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Berwick appointed to CMS during summer recess

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President Barack Obama nominated Donald Berwick to head the Centers for Medicare and Medicaid Services, the first confirmed leader in this role since 2006. Berwick has been an outspoken critic of waste and inefficiency.

If the main objective of health reform is to lower expenditures while expanding access and improving quality of care, Donald Berwick is well-suited to play a lead role in the effort.

Despite its importance, CMS has not had a confirmed leader since 2006, when Mark McClellan left the job after establishing the Medicare drug benefit. Democrats stymied confirmation of the next Bush administration nominee, Kerry Weems, and Obama delayed naming someone to the job last year for fear it would detract from health reform legislation.

Yet, the new CMS chief also raised a lot of eyebrows by voicing admiration for the British national health system and by acknowledging that efforts to reduce healthcare spending will involve some kind of rationing and cost controls. He is a fan of managed care in principle, but highly critical of MCOs that he says just "manage money" and don't provide quality care.

Republicans seized these comments, calling them evidence that the real intent of "Obamacare" is to establish a government-run system. Critics also noted that Berwick has little experience running large organizations like CMS, with its annual budget of $800 billion.

Even so, Berwick has full authority over CMS for a limited tenure, during which he will be positioned to defend administration reforms. As a recess appointee, though, his term will end when Congress adjourns in late 2011, unless renominated by the White House.

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