Dr. Berwick may have little future at CMS beyond this year

Washington -- -- Forty-two Senate Republicans are asking President Obama to withdraw his nomination of Donald M. Berwick, MD, as administrator of the Centers for Medicare & Medicaid Services beyond 2011, citing what they deem the CMS chief's lack of experience and controversial statements.

With Democrats needing 60 votes to overcome a GOP block of the nomination, the nearly united front from Republicans, spelled out in a letter to Obama, probably means Dr. Berwick does not have a long-term future at the helm of CMS. Senate Finance Committee members Orrin Hatch (R, Utah) and Mike Enzi (R, Wyo.) have led the effort to remove him.

Dr. Berwick

"The White House's handling of this nomination -- failing to respond to repeated requests for information and circumventing the Senate through a recess appointment -- has made Dr. Berwick's confirmation next to impossible," Hatch said.

Dr. Berwick was placed in the position during a congressional recess in July 2010 after Obama determined that following the normal Senate confirmation process would take too long. But sidestepping the upper chamber means his appointment will run out at the end of this year. On Jan. 26, Obama officially renominated Dr. Berwick for the post.

Despite the nearly unanimous GOP opposition, the White House indicated that Obama won't pull his support.

"The president nominated Don Berwick because he's far and away the best person for the job, and he's already doing stellar work at CMS: saving taxpayer dollars by cracking down on fraud and implementing delivery system reforms that will save billions in excess costs and save millions of lives," White House spokesman Reid Cherlin said in an e-mail. "We won't be withdrawing the nomination."

In the letter, the GOP senators said Obama's use of a recess appointment was an "abrupt and unilateral" action that denied senators the opportunity to ask Dr. Berwick questions before he took charge of an agency with a budget larger than the Dept. of Defense. They questioned whether the pediatrician, Harvard professor and president of the Institute for Healthcare Improvement in Cambridge, Mass., has had enough experience in health plan operations and insurance regulation.

Republicans referred to Dr. Berwick's previous statements praising the United Kingdom's National Health Service as an indication that he supports socialized medicine and health care rationing, a charge Dr. Berwick has dismissed.

"Withdrawing Dr. Berwick's nomination would be a positive first step in rebuilding the trust of the American people," the letter said. "The occupant of this important position, which affects the health care of so many Americans on a daily basis, requires an individual with the appropriate experience and management ability. Our seniors and those who rely on Medicaid deserve no less."

Dr. Berwick's nomination and recess appointment was supported by numerous physician organizations, including the American Medical Association.