While Congress is away

By all accounts, Dr. Donald Berwick, whom President Barack Obama nominated in April to lead the Centers for Medicare & Medicaid Services, is an excellent choice to head the $800 billion-a-year federal agency that oversees health care services to the nation's elderly, poor and disabled. A 63-year-old pediatrician, Harvard Medical School professor and founder of a nonprofit health care institute, Dr. Berwick is widely respected by his peers as an innovator and reformer who has dedicated his career to helping hospitals and medical insurers deliver more efficient and effective patient care.

Yet in the months since his nomination, there seemed little chance that Dr. Berwick would ever get to bring his talents to bear on the federal health-care programs that serve more than one out of three Americans. The reason: Senate Republicans figured to torpedo his confirmation hearings using the tactics of endless obstruction and delay.

That's why Mr. Obama was right to cut through the impasse this week by using his constitutional power to unilaterally fill important offices when Congress is in recess, as it is now. That was the only way to ensure capable leadership at the agency at a time when it is struggling to transform itself in the wake of this year's historic health-care reform legislation. With the appointment, Dr. Berwick will wield all the powers of a permanent appointee, though his tenure will expire when next session of Congress ends in late 2011.

Republican objections to Dr. Berwick's nomination were, it must be said, so lacking in substance as to be almost laughable. There was never any question that he was qualified for the job or possessed the requisite experience. He has chaired a slew of national advisory councils on health-care quality and research and served two years on the Advisory Commission on Consumer Protection and Quality in the Healthcare Industry under President Bill Clinton. He's also been the recipient of numerous professional awards and honors for his contributions in the area of public health administration.

Yet despite these well-documented achievements, Dr. Berwick's opponents chose to focus almost exclusively on a half-dozen unguarded comments he made in England years ago, to the effect that Britain's national health-care system might hold useful lessons for U.S. policymakers. Dr. Berwick no doubt is well aware of the shortcomings of the British system — as he is of its American counterpart. Yet Republicans have been falling all over themselves to take the remark out of context as evidence of a hidden agenda to impose "socialized medicine" that inevitably would lead to the "rationing" of care for sick and vulnerable Americans.

Never mind that the worst Dr. Berwick was guilty of was saying something nice about British medicine to a British audience. The point of the president's Republican opponents was never really to discover whether Dr. Berwick was a closet "socialist" — an epithet routinely flung at Obama appointees with whom they disagree — or even what kinds of reforms he might bring to America's broken health care system.

Instead, it was to use the occasion to refight last spring's vitriolic battle over health-care reform all over again — and, not coincidentally, just in time for November's midterm congressional elections. For months it's been clear Republican leaders meant to drag out the confirmation process right up to the moment Americans went to the polls, in order to rally their conservative base and attack the president. The complaint by Rep. Tom Price, who heads the caucus of conservative House Republicans, that Democrats are ramming the nomination through without formal hearings or debate rings pretty hollow after his party telegraphed its intentions so transparently.

In bypassing the opposition through a recess appointment, Mr. Obama deftly avoided a wholly contrived controversy ginned up for the sole purpose of scoring political points. Recess appointments are often controversial, but both parties have used them, and the Medicare post now held by Dr. Berwick had in fact been vacant since 2006 because of partisan bickering. President George W. Bush made at least 171 recess appointments and President Bill Clinton made 139.

But that doesn't let Senate Republicans off the hook for perpetuating one of the more dysfunctional aspects of their chamber, which along with such archaisms as the filibuster serves mainly to enforce the tyranny of a capricious minority over the majority.

On health care, it simply makes them look more interested in thwarting the president at every turn than in working to solve the health-care conundrum — and this at a time when opinion polling shows the public almost evenly split over the wisdom of reform, with approval rates rising steadily.

Given the trends, it's hard to see how continuing to bash health care overhaul is a winning formula for the GOP come November. So long as Republicans take a reflexively obstructionist attitude on every issue without offering practical alternatives of their own, their party is going to have a tough time convincing Americans it's ready to govern the country again.

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