Health care official stays cool amid GOP grilling

Defends system to critics bent on revising it

‘The Affordable Care Act is the right solution ‘The Affordable Care Act is the right solution
By Mark Arsenault
Globe Staff / February 11, 2011

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WASHINGTON — House Republicans peppered Donald Berwick, a former Harvard professor, with barbed questions yesterday over his previous statements on patient care and his leading position in rolling out President Obama’s new health care law.

In Berwick’s maiden appearance before a hostile majority on the Republican-controlled House Committee on Ways and Means, the GOP pounded the top administrator for the Centers for Medicare and Medicaid Services over his previous praise of the British single-payer health care system. GOP members also argued stridently that Obama’s health care overhaul is prompting doctors to drop Medicare patients and denying seniors choices in their care.

But in two hours of often-tense testimony, Berwick staunchly defended the health care law. Repeatedly, he insisted the law will control rising medical costs, reduce waste and abuse, provide security to seniors, and expand preventative care that will head off many expensive medical problems and save money.

“I’ve never been more optimistic about the health care system in our country,’’ he said.

He tried to blunt Republican criticisms, citing what he said are new data showing that premiums for Medicare Advantage plans have dropped and that plan enrollment has risen by 6 percent for 2011. Some analysts have predicted that interest in the privately run program would fall as the government prepares to cut reimbursement rates as part of the overhaul.

Berwick, a pediatrician, is a lightning rod for conservative criticism of the president’s sweeping health care law, known as the Affordable Care Act. Many Republicans insist he favors government solutions over harnessing the competitive marketplace to improve health care. To get around Republican resistance to Berwick’s nomination, Obama bypassed the Senate confirmation process last year and placed Berwick into his current post with a recess appointment, further inflaming opponents.

Obama last month resubmitted Berwick’s nomination for a formal confirmation to head the agency, which oversees medical programs for seniors and low-income Americans. A hearing date has not yet been set.

Berwick, who ran the Cambridge-based Institute for Healthcare Improvement, has consulted on health care issues around the world, concentrating on the thorny issues of improving quality and eliminating medical errors while lowering costs. His nomination to his current post was supported by the American Medical Association and the AARP, the seniors’ lobbying group.

The House Ways and Means hearing with Berwick is the latest high-profile effort by Republicans to attack the health care law, which they have pledged to undo. House Republicans have approved a bill to repeal the law, but it was defeated on a party-line vote in the Democrat-controlled US Senate.

Under often sharp questioning yesterday, Berwick was unflappable and exuded enthusiasm for the health care law, while frustrating Republicans by refusing to offer a “yes’’ or “no’’ answer to many questions.

In one exchange, committee chairman Dave Camp, a Michigan Republican, pressed Berwick repeatedly on his past praise for health care in England.

“Is the British health care system a good model?’’ Camp asked.

“The American health care system needs an American solution,’’ Berwick replied.

Camp persisted: Do you still think a government-run single-payer system is the best option?

“I believe the Affordable Care Act is the right solution for America,’’ said Berwick.

“If I could have a simple yes or no answer?’’ Camp pleaded. He didn’t get one.

A frustrated Representative Tom Price, Republican of Georgia, accused Berwick of ducking direct questions. “I think you missed your calling,’’ Price told Berwick. “You would have made a great lawyer.’’

Throughout the hearing, the Republican committee members and Berwick seemed to be describing two different worlds: The GOP cited complaints from constituents and doctors that the new law is forcing people out of existing coverage that they like; Berwick insisted he speaks regularly with patients, physicians, and business owners who are excited about the changes.

Despite the wide disagreement, several points of harmony emerged. Berwick said he “abhors’’ the rationing of medical care and promised that no bureaucrats will interfere with treatment decisions. “Government has no role at all in the encounter between doctor and patient,’’ said Berwick.

He said he supports medical liability reform, a longtime Republican goal, though he declined to endorse specific provisions. The president, in his State of the Union speech last month, invited Republicans to work with him on liability reform.

Democrats on the committee offered Berwick repeated openings to defend the law.

Under questioning by US Representative Richard Neal, a Springfield Democrat, Berwick said that the most controversial provision of the new law — the requirement that nearly everyone have health care coverage by 2014 — is necessary because the law also prohibits insurance companies from refusing to sell insurance to people who have preexisting condition.

Without the mandate to recruit many more healthy bodies into the insurance pool, some people would merely wait until they got seriously hurt or ill to buy insurance, Berwick said, which would cause rates to rise astronomically.

“It’s mathematically true,’’ he said.

Mark Arsenault can be reached at