Obama To Recess Appoint Radical CMS Nominee Without Public Hearing

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Philip Klein
7/6/2010

The White House on Tuesday night announced that President Obama would use use a recess appointment on its nominee to head the Centers of Medicare and Medicaid Services, Donald Berwick, before the Senate was even able to schedule a confirmation hearing.

This way, Berwick will assume his post without having to explain statements such as this: "Cynics beware, I am romantic about the (British) National Health Service; I love it."

Nor will he have to answer for his extensive writings and speeches endorsing central health spending caps and government rationing of care to the sick, which I detailed here. At the time, I explained why his draconian views would make him dangerous as the head of CMS:

While Berwick would not have the authority to impose a British health care system on the United States in one fell swoop, as head of CMS, he would be running both Medicare and Medicaid. Given that the two programs alone account for more than one out of every three dollars spent on health care in America (all government programs combined account for 47 percent), private players tend to follow CMS's lead. Berwick himself has made this point.

"(G)overnment is an extraordinarily important player in the American health care scene, and it has inescapable duties with respect to improvement of care, or we're not going to get improved care," he said in a January 2005 interview with Health Affairs. "Government remains a major purchaser.… So as CMS goes and as Medicaid goes, so goes the system."

He also said that, "(T)he Holy Grail of universal coverage in the United States may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per capita costs."

More specifically, he has praised the British rationing board, the National Institute for Clinical Excellence:

"NICE is extremely effective and a conscientious, valuable, and -- importantly -- knowledge-building system," Berwick said in an interview last June in Biotechnology Healthcare. "The fact that it's a bogeyman in this country is a political fact, not a technical one."

Justifying the move on the White House blog, communications director Dan Pfeiffer wrote:

Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points.

But with the agency facing new responsibilities to protect seniors’ care under the Affordable Care Act, there’s no time to waste with Washington game-playing. That’s why tomorrow the President will use a recess appointment to put Dr. Berwick at the agency’s helm and provide strong leadership for the Medicare program without delay.

But this analysis doesn't pass the basic smell test. Obama could have announced his CMS appointment at any time after winning the election in November 2008 if it were so urgent, but he waited almost a year and a half -- until April of this year -- to name Berwick. Conveniently, this was after the health care law had already passed. Had he appointed Berwick during the health care debate, it would have exposed how much Obama's ultimate vision for U.S. health care borrows from the British model.

Even the New York Times writes that, "The recess appointment was somewhat unusual because the Senate is in recess for less than two weeks and senators were still waiting for Dr. Berwick to submit responses to some of their requests for information. No confirmation hearing has been held or scheduled."