Donald Berwick, who became head of Medicare and Medicaid via a controversial (and temporary) recess appointment by President Obama, will have a tough time getting confirmed by the Senate. The road ahead looks so difficult that some Democrats are joining Republicans in calling for a new nominee, The New York Times reports . It’s a matter of math; 42 Republicans have already urged President Obama to pick someone else, and by voting accordingly, they could block confirmation, the paper says. A White House spokesman tells the NYT the nomination won’t be withdrawn and praised Berwick’s performance thus far. Berwick,

a doctor and a patient-safety expert, faced criticism of his past statements — including praise for the U.K.’s National Health Service — almost as soon as he was nominated last April. He was head of the Institute for Healthcare Improvement when President Obama nominated him , saying Berwick “has dedicated his career to improving outcomes for patients and providing better care at lower cost.” The Times reports Berwick’s principal deputy, Marilyn Tavenner, would be more acceptable to Republicans and is a potential replacement.

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Senate Confirmation for Medicare’s Berwick Looks Tough