Multiple sources are reporting that the Obama administration is poised to nominate Dr. Donald Berwick as the administrator of the Centers for Medicare and Medicaid Services (CMS). The agency has not had a permanent head since 2006, when Mark McClellan left, in large part because the Democratic Senate refused to confirm the well-regarded career official Kerry Weems to the post. Weems closed out the Bush administration in an acting capacity.
The Berwick choice itself is not very contentious. He is a quality expert who believes that we can get more value out of our system — higher quality for lower cost. But the timing is problematic. Berwick was reportedly slated to get this appointment well over a year ago. The Obama administration, however, held off on going forward until health care was done before making the announcement and pursuing the confirmation, presumably because they — and possibly Berwick, according to Politico – wanted to avoid another health battle while they were pursuing their overhaul bill.
Unfortunately, the administration seems to have failed to appreciate the difficulty of two processes — confirmation and implementation — in making this calculation. Confirmation is a process that takes months even in the case of uncontroversial nominees, and contentious nominations can take far longer. While Berwick himself is not hugely controversial, the bitter feelings over the way health care was passed could lead Senate Republicans to delay his approval.
The Obama team should have thought of this beforehand because CMS needs an administrator to work through the difficult issues that implementation of the complicated new bill presents. As I argued in the Examiner last week, the implementation process of complex legislation is tricky, and agencies need political leadership to sort through difficult questions. Because of this decision to delay the nomination, the administration will have an even harder time making their health-care scheme work.