T Nation

Appointment of New Healthcare Tsar


I read this and thought of PWI. I didn't think it fit into the other healthcare thread and I didn't want to derail it...

Health-care reform
The appointment of a new health-care tsar angers Republicans

Jul 15th 2010 | Washington, DC
Berwick snuck past

â??AN INSULT to the American people,â?? storms Senator John Barrasso. Like many other Republicans, he is outraged that Barack Obama has bypassed the traditional congressional review process by installing Donald Berwick, a paediatrician and Harvard academic, as the head of the Centres for Medicare & Medicaid Services (CMS). In this position, which supervises the federal health schemes for the elderly and indigent, Dr Berwick will have a big say in determining how Mr Obamaâ??s controversial new health reforms are implemented.

That is an important post, and it is reasonable that any candidate should be vetted. But since Dr Berwick got the job merely as a â??recess appointmentâ??, Republicans will get their chance to grill him in the future. His term must expire by the end of 2011, when the next session of Congress draws to a close. So why are Republican politicians and pontificators so angry?

The short answer is that they would much rather have full-blown hearings now, so that they can attack Dr Berwick (and, by extension, ObamaCare) in the run-up to the mid-term elections in November. Deprived of the congressional stage, right-wing partisans are taking to the airwaves with a three-pronged attack: the recess appointment is unjustifiable, and Dr Berwick is both poorly qualified for the post and ideologically unsound.

Consider the charges in turn. Dr Barrasso may be â??insultedâ?? by Mr Obamaâ??s use of a recess appointment, but the procedure is hardly unusual. Indeed, presidents have been making use of it since George Washington. Moreover, Republicans do not seem to mind when the same tactic is used by presidents of their own party: George Bush did it 171 times, surpassing Bill Clintonâ??s 139 recess appointments.

Conservatives accuse Dr Berwick of being anti-market and suggest that he will run the new health-care system with a bureaucratâ??s self-regard and heavy hand. But the doctorâ??s career has been built on spreading private-sector practices into the American hospital industry, which is dominated by not-for-profit institutions. Drawing on successful practices developed by other industries, he has helped many hospitals reduce their errors and improve their performance.

This has won him the endorsement of the American Hospital Association, the American Medical Association and other non-partisan bodies. He has broad support from the health-care industry, which has implemented many of the safety and efficiency measures proposed by his think-tank, the Institute for Healthcare Improvement. Even Mark McClellan, a Bush-appointed predecessor in the CMS job, supports his nomination.

That leaves the third charge levied against Dr Berwickâ??that he will become Americaâ??s â??rationer-in-chiefâ?? of medical care. This is a politically explosive claim: Americans do not like the sound of rationing. Indeed, the noisiest protests against Mr Obamaâ??s reform efforts broke out last August when some Republicans, including Sarah Palin, claimed that â??death panelsâ?? would eventually decide which sick people to kill off first to save money.

Conservatives point to the doctorâ??s endorsements of Britainâ??s National Health Service, a government-run system that is called â??socialismâ?? in right-wing America. What this means, says Dr Barrasso, is that â??Dr Berwick is a self-professed supporter of rationing health care.â??

That is true, but it obscures the larger point. Every health system rations in some way or other; the demand for health care is always greater than the resources available. The question is whether rationing is done openly and as sensibly as possibleâ??or done implicitly, through murky pricing, bureaucratic fiat or denial of care.

Even Paul Ryan, a leading Republican congressman, has acknowledged this. â??Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?â?? he asks. The most objectionable aspect of Dr Berwickâ??s recess appointment is that Americans deserve a grown-up debate about this subject. It appears they will have to wait a bit longer for it.

United States


Has anyone else noticed how so many people are attempting to put a soft spin on the idea of government rationing of health care. It seems to me that there is a major uptick in articles such as this with claims like "everyone rations anyway", or "we'll have to lower costs somehow and we'll be delivering more efficiency", and "only right wingers call it socialism", etc.

Anyways, I personally have less of a problem with who he's appointed, but the position itself. I mean, bam bam is a collectivist, this is no secret to anyone and elections have consequences. Collectivist presidents make collectivist appointments. My real problem is with the position of czars themselves.

Anyone else remember when the left went crazy over John Bolton's recess appointment to the UN? Remember how they screamed about the foul nature of recess appointments? lol I love politics, in a sad clown sort of way. Both parties, full of petulant adult children. Yes, I'm feeling quite cynical this morning...


You will notice some other citations I have posted here:

I do not know the source of your citation, GL, but it is not "fair and balanced."

The offensive part of the recess appointment was that the Congress majority party is the same as the President's, and it had not even scheduled committee hearings to examine Dr. Berwick. Thus, Obama has bypassed Congressional scrutiny--his own party included!--by cynically appointing him during the briefest of recesses. There was simply no emergency here that required this appointment.

If other presidents have done recess appointments, it may have been during long recesses, or after committee hearings, or in brief appointments with less consequential policy implications.

Dr. Berwick will now serve and write regulations until January 2012--without Congressional oversight.

Now, as for Dr. Berwick himself, I have read some of his more casual writings, and he is a lightweight in the field; a pediatrician who has never practiced adult medicine, who very early on shunted himself off to administration at Harvard. His academic work is not exceptional in any sense. But none of that will come to examination now.


Sorry, I should have posted the link. It's from the Economist.

Thanks for the links. I'll try to give 'em a look when I have more time.