Medicare chief's controversial exit creates squabbles among Democrats

A prominent liberal lawmaker is suggesting that the Democrat-controlled Senate Finance Committee botched the nomination process for President Obama’s pick to head Medicare by failing to stand up for him.

“Quite frankly, I still think he should have had a hearing,” Sen. Tom Harkin (D-Iowa) told The Hill on the eve of Donald Berwick’s departure late last week.

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“If it had been in my committee, he would have had a hearing. I would let the Republicans make fools of themselves and I would have shown what credentials he has. And then let’s have a vote.”

The remarks highlight the tension between liberal members who championed Berwick and centrists worried that a hearing for the easily demonized nominee would have sparked a painful re-litigation of the healthcare reform debate ahead of the 2012 election. 

Finance Committee Chairman Max Baucus (D-Mont.) never scheduled a hearing for Berwick, leading Obama in July 2010 to give him a temporary recess appointment that expires at the end of this year.

Baucus’s office denounced any suggestion that the chairman was to blame for Berwick’s demise.

“There have never been 60 votes for Don Berwick, and Republicans have made clear he simply wasn’t getting through the Senate,” a Senate Democratic aide said in a statement.

“Given that the votes were never there, Democrats were 100 percent correct not letting Republicans turn the Berwick nomination into a circus where they attempt to torch healthcare yet again,” the aide said. “The end of Don Berwick’s tenure lies solely at the feet of Republicans, who made clear he was going nowhere from the start.”

Republicans, eager to suggest they had the upper hand, rushed to Baucus’s defense.

“Having a hearing would have been the stupidest thing Democrats could have done,” said a Senate Republican aide. Senators who believe otherwise “seem to be living in an alternative political reality.”

The Republican aide said it’s not just Democrats on the Senate Finance panel who would have been hurt by a Berwick hearing. Approval by the panel would have created overwhelming pressure on the full Senate to take a vote — potentially putting every centrist Senate Democrat up for reelection at risk in 2012.

Senate Republicans’ ability to block Berwick has been clear since March, when 42 of them signed a letter to the president urging him to withdraw Berwick’s nomination. The letter cited past statements that praised European-style universal healthcare, which Republicans have interpreted to suggest he favors rationing.

Obama, however, nominated Berwick in April 2010, creating a window of opportunity before Democrats lost six seats in the November 2010 elections. The White House has consistently called for the Senate to hold a confirmation hearing but has focused its criticism on Republican obstructionism.

Likewise, healthcare industry stakeholders and health policy experts have consistently stood by the nominee. As recently as March, four physician organizations and dozens of prominent physicians signed a letter to Obama urging him to weigh in with Senate leaders and urge them to hold a hearing.

“It is critically important that he have the opportunity to defend his record and share his views in full view of the public,” the letter said.

Sen. Olympia Snowe (Maine), a high-ranking Republican on the Finance Committee, said she hadn’t made up her mind about Berwick and would have welcomed a hearing.

“I think the hearings always serve a very vital public purpose,” she said. “You can then flesh out the issues and the concerns regarding a nominee … Sometimes when those issues are aired, you might come to a different conclusion. I would have certainly considered him.”

Harkin said Berwick was such a strong nominee that he would have turned the tables on his Republican critics.

“Don Berwick is such an accomplished person and so smart, it would not have been a circus,” Harkin said. “If the Republicans had tried to go after him, they would have made fools of themselves. That’s why I’m really disappointed he was never able to have a hearing and really lay his case out there and let the public see who this guy really is.”

But Sen. Orrin Hatch (Utah), the top Republican on the panel, said in February that a nomination hearing would have been “a waste of the committee’s time” because the votes weren’t there.

Some Republicans had clearly made up their minds from the get-go.

“As a patient in the United States, you may say: ‘Do I really want Dr. Berwick? Do I want somebody who favors the National Health Service of Britain, someone who says they have incredible respect for the way it works and thinks it is the right way to go?’ Would an American citizen want that person to be in charge of Medicare and Medicaid for this country?” Sen. John Barrasso (R-Wyo.) said on the Senate floor on May 12, 2010 — less than a month after Berwick was nominated.

During the same floor speech, Barrasso said Senate Minority Leader Mitch McConnell (R-Ky.) seemed “incredulous that we would be considering that sort of a system and that sort of a director for Medicare and Medicaid in this country” — to which McConnell answered, “Yes.”

Thomas Scully, who held Berwick’s job under President George W. Bush, said anyone nominated less than a month after passage of the bitterly contested healthcare reform law was sure to face long odds.

“It’s unfortunate; he’s a nice guy and did a very good job,” Scully told The Hill.

Berwick told MSNBC over the weekend that when he met Sen. Jon Kyl (R-Ariz.) for the first time, “his first words to me, right out of the box, were, ‘Dr. Berwick, I haven’t seen a single thing that you’ve said or written that I agree with.’

“That’s not a framework for a conversation,” Berwick said.



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