Don Berwick Is About To Be Named to Take the Helm at Medicare; Obama Rejects Conservative Attempts to Stall Appt.

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 (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 (, 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 consevatives 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 need Berwick, in Washington, guiding CMS. 

A Postscript— As Joanne Kenen points out over at the  New America Foundation's  New Health Dialogue,:There is a down side to Berwick's recess appointment:  "a recess appointment only lasts until the end of 2011 when the current Congress expires."

13 thoughts on “Don Berwick Is About To Be Named to Take the Helm at Medicare; Obama Rejects Conservative Attempts to Stall Appt.

  1. **sigh of relief**
    I work hard at my Christianity but this turning-the-other-cheek stuff is getting old.
    It only changes with people with hearts.

  2. Fantastic news. I like the idea of Dr. Berwick in charge of CMS. My reservations about his “extremist” views of patient-centeredness (a topic nicely addressed by you here) is more than mitigated by what I perceive as his intelligence, common sense and experience. I get the sense I can explain the shortcomings of his position to him, that he would “get it”, and would be willing to work towards more functional solutions.

  3. The link didn’t come through. I was referring to your post, “Doctors and Patients sharing information; a two-way street”.

  4. Everyone– John, Jenga, Gregory, #1 Dinosaur,
    Everyone–Thank you. Yes, it is great news, and I’m so glad that many HealthBeat readers agree.
    (We don’t always agree, but this is a time where most of us can–a good feeling.)
    Yes, trying to be tolerant of people who seem filled with hatred is getting old.
    I’m hoping that perhaps (possibly) in November voters will elect some Republicans who might not agree with you and I on many issues, but are not
    hard-line ideologues. That would be a great relief.
    It’s the anger (toward Obama, liberals, liberal ideas, etc.) that I find wearing.
    Jenga– Indeed!
    Gregory–yes, I’m glad that the administration decided not to accept “Stall” We just can’t afford it.
    #1 Dinosaur– You wrote: “I get the sense I can explain the shortcomings of his position to him, that he would ‘get it’, and would be willing to work towards more functional solutions.”
    Yes, Berwick is very good at listening. And after hearing your concerns, he also would be extremely articulate and reponsive in addressing them–he might persuade you on some points . . .

  5. Is this a done deal now? For a change most people seems to agree on his nomination.

  6. Ray, yuwiiu,
    Ray, Yes, a done deal. He still needs to be sworn in, but I don’t see any way to stop it. Recess appointments are perfectly legal.
    yuwiiu– Amen.

  7. Actually, recess appointments can potentially be removed, since the senate is required to vote on the appointment before the end of the next session of congress — in this case that would be the end of 2011. By history, it would be unusual to unseat Berwick, although one of Bush’s court appointees — Thomas Pickering — chose not to face reconfirmation and resigned at the end of his recess appointment. John Bolton, the Bush recess appointee as UN representative, also resigned rather than face a hearing, but in his case it was related to Democrats’ determination to investigate his perfomance regarding use of the NSA to intercept communications by US citizens, an issue the Bush administration did not want to see discussed in daylight.
    In perspective, Bush made 171 recess appointments in his 8 years, and those were the only two who did not gain final appointment. Neither were actually rejected, although Pickering probably would have been. In the Bolton case, he may have been, but the major issue was the facts that would have been discussed at his hearing.
    Given the atmosphere in the senate these days, what will happen to Berwick is unclear. His position is not helped by the fact that Max Baucus has also protested against the appointment. Baucus seems to have been a Berwick opponent, and had refused to schedule hearings for him.
    The fact that there had been no hearings before the recess appointment has been the focus of opponents in attacking this appointment, and is unusual but not unique. There had been no actual voting on filibuster at that point either, since there had been no discussion which would have required filibuster. However, the Republicans had promised filibuster.

  8. Maggie-
    It is always a pleasure to hear great news from you on this blog.
    We are getting there on fair and meaningful US health care reform. Not fast enough but indeed moving forward.
    Berwick, as you have pointed out on many occassions,will help enormously.
    Be Well,
    Dr. Rick Lippin

  9. Pat S.
    Good to hear from you.
    Yes, Bush made a huge number of recess appointments, and the fact that only two were not confirmed when the initial recess appt. expired is telling.
    What will happen to Berwick at the end of 2011?
    We live in volatile times.
    So much can happen between now and the end of 2011 in the economy, internationally, and in the Middle East . . .
    But all other things being equal, Berwick’s history shows that he has been extraordinarily successful in winning trust. This is largely because he listens–and is totally authentic.
    People sense that.
    So I’m not terribly worried about what will happen at the end of 2011,
    I also believe that, given the uncertainites of this
    period in our history, it’s futile to try to predict.
    Max Baucus has always been someone who will say whatever seems expedient– a totally unreliable narrator.
    And yes, the Republicans had promised filibuster.
    There was no question but what they would delay this confirmatin for as long as possbile, hoping to slow and cripple reform.
    The elections in November will be tought, though they’ll be tough for many who are now in office. Voters want to thrown the bums out, all of them, Republicans as well as Congresional Democrats.
    But by the end of 2011 –and going forward, as we move toward the next presidental election, I am hopeful that liberals will be in a better position.
    I’ll be interested in what is happening in Minnesota . .

  10. Dr. Rick–
    Thank you.
    When it comes ot healthcare, I do think that this administration is going to take us forward.
    It won’t be easy, but we can help only if we try to explain the promise of reform to the public.
    Naysayers and professional cynics (often people who are ambivalent about universal coverage) just aren’t helpful.