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Obama bypasses Senate by appointing Medicare chief

President Barack Obama, gestures during his meeting with Israeli Prime Minister Benjamin, Tuesday, July 6, 2010, in the Oval Office of the White House in Washington. (AP Photo/Pablo Martinez Monsivais)
President Barack Obama, gestures during his meeting with Israeli Prime Minister Benjamin, Tuesday, July 6, 2010, in the Oval Office of the White House in Washington. (AP Photo/Pablo Martinez Monsivais) (Pablo Martinez Monsivais - AP)
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By William Branigin and N.C. Aizenman
Washington Post Staff Writers
Wednesday, July 7, 2010; 5:56 PM

President Obama on Wednesday appointed health-care expert Donald M. Berwick to administer the Centers for Medicare and Medicaid Services, bypassing the Senate confirmation process over strong objections from Republicans who oppose the choice.

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Obama used a recess appointment to name Berwick, a 63-year-old pediatrician, Harvard University professor and head of a nonprofit health-care institute, to the post that oversees the $800 billion-a-year program that provides health care to the nation's elderly, poor and disabled. He was nominated in April, but no confirmation hearing was scheduled. The appointment during a congressional recess allows him to serve through 2011 without Senate confirmation.

Obama also used recess appointments Wednesday to install Philip E. Coyle III as associate director for national security and international affairs at the White House Office of Science and Technology Policy and Joshua Gotbaum as director of the Pension Benefit Guaranty Corp.

In a White House statement announcing the moves, Obama accused Senate Republicans of stalling dozens of his appointments for political ends.

"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," Obama said. "These recess appointments will allow three extremely qualified candidates to get to work on behalf of the American people right away. With more than 180 nominees still pending before the Senate, it's my hope that my colleagues in Congress will agree to put politics aside and move forward on these vitally important positions."

But Republicans blasted the appointments, particularly that of Berwick, who they say supports lowering health-care costs by rationing services.

GOP leaders also denied that they had blocked Berwick's Senate confirmation hearing. Rather, the proceedings were reportedly held up by Democrats because they wanted to avoid a confirmation fight that would allow Republicans to raise Obama's health-care legislation as an issue again in the months leading up to the November midterm elections.

Sen. John Barrasso (R-Wyo.) called the recess appointment "an insult to the American people" and described Berwick as "a self-professed supporter of rationing health care." He charged that Obama "has made a mockery of his pledge to be accountable and transparent."

Berwick has praised Britain's National Health Service, and he told an interviewer last year: "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." He has also 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.''

Such comments have made Berwick a target of Republicans who charge that he will implement a plan to cut about $400 billion out of Medicare over 10 years by denying needed care based on cost.

But supporters say rationing is already being carried out by insurance companies and that Berwick is well qualified to run Medicare and Medicaid, which have not had an administrator since 2006. Berwick has been lauded by many in his field as a visionary for investigating ways to improve patient care, then persuading hundreds of doctors and hospitals to adopt his recommendations.

As co-founder of the Institute for Healthcare Improvement, a Boston-area consulting and research group, Berwick has promoted the use of such uncontroversial procedures as checklists to substantially reduce hospital infection rates and errors.


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