"An insult to the American people," storms Senator John Barrasso. Like many other Republicans, he is outraged that Barack Obama has bypassed the traditional congressional review process by installing Donald Berwick, a paediatrician and Harvard academic, as the head of the Centres for Medicare & Medicaid Services (cms). In this position, which supervises the federal health schemes for the elderly and indigent, Dr Berwick will have a big say in determining how Mr Obama's controversial new health reforms are implemented.
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