Dr. Donald M. Berwick, the chief of the Center for Medicare and Medicaid Services who has frequently been targeted as a symbol of what Republicans oppose in health care law reform, announced he will step down from his post effective Dec 2.  

Berwick's temporary recess appointment was scheduled to expire at the end of the year. President Barack Obama nominated Berwick for the position in April 2010 but the doctor -- who has worked to raise both the quality and efficiency of the healthcare system -- never received a Senate confirmation hearing.

The president said he will nominate Berwick's deputy, Marilyn B. Tavenner to replace Berwick as the administrator of the Centers for Medicare and Medicaid Services.

Berwick was met with strong hostility by the GOP when he was nominated by Republicans, culminating to a point that Senate Republicans asked the White House to withdraw the nomination and vowed to block his confirmation. Berwick, who previously served as the President and Chief Executive of the Institute for Healthcare Improvement (IHI), a non-profit organization aiming to improve global healthcare quality, was criticized for allegedly being an advocate of healthcare rationing due to his belief that healthcare needs to redistribute resources from the rich to the poor.

Berwick was particularly attacked over comments he made to a biotechnology journal in 2009, when he praised the British nationalized health care system, saying, The decision is not whether or not we will ration care -- the decision is whether we will ration with our eyes open.

Berwick Won Praise From Gingrich

However, long before he was approached by the Obama administration, Berwick won the praise of some leading Republicans for his work at IMS, including Republican presidential contender Newt Gingrich.

Gingrich, who has been hammered by conservatives for supporting an individual health care mandate before he was against it, discussed Berwick's role in advocating a computerized medical record system in a 2000 editorial he penned for The Washington Post.

Don Berwick at the Institute for Healthcare Improvement has worked for years to spread the word that the same systematic approach to quality control that has worked so well in manufacturing could create a dramatically safer, less expensive and more effective system of health and health care, Gingrich wrote, later adding that similar reforms in hospital health care would save money and tens of thousands of lives a year.

More recently, Tom Scully, who ran CMS under former President George W. Bush between 2001 and 2004 and Gail Wilensky, who ran the agency under the first President Bush, both said it would be more beneficial to confirm Berwick rather than leave CMS without a chief administrator during a 2010 roundtable discussion with the journal Health Affairs.

Scully acknowledged that while Berwick was qualified for the position, he would likely face strong political opposition during the confirmation process, which he said was a shame.

Ninety-five percent of this job is not, in my opinion, political.  Ninety-five percent of it is just making the trains run on time and making these programs run, and it's crazy not to have somebody in there day to day, steering the ship, he said.

CMS finances the health care expenses of about 1 in 3 Americans, in addition to regulating hospitals, medical providers, and healthcare plans. The agency has a higher budget than the Pentagon.

Berwick's successor, Tavenner, is more of a manager than a visionary, according to multiple reports, but her nomination was immediately supported by organizations such as the American Hospital Association. Tavenner, a nurse, worked for in the private sector for more than 20 years as a nursing supervisor, a hospital executive and ultimately the president of outpatient services group for the Hospital Corporation of America.