Politics & Policy

Donald Berwick Bows Out

A tale of presidential cowardice.

On the day before Thanksgiving, controversial health wonk Donald Berwick tendered his resignation as administrator of the Centers for Medicare and Medicaid Services. “It’s unfortunate that a small group of senators obstructed his nomination, putting political interests above the best interests of the American people,” said deputy White House press secretary Jamie Smith. “One of [health care’s] most distinguished leaders and voices got mugged by partisan Republicans who know better and who got away with it,” wrote John McDonough of the Boston Globe. Berwick, however, wasn’t done in by Republican intransigence. He was done in by presidential cowardice. And therein lies a microcosm of everything that’s been wrong with Obamacare.

Let’s review the history. In April 2010, President Obama nominated Berwick, a decorated triple-graduate of Harvard and dean of the liberal health-policy community, to run the agency known as CMS. Berwick, who has tenured faculty appointments both at Harvard Medical School and the Harvard School of Public Health, also founded a think-tank called the Institute for Healthcare Improvement, which focuses on improving health-care delivery, and where Berwick collected compensation of nearly $900,000 in 2009. Berwick has had his admirers on the right; Newt Gingrich once saluted Berwick for seeking a “dramatically safer, less expensive, and more effective system of health care.”

Berwick was knighted by Queen Elizabeth II for his involvement in Tony Blair’s ill-fated efforts to improve Britain’s National Health Service. It was during this period that the NHS set up its notorious health-care-rationing board, the National Institute for Clinical Excellence, which routinely stymies the use of life-saving treatments in order to save money. Speaking at the NHS’s 60th anniversary in 2008, Sir Donald extolled the NHS as far superior to the American health-care system, a system veiled by the “darkness of private enterprise.” 

“Please don’t put your faith in market forces,” said Berwick. “It is a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can do. I do not agree. I find little evidence anywhere that market forces, bluntly used, that is, just consumer choice among an array of products with competitors’ fighting it out, leads to the health care system that you want and need. In the US, competition has become toxic. . . .  Do not trust market forces to give you the system you need. . . . I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.” Berwick, as head of CMS, sought to be one of these “leaders with plans.”

Berwick deserves credit for his intellectual honesty. Unlike the president, who repeatedly tries to describe his health-care agenda in chin-strokingly centrist tones, Berwick embodies what that agenda is really about: an attempt to move America in the centrally planned direction of Britain, a move that Berwick is “romantic” about.

Unfortunately for the subjects of Her Majesty, the NHS stands out as the worst health-care system in western Europe. Health outcomes for British patients are among the poorest in the developed world, and British health spending grows at a faster rate than America’s, despite the NHS’s extensive rationing program.

It was precisely for these reasons that the Republican minority in the Senate was looking forward to Berwick’s confirmation hearing. It was to be an important civic moment, a moment in which America’s most eloquent defender of socialized medicine would be forced to match wits with  . . . a bunch of politicians. It was going to be great television.

It never happened. President Obama, fearing that Berwick’s testimony would reinforce the public’s doubts about Obamacare, took advantage of Congress’s brief Fourth of July break to install Berwick at CMS via a recess appointment.

This was an egregious move. Presidents Bush and Clinton had both used recess appointments to appoint nominees who were actually being stalled, by filibusters or Senate holds. But no one was stalling Berwick’s nomination — quite the opposite. And this maneuver was undertaken for a man who was to control a budget of $800 billion, larger than that of the Department of Defense. It has become a familiar pattern: President Obama frequently seeks to implement an agenda in private that he is unwilling to defend in public.

If Republicans were “caricaturing” Berwick’s positions, as the New York Times alleged in a Wednesday news piece, why didn’t the president give Berwick an opportunity to express himself more fully? Indeed, Obama’s Senate end-around was clearly designed to prevent an honest debate about the centrally planned approach to health policy, and to spare vulnerable Democrats from having to publicly support Berwick’s philosophy. Indeed, Obama had originally sought to nominate Berwick in early 2009, but chose not to, because he didn’t want to risk adding more controversy to his health-care agenda.

And it wasn’t just Republicans who were appalled by Obama’s maneuver. “I’m troubled that, rather than going through the standard nomination process, Dr. Berwick was recess-appointed,” said Sen. Max Baucus (D., Mont.), chairman of the Senate Finance Committee. “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.”

Last week’s resignation ended Berwick’s 14-month Washington odyssey, but it’s the end neither of Berwick nor of Obamacare. Berwick’s top lieutenant, Marilyn Tavenner, will take over as acting administrator of CMS, where she will be tasked with installing Obamacare’s NHS-style rationing board — the Independent Payment Advisory Board — and implementing its massive expansion of Medicaid. It remains to be seen whether Tavenner will be confirmed, or whether Republicans will return the favor of Democrats, who refused to confirm a CMS head for President Bush from 2006 to 2009.

Berwick, meanwhile, can return to Boston as a martyr for socialized medicine. He likely will be able to improve on his old $900,000 pay package. And he will finally, once again, be able to say what he truly thinks. The world will be a better place for it.

— Avik Roy is author of The Apothecary, a blog on health-care and entitlement reform, and a senior fellow at the Manhattan Institute. You can follow him on Twitter at @aviksaroy.

Avik RoyMr. Roy, the president of the Foundation for Research on Equal Opportunity, is a former policy adviser to Mitt Romney, Rick Perry, and Marco Rubio.


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