Barack Obama promised the most open and transparent administration in history. His vow didn't convince him to extend senators the courtesy of listening to their advice and consent on the nomination of Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services (CMS).
On Wednesday, White House Press Secretary Robert Gibbs defended the recess appointment of Mr. Berwick, saying, "This is somebody ... who all involved say is uniquely qualified." If that's so, then a friendly hearing in the Democratic-controlled Senate would be a slam dunk. After all, it's not like the $823 billion agency can't wait a few weeks for one more bureaucrat to join the 66 members of the senior executive service who currently manage CMS's 4,594 employees. This bureaucracy, where the average salary is $100,000, is used to waiting for confirmations; anarchy rarely ensues.
The White House obviously fears the embarrassment of exposing this nominee to a public examination. Dr. Berwick's 2008 remarks made in celebration of the 60th anniversary of Britain's National Health Service (NHS) are of particular interest. Although he acknowledged the nationalized system of doctors and health care providers faced a number of serious problems, the fundamental principle upon which the massive government program was based drew his enthusiastic endorsement.
"Any health care 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," Dr. Berwick said. "Excellent health care is by definition redistribution."
In Britain, the NHS uses 1.4 million government employees to redistribute medical care among the island nation's 61 million subjects. Perhaps Dr. Berwick imagines himself at the head of the 7 million employees that would be required to run a system on the same scale in America. That's more than the total who serve in any military in the world, including America, Britain and China combined. Dr. Berwick believes an army of public servants ought to operate health care under the banner of central planning. He dismissed the possibility that competition gives hospitals an incentive to produce higher quality goods and lower costs to attract patients.
"Please don't put your faith in market forces," Dr. Berwick urged his British comrades. "It is a popular idea that Adam Smith's invisible hand would do a better job of designing care than leaders with plans can do. I do not agree. I find little evidence anywhere that market forces bluntly used - that is, just consumer choice among an array of products with competitors fighting it out - leads to the health care system you want and need."
There's no mystery why the O Force is afraid to put the good doctor in front of a Senate panel. President Obama selected the man who best reflects his vision for Obamacare. Discussion of Dr. Berwick's anti-capitalist idealism and his statements about rationing care to those "at the end of life" at a public hearing would open the president's ultimate plans to public scrutiny. However painful, such an inquiry needs to take place.
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