With the recess appointment this week of Dr. Donald Berwick to head CMS, Obama stuck his thumb once again in our country’s eye, demonstrating what kind of American president he intends to be – more imperial than representative; more a ruler than a governor, more the lawgiver than his party’s legislative agenda leader.
His first “in your eye” moment was the ramming through of his unpopular ObamaCare, for which the only bipartisanism was in its opposition. It remains to be seen whether his individual mandate, whose constitutionality has yet to be tested, will give him his third opportunity to show that when it comes to running America, he’s in charge.
Senator John Barrasso, an orthopedic surgeon from Casper, Wyoming commented on Obama’s recess appointment: "I think this was his intention all along." Perhaps so. Why otherwise would a nominee who was only put forward a few months ago, who was in the process of preparing his responses to the hearing committee’s questionnaire and the information it requested, whose hearings had not even been scheduled and, therefore, faced no opposition yet, suddenly be given a recess appointment when Congress goes on a break of less than two weeks?
Dan Pfeiffer, White House communications director, posted a possible answer Tuesday on the White House blog:
"With the agency facing new responsibilities to protect seniors' care under the Affordable Care Act, there's no time to waste with Washington game-playing. That's why tomorrow the president will use a recess appointment to put Dr. Berwick at the agency's helm and provide strong leadership for the Medicare program without delay."
So compliance with Article II, Section Two of the U.S. Constitution is playing games? The Advise and Consent provision says:
“[The President] shall have Power, [to] nominate, and by and with the Advice and Consent of the Senate, shall appoint … public Ministers and Consuls, … and all other Officers of the United States, whose Appointments are not herein otherwise provided for….”
This doesn’t sound like “playing games,” unless, like Pfeiffer, you consider the Constitution an “oh so ‘yesterday’” document that gets in the way when the big boys are trying to get government done.
Apparently Obama & Company were planning to blame the Republicans for making the recess appointment necessary … until Senator Max Baucus, Democrat Chairman of the Finance Committee, opened his mouth: “Senate confirmation of presidential appointees is an essential process prescribed by the constitution that serves as a check on executive power and protects . . . all Americans by ensuring that crucial questions are asked of the nominee — and answered.”
Senator Chuck Grassley, Baucus’ Republican counterpart on the Committee, had added to Berwick’s homework assignment a request for information about the Institute for Healthcare Improvement – a non-profit founded by Berwick ten years ago. After years of receiving about $600,000 in income from the IHI, it suddenly quadrupled his income to about $2.3 million in 2008 – a year in which IHI revenues fell $7 million and it produced a deficit of over $600,000. It could be that there is nothing there, but a lot of money orbits around and through the foundation, and Grassley was right to pursue it even when questions about the IHI were not on Berwick’s questionnaire.
Berwick and the IHI have also been associated with controversial assertions about the efficacy of their research and outcomes in the so-called 100,000 Lives Campaign, claiming to have prevented over 100,000 deaths among inpatient hospitalizations. The methodology has been widely criticized, and one assessment is surprisingly frank in its judgment:
“We do not see ourselves as “cynics” accusing hospitals of “manipulating” their data but rather as students of epidemiology and evidence-based methods who know that humans, working with a predetermined belief (and hope) that a practice works and with an incentive system that rewards positive findings, are capable of producing biased results in ways that neither they nor investigators are even aware of or can anticipate. The rationale for controlled studies, audited data, and other accepted scientific methods is to protect not against fabrication but against the more subtle biases that can contaminate the work of well-meaning, honest individuals who deeply believe in what they are doing.”
Dr. Berwick apparently never planned to hold a public policy level position during his career, because he has been impolitic over the years with his public remarks and writings, to wit:
"I am romantic about the National Health Service," he told a London audience in 2008, referring to the British single-payer system. "I love it," going on to call it "such a seductress" and "a global treasure."
“Most people who have serious pain do not need advanced methods; they just need the morphine and counseling that have been around for centuries"
“Any healthcare funding plan that is just, equitable, civilized, and humane must … must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent healthcare is by definition redistributional”
In his 1996 book New Rules, Dr. Berwick theorized that the primary goal of healthcare regulation is "to constrain decentralized, individual decision making" and "to weigh public welfare against the choices of private consumers."
During a time when a majority of Americans want ObamaCare repealed, perhaps these and other radical remarks that Berwick has made during his career, coupled with Grassley’s nosing around the IHI was sufficient handwriting on the wall to cause TeamObama to exploit the fact that Congress was out of town and take the flack for making a recess appointment. Article II, Section Two of the Constitution further says:
“The President shall have Power to fill up all Vacancies that may happen during the Recess of the Senate, by granting Commissions which shall expire at the End of their next Session.”
Madison’s notes taken during the Constitutional Convention are silent as to the Founder’s motives in the recess appointment clause. But keep in mind that 18th century America was agrarian and the Founders realized that those in government had farms to care for that would take them home for longer periods than they would be in the halls of government. It made sense that the President had to keep the government running under these conditions. The recess clause was not meant for times when Congress went home for an extended weekend.
So Obama has his man in office until the end of 2011. With Berwick, Obama now has a like-minded lieutenant who will be fanatically committed to transform American healthcare into a top down, government run system.
"Please don't put your faith in market forces," Berwick wrote a couple of years ago. "It's a popular idea: that Adam Smith's invisible hand would do a better job of designing care than leaders with plans can. I find little evidence that market forces relying on consumers choosing among an array of products, with competitors fighting it out, lead to the healthcare system you want and need."
However, both men have to consider in their political calculus the possibility, if not the likelihood, that the House will be lost to the Republicans this fall. Republicans will gain seats in the Senate, not likely a majority, but enough to force the Democrats to come courting in order to get the Democrat agenda passed. And unlike previous mid-term elections, between this November and next January a lot of important legislation will be shoved into the lame duck session.
In by-passing the Senate hearing, Obama assures that Berwick will face even tougher scrutiny if he is nominated again after his recess term ends in 2011. Senators have thin skins when treated as if they are insignificant – even the Democrat types. And Berwick arrives on his new assignment much like John Bolton did when Bush appointed him to the UN post – as damaged goods. There is a patina that a confirmed candidate gets which one appointed in recess lacks. Berwick will lack stature with his CMS staff and in his relations with Congress.
His first “in your eye” moment was the ramming through of his unpopular ObamaCare, for which the only bipartisanism was in its opposition. It remains to be seen whether his individual mandate, whose constitutionality has yet to be tested, will give him his third opportunity to show that when it comes to running America, he’s in charge.
Senator John Barrasso, an orthopedic surgeon from Casper, Wyoming commented on Obama’s recess appointment: "I think this was his intention all along." Perhaps so. Why otherwise would a nominee who was only put forward a few months ago, who was in the process of preparing his responses to the hearing committee’s questionnaire and the information it requested, whose hearings had not even been scheduled and, therefore, faced no opposition yet, suddenly be given a recess appointment when Congress goes on a break of less than two weeks?
Dan Pfeiffer, White House communications director, posted a possible answer Tuesday on the White House blog:
"With the agency facing new responsibilities to protect seniors' care under the Affordable Care Act, there's no time to waste with Washington game-playing. That's why tomorrow the president will use a recess appointment to put Dr. Berwick at the agency's helm and provide strong leadership for the Medicare program without delay."
So compliance with Article II, Section Two of the U.S. Constitution is playing games? The Advise and Consent provision says:
“[The President] shall have Power, [to] nominate, and by and with the Advice and Consent of the Senate, shall appoint … public Ministers and Consuls, … and all other Officers of the United States, whose Appointments are not herein otherwise provided for….”
This doesn’t sound like “playing games,” unless, like Pfeiffer, you consider the Constitution an “oh so ‘yesterday’” document that gets in the way when the big boys are trying to get government done.
Apparently Obama & Company were planning to blame the Republicans for making the recess appointment necessary … until Senator Max Baucus, Democrat Chairman of the Finance Committee, opened his mouth: “Senate confirmation of presidential appointees is an essential process prescribed by the constitution that serves as a check on executive power and protects . . . all Americans by ensuring that crucial questions are asked of the nominee — and answered.”
Senator Chuck Grassley, Baucus’ Republican counterpart on the Committee, had added to Berwick’s homework assignment a request for information about the Institute for Healthcare Improvement – a non-profit founded by Berwick ten years ago. After years of receiving about $600,000 in income from the IHI, it suddenly quadrupled his income to about $2.3 million in 2008 – a year in which IHI revenues fell $7 million and it produced a deficit of over $600,000. It could be that there is nothing there, but a lot of money orbits around and through the foundation, and Grassley was right to pursue it even when questions about the IHI were not on Berwick’s questionnaire.
Berwick and the IHI have also been associated with controversial assertions about the efficacy of their research and outcomes in the so-called 100,000 Lives Campaign, claiming to have prevented over 100,000 deaths among inpatient hospitalizations. The methodology has been widely criticized, and one assessment is surprisingly frank in its judgment:
“We do not see ourselves as “cynics” accusing hospitals of “manipulating” their data but rather as students of epidemiology and evidence-based methods who know that humans, working with a predetermined belief (and hope) that a practice works and with an incentive system that rewards positive findings, are capable of producing biased results in ways that neither they nor investigators are even aware of or can anticipate. The rationale for controlled studies, audited data, and other accepted scientific methods is to protect not against fabrication but against the more subtle biases that can contaminate the work of well-meaning, honest individuals who deeply believe in what they are doing.”
Dr. Berwick apparently never planned to hold a public policy level position during his career, because he has been impolitic over the years with his public remarks and writings, to wit:
"I am romantic about the National Health Service," he told a London audience in 2008, referring to the British single-payer system. "I love it," going on to call it "such a seductress" and "a global treasure."
“Most people who have serious pain do not need advanced methods; they just need the morphine and counseling that have been around for centuries"
“Any healthcare funding plan that is just, equitable, civilized, and humane must … must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent healthcare is by definition redistributional”
In his 1996 book New Rules, Dr. Berwick theorized that the primary goal of healthcare regulation is "to constrain decentralized, individual decision making" and "to weigh public welfare against the choices of private consumers."
During a time when a majority of Americans want ObamaCare repealed, perhaps these and other radical remarks that Berwick has made during his career, coupled with Grassley’s nosing around the IHI was sufficient handwriting on the wall to cause TeamObama to exploit the fact that Congress was out of town and take the flack for making a recess appointment. Article II, Section Two of the Constitution further says:
“The President shall have Power to fill up all Vacancies that may happen during the Recess of the Senate, by granting Commissions which shall expire at the End of their next Session.”
Madison’s notes taken during the Constitutional Convention are silent as to the Founder’s motives in the recess appointment clause. But keep in mind that 18th century America was agrarian and the Founders realized that those in government had farms to care for that would take them home for longer periods than they would be in the halls of government. It made sense that the President had to keep the government running under these conditions. The recess clause was not meant for times when Congress went home for an extended weekend.
So Obama has his man in office until the end of 2011. With Berwick, Obama now has a like-minded lieutenant who will be fanatically committed to transform American healthcare into a top down, government run system.
"Please don't put your faith in market forces," Berwick wrote a couple of years ago. "It's a popular idea: that Adam Smith's invisible hand would do a better job of designing care than leaders with plans can. I find little evidence that market forces relying on consumers choosing among an array of products, with competitors fighting it out, lead to the healthcare system you want and need."
However, both men have to consider in their political calculus the possibility, if not the likelihood, that the House will be lost to the Republicans this fall. Republicans will gain seats in the Senate, not likely a majority, but enough to force the Democrats to come courting in order to get the Democrat agenda passed. And unlike previous mid-term elections, between this November and next January a lot of important legislation will be shoved into the lame duck session.
In by-passing the Senate hearing, Obama assures that Berwick will face even tougher scrutiny if he is nominated again after his recess term ends in 2011. Senators have thin skins when treated as if they are insignificant – even the Democrat types. And Berwick arrives on his new assignment much like John Bolton did when Bush appointed him to the UN post – as damaged goods. There is a patina that a confirmed candidate gets which one appointed in recess lacks. Berwick will lack stature with his CMS staff and in his relations with Congress.
After the 2010 election Obama and Berwick will likely look at each other and realize they aren’t in Kansas anymore. Therefore the recess appointment of Dr. Berwick could prove to be a Pyrrhic victory.
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