The Case Against (and for) Donald Berwick

Margaret Dick, for HealthLeaders Media, March 16, 2011

In a town where power is often measured in dollars controlled, Donald Berwick, MD, should be a rock star. CMS has a budget larger than the defense department and with the implementation of the Affordable Care Act, Berwick as the CMS administrator (at least for now) could influence healthcare policy for years to come. So why is his nomination being stonewalled?

The simple reason is probably because he will have money and power. But it is more complicated than that. Here is the lowdown on arguments swirling the beltway as to whether Berwick should stay or go.

It's politics. Tom Scully probably put it best. The former CMS director and Berwick supporter is widely quoted as saying, “You could nominate Gandhi to be head of CMS and that would controversial right now." Congressional Republicans were still licking their wounds from passage of the ACA when the White House nominated Berwick in April 2010. The GOP pounced and promised to make Berwick a poster child for everything wrong with the reform effort.

Congressional Democrats, worried that their ACA support would be an election issue, did not push for confirmation hearings. It looked like the nomination was dead until the Obama administration installed Berwick as a recess appointment.

Congress was not amused.

This month 42 Republican senators signed a letter to Pres. Obama telling him that they will not support Berwick. That leaves 58 senators who may support the acting CMS chief, but rules require 60 votes for confirmation.

  • Why he should stay: CMS has had five administrators since 2000 and only two, Scully and Mark McClellan, were confirmed by the Senate. CMS is the agency Congress loves to hate. It has a lot of power, affects the lives of more than 100 million Americans and is a key player in the implementation of ACA. Opposition to Berwick looks like an effort to reignite the reform debate.
  • Why he should go: The White House waited for more than a month after passage of healthcare reform to nominate Berwick and then they tucked him away from the press and Congress. Instead of being proactive, the Obama administration has allowed Berwick opponents to set the tone and tenor of the argument. It makes you wonder if they really want the guy.
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