Obama appoints Berwick to head CMS

Donald Berwick’s nomination to head the Centers for Medicare and Medicaid Services (CMS) had been in limbo since April. Republicans opposed Berwick, in large part, because he admires the British National Health Service. For conservatives, this translates into rationing and the dreaded “death panels.” The Senate was in recess, so Obama went ahead and made a recess appointment.

Both Democrats and Republicans objected to Obama’s use of this tactic. Congress has become so polarized, however, that presidents must increasingly resort to this option. The statistics for recent presidents: Reagan 243, Clinton 139, George W. Bush 171, and Obama (so far) 15.

Even former heads of CMS who supported Berwick object to the recess appointment. Here’s Gail Wilensky, as quoted in The New England Journal of Medicine:

[H]is appointment is tainted, certainly in the eyes of Republicans — even those who had not spoken out on sensitive issues that Don had raised in previous statements and writings. . . . Don will carry an extra burden because he was not confirmed by the full Senate through the normal confirmation process.

This sounds somewhat reasonable, but with so much opposition to health care reform among Republicans, a recess appointment is hardly a tipping point.

Without FFS payments, doctors aren’t “motivated”

One physician-congressman who’s been against Berwick is Rep. Michael Burgess (Texas), the ranking Republican on the House Energy and Commerce Subcommittee on Health. The obstetrician–gynecologist opposes one of the fundamental assumptions of the new health care law – that physicians should be paid according to the quality of their work, not the quantity. How can you argue against the quality of health care? Burgess spoke on the subject at a recent Health Affairs Media Breakfast:

Burgess came to the defense of the current fee-for-service [FFS] system where the provider is paid for each individual service rendered to a patient. The congressman argued that doctors are “so goal directed that we need that impetus” of FFS as motivation to provide the best possible care.

That really improves the image of the medical profession, doesn’t it? And inspires confidence in doctors among patients. Understandably doctors are motivated to expect reasonable compensation for their time and expertise, but do we really need to question their motivation when it comes to providing the best possible care?

Burgess’ comment creates the wrong impression. When a physician needs to decide on another expensive procedure – which I suspect is what Burgess has in mind by “best possible care” – considerations include insurance company reimbursement and potential lawsuits. This does not belong in the same category as a physician’s basic motivation to care for an individual patient.

Burgess also predicted a possible “sea change” in Congress, with more physicians seeking House seats than any time in the past 100 years. There are 46 doctors, 40 of whom are Republicans, who are vying for seats, he added. This is the result of doctors’ dissatisfaction with the new law and the way it was passed, Burgess said.

Burgess admits that repeal of the new law is unlikely, but he hopes to obstruct progress with objections to the bill’s funding.

Update 7/27/10:
New Health Official Faces Hostility in Senate (The New York Times)

[H]e is finding his ability to do his job clouded by the circumstances of his appointment, with many Republicans in open revolt over President Obama’s decision to place him in the post without a Senate confirmation vote. … [h]is supporters worry that he will be a lame duck because agency employees and health care interest groups know he may be gone in 18 months. Unless he is confirmed, his appointment will expire at the end of the Senate’s next session.

Among its [the British National Health Service] virtues, he [Berwick] cited a strong emphasis on primary care and a commitment to equity. He praised Britain as “recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any health care funding plan that is just, equitable, civilized and humane must — must — redistribute wealth from the richer among us to the poorer and less fortunate.”

Resources:

Image source: Fox News

John K. Iglehart, Facing the Wild West of Health Care Reform — Donald Berwick, Pioneer, The New England Journal of Medicine, July 14, 2010

Stephen Langel, Rep. Burgess Gives Physicians’ Take on New Health Care Law, Health Affairs Blog, July 1, 2010