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Public Service: Does Having An Opinion Disqualify You?

Many conservatives are up-in-arms about President Obama’s decision to appoint Don Berwick, a pediatrician and renowned expert in quality improvement and patient safety, to lead the Center for Medicare and Medicaid Services (CMS). They object to Dr. Berwick’s views on a range of issues, and to Obama’s decision to use his office’s authority to appoint Dr. Berwick while the Senate was out on a short Independence Day holiday recess. As a “recess appointment,” Dr. Berwick was able to take office without Senate hearings and confirmation, but he can only serve through the end of the 111th Congress — that is, until the end of 2011 — unless ratified by the Senate.

Berwick, though, also has many supporters. Maggie Mahar articulates the “pro” viewpoint on Dr. Berwick’s appointment in a recent Health Beat post. She observes that two former CMS administrators who served in Republican administrations have commented positively about Dr. Berwick’s qualifications.

Dr. Berwick also is supported by the American Medical Association (AMA), AARP, and ACP, which said in a July 7 statement that, “Dr. Berwick’s career and work at the Institute for Healthcare Improvement illustrates the drive to provide patient-centered care, patient safety, quality improvement, and care coordination in healthcare. He is well respected in the healthcare community and known for his desire to bring constructive change to healthcare delivery. We share these objectives and believe Dr. Berwick will be an able Administrator and partner for change.”

I think it is fair game to debate the views of individuals appointed to public office — it comes with the territory. I understand why Republicans object to Obama’s decision to bypass the usual Senate confirmation process, just as Democrats objected to President Bush’s recess appointment of John Bolton as ambassador to the United Nations.

But I worry though that the hyperpartisan political environment makes it almost impossible to have a serious discussion about the views and qualifications of individuals nominated for public office. People who have a record of demonstrating leadership by taking (provocative) positions on the issues are dissuaded from seeking public service, and if they are nominated, they can expect to have everything they’ve said dissected, taken out of context, attacked and even ridiculed for political and partisan persons, no matter how strong their qualifications.

Democrats do this to appointees of Republican presidents, and Republicans do this to appointees of Democratic presidents, but I don’t think the public benefits if we end up driving away or damaging the people who are most qualified to serve in public service roles, just because they had the audacity to challenge the status quo.

Bob Wachter, Associate Chairman of the Department of Medicine at the University of California-San Francisco makes this point effectively in his post in defense of Berwick’s appointment:

“CMS’s head honcho now needs to be someone with a point of view, passion, and a backbone. Although I guess there might be a healthcare version of Elena Kagan -– a brilliant, charismatic leader who manages to come with a scanty written and oral footprint to be dissected and distorted -– most healthcare folks with the Right Stuff will have a public record that illustrates that the person has periodically done battle with the status quo. I certainly hope so.”

Think about the alternative: Do we really want government to be filled only with people who have no real record of having anything important to say?

I also believe that conservative presidents, by and large, should be able to appoint persons with conservative views, and liberal presidents should be able to appoint persons with liberal views, barring something in their record that says that they are unfit for office.

In the case of Berwick, it is hard to imagine anyone who could have had stronger credentials to champion innovations to improve patient safety, reduce medical errors, and promote patient-centered care. I personally don’t agree with some of his views, including his overly-effusive praise of Great Britain’s National Health Service, but he is undoubtedly qualified to serve as CMS administrator. He will bring to the agency the skills honed by a professional lifetime record of advocating for patient-centered care.

Today’s question: What is your take on the controversy over Dr. Berwick’s views and qualifications?

P.S. I have just joined the world of Twitter! You can follow me @BobDohertyACP!

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*


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