwick was recess appointed," Baucus said in a statement.

"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," Baucus said.

Crossposted at NB sister site CNS News.