Another Medicare Tug-of-War in Washington

First, Congress let a Medicare reimbursement cut take effect before the “doc fix” put things right – temporarily – for another six months. Now, the Obama Administration has another Medicare crisis to deal with, this time in the front office.

President Obama has announced that enough time has lapsed on his appointment of Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services. Nominated for the post in April, the White House said Republican congressmen have “made it clear” of their intent to stall the nomination as long as possible.

With this in mind, the president has decided to bypass Senate confirmation altogether and make a recess appointment of Berwick to the CMS, which has gone without a permanent leader for nearly four years.

Last week, members of the GOP Doctors Caucus – a group of more than a dozen members who currently or in the past practiced medicine – expressed their “significant concerns” with Berwick, notably that he “openly advocated rationing of care,” according to the text of a letter the group sent to the president.

In the letter, the caucus discusses federal health reform’s impact in cutting Medicare Advantage to seniors, as well as “new hidden taxes and premium increases” through the Patient Protection and Affordable Care Act.

“With seniors’ access to care already threatened by these cuts, we are especially troubled by Dr. Berwick’s history of support for government rationing of medical services,” the Republicans said.

The White House, through communications director Dan Pfeiffer, agrees that seniors are in trouble, hence the need for a leader now. The Obama Administration has praised Berwick’s past – founder of the Institute for Healthcare Improvement and professor at Harvard are part of his resume – and support from groups including the American Medical Association.

So the president says his guy is right for the job and Republicans disagree. A recess appointment is only good through January too – when a new Congress comes to town – so Berwick will have to be formally vetted then, if reappointed by the president.

Does anyone else think forcing the nomination will be met with some retaliation by Republicans…say in November when the reimbursement issue comes back around on Capitol Hill for debate?

Berwick is a doctor, so perhaps having that experience will help, not hurt, when “doc fix 2.0” comes around this winter, but I have a feeling the good doctor’s advice will not be heard. Stay tuned.