Thursday, July 22, 2010

Is having an opinion disqualifying for public service?

Many conservatives are up-in-arms about President Obama's decision to appoint Don Berwick, a pediatrician and renowned expert in quality improvement and patient safety, to lead the Center for Medicare and Medicaid Services (CMS). They object to Dr. Berwick's views on a range of issues, and to Obama's decision to use his office's authority to appoint Dr. Berwick while the Senate was out on a short Independence Day holiday recess. As a "recess appointment," Dr. Berwick was able to take office without Senate hearings and confirmation, but he can only serve through the end of the 111th Congress - that is, until the end of 2011 - unless ratified by the Senate.

Berwick, though, also has many supporters; Maggie Mahar articulates the "pro" viewpoint on Dr. Berwick's appointment in a recent Health Beat post. She observes that two former CMS administrators who served in Republican administrations have commented positively about Dr. Berwick's qualifications.

Dr. Berwick also is supported by the American Medical Association, AARP, and ACP, which said in a July 7 statement that, "Dr. Berwick's career and work at the Institute for Healthcare Improvement illustrates the drive to provide patient-centered care, patient safety, quality improvement, and care coordination in health care. He is well respected in the health-care community and known for his desire to bring constructive change to health care delivery. We share these objectives and believe Dr. Berwick will be an able Administrator and partner for change."

I think it is fair game to debate the views of individuals appointed to public office - it comes with the territory. I understand why Republicans object to Obama's decision to by-pass the usual Senate confirmation process, just as Democrats objected to President Bush's recess appointment of John Bolton as ambassador to the United Nations.

But I worry though that the hyper-partisan political environment makes it almost impossible to have a serious discussion about the views and qualifications of individuals nominated for public office. People who have a record of demonstrating leadership by taking (provocative) positions on the issues are dissuaded from seeking public service, and if they are nominated, they can expect to have everything they've said dissected, taken out of context, attacked and even ridiculed for political and partisan persons, no matter how strong their qualifications.

Democrats do this to appointees of Republican presidents, and Republicans do this to appointees of Democratic presidents, but I don't think the public benefits if we end up driving away or damaging the people who are most qualified to serve in public service roles, just because they had the audacity to challenge the status quo.

Bob Wachter, Associate Chairman of the Department of Medicine at the University of California, San Francisco makes this point effectively in his post in defense of Berwick's appointment:

"CMS's head honcho now needs to be someone with a point of view, passion, and a backbone. Although I guess there might be a healthcare version of Elena Kagan – a brilliant, charismatic leader who manages to come with a scanty written and oral footprint to be dissected and distorted – most healthcare folks with the Right Stuff will have a public record that illustrates that the person has periodically done battle with the status quo. I certainly hope so."

Think about the alternative: Do we really want government to be filled only with people who have no real record of having anything important to say?

I also believe that conservative presidents, by and large, should be able to appoint persons with conservative views, and liberal presidents should be able to appoint persons with liberal views, barring something in their record that says that they are unfit for office.

In the case of Berwick, it is hard to imagine anyone who could have had stronger credentials to champion innovations to improve patient safety, reduce medical errors, and promote patient-centered care. I personally don't agree with some of his views, including his overly-effusive praise of Great Britain's National Health Service, but he is undoubtedly qualified to serve as CMS administrator. He will bring to the agency the skills honed by a professional lifetime record of advocating for patient-centered care.

Today's question: What is your take on the controversy over Dr. Berwick's views and qualifications?

P.S. I have just joined the world of Twitter! You can follow me @BobDohertyACP!


Steve Lucas said...

I believe the real issue is that Dr. Berwick, while controlling a budget greater than any other government agency, was appointed without the confirmation called for by our laws.

Using John Bolton is a straw man argument since he did not control funding for the single largest part of our economy.

Dr. Berwick’s strengths and weaknesses should have been discussed in a public forum, regardless of the partisan politics, that seems to have degraded the debate in the halls of Congress to that of children in a sand box.

Steve Lucas

Arvind said...

Why am I not surprised by the list of organization that support Dr. Berwick's nomination? If the President had nothing to hide and truly meant what he said about transparency earlier, he would not have bypassed the Senate. This position affects the lives of millions of Americans directly; therefore this appointment is not only cowardly but poor judgment for those that support him and the President. One more time the ACP's mistake will adversely affect its constituent physicians.

Jay Larson MD said...

The irony is that a kid doctor is overseeing an insurance plan for seniors.

ryanjo said...

Dr. Berwick's views praising the UK's National Health Service are much more than a personal opinion. He has revealed an important bias toward state-run medical care, an opinion that most US physicians and their patients do not share. Nor does the government of the UK necessarily agree with him, as they have recently proposed sweeping changes to the structure of the NHS -- turning much of the decision-making back to physicians.

Maybe one of the questions that could have been asked of Dr. Berwick, had a public hearing been held, is how many decades will it take our government to take similar steps?

junebug388 said...

Hiring a pediatric public health academician to oversee Medicare is like hiring a roofer to paint your fence. I disagree that there is little track record to review. There is a 15 year paper trail of open hostility toward real physicians providing care, disdain for real patient choice and a whole list of personal agendas that he now has unelected authority to execute.
He has been involved directly with the failed policies of continuous improvement and national health prevention committee. In fact, except for the entertaining rhetoric and video clips as a paid speaker there are very few lasting accomplishments to note.
In spite of this , I remain open minded as my obligation to patients comes first.... even though Dr. Berwick feels my obligation to society comes first
Linda Ray, M.D.