Republicans responded to today’s swearing in of Dr. Don Berwick to head the Center for Medicare and Medicaid Services (CMS) by condemning President Obama for recess appointing the nominee. One by one, the GOP took to the Senate floor to argue that they would have welcomed a debate on Berwick’s qualifications in a fair and open hearing. “For anybody to suggest that Republicans are to blame for the fact that Dr. Berwick’s nomination didn’t come to a vote or wasn’t brought to the senate floor is sheer fantasy,” Sen. Jon Kyl (R-AZ) insisted. “We have not held up the nomination. We have not protested a vote.” “We’ve been critical of Dr. Berwick. Since when has that been a crime?”

Kyl began with the standard Republican talking points. He claimed that Berwick will ration health care for American seniors, deny payment for services that were not cost effective and import British health care to America. But then, in an apparent effort to criticize Berwick’s view of prevention, Kyl took a turn for the unexpected and suddenly took credit for the preventive service provisions in the health law:

KYL: Another couple things about Dr. Berwick. He’s expressed disapproval for costly cutting-edge medical technologies and said prevention services like annual physicals, screening tests and other measures were over demanded. Well, one of the things we did in the health care legislation was to provide a lot of different incentives for preventive care, for screening to try to help people avoid illnesses on the theory that it would be a lot cheaper if we didn’t do a lot of treatment that was unnecessary. If you could identify in advance that an individual had a need for some treatment, maybe you could catch the disease, say the cancer, for example, early and not have to have the expensive treatment, the end-of-life kind of care that frequently is very, very expensive.

Watch it:

Kyl’s use of the pronoun “we” is surprising, since every single Senate Republican voted against the preventive provisions in the health care bill when they voted against the measure, and many in the GOP now want to repeal the entire law — including the very preventive screenings that could “catch the disease.” Kyl is co-sponsoring a measure to repeal the entire law.

Still, he isn’t the only Republican to take credit for some of the health care law’s more popular provisions. In April, House Minority Leader John Boehner (R-OH) took credit for provisions that would outlaw rescission of coverage and allow children to stay on their parents’ health plans for longer. Sen. Chuck Grassley (R-IA) similarly issued two press released praising the law’s “standards for the tax exemption of charitable hospitals” and its improvements of “Medicare payments to doctors in rural states like Iowa.”

Steve Benen highlights Robert Gibb’s explanation for why President Obama had to recess appoint Don Berwick and observes that the entire nominating process has fallen apart within today’s hyper-politicized environment:

Putting aside the merits of the Berwick move, can anyone come up with a credible reason to disagree with Gibbs’ criticism of the system? Can anyone seriously look at the existing process and think it’s an effective way for an advanced democratic government to operate in the 21st century?

A civics textbook would make it seem simple — the president chooses a nominee for a government post, and the nomination goes to the Senate. A relevant committee holds a hearing and considers the nominee’s qualifications. From there, the nomination goes to the Senate floor, and if a majority approves, he or she can get to work on the country’s behalf.

And that was a fairly straightforward system for most of American history. But as we’ve seen of late, that process has completely fallen apart. Some of this has to do with the Senate having confirmation authority over far too many administrative positions, but most of it has to do with blind, petty obstructionism — holds and/or filibusters that can delay consideration of nominees for months, and in some cases, well over a year.

This is particularly true in the Berwick nomination. Recall that Republicans caricatured Berwick as a British-loving-health-care-rationer just days after Obama announced his nomination. On several occasions they condemned Berwick from the Senate floor without conducting a full review of his record or meeting with the nominee. They sought to use his nomination to revive the health care debate and delay the implementation of health care reform — a delay they would have undoubtedly blamed on the Democrats.

The recess appointment accomplished two important objectives. It avoided the dog and pony show of a nomination process in which every Republicans would have stripped Berwick’s quotes of any context and used the occasion to revive the death panels rhetoric that looks so good in a campaign fund raising letter. And, it helped keep the implementation of reform on track, all the while ensuring the appointment of a man who was most qualified to lead the department. This wasn’t only good politics, it was also good government.

Refusing to allow Republicans to delay implementation of reform any longer, the White House announced last night that President Obama would recess appointment Harvard Professor Don Berwick as head of the Center for Medicare and Medicaid Services (CMS), a position vacant since 2006. Republicans had characterized Berwick as a proponent of “health care rationing” and the British health care system just days after Obama announced his nomination in April, precluding any possibility of an open and honest confirmation process that could contextualize Berwick’s statements or debate the need in using quality measures to control health care spending.

Now, the GOP is outraged by his recess appointment:

- SEN. MITCH MCCONNELL (R-KY): “As if shoving a trillion dollar government takeover of health care down the throat of a disapproving American public wasn’t enough, apparently the Obama Administration intends to arrogantly circumvent the American people yet again by recess appointing one of the most prominent advocates of rationed health care to implement their national plan.”

- SEN. JOHN BARRASSO (R-WY): “This recess appointment is an insult to the American people. Dr. Berwick is a self professed supporter of rationing health care and he won’t even have to explain his views to the American people in a Congressional hearing. Once again, President Obama has made a mockery of his pledge to be accountable and transparent.”

- SARAH PALIN: SarahPalinUSA: Press Corps-pls do your job as Obama sneaks in Berwick appt;pls cover his mission:socialized healthcare&rationing based on”quality of life.”

The GOP’s rhetoric justifies Obama’s recess appointment. Had Berwick’s nomination gone through the committee process, it would have undoubtedly been subject to anonymous GOP holds and delays. The party would have used the hearings as an opportunity to revive the old “death panel” and health rationing smears, putting Democrats on the defensive just as the first benefits of reform are beginning to take effect. The shenanigans would have jeopardized the implementation of the health care law, which relies on CMS to “expand coverage to millions of new Medicaid recipients” and “re-engineer Medicare itself, so that it pays for services in ways that foster better, more efficient care.” As Mark McClellan, who served as CMS administrator from 2004-2006, put it, “What happens at CMS in the next few years will determine whether the new legislation actually improves quality and lowers costs.” “Don [Berwick] has a unique background in both improving care on the ground and thinking about how our nation’s health care policies need to be reformed to help make that happen,” he said.

Berwick is a respected Harvard professor and pediatrician who has built a reputation for improving quality and reducing health care costs. The American Hospital Association, the Federation of American Hospitals and a host of other provider groups praised Berwick, predicting that he “will bring a wealth of knowledge and practical experience to CMS from his perspective as a physician, teacher and passionate advocate for high-quality care.” Berwick’s “experiences from his lifelong quest to find better and safer ways to deliver care will greatly inform and enhance the implementation [of] healthcare reform,” the groups wrote in letter to the Senate Finance Committee.

Thomas Scully, who led the CMS from 2001 to 2003 put it best: “He’s universally regarded and a thoughtful guy who is not partisan,” he said. “I think it’s more about … the health care bill. You could nominate Gandhi to be head of CMS and that would be controversial right now.” 

Berwick’s appointment will expire at the end of the next session of Congress, in late 2011.

Senator Pat Roberts (R-KS) took to the Senate floor today to continue the GOP’s ‘second opinion’ campaign against the new health care law and Donald Berwick, President Obama’s nominee to head the Center for Medicare and Medicaid Services (CMS). During a rather meandering speech about health care rationing, Roberts tried to connect Berwick to the British health care system and imply that the nominee supports death panels:

ROBERTS: What did he [Berwick] mean when hesaid that equity is a necessary component of quality? Does that mean that high-quality care should not be available unless it is available to all? This certainly seems to square with the United Kingdom’s practice of denying or delaying access to the latest break though drugs or technologies because of its high cost…Now I know that “socialized medicine and “death panels” have become loaded terms. I understand that. But if that is what you are for, you should just say so. Don’t be afraid to have this discussion. Dr. Berwick certainly hasn’t been shy about his views in the past.

Watch a compilation:

Roberts also criticized Berwick for supporting universal health care, noting that Berwick’s sentiment may “sound very nice” and “very realistic.” “The reality is, that declaring health care a human right necessarily places one above others, suppressing the rights of others in favor of another government favored group….what you’re essentially saying is that some people have a right to somebody else’s property, whether that be taxable income or doctor’s services or their health care,” he said. Health care “cannot be properly described as a right without egregious government coercion and income redistribution and patient care consequences.”

Despite Roberts’ fear mongering and use of ‘loaded terms’ like ‘rationing,’ the non-GOP talking point reality is that “Medicare makes decisions on coverage all the time.” As Bush appointee Thomas Scully, the Administrator of the Centers for Medicare and Medicaid Services (CMS) from 2001-2003, told me last year, “I made decisions on coverage all the time… You got to do it the right way” by relying on research about the effectiveness of certain drugs. There is simply no way around it. However, since the government spends about $700 billion a year on treatments that don’t improve health care outcomes, the first order of business is to identify this waste and redistribute it to other parts of the health system.

Our guest blogger is Sonia Sekhar, a research assistant for Health Policy at the Center for American Progress Action Fund. TP intern DJ Carella provided research assistance for this post.

Last night, Senate Republicans launched their opening salvo against Don Berwick, President Obama’s nominee to head the Center for Medicare and Medicaid Services (CMS). Recycling old talking points from the health care debate, the GOP ripped into Berwick’s association with the British health care system and argued that he would “explicitly advocate for rationing”:

SEN. MITCH MCCONNELL (R-KY): I think many of us are alarmed by this nominee’s focus on the British System, where government makes decision for people on their care.

SEN. PAT ROBERTS (R-KS): Dr. Berwick is a huge fan of the British National Healthcare System, called the NHS, a system that relies on rationing health care to hold down costs. … Dr. Berwick is the perfect nominee for a president whose aim has always been to save money by rationing health care.

SEN. JOHN BARRASSO (R-WY): So when you think about that, as a patient in the United States, you say “do I really want Dr. Berwick? Do I want someone who is in love with the National Health Service of Britain? Someone who says they have incredible respect for the way it works and thinks its the right way to go.” Why would an American citizen want that person to be in charge of Medicare and Medicaid for this country?

Watch it:

The GOP is using Berwick’s nomination to make their case against the health care law ahead of the midterm elections. But here again the GOP is purposely conflating managing health care services and containing health care spending with malicious rationing.

As for Berwick himself, the former Harvard professor has spent his career helping hospitals control costs and has built a reputation of finding innovative ways of squeezing value out of every health care dollar. His approach — which is based on the idea that “less intensive, less invasive — and less expensive — healthcare can sometimes be more effective than the most aggressive care” — is nothing like the one-size-fits all government-takeover caricature.

“I think he’s a great guy and a great pick for that kind of big-picture reformation thing,” Bush’s former CMS head Tom Scully told the Wonk Room.

Ultimately, the CMS administrator will be contained by the law. By not confirming Don Berwick, the GOP is hurting Medicare and Medicaid’s abilities to serve their over 80 million beneficiaries well. As Tom Scully said at a recent Health Affairs Round table “…there’s a lot of discussion that [Don Berwick] won’t be confirmed for months, that it will be political; that’s really a shame, whether you’re a Democrat or a Republican. Ninety-five percent of this job is not, in my opinion, political. Ninety-five percent of it is just making the trains run on time and making these programs run, and it’s crazy not to have somebody in there day to day, steering the ship.”

Several news outlets are reporting that Republicans are preparing to re-litigate the health care reform debate by blocking the nomination of Donald Berwick, Harvard University professor, to head the Center for Medicare and Medicaid Services (CMS). As the Washington Post notes, “Democrats in the Senate said that, given Berwick’s national stature and broad-based support, he would be easily confirmed under ordinary circumstances,” but “Berwick must first clear the Senate Finance Committee, where ranking Republican Charles E. Grassley (Iowa) said that he plans to vigorously ‘explore the nominee’s preparedness for the enormous challenges that face the agency.’”

The Republican Policy Committee has already prepared a memo — which I’ve obtained — that links Berwick to the British health care system and presents him as someone who supports rationing and a government takeover of health care (Download the full memo HERE):

Donald Berwick, President Obama’s nominee to head the Centers for Medicare and Medicaid Services (CMS), has a history of support for government rationing of health care resources on cost grounds. He has spoken favorably about Britain’s National Institute for Health and Clinical Excellence (NICE), which denies patients access to life-saving treatments the National Health Service (NHS) deems too expensive. The American people should have their eyes open to the ramifications of NICE-style rationing in the United States as part of Democrats’ brave new health care world….They may see a Medicare Administrator who explicitly advocates for rationing as indicative of Democrats’ government takeover of health care…

All this is to be expected, particularly since Republicans have pledged to turn the 2010 midterm elections into a referendum on health care reform. But it’s worth pointing out two things.

First, Republicans are deliberately misinterpreting Berwick’s comments about transforming the American health care system from one that pays for the quantity of care into one that pays for value of care. Berwick has built a reputation of finding innovative ways of squeezing value out of every health care dollar and “persuading hospital administrators and doctors to adopt his recommendations.” But his approach — which is based on the idea that “less intensive, less invasive—and less expensive—healthcare can sometimes be more effective than the most aggressive care” — is nothing like the one-size-fits all government-takeover caricature.

Instead, he understands that to find solutions to specific problems, different communities will have to experiment with different solutions. “How could Congress possibly know enough to specify for every community, the exact design for care that is safe, effective, timely, patient-centered, equitable and sustainable?” Berwick asked during a speech in December. “The legislation does contain long sections focusing on quality,” Berwick acknowledged, “and there legislators lay out possibilities. But it is up to health care communities to test, adapt and perfect these strategies in real world.” His focus on improving care quality, while lowering costs has won over some fairly influential admirers. Nancy Nielsen, the immediate past president of the American Medical Association praises Berwick’s “ability to inspire doctors and hospital administrators to work together.” “Don is so widely respected because he has worked in such a collaborative way,” she said.

The second point is that while Berwick will certainly have discretion in running the delivery reform pilot projects in Medicare as well as other liberties, it’s difficult to argue that he’s be able to transform the American health system into NICE. However “radical” his views may or may not be, ultimately he’ll be working within the confines of a fairly conservative law. Even if he is the biggest single payer advocate/socialist in the world, the bill’s managed competition core as well as the obvious need to work with, and to a certain level please, the different health care stakeholders, will naturally prevent the next British invasion.