Obama uses recess appointment to install Berwick as head of Medicare, Medicaid

President Barack Obama Wednesday will use a recess appointment to install Harvard Professor Donald Berwick to run the Centers for Medicare and Medicaid Services, the White House announced Tuesday.

The Boston Globe: "The recess appointment to the Centers for Medicare and Medicaid Services means Obama won't have to subject his nominee to promised Republican grilling of Berwick in nomination hearings, because appointments made during official congressional breaks do not require a vote. The agency has not had a permanent director since 2006." Berwick would have faced tough questioning from Republicans on a number of controversial statements, including those expressing admiration for the British health system and on rationing health care.

The White House said that Republicans wanted only to stall the nomination to score political points. "Berwick is a Harvard Medical School professor and president of the Institute for Health Care Improvement. He is widely respected by veteran policy officials across the political spectrum, analysts largely agree." Republicans, however, seized on the opportunity to attack the appointment and Berwick. "'This recess appointment is an insult to the American people,' Senator John Barrasso, a Wyoming Republican, said. 'Dr. Berwick is a self-professed supporter of rationing health care, and he won't even have to explain his views to the American people in a hearing. Once again, President Obama has made a mockery of his pledge to be accountable and transparent'" (Milligan, 7/7).

Roll Call: "Senate Minority Leader Mitch McConnell (R-Ky.) and Republican Sens. Bob Bennett (Utah) and Pat Roberts (Kan.) attacked Berwick's record during a colloquy on the floor in May, and 56 House Republicans wrote to Obama last month to ask him to withdraw the nomination over Berwick's support of comparative effectiveness research. The research is used to identify treatments, and some critics equate it with rationing" (Starkey, 7/6).

Bloomberg Businessweek: "McConnell criticized Obama for trying to 'sneak' Berwick's nomination through the Senate without 'public scrutiny.' ...  'Apparently the Obama administration intends to arrogantly circumvent the American people yet again,' McConnell, of Kentucky, said in a statement" (Johnston, 7/6).

Reuters: "The president has the power to fill top federal vacancies that would normally require Senate approval while the Senate is in recess. Many presidents have used this power to get around a Senate that is obstructing the administration's nominations" (Bull, 7/6).

Kaiser Health News has a resource guide on Berwick with a biography, collection of media profiles and a video interview (7/7).

The New York Times: "In two decades as a professor of health policy and as a prolific writer, Dr. Berwick has championed the interests of patients and consumers. At the same time, he has spoken of the need to ration health care and cap spending, has supported efforts to 'reduce the total supply of high-technology medical and surgical care' and has expressed great admiration for the British health care system. Under the new law, Medicare will be a testing ground for many innovations that reward high-quality care and penalize providers of poor care. The law will expand Medicaid to cover 16 million more people with low incomes" (Pear, 7/6).

Los Angeles Times: The new health law "strives to make Medicare more efficient as well as dramatically expand Medicaid, the joint state-federal insurance program for the poor. Approximately 47 million people are enrolled in Medicare, and 58 million people are enrolled in Medicaid. Berwick, 63, is a leading advocate of expanding research into the comparative effectiveness of various medical treatments, a major focus of the new healthcare law that many experts think is crucial to improve the quality of care that Americans receive and cut waste in the system" (Levey, 7/7).

The Wall Street Journal: The position will be one of the most instrumental positions in implementing health reform because it will eventually oversee the placement of millions more in Medicaid and "it will cut more than $400 billion over a decade in Medicare payments to health-care providers" (Adamy, 7/7).

Politico: "CMS has not had a permanent head for four years now, a point that [White House spokesman Dan] Pfeiffer used in explaining the White House's decision to appoint Berwick with the Senate out of session for the July Fourth recess. The Democratic-controlled Senate never took up the nomination of Kerry Weems, former President George W. Bush's choice in 2007 to head the agency, and the CMS has cycled through a series of acting administrators who do not need Senate confirmation" Berwick has attracted the support from medical societies and trade groups including the American Medical Association, the leading doctor group (Kliff and Haberkorn, 7/7).

The Washington Times: Some observers question his qualifications, however, as evidenced by some of the disclosures on questionnaires he has filled out during the nomination process. "In all, Dr. Berwick disclosed holding more than a dozen current positions on a government ethics filing, though one full-time paying job: his 40-hours-per-week position as the president and chief executive of the nonprofit Institute for Healthcare Improvement (IHI), where he earned nearly $900,000 in salary, bonus and deferred compensation last year. ... In response to a query from The Times about why no compensation was reported with [some of] those positions, a White House spokesman described them as 'essentially honorary professorships,' where he holds two or three lectures, seminars or meetings a year." (McElhatton, 7/6).