President Obama has circumvented the Senate and the American public by using a recess appointment to install Dr. Donald Berwick at the helm of the Center for Medicare and Medicaid Services. It not only confirms the president's disregard for the legitimate legislative process, but also exposes the frightening big government extremism of the president’s health care agenda.

The same president who, throughout the health care debate, dismissed concerns about rationing of care as a crazy right-wing “death panels” claim, has now bypassed the Senate to appoint a man who is a strong proponent not just of rationing care, but of politicizing all health care decisions.

Berwick supports the rationing of medical care using the British National Health Service as a model, and is now in a position to experiment with rationing of care in the Medicare and Medicaid programs Obama has unilaterally empowered him to run.

In an interview last year, Berwick said: “The decision is not whether we will ration care. The decision is whether we will ration with our eyes open.”

The inevitability of rationing – that is, government deciding, instead of patients and doctors, what treatments will be available – would come as a shock to anyone who listened to the president explain how his plan would boost the availability of care.

Obama’s new health care boss goes even further, it openly supports giving the government centralized control over health care. Berwick specifically looks to the National Institute for Clinical Excellence in Britain as a model, with its measure of "quality adjusted life years." In Britain, they estimate that a year of your life – adjusted for “quality,” (i.e., meaning how sick you are), is worth about $45,000. If you’re too old or too sick to justify the cost, you’re denied treatment.

Berwick said of this system: "Cynics beware, I am romantic about the National Health Service; I love it. All I need to do to rediscover the romance is to look at health care in my own country. The NHS is one of the astounding human endeavors of modern times. Because you use a nation as the scale and taxation as the funding, the NHS is highly political."

Not only does he love rationing, but he rhapsodizes about politicizing health care decisions. Now, thanks to Obama, he is in a position to impose his views on Medicare.

How could the president successfully install such an extreme advocate of rationing and government control of health care? By cheating the process. The Senate didn’t hold a single hearing. Berwick wasn’t filibustered, because Republicans didn’t even have a chance – he was never put on the calendar.

Even Senate Finance Committee Chairman Max Baucus, one of the key architects of Obamacare who steered the law through tough Senate negotiations, broke with the president over the way he sidestepped Congress to get Berwick in, saying: “I'm troubled that, rather than going through the standard nomination process, Dr. Berwick was recess appointed. Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power and protects Montanans and all Americans by ensuring that crucial questions are asked of the nominee – and answered.”

Senate Republicans have been even more critical, but the president sidestepped the Senate and unilaterally installed Berwick.

With Obama’s rationer in power now, the tragic “cost containment” mechanism under Obamacare -- denying essential treatments -- is now on full, grotesque display.

Obama’s political gambit is that by avoiding the Senate he can avoid public scrutiny. Outraged citizens must therefore counter by doing everything possible to make an issue of Berwick and demand that Congress repeal Obamacare and start over with real reforms that put patients first.

Mr. Kerpen is vice president for policy at Americans for Prosperity. He can be reached on Twitter @PhilKerpen, Facebook, and through PhilKerpen.com

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