It's official, at least until the end of 2011. Healthcare quality expert Donald Berwick will run the Medicare and Medicaid programs.
The Obama administration, no doubt frustrated that the Senate couldn't get its act together to confirm Berwick, finally announced late Tuesday that it is temporarily bypassing that body and installing him this week.
"There's no time to waste with Washington game-playing," pronounced Obama's communications chief Dan Pfeiffer on the White House blog.
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.
But those efforts are meeting with less than complete success, according to the health newsletter Politico Pulse. The Pulse reports that while Arizona residents have gathered enough signatures to get a ballot initiative to repeal the "individual mandate" that requires most Americans to have health insurance starting in 2014, opponents in Michigan and Ohio both missed petition deadlines.
Meanwhile, it's unclear whether states can constitutionally undo what Congress has done.
Last week, a federal court heard oral arguments in a case filed by the state of Virginia against the federal government, charging that the individual mandate violates a law that state's legislature passed in March, protecting state residents from such a requirement. The federal government wants the case dismissed.
"This lawsuit is not so much about health care, it's about liberty," declared Virginia Attorney General Ken Cuccinelli, who filed the action in federal court. If the law is upheld, Cuccinelli said, "there's nothing to stop Congress from forcing people to buy Chevrolets, or any other private product it wants."
Even Federal District Court Judge Henry Hudson wondered what the outer limits might be on the Constitution's authority to Congress to regulate commerce between the states. "Can you require (individuals) to have an annual physical? Can you require them to join a health club? Can you require them to have a medical procedure?"
But Deputy Assistant Attorney General Ian Gershengorn, who argued the case for the Obama Administration, insisted that the government already requires many things of its citizens, and that requiring the uninsured -- the vast majority of whom consume health care anyway -- to pay for it upfront is hardly outlandish in comparison.
People who live in flood-prone areas must buy flood insurance, he pointed out. Everyone with a bank account pays for deposit insurance.
And there are more universal requirements are well, he said, like sitting on juries, or registering for the draft. At one point in history, Gershengorn said, men were required to serve in militias "and pay for their own guns and ammunition."
Clearly, this is not a dispute that will be settled to everyone's satisfaction anytime soon. [Copyright 2010 National Public Radio]