"Why Donald Berwick is Dangerous to YourHealth
"President Obama's nomination of Donald Berwick M.D. to head HHS's Center forMedicare & Medicaid Services (CMS) eliminates any lingering doubt he seeksto impose state-run medicine and a European style health care system on America.But before Dr Berwick gets an official nod of approval for the federalgovernment's most important health care appointment -- the CMS covers over 100million Americans, has an annual $800 billion budget that is larger than thedefense department's and is the 2nd largest insurance company in the world, theUS Senate may want to consider the nominee's remarkable and quite literalattachment to the socialist health-care model.
"I am romantic about the NHS. I love it." Dr Berwick says about probably thebest-known case of socialized medicine -- Britain's National Health Service(NHS). "All I need to do to rediscover the romance is to look at healthcare inmy own country," he says about a US health care system that is "bloated," runsin "the darkness of private enterprise," and has "tremendous excesscapacity."
Rationing -- Dr Berwick uses the "r" word himself -- is why he much prefersthe "politically accountable" British system. About Britain's rationing board,The National Institute for Clinical Health Excellence (NICE), Dr Berwick says:"NICE is not just a national treasure; it is a global treasure"
In using "quality adjusted life years" per British pound to make treatmentdecisions, NICE mandates that Britain cannot afford to spend, except in unusualcases, more than $22,000 to extend a life 6 months. But despite its Orwellianacronym and properly polite British exterior, NICE harbors a deep bureaucraticaversion to extended care for the elderly and those with chronic disease, anapproach which Dr. Berwick explicitly endorses.
"The chronically ill and those toward the end of their lives are accountingfor potentially 80% of the total health care bill out there. There is going tohave to be a very difficult democratic conversation that takes place. Thedecision is not whether or not we will ration care. The decision is whether wewill ration with our eyes open."
This sort of "eyes-open" endorsement of rationing by government panels,especially for the chronically ill and those (Sarah Palin call your office) whoare "towards the end of their lives", has about it chilling echoes of an earliercontroversy over similar views held by Dr. Ezekiel Emanuel, the brother of WhiteHouse chief of Staff .
But even if Dr Berwick does see America doing too much for the elderly andthe chronically ill, his vision for health-care change hardly stops with justone demographic.
"Any healthcare funding plan that is just, equitable, civilized and humane,must redistribute wealth from the richer among us to the poorer and the lessfortunate. Excellent healthcare is by definition redistributional".
Indeed, lest there be any doubt about the range of Dr Berwick's schemes for"redistribution" - code for transferring power to the government -- he makesclear how grand his vision for statist health care.
"There needs to be global budget caps on total healthcare spending fordesignated populations (ie-rationing)" Dr. Berwick says. "The simplest way toreach these goals is with a single payer system."
But if Dr Berwick leaves little doubt who is going to be in charge of theredistribution, global caps, and the single payer systems, he shows with his useof words like "politically accountable" or "democratic", the sort of verbal ticthat betrays his own understanding. He seeks not broad-based, bottom-updecision-making but top-own edicts from elite panels of enlightened and, ofcourse, "global" thinkers like himself that preempt decisions now made bydoctors and their patients.
And that is what those of us who are practicing physicians find so troublingabout Dr. Berwick's nomination. We see him as a White House Rose Garden,photo-op doctor with a borrowed white coat; an academic who runs a $58 millioninstitute, who analyzes numbers and reports and theories about populations butis now totally out of touch with his former peers and the patients that theytreat every day. And this is the sobering point-- Dr Berwick will not be therewith us at the patient's bedside looking them in the eye and telling them thatthe life saving treatment that they need is not approved because they don't fitinto the right demographic.
So, US Senators might ask Dr. Berwick why he "loves" and is "romantic" abouta British health care system that institutionalizes such moments. A health caresystem where patients have little or no choice about their provider and littleaccess to specialists. A health care system where waiting lists for visits tospecialists and for surgery can sometimes last a year, 40% of cancer patientsnever see an oncologist, rationing for kidney dialysis and open heart surgery isopen and explicit, and minimum wait times have been instituted for hospitaladmission (of 122 days) to reduce costs, leaving 750,000 people on waitlists.
"The cult of the state is dying" Ronald Reagan said in 1982. "The Era of BigGovernment is over" Bill Clinton declared a decade later. Both presidents wereonly acknowledging the progress of modern economics and its insight thatgovernment panels - because they lack the information built into market-basedsystems-- make far less wise decisions than individuals making their own choicesand benefiting competition. The failure of "global" and "redistributive"thinkers like Dr Berwick to see any of this is compelling evidence that in theend they are not about better health care but an avarice for power."
Dr. Scherz is a pediatric urological surgeon at Georgia Urology andChildren’s Healthcare of Atlanta, serves on the faculty of Emory UniversityMedical School and is president and cofounder ofDocs4PatientCare.