“Although administration officials are eager to deny it, rationing health care is central to President Barack Obama’s health plan. The Obama strategy is to reduce health costs by rationing the services that we and future generations of patients will receive.”

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.”

Senate Finance Committee Chairman Max Baucus (D-MT) was one of the principle architects of ObamaCare. His committee has oversight over the Centers for Medicare and Medicaid Services, and he was waiting to receive materials from Dr. Don Berwick, the nominee to run CMS. But before Baucus’s committee received a reply or held a hearing, Obama made a recess appointment, infuriating the powerful Democrat. “’Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power and protects Montanans and all Americans by ensuring that crucial questions are asked of the nominee — and answered,’ Baucus said in a statement.”

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.”

While the White House highlights their favorite parts of ObamaCare, the real work is being done in the depths of the federal bureaucracy. “Track two is the regulatory process, where Obamacare is sinking its roots deeper and deeper into the bureaucracy and the health sector. This is below the radar of most Americans, but the implementation rules are beginning to frighten many industry groups that thought their seat at the table would inoculate them against the wrath of the regulators. The Centers for Medicare and Medicaid Services just issued a 1,250-page proposed rule on Medicare payment policies for 2011. That follows a 121-page proposed rule limiting how companies can grandfather their employee health-insurance plans to avoid even more onerous federal mandates.”

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.

In a dramatic move blamed in part on “health-care reform requirements” and described as being “as much a move to address what’s coming as what’s already occurred,” 1,500 hospital workers will be laid off, as a major Pittsburgh hospital closes its emergency department and cuts its beds from 505 to 202 — in what will rank among the largest round of layoffs in the region, in any industry, since the layoffs of Pittsburgh steel workers.