Perspective:

This essay is an opinion piece by John K. Iglehart, a long-standing national correspondent for the New England Journal of Medicine. Mr. Iglehart is the founding former editor of the journal Health Affairs, a position he held for 27 years. In this piece, Mr. Iglehart discusses the messy political process facing the current nominee (and seemingly all past nominees) for the directorship of the Centers for Medicare and Medicaid Services (CMS). The current director, Dr. Don Berwick, was the founding director of the Institute for Healthcare Improvement (IHI) prior to being selected by President Obama. Iglehart reminds us that nominees for the directorship of CMS must obtain Senate approval. This process has proved to be so politically contentious recently, that President Obama resorted to the process known as “recess appointment” to install his selection for CMS director without Senate approval, and President Bush’s selection for this position, Kerry Weems, never had his appointment taken up by a Democratically controlled Senate. According to Iglehart, CMS has not had a Senate confirmed administrator since October 2006.

Iglehart goes on to discuss the experience and qualifications of the current nominee, Marilyn Tavenner. He points out that she has had 35 years of experience as a practicing nurse and health care manager, having been a senior executive at the Hospital Corporation of America, and having served as the state of Virginia’s Secretary of Health and Human Services. Iglehart also makes clear that the current nominee supports the current policies and health care plan taking shape under the Affordable Care Act, and the policy course put in place by her predecessor, Dr. Berwick. Iglehart also quotes Dr. Berwick’s defense of that policy, saying that there was and is no component of rationing end-of-life care in what opponents have labeled “death panels.” As Dr. Berwick said, it is “beyond cruelty to have subjected our elders. . . to groundless fear in the pure service of political agendas.” According to Iglehart, what Dr. Berwick did do as director of CMS was to seek to “instill in the agency a belief that it could be a stronger force for the continual improvement of healthcare for all Americans, rather than primarily a bill payer.”

Mr. Iglehart discusses many of the prominent political actors who are, and will be, involved in the Senate approval process for this directorship. After briefly describing these players and some of their opinions and political agendae, Mr. Iglehart basically concludes that this process has become, for some time now, inexorably dysfunctional, a victim of the “poisonous partisanship of US politics.” While not directly endorsing the current candidate, he makes a plea for a suspension of the usually divisive political environment for the good of advancing health care policy in this country. He points out that the directorship of a federal agency with an annual expenditure of $800 billion deserves the thoughtful consideration of all involved, rather than the single-purpose pursuit of a political agenda.