President Obama is done waiting for the Senate to approve his nominee to run Medicare and Medicaid. On Tuesday evening, the White House announced Obama will use a recess appointment to make Don Berwick director of the Center for Medicare and Medicaid Services (CMS). That means Berwick can serve as the agency's administrator without Senate approval, but only until the next congressional session expires in 2011.
CMS director is always an important job. But it's even more important now, as the Obama administration starts to implement health care reform. Not only must CMS prepare to deliver coverage to millions of new Medicaid recipients. It must also re-engineer Medicare itself, so that it pays for services in ways that foster better, more efficient care.
Figuring out how to provide better care for less money is Berwick's specialty, making him, at least on paper, a perfect choice for the job. Here's how The Health Care Blog described him recently:
Don’s story is well known--a Harvard pediatrician and policy expert who became passionate about improving healthcare well before it was fashionable, he ultimately left his full-time academic perch to pursue his calling. In 1991, he founded the Institute for Healthcare Improvement, which ran on a shoestring for its first decade, fueled largely by the considerable power of Don’s vision and personality. ...
IHI became the essential organization--a source of networking, best practices, conferences, sustenance, courage, and more. To many in the quality and safety world, IHI became their church, and Don its Pope.
Republicans weren't interested in any of this. Instead, they wanted to talk about what they always want to talk about with health care reform: rationing. As I wrote a few weeks ago,
Berwick made the great error of declaring himself a “romantic” about the NHS. He praised Britain for making health care a right, rather than a privilege--and bemoaned the fact that the U.S. had not done the same. He talked up the British focus on primary care--and applauded its willingness to scrutinize technology for effectiveness rather than to simply pay for anything the drug or device industry conjures up.
You might think these are perfectly sensible positions. You would be right. In fact, most respectable health care experts would say the same thing, whether they are liberal or conservative.
Mark McClellan and Gail Wilensky both praised Berwick’s nomination. McClellan ran Medicare and Medicaid under President George W. Bush. Wilensky held the same position during the administration of Bush’s father. That's the same position for which Obama nominated Berwick, so you might think their opinion counts for something.
Could Democrats have withstood the inevitable media frenzy and have broken the equally inevitable Republican filibuster? Maybe. But the Senate calendar is crowded and, meanwhile, CMS needs a leader. That's why, understandably, Obama used the recess appointment.
For the record, a serious conversation about Berwick's qualifications and plans would have been worthwhile. I've heard even people sympathetic to Berwick question whether his administrative experience is adequte. But, again, it's hard to have a serious conversation when one of the two political parties refuses to be serious.
Update: Looks like the nomination has generated some controversy. In case it's helpful, here's a bit more about what Berwick said on British health care and why, in my opinion, he was spot-on:
The strengths Berwick saw in the NHS are real, particularly when it comes to primary care. On a visit I made to London a year ago, a family doctor demonstrated to me how the NHS used information technology to make sure diabetics get proper routine care. It was light years ahead of what I’d seen in the U.S.--and not atypical. A 2009 survey from the Commonwealth Fund (which also underwrote my reporting trip to England) found that 89 percent of British doctors have advanced electronic medical record capability in their offices, compared to just 26 percent in the U.S.
Still, the NHS has some real flaws. Relatively low cancer survival rates trouble patients, physicians and policymakers. Waiting times for specialists have come down in the last few years, but they remain higher than much of the country would like. Berwick actually mentioned this in his speech. You wouldn’t know it from listening to Fox News, which has replayed excerpts of the speech, but the tribute he gave was nuanced--not to mention smart. A lot of the advice he gave the Brits would work here, as well.
I also recommend Maggie Mahar's extensive analysis of Berwick's work and the efforts to misrepresent what he thinks.