Medicare and Medicaid are to be headed by a new Obama appointee, and I smell trouble. Robert Pear of the New York Times reports:

President Obama will soon name Dr. Donald M. Berwick, an iconoclastic scholar of health policy, to run Medicare and Medicaid, the programs that serve nearly one-third of all Americans, administration officials said Saturday.

The law, signed Tuesday by Mr. Obama, will expand Medicaid to cover 16 million more people, squeeze nearly a half-trillion dollars out of Medicare in the next 10 years and establish many demonstration projects to test innovative ways of delivering health care.

Dr. Elliott S. Fisher, director of the Center for Health Policy Research at Dartmouth Medical School, said Dr. Berwick was "a visionary leader who can motivate people to change."

However, he does not appear to have experience managing a large bureaucracy.

Don has been an intellectual force in health care for decades. He helped forge many ideas incorporated in the new health care law."

As examples, Mr. Findlay cited provisions of the law intended to reduce readmissions to hospitals, prevent hospital-acquired infections and hold doctors and hospitals more accountable.

At his institute's annual conference in December, Dr. Berwick issued this challenge to health care providers: "Over the next three years, reduce the total resource consumption of your health care system, no matter where you start, by 10 percent. Do that without a single instance of harm, without rationing effective care, without excluding needed services for any population you serve."

He said he had learned from his own medical problems, which include osteoarthritis in his right knee. "It comes from medical error, botched surgery when I was a medical student, aggravated by years of jogging," he said.

Doctors urged him to have a knee replacement operation several years ago, but he decided instead to have just a "steroid injection," and the outcome has been fine, he said.