Wednesday, July 07, 2010

Two Words: John Bolton

The White House has announced that President Obama will make at least one recess appointment in the coming days: Dr. Donald Berwick, an expert in health care quality, will take over the top spot at the Center for Medicare and Medicaid. The announcement has already twisted Republicans' knickers, something I always approve of.

Berwick, 63, is a leading advocate of expanding research into the comparative effectiveness of various medical treatments, a major focus of the new healthcare law that many experts think is crucial to improve the quality of care that Americans receive and cut waste in the system.

He has been praised by the American Medical Assn., healthcare groups, consumer advocates and former CMS directors, including Dr. Mark McClellan and Thomas A. Scully, both of whom served in the George W. Bush administration.

But GOP senators accuse Berwick of embracing cutbacks to Americans' access to healthcare, citing his laudatory comments about the British healthcare system, which evaluates the cost of medical treatments in making coverage decisions.

"The decision is not whether or not we will ration care," Berwick told an interviewer last year. "The decision is whether we will ration with our eyes open. And right now, we are doing it blindly."

That last statement by Dr. Berwick is what the Republicans are using for their rallying cry: the rationing of health care. You see, on their planet, insurance companies don't ration health care, even when it makes sense to do so.

Dr. Berwick is one of those pests who points to the uncomfortable fact that in most cases of simple back strains, the expensive diagnostic test known as an MRI is unnecessary unless there are certain neurological findings (for example, drop foot or incontinence). The latest and far more expensive drugs for the control of hypertension often don't do the job any better than older and much cheaper drugs, and people like Dr. Berwick have a bad habit of citing the peer-reviewed studies which establish that fact.

And what really outrages the GOP is that Dr. Berwick's appointment is coming via a recess appointment, thereby frustrating their plans for additional obstructionist delays to show just how tough they are. To that I reply with only two words: "John Bolton." As the article quoted above notes, recess appointments have a long and storied history with presidents of both parties: President Clinton made 139 of them and President George W. Bush made 171.

This time President Obama got it right. Dr. Berwick was nominated in April, and that nomination was going nowhere. CMS needs a strong leader, which Dr. Berwick will be, and it needs it now.

So, pass the popcorn. This is going to be fun to watch for a few days.

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Anonymous paula said...

I've written about CER for KevinMD and Progress Magazine. It's a necessary evil that will make many people angry, but should save us all a lot of time and money, in the long run.

10:59 AM  

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