GOP targets nominee to run health agency

Contends Berwick would ration care

Should he be confirmed, Donald Berwick would administer an agency with 4,500 employees and an annual budget of $780 billion. Should he be confirmed, Donald Berwick would administer an agency with 4,500 employees and an annual budget of $780 billion.
By Susan Milligan
Globe Staff / May 13, 2010

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WASHINGTON — Republicans have opened an assault on the nomination of Harvard professor Donald Berwick to lead the huge agency that runs Medicare and Medicaid, calling Berwick an advocate for “rationing’’ health care.

Berwick, a pediatrician and president of the Institute for Healthcare Improvement, a not-for-profit organization in Cambridge, is widely respected by many veteran policy officials across the political spectrum, who say he has a firm understanding of how to overhaul parts of the healthcare system that lead to excessive costs, waste, and poor health outcomes.

But GOP lawmakers are becoming increasingly vocal in their attacks on Berwick, citing his support of controlling costs and his statements praising aspects of the United Kingdom’s national health system. They contend his positions show that he would seek to transform US health care into a tightly controlled system, reducing patient choices and delaying treat ments.

Democrats believe Berwick will ultimately survive the nomination process, and no Republicans have said yet that they will vote against him.

But the GOP’s senators are making it clear they plan to turn Berwick’s confirmation hearings into a forum for continuing debate over the newly-minted health care overhaul law. Republicans believe hammering at the law will help them win seats in the fall’s midterm elections.

Senate Republican leader Mitch McConnell of Kentucky said on the Senate floor last night that Berwick is an “expert on rationing.’’

By lauding the United Kingdom’s National Health System, McConnell said, Berwick “is applauding a system where care is delayed, denied, or rationed.’’

Republican Senators John Barrasso of Wyoming and Pat Roberts of Kansas said Berwick’s focus on reducing costs could damage rural health systems.

“I can see a time when the rural health care system will consist of a Band-Aid and a bedpan,’’ said Roberts, who met with Berwick yesterday. “Most of us will agree that he is the wrong man, wrong time, wrong job.’’

Should he be confirmed, Berwick would administer an agency with 4,500 employees and an annual budget of $780 billion. Tasked with providing government health insurance programs for the elderly, the poor, and the disabled, CMS will be a critical player in the health care overhaul law, which includes a massive expansion of Medicaid for low-income people.

The law requires more than $400 billion in cuts to Medicare over the next 10 years, a hefty sum for a program whose 2009 budget was about $500 billion. The Obama administration contends that the cuts can be made through program efficiencies, but Republicans contend that seniors will be harmed.

Berwick declined comment prior to his hearings. White House press secretary Robert Gibbs dismissed the charges against Berwick as political.

“I don’t doubt that those who oppose health care reform are going to continue to make the same tired, old arguments that have been made for years and years as it relates to health care,’’ Gibbs said.

“I think he’ll be confirmed,’’ said Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, which will hold confirmation hearings that have yet to be scheduled. But “there are going to be some people who will bring up a lot of [questions] to re-litigate the health care debate.’’

In his writings, Berwick has underscored the general need for cost controls, and has backed the “pay for performance’’ model of health care instead of the more prevalent “fee for service’’ structure. Critics charge that paying for performance — meaning that hospitals and doctors are rewarded for providing better, more efficient care, rather than ordering lots of tests — can result in denial of certain treatments.

Berwick’s defenders say his words are being distorted, painting him as someone who wants to cut health care instead of trim escalating health care costs.

“They [Republicans] think they can demonize him, and demagogue the Medicare issue to scare people into thinking that he or the administration is an advocate of rationing or ‘death panels’ or whatever hits the one-liner,’’ said Chris Jennings, a veteran health care analyst who was senior health care adviser to President Clinton.

A recent paper prepared by the Senate’s Republican Policy Committee, a GOP study group, signaled the line of attack, saying Berwick wants to take the nation toward rationing as “part of the Democrats’ brave new health care world.’’

A graduate of Harvard College and Harvard Medical School, the 63-year-old Berwick, who lives in Cambridge, is a professor at both Harvard Medical School and the Harvard School of Public Health. In addition to his job running the 111-employee Institute for Healthcare Policy Improvement, he is a consultant in pediatrics at Massachusetts General Hospital.

So far, no industry groups have marshaled forces to defeat his nomination. Senator Scott Brown, a Massachusetts Republican, has not decided how he will vote, a spokesman said, while Senator John F. Kerry, a Bay State Democrat, has been a Berwick supporter.

Republicans also must weigh the political fallout of targeting Berwick for defeat while the Senate is considering the much higher-profile nomination of Elena Kagan to the Supreme Court.

“There’s no issue here with his talent, him personally, his skills, or his academic credentials,’’ said Bob Moffett, a health care specialist with the conservative Heritage Foundation. “He could be the greatest thing since Albert Einstein, and the hearings are going to be difficult, because they are going to ask him some very serious questions about the bill.’’