WASHINGTON — Just because Congress passed a health care law, the fight isn't over.
Get ready for round two.
The confirmation hearings for Dr. Donald Berwick, the White House's choice to run Medicare, could turn into a proxy war over a debate that, while settled, left many Americans angry and confused.
"I think anyone who is close to this understands this debate is really not about Don Berwick, but the opportunity to re-litigate the underlying health care reforms," said John Rother, executive vice president for policy and strategy at the AARP. "In ordinary times, the nomination of somebody with Don's record and standing in the field would not be controversial."
Politically speaking, however, these aren't ordinary times. The health care overhaul passed on a largely party-line vote, and the bitterness and anger that punctuated the debate has colored the coming November battle for control of Congress.
Berwick, a Harvard professor of pediatrics, has been an outspoken critic of some aspects of the U.S. health care system. Allies call him a visionary for the work done by his Cambridge, Mass., policy organization, the Institute for Healthcare Improvement, to find ways to lower costs through better patient care and safety. One of his particular causes is reducing medical errors.
In 2002, Modern Healthcare magazine called him the third most powerful person in health care. He trailed only the secretary of Health and Human Services and the director of the Centers for Medicare and Medicaid Services, the position that President Barack Obama nominated him to take. The agency serves about 100 million people, a third of the U.S. population.
Berwick's critics, meanwhile, call him a "starry-eyed health guru."
They complain that he's lavished praise on Britain's government-run National Health Service, which makes them nervous. It's also fuel for continuing the Republicans' claim that the health care law amounts to socialism.
Critics also say Berwick supports the rationing of medical treatment, evoking last summer's controversy over "death panels."
"Dr. Berwick is the perfect nominee for a president whose aim has always been to save money by rationing health care," said Republican Sen. Pat Roberts of Kansas, calling Berwick "the wrong man, wrong time, wrong job."
However, Dr. Nancy Nielsen, a former president of the American Medical Association and a Berwick supporter, said the attacks were disingenuous because medical rationing occurs, whether critics choose to believe it or not.
"If you don't think there's rationing in this country, you haven't looked at what happens when you don't have money or insurance," she said.
Berwick hasn't commented about his nomination. A spokesman couldn't be reached for comment.
Rumors floated in recent days that Berwick might withdraw his name. The White House has denied it. However, the health care overhaul is still something of an open wound, and the political fallout is hard to gauge.
The Obama administration has been trumpeting the fact that seniors are just now beginning to see the checks for $250 promised by the health care law to plug the so-called "doughnut hole" in Medicare's prescription drug coverage.
Another battle looms in the Senate next week on whether it should follow the House and delay a scheduled cut in Medicare payments to doctors.
Democratic lawmakers might be getting nervous about yet another health care fight, this one over a nominee, who — despite widespread support from doctors, hospitals, medical schools, consumer groups and others — has become a political weapon in the hands of opponents.
The Senate Finance Committee hasn't scheduled confirmation hearings for Berwick. Roberts, who's on that panel, and other Republicans have promised to question him intensely on his views.
"My effort to warn the American people of the troubling nomination of an unabashed supporter of rationing to head CMS, the nation's leading purchaser of health insurance, is just that," he said. "Any added criticism of the health care reform bill that I voted against is unavoidable and, frankly, a bonus."
Critics have pointed to this Berwick comment about rationing: "The decision is not whether or not we will ration care. The decision is whether we will ration care with our eyes open."
However, they generally leave off the last sentence of the quote: "And right now, we are doing it blindly."
Here's what Berwick said to health care providers in December at the annual conference of the Institute for Healthcare Improvement:
"Over the next three years, reduce the total resource consumption of your health care system, no matter where you start, by 10 percent. Do that without a single instance of harm, without rationing effective care, without excluding needed services for any population you serve."
Berwick will also have to defend comments such as calling Britain's national health care system "a global treasure."
"We've got a problem with the health care system, but it's hard to believe that Americans would put up with an explicit rationing system that's become notorious in Great Britain," said Robert Moffit, a health policy expert at the conservative Heritage Foundation.
Berwick can count on some Republican support. Three former CMS directors who served under Republican presidents back his nomination.
"I'm sure people can go through Don's writing and pick on a lot of things," said Thomas Scully, who led the agency under President George W. Bush. "He's universally regarded and a thoughtful guy who is not partisan. I think it's more about ... the health care bill. You could nominate Gandhi to be head of CMS and that would controversial right now."
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