Wednesday, July 7, 2010

Don Berwick Becomes Part of the Problem

According to the New York Times, a "recess appointment" will be used to install Don Berwick as the CMS Administrator. It seems this was the only way the Obama Administration could bypass those obstreperous Senate Republicans, who were apparently planning to abuse the confirmation process with toxic puffery, "gotcha" politics and other forms of unpleasantness.

There are plenty of good arguments in favor of the recess appointment, including fixing an obvious leadership vacuum at the worlds largest health insurer, accessing Dr. Berwick's considerable skills in implementing countless details of the Affordable Care Act (ACA) and capitalizing on his widespread support from the multiple corners of the health care industry. As my liberal colleagues like to point out here and here, this is also an opportunity for the Administration put its reasonable centrism on display while reminding its base of its commitment to health reform and simultaneously poking the eye of a bullying opposition.

While the non-liberal contrarian Disease Management Care Blog was among the first to endorse Dr. Berwick, it respectfully if naively disagrees with the strategy of a recess appointment. Here's why:

1. The Body Politic: While he's well known among physician and policy types, this was an opportunity to use a visible forum to introduce Dr. Berwick to other constituencies less familiar with him and his important ideas. Our nation's healthcare dialog did not end with the passage of ACA.

2. Transparency: Dr. Berwick's academic record, obvious leadership record and considerable rhetorical skills are more than a match for the Senate's scrutiny. Who is afraid of who?

3. Seizing the High Road (OK, it is the oxymoron of politics, but....): Republicans threatening to behave badly and remind Americans about their dysfunctions is a problem for the Democrats? In the few months until the election, it may be time for the Dems to start rolling the dice on acting honorably.

4. It stinks! Speaking of dysfunction, is the outcome of expediency worth short circuiting merits of a Senate supermajority? Will Dr. Berwick's credibility over the next two years be hampered by the recess appoointment? The Obama Administration is one-upping the opposition's political maneuvering with their own. The whole thing brings discredit to both parties.

5. Bloggery: The confirmation hearings promised to be a cornucopia of detailed analysis, second guessing and extreme wonkism. Darn.

Of course, even the DMCB isn't too sure that, if it were Dr. Berwick, it would have been able to resist the sure bet of a recess appointment in lieu of bruising Senate confirmation. There's something to be said, however, for the selfless heroism of the third option: respectfully declining the CMS post with the option of reconsidering when one of three things happen: 1) both sides get serious about putting the people's business over politics or 2) the bums get replaced by politicians who know how to compromise or 3) the Feds realize that intelligently centrally controlling health care is a myth.

Unfortunately, accepting the recess appointment continues business as usual.

As for things changing, the DMCB isn't holding its breath.

Coda: It didn't occur to the DMCB that the confirmation process posed election risks for some incumbent Democratic Senators. One small consolation is that at least Senator Baucus (D-MT) understands the bigger picture.

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