Senator John Barrasso, a leading spokesman for congressional Republicans on health care issues, today accused President Barack Obama of "intentionally misleading" the country and Congress by appointing Donald Berwick to run the Centers for Medicaid and Medicare Services. The White House yesterday announced that Berwick would receive a "recess appointment," which allows the president to put a nominee in place without Senate confirmation.

"This appointment shows incredible arrogance on the part of the president and it makes a mockery of his promise to run a transparent administration," said Barrasso, an orthopedic surgeon from Casper, Wyoming.

Barrasso repeatedly urged Obama to appoint someone to head CMS during the year-long health care debate that ended this past spring. In an interview this afternoon, Barrasso said that Congress did not yet even have all of the paperwork to conduct a hearing on the nomination. The Obama administration, he argues, planned to recess-appoint Berwick from the beginning in order to avoid a public debate over Berwick's radical views. Barrasso says of Obama: "I think this was his intention all along."

Barrasso and other Republicans have criticized Berwick since he was first mentioned for the CMS job. They point to his writings in favor of health care rationing and in praise of Britain's state-run National Health Service (NHS). "I think the NHS is one of the great human health care endeavors on earth," he said in a 2005 speech. "It can be an example for the whole world -- an example, I must say -- that the United States needs now more than most other countries do."

Over the course of the health care debate, Democrats dismissed and even mocked those who described White House proposals as socialized medicine or a step toward a single-payer system.

Berwick has also long advocated a single-payer system, writing as far back as 1996 that "a single-payer mechanism" was "the only sensible approach to health care finance I can think of." More recently, Berwick said: "If I could wave a wand…health care [would be] a common good-single payer, speaking for and buying for the common good."

Not surprisingly, Berwick has expressed skepticism of market-driven health care and market-focused reforms. "Please don't put your faith in market forces," Berwick wrote in 2008. "It's a popular idea: that Adam Smith's invisible hand would do a better job of designing care than leaders with plans can. I find little evidence that market forces relying on consumers choosing among an array of products, with competitors fighting it out, leader to the health care system you want and need."

The White House claims that likely Republican opposition to Berwick left the president no choice but to offer him a recess appointment. And there's no question that Republicans were eager to have an opportunity to grill Berwick in confirmation hearings and, quite possibly, seek to block his nomination. But in a letter to Secretary of Health and Human Services Kathleen Sebelius three weeks ago, Senator Pat Roberts, a fellow Kansan, wrote that while he would "thoroughly vet this nominee…it is my sincere hope that you and I can cooperate throughout this process to insure that Kansans and all patients, especially our seniors, are protected from government rationing."

By offering Berwick a recess appointment now, the White House is circumventing the entire process -- shielding Berwick from having to answer for his views, which Barrasso describes as "far out of the mainstream."