Confirmation déjà vu

WASHINGTON-On Tuesday night there was a feel-good bipartisan theme to President Barack Obama's State of the Union address. But by the following evening it was back to politics as usual after the president's formal re-nomination of two of his most controversial administrative appointments.

With the dual nominations of Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services and Craig Becker to the National Labor Relations Board, the Obama administration has signaled that shifts in rhetoric will not be accompanied by policy changes.

Obama nominated Berwick to his post last year. But Senate confirmation hearings were never held as senators questioned Berwick's advocacy for rationing healthcare and for England's national health system.

In the face of likely Senate opposition, Obama, last summer, simply bypassed the confirmation process by installing Berwick to his position while Congress was in recess. Recess appointments do not require Senate approval. But Berwick's appointment only lasted until the end of 2010.

Now, with a new Congress seated that includes a smaller Democratic Senate majority and a new batch of freshmen Republicans who will offer strong opposition to Berwick, Obama is initiating a new fight. His second nomination of Berwick, announced Wednesday night, faces even greater obstacles than last year's initial nomination.

Sen. Orrin Hatch of Utah, who is the ranking Republican on the Senate Finance Committee, did not waste any time answering the challenge in a statement Thursday: "A day after the president committed to coming together to move our country forward, he's chosen to re-nominate one of his most contentious nominees to head an agency that impacts the lives of more than 100 million Americans."

As the top administrator for Medicare and Medicaid, Berwick, is a pivotal player in the implementation of the nation's new healthcare law. He has attacked the free market system and called England's socialized medical services superior to those in the United States. Berwick has said "any healthcare funding plan that is just, equitable, civilized, and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent healthcare is, by definition, redistributional."

In 2009, Berwick, a Harvard professor, tackled the issue of rationing, saying it is "not whether or not we will ration care-the decision is whether we will ration with our eyes open."

Twila Brase, president of the Citizens' Council for Health Freedom wonders why the White House would want to expend additional political capital on healthcare so soon after Democrats took a bruising last November, largely for their yearlong overhaul push.

"No matter what President Obama says, actions speak louder then words," said Brase. "Keeping Berwick in charge of the nation's most vulnerable is a clear sign that the White House intends to ration healthcare."

The other controversial pick, Becker, was also a recess appointment. Obama named him to the National Labor Relations Board after Republican senators joined small business organizations in successfully blocking his initial confirmation.

Now the administration is pushing to retain the former counsel for labor unions. During his first year on the board, Becker, who has worked for both the Service Employees International Union and the AFL-CIO, has angered business groups by refusing to recuse himself from hearings that involve his former employers.

"In re-nominating Becker, President Obama has sent the message to employers across the country that . . . the nation's chief executive is more concerned with paying back union bosses than turning the economy around," said Katie Gage, executive director of the Workforce Fairness Institute.

With Republicans now controlling 47 Senate seats, the Obama administration faces long odds on getting the 60 votes needed for formal confirmation of Berwick and Becker. Are two more recess appointments ahead? Stay tuned until the next Senate recess.