“The most important man that you’ve never heard of.” That’s a good description of Dr. Donald Berwick, director of the Center for Medicare and Medicaid Services, the federal agency that will oversee the spending of $823 billion in fiscal year 2011. Yup, $823 billion--a lot of money, even in Barack Obama’s Washington. So those words, “the most important many you’ve never heard of,” coming from Tony Perkins, president of the conservative-leaning Family Research Council, are quite apt.
Perkins, by the way, is not a fan; the FRC chief denounces Berwick for his “radical plans for health care.” Perkins is referring to Berwick’s oft-stated admiration--adoration might not be too strong a word--for the National Health Service of the United Kingdom.
The NHS, of course, is the world-beacon for socialized medicine; the British instituted their “single payer” plan back in 1947. And that’s what Berwick admires and would like to bring to the U.S. As he said in a 2008 speech, “I am romantic about the National Health Service. I love it,” adding that the NHS is “generous, hopeful, confident, joyous, and just.”
Gee, you might be saying to yourself, that’s kinda radical, what Berwick is saying. And so you might ask: How could someone like that get confirmed by the U.S. Senate? The answer is that he couldn’t. Berwick is on as a “recess appointment,” a nifty, but temporary, way of bypassing the “advise and consent” process of Senate confirmation.
Both parties do it; in 2005, John Bolton, for example, was given a recess appointment as ambassador to the U.N. by President George W. Bush. According to the same rules by which Bush appointed Bolton, Berwick has his job through the end of the 112th Congress.
Let’s see, appointed, and not accountable. So one could call Berwick the “czar” of the Center for Medicare and Medicaid Services. CMS, as it’s called, is the largest purchaser of health care in the U.S., serving 102 million beneficiaries, one-third of the U.S. population.
Having skipped past the Senate earlier this year, Administrator Berwick finally appeared on Capitol Hill. Indeed, he appeared before the Senate Finance Committee, the folks who were supposed to confirm him, or not, through the “advise and consent” process. But committee chairman Max Baucus (D-Mont.) limited each senator to five minutes of Q & A with Berwick. “This is pathetic,” muttered a fellow committee member, Sen. Orrin Hatch (R-Utah). “We ought to have time to ask the most important man in American health care questions that are important.”
For his part, Berwick was ready for a fight. Before the committee, he volunteered his opinion of Republican efforts to repel Obamacare: “I can't think of a worse plan.” But he was just warming up. Repeal, he added, “would mean that seniors would not be getting the 50% discount on prescription drugs.” Berwick kept going: “Would we tell them . . . that they will not be able to afford life-saving medicine? Would we tell them they would not be getting life-saving access to preventive services? That we won’t work on safer care? . . . That we’re not going to be more transparent? … That we’re not going to work hard on fraud and abuse?” That was strong pushback from Berwick, and that’s what it will be like for the next two years, at least.
And so Republicans are on notice that they will not have an easy time in their effort to “repeal and replace” Obamacare. Indeed, while Democrats took a “shellacking” on November 2, as Obama ruefully put it at a next-day press conference, the Berwicks of his administration are as committed as ever to their agenda.
Indeed, Republicans will have to be careful about over-interpreting the mandate they won from the voters earlier this month. On the eve of the midterm elections, a Fox News/Opinion Dynamics poll found the following wide split in public opinion: 29 percent of registered voters wanted to repeal Obamacare entirely, 29 percent wanted to repeal parts, 15 percent wanted to leave it as is, and 20 percent wanted to expand it.
So Republicans, soon to be in control of the House, but not the Senate, will have to choose their anti-Obamacare shots carefully; a head-on assault is not going to succeed.
One promising pressure point: rollback of the plan to spend $10 billion to hire 13,500 more IRS agents to enforce the individual mandate--that is, the individual must have health insurance--provision of Obamacare.
Meanwhile, from within CMS, the bureaucratic beat goes on. Just this week, separate and distinct from these hearings, CMS and HHS issued a binding rule on how hospitals must treat the guests of medical patients.
The point of the ruling was to ensure equal treatment of gay visitors. Yet CMS took 78 pages to make that point. One can say that equality is a good thing, but still, one has to wonder, why did the document go on for 78 pages? Do bureaucrats get paid by the page? Or are they trying to slip in other provisions, written in coded legalese, just as they did in that 2,800-page Obamacare bill? Plus the 15,000 or pages of regulations--many of them written by CMS--that will accompany the actual legislation. All good questions. So here, have a look, and try your hand at deciphering all this.
James P. Pinkerton is a writer, Fox News contributor and the editor/founder of SeriousMedicineStrategy.