Burnt Offering: Berwick Appointment Doomed

In one of the saddest episodes in the recent history of Washington health policy, President’ Obama’s Congressional allies have apparently decided to walk away from the appointment of Dr. Donald Berwick to run the Medicare and Medicaid program and to lead the implementation of health reform. http://www.politico.com/news/stories/0311/50698.html.

Berwick, a nearly universally respected and aggressive advocate for a safer and more consumer friendly health system, was approached about running the Centers for Medicare and Medicaid Services (CMS) by the Obama transition team.  In retrospect, his refusal to consider the appointment at that time was prescient. What followed, as we all know, was a nasty fifteen month mudfest which ended in March of 2010 with the enactment of the Affordable Care Act, known by its enemies as “Obamacare”. 

Then, less than a month after signing ACA into law, Obama nominated Berwick to head CMS.  The Senate Finance Committee, firmly in the shaky grasp of the Democrats, never even scheduled a hearing on Berwick, perhaps fearing creating a showcase for the worsening public reception to the law.  In frustration, less than ninety days after nominating Dr. Berwick, Obama simply installed him as CMS administrator, disengenuously blaming the Republicans for stalling his nomination.  This recess appointment not only infuriated Republicans, but also the President’s “friends” on the Finance Committee. (The same huge Democratic majorities could not pass an FY 2011 budget despite 59 Senate votes and an 81 vote House majority).

Renominated again this winter, Finance yet again refused to give Berwick a hearing and is now telling the administration through back channels to walk away from the nomination. Thank you, Chairman Baucus, for your stalwart support.  While Berwick lacked the managerial credentials to run the agency, he had already accomplished perhaps the central task of health reform, mobilizing the nation’s doctors and hospitals to redirect their energies into safer and more effective care (through the Institute for Health Improvement which he founded).   He knew EVERYONE, and what rhetorical buttons to push to get it to happen again and on a much broader scale.  He will return to the medical care system scarred and needlessly tarnished.

Shame on Washington!   Shame on the Finance Committee and shame on the White House for fumbling this nomination.  It is going on five years since CMS has had a permanent administrator (!!!) while health costs spin “out of control”.  Imagine the political consequences if the smaller Defense Department operated with interim leadsership for five years.  

A Nation of Cranks?

Yesterday’s two hours on the BBC World Service call in program on our health reforms was a revelation.  People called in all over the world, from places like Ghana and Kenya, over sputtering telephone connections,  to praise President Obama and Congress for a courageous and generous health reform.  People called in from all over the American heartland too.

Some American callers were pleased and proud that we’d righted a great wrong.  Others, however, seethed and parrotted Rush Limbaugh rants about political corruption and lazy people who simply needed to pull themselves up by their bootstraps and go out and get insurance for themselves, etc.  The contrast between people overseas who really want to believe our national hype about being a generous and caring people and many fellow Americans who, at base, plainly do not care about their fellow citizens was painful and embarrassing.

The most painful and embarrassing part:  I could hear echoes of their anger in some of my own comments, and  lame excuses about our polarized and mistrustful attitude toward government.  I’ve got plenty of reservations about what Congress did, but at base, letting tens of millions of uninsured people twist in the wind was morally intolerable. However flawed the health reforms, at least we helped maybe 30 million of them.

I’m really worried about our country.  How can we summon the gall to tell other people how to run their countries when we can barely run our own?  People abroad want to believe in what America has long stood for.  My question is:  what is it, exactly, that we stand for?