Maggie Mahar on the Fall of Berwick

Maggie Mahar — the smartest left-of-center writer on health policy today, in our view — outlines the fall of Don Berwick as charted over the past few weeks in a very thorough post today. Mahar is a health policy expert and a Berwick supporter — not a political insider — and assesses Berwick’s prognosis at CMS from that perspective, with insights from an administration insider. A few excerpts:

But first, is there any way that Berwick can hang on? Today, Reid Cherlin, a White House spokesman, told the New York Times that the president would not withdraw the nomination. “The president nominated Don Berwick because he’s far and away the best person for the job, and he’s already doing stellar work at C.M.S.” But, the Times added, “It is not clear whether the White House will fight for the nomination or press the Finance Committee to hold a confirmation hearing, which could provide Republicans another opportunity to criticize the new health law.”

Mahar asks her source whether it’s possible Berwick could survive, prompting laughter:

“I don’t think he’s going to stay. The Congressional conservatives think they got screwed in the sense that he was a ‘recess appointment’ and they didn’t have a chance to vote on him. . . . I think the administration doesn’t want it to look as if they are abandoning him, but . . .” If Berwick’s backers in the Senate don’t have 60 votes, the White House may not have a choice.

Noting the same loophole that we did yesterday — that Berwick could technically be recess-appointed again, but only if he served in an unpaid capacity — Mahar notes that this would further restrict his ability to impact CMS.

But would an unpaid recess appointee have the power to do the job at the Centers for Medicare and Medicaid (CMS). “He wouldn’t have any authority,” my source said flatly. “They’d skewer him.”

Mahar urges her readers at the end of the piece to contact the 42 Senate Republicans to support Berwick, but the line has been drawn, and there’s unlikely to be any movement on this front in the direction of the White House.