Obama appoints Berwick to run Medicare, Medicaid

WASHINGTON — President Obama will bypass Congress and appoint Dr. Donald M. Berwick, a health policy expert, to run Medicare and Medicaid, the White House said Tuesday.

Dan Pfeiffer, the White House communications director, said the "recess appointment" was needed to carry out the new health care law. The law calls for huge changes in the two programs, which together insure nearly one-third of all Americans.

Pfeiffer said the president would appoint Berwick on Wednesday. Obama decided to act because "many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points," Pfeiffer said.

As a recess appointee, Berwick will have all the powers of a permanent appointee. But under the Constitution, his appointment will expire at the end of the next session of Congress, in late 2011.

In April, Obama nominated Berwick to be administrator of the Centers for Medicare and Medicaid Services. The agency has been without a permanent administrator since October 2006.


The recess appointment was somewhat unusual because the Senate is in recess for less than two weeks and senators were still waiting for Berwick to submit responses to some of their requests for information. No confirmation hearing has been held or scheduled.

Although hospital executives who have worked with Berwick describe him as a visionary, inspiring leader, he would have faced a long, difficult struggle to win Senate confirmation.

The president's action will give the administration a strong voice to defend provisions of the new law that have come under almost daily attack from Republicans in Congress and in political campaigns around the country.

Berwick, a pediatrician, is president and co-founder of the Institute for Healthcare Improvement, a nonprofit organization in Cambridge, Mass. He is also a professor at Harvard Medical School and the Harvard School of Public Health.

In two decades as a professor of health policy and as a prolific writer, Berwick has championed the interests of patients and consumers. At the same time, he has spoken of the need to ration health care and cap spending, has supported efforts to "reduce the total supply of high-technology medical and surgical care" and has expressed great admiration for the British health care system.

Under the new law, Medicare will be a testing ground for many innovations that reward high-quality care and penalize providers of poor care. The law will expand Medicaid to cover 16 million more people with low incomes.

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