KHN Morning Briefing

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Lawmakers, Pundits Offer Mixed Take On Berwick’s Appointment To Head CMS

Politicians and pundits are reacting to President Barack Obama's recess appointment of Dr. Donald Berwick to run Medicare and Medicaid, with some saying such an appointment bypasses an important process while others praise the move.

The Hill: Berwick's recess appointment "offers Republicans an opportunity to rehash the ideological differences between the parties. And they are seizing it." Even some Democrats, like Senate Majority Leader Harry Reid's office termed it "'unfortunate' Democrats had to resort to a recess appointment, but it became necessary to prevent Republicans from using the longer process as 'a stalking-horse for their further attempts to hammer away at healthcare reform,'" Reid's office said (Lillis, 7/7).

The Wall Street Journal's Washington Wire: "The real issue, once the dust settles, is whether being appointed this way will make it more difficult for Berwick to do his job. As head of the Centers for Medicare and Medicaid Services, Berwick has one of the most critical posts in making the sweeping health overhaul succeed" (Adamy, 7/7).

USA Today: "Though the agency is little known outside the medical industry it controls an annual budget of more than $800 billion and oversees two health programs - Medicare for seniors and Medicaid for the poor - with more than 90 million enrollees. … Berwick will also play a pivotal role in implementing Obama's health care law - from finding a way to trim about $500 billion out of Medicare over the next decade to expanding Medicaid coverage by 16 million people" (Fritze, 7/8).

CongressDaily: Some former heads of Medicare are themselves critical of the move of appointing Berwick during a recess: "'There is just nothing good about having it happen this way,' said Gail Wilensky, a former administrator of the Medicare and Medicaid programs under President George H.W. Bush. 'His tenure will be more complicated and acrimonious.'" Because Berwick's appointment is considered temporary, his appointment will only last through 2011 (McCarthy, 7/7).

The Christian Science Monitor: Obama's use of the recess appointment is not, at least in recent history, an unusual action. "The increased presidential use of recess appointments bears a direct correlation to political polarization in Congress – and willingness of the minority party to filibuster to delay or deny confirmations, says Thomas Mann, a senior fellow at the Brookings Institute. He expects that trend to continue. As president, George W. Bush made 171 recess appointments, and Bill Clinton 139. Many of those recess appointments were also contentious, but it was the only way for presidents to fill positions, Mr. Mann says" (Parti, 7/7).

Boston Herald: But members of Congress continue to react. Sen. Scott Brown "isn't happy about the appointment of a fellow Bay Stater to head the nation's Medicare and Medicaid systems. President Barack Obama officially tapped Dr. Donald Berwick ... while the Senate was in recess this week. Republicans were hoping to grill Berwick on his past favorable comments about the British national health-care system and his views on possible rationing of medical care in America" (Fitzgerald, 7/7).

Kaiser Health News has posted a transcript of one of Berwick's speech in 2008 when Britain's National Health Service celebrated its 60th anniversary. Comments in this speech have been widely criticized by Republicans.

The Washington Times: At least one Democrat was also critical of the appointment. "'I'm troubled that, rather than going through the standard nomination process, Dr. Berwick was recess-appointed,' said Senate Finance Committee Chairman Max Baucus, Montana Democrat. The Senate confirmation process, he added, is a check on executive power and 'ensures that crucial questions are asked of the nominee - and answered.'" The Finance Committee's top Republican, Sen. Charles Grassley of Iowa, said he requested a hearing on Berwick's nomination two weeks ago, but none was ever scheduled (Rowland, 7/7).

The Washington Post, on Obama's explanation of his recess appointments: "'It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes,' Obama said. 'These recess appointments will allow three extremely qualified candidates to get to work on behalf of the American people right away. With more than 180 nominees still pending before the Senate, it's my hope that my colleagues in Congress will agree to put politics aside and move forward on these vitally important positions.'" Obama also appointed two others to other posts in the administration Wednesday (Branigin and Aizenman, 7/7).

And, as Berwick leaves his position running the Institute for Healthcare Improvement, that Massachusetts nonprofit will be headed by Maureen Bisognano, IHI's current chief operating officer, The Wall Street Journal's Health Blog reports. She "first collaborated with Berwick on a quality-improvement project when she was CEO of the Massachusetts Respiratory Hospital, [and] is known in the industry as an expert on the nuts and bolts of improving health-care systems while lowering costs. … IHI has focused in recent years on gathering hospitals into collaborative groups, using strategies from other industries, such the concept of continuous improvement - an ongoing effort to improve the quality of products, services and processes" (Landro, 7/7).

For summaries of yesterday's coverage of Berwick's appointment, read KHN's Daily Report

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