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D.C. health care feud boils over in Mass. governor’s race

Across political divide, Astrue, Berwick hit hard

Michael Astrue, left, and Donald Berwick, right.

Win McNamee/Getty and J. David Ake/AP

Michael Astrue, left, and Donald Berwick, right.

WASHINGTON — They were two heavyweights of the Obama administration, both Harvard-educated wonks who ran the US government’s biggest social welfare agencies. Now they are trading bitter political insults like “incompetent” and “hack.”

The fissures between Michael Astrue and Donald Berwick, a Democratic candidate for governor, opened in early 2011 when Berwick, then administrator of the Centers for Medicare and Medicaid Services, summoned Astrue, then Social Security Administration commissioner, to his office.

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Berwick wanted Social Security to help pay for a piece of the health care insurance marketplace, which was in the planning stages and due to go online almost three years later in October 2013.

Astrue said he felt bullied by Berwick and rebuffed him.

Now they have brought the fallout from their Washington dispute back to Cambridge, where, in new roles, they are locked in an increasingly fierce feud with implications for the 2014 campaign for governor.

Astrue, a Republican biotechnology chief executive and supporter of GOP gubernatorial candidate Charlie Baker, said in news media appearances in recent weeks and in an interview with the Globe that Berwick’s weak leadership and “dawdling’’ during his tenure at CMS in 2010 and 2011 were the root cause of the embarrassing failures this month of Obama’s insurance marketplace.

Berwick, asked by the Globe to respond, vigorously denied Astrue’s accusations. The former Social Security commissioner, he said, is a “hack’’ and a “right-wing pundit’’ who is “just not credible.’’

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“His comments are basically ridiculous,” said Berwick, who is seeking his party’s nomination for governor while serving as a fellow at the nonprofit health care think tank he founded in Cambridge. “He’s uninformed, and he’s politically motivated. I met with that guy probably twice in my life.”

Berwick resigned from his CMS post after 17 months, in December 2011, as Republicans threatened to block his confirmation. A former Harvard professor and pediatrician, he is widely admired as a visionary whose expertise in preventing medical errors and containing health costs at his Institute for Healthcare Improvement led him to Washington. Berwick’s stint in the capital has been thrust into the recent debate because he was in charge of the early, crucial planning for the marketplaces.

Responding to complaints about the computer crashes, inaccurate data, and other crippling problems that have plagued the site since its Oct. 1 debut, he told the Globe last week that he was not involved in key decisions he considered “staff-level’’ functions.

He said he did not remember any conversations about whether to hire a company to oversee development of the computer network. The lack of such outside expertise has been sharply criticized by experts and members of Congress. The administration on Friday said it has decided to hire such a contractor to fix the flawed system.

In recent opinion columns in The Wall Street Journal and The Weekly Standard, in a television interview on Fox, and in congressional testimony, Astrue has chastised Berwick for his early planning for the marketplace. In The Weekly Standard column, he accused Berwick of “plain old incompetence and arrogance.”

Astrue served under Obama as a holdover from the Bush administration and completed his six-year term leading Social Security in January 2013. A Harvard-trained lawyer, he now serves as interim chief executive of InVivo Therapeutics, which develops technologies to treat spinal cord injuries. Astrue was also general counsel of the Department of Health and Human Services under President George H.W. Bush and led the Massachusetts Biotechnology Council.

During their 90-minute meeting in 2011, Berwick and Astrue faced off at opposite ends of a long table, with Berwick’s staff seated along the walls. Astrue said he rebuffed Berwick’s request for Social Security operating funds because rules prohibited it. Berwick responded at the meeting, said Astrue, by lifting his chin and going into “full bullying mode.’’

“He went at me, saying this is a mom-and-apple-pie program. You have to get with the program,” Astrue said.

Berwick also railed about not getting enough financial support from Congress, Astrue said. Nor was the administration — specifically, Health and Human Services Secretary Kathleen Sebelius, Berwick’s boss — ponying up the funds he needed for the insurance marketplaces, also called exchanges, Astrue recalled Berwick saying.

“He excoriated Secretary Sebelius for not using the Affordable Care Act discretionary fund to help fund this project,” Astrue said. “What Berwick complained about in my presence and 20, 25 of his staff was that not only would Sebelius not fund the exchanges, but that she had not given one penny to CMS for anything ACA-related.”

Astrue also contends Berwick did not move swiftly enough to design specifications for the new insurance marketplace, a complex computer engineering problem, and get all of the contracts out to bid.

“It’s like the general manager who instructed the coach not to hand out the playbook until 24 hours before the first game,” Astrue said. “You can’t fritter away a year and a half and then do it in two years. That’s the position that Don Berwick put the Obama administration in. Berwick set them up for failure.”

“He was an utter failure at the one most important thing he had to get done, which was the exchanges.”

Officials with the Obama administration, including CMS and Health and Human Services, declined to comment.

Berwick, who is pinning much of his gubernatorial run on his experience implementing federal health reform, called Astrue’s anecdote about the 2011 meeting a “figment of his imagination.”

“The allegation that I was upset was inaccurate in the extreme,” Berwick said. “That is pure speculation. I deny it categorically.” Berwick denies ever criticizing Sebelius. He said he and Sebelius, who appears before Congress Wednesday to discuss marketplace system failures, operated as “one team” and that he feels “very fortunate to have worked for her.”

Peter V. Lee, former deputy director of the Center for Medicare and Medicaid Innovation, part of CMS, said Berwick established relationships with many agencies to start the federal data hub that would verify consumers’ income in real time.

“The collaborative relationships that Don put in place when he was at CMS are now the backbone of our success,” said Lee, who runs the California insurance marketplace.

Berwick said his agency interacted regularly with counterparts at Social Security. Lack of resources made the work all the more challenging, he said. “Nevertheless, we forged ahead. I stand by my record there.”

He declined to respond further. “I’m through commenting on what Michael Astrue said.”

Tracy Jan can be reached at tjan@globe.com.

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