The Berwick Nomination

The nomination of Don Berwick to head CMS is proving controversial. I was surprised by the nomination. Berwick is okay as an academic, if a bit inconsistent. Last year we wrote in praise of a piece he published in Health Affairs, but had to condemn another piece published in the New England Journal of Medicine just a week later. In the first it seemed he wanted to empower patients, but in the second he wanted to empower bureaucracies. Overall he came across as confused.

That is fine in a scholar, but not so great for the administrator of the second largest health insurer in the world. CMS directly controls about one-third of all the money in health care in the United States and employs some 4,500 people. As far as I know, Berwick has never administered anything more than a small think tank in Cambridge. Now they want to put him in charge of not only running the Medicare and Medicaid programs, but of also implementing a vastly complex and brand-new law that expands federal authority in unprecedented ways? Berwick’s wistful musings hardly seem up to the task.

More importantly, now that he has become so public people are looking into his background and finding some things that are more than a little disturbing. Last week we cited Robert Goldberg’s report on Berwick’s speech to a British audience celebrating the 60th anniversary of the National Health Service. In it he was contemptuous of consumer choice and private enterprise, favoring the “joy” and “romance” of political leaders running the show.

Since then there has been more commentary coming out on this nominee, including fine articles by Heartland’s Ben Domenech, Jeffrey Anderson in the Weekly Standard, and American Spectator’s Philip Klein. These confirmation hearings should be very illuminating – assuming the Senate Republicans can rent some backbone.

SOURCE: Ben Domenech on Berwick; Philip Klein on Berwick; Jeffrey Anderson on Berwick; Berwick in Health Affairs; Berwick in the New England Journal