Donald Berwick: 5 Questions About Obama's Recess Appointment, Answered

The White House announced Tuesday evening that President Obama would be using a recess appointment to place Donald Berwick, the administration's nominee to lead the Centers for Medicare and Medicaid Services (CMS), in office. The position has been vacant since 2006, but the choice of Berwick has caused an uproar from Republicans, who by some accounts are using the confirmation process to reignite the health care debate.

Below, Surge Desk answers some of your questions about the contentious appointment.

1. Who is Donald Berwick?
Berwick, 63, is the president and CEO of the Institute for Healthcare Improvement, a nonprofit health care reform group, and a professor at Harvard. He is a pediatrician with an M.P.P. in addition to his M.D. He was appointed an Honorary Knight Commander of the British Empire by Queen Elizabeth II in 2005.

2. What are his positions on health care?
Berwick wants to improve the quality of health care and decrease its cost at the same time. He is passionate about the British health care system, having said he is "in love with the [National Health Service]" and that it is "a global treasure."

Berwick believes that, in terms of health care at least, wealth should be redistributed from the rich to the poor because the poor tend to be sicker and that market forces should not be used to steer medical care, according to the New York Times.

Berwick supports Comparative Effectiveness Research (CER), which is the study of health care treatments to see which options work best for which types of scenarios and patients. The economic stimulus bill carved out a whopping $1.1 billion for CER research. Supporters believe that CER will save money in the long run by cutting out expensive, ineffective medical options.

3. What do his opponents think?
Opponents of CER, and of Berwick, say it (and his appointment) will lead to the government's rationing of health care based on cost/benefit analyses of treatments. Berwick has said that rationing already occurs in society (as when insurance companies decide which procedures they will or will not pay for), but with CER those decisions will be more informed.

"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," he told the journal Biotechnology Healthcare last summer.

Other opponents simply don't want the government involved in their health care decisions at all.

4. What's a recess appointment?
The Constitution allows the president to appoint a senior federal official, normally subject to confirmation hearings in Senate, while the Senate is in recess. However, the Senate must confirm the appointment by the end of the next session of Congress. The Senate is currently in recess until July 12.

5. Why does this all matter?
Because Medicare and Medicaid are the largest purchasers of health care in the country, the CMS chief has a lot of say in the direction that health care takes in the country.