There’s nothing wrong with a recess appointment. Presidents use them all the time to put into office people who share their views but who give members on the other side of the aisle indigestion. John Bolton, one of my personal heroes, was a recess appointment to be ambassador to the United Nations. So we should quit griping about recess appointments in general and focus in particular on exactly what the recess appointment of Donald Berwick to run Medicare and Medicaid means. It means a lot.


 This recess appointment basically means that the administration remains determined to foist an unpopular healthcare system on the public come hell or high water. The president knows that a thorough airing of Berwick’s views-he’s a fan of healthcare system of not so merrie old England-would only serve to reopen an issue that does his party no good.


 The Wall Street Journal has an excellent piece this morning about the Berwick appointment:


But it doesn’t take an M.D. to understand the opposition to Dr. Berwick. “I am romantic about the National Health Service,” he told a London audience in 2008, referring to the British single-payer system. “I love it,” Dr. Berwick added, going on to call it “such a seductress” and “a global treasure.” He routinely points to the NHS as a health-care model for the U.S.


Yet despite this torrid affair, new British Prime Minister David Cameron is devoting an extra £1 billion to cancer care and other specialty treatments and surgeries that the NHS currently denies to patients because the bureaucracy deemed them too costly. Dr. Berwick has been careful to say that the NHS is “far from perfect,” but in a now-notorious interview last year he said that “The decision is not whether or not we will ration care-the decision is whether we will ration with our eyes open.”


The White House talking points on Berwick insist that rationing is already “rampant” and that Berwick would simply bring a more rational form. The Journal notes:


The people who can write such things with a straight face believe there is no difference between rationing through individual choices and price signals and rationing through politics and bureaucratic omniscience. In an influential 1996 book “New Rules,” Dr. Berwick and a co-author argued that one of “the primary functions” of health regulation is “to constrain decentralized, individual decision making” and “to weigh public welfare against the choices of private consumers.”


He then recommended “protocols, guidelines, and algorithms for care,” with the “common underlying notion that someone knows or can discover the ‘best way’ to carry out a task to reach a decision, and that improvement can come from standardizing processes and behaviors to conform to this ideal model.” And guess who will determine the “best way”?


Washington Post blogger Ezra Klein has a disingenuous piece explaining that Berwick is the ideal person to run a big chunk of the nation’s health system from a conservative point of view. Or, as the spider said to the fly, “Come into my parlor.” (For some reason, the link won’t work, but if you want to read an exercise in faux reasoning, you can find the Klein piece on the Washington Post website.)