Dr. Donald Berwick, head of the Centers for Medicare and Medicaid Services, is facing a hot seat in Washington, D.C., tomorrow as he prepares for his first appearance in front of the U.S. Senate since a controversial recess appointment in July.
Republican senators, led by healthcare hawk Charles Grassley of Iowa, are gearing up to grill Berwick on a number of issues, according to the Politico website.
“Dr. Berwick was recess appointed before he had even a nomination hearing before the committee of jurisdiction,” Grassley told the website in prepared remarks. “The public doesn’t have any insight into his thinking on anything. The hearing will offer a chance to shed some light on what CMS is doing to prepare for some of the biggest changes in the history of modern health care. It’s overdue, and it should be the first of many.”
Berwick can expect versions of five basic questions tomorrow, according to Republicans interviewed by Politico:
- You’ve professed great admiration for Britain’s National Health Service. How have you helped shape that system and do you see it as model for the U.S. system?
Berwick, unlike some of his career-bureaucrat predecessors, is a professor at Harvard Medical School and Harvard School of Public Health in pediatrics and healthcare policy, respectively. He also co-founded the Institute for Healthcare Improvement. President Barack Obama’s nomination of Berwick as CMS administrator brought about a fervid addendum to the healthcare reform debate, as partisan Republican opposition threatened to derail the appointment. Obama’s use of a recess appointment to skirt the political battle to bypass the deadlock prompted attacks from the right of Berwick’s praise of the United Kingdom’s single-payer, publicly funded National Health Service. The attacks, based on an out-of-context aside, suggested that Berwick would "ration" healthcare. Berwick was given an honorary knighthood in 2005 for his efforts to improve the U.K.’s system.
“He’ll be asked about what exactly he did for the U.K. government to be knighted,” Mark Hayes, a former health policy adviser for Grassley, told Politico. “For him to have that level of recognition conveyed on him, people will want to know that.”
“We really want to get Dr. Berwick on the record explaining some of his past controversial statements. We’re going to be armed with a litany of op-eds he’s written and statements he’s made, and we’re going to be asking him about it,” added a Senate aide health policy aide.
- CMS actuary Richard Foster says healthcare reform will cut benefits and cost taxpayers. How can you and the Obama administration continue to defend the reforms on economic grounds?
Foster’s analyses, including his October estimate that some seniors will have “less generous benefit packages” under the new law, will certainly be an arrow in the Republican quiver as they look to challenge the Obama administration’s claims about the new law.
- How will $500 million in Medicare Advantage cuts affect the elderly?
Republicans are likely to use another weapon they found helpful during the mid-term elections: Reduced payments to privately-administered Medicare Advantage plans.
“Our members will be very curious to know how he plans to cut a half-trillion dollars from Medicare and still maintain benefits,” a Republican Senate aide told the website.
- Explain how you plan to implement the Independent Payment Advisory Board, Patient Centered Outcomes Research Institute and Center for Innovation. Why should these new bureaucracies stand between Americans and their doctors?
Republicans are already looking to undo some of the bureaucracies created by the Patient Protection and Affordable Care Act, introducing legislation in July to shut down the IPAB
“The Independent Payment Advisory Board is a government command-and-control bureaucracy that will dictate payment decisions and interfere with the best judgment of physicians and families,” Sen. Tom Coburn (R-Okla.) said at the time. “The task of repealing this misguided law begins here.”
- What is your vision for the U.S. healthcare system: What do you want to accomplish, how will you do it and why should we trust you?
“Dr. Berwick is a good man who wants to do the right thing, but he has a fundamentally different approach than Republicans,” a healthcare aide told Politico. “The natural tendency will be to vent some of the pent-up questions from the confirmation that never happened. But I think you’ll probably see senators be fairly strategic, try and not let that become the focus. He’s in charge now, so rather than examining ‘Is he qualified,’ it should be a lot of ‘Where are you going, and how will you get there?'”