“Indiana’s Medicaid chief told lawmakers Thursday that the federal government has largely left states in the dark on implementing the federal health care overhaul because it hasn’t yet provided needed guidelines. Medicaid Director Pat Casanova told the Health Finance Commission that key parts of the overhaul take effect in 2014 — about 3 1/2 years away — but states will need several years to pass their own rules and implement the overhaul.”

“The Congressional Budget Office estimates that the PPACA will add 16 million new individuals to Medicaid. And that almost certainly means many, many more emergency room visits. ObamaCare was sold as a way to ease America’s health care burdens. Instead, it looks more and more like its legacy will be to increase the strain on a broken system.”

“Considering how dubious the public remains about Obamacare, there is every reason to believe the Republicans really did want an exchange with the candid, erudite Berwick. The recess appointment strongly suggests the White House simply did not want to have another fight over the contentious health-care issue.”

According to surveys, only about a third of Texas primary care doctors accept Medicaid patients, because the government-run insurance program sets very low doctor fees. Over half of the people who will become newly insured because of ObamaCare will be added to Medicaid, which means their insurance will likely not actually allow them access to medical care.

When he takes control of Medicare and Medicaid, Don Berwick will begin to implement his vision of a more centralized, government-run health care system. This viewpoint is at the heart of ObamaCare, with the aim of putting Washington in charge of all health care decision-making. “Such a command-and-control vision is widespread among America’s technocratic medical left, but it is also increasingly anachronistic amid today’s breakneck medical progress. There isn’t a single ‘ideal model’ in a world of treatments tailored to the genetic patterns of specific cancers, or for the artificial pancreas for individual diabetics, or other innovations that are increasingly common.”

One of the consequences of President Obama’s recess appointment of Dr. Berwick is that he will completely avoid any scrutiny of his views on government rationing of care, especially end-of-life care. “Grassley had asked for information pertaining to sources of funding for Berwick’s Institute for Healthcare Improvement; he had also asked whether ‘Berwick had ever received funding from, been a member of, consulted with or for, or been associated in any way with Compassion and Choices, formerly known as The Hemlock Society,’ which advocates for patients’ right to choose euthanasia.”

“Some have speculated that the White House chose to make the recess appointment because the answers to some of those questions might cause some problems for the nomination or the administration. Perhaps. But it seems more likely that the primary motivation for the recess appointment was to avoid a clear and transparent fight over the merits of the competing visions of health care reform. Dr. Berwick is an unvarnished governmentalist of the first order. The debate over his nomination would have been the perfect opportunity to present clearly to the public the consequences of handing over so much power in the health sector to the federal government.”

“Senate Finance Committee Chairman Baucus and Senator Grassley have for some time been asking Dr. Berwick to disclose the list of donors to his foundation. In the eleven weeks since he was nominated he has not yet done so. Recess appointments are not quite routine, but they are Constitutional and are an ugly reality of how things sometimes work in Washington. Yet the timing and manner of Dr. Berwick’s recess appointment are clear process fouls by the Obama Administration. In this case the President is using the recess appointment power not to work around a filibuster as claimed, but to avoid disclosing information that is potentially relevant to Dr. Berwick’s service, to avoid an unpleasant reprise of the health care debate, and because it’s convenient for the Administration.”

Those on Medicaid are more likely than the uninsured to visit the emergency room. Given that ObamaCare assumes substantial cost savings from reduced ER visits after people who were previously uninsured become covered by Medicaid, its cost increases will likely be substantially higher than anticipated by the Administration.

Dr. Don Berwick will be recess appointed as head of the Centers of Medicare and Medicaid Services, without even a single committee hearing. “This way, Berwick will assume his post without having to explain statements such as this: ‘Cynics beware, I am romantic about the (British) National Health Service; I love it.’… Obama could have announced his CMS appointment at any time after winning the election in November 2008 if it were so urgent, but he waited almost a year and a half — until April of this year — to name Berwick. Conveniently, this was after the health care law had already passed. Had he appointed Berwick during the health care debate, it would have exposed how much Obama’s ultimate vision for U.S. health care borrows from the British model.”