President Obama's decision to use his recess appointment power to fill a powerful health care post circumvented a bitter political proxy war over health care reform.

But whether his move flouted a promise to reject business-as-usual Washington politics depends on who is judging.

"I would call his using a recess appointment in this case a matter of Obama trying to overcome politics as usual," said Clark Ervin, an Aspen Institute scholar and the recipient of a recess appointment to be inspector general of the Department of Homeland Security from President George W. Bush.

Some Senate Republicans disagreed, however. Sen. Orrin Hatch of Utah said Obama's move showed an "arrogance of power."

"This demonstrates a troubling pattern by this administration to force a dangerous agenda on the American people by whatever means necessary," Hatch said.

The White House announced recess appointments Wednesday, naming pediatrician and Harvard professor Donald Berwick to head the Centers for Medicare and Medicaid Services.

To make it happen, Obama tapped a privilege that allows him to fill a post when the Senate is in recess and unable to vote on a nomination. Doing so circumvents the vetting process and is a fallback for presidents whose nominees are on hold or in some way controversial.

Former President Clinton made 139 recess appointments, and former President George W. Bush made 171 -- including Ervin.

While he still had all the powers and duties of office, Ervin said there were some "vague, intangible" effects of doing the job without the legitimizing effect of Senate confirmation.

Berwick, who will oversee implementation of a significant part of Obama's health care reform program as administrator of the Centers for Medicare and Medicaid Services, is a recess appointee of some consequence -- and Republicans had hoped to use his nomination hearings to highlight their gripes about what many call "Obamacare."

Berwick also comes with some baggage. He has praised the British health system, spoken of the necessity of rationing care and supports a single-payer system.

His confirmation was far from assured, and the nomination process guaranteed to reopen the debate over health care reform. The appointment also underscores Obama's reliance on outside experts to shape policy, and close ties to Harvard -- all flash points for the Right.

The White House was fully aware of the battle Berwick was facing, and was eager to skip it.

"There's no time to waste with Washington game-playing," communications director Dan Pfeiffer wrote on the White House blog.

The recess appointment also means Berwick can serve only until the end of the Senate's session, in late 2011. That gives him a limited window to perform a huge undertaking.

Obama could reappoint him after that -- but under the laws governing recess appointments, Berwick couldn't get paid.

"There is no question he was going to go through a grueling hearing, and the purpose of this recess appointment was partly because of that -- and also because of the red flags for the right wing, which regard him as a pointy-headed intellectual," said Stephen Hess, a presidential scholar at the Brookings Institution.

Hess added, "This one wasn't going to be quick and easy."