Obama bypasses Senate by appointing Medicare chief

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.

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.

Sen. John F. Kerry (D-Mass.) said in a statement: "Republican lockstep stalling of Don's nomination was a case study in cynicism and one awful example of how not to govern. Republicans screamed that these federal programs were in trouble, then tried to deny the administration the capable guy the president had chosen to oversee them."

Kerry said Obama "did the right thing" in making the recess appointment. "He wasn't going to let the Republicans thrive in a chaos of their own making. Instead, he put seniors, kids and the disabled ahead of Republican gamesmanship, and he put a terrific public servant in place."

In a 2005 interview, Berwick said, "The waste level in American medicine approaches 50 percent."

A "lot of people make a lot of money on inefficiency -- on production of things that have no value. So the minute you try to become truly efficient, you're going to run into stakeholders who are going to tell you that you're harming care, and the knee-jerk reactions of doctors and others will be to reinforce that idea."

Senate Finance Committee Chairman Max Baucus (D-Mont.) said he was "troubled" that Berwick's appointment sidestepped the standard nomination process but added, "I look forward to working with CMS as they implement health reform to deliver the better health-care outcomes and lower costs for patients we fought to pass in the landmark health reform law."

The two other recess appointments announced Wednesday were less controversial.

Coyle previously served on the Defense Base Realignment and Closure Commission and spent 33 years working on nuclear weapons programs and high-technology programs at the Lawrence Livermore National Laboratory in California.

Gotbaum was controller in the Office of Management and Budget during the Clinton administration and later served as the first chief executive of the September 11th Fund, which distributed more than $500 million to more than 100,000 people affected by the 2001 terrorist attacks.

Obama has made 18 recess appointments, including the three announced Wednesday. By comparison, President George W. Bush made 23 recess appointments by the end of his second year in office and 171 recess appointments during his eight years in office. Bill Clinton made a total of 139 recess appointments during his presidency.

Berwick, who holds master in public policy degree from the John F. Kennedy School of Government and a medical degree from Harvard Medical School, currently serves as president and chief executive of Institute for Healthcare Improvement. He is also a professor of pediatrics and health-care policy at Harvard and works at Boston's Children's Hospital.

Clinton appointed Berwick to serve on the Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998. He has also chaired the National Advisory Council of the Agency for Healthcare Research and Quality and served on the governing council of the congressionally chartered Institute of Medicine, part of the U.S. National Academies.

In a statement when he was nominated in April, Berwick said he would "welcome the opportunity to lead [CMS] because it offers the chance to help extend the effort to improve America's health care system -- the very vision that led to the founding of the Institute for Healthcare Improvement." He added, "I have never felt more excited about what is possible for what we all care about -- a healthier nation, a healthier system of care, and a healthier world."

Two CMS administrators who served in the George W. Bush administration -- Mark McClellan and Thomas Scully -- have backed Berwick's nomination. The American Medical Association has welcomed it, praising Berwick's "visionary leadership efforts that focus on optimizing the quality and safety of patient care in hospitals and across health-care settings." Other expressions of support have come from the American Hospital Association, the AARP and the National Committee to Preserve Social Security and Medicare.

Staff writer Ed O'Keefe contributed to this report.

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