Donald Berwick: A Few More Thoughts

by Benjamin Domenech on 6:09 am July 7, 2010


A few additional thoughts this morning on the late-night recess appointment of Donald Berwick — the video above is of Berwick’s remarks from this speech in the UK, where he said:

Please don’t put your faith in market forces. It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can. I do not agree. I find little evidence anywhere that market forces, bluntly used, that is, consumer choice among an array of products with competitors’ fighting it out, leads to the health care system you want and need.

-President Obama is not just circumventing the approval process, he’s circumventing the “basic vetting standards” process — Berwick is avoiding outstanding questions from the Senate, including requests for additional documentation considered standard for nominees. This will come up next January. (But hey, no one gave a flip about Geithner.)

-Berwick likes to pontificate — a dangerous recipe for a committee hearing. Given the fact that the Senate Democrats never scheduled a hearing, it’s possible they never intended to have one — or it could be that when the White House tried to prep Berwick and determined this was a risk they wanted to avoid.

-As head of CMS, Berwick represents a worse step than any policy actually contained within Obamacare. I’ve said repeatedly this legislation was, more than anything, about authority — the redistribution and enhancement of Washington regulators at the loss of states, doctors, and the marketplace. The vast majority of that authority now belongs to Berwick.

-Rumors abounded on Capitol Hill last night that certain moderate Democrats were nervous about a vote on Berwick. I believe these rumors are true. The White House did not want a situation where moderates would be faced with a difficult vote.

-I’m a little surprised they didn’t do this on Friday and let it disappear over the holiday weekend. Why not? Odd.

A few additional reactions worth noting:

-Democrat Senator Max Baucus, chair of the committee which would’ve heard Berwick’s testimony, openly criticized the White House’s decision: “I’m troubled that, rather than going through the standard nomination process, Dr. Berwick was recess appointed. Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power and protects Montanans and all Americans by ensuring that crucial questions are asked of the nominee – and answered.”

Avik Roy writes that the hearings on Berwick would’ve embarrassed Senate Democrats: “Indeed, the White House’s action is being taken to protect Democrats, some of whom won’t support Berwick, and don’t want to be forced to take an uncomfortable public vote months before an election … As we and others have documented, Berwick is “starry-eyed” about Britain’s National Health Service, in which government owns the insurers, the hospitals, and the doctors’ offices. He is a highly intelligent and articulate defender of that position. Liberals claim that Republicans are taking his views out of context. If that is true, why not give Berwick a public platform to explain himself? The answer is clear: Berwick would only generate more controversy if he aired his views in Congress. And we’re not talking “controversy” in the mountain-out-of-a-molehill sense: we’re talking about the basic philosophy of whether or not we should have a free or centrally-planned health care system. The American public, and more importantly, the American idea, are not on Berwick’s side.”

Grace Marie Turner writes that this is the elevation of a “rationer in chief”: “In an interview last year in the journal Biotechnology Healthcare, he said, ‘The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.’ Even The New York Times has taken notice of Berwick’s controversial nomination. Robert Pear reported last month: ‘Long before the uproar over ‘death panels’ last year, Dr. Berwick was urging health care providers to ‘reduce the use of unwanted and ineffective medical procedures at the end of life.” His nomination hearings were certain to shine a bright public light on those comments, and he now is certain to gain the title of Rationer-In-Chief.”

Ed Morrissey notes the clear questions which remain about Berwick: “It’s one thing to use a recess appointment when a President thinks that Congress has stalled a nomination unfairly, although it still may arguably be an abuse of the privilege; the recess clause was intended to allow Presidents to fill urgent openings without quickly recalling Congress into session, a difficult prospect in those days. It’s quite another to use the power to appoint someone who hasn’t bothered to fully respond to initial inquiries for information. That speaks to a certain lack of intestinal fortitude in providing the accountability demanded by the Constitution of the executive branch to the legislative branch. No one ‘stalled’ Berwick. The truth is that Obama was afraid to have Berwick questioned by Congress, which should have everyone questioning his suitability for the position, even without considering his prior statements on wealth redistribution and slobbering fanboyism of the British state-run health service.”

Additional reactions from Senators here. John Barrasso, Republican Senator from Wyoming, has the best reaction thus far, calling it “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.”

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