President Barack Obama bypassed the Senate Wednesday and appointed Dr. Donald Berwick, a Harvard professor and patient care specialist, to run Medicare and Medicaid.
The decision to use a so-called recess appointment to install Berwick as administrator of the Centers for Medicare and Medicaid Services drew immediate fire from the GOP. Republicans have raised concerns about Berwick's views on rationing of care and other matters and said it was wrong for Obama to go around the normal Senate confirmation process, even though the recess appointment is a tool used by presidents of both parties.
Berwick has wide support in the medical community but Democrats feared the GOP would use his confirmation hearings as an opportunity to reopen last year's divisive health care debate. Obama defended the decision to appoint Berwick and two other officials, one to a pension board and the other to a White House science post.
"It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes," Obama said in a statement Wednesday. "These recess appointments will allow three extremely qualified candidates to get to work on behalf of the American people right away."
Senate Minority Leader Mitch McConnell accused Obama of trying to "arrogantly circumvent the American people" with Congress out of town for its annual July Fourth break. Berwick could serve through next year without Senate confirmation.
"Democrats haven't scheduled so much as a committee hearing for Donald Berwick but the mere possibility of allowing the American people the opportunity to hear what he intends to do with their health care is evidently reason enough for this administration to sneak him through without public scrutiny," said McConnell, R-Ky.
Berwick, 63, is a pediatrician, Harvard University professor and leader of a health care think tank, the Institute for Healthcare Improvement, that works to develop and implement concepts for improving patient care. The programs he will oversee -- Medicare and Medicaid for the elderly, poor and disabled, along with the Children's Health Insurance Program -- provide care to about 100 million people, or around 1 in 3 Americans.
The American Hospital Association was among the groups that weighed in to support Berwick Wednesday.
"Don has dedicated his career to engaging hospitals, doctors, nurses and other health care providers to improve patient care," said Rich Umbendstock, head of the hospital association. "A physician and innovator in health care quality, his knowledge of the health care system makes him the right choice."
Republicans have seized on comments like one Berwick made to an interviewer last year: "The decision is not whether or not we will ration care -- the decision is whether we will ration with our eyes open. And right now, we are doing it blindly."
Republicans say that shows Berwick would deny needed care based on cost. Supporters contend rationing already is done by insurance companies and Berwick simply wants transparency and accountability in medical decisions.
It's just those echoes of the health care debate that Democrats would prefer not to replay on the Senate floor.
Medicare has been without an administrator since 2006, and the White House says the need to fill the post is critical because of its role in implementing the new health care law. Medicare is to be a key testing ground for numerous aspects of the new law, from developing new medical techniques to trying out new payment systems, and the White House says a permanent leader is key with deadlines approaching.
Obama last made a batch of recess appointments in March. Also appointed Wednesday were:
--Philip E. Coyle III as associate director for national security and international affairs at the White House Office of Science and Technology Policy.
--Joshua Gotbaum as director of the Pension Benefit Guaranty Corporation.