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Battle Looms in Senate Over Obama's Pick to Run Medicare and Medicaid

As all eyes watch Elena Kagan make the rounds of Senate office buildings, greeting senators, answering questions and building support, another of President Obama's nominees is taking the same route -- but with much less fanfare. And he very well could wield as much -- or even more -- influence on America's future as the Supreme Court nominee.

Dr. Donald M. Berwick, if confirmed by the Senate, will run Medicare and Medicaid, the world’s second largest insurance provider, as the two health care giants transform to meet the requirements of the recently passed health care reform act. Among Berwick's duties under the new law will be to oversee the expansion of Medicaid to cover 16 million more people and to cut nearly half a trillion dollars in costs from the program.

Berwick's supporters say he is the right man in the right place at the right time. But his opponents are lining up against him. They say that while he may be a the highly respected doctor, he is also an outspoken proponent of the British health care system, which they say is all wrong for Americans.

Berwick, a pediatrician, heads the Institute for Health Care Improvement in Cambridge, Mass., and he has been a longtime leader of the movement to reform health care from within. For decades he has challenged doctors and hospitals to provide health care that “is safe, effective, patient-oriented, timely, efficient and equitable,” with a surprising degree of success. In the two months since he was nominated, not one industry group has voiced opposition to his nomination.

His success in cutting hospital infection rates and implementing better asthma care and coronary surgery improvements has not been made by imposing regulations or raising fees, but in creating teams to explore ways to improve procedures and techniques with little additional costs. His efforts earned him garlands, including the $100,000 Purpose Prize, which credited him with saving more than 100,000 lives, and plaudits that include the words “visionary,” “profound thinker,” and “revolutionary.”

But the early accolades for the Harvard Medical School graduate’s nomination to head the Centers for Medicare and Medicaid Services came to an abrupt end this week when a triumvirate of Republican senators attacked Berwick for “favoring health care rationing" and “being in love” with Britain's National Health Care System. 

Kansas Sen. Pat Roberts, who had met privately with Berwick, threw down the gauntlet.

“Dr. Berwick is a huge fan of the British National Healthcare System, called the NHS, a system that relies on rationing health care to hold down costs," Roberts said.

"Dr. Berwick has said, ‘I am a romantic about the NHS; I love it,’ and ‘the NHS is not just a national treasure, it is a global treasure.’ In addition to rationing, the NHS utilizes an end-of-life pathway to death that many British doctors say leads to premature death in patients that could otherwise have recovered.

“Dr. Berwick is the perfect nominee for a president whose aim has always been to save money by rationing health care,” Roberts charged.

The senator's conclusion was that Berwick “was the wrong man, at the wrong time, for the wrong job.”

Roberts was joined by two other powerful senators, Minority Leader Mitch McConnell of Kentucky and Wyoming Sen. John Barrasso, a physician, in the effort to block Berwick's nomination.

While Roberts spoke of the bigger issues, Barrasso’s objections were personal. He compared the British system’s treatment of cancer care with the treatment his wife received after she was diagnosed with breast cancer. He said that cancer surgery in Britain takes 18 weeks to schedule, and that “American cancer patients have a higher survival rate for every major form of cancer than patients in Canada and Britain.”

Barrasso said his wife, Bobbi, had been diagnosed in 2003 with breast cancer that had spread to one of her lymph nodes -- and that timely care had saved her life. And she probably would not have gotten that immediate care, he said, under the British health care system Berwick admires.

“As a patient in the United States, you may say: Do I really want Dr. Berwick?" Barrasso asked. "Do I want somebody who favors the National Health Service of Britain, someone who says they have incredible respect for the way it works and thinks it is the right way to go? 

"Would an American citizen want that person to be in charge of Medicare and Medicaid for this country?"

His answer was an adamant "no."

In reaction to the senators' charges, the White House issued a statement saying, “No one is surprised that Republicans plan to use this confirmation process to trot out the same arguments and scare tactics they hoped would block health insurance reform. 

"The fact is, rationing is rampant in the system today, as insurers make arbitrary decisions about who can get the care they need. Don Berwick wants to see a system in which those decisions are transparent – and that the people who make them are held accountable. 

"He’s dedicated his career to finding ways to making our health care system work better for patients and cost less for taxpayers, which is why he’s earned praise from across the political spectrum and from every corner of the industry. The President is looking forward to Dr. Berwick’s confirmation.”

But it won't be without a fight. As one insider said of the Republican senators' nascent effort to stop his nomination, “You ain’t seen nothing yet.”

No date has been set for Berwick's confirmation hearing before the Senate Finance Committee.