"You Could Nominate Gandhi to Be Head of CMS and That Would Be Controversial Right Now"

by Norman Horowitz

Do we determine the politics of our soldiers we send off to possibly die in Iraq and Afghanistan? Do we send only Democrats or only Republicans to die on our behalf?

Do we determine the politics of a firefighter who comes to put out a fire in your house? Do we allow only Democrats’ or Republicans’ to risk their lives in order to defend our lives and property?

Do we determine the politics of a plumber who will unclog a drain in your home? Does a plumbing problem respond more to a plumber who is a Democrat or a Republican?

Do we determine the politics of the police when you have called them to protect you and your property? Can we rely on either Democrats or Republicans to do this job?  

The Senate will not confirm Don Berwick, MD, as administrator of the Centers for Medicare & Medicaid Services (CMS). CMS has been leaderless for years, with decades of acting administrators.

Being leaderless is bad enough, but not to confirm one of the nation’s leaders for patient safety would appear to represent the worst of partisan politics.

Here we have an outstanding nominee who is a patient advocate in a critical and influential position, as well as a physician who understands clinical practice and has the respect of his colleagues.

Now, how bad is that?

Seniors deserve a knowledgeable and thoughtful advocate to guarantee their safety and access to the best possible care.

If we fail to confirm him, we will face more years of leaderless inertia in agencies that have a direct impact on health care practices and patient safety.

Apparently, 42 Republican senators have urged that Berwick's permanent nomination by withdrawn, citing his “lack of experience in the areas of health plan operations and insurance regulation.”

It’s incredible to me that Berwick has greater management experience than many previous CMS administrators. Few have matched his knowledge of the American health care system or his high standing within the medical profession. He is one of the world's leading experts in patient safety and quality improvement. A pediatrician and health policy researcher, he has authored hundreds of scholarly articles. He has spent decades in the trenches of the American health care system seeking to improve it. It seems odd and unusual that “the system” wants to appoint a person who is uniquely qualified for the job.

As an “ordinary citizen,” I’m appalled by another partisan campaign driving another distinguished figure out of American government.

Thomas Scully, CMS administrator under President George W. Bush, got to the nub of things: "He's universally regarded and a thoughtful guy who is not partisan. …it has been said that you could nominate Gandhi to be head of CMS and that would be controversial right now."

The proper purpose of the confirmation process is to scrutinize nominees, to question them and then to approve or reject them through an up-or-down vote. If senators continue to exploit ossified procedures simply to obstruct opposing administrations, presidents of both parties will pursue recess appointments with greater frequency.

Imagine what would happen if Democrats were to pursue the same sound-bite fishing expedition that was pursued against Berwick.

Berwick's critics have cited his statements about the need for health care to redistribute resources from the rich to the poor, and his favorable statements about the British health care systems. They quote Berwick as saying, “The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open.” They point to statements such as, “Any health care funding plan that is just, equitable, civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition re-distributional.” Berwick's vision for health care is an adaptation from the Institute of Medicine's six improvement aims for the health care system – care that is safe, effective, patient-centered, timely, efficient, and equitable.

In my never-humble opinion, Senate hearings continue to be, in many cases, just plain “rightwing theater.” Dr. Berwick has gone on record with whatever the Senators would like to ask. All they need to do is read the record.

To repeat: “He's universally regarded and a thoughtful guy who is not partisan. … it has been said that you could nominate Gandhi to be head of CMS and that would be controversial right now.”