Republicans vs. Medicare Chief: Over Before It Starts?

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It can't be easy for Dr. Donald Berwick, the current head of the Centers for Medicare and Medicaid Services, constantly being vilified by the President's conservative critics but not able to respond and defend his reputation.

Thanks to his past criticism of the free market's effect on the U.S. health care system, Republicans have charged that Berwick intends to ration Medicare coverage, limiting patients' ability to control their own care and coldly doling out treatments to patients based solely on government revenues and expenditures. So Berwick has been called Obama's "rationer-in-chief." Conservative columnists have warned that a Berwick tenure will bring socialized medicine to the U.S. His name has been used in speeches on the Senate floor to evoke the deepest fears of America's seniors — that their life and death health care decisions will be made by bureaucrats focused only on the bottom line.

And all along Berwick — who will play a central role in implementing the new Affordable Care Act and who was given a temporary, recess appointment back in July because the White House didn't want to keep defending its health care plan — has had to just sit there and take the abuse. Cloistered by a White House seeking to move the national conversation away from health reform, Berwick, a soft-spoken pediatrician who insists everyone call him Don, has given no major media interviews since assuming his new post. Until Wednesday, the Administration had not even let him face his critics in Congress publicly.

Yet as it turned out, even that face-to-face confrontation didn't allow either side to really have its say. Instead, the CMS chief's first public appearance on Capitol Hill was as a bit player in political theater choreographed and then cut short by Max Baucus, the Democratic chairman of the Senate Finance Committee.

The hearing lasted only about 80 minutes, and there was not much opportunity to explore the key facets of Berwick's new job, in which he could determine - through changes in the Medicare payment system - if health care reform truly slows the growth of medical costs. At the hearing, there was not much time to figure out how the sweeping new reform law will impact the ability of seniors to find doctors when Medicare reimbursements are cut. There wasn't time to dig into how a huge expansion of Medicaid will affect states. The hearing was so stunted that Britain's National Health Service — a socialized system which Berwick has been heavily criticized for praising — didn't come up once.

Baucus and Ranking Republican Chuck Grassley gave brief opening statements, followed by a statement from Berwick, in which he outlined his broad goals for CMS. (The agency has an annual budget of about $750 billion, providing insurance for some 100 million Americans.) After this, senators on the committee were allowed five minutes each to ask questions.

Republican Sen. Orrin Hatch remarked that this was "like asking us to drain the Pacific Ocean with a thimble." Democrats, not surprisingly, lobbed softball questions at Berwick. The Affordable Care Act will better measure clinical outcomes, noted Sen. Jeff Bingaman. What did Berwick think of that? How will new bonus payments in Medicare Advantage make the program work better, Sen. Ron Wyden wanted to know. What would happen to seniors' drug costs if the new extra coverage for seniors' drug costs was repealed, asked Sen. Debbie Stabenow.

Republicans, meanwhile, spent much of their time complaining that they didn't have enough time to properly question Berwick. "This is pathetic," said Hatch, "My gosh, we ought to have time to ask the most important man in America on health care questions that are relevant and important." Grassley opened his questioning period by asking Berwick if he would commit to coming back for another hearing.

Baucus intervened before Berwick could answer. "That's really the prerogative of the chair," he said, adding that while he couldn't guarantee there would be another hearing, "It is my intention to have a good number of hearings."

Despite the truncated session and the White House's previous reluctance to let its new CMS chief step out of the shadows, Berwick seemed far from a reluctant witness. A veteran expert on health care policy and popular lecturer who published a book in 2004 consisting purely of his most notable speeches, Berwick spoke at a clear and rapid clip when questioned. It was as if he was trying to squeeze as much information in as possible before he was hushed up again.

When, in the course of asking a question about rewarding patients whose lifestyle choices keep them healthy, Republican Sen. John Ensign mentioned that the Department of Health and Human Services hadn't been very forthcoming with its data, Berwick extended an unsolicited offer of help. "By the way," he said, "if you're having trouble with a response to an issue as important as that, please let's deal with that afterward. I'd be happy to look into further and work with you on that." Several times Baucus prodded Berwick to wrap up his answers so the hearing could conclude on time.

It emerged in the hearing that Berwick has met with Ensign and Grassley personally in their offices. In fact, Berwick said he has met privately with any member of Congress who's asked him.

While it's not clear if Berwick will face a more lengthy Senate hearings anytime soon, he's sure to be called before committees in the House once Republicans assume their majority in that chamber.

At Wednesday's hearing, Republican Sen. Jim Bunning, who's retiring, warned Berwick of this. "I can assure you that you will not get special treatment next year," said Bunning. "You will get open and transparent and it will be on the other side of the house. They will see to it that you are open and transparent."

The White House is likely dreading this prospect. It's unknown if the much-maligned Berwick feels the same way.