It is day four of the Senate Finance Committee consideration of a sweeping overhaul of the $2.5 trillion U.S. healthcare system in an effort to rein in soaring costs and expand medical coverage to millions of uninsured people. The debate has turned to White House czars. RUSSIA

This is a hot topic among conservatives who complain that these White House positions wield great power but are not subject to public scrutiny or Senate confirmation. As advisers to the president they also cannot be called to testify before Congress.

Republican Senator John Ensign proposed an amendment to the healthcare legislation that requires Senate confirmation of any White House health czar, in this case Nancy Ann Deparle, counselor to the president and Director of the White House Office of Health Reform. The problem with requiring Senate confirmation is that there is no government position called “czar,” argued opponents to the measure.

“The concept of czar is a term of fiction,” said Democratic Senator John Kerry.

The term is basically a creation of the media not wanting to spell out the long titles given to these positions by presidents.