Tuesday, June 29, 2010;
THE HOPE FOR health-care reform -- specifically, the hope that it will manage to bend the dreaded cost curve --depends on its execution. In that regard, no job will be more important than that of overseeing the giant government health-care programs: Medicare for seniors and the disabled, Medicaid for the poor. The administrator of the Centers for Medicare and Medicaid Services oversees more than $800 billion in annual spending, about one-third of all health-care spending. Getting these costs under control is crucial for the federal budget, but it is also significant in shaping overall health-care spending: In terms of health-care practices and reimbursement policies, as Medicare goes, so goes the private sector.
As influential as this position is, CMS has not had a confirmed leader since 2006. The Obama administration dawdled on naming anyone while it concentrated on the legislative fight. In April, President Obama nominated Donald Berwick, a professor at Harvard Medical School and one of the nation's leading experts on improving health-care quality while saving money -- in short, just what the doctor ordered for CMS. Dr. Berwick's bona fides for the job are exemplified by the broad range of individuals and institutions supporting him. President George W. Bush's two CMS administrators, Mark McClellan and Thomas Scully, back the nomination, as does Gail Wilensky, who served in the role under President George H.W. Bush. So do the American Hospital Association, the AARP, the National Committee to Preserve Social Security and Medicare, and a pages-long list of local medical groups. The American Medical Association called the nomination "welcome," and, in an official statement by the immediate past president, praised "his visionary leadership efforts that focus on optimizing the quality and safety of patient care in hospitals and across health-care settings."
So what's the holdup? Partisan politics. Republicans are seizing on the Berwick nomination as an opportunity to relitigate the health-care debate, latching on to a few of Dr. Berwick's statements to wage their campaign. Dr. Berwick has praised Britain's National Health Service: "not just a national treasure; it is a global treasure." In an assessment both accurate and inflammatory, he said just last year, "The decision is not whether or not we will ration care -- the decision is whether we will ration with our eyes open." He has said that "any health care funding plan that is just, equitable, civilized, and humane must -- must -- redistribute wealth from the richer among us to the poorest and less fortunate.'' Not surprisingly, Republican critics, including Sens. John Barrasso (R-Wyo.) and Pat Roberts (R-Kan.), have seized on these statements. "Dr. Berwick is the perfect nominee for a President whose aim has always been to save money by rationing health care," Mr. Roberts said on the Senate floor last month.
Actually, Dr. Berwick is the perfect nominee to help reshape a health-care system that is wasteful and bloated. He has a track record of understanding how to wring inefficiencies out of health-care systems and improve care in the process. Whatever his vision of the perfect health-care system, as administrator he would be constrained by legal and political realities; he would administer existing programs and help implement the new law.
The Senate Finance Committee has not scheduled a hearing on the Berwick nomination; that may not even happen before the August recess. Meanwhile, the prospect of rounding up 60 votes is uncertain. That's unfortunate. CMS -- and the country -- deserve a confirmed administrator, stat.