Oscar Wilde famously wrote, “I like men who have a future and
women who have a past.” We can thus assume that, were he with us
today, he would turn up his nose at Donald Berwick and offer
Marilyn Tavenner his most charming smile. This is Berwick’s last
day as Administrator of the Centers for Medicare and Medicaid
Services (CMS), and Tavenner is his replacement. If it’s not
obvious why Wilde would beam on the latter, it soon will be. First,
however, it’s necessary to recall a sentence from Obama’s first
address before a joint session of Congress. During that speech he
talked a lot about fraud. He was particularly effusive about his
intent to end the widespread bilking of government health care
programs: “We will root out the waste, fraud, and abuse in our
Medicare program that doesn’t make our seniors any healthier.”
Still confused? Well, Marilyn Tavenner is a former
executive of Hospital Corporation of America (HCA), which was
responsible for the largest single example of Medicare fraud in
history. As the Boston Globe
reports, “While Tavenner worked for HCA, the company was busily
enhancing its profit margin by defrauding the Medicare, Medicaid
and TRICARE systems.” HCA ended up paying nearly $1.5 billion in
fines before the smoke cleared. CMS falls under the aegis of HHS
and, as its administrator, Tavenner would work with the Office of
Inspector General in fraud cases. Thus, as the Globe
points out, “It hardly seems wise to put her in charge of the
government system her company helped defraud.” And yet Tavenner is
the President’s nominee to replace Donald Berwick.
There is no indication that Tavenner was directly involved
in HCA’s billing skullduggery. However, after the Berwick
controversy, it’s surprising that even the famously tone deaf Obama
would nominate someone with such problematic ties to the industry
she will regulate. These ties have also been ignored by most major
media outlets, whose coverage of Tavenner has consisted primarily
of
puff pieces focusing on her early years as a nurse. This
contrasts sharply with the coverage received by Republican Rick
Scott, who was the CEO of HCA during the investigations. Scott was
never implicated in the fraud scheme either. But it did happen on
his watch, and every “news” story written about him while he was
running for Governor of Florida insinuated that he was somehow
involved in the fraud.
Obama’s tone deafness and disparate treatment of Scott and
Tavenner by the media are less important, of course, than the
latter’s likely policies as the head of CMS. Unfortunately, there
is little comfort to be gleaned from the record. For example, as
Deputy Principal Administrator of CMS, Tavenner had responsibility
for the Center for Consumer Information and Insurance Oversight
(CCIIO) and its director, Steve Larsen. If this bureaucracy and its
director sound familiar it is because they were the fount from
which the infamous Obamacare waivers spewed forth. And the CCIIO
continues to ignore congressional requests to provide the criteria
by which its decisions to grant the waivers were made. In other
words, that supreme symbol of corruption and bureaucratic arrogance
answered to Obama’s new nominee to head CMS.
If the high-handed behavior of the CCIIO is a harbinger of
things to come, the only real difference between Marilyn Tavenner
and Donald Berwick is that she didn’t run her mouth as much as he
did before leaving the private sector and going to work in
government. After leaving HCA, she joined the administration of
Virginia’s Democrat Governor Tim Kaine as the Old Dominion’s
Secretary of Health and Human Resources. She left that position
when Republican Bob McDonnell replaced Kaine and joined CMS as
Berwick’s deputy in February of this year. Despite her obviously
important role at CMS and her direct connection to the
controversial CCIIO, she has managed to keep a low profile. This,
and her ability to survive the HCA scandal unscathed, suggests that
she is more politically savvy than Berwick.
There is no sign, however, that she holds different views
than her controversial predecessor. She spoke to the National
Association of Medicaid Directors last month and echoed refrains
often heard from Berwick. Her position on giving the states control
of their own Medicaid programs, which are funded by state as well
as federal funds, is virtually
identical to that of the good doctor: “That approach would
simply dump the problem on states and force them to dump patients,
benefits or make provider cuts or all the above.” In reality it
won’t necessarily force them to do any of these things. It would,
however, allow the states to develop creative ways of covering the
poor, reduce administrative costs, and reduce the coercive power of
Washington over the states. One suspects that the last is
Tavenner’s primary concern.
Nonetheless, she has earned the tentative approval of at
least one Republican. Yesterday, House Majority Leader Eric Cantor
said, “Obviously, I’m not in the Senate, so I don’t have that
vote, but I do think she is qualified.” Other interested parties
have been less supportive. Her history produced the following
remark from Dr. Jane M. Orient, Executive Director of the
Association of American Physicians and Surgeons. “Tavenner has
served the largest for-profit operator of medical facilities in the
world, and the gubernatorial administration of a strong Obama
supporter and rising star in Democrat Party politics, neither of
which has a sterling record of integrity.” In other words, Tavenner
is a woman with a past, and Dr. Orient is less fond of such people
than was Oscar Wilde. The Senate would be wise to heed the
former.
