Dr. Donald M. Berwick. It's a name as likely to incite a political brawl in Washington as it is to attract a blank stare almost anywhere else. But if most Americans haven't heard much about the man who now oversees two of the nation's biggest entitlement programs -- Medicare and Medicaid -- it's in part due to the political fight surrounding his appointment. President Obama slipped Berwick into the post when most lawmakers were out of town last summer. Called a recess appointment, the move allows a president to unilaterally appoint a senior federal officer to a post without the typical Senate approval process -- allowing them to serve until the end of the next congressional term. At the end of the temporary term, they must either be approved by the Senate or replaced. For Berwick, that meant the man charged with laying much of the groundwork for healthcare reform and cementing the president's vision for the law into Washington's institutional framework avoided the political gridlock that often accompanies the normal process.