Morning Update on Donald Berwick Appointment
Unsurprisingly, the Berwick nomination and recess appointment heads the news this morning – Politico, the New York Times, the Wall Street Journal, and the Associated Press all have stories. I think it’s worth pointing out three additional angles to this story:
- Unanswered Questions: As Robert Pear points out in his New York Times piece this morning, “The [President’s] recess appointment was somewhat unusual because the Senate is in recess for less than two weeks and senators were still waiting for Dr. Berwick to submit responses to some of their requests for information.” For instance, one request pending asked Dr. Berwick to disclose a list of donors for the nearly $10 million in gifts the Institute for Healthcare Improvement (which he heads) received over the past two years. Keeping aside the question of why an Administration that promised “an unmatched level of transparency, participation, and accountability” cannot wait until Dr. Berwick receives even a public hearing before giving him a recess appointment, there’s also another question: Why are these due diligence requests still pending after so many months? What, if anything, about their nominee is the Administration trying to hide—and is this recess appointment part of that effort?
- The Devil IS in the Details: Last night the White House claimed “there’s no question that Don Berwick is the right choice to be our next CMS administrator” as a result of the endorsements he received from various trade associations (most of whom have substantial business before CMS). But here’s what Dr. Berwick said about himself in a 2006 interview:
Effective leaders know their deficiencies. How do you address yours?
I don’t feel like a leader, so it’s very hard for me to project myself into that situation. But inattention to detail is my biggest defect. I’m always leaning forward into something new. I can create a mess. Luckily, I have people who are willing to create the detail around the idea or, if they’re really smart, know which ideas to ignore.
Remember, this fiscal year, CMS will disburse $803 billion in benefits – making the agency larger than the economies of Denmark, South Africa, and Israel combined. The agency will implement most of the health care law’s 2,700 pages, and will issue thousands more pages of regulations to implement the statute – a series of physician payment regulations released last week reached to 1,250 pages alone. Appointing someone who freely admits “inattention to detail is my biggest defect” to head such a massive undertaking without so much as a confirmation hearing does not inspire confidence that CMS under Dr. Berwick will be up for this implementation effort.
- “Damaged Goods?” In 2005, then-Senator Obama said of John Bolton, whom President Bush gave a recess appointment as UN Ambassador, “to some degree, he’s damaged goods.” Some may view this recess appointment – again, without even a hearing on the nomination – as a tacit admission by the White House that Dr. Berwick is unconfirmable to a permanent appointment as CMS Administrator. If so, that would consign him to a tenure of fewer than 18 months in office at CMS (the appointment expires at the end of the next session of Congress, circa December 2011), where his “lame duck” status could encourage resistance to his agenda from within the agency. In other words, this recess appointment does nothing to solve the permanent leadership vacuum within CMS – and could actually make it worse.