Centers for Medicare and Medicaid Services (CMS) chief Donald Berwick will step down on December 2, three weeks before his recess appointment expires on December 31.  Fortunately, Dr. Berwick left a voluminous paper trail, leaving little doubt about his affinity for socialized medicine.  His controversial views on "redistributional" healthcare and rationing prompted 42 senators to vehemently oppose his nomination last spring.

Not wishing to have another fight on his hands, President Obama has nominated Berwick's second-in-command, Marilyn Tavenner, to head the agency.  Tavenner will act as CMS director until her own confirmation hearings sometime next year.

As principal deputy administrator and chief operating officer of CMS since 2010, Tavenner has stayed under the radar.  Unlike Berwick, the former nurse graduated from a state school, worked her way up in the private sector, and ended up as Governor Tim Kaine (D-VA)'s secretary of Health and Human Services for the Commonwealth of Virginia from 2006-2010.

Tavenner's quiet, bipartisan rise to the top makes her a strategically smart choice, but at a time when most Americans' tolerance for self-serving politicians has reached an all-time low, the Virginia native might not fare any better than Berwick.

Last March, Tavenner told the Nashville Health Care Council that if she were nominated to lead CMS, the agency would follow the five-year plan outlined in the Patient Protection and Affordable Care Act.  "Whether I'm nominated or not, we would not have a different approach."  She assured the council that in the future, "the agency's priorities would not change."

In August 2010, Tavenner toed the party line, chastising critics of ObamaCare for "stoking fears" and targeting seniors with "misinformation" regarding their Medicare benefits.

The NASCAR fan from Martinsville may appeal to Republican sensibilities, but by her own admission, there is little doubt that she will be more of the same -- red flags and all.

While she was Virginia's HHS secretary in 2009, Tavenner and the governor conspired to delete certain details from a report on two state children's hospitals which Kaine wanted to close.

Psychiatric Solutions, Inc. (PSI), a private hospital group based in Tennessee with a "well-above-average numbers of founded complaints of abuse -- in one case, roughly 20 times the average of other licensed residential facilities," was interested in purchasing the facilities.  PSI was a major donor to Kaine's political action committee at the time.

E-mails obtained by the Richmond Times-Dispatch in 2010 revealed communication among the governor's office, Tavenner, and the Department of Behavioral Health and Developmental Services even before the panel's report was complete.  One e-mail indicates that Tavenner personally escorted PSI officials on a tour of one of the state hospitals, where the latter displayed an interest in "treating the young people there."  In another e-mail regarding the tour, Tavenner wrote that she was "trying not to make a big deal of it for obvious reasons."

Then-Gov. Timothy M. Kaine's office was involved in discussions that led to the suppression of findings that a state children's hospital he wanted to close provided an essential service.

The state Department of Behavioral Health and Developmental Services said a series of e-mails from Nov. 5 to Dec. 16, 2009, between the governor's office, then- Secretary of Health Marilyn Tavenner and the department discussed revisions to an expert panel's report on the care for children with severe mental illness.

The revision removed from the report a finding that no other hospitals in Virginia could care for the 800 children with serious mental illnesses treated every year at the state's Commonwealth Center for Children and Adolescents in Staunton and a smaller facility in Marion.

When contacted about the e-mails in March 2010, Tavenner, the newly appointed CMS deputy director told the Times-Dispatch that she no longer worked as Virginia's HHS secretary and would not comment.  Kaine, who went on to become chairman of the DNC, has also refused to talk about his part in the quashed findings.

Prior to her tenure as Virginia's HHS Secretary, Ms. Tavenner worked for the Hospital Corporation of America (HCA), founded by former Senator Bill Frist's father.  Her career spanned 25 years, from nurse manager to president of Outpatient Services Group.

Tavenner's private-sector experience has already proved controversial for some in the health care field.  In April 2011, Suzanne Gordon, editor of the "Culture and Politics of Health Care Work" series at Cornell University Press, sized up the potential CMS director for the Boston Globe, citing her affiliation with HCA.

While Tavenner worked for HCA, the company was busily enhancing its profit margin by defrauding the Medicare, Medicaid, and TRICARE systems. In 2000, for example, HCA paid fines of $840 million for improperly billing the government and in 2003 HCA had to fork over another $631 million.

Although Tavenner may not have been personally involved in these scandals, it hardly seems wise to put her in charge of the government system her company helped defraud. The job of CMS administrator is to protect patient safety and quality, something that federal officials with close ties to the industries they are supposedly regulating and monitoring seem to have a hard time doing.

Tavenner has been called "tough," "a pragmatic moderate," a "skilled operator," and "a person who makes things work and has patients at heart."

Mira Signer, executive director of the National Alliance on Mental Illness (NAMI) in Virginia, might disagree with that last description.  She stated that her organization "was caught off guard" by Kaine's and Tavenner's attempt to shut down a state facility that would leave 800 children without adequate care in favor of a scandal-ridden PSI.

So far Tavenner has managed to avoid a serious vetting.  Her down-home, non-elitist background contrasts nicely with most of Obama's nominees.  With the First Lady's recent visit to the Homestead-Miami Speedway, the president may be trying to win over the "bitter Bible-clinging gun owners" with his choice of Tavenner.

Read more M. Catharine Evans at Potter Williams Report.