Senator Max Baucus finally admitted what everyone has known for eight months. Donald Berwick cannot be confirmed as administrator of the agency that runs Medicare, Medicaid, and now private health insurance. Dr. Berwick was given a recess appointment as the country’s de facto health czar on July 7, 2010, after it became clear that confirmation by the Senate would be extremely difficult. Using a recess appointment to avoid a political confrontation limits Berwick’s term to the end of 2011 and sealed his fate. Even without the strong Republican showing in the November election, there was no chance that Berwick could be confirmed by the Senate after having avoided the inevitable grilling the first time.
Given the questionable political judgment displayed by the Obama White House throughout this affair, I offer some practical advice. First, consider what kind of job running the government healthcare financing agency (let’s call it HCFA for short—kind of catchy, don’t you think?) actually is. It’s not a place for the fainthearted or the inexperienced. Desiree Rogers need not apply. Second, consider how long that job might last. There’s an election next year, and we might get a new president. Even if Obama is re-elected, he is likely to have a new outlook on what Americans want the government to do with their healthcare. Foreclosing options, particularly at HCFA, would be a bad idea. Third, the vetting process that candidates go through before they can be nominated takes a tremendous amount of time and money. A new person is likely to still be struggling with disclosure forms and embarrassing questions well into next year, losing valuable time in an agency that touches all of our lives.
What, then, is a president to do? Simple. Go with someone who is already doing the job. Marilyn Tavenner is HCFA’s principal deputy and she was acting administrator for five months before Berwick arrived—and she can be acting administrator again without any new political problems. She’s a nurse, ran private hospitals, and was secretary of health in Virginia. Tavenner has a reputation for making the trains run on time, and she would be a steadying influence on an agency that has been in constant turmoil in this administration. More importantly, Tavenner would not act as if she has a mandate to upend the health system, because she doesn’t.
Okay, she’s a Democrat. But everyone has a flaw.