Obama To Fill A Big, Big Job

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In this week’s cover story, we noted that one of the biggest challenges for the Obama Administration in implementing the new health care law is:

… filling key posts in the Executive Branch that remain empty more than 14 months after Obama was inaugurated. After all, there will be thousands and thousands of new regulations to be written and administered. But no one has yet been named to head the Centers for Medicare and Medicaid Services, the huge agency that runs those two programs. And Senate Republicans have held up the nomination of Columbia University professor Sherry Glied for the important post of Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services. Congressman George Miller, chairman of the House Committee on Education and Labor, grouses that the Administration “is going to have to be more aggressive. They have not been aggressive enough on the appointments process.”

Today, the NYT’s Robert Pear reports the Administration has settled on someone to run the agency that runs Medicare and Medicaid. The early reviews are good:

WASHINGTON — President Obama will soon name Dr. Donald M. Berwick, an iconoclastic scholar of health policy, to run Medicare and Medicaid, the programs that serve nearly one-third of all Americans, administration officials said Saturday.

Dr. Berwick, a pediatrician, is president of the Institute for Healthcare Improvement in Cambridge, Mass. He has repeatedly challenged doctors and hospitals to provide better care at a lower cost. He says the government and insurers can increase the quality and efficiency of care by basing payments on the value of services, not the volume.

Mr. Obama plans to nominate Dr. Berwick to be administrator of the Centers for Medicare and Medicaid Services, a unit of the Department of Health and Human Services that has been without a permanent chief since October 2006, when Dr. Mark B. McClellan stepped down.

If confirmed by the Senate, Dr. Berwick would have a huge plate of responsibilities under the new health care law.

The law, signed Tuesday by Mr. Obama, will expand Medicaid to cover 16 million more people, squeeze nearly a half-trillion dollars out of Medicare in the next 10 years and establish many demonstration projects to test innovative ways of delivering health care.

Dr. Berwick’s nomination would be subject to Senate confirmation. Senators would almost surely use a confirmation hearing as a forum to debate the merits of the new health care law and to investigate how the administration plans to carry it out.

Steven D. Findlay, a health policy analyst at Consumers Union, said: “This would be a spectacular appointment. Don has been an intellectual force in health care for decades. He helped forge many ideas incorporated in the new health care law.”

As examples, Mr. Findlay cited provisions of the law intended to reduce readmissions to hospitals, prevent hospital-acquired infections and hold doctors and hospitals more accountable.

Dr. Elliott S. Fisher, director of the Center for Health Policy Research at Dartmouth Medical School, said Dr. Berwick was “a visionary leader who can motivate people to change.”

The early reaction from Hill Republicans is wary, judging by this statement from Senator Charles Grassley, ranking Republican on the Finance Committee, which will handle the appointment:

“This is always a big job, but the administration of health care reform, which includes implementing the hundreds of billions of dollars in Medicare cuts and the biggest expansion of Medicaid in its history, will make it more challenging than ever. The Finance Committee vetting will need to explore the nominee’s preparedness for the enormous challenges that face the agency.”

I’m predicting a big fight–mostly, because pretty much everything is a big fight these days. But this is a job that needs to be filled, so it will be unfortunate if this nomination turns into a relitigation of the entire health care debate, rather than focusing on Berwick’s qualifications.