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Obama Uses Recess Appointment to Install New Medicare, Medicaid Chief

President Obama on Wednesday announced that he would sidestep congressional hearings and use a recess appointment to install Dr. Donald Berwick as the head of the Centers for Medicare and Medicaid Services.

The job — running the federal health insurance programs for the low-income and elderly — has gained particular prominence this year as the new health care reform law begins to go into effect.

“One out of three dollars spent by the U.S. is spent on healthcare — and most of those dollars flow through CMS” says Susan Dentzer, editor of the health policy journal Health Affairs and occasional NewsHour analyst. “So it is a hugely important position all the time. But it’s particularly important now because so much is riding on healthcare reform, and on efforts to restructure the health care system and bend the cost curve. And the big lever that the federal government has to do that is the federal programs.”

Under the new law, Medicaid will expand to cover everyone who makes up to 133 percent of the poverty level (up to 16 million more people). Meanwhile, the reform act relies on major changes to the Medicare to save hundreds of billions of dollars over the next decades.

Berwick, a pediatrician and a professor at Harvard Medical School, is an expert in health care quality. He runs the Institute for Health Care Improvement, a not-for-profit organization that works to improve patient care. In 2006, the NewsHour profiled the Institute’s 100,000 lives campaign to reduce medical errors in hospitals. That program later morphed into the 5 million lives campaign.

The NewsHour also talked to Berwick about using evidence-based medicine to improve health care, and about moving to an electronic health care record-keeping system in the U.S.

Kaiser Health News has pulled together a resource guide to Berwick’s career.

Despite his strong reputation in the health policy community, Berwick’s nomination had become yet another flashpoint in the debate over health care reform.

Opponents seized on comments he had made over the years about rationing health care and the fact that he had expressed admiration for some aspects of the U.K.’s national health care system.

In a statement a Washington Post editorial characterized as “both accurate and inflammatory,” for example, he once said in an interview: “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.”

Given the difficult political path ahead, the president decided to appoint Berwick via a recess appointment while Congress was not in session. The recess appointment means that Berwick can start his job without Congressional approval, but his term will expire at the end of the next session of Congress, in late 2011.

White House Communications Director Dan Pfeiffer said in a press release:

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. […] There’s no question that Don Berwick is the right choice to be our next CMS administrator […] He’s dedicated his career to finding ways to make our health care system work better for patients and cost less for taxpayers.”

But some Republican Senators reacted with anger:

“This recess appointment is an insult to the American people,” Sen. John Barrosso, R-Wyo., said in a press release. “Once again, President Obama has made a mockery of his pledge to be accountable and transparent.”

And even some Democrats were uneasy. Senate Finance Committee Chair Max Baucus, D-Mont., who would have led the confirmation hearings, said in a statement:

“Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power and protects Montanans and all Americans by ensuring that crucial questions are asked of the nominee — and answered.”

John Pitney, a professor at Claremont College in California and a former House GOP staff member, told the Boston Globe that it wasn’t a surprise that the president would use the recess appointment move:

Congress moves slowly during the summer, and there are only a few months left in this Congress. Whatever happens in November, it’s very likely that the next Congress is going to be less hospitable than this one. Given the immediacy of the task, you can see why the president would want a full bench.

And the Washington Post’s Ezra Klein opines that although conservatives are crying foul about the appointment, they may in the end be happy with Berwick’s patient-centered approach to health care:

Insofar as Berwick is a radical, he’s a radical in favor of a patient-centered health-care system — a position that has traditionally been associated with conservatives, not liberals […]None of this is to suggest that Berwick is a Reaganite. But there is much in his vision that conservatives will find appealing. The reality of the situation is that Barack Obama just put an advocate for a patient-centered health-care system in charge of much of health-care reform. Conservatives have scored a big win here, even if they don’t know it yet.

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