Sunday, March 28, 2010

A Raw Political Analysis of the Nomination of Donald Berwick to Lead CMS

The Institute for Healthcare Improvement's Don Berwick MD has reportedly been tapped by the Obama Administration to be the Administrator for CMS. Like other denizens of the health policy bogmos (here, here and here), the Disease Management Care Blog is a big fan of Dr. Berwick's. Anyone who has done anything about health care quality, patient empowerment, systems of care, access disparities and health care value has certainly read his articles and heard him speak. He has been a tireless advocate on behalf of righting what is wrong with the system and the DMCB wishes him all the luck in the world.

He's really going to need it when it comes to his Senate confirmation.

The DMCB recalls this article suggesting that the White House seems to have two complimentary styles. On one side is the pragmatic Chief of Staff Emanuel Rahm, while on the other is the partisan top aide David Axelrod. While Mr. Rahm was urging caution on health reform following Republican Scott Brown's Senate victory, it was apparently Mr. Axelrod that successfully argued for a full court press. The rest is, as they say, history. Reform passed, leaving the Democrats resurgent and Mr. Axelrod's role intact.

In the meantime, the Republicans are in no mood to cooperate in any way. The DMCB agrees with the pundits who say the Republican game plan is to resist every Obama initiative until the November elections, hoping that's when they can capitalize on voter anger and further reduce the Democratic Senate majority and maybe even take control of the House of the Representatives.

Which leads us back to the iconoclastic and 'extremist' and outspoken Dr. Berwick. This is less about him and more about boxing in the Republican minority.

Which leads the DMCB to a prediction.

While Dr. Berwick is a genius, he may also be part of David Axelrod's purposeful political calculus that is now practically inviting the Senate Republicans to publicly stymie the able and widely admired Dr. Berwick's appointment to CMS. In fact, Harvard's Dr. Berwick has written and spoken so extensively that there should be little problem for some Senate staffers to find some juicy quotes to take out of context. This will prompt the usual D.C atmospherics that will leave both parties bloodied and each believing that the other lost more support. Scott Brown of Massachusetts may also be squeezed with some tough lose-lose decision-making. In the end, and assuming Dr. Berwick hangs in there, there'll be a recess appointment.

Until then, it will be business-as-usual at CMS. Unfortunately, it will also be business-as-usual in Congress.


Vince Kuraitis said...


I totally see your point and your reasoning.

I also hope you're totally wrong. I can't imagine a more qualified candidate than Don Berwick to run CMS. I think it would be political suicide for R's to be obstructionist in opposing his appointment.


Jaan Sidorov said...

We're not wrong on Dr. Berwick's qualifications. I also agree on the political suicide, which is the political reason why he was chosen. I hope I'm wrong on how this is going to play out.

Ralph Schmeltz, MD said...

For those of us who have been invested in pursuing "quality" in healthcare delivery, the choice is hard to argue. Hopefully, policy will win out over politics, which as Jaan cautions, is not always the case. It will be of interest to see where the House of Medicine comes down on the appointment. If the majority of medical organizations are vocally supportive that may help.


Jaan Sidorov said...

Jaan seconds Ralph's motion!