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President Obama to Make Recess Appointment of CMS Administrator Republicans Attacking as 'Expert on Rationing'


With Congress officially on recess, President Obama will on Wednesday use his ability to make recess appointments to name one of his more controversial nominees: Donald Berwick, nominee to be Administrator of the Centers for Medicare & Medicaid Services (CMS).

The April nomination of Berwick -- president and chief executive officer of the Institute for Healthcare Improvement -- was in trouble and might not have been able to meet Senate confirmation due to comments Berwick made in the past about rationing health care. Even if Berwick could have been confirmed by the Senate, Democrats have little appetite for another round of fighting about changes to the health care system, Democrats said.

In an interview last year with Biotechnology Healthcare, Berwick said society makes decisions about rationing all the time, and that the "decision is not whether or not we will ration care -- the decision is whether we will ration with our eyes open. And right now, we are doing it blindly."

He has also praised the UK's National Institute for Health and Clinical Excellence (NICE), which he said had "developed very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn."

Said Berwick, "You can say, 'Well, we shouldn’t even look.' But that would be irrational. The social budget is limited -- we have a limited resource pool. It makes terribly good sense to at least know the price of an added benefit, and at some point we might say nationally, regionally, or locally that we wish we could afford it, but we can’t. We have to be realistic about the knowledge base."

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Berwick, a 63-year-old pediatrician, heads the Institute for Health Care Improvement in Cambridge, Mass., and he has been a longtime leader of the movement to reform health care from within. For decades he has challenged doctors and hospitals to provide health care that “is safe, effective, patient-oriented, timely, efficient and equitable,” with a surprising degree of success. In the months since he was nominated, not one industry group has voiced opposition to his nomination.