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Don Berwick’s Legacy



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Recess-appointed Centers for Medicare and Medicaid Services head Don Berwick has announced his resignation, effective December 2. In stepping down, Berwick has officially recognized what everyone in Washington has long known — that he had no chance of Senate confirmation.

Berwick’s problem was not that his health-care views were so different from that of President Obama, but that he was so open in his support of rationing that Democrats were too embarrassed to give him a hearing in which to air those views. His designated replacement, Marilyn Tavenner, probably does not differ greatly from him — or from Obama — from a policy perspective, but she is much quieter and lower-profile.

Berwick’s unfortunate legacy will not be in the area of transforming CMS or of changing health-care policy, but in the continually problematic area of confirmations for presidential nominees. There has not been a confirmed CMS head since Mark McClellan left in 2006, and there is no guarantee that Tavenner will have a quick or easy confirmation. Ideology aside, a string of acting heads is no way to run a $700 billion agency.  

As I wrote this past spring in National Affairs, the clunky way the Obama administration handled Berwick’s entire nomination slowed down their efforts to implement the health-care law, increased mistrust with Senate Republicans on the already broken confirmation process, and even managed to alienate key Democrats, such as Finance Committee chair Max Baucus. Berwick may be going, but the problems caused by the poor handling of his nomination are likely to continue.



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