Rep. Pence: Medicare Chief Berwick ‘Not Entitled to That Job,’ Must Explain Praise for UK ‘Socialist Health Care System’

By Adam Cassandra | July 27, 2010 | 9:22 PM EDT

This undated handout provided by Goodman Media International, Inc., shows Donald Berwick. President Barack Obama is planning to appoint the head of Medicare and Medicaid without Senate hearings. Obama intends to use a so-called recess appointment to put Berwick in charge of the Centers for Medicare and Medicaid Services, a White House official said Tuesday night. (AP Photo/ Goodman Media International, Inc.)

Washington ( – Rep. Mike Pence (R-Ind.) says he is concerned about the prospect of health care rationing following the recess appointment of Dr. Donald Berwick to serve as the administrator of the Centers for Medicare and Medicare Services.

Pence, speaking Tuesday at a Congressional Health Caucus event, said Berwick was “not entitled to that job” and should have had a confirmation hearing. 
“I think an appointment of such magnitude, at a time of enormous public debate, as a recess appointment was wrong,” Pence told  “I think it was wrong for the president to bypass the confirmation process at a time when the American people are so focused on legislation where the ink is barely dry.
“I also believe, as a part of those confirmation hearings, Dr. Berwick would certainly have an opportunity to explain why he referred to the British socialist health care system as ‘a global treasure,’” said Pence.

“Now, he’s certainly entitled to his opinion, but he’s not entitled to that job,” Pence said,  “and I expressed great disappointment that the president used a congressional recess to bypass what had the potential to be a very helpful and informative confirmation process, and a critical part of the national debate.”
As previously reported, Dr. Berwick praised Britain’s National Health Service in a July 2008 speech at Wembley Stadium, saying he was “a romantic about the National Health Service,” and that “any health care funding plan that is just, equitable, civilized and humane must – must -- redistribute wealth from the richer among us to the poorer and the less fortunate.” 
In that same speech, Berwick said, “Excellent health care is by definition redistributional. Britain, you chose well.”
At a Capitol Hill press conference on Tuesday about health care, Pence said, “At the very core of this debate, it’s about who decides.  The very core of this debate is about who makes decisions about resources that are deployed in the most precious area of our lives.”
Pence also said that the new health care reform law adds $2.5 billion to a Comparative Effectiveness Research (CER) board that he said is meant to ration care.  The CER program was established by the American Recovery and Reinvestment Act of 2009, which provided $1.1 billion for research and development in the area of CER.
“On the subject of rationing, Obamacare actually adds $2.5 billion for comparative effectiveness research with the Comparative Effectiveness Research Board,” Pence said. “This board will determine the type and quantity of medical care coverage Americans will get. It’s modeled after the British system that rations health care.” 
Pence then pointed out how Berwick called the British system “a global treasure” in the past.
In a June 2009 interview, Dr. Berwick was asked if a federal CER agency should get involved in cost determinations.
“You can say, ‘Well, we shouldn’t even look.’ But that would be irrational,” Berwick said.  “The social budget is limited --  we have a limited resource pool.  It makes terribly good sense to at least know the price of an added benefit, and at some point we might say nationally, regionally, or locally that we wish we could afford it, but we can’t.”
“We have to be realistic about the knowledge base,” said Berwick. “The degree to which that is linked directly to policy and decision is a matter of choice.  You could make it advisory, or you could make it mandatory, or you could make it a policy rule. But to remain ignorant of the cost implications of a drug that is marginally better than what is already out there is simply bad policy.”
Berwick also said, “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.”
However, in the same June 2009 interview, Berwick did say that mandatory compliance with CER directives could be dangerous if physicians, payers, and patients are not able to use their own judgment. also asked Rep. Pence on Tuesday if Senate Republicans should filibuster any and all legislation until a confirmation hearing is held for Berwick.  The Republicans, having 41 seats in the Senate, could filibuster any legislation and demand that a hearing be held for Berwick.
“I’ve never succeeded in getting a senator to do anything since I’ve been here, so I generally don’t make recommendations to them,” Pence told  “But I will just say the administration was wrong to make a recess appointment in that position.”
Senate Minority Leader Mitch McConnell (R-Ky.) called President Obama’s recess appointment of Berwick on July 7 “outrageous” on the Senate floor, after the appointment.
“This has been the administration’s approach all along: go around the American people, and now go around Congress,” McConnell said.  “The administration can try to blame Republicans for a debate they don’t want to have. But by denying Congress the ability to scrutinize this nominee, it only raises Americans’ suspicions about its health care plan and increases the burden on Democrats who supported it.”
Because of Obama’s recess appointment, Berwick can serve as the CMS administrator until December of 2011 without being confirmed by the Senate.