Senate Republican leaders are considering retaliatory measures in response to President Barack Obama’s decision to use a recess appointment to install Donald Berwick as administrator of the Centers for Medicare and Medicaid Services.

Fuming over Obama’s move to circumvent Senate confirmation of Berwick absent even a committee hearing, Senate Republicans took to the floor Tuesday to aggressively criticize some of the more controversial statements Berwick has made in praise of the United Kingdom’s government-run health system. In a floor colloquy with fellow Republican Senators, Sen. John McCain (Ariz.) mocked Berwick, who was awarded an honorary knighthood by the Queen of England in 2005, as “Sir Donald.”

Speaking to reporters later in the day, Minority Leader Mitch McConnell called the appointment of Berwick during the July Fourth recess period a “truly outrageous” political move. The Kentucky Republican declined to specify what Republicans might do in retaliation, but Senators in his inner circle suggested some action was forthcoming.

“I think the leader is thinking about that. But I wouldn’t want to get ahead of him,” Sen. Judd Gregg (R-N.H.) said.

“We will talk about what steps we can take, but we’re not ready to say,” Republican Conference Chairman Lamar Alexander (Tenn.) added.

Under the terms of recess appointments prescribed in the Constitution, Berwick will be able to serve until the end of next year. Some Democrats, including Finance Chairman Max Baucus (Mont.), have joined Republicans in voicing their displeasure with Obama’s handling of the Berwick nomination to head CMS.

But others defended the president, contending he had no choice after Republicans signaled their intent to make a political issue of Berwick’s nomination and use his favorable views of the UK’s medical system to disparage the health care reform law signed by Obama in March. In fact, Republicans had made no secret of plans to target Berwick, a pediatrician and college professor, as part of a continuing campaign to highlight what they argue are the new health law’s flaws.

[IMGCAP(1)]”It is regrettable that [Obama] bypassed the Senate procedures. But it is understandable given the relentless blockade that the Republicans have erected to his nominees,” Sen. Sheldon Whitehouse (D-R.I.) said. “I think the president’s decision was very prudent to realize that if you wanted to get this guy to work soon on behalf of the American public, you simply had to spare him the nonsense that was clearly coming his way.”

Among Berwick’s public statements highlighted by Republicans was one made in a 2009 interview about health care rationing: “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

The GOP has also attempted to tar Berwick for voicing support for a single-payer, government-run health care system in 1996, when he wrote: “I admit to my own devotion to a single-payer mechanism as the only sensible approach to health care finance I can think of.”

Regarding the UK’s National Health Service, Berwick said in a 2008 speech in London: “I fell in love with the NHS. … To an American observer, the NHS is such a seductress.”

The Obama administration is coordinating with Congressional Democrats to roll out provisions of the new law in the hopes that its public standing improves and is not a liability in November.

Democrats argue that Berwick’s previously stated views on health care policy generally are irrelevant to his running CMS.

Whitehouse described Berwick as the “founding father of the quality reform movement” whose expertise in implementing the new health care law is vital. “If he said some things that are overly affectionate about the British health care system, big deal,” Whitehouse said.

But Republicans argue that Berwick’s views are on point precisely because the new CMS administrator will have enormous influence over the delivery of health care given how the new law will affect the Medicare and Medicaid systems. Republicans charge that the health care law’s mandate to cut $500 million from Medicare’s budget will lead to rationing, which Democrats deny.

“The comments of Sir Donald certainly give one extreme pause,” McCain said during the Tuesday morning conversation.

Sen. John Barrasso, an orthopedic surgeon who participated in the colloquy, referred to Berwick as Obama’s “health care rationing czar.”

A few times per week, the Wyoming Republican hits the Senate floor to offer a “doctor’s second opinion” to the administration’s pitch that the new law will improve health care delivery and lower costs. His weekly remarks are part of a coordinated GOP strategy to frame the health law in a politically advantageous light in advance of the midterm elections.

While Senate Republicans mull what to do tactically in response to the Berwick nomination, which could include even more delays for other administration nominees, they are sure to continue pounding the administration rhetorically.

“The president just thumbed his nose at the American people by saying, ‘I’m not even going to allow the Senate to have a hearing on this nominee before we put him in the position,'” Alexander said.