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.”

“If implemented as enacted, Obamacare will impose significant new Medicaid costs on states and constitute a major federal usurpation of long-standing state authority in regulating private insurance. This will be expensive and disruptive for those Americans who rely on individual or employer-based insurance for their health insurance. While some of the most expensive and disruptive provisions of the massive legislation do not take effect until 2014, other provisions are already going into effect and state lawmakers need to act right away if they are to implement their own Medicaid and private insurance market reforms to mitigate the harmful effects of Obamacare. State lawmakers must recognize that states are not mere agents of the federal government. They are not powerless, and there is nothing that requires them to assist in implementing this new, misguided federal health care agenda. They should assert their rightful authority, and represent and protect their citizens by resisting the disruptions entailed in Obamacare—taking actions that pressure the next Congress to scrap or redesign this harmful federal legislation.”

Dr. Don Berwick will now head the Centers for Medicare and Medicaid without Senate confirmation, or even a single hearing, after Obama’s recess appointment. “The recess appointment was somewhat unusual because the Senate is in recess for less than two weeks and senators were still waiting for Dr. Berwick to submit responses to some of their requests for information. No confirmation hearing has been held or scheduled.” Berwick would have had to face tough questions about his views on rationing and his support for the British socialized health system, which would have been difficult since ObamaCare was guaranteed to not limit Medicare benefits.

ObamaCare is predicted to result in over 30 million more Americans getting insurance, but what exactly does that mean if they don’t have access to actual medical care? Emergency rooms are expected to be severely overcrowded because of the law, even though they are currently over capacity. “The biggest users of emergency rooms by far are Medicaid recipients. And the new health insurance law will increase their ranks by about 16 million. Medicaid is the state and federal program for low-income families and the disabled. And many family doctors limit the number of Medicaid patients they take because of low government reimbursements.”

The history of federal health-care programs shows that costs have surpassed estimates by tremendous margins.  The exception has been the Medicare prescription drug program, which has controlled costs by injecting the sort of private competition and choice that ObamaCare would dramatically diminish.