There’s been much discussion to the effect that Barack Obama chose to recess-appoint Dr. Donald Berwick to run Medicare and Medicaid because the White House wanted to avoid a contentious debate over Berwick’s support for health care rationing and his championing of European government health care systems. With midterm elections less than four months away, and a large part of the American public in favor of repealing Obamacare, such a debate would not be good for Democrats.
What has received less attention is that the White House bypassed the Senate confirmation process after Sen. Charles Grassley, the ranking Republican on the Finance Committee, asked Berwick for detailed information about the Institute for Healthcare Improvement, a nonprofit organization Berwick founded and for which he serves as chief executive officer.
The Institute describes its work as an effort “to accelerate improvement [in health care] by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action.” It has about 110 employees and net assets of $49.5 million, according to its 2008 filing with the IRS. (2008 is the most recent year for which such filings are publicly available.) A 501(c)(3) tax-exempt organization, the Institute reported receiving $12.2 million in contributions and grants in ‘08, as well as $27.4 million in revenue from its various programs.
As CEO, Berwick received $2.3 million in compensation in 2008. That was a substantial raise from 2007, when he received $637,006 in compensation, and from 2006, when he received $585,008 in compensation.
At the time the White House decided to bypass the Senate on Berwick’s nomination, Senate sources say, Berwick had already completed the questionnaire required by the Finance Committee, as well as provided his tax returns and other documents. He had answered one round of vetting questions from senators.
Then, on June 4, Grassley asked for information about the Institute. In particular, Grassley wanted to know the sources of the millions of dollars in grants and contributions to the nonprofit organization. Who has been giving? (The IRS collects some donor information from nonprofits like the Institute, but it does not make that information public.) Given all the money that has been flying around in the health care debate, it was an entirely reasonable question.
Grassley’s inquiry had not been answered by the time the president recess-appointed Berwick. The White House justified its action by accusing Republicans of planning to block the nomination.
According to a source close to the committee, Grassley’s questions were the result of thoroughness, not any particular suspicion. “What he asked for was not covered by the questionnaire,” the source says. “It’s not unusual for Grassley to look into this. It doesn’t mean that it’s an issue. It means he’s identified something he’d like to have more information on.”
That question is now moot. The White House acted before any hearing had been held, or even scheduled, for Berwick. He’s got the job now and doesn’t have to answer Sen. Grassley’s questions — at least until he appears before the Finance Committee in his role as head of Medicare and Medicaid.