In a Surprise Move, Administration Appoints Berwick to Head CMS

Tuesday night the White House Blog explained: “In April, President Obama nominated Dr. Donald Berwick to serve as Administrator of the Centers for Medicare and Medicaid Services (CMS). 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.”

A “recess appointment” means that the president is putting Berwick in place while Congress is on recess (i.e. is taking a vacation). As a result, Berwick won’t have to go through a Senate confirmation hearing. Senate conservatives had made it clear that they hoped to defer this hearing for as long as possible.

The White House Blog notes that “CMS has been without a permanent administrator since 2006, and even many Republicans have called on the Administration to move to quickly to name a permanent head.”

Predictably, conservatives do not share this point of view.

But the truth is that, in the end, Berwick was bound to be confirmed. As I wrote in “Media Myths about Dr. Donald Berwick,” Dr. Berwick enjoys support that ranges from the AARP to three former directors of the Centers for Medicare and Medicaid Services (CMS) who served under Republican presidents. “This is not really about Don Berwick,” John Rother, executive vice president for policy and strategy at the AARP told McClatchy Newspapers. “In ordinary times, the nomination of somebody with Don’s record and standing in the field would not be controversial.” Thomas Scully, who led the CMS under President George W. Bush agreed: “He’s universally regarded and a thoughtful guy who is not partisan. I think it’s more about … the health care bill. You could nominate Gandhi to be head of CMS and that would be controversial right now.”

Berwick also enjoys warm endorsements from the American Association of Family Physicians, the American Medical Association, and the American Hospital Association.

When I wrote that post, arguing that Berwick would be confirmed, I realized that the real danger was that conservatives would manage to postpone Berwick’s appointment for months, using that time to continue their campaign to demonize him, while leaving Medicare without a leader– thus crippling Medicare’s ability to set an example for health care reform. (As I have written for the past three years, I believe that Medicare reform will pave the way for healthcare reform.)

Mark McClellan, who served as Administrator under President George W. Bush from 2004-2006, made this point two months ago, when President Obama tapped Berwick: “What happens at CMS in the next few years will determine whether the new legislation actually improves quality and lowers costs. Don [Berwick] has a unique background in both improving care on the ground and thinking about how our nation’s health care policies need to be reformed to help make that happen.”

Not long ago, while responding to a comment on another blog (www.thehealthcareblog.com), I said that I doubted that Obama would appoint Berwick during the Congressional recess. Fortunately, I added: “I could be wrong. If the administration realizes that conservatives can defer Berwick’s confirmation for too long, it will have to act.”

I’m so very glad that my initial prediction was wrong. We needed Berwick, in Washington, guiding CMS. Yesterday– or eight years ago.

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of  “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

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  6. James-
    Democrats as well as Republicans were critical of Robert Kennedy’s “intemperate” speech. They thought it was over-the top.
    On the other hand, everyone recognized that the core of what he said about Bork was true. My husand took law school classes with Bork; he thought Bork was very bright and basically liked him, but was shocked by the extremity of his views and how passionately he argued for them.
    For example: Bork was anti-abortion. He thought that illegally seized evidence should be admitted in court. He personally was opposed to evolution theory (though I don’t think he would have ruled against teaching it if a case came to the Supreme Court, which wouldn’t have happened. Finally he was very negative about civil rights’ legislation . . . . This is what upset people most. Barbara Jordan (hardly a radical) would testify against him at the hearing.
    Here’s his record on civil rights: “In 1963 and 1964, as a 36-year-old law professor, Mr. Bork wrote impassioned attacks on legislation to desegregate lunch counters and other public accommodations. He argued that the bill, by invading the liberty of proprietors to turn away blacks, was based on ”a principle of unsurpassed ugliness.” [NOTE THIS IS PRETTY EXTREME–mm] Not until 1973, when seeking Senate confirmation as Solicitor General, did he publicly renounce this view, stated with such unsurpassed surliness.
    “Even in his latest appearance he declined to revise his pinched view of civil rights. He has criticized some of the Supreme Court’s landmark civil rights decisions for reasons that vary from case to case. The bottom line, however, is almost always the same – unfavorable to minorities.” (This is all from the New York Times, at the time of the hearing.)
    On women’s rights: Just a few weeks before the confirmation hearings, “Bork told an interviewer that he thought the 14th Amendment, which covers all persons, ”should have been kept to things like race and ethnicity” and not extended to women.”
    On Art: He believed that only political speech was protected under the constitution not art or literature. Later he said art might be protected, but only if it related to politics.
    He did not believe that the constitution protected a right to privacy, except against unreasonable search. It did not protect the right of a married couple to use contraception.
    The Times describes him as a “flamboyant provocatuer”–
    he had written, for example, that “there is no constitutional principle by which judges can prefer, say, the right of married couples to practice birth control over the right of a utility company to pollute the air. ”
    Clearly, the issues discussed in his confirmation hearing were
    substantive–abortion, civil rights, etc.
    Clearly, Kennedy’s language was hyperbolic. For instance, while Bork believed that the states had a right to declare abortion illegal, that didn’t mean women would have to have abortions in back alleys. They could given birth to the child, or if they had the financial means, travel to another part of the country where abortion was legal (or, if necessary, another part of the world, like the U.K.)
    But Kennedy was not distorting Bork’s basic beliefs. Bork was proud of those beliefs.
    Attacks on Berwick even before the hearings began, by contrast, tended to focus on myths, not his actual beliefs– for example, the myth that Berwick wants to “ration health care for the elderly,” denying people treatment because they are too old, “death panels,” Berwick as “rationer in chief” and how he loves the NHS (He professed his admiration for the NHS in a very long speech–the second half of the speech was all about what is wrong with the NHS and needs to be fixed.)
    A great many fairly objective observers–including all of the Republicans who have directed Medicare in recent years– have said that these attacks are made up out of whole cloth. These do not reflect Berwick’s beliefs. His comments on the NHS come from a long speech; he spent the second half of the speech talking about all of the things wrong with the NHS.
    On “rationing” he has always made it clear that we already ration “by ability to pay”. He would ration “with our eyes wide open” using comparative effectiveness research, paying only for the most effective treatments. This would have nothing to do with the age of the patient. He has made it very clear again and again, that all patients should receive all the care that is effective.
    The “death panel” slur is simply that– a slur. If I recall correctly, Sarah Palin came up with the phrase to descrribe the palliative care that the reform legislation would have paid for.
    Sarah Palin’s level of discourse is what Bob Wachter is talking about– name-calling, phrases pulled out of the air, “talking points” with no solid foundation in realitly. Sheer stupidity, wrapped in sound bites.

  7. “The confirmation hearing would not have been a substantive example of Advise and Consent.”
    So the standard now for whether or not to follow the U.S. Constitution’s clear check and balance on the power of the Executive Branch is whether one thinks such a review of a nominee would be “substantive.”
    Who decides whether the review would be “substantive”? Why, the Executive Branch and the party in power, of course!
    So, here is an example of the level of “substantive” discourse exhibited towards a prior nominee for a judicial position:
    “Robert Bork’s America is a land in which women would be forced into back alley abortions, blacks would sit at segregated lunch counters, rogue police could break down citizens’ doors in midnight raids, school children could not be taught about evolution, writers and artists could be censored at the whim of government, and the doors of the federal courts would be shut on the fingers of millions of citizens of whom the judiciary is — and is often the only —
    protector of the individual rights that are at the heart of our democracy.”
    Edward Kennedy
    Was that sufficiently “substantive”? If not, should judicial nominees also be excused from having to go through the confirmation process?
    Would anything in the Berwick nomination process have come close that example from above?
    Hey, I am just trying to better understand this new “substantive” standard that governs whether or not we THE PUBLIC get to see nominees to high govermment positions TRANSPARENTLY confimed via the default of the U.S. Constitution.

  8. Um, Matthew;
    I find myself in the surreal position of commenting to defend Nate! Actually you are very late to the party; he USED to malign people personally but has vastly improved lately. And I myself have had previous disagreements with Maggie’s facts. Perhaps it is the way she puts her own interpretation on things and then presents them as fact. (No, Maggie; I still have not forgotten the “watch all prostate cancer regardless of grade” thing – but spare me arguing it over again, please.)
    And, as a woman, even I would say that her misogynist comment was over the top. It’s the ultimate female defense when all else fails – ‘he hates me because I’m a woman.’ Having worked with men all my life, that just doesn’t cut it in my book.
    Just because you agree with Maggie’s politics and not Nate’s is no reason to apply different rules to him.

  9. Carvil has healthcare reform -16
    Interesting stats from NRO
    This June in Arizona’s Maricopa County, 227 voters switched from no affiliation or some other party to the Democratic party. This includes 44 former registered Republicans.
    Another 211 voters switched to “independent”; this total included 55 Democrats and 69 Republicans.
    Another 217 left the Democratic party to become “Party Not Designated.”
    And 530 joined the Republican party, including 190 former registered Democrats and 252 who were “Party Not Designated.”

  10. Poolster.com has it 38.5 D to 33.6 R. Double the spread and throw in a big margin of error and Bush was the fav prez eva!

  11. what is the rule on personal attacks so I know?
    It appears attacking anyone with beliefs that track right is ok and encouraged but saying the exact same thing to someone who shares the left slant is not allowed?
    I understand why you wouldn’t want readers calling each other misogynist or publiclly questioning the size of their genitalia but it seems that is acceptable if it comes from the left. Question someone’s accuracy and honesty though is going to far? Even when that person CONSTANTLY questions the honesty and accuracy of others?
    Still trying to find the meat of the polls that show growing support, love the links through Ezra. Why is Pollster.com a more reliable source then Rassumussen? Rass has a pretty good track record to dismiss based soley on other polls with a far less accurate tracdk record. USA Today, NBA, and ABC are jokes with a long history of over sampling democrats and being way off. Kaiser generally does a good job but I would want to see their internals and questions before giving them any more credance then Rass.
    So finally found the internals, first the site you link to attacks the Rass poll based on;
    “It’s also worth noting that Rasmussen polls via telephone polls, so their voter responses are likely to be older, retired people who are home to actually respond to the poll.”
    When I pull up kaiser methodology they say;
    “Telephone interviews conducted by landline (806) and cell phone (401, including 105 who had no landline telephone) were carried out in English and Spanish.”
    So which is phone poll bad for the right accpetable when it supports your narrative?
    and here we go…so 35% D vs 25% R, 10% spread that explains the trend up, are you really going to argue the public mood is trending left? Dems are equal to Repubs on party identification. Polltrack has it 38/36 for Dems, 10 point spread is pipe dream.
    Its really hard to lambast you Matt. You state your opinion as opinion, are accurate with your facts, and only on occasion launch into personal attacks on those from the right. I don’t lambast people for having a difference of opinion. Now if you keep referencing polls with 10% party spread as accurate I might just start.

  12. Nate, if that’s the best you can do perhaps you’d better go find other windmills to tilt out and leave THCB to the serious people. Maggie’s right that overall the feeling towards repeal is waning. And the Rassmussen poll that you quote has, at the least, severe methodological problems, and is based on a useless “should the bill be repealed” question. You want back up, go here http://crooksandliars.com/karoli/rasmussen-polls-lies-damn-lies-and-statisti
    And when it comes to the real aspects of the bill that would be repealed (you know, reality, Nate, rather than the Thomas Moore Utopian anarchistic society with no government where your imagination lives) let me show you another poll. This one asks WHICH ACTUAL PARTS of the bill people want repealed.
    The answer is there is NO PART of the bill that EVEN A MAJORITY OF REPUBLICANS WANT REPEALED. The most support AMONG REPUBLICANS is for repealing the compulsion to purchase insurance and only 45% want that part repealed.
    So back in the real world, Maggie’s right, you’re wrong, so please drop the continual personal attacks on her.
    Feel free to lambast me instead….

  13. Maggie,
    You honestly think that response put you on a different level than Tapper? Now that you’ve called Tapper names (feel better?), put your “journalist” hat back on: was there a hold on the nomination by a GOP Senator, or not? If so, which one? Was there any GOP control on the scheduling of a confirmation hearing, or not?
    The substantive distinction you are working very hard to avoid is between the delay of a hearing — which would justify a recess action — and the exercise of the minority party’s right to “fight” during a constitutionally sanctioned hearing.
    So your entire report comes down to your untestable judgement of “the consensus throughout D.C.”?
    I’m sorry, that lacks rigor, and you know it.

    As a matter of politics, the president’s choice of Berwick was, well, the polite word would be bold. The less polite word: boneheaded. Administration officials argue that Republicans would have seized on any nominee as an opportunity to re-litigate the health-care debate. But Berwick offered opponents a loaded gun with his talk about rationing, his discussion of health reform as a matter of redistributing wealth, and his effusive praise for the British system. If the president wanted to buy a fight like this, he ought to have been better prepared to wage it.
    Yeah, yeah — Bush’s fault. Racism. Sexism. Got it, the first goog-illion times.
    Nov. 2 — a reckoning, for reckless, incompetent acts. Can’t wait.

  15. Its great to see so many other clear thinking people stand up and call BS to the propoganda being pushed here.
    James, Doc AW, TRG, Tim, Gary. Even a year ago Maggie would post her twisted view of the facts and not a single person would correct her. Now we have 5 people with clear and concise couter arguments disproving her post.
    This keeps up I can saddle up my horse and move on after other windmills.

  16. “The majority are waiting to see what happens– support for the legislation has been growing steadily since March.”
    Link even one source to back this up!
    “The polls show that the more people know about it, the more they like it.”
    Exact opposit, more people learn the more they want it repealled.
    “A new national poll shows support for repealing President Obama’s health care reform law has not abated in the month since its passage, and actually ticked up.”
    ““Support for repeal of the recently-passed national health care plan remains strong as most voters believe the law will increase the cost of care, hurt quality and push the federal budget deficit even higher,” said the new release from the polling firm Rasmussen Reports.
    Fifty-eight (58) percent of likely voters said they would support an effort to repeal the legislation, as Republicans have given consideration to campaigning on such a promise. Just 38 percent communicated opposition to such an effort.”
    I know how much you love internet fact checking maggie, can you produce ANYTHING to support your claim?
    bev M.D. when Nancy says you must read the bill to know what was in it and the FACT we are still finding surprises how can you claim;
    “The time to rail against the bill was during its passage, and rail they did. The vote was taken and they lost. So be it.”
    Maybe if you liberals would write the bill and allow people to read it before you passed them we could rail. Also the vote wasn’t taken under normal constitutional guidelines, the bill was reconciled and we lost, far different then losing an actual honest vote.
    Obama take 15? months to appointment someone…Republicans MIGHT take two months to debate and that is unacceptable? It’s always amusing watching the left spin.

  17. Janes & Andrew, Barbara Rubin, tcoyote,Ellen R., Tim
    James & Andrew —
    Please see Bob Wachter’s new post on the recess appt. (posted here on THCB today).
    The confirmation hearing would not have been a substantive example of Advise and Consent. As Wachter writes:
    “In today’s political environment . . all serious debate is trivialized and caricatured via talking points and schoolyard name calling. (This week’s na na na na na was calling Berwick “Rationer-in-Chief.” One can hardly resist a comeback like, “And so’s your mother.”) In such an environment, the ends do justify the means. In making this recess appointment, Obama did not bypass a substantive airing of Berwick’s qualifications to run the most important healthcare organization in the country. Rather, he avoided a sandbox brawl. As Jonathan Cohn wrote in the New Republic,
    “For the record, a serious conversation about Berwick’s qualifications and plans would have been worthwhile. . . . But it’s hard to have a serious conversation when one of the two political parties refuses to be serious.”
    I’ve written about how to many politicians have dumbed down the level of political discourse in this country by resorting to “framing” issues in bumper-sticker one-liners. Some conservatives take pride in this, seeing this as effective political rhetoric.
    In fact, serious debate is, as Bob says, “trivialized” via “talking points.” It’s easy to tell a lie in one sentence, or even one phrase (“death panels.”)
    The truth is usually far more complicated, and requires a paragraph or two. The conservatives who have taken Berwick’s statements out of context don’t want to read a paragraph or two–and they certainly don’t want you to read a paragrpah or two.
    But Berwick’s writings are readily available–on Google, on Amazon.
    He is hardly an “unknown” there are no “dark corners” of his life that haven’t been examined.
    “Modern HealthCare,” (a trade publication) named him the third most important person in healthcare a few years ago. People intersted in health care reform and health care quality have been following Berwick for years. They know Berwick’s views. He has spoken openly and candidly; he has written voluminously.
    Also James– the voters are not Mad AS Hell about healthcare reform. A vocal minority are angry. The majority are waiting to see what happens– support for the legislation has been growing steadily since March.
    The polls show that the more people know about it, the more they like it.
    Conservatives will continue to say that people are mad as hell, just as they said that Americans wouldn’t put up with civil rights legislation.
    Barbara Rubin– Yes, we need universal healthcare– we needed it back in ’94. And in ’74.
    Finally, we have the legislation; now, we need to move foward to implement it. As someone wrote recently “Berwick’s an impatient guy, and that’s good.”
    He’ll be active, on the ground.
    I think you underestimate Berwick’s ability to make the job his own. This is why the administration picked him– not to be a bureaucrat sucking up to Congressmen.
    See Wachter’s description of Berwick’s job–and the freedom the legislation gives him– in his recent THCB post.
    Ellen R.– Yes, earlier in teh year people were criticizing hte administration for not moving faster to fill slots. Now, the same people say they’re moving too fast.
    I was pretty sure they were putting off appointing someone to head CMS because they wanted someone very intelligent, and very strong. A leader. This would make him controversial, and they didn’t want to fight for his appointment while also fighting for health care reform legislation. Also, I have heard that Berwick was not willing to take the job unless the reform legislation passed. (I don’t know if that’s true.)
    Jake TApper’s idea of jouranlism is that famous story he wrote about how he dated Monica Lewinsky.
    Then there’s the report that he once took chewing gum out of his mouth, handed it to a USA Today Reporter and said “Here, keep this–someday it will be worth something.”
    Walter Cronkite he’s not.
    He’s juvenile, a boy-broadcaster trying had to make a splash by saying something different.
    The report you link to comes down to “he said/ he said”–Kerry vs. Grassley.
    The consensus, throughout D.C. has been that the REpublicans hoped to stall Berwick’s confirmation and were eager for a fight.

  18. While I support Berwick to head CMS, Obama wasn’t elected to continue politics as usual. The purpose of hearings is to shed light on dark corners. It also allows someone to explain the context surrounding a remark. This lack of transparency, lack of Q & A, lack of input from the minority party is just plain wrong. It doesn’t become right simply because one likes Berwick.

  19. Hey, I respect Dr. Berwick, but this was a seriously bad idea. It makes a hash out of very wise Advise and Consent requirements and his nominations wasn’t blocked be the GOP — because he hadn’t even finished the vetting paperwork and scheduling of a hearing.
    And, the GOP is in the minority. The Democrats control everything. If Dr. Berwick wasn’t moving forward, it was key Democrats who made that decision.
    The idea that Congress gone for two weeks justifies waiving the U.S. Constitution is laughable. I have looked and I can’t find anywhere an option to waive Senate review if the POTUS simply doesn’t want to do it. Where is the much-invoked “because I don’t feel like it” clause?
    Why even HAVE an Advise and Consent requirement if a post like this one is not going to go through it? The CMS head has enormous power, controls gazillions of dollars, and is exactly the type of position that should be reviewed.
    Democrats savaged President Bush for recess appointments, but now we see that where you stand depends solely upon whether or not your party benefits.
    The nomination of Dr. Berwick might have indeed been stormy, but I am uncomfortable with saying that following the Constitution is something we do only when we feel like it.
    Also, I must address this:
    “Beverly M.D. Thanks for your comment. Yes, you’re right—the vote was taken on healthh care reform and the conservatives lost.
    They should accept that. Now,Congress needs to move on to other pressing issues: unemployment, the economy, the wars, our dependence on fossil fuels .”
    The public vehemently doesn’t like what Congress did in this area. Why in the world should the GOP NOT respond to the public-driven anger? That would be politically stupid. These are VOTERS in a DEMOCRACY and they are MAD AS HELL. Do you, as a politician, get in front of that wave or get washed under it?
    Also, the GOP still thinks this was a BAD BILL and that WE CAN’T PAY FOR IT. If they believe this is the case, they have every right as lawfully elected representatives to try to amend or repeal it. Indeed, their constituents may demand it and replace them if they don’t.
    No law is set in stone tablets here. Do the Democrats decide that they can’t repeal anything done by the GOP because it is time to move on? Get real. In politics, nothing is ever fully done. If it was, we wouldn’t need a Congress.

  20. Beverly M.D., Jay, Margalit, tcoyote–
    Beverly M.D. Thanks for your comment. Yes, you’re right—the vote was taken on healthh care reform and the conservatives lost.
    They should accept that. Now,Congress needs to move on to other pressing issues: unemployment, the economy, the wars, our dependence on fossil fuels . .
    Jay– The positive response to Berwick comes from many associations of docs who do see patients–including the AMA.
    As to his “adoration” of the British health care system– I guess you didn’t read his speech. More than half of that speech is devoted to severe criticism of the British Health Care System. As usual, conservatives pulled a couple of lines out of context in order to create a myth that fit their story-line. See my earlier post on Berwick on THCB..
    Margalit– good question. . But the fact is that Bush
    made a great many recess appointments. See this list:
    And for reasons I don’t fully understand, the media gave Bush a free pass much of the time– even as he lied about weapons of mass destrution, took us into a war we couldn’t win, and offered tax cuts to the wealthy that helped the create the deficit
    I find it remarkable that the administration, Pelosi and Reid managed to get such comprehensive health reform legislation through Congress in just 15 months.
    When you think of how many times reformers have tried and failed. And this was not a reform-minded Congress; it took many compromises to get there. But what they accomplished marks a turning point in American history. In my view, this is the most important legislation we have seen since civil rights legislation. So it was hardly at waste of time.

  21. No leadership since 2006 and suddenly we are in a hurry? If Berwick doesn’t have the stomach for a proper vetting, he won’t be able to run CMS in Baltimore without a puppet regime from Chicago calling the shots. Good luck and
    God Speed.

  22. The appointment will last until the end of 2011 — likely the republicans do to him what the Democrats did to John Bolton…
    and the administration is left scrambling to fill a job that is not going well (look at all the deadlines missed already) — during a presidential election year…

  23. The part Don Berwick is going to hate is sucking up to a lot of brain dead Senators and Congresspeople and putting up with the Secretary and her staff trying to micromanage his agency and rewrite his speeches. We’ll see how long he can stand it.

    ” .. killing huge numbers of our citizens annually who can’t manage costs or co-pays for basic services like tooth extractions ..”
    1,000,000? 100? 1?
    USA health care is the only deal in the world where a DOPED-UP ILLEGAL can stumble into an ER and create a $$$$$ problem with the ACLU. Insane, ridiculous, and absurd.
    This is so much comedy. President “Hope,” with 58 senators of his money-grabbing party, incapable of public hearings. And it is the other party’s fault. How utterly absurd.
    Nov. 2, there will be a reckoning. And it will not be pleasant.

  25. Bev M.D.
    We are a constitutional republic which elects others to make our decisions for us. This recess appointment is Obama’s only way to get the job done since Congressional practices, like most legal processes, have become centered around profit and the exercise of power (granted them in good faith by voters).
    We aren’t a democracy. However, a congress determined to deprive citizens of a functioning government and health care system via filibuster, (rather than reason), requires a responsible executive officer to act in spite of such obstacles. If our only other option in government is Bin Laden, the constitution needs some re-writing.
    Exhausted MD:
    Admiration for a system does not mean admiration of its failures. But we won’t get the chance to hear about it in advance because no appointee will receive a hearing in good faith with this congress. Nonetheless, we’ve been rationing health care for decades – it’s called lack of insurance and ‘under’ insurance, killing huge numbers of our citizens annually who can’t manage costs or co-pays for basic services like tooth extractions. Read this:

  26. Careful what you wish for, dolts! Yeah, this guy is just the role model for promoting health and caring.
    Do you people read the stuff this guy promotes and espouses? No, you don’t, and unfortunately, this guy is more right than wrong.
    Doesn’t that last comment I made bother some of you?

  27. The administration was criticized earlier this year for not making more use of recess appointments to fill important slots.
    I’m glad to see that after 18 months on the job they’ve figured out a few things and moved on with this.

  28. “Senate conservatives had made it clear that they hoped to defer this hearing for as long as possible.” – Maggie
    but Jake Tapper says:
    “Republicans were not delaying or stalling Berwick’s nomination.
    Indeed, they were eager for his hearing, hoping to assail Berwick’s past statements about health care rationing and his praise for the British health care system.
    “The nomination hasn’t been held up by Republicans in Congress and to say otherwise is misleading,” said Sen. Chuck Grassley, R-Iowa, the ranking Republican on the Senate Finance Committee, which would have held Berwick’s hearing.
    Grassley said that he “requested that a hearing take place two weeks ago, before this recess.”
    Berwick’s nomination was sent to the Senate in April, and his hearing had not been scheduled because he was participating in the “standard vetting process,” a Democratic aide on the Senate Finance Committee told ABC News.
    But speaking not for attribution, Democratic officials say that neither Senate Majority Leader Harry Reid, D-Nev., nor Sen. Max Baucus, D-Mont., the chair of the Senate Finance Committee, were eager for an ugly confirmation fight four months before the midterm elections.”
    Making a recess appointment TO AVOID A FIGHT is actually a different thing than making a recess appointment because the other party is blocking the confirmation process.

  29. WTF???
    Given that Obama is finding out that you really CAN’T change Washington, he is forced to play by their rules and he won this one. The Republicans got nothing less than what they deserve.
    Oh, yeah. Twenty years in Chicago (D) — no politics in that honest and good town.
    And just ignore the six Illinois governor/felons in orange jump suits.
    Too bad Capone isn’t here — he’d be LOL.
    Nov. 2, the reckoning (D). Will be ROTF, LOL.

  30. In all this umbrage over the reasons for the recess appointment — on both sides — please let us not forget that it took the President more than a year to appoint a person to run the agency that is the world’s largest health care payer. And one of the reasons CMS has not had an administrator since 2006 (full disclosure: I worked for Dr. McClellan at CMS) is confirmation politics played by the current majority in Congress made putting Kerry Weems name forward a pointless exercise. (Weems was a career bureaucrat who knew tons about how the agency spends money and time). So in my opinion, no one should get on their high horse about why Dr. Berwick is now a recess appointment, and that includes the current administration.

  31. Wasn’t the interminable fifteen months enough time for discussion of this bill? We can see now all the business Congress and the White House neglected by focusing so much energy and bandwidth on health reform. . .

  32. Yep, I think this is a good decision and a stellar appointment. But then, there is this little voice in my head asking “what if”. What if the situation was reversed and conservatives would have made a recess appointment to avoid further discussion on a bill that liberals fiercely opposed, even if the candidate was unquestionably qualified? Would I support that, or would I be duly outraged along party lines? I don’t think I like my own answer….
    Nevertheless, I am glad CMS has a great leader now.

  33. Berwick will be a disappointment just like everyone else. The American public absolutely deserved to hear him defend his comments on rationing and adoration of the British health system. The positive response does not come from regular doctors. Remember those that actually see patients–unlike Berwick.

  34. Given that Obama is finding out that you really CAN’T change Washington, he is forced to play by their rules and he won this one. The Republicans got nothing less than what they deserve.
    Regardless of what one thinks of the health care bill, depriving this most important of government agencies of permanent leadership for solely political reasons (which even the Republicans admit) is inexcusable dereliction of duty. The time to rail against the bill was during its passage, and rail they did. The vote was taken and they lost. So be it.
    It’s called the democratic process. Anyone want to run it bin laden’s way instead?

  35. Gary,rbar, Michael, Tcoyote
    Gary, The American public deserves to hear of the controversial statements that Berwick has made IN CONTEXT. As I wrote in an earlier piece, cross-posted on this blog, conservatives repeatedly and regularly pulled one or two lines out of context to distort what he had said.
    Since the president nominated him in the spring, the public has had many opportunities to learn about Berwick–much has been written about him.
    And the response –from Republican former heads of CMS, from the medical community, from the industry, from AARP, representing the seniors Medicare serves– has been overwhelming positive.
    rbar– I don’t think Ghandi would have wanted to run CMS. I’m reminded of what he said when asked what he thought about Western Civilization . . .Gahndi replied “I think it would be a very good idea.”
    Michael–Thank you–and thanks for further background on the appointment. As I’ve said before, I think Berwick could have handled the confirmation hearings. But I’m sure he didn’t relish the prospect.
    I think the right-wingers definitely would have used the hearing to put “rationing,” “death panels” etc. back in the news.
    Yes, you did predict a recess appointment. That was a “hat-tip” to you in my post. (I had a name, I would have credited you by name.)
    I’m glad we agree that Berwick is the right man for the job.

  36. What do you expect from Obama’s promises of transparency and open government? Only when it serves him. The American public deserved to hear about the controversal statements he has made, regardless of how ‘brilliant’ he is.

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  38. I am no expert with regards to confirmation hearings, but it seems reasonable that only candidates with doubtful qualification and/or extreme views should not be appointed. Both does not seem to be the case with Dr. Berwick, so it is too bad when show politics delay the appointment of an obviously qualified nominee, regardless of policy differences.
    But I personally don’t think that Mahatma Gandhi would have been a good candidate for the CMS, even alive.

  39. Here’s more perspective to add to Maggie’s excellent post. A few weeks ago, the word in the policy community was that Berwick could withdraw his name for consideration because of the brutal fight he was facing, one that promised to smear his reputation with out-of-context writings about rationing and the like.
    As the talk surfaced in Politico and the New York Times, the administration responded most recently by encouraging a letter of support sent to the Hill by various important health care groups. That was a signal that the nomination was not going to be withdrawn.
    This recess appointment avoided a long, drawn-out battle — and, perhaps, one that Berwick, a true gentleman and scholar, did not really have the stomach for.
    Personally, I think that Berwick’s friends should have gone to the putatively moderate Republican senator from Massachusetts, Scott Brown, and told him to prove he wasn’t a pawn of the right-wing crazies and champion his state’s stellar appointment. Perhaps that happened and Brown turned them down. Or perhaps, as Maggie noted, the right-wingers wanted to ight no matter what. And, of course, there was the delay factor.
    Politics plus policy gives us a full-time CMS head. And that, plus the individual serving there, is a good thing

  40. Not a surprise. Called it last week in response to one of your blog postings. It needed to be done, regardless of political blowback. It’s absurd for the agency to continue to be leaderless given the astonishing implementation challenge CMS faces in dealing with PPACA. Hope Don gets off to a fast start. . .