Donald Berwick's tenure at the Center for Medicare & Medicaid Services was brief, but should come as no shock to anyone who knows how the former physician came to the job. What's stunning is how many believe the Obama administration and House and Senate Democrats bear no responsibility for the brevity of his stint at CMS.
Let's take things in chronological order. First, President Obama and Democrats in Congress drafted what is probably the largest piece of legislation ever to pass without any input from the legislative minority. They then rammed the vote through Congress with only feeble support from a handful of Republicans with large constituencies among “blue” voters. That apparently was sufficient to call it bipartisan legislation.
When Obama nominated Berwick to the CMS post early last year, the White House recognized that getting Berwick in at CMS would be close to insurmountable (assuming they believed it could be done at all) given the way the Affordable Care Act (ACA) was handled. So rather than have Berwick appear on Capitol Hill in any capacity – let alone for a confirmation vote – the administration appointed Berwick to the job during the 2010 summer recess.
Anyone with any common sense knows you don't use recess appointment for a job like that at a time like that unless you're willing to jettison any prospect for bipartisanship. Berwick waited 'til last November to appear before the Senate – he had been on the job for a third of a year by then – and according to an article in the Washington Post, Sen. John Kyl told Berwick “I haven't seen a single thing you've written or said I agree with,” to which Berwick is said to have replied “that's not a framework for a conversation.”
If Berwick was worried about frameworks for conversations, he should have shown up before November 2010. To be nice about it, his riposte to Kyl was hypocritical given the way the ACA was handled, not to mention his recess appointment.
One line of thinking about all this is that the administration hoped Republicans would roll over and play dead for Berwick despite the tone set by Democrats in getting the ACA through, but another line of thinking is that the President figured a year and a half of Berwick was better than no Berwick. After all, we've had a stretch of acting administrators at CMS in the post-Tom Scully world, so a brief tenure for Berwick would be no shock to anyone in this town.
I'm not here to proclaim the GOP the Party of All Things Good and Democrats the Root of All Evil. After all, the GOP stupidly used budget reconciliation to ram through the tax cuts passed during George W. Bush's time in the White House, and this is a town with a lot of sharp elbows on both sides of the aisle, not to mention long memories.
All the same, I find it naive to think this appointment could be handled this way. Whether you believe the ACA was both appropriate and constitutionally sound is irrelevant because of the ham-fisted approach taken by Democrats in the White House and on the Hill. Hence, this Berwick business can't be interpreted as anything more than one of two things; a case of towering political arrogance on Obama's part, or a belief that a year and a half of Dr. Berwick is better than no Dr. Berwick at all.