Today is the 45th anniversary of the Medicare program, and several bloggers take note and even find a new video featuring an American icon. Other commentators review the implementation and design of the high-risk pool program created by the health law.

Don Berwick, the new Medicare and Medicaid administrator, compares the enactment of Medicare with the efforts this year to get a health care overhaul. He writes on healthcare.gov: “Today, CMS is not only celebrating Medicare’s 45th anniversary but also using it as an opportunity to redouble its efforts to educate and inform people with Medicare and their family members about the many changes and improvements to the program’s various options [in the new health law] in advance of Medicare Open Enrollment.  We have done mailings for beneficiaries, posted materials on Medicare.gov, and unveiled radio ads educating beneficiaries about where to go to get their questions answered and how to prevent fraud and scams.”

Kate Philips of the New York Times’ Prescriptions blog looks at the new information campaign led by the Department of Health and Human Services and posts a television ad HHS commisioned featuring actor Andy Griffith (below):

Cathy Hope of Georgetown’s Say Ahhh! notes that it’s also Medicaid’s birthday, and says: “I think Medicaid represents an appropriate moral test for our government and the American people as it was created to serve those in the dawn of life, twilight of life and shadows of life.  Medicaid is there for families facing poverty, the elderly who cannot afford long-term care, people with disabilities and for children with severe and chronic health conditions.”

Peter H. Stone of the Center for Public Integrity’s Paper Trail reports that a group of health insurers are considering a new lobbying campaign of up to $20 million. “Aetna Inc., Cigna Corp., Humana Inc., United HealthCare Inc. and WellPoint Inc. are weighing the new drive in part to shape the government regulations that will implement this year’s sweeping new health care legislation. Two lobbying sources familiar with talks underway by high-level insurance executives say that a decision to go forward with such an effort is likely to be made by at least four of the insurers—and possibly Cigna – in coming weeks.”

Cato’s Daniel Mitchell posts a graphic that tries to illustrate the organizational and decision-making structure under the new health overhaul law. Mitchell says: “It’s worth noting, by the way, that the system already was a disaster even before Obamacare was enacted. In the health care sector, free markets are only allowed to operate in very rare cases, such as cosmetic surgery, laser eye surgery, and (for better or worse) abortion. The rest of the sector was heavily distorted by government intervention. Obamacare simply makes a bad situation worse.”

On the Health Affairs blog Thomas Miller and James C. Capretta say the structure of a new high-risk insurance program created by the health law is flawed and call for a different definition of “high-risk”: “A better solution would begin with redefining the problem to avoid the temptations of trying to achieve multiple policy objectives with a single tool, which results in mission creep and failure to target scarce resources more effectively and sustainably.  True high-risk pools should be limited to covering the most likely, highest-risk individuals, as identified before the fact.  They don’t work as well as a mechanism for subsidizing the health care costs of low-income individuals more broadly, or for covering the uninsured in general.”

John Goodman also criticizes the new program but doesn’t necessarily agree with Miller and Capretta. He says that “socializing the costs of patients with expensive conditions … surely invites a mechanism whereby insurers, employers, and individuals would crawl out of the woodwork to lobby continuously and perpetually for more federal money and expanded eligibility for high-risk pools — just as happened to Medicaid over the last four and a half decades. A far simpler and more effective reform would be to eliminate employers’ monopoly control of Americans’ health dollars, so that individuals and families could buy their own health insurance that is portable from job to job and state to state.” 

And Wonk Room’s Igor Volsky doesn’t like the fact that the regulations released yesterday bar elective abortion coverage. He writes, “Indeed, rather than developing a compromise that would have either allowed states to decide whether to cover abortions with federal funding or required them to segregate funding and use private or state money to pay for the abortion services, the administration prohibited abortion coverage almost instantly. … it’s hard to understand why the administration felt so compelled to make this decision so quickly and reactively. If it was hoping to score points with conservative pro-life voters, then it overestimated the GOP’s willingness to recognize its concessions and may be surprised when Republicans continue to send fundraising letters about the abortion issue.”

A wonky debate took hold of health policy bloggers this week as they reexamined the health reform law in Massachusetts, which shares many features with the new national health overhaul law. Commentators considered new data from the state and what it might signify for the national law.

Cato’s Michael Cannon notes several disagreements with economist Jonathan Gruber’s letter-to-the-editor  defending the law, then concludes: “it does not speak well of the Left’s approach to health care that in order to reduce wasteful government spending — or at least pretend to — they must first create more wasteful government spending.”

Critical Condition’s Avik Roy looks at some left-leaning writing about the Massachusetts’ reform law and disagrees: “The reason why health care costs keep rising, and the reason we face fiscal disaster, is because of subsidized insurance. Government programs like Medicare and Medicaid, which started out small, reward irresponsible utilization of health-care resources. … And, so, we end up with the death spiral of state-funded health care. As the cost of health care increases, driven there by government subsidies, fewer people can afford private insurance, leading to more cries for more government subsidies, which will drive costs up even further. Wouldn’t it be nice if we could try the opposite approach?”

Hot Air’s Ed Morrissey says the incentives for employers to cover their workers are insufficient and prospects don’t look great for the national law: “With the Senate and the White House eyeballing price controls for health insurance, the federal system will have the same perverse incentive structure as Massachusetts, and businesses will eventually respond to them in ways that will create a de facto single-payer system in the US.  That appears to be more like a designed outcome than a policy mistake as Barack Obama and Congress follow the Massachusetts playbook.”

The Washington Post’s Ezra Klein emphasizes that the Massachusetts law did not target health care costs and writes: “What we can say about Massachusetts now is pretty much what we’ve been able to say about Massachusetts since the early days of its implementation: It’s been a successful attempt to expand coverage and reform the non-group market, and it was never an attempt to control costs. As such, costs in Massachusetts, much like costs nationally, are rising. Insofar as that contains lessons for the national effort, it’s that we should stick to the law and make sure to implement the cost controls and delivery-system reforms.”

Insure Blog’s Bob Vineyard responds to Klein, saying: “Ezra tells us ‘the plan’s popularity also remains quite high: The Urban Institute study found approval at 67 percent’. And why wouldn’t it be popular? When you can wait to buy insurance AFTER you get sick or injured, that’s a great deal for you. But not so for the rest of the folks who have to pay for your claims in the form of higher premiums.”

(For additional takes on the Massachusetts reform law, see the KHN opinion pieces from Austin Frakt and Grace-Marie Turner.)

And for other wonky policy posts from the last two weeks, Julie Ferguson of  Worker’s Comp Insider hosts the newest edition of Health Wonk Review.

A number of right-leaning bloggers reacted to news that the Obama administration may change the way it legally defends the new health law’s requirement that all Americans buy health insurance. The New York Times reported that the federal government may now argue it can impose the mandate through its tax authority, but White House officials (and Obama himself) had previously argued the mandate was constitutional under “interstate commerce” authority. Left-leaning writers were largely silent about the development. Other commentators wrote about reform in Massachusetts and the coming health insurance exchanges.

Previewing the kinds of  arguments that health law opponents’ offer against the interstate commerce reasoning, Eric Novack says on the Heritage Foundation’s blog: “‘The mandate,’ as it’s known, has its origins in the Commerce Clause of the Constitution, which grants Congress the authority to regulate interstate commerce. And yet it doesn’t take an Elena Kagan-level legal scholar (or even a fan of “Boston Legal” reruns) to see that the mandate, rather than regulating commerce, is this time being used to regulate the absence of commerce. Why does that distinction matter? Well, at the risk of sounding alarmist, if Congress can compel the purchase of a product – health insurance – under its authority to regulate the interstate market for health care, then, using the same legal theory, what transaction can’t it compel?”

Cato’s Ilya Shapiro reacts to the administration’s new position that relies on its tax authority: “This is huge.  After months of arguing that cases like Wickard v. Filburn (Congress can regulate the wheat farmers grow for personal consumption) and Gonzales v. Raich (Congress can regulate personal growth of state-allowed medicinal marijuana) justify the requirement that every man, woman, and child buy a health insurance policy, government lawyers (and spokesmen) now say the mandate is just a regulation accompanying a lawful tax (the penalty you pay for not buying insurance). ”

Randy Barnett of the Volokh Conspiracy says, “Let that sink in for a moment. If the Commerce Clause claim of power were a slam dunk, as previously alleged, would there be any need now to change or supplement that theory? Maybe the administration lawyers confronted the inconvenient fact that the Commerce Clause has never in history been used to mandate that all Americans enter into a commercial relationship with a private company on pain of a ‘penalty’ enforced by the IRS. So there is no Supreme Court ruling that such a claim of power is constitutional. In short, this claim of power is both factually and judicially unprecedented.”

Hot Air’s Ed Morrissey posts clips of Obama defending the mandate and writes, “That is exactly what the mandates do — regulate individual behavior in an area where the federal government has no jurisdiction and punish those who don’t exhibit favored choices, in this case buying comprehensive health insurance regardless of whether it makes sense for anyone.  This court will almost certainly take a dim view of the same attempt that the 1922 court struck down as a gross overreach by the government.”

Insure Blog’s Henry Stern laments: “As we’ve already noted, there was never any doubt that the individual mandate is evil because it is a tax on simply living. There is no legal requirement to own or drive a car, or buy or sell property, or eat or drink. But there is now a tax on breathing.”

Elsewhere, some bloggers opted to focus on other issues, including those stemming from the Massachusetts experience. The New Republic’s Jonathan Cohn responds to a critical column from Robert Samuelson about that state’s health reform law.  Cohn argues: “if the lesson from Massachusetts is that “genuine cost control is avoided because it’s politically difficult” then fiscal disaster is inevitable. Health care costs are going to keep rising, no matter what we do. And if that’s the case, I would certainly prefer a world in which people don’t have to worry about paying their medical bills. It doesn’t cost a lot to make that happen; the incremental cost of insuring the uninsured is a small fraction of health care spending.”

Wonk Room’s Igor Volsky responds as well, pointing to innovative health systems like Geisinger in Pennsylvania, and concludes: “Samuelson is undoubtedly right about the political challenges to controlling health care spending but he’s underestimating the extent to which economic necessity shapes reality for politicians and providers.”

And legal expert Timothy Jost writes on the Commonwealth Fund’s blog about “key” issues for HHS to consider when implementing the new health insurance exchanges, including state participation in regional exchanges and how those exchanges would be designed, along with “hold[ing] down administrative costs.”

The New Health Dialogue’s Joanne Kenen interviews John Prible of the broker group Independent Insurance Agents and Brokers of America about the future of insurance brokers under health reform. Kenen explains, “Not all the states will design their exchanges the same way. In a state where the exchange looks more like an online telephone book with lots of choices and minimal explanation, a broker might indeed give a lot of value added. In a state that more actively selects which plans can be in the exchange, and how easily consumers can compare them, brokers might be more superfluous.”

As health law regulations are released with more frequency, there’s plenty for bloggers to digest including developments in health information technology rules, abortion coverage and the Center for Medicare and Medicaid Innovation.

New rules announced this week about what health information technology practices and services will be considered “meaningful use” and make doctors and hospitals eligible to receive federal grants inspired plenty of commentary. Margalit Gur-Arie of the Health Care Blog analyzes “the good”, “the bad” and “the inconsequential,” and then sums it up: “what was bound to become a typically painful bureaucratic attestation for physicians, is now a rather straightforward process.”

Brian Ahier provides a detailed run-down of the provisions, and notes: “A major shift is the move away from an all-or-nothing approach, where providers had to meet every single measure to be eligible for payments. Instead, there’s now a set of must-have core requirements and an a la carte menu of discretionary options. There are 15 core requirements for physicians and 14 for hospitals. Health care providers can then choose five of 10 menu options to meet phase one of meaningful use. This strategy will enable a great many hospitals and small practices in rural and underserved areas to have a shot at cashing in on incentive payments.”

And the Wall Street Journal’s Katherine Hobson rounds up various association group and health IT company responses to the rules.

Several bloggers look at coverage of abortion in the new high-risk pool programs.

Julie Rovner on NPR’s Shots Blog reports on a fight in Pennsylvania: “Abortion opponents say the administration is already breaking the promise it made as part of the new health law not to fund elective abortions. … The National Right to Life Committee, Family Research Council, and House Minority Leader John Boehner, (R-OH) are up in arms about what they contend is Pennsylvania’s plan to provide abortion coverage to people who sign up for the state’s new high-risk health insurance plan. … Only there’s one problem. Both Obama Administration and Pennsylvania officials say the NRLC’s interpretation is simply incorrect — elective abortions will NOT be allowed in the new program.”

Wonk Room’s Igor Volsky thinks the legal language doesn’t include prohibition of abortion coverage: “But as I pointed out yesterday, the Nelson abortion amendment in the health care law and President Obama’s subsequent executive order place restrictions on federal funding within the exchanges and the community health centers, but says nothing of the moneys appropriated to the temporary high risk pools or other programs like reinsurance for early retirees or the small business tax credits.The federal legislative language seems to contradict the state’s interpretation.” Volsky then posts a statement from HHS spokeswoman Jenny Backus, who said: “As is the case with FEHB plans currently, and with the Affordable Care Act and the President’s related Executive Order more generally, in Pennsylvania and in all other states abortions will not be covered in the Pre-existing Condition Insurance Plan (PCIP) except in the cases of rape or incest, or where the life of the woman would be endangered.”

Insure Blog’s Henry Stern responds to the events by critiquing Rep. Bart Stupak, D-Mich., who authored a strict ban on abortion coverage in the House version of the health overhaul bill, “We previously made the point that anything not specifically excluded would be covered; Rep Stupak’s cowardly retreat made this development inevitable.”

The Daily Beast’s Dana Goldstein looks at another aspect of the debate: labeling contraceptives as preventive care, which would make them available without cost-sharing under the new health law.  Goldstein reports: “many conservative activists, who spent most of their energies during the health-care reform fight battling to win abortion restrictions and abstinence-education funding, are just waking up to the possibility that the new health care law could require employers and insurance companies to offer contraceptives, along with other commonly prescribed medications, without charging any co-pay.”

Georgetown’s Jocelyn Guyer of the Say Ahh! blog points to a study that found a significant portion of children lose their health coverage when a parent loses a job. Many of those families look to Medicaid and the CHIP program to cover the youngsters.  Guyer adds: “At the end of this year, the extra [Medicaid] help the federal government has given states is slated to expire even though state budgets continue to be battered by rising demand for services. Without a short-term continuation of the extra help, states will be under enormous pressure to scale back Medicaid and CHIP, including children’s coverage.  …  If this happens, the reality … that children often lose their private coverage when their parents lose a job will translate into more and more uninsured children.” 

The Heritage Foundation’s Kathryn Nix, in her “Side Effects of ObamaCare” series, also talks about Medicaid.  But she sees a different issue: “As more and more doctors withdraw from Medicaid, more and more Medicaid patients are having trouble finding a physician to treat them.  It’s hard to see how the program can possibly deliver health care to an additional16 million patients dumped into the mix by Obamacare.”

On the Health Affairs blog, Carol Levine examines the health law’s requirement to set up a Center for Medicare and Medicaid Innovation. Levine is concerned that the center does not have to consider when funding projects whether they are “patient-centered” and focus on care coordination.  She says, “these should not be optional priorities.”

In a separate Health Affairs post, John Goodman thinks the health overhaul could lead to ER overcrowding: “One of the most oft-repeated arguments for health reform is that uninsured patients make costly and delayed trips to the ER when they do not have a health plan that pays for care at physicians’ offices. Insure the uninsured, it is said, and they will decrease their reliance on the ER and get prompter, less costly care elsewhere. Yet this has not been the experience in Massachusetts and it is unlikely to be the experience nationwide under the new health reform legislation. In fact, far from seeing a decline in ER visits, the number of such visits is more likely to soar.”

The New Health Dialogue’s Tony Cardona takes a look at legal action surrounding the Healthy San Francisco program, which requires employers with more than 20 workers to help cover cost of health care services.  Cardona writes, “Play-or-pay models may continue to be an option for states and local governments to provide insurance for individuals not covered under federal law (such as undocumented workers.) But the Supreme Court’s denial of review of Healthy San Francisco was tantamount to an announcement that such models are no longer germane in reshaping the larger health care debate.”

The Washington Post’s Ezra Klein is also talking about Healthy San Francisco because of a new National Bureau of Economic Research study of employer reaction to the program. Klein calls the results “encouraging,” focusing on business approval of the law (at 64 percent) then adds, “I guess in San Francisco, even the private businesses are run by socialists.”

The National Journal’s Megan McCarthy asks the health policy experts if a recess appointment of Dr. Donald Berwick to head the agency that oversees Medicare and Medicaid was “necessary.” James Gelfand, Newt Gingrich, John Goodman, Bruce Lesley, Larry McNeely and Gail Wilensky respond. Reaction ranged from “inexcusable” and “shameful” to “superb.”

Speaking of Berwick, The Apothecary’s Avik Roy lists problems with Britain’s National Health Service then argues: “These problems are not an accidental side effect of socialized medicine—they are inherentto socialized medicine. Liberals who believe that technocratic experts can rationally allocate health care resources ignore the real-world examples, like Britain’s, of how that model fails in practice. The American health care system has its flaws, and real reform is urgently needed. But the reason why Obamacare is so unpopular is that most people would never trade our approach, warts and all, for that of Donald Berwick’s NHS.”

Cato’s Michael Cannon points to news that Republican lawmakers are pressing Supreme Court nominee Elena Kagan to recuse herself from any case about the new health care law.  Cannon predicts: “That would also be the worst possible outcome for the administration.  In fact, universal coverage is so important to the Leftthat if Kagan would leave them with one less pro-ObamaCare vote on the Court, I wouldn’t be surprised to see President Obama withdraw her nomination.  He could then appoint someone as ideologically reliable as Kagan, but who could actually defend the president’s signature accomplishment. This could get interesting.”

Elsewhere, a few bloggers react to the new National HIV/AIDS strategy released by the administration on Tuesday. 

Health Beat’s Maggie Mahar calls the strategy “promising” then adds, “But we must make sure that in the short-run we are not abandoning the very people we purport to help; the vulnerable groups who depend on ADAP for their medications.”

The Nation Review Online’s Tevi Troy has five observations, including, “The major conservative objections to the policy will be in the areas of the endorsements of needle exchange, condom distribution, and sex education, which are neither news nor surprising in any way.  After 15 months of study, the administration does not appear to have broken much new ground on this issue.  No wonder the Left appears disappointed.”

Bloggers continue to argue about President Barack Obama’s recess appointment of Dr. Donald Berwick to head the agency that oversees Medicare and Medicaid. Others explore the intricacies of several health overhaul issues, including whether the law could be defunded by Republicans and if more competition among health insurers would really help control health costs.

The New Republic’s Jonathan Cohn adds an addendum to his initial positive reaction to the recess appointment after considering the argument made by Tevi Troy, a conservative health policy expert. Troy wrote, “Being a confirmed appointee really makes a difference at the agencies, and it is worth taking some political hits to give your nominees that important blessing.  Given the Democrats’ strong 58 seat majority in the Senate, Dr. Berwick could have gotten there if the White House had just let the process play out. When I told Jonathan that I disagreed with him on this issue, he said that if the Republicans were willing to promise that they would not filibuster Dr. Berwick, then he would be willing to say that the White House was wrong to go this route.  I disagree. Nobody, Republican or Democrat, could or should make that promise, as we can’t know what information the confirmation process will reveal.”

James Capretta makes a similar argument: “Unlike the president, Dr. Berwick hasn’t hid his worldview. The White House says Republicans were planning to obstruct the nomination. Republicans haven’t obstructed anything. All they did was signal an eagerness to engage in a spirited debate over Dr. Berwick’s vision for health-care cost control. The reason Dr. Berwick’s nomination hasn’t moved forward is because he hasn’t yet submitted responses to relatively routine questions posed by the Senate Finance Committee — questions that would have been asked of any nominee, from either party, given the same set of facts and circumstances.”

The Washington Post’s Ezra Klein is puzzled by Tevi Troy’s argument.  Klein writes, “I don’t like this state of affairs. As I keep saying, the procedural arms race set off by the endless filibuster is bad for both parties, and needs to be ended. But it does seem like the argument here is that Democrats should have acted in good faith even though Republicans seemed poised to act in bad faith, and even though there were real consequences both for Berwick and for the administration if Republicans crucified and then blocked him.”

But Avik Roy of The National Review’s Critical Condition adds: “There is another reason for thoughtful (and philosophically consistent) liberals to oppose Berwick’s recess appointment: There won’t always be a Democrat in the White House.”

Elsewhere, on the Health Affairs blog economist Uwe Reinhardt looks at some experts’ contention that a more competitive health insurance market would better control health care costs. Reinhardt writes, “I have some trouble, however, grafting this model onto the market for health insurance, which is not quite like the market for the legendary widget. … Ideally, in my view, the market for health insurance would be oligopolistic, which means that only a few insurers — each with some market clout vis à vis providers — would compete for enrollees in a local market. What the ideal number would be is an interesting question on which economists can have a lively debate. So what am I missing here? Why do so many otherwise sensible people believe that fragmenting the buy side of the health care market even more than it already is will help contain the rising cost of health care? I would argue just the opposite.”

Economist Austin Frakt responds: “Reinhardt should not hold his breath. I can think of no sensible argument that–holding all else constant–starts with a reduction in insurers’ market power and ends with a decrease in medical costs and health care premiums. However, if one is willing to add in other elements of reform, I can think of some possibilities that include increased insurer competition. For example, if insurers are permitted to collude to set all-payer rates to medical providers then they can maintain a high degree of leverage over providers while competing vigorously for policyholders. Or, the provider market could be commensurately diluted so that the relative provider-insurer balance of power was held constant.” He concedes neither of those options is likely.

Wonk Room’s Igor Volsky examines whether Republicans would be able to defund health reform if they take over Congress in the November elections. Volsky looks at comments by Gail Wilensky suggesting this is unlikely and then he explains, “Indeed, mandatory spending, such as Medicare and Medicaid, continues from year to year unless Congress passes new legislation to reduce it; discretionary spending, which covers most of the day-to-day operations of federal agencies, is appropriated every year in annual appropriations bills. It’s far easier for Congress to adjust an appropriations mark than muster the political support to pass new legislation to defund the new Medicaid expansion or affordability credits to middle class Americans.”

AHCJ’s Andrew Van Dam looks at a provision of the health care law that requires insurers to spend a certain percent of revenues on medical expenses or treatment. Van Dam says, “At present, the key issue seems to be subsidiaries. Major insurers have hundreds of them each, and while the insurer could meet the requirements if all subsidiaries were averaged together, they won’t be able to hit the numbers at every single subsidiary.”

And the Cato Institute’s Michael Tanner has a new brief on the health overhaul law. The Cato website says the brief finds that “the bill is bad medicine. It is likely to make Americans less healthy, less prosperous, less able to direct their own health care decisions, and places huge burdens on our economy and already massive national debt.” The Heritage Foundation’s Stuart Butler also authored a new paper on the law, according to the foundation’s blog.

President Barack Obama’s recess appointment of Dr. Donald Berwick to head the Centers for Medicare and Medicaid has created a furor among conservative bloggers, including one who refers to Berwick as “rationer-in-chief.” But his supporters say Medicare needs his leadership now.

Dan Pfieffer, the administration’s communications director, wrote on WhiteHouse.gov that Obama made the appointment because “[m]any Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points. But with the agency facing new responsibilities to protect seniors’ care under the Affordable Care Act, there’s no time to waste with Washington game-playing.”

The Apothecary’s Avik Roy calls Pfieffer’s explanation “laughable” and says because of Berwick’s views on the British National Health Service, Democrats did not want to hold public hearings. Roy continues, “Berwick would only generate more controversy if he aired his views in Congress. And we’re not talking ‘controversy’ in the mountain-out-of-a-molehill sense: we’re talking about the basic philosophy of whether or not we should have a free or centrally-planned health care system. The American public, and more importantly, the American idea, are not on Berwick’s side.”

Hot Air’s Ed Morrissey also disagrees with the White House explanation: “No one ’stalled’ Berwick.  The truth is that Obama was afraid to have Berwick questioned by Congress, which should have everyone questioning his suitability for the position, even without considering his prior statements on wealth redistribution and slobbering fanboyism of the British state-run health service.”

April Fulton and Julie Rovner observe on NPR’s Shots blog that “Senate Republicans vowed to block Berwick, even though many admit he’s highly qualified, because they want to revive their battle over the health care law, which is getting decidedly mixed reviews on an array of fronts. Recent polls have shown support for the new health overhaul up slightly. But still only about half the public has a positive view of the law. One strategy of health care overhaul opponents has been to try to get measures that would effectively nullify the measure on a state-by-state basis onto November ballots.”

Heritage’s Conn Carroll calls Berwick “rationer-in-chief” and continues, “The fact that the White House chose to empower Dr. Berwick by recess appointment is particularly audacious. The recess appointment power was intended to be used for occasions when the Senate is out for months at a time. The Senate is currently out of session for just 11 days. Worse, the Senate majority has never even scheduled a hearing so that Dr. Berwick’s rationing views could be given an ‘open’ forum. In fact, Dr. Berwick has not even returned Senators’ written questionnaires.”

Philip Klein of the American Spectator notes several controversial statements from Berwick and says, “Had [Obama] appointed Berwick during the health care debate, it would have exposed how much Obama’s ultimate vision for U.S. health care borrows from the British model.”

The New Republic’s Jonathan Cohn has a cautiously optimistic take: “CMS director is always an important job. But it’s even more important now, as the Obama administration starts to implement health care reform. Not only must CMS prepare to deliver coverage to millions of new Medicaid recipients. It must also re-engineer Medicare itself, so that it pays for services in ways that foster better, more efficient care. Figuring out how to provide better care for less money is Berwick’s specialty, making him, at least on paper, a perfect choice for the job. … For the record, a serious conversation about Berwick’s qualifications and plans would have been worthwhile. I’ve heard even people sympathetic to Berwick question whether his administrative experience is adequte. But, again, it’s hard to have a serious conversation when one of the two political parties refuses to be serious.”

Wonk Room’s Igor Volsky agrees with the administration’s reasoning behind a recess appointment: “The GOP’s rhetoric justifies Obama’s recess appointment. Had Berwick’s nomination gone through the committee process, it would have undoubtedly been subject to anonymous GOP holds and delays. The party would have used the hearings as an opportunity to revive the old ‘death panel’ and health rationing smears, putting Democrats on the defensive just as the first benefits of reform are beginning to take effect.”

Health Beat’s Maggie Mahar seems pleased, writing: “We needed Berwick, in Washington, guiding CMS.  Yesterday — or eight years ago.”

Time’s Kate Pickert tries to figure out what the recess appointment could mean for Berwick’s success in his new role: “So the White House is trying to stay a step ahead of Republicans – playing defense even before they could run their offensive play against Berwick, labeling the pediatrician, highly regarded researcher and expert on health care policy simply an ‘expert on rationing.’ How this will affect Berwick, who is a brilliant policy wonk but whose provocative public statements exposed his political naivete? Well, Berwick is getting a lesson in politics now and it’s one that Republicans will eagerly remind him of every time he comes into contact with them in the next 18 months or so.

And the website for the documentary Money-Driven Medicine has posted several video excerpts of interviews with Berwick from the film.

Bloggers chatter about the high-risk pool program that began enrollment Thursday and react to the Department of Health and Human Services’ new consumer web portal, healthcare.gov.

Hot Air’s Ed Morrissey examines that the high-risk pools may be under-funded, declaring: “As this demonstrates, Congress had no clear idea of actual costs or complications in the program.  It should never have passed in the first place, but this key issue shows what happens when government attempts to run a business sector without having any expertise in it.”

Austin Frakt of the Incidental Economist, who estimated that up to 1 million people likely eligible for such pools, is puzzled by the way Congress designed the benefit:

Frankly, I’m surprised the Democrats got themselves into this pickle. The high-risk pools are one of the first things the new law creates. You want the early stuff to be successful. You don’t want to have to admit you blew it. Even if they had put $25 billion into the pools that would have hardly changed the total spending in the bill (close to $1 trillion). Why were they so stingy?

My guess is they’ll sneak a payment increase into some other bill, bury it among all sorts of tweaks, and pay for it with a tiny cut to something else (or claim as much). Nevertheless, it was a silly mistake. Or am I missing something?

AEI’s Tom Miller and James Capretta think the high-risk pool program is a harbinger: “It misrepresents the real problem, promises more than it can deliver, tries to hide the real costs, and gives sensible reforms a bad name—all because the administration is more committed to its long-term vision of central government control than to actually building a sustainable solution.”

Insure Blog’s Bob Vineyard notes the ambiguity listed online in terms of what the plans cover and how much they cost, and says: “The folks in DC have allocated $5 billion to this fund. Even given you don’t know what kind of coverage you will get or how much it will cost, $5 billion could fall short just like Cars 4 Clunkers.”

Another key part of the new health overhaul law also launched Thursday — the web portal meant for comparing health insurance options: www.healthcare.gov.

Jonathan Cohn, on his new Citizen Cohn blog, weighs in: “putting together and presenting this much material after just three months strikes me as impressive. And that’s a positive sign about more than just health care reform. Sometimes government fails, as it did (spectacularly) with the oversight of offshore oil drilling. But sometimes government works really well.”

On NPR’s Shots Blog, KHN’s Mary Agnes Carey notes that insurers are displeased with certain ways in which some information is cast and communicated: “America’s Health Insurance Plans is especially angry about a graphic located in the timeline section of the site, discussing what the law means for the Medicare Advantage program — the program where the government pays insurers to offer additional coverage to Medicare recipients.” The graphic reads, “Stopping Overpayments to Big Insurance Companies.”

Time’s Kate Pickert writes, “Some critics of the health care law and the Obama Administration will no doubt scoff at healthcare.gov, but they shouldn’t. There’s nothing wrong with helping Americans find out more about what their insurance options. This means more accountability and a more competitive marketplace.”

Dawn Horner of Say Ahhh! says the site isn’t “quite Amazon yet” but notes, “This is light years away from what exists today for families shopping for health coverage. But there still is a ways to go — once families are provided with the list of options, they have to navigate through a number of links, and ultimately, leave the site to find more information and apply for coverage.”

You can watch a virtual video tour of the site posted by HHS on YouTube: