Employing a tool as old as the presidency itself, President Barack Obama has named Donald M. Berwick, MD, MPP, a Harvard professor and patient care specialist, in a recess appointment as chief of the Centers for Medicare and Medicaid Services.

The move was designed to delay what is certain to be a contentious battle; since Berwick’s nomination in April, Republicans have voiced concerns over his approach to health care, including favorable statements about Britain’s government-run health system.

Another Berwick stance raises concerns for the GOP, including one made to an interviewer last year: "The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open. And right now, we are doing it blindly."

In a statement publicizing the move, Obama said, “It’s unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purpose."

According to the US Constitution, appointments made by presidents during Senate recess are temporary; they last through the end of the next session of Congress, but to remain in effect, the individual must be approved by the Senate before then.