Unable to repeal President Barack Obama's health care law, Republicans are trying to oust the official who is quarterbacking the overhaul of the nation's medical system.
In a letter released Thursday, 42 Republican senators asked the president to withdraw the nomination of Dr. Donald Berwick as Medicare administrator, saying his experience isn't broad enough and past statements raise fundamental questions about his views on policy.
The Medicare administrator's job carries major responsibilities under the health care law, such as setting up new insurance markets, expanding Medicaid to cover millions more low-income people, and revamping the way Medicare pays providers to reward quality instead of volume.
Republicans would need 41 votes to block Berwick's confirmation by the full Senate, and the letter indicates they have more than enough. The loss of Berwick, a well-known medical innovator and advocate for patients, would be a blow to the administration as it moves ahead with critical building blocks of the health care remake.
Obama bypassed the Senate last year to install Berwick as a recess appointment. Under the rules, that means that unless Berwick can be formally confirmed, his appointment would run out at the end of this year.
White House spokesman Reid Cherlin said Berwick is "far and away the best person for the job" and the president will not withdraw his nomination.
But Sen. Orrin Hatch of Utah, ranking Republican on the committee that oversees Medicare, says Berwick lacks experience in insurance, and past statements praising the British health care system mark him as a proponent of big government solutions to the nation's problems of soaring health care costs and dwindling coverage.
"Dr. Berwick's lack of experience in the areas of health plan operations and insurance regulation raise serious concerns about his qualifications for this position," said the senators' letter, circulated by Hatch. "Withdrawing Dr. Berwick's nomination would be a positive first step in rebuilding the trust of the American people."
In a recent appearance before the House Ways and Means Committee, Berwick said he doesn't think Britain's government-run system should be copied here. "There are strengths and weaknesses in every health care system around the world, and we need to learn from each other," he said. "The American system needs its own solution."
Berwick added that his belief that health care reforms should redistribute resources from the wealthier to the less fortunate does not stem from ideology.
"Poorer people tend to be sicker, and sicker people tend to be poorer," said Berwick.
A pediatrician before becoming a Harvard professor, the 64-year-old Berwick is widely respected in the medical community and among health care experts, including some former Republican administrators of Medicare. His self-styled "triple aim" for the health care system includes providing a better overall experience for individual patients, improving the health of groups of people such as seniors and African-Americans, and lowering costs through efficiency.
But in polarized Washington, his statements as an academic became an instant source of controversy. Republicans accused him of advocating health care rationing, which Berwick denies.
"His past record of controversial statements, and general lack of experience managing an organization as large and complex as (Medicare and Medicaid) should disqualify him," the GOP senators wrote.
The administration kept Berwick out of the public eye in the run-up to the congressional midterm elections. But this year, he has made the rounds of Capitol Hill, testifying before congressional committees. Rumpled and usually ready with a firsthand anecdote from his clinical experience, he stood up to hard questioning.
Berwick is currently working on a major regulation that would allow hospitals and groups of doctors to band together to provide coordinated health care for Medicare patients. Incorporated in the health care law, so-called "accountable care organizations" would try to save taxpayers' money while improving patients' lives by trying to avoid unnecessary hospitalizations.
Those changes "will save billions in excess costs and save millions of lives," said White House spokesman Cherlin.
The only Republican senators who did not sign on to Hatch's letter are Scott Brown of Massachusetts, Susan Collins and Olympia Snowe of Maine, Lisa Murkowski of Alaska, and Rob Portman of Ohio.