The Administration announced last night that it would use a recess appointment to get Donald Berwick in place as the Administrator of the Centers for Medicare and Medicaid Services (CMS). Recess appointments are controversial and this is no exception. Republicans are downright angry that the White House, apparently without much warning, decided to circumvent Congress and critics who were gearing up for a high-profile fight over Berwick’s past statements.
(Among other impolitic utterings, Berwick has said he “is romantic about the NHS,” the UK’s oft-maligned nationalized health system, and believes “excellent health care is by definitional redistributional.”)
Maybe the Administration didn’t have the stomach for another partisan health care reform battle. Maybe it didn’t feel confident in its ability to defend Don Berwick’s contention that rationing should not be the boogeyman of health care policy. Maybe vulnerable Congressional Democrats successfully lobbied for a recess appointment, eager to avoid a contentious confirmation hearing that would bring health care reform to the fore just ahead of this fall’s election. Most likely, it was all of these things.
There was no doubt that Berwick’s confirmation hearing would have created fireworks and there was a chance he would have lost the battle and not garnered the votes needed to be confirmed. His past statements, in or out of context, were a perfect means to caricature the Administration’s health care policies as being all about government control at the expense of quality care. (This, despite that Berwick’s passions include better quality care and a better experience for patients in the hospital.)
In other words, it’s abundantly clear what motivated the White House to install Berwick via a recess appointment. But why do so less than three months after he was officially nominated? It’s not as if this is the only congressional recess on the calendar. CMS has been without a permanent head since 2006 and Berwick’s name has been bouncing around as a leading candidate for more than a year. And how hampered will Berwick be in his job because of the means by which he got it?
