President Barack Obama spent the last year insisting he doesn’t want to turn the American health care system into a carbon copy of the government-run British system.
But Obama’s pick to run Medicaid and Medicare — Donald Berwick — is a pediatrician and Harvard University professor with a self-professed “love” of the British system.
Berwick has called Britain’s National Health Service “one of the greatest health care institutions in human history” and “a global treasure.” He once said it sets an “example” for the United States to follow. And his decade-long efforts to improve the NHS were so well-regarded that Queen Elizabeth granted him an honorary knighthood in 2005.
This will be an critical confirmation battle, as Politico notes.
Obama tapped Berwick to serve as administrator of the Centers for Medicare & Medicaid Services — a post second only to Health and Human Services Secretary Kathleen Sebelius in influence within the department over implementing the massive new health care law. CMS is tasked with expanding Medicaid to an additional 16 million people, writing regulations to implement the law and establishing dozens of pilot projects that are central to realizing long-term deficit savings.
Though you have to wonder how important this job is, minus its influence. There hasn’t been a person in this position for the last four years, and Medicare and Medicaid are still chugging along. They’re killing our solvency, of course, which is where Democrats think Berwick might come in handy. He’s known for being a proponent of cost-cutting in the medical realm. The problem with the Politico piece is that the writer seems so anxious to disperse doubts about Berwick subtly. Take this paragraph, which informs us of his multiple Ivy League degrees, his bipartisan fan club, and the momentous nature of his work.
Berwick, a physician with three Harvard degrees, founded the nonprofit Institute for Healthcare Improvement in 1991. In this capacity, Berwick has traveled the country and the world, pressing his theory that doctors and hospitals can boost care and reduce medical errors while saving money. Admirers — a group that includes a few Republicans who headed CMS — have described his work as “revolutionary.”
The article does make it clear that Berwick is a fan of Britain’s National Health Service.
“I fell in love with the NHS,” Berwick said in a 2008 speech of the system that he had worked on since the 1990s. “To an American observer, the NHS is such a seductress. … Like any lover, it took me a while to see the blemishes of my beloved, though I soon had help from people quite willing to point out the warts.”
But it doesn’t say much about why it matters. Here’s a less amusing but more telling remark from Berwick that came in an interview he gave last year (link is a PDF).
The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom and also, to some extent, the Institut National de la Sante in France have developed very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn.
What can we learn from them? How to control costs by cutting care, just the thing to which ObamaCare’s critics warned the legislation would lead. Berwick says very plainly:
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.
NICE—when an acronym sounds as if it belongs in an Orwell novel, it probably does—is the British version of the Independent Payment Advisory Board (IPAB), an independent, unelected body created by Obama’s health-care reform legislation that instructs Congress on how to reduce Medicare spending. Critics charged that creating IPAB would be enacting health-care rationing. NICE has certainly led to rationing in Britain, with deadly results. The Rarer Cancers Forum found that in one year, up to 16,000 patients died prematurely (link is PDF) because NICE refused them cancer medication. A court called NICE’s policy on denying treatment to Alzheimer’s patients “procedurally unfair.” The cost-effectiveness analysis the agency used to arrive at its guidelines—the sort of work Berwick is being brought in to do—was simply wrong, a group of doctors and researchers judged.
Health-care costs are out of control, of course. When government is given the task of reining them in, the result inevitably is rationing. So few bureaucrats, though, are as bluntly honest about it as Donald Berwick.