Morning Berwick Update

by Benjamin Domenech on 5:53 am July 8, 2010

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Avik Roy — who has been doing superb work on the topic at hand — has an excellent roundup of the best reactions to Donald Berwick’s recess appointment. He notes one post that you should be sure to read from Tevi Troy, former deputy secretary of Health and Human Services under President Bush, at NRO on why Berwick’s recess appointment puts this position in a newly political light.

I agree with Troy that, going forward, this is going to be another position which enters a true political see-saw, something that could’ve been avoided by choosing a less controversial figure, or at the very least, allowing for said controversial figure to be thoroughly vetted.

Now for two other points: I offered explanations to a few commenters on this thread regarding the difference between United Nations Ambassador John Bolton (who seems to be the comparison the president’s allies online are using) and Donald Berwick, and also on the nature of Senate holds. They seemed worth sharing with you all, and it is below the fold.

First, on the claim that Berwick was under a so-called “secret hold”:

This is actually not an accurate statement, and no media source other than [the commenter] has claimed this is the case — probably because it is an impossibility given the procedure on when such a hold can be placed.

A “secret hold” can be placed to block a nominee from getting a floor vote. It cannot block them from getting a hearing, because there is no unanimous consent demand in order to obtain a hearing (in this case, Ranking Member Grassley had requested a hearing occur weeks ago, and Chairman Baucus publicly expressed disgust with bypassing the approval process), and certainly not one to ask a nominee to submit standard financial information — the point in the process at which Berwick has stood since April.

Only one of the people the president recess appointed yesterday was subject to a secret hold — except it wasn’t secret. It was blocked by Sherrod Brown, Democrat of Ohio:

The White House confirmed late Tuesday that President Barack Obama would bypass the Senate and install his choice to head the government’s pension insurer. In May, Sen. Sherrod Brown, D-Ohio, blocked the nomination of Joshua Gotbaum to serve as director of the Pension Benefit Guaranty Corp. because he objects to how Delphi Corp.’s salaried retirees have been treated with the company’s termination of its pension plans last year.

In sum: there was no hold placed on Berwick, nor could there have been under Senate rules given how early he was in the process of legislative approval. I hope that clarifies things.

Second, in regards to the comparison of Bolton and Berwick:

Perhaps this is because I worked at HHS alongside Dr. McClellan, the CMS administrator at the time, or perhaps it’s just because of being professionally in the health policy field, but speaking only for myself, I see Berwick’s position as dramatically more significant than Ambassador Bolton’s.

I’m not in the foreign policy space, so I think of ambassadors — even ambassadors to the United Nations — as having a far more limited ability to impact Americans. It’s my understanding that Bolton was a representative of the views of the president (you seem to acknowledge as much with your “neocon conservatism and hostile isolation from the world” comment — which Bolton would probably reject as a description conflicted out of existence), and that as a permanent representatives at the UN — a non-Cabinet position under George W. Bush — answered to the Secretary of State on all matters.

Within the health policy sphere, the power of the CMS administrator is far more significant going forward, and more significant than when McClellan was in charge. The nature of this position has expanded greatly under the new health care legislation — which is likely why the President sought a think tank fellow viewed as an “idea man” for the job as opposed to an experienced administrator or manager of a large organization. The new CMS administrator will be tasked with applying and determining the path forward for literally hundreds of large and small regulatory changes, which will have a significant impact for doctors, hospitals, and most of all, Medicare and Medicaid patients going forward. This is a position that will profoundly impact the lives of millions of Americans, where Berwick will be placed in charge of an office with a small number of political appointees heading the second largest insurer in the world (after the NHS), with authority over the disbursement of a more than a trillion dollars over the coming year in payments.

I am not sure there is anything that Bolton — or Negroponte, or Danforth, or Susan Rice even today in a Cabinet position — does or could do which could be said to have such a wide-ranging effect.

Your point is valid that the Republicans in the Senate want to use “Berwick’s philosophical inclinations to single-payer health care … as a whipping post.” This is of course one of the reasons they supported hearings. But there are also significant issues in other areas where Berwick’s views actually do matter, and where he would be in a position to apply them as policy.

Assume for the sake of argument your view is correct — that Bolton and Berwick are equivalent nominees, except that in your view Berwick is more qualified for the job (I would dispute this, as the man is an intellectual technocrat with no experience managing large organizations or budgets, as opposed to an experienced administrator). Then at the very least you will concede that unlike Bolton, Berwick has not completed the base expectations for any nominee applying to be in a government position — namely, he has answered no questions from the Senate, either in hearings or in response to standard questions regarding potential financial conflicts of interest?

Had Berwick gone through this standard process and been blocked from a floor vote, I would not call a recess appointment “hubris”, even if I disagree with the appointment, because he would have already been vetted by the Senate process. We would know, in other words, that there are no conflicts of interest, no financial concerns, no questions to be answered about the funding of IHI.

For the sake of comparison, consider acting administrator Kerry Weems, an experienced 24-year civil servant with nothing in the way of views as controversial as Bolton or Berwick, who was vetted thoroughly for the CMS Administrator job in 2007 — and then was blocked by Senate Democrats, for no particular reason at all. In that case, you’re talking about a non-controversial, thoroughly vetted career bureaucrat who’s merely being used as a political pawn.

If that was the case with Berwick, than everything you say would be correct. Unfortunately, it is not.

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