Thursday, April 1, 2010

Six Reasons Why the Senate Republican Leadership Should Approve Dr. Berwick's Nomination to Lead CMS - An Open Letter

Dear Senate Republican Leadership:

You have the Disease Management Care Blog's sympathy. Despite your Verdun-style stand, Mr. Obama and his Democratic allies passed health reform and, to add insult to injury, convinced some voters that they may know how to govern after all. In the meantime, there's the toxic contamination of those wacky tea baggers, expensed soirees at clubs of dubious reputation, Sarah Palin’s unending media presence and generalized voter animus. Under these trying circumstances, who can blame you for planning to hunker down until the November election and lob filibustering daisy cutter neutron bombs that uniformly kill all Democratic-inspired appropriations, deals, legislation and nominees.

Yet, on the matter of Donald Berwick MD's apparent nomination to CMS Administrator, you may want to calibrate your scorched earth approach.* The DMCB is at your service with some unsolicited advice on three reasons why you may have no choice but to go along. Be of good cheer, however, because the DMCB says are three ways to turn this to your advantage.

No Choice

1. It's hard to underestimate St. Berwick's standing in the healthcare community. Don't be fooled by their faux-cooperation with the President, who is holding them hostage with the repugnant SGR threat and back-room deals. They don't like the Democrats but, if you block the nomination, they will be again reminded how little they like you.

2. You're trapped. Dr. Berwick's tireless advocacy on behalf of consumers is a David vs. Goliath story that will used by Mr. Axelrod et al to portray you as being on the wrong side of history. While letting the nomination go though may end up making you look feeble, the political calculus suggests you need to take the lesser of two evils.

3. The Medicare Constituency. Most Americans couldn't care less about the filibustering or recess appointment of nominees for offices like the Under Vice-Secretary for Budgetary, Fiscal and Dress-Code Affairs at the Office for Import and Lavatory Safety and Integrity in the Deparment of Commerce. In fact, we think it might actually save money. Medicare, however, is different. Blocking a CMS Administrator may needlessly provoke the seniors who are paying attention.

Turn this to your advantage by.....

1. Being Clinonesque. Recall how your nemesis co-opted your ideas when "he took the center?" While Dr. Berwick is by no means a centrist (more on that below), announcing that Dr. Berwick's selection for CMS Administrator fits with your vision for America will help you regain the center. Mr. Obama will not be helped when you publicly congratulate him and his advisors for finally making a selection that fits with your conservative principles.

2. Considering it as a non-event? CMS is a huge bureaucracy and, thanks to the passage of health reform, has an impossibly unwieldy mandate. On top of that, Dr. Berwick has little experience in health insurance and will have an imperial boss. While the last confirmed CMS Adminstrator showed how powerful the office can be, it's possible that kicking Dr. Berwick upstairs into CMS bureaucracy will dilute any negative impact he might have. The DMCB doesnt think so, because it is......

3. Banking on Dr. Berwick being a greater long-term risk for the Administration. The DMCB says this with only the greatest respect. but there must be a reason why he had to start his own not-for-profit. Don't be fooled by the left's elitist ardor for him: this is an apolitical extremist maverick that is fed up with many of the same dysfunctions in the health system that also vex the Republicans. With his ascent into the head office at CMS, Dr. Berwick will undoubtedly discover much of the truth behind the The Gipper's famous quote. When he does, the DMCB suspects he'll be a bigger headache for his handlers than for you.

In fact, the DMCB thinks it's not unreasonable to believe that if we had a Republican Administration and majorities in both Houses of Congress, you could have just as easily nominated Dr. Berwick to the irritation of your Democratic opponents. Comfort yourselves by pretending it is so and cheer him on.

Oh, one more thing. Last but not least, politics aside, Dr. Berwick simply represents a right thing to for Medicare and Medicaid beneficiaries. If he lives up to his potential, we'll all be better off for it.

Sincerely yours,

The Disease Management Care Blog

*Hat Tip to Maggie's HealthBeatBlog

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