On the day before Thanksgiving, controversial health wonk Donald Berwick tendered his resignation as administrator of the Centers for Medicare and Medicaid Services. “It’s unfortunate that a small group of senators obstructed his nomination, putting political interests above the best interests of the American people,” said deputy White House press secretary Jamie Smith. “One of [health care’s] most distinguished leaders and voices got mugged by partisan Republicans who know better and who got away with it,” wrote John McDonough of the Boston Globe. Berwick, however, wasn’t done in by Republican intransigence. He was done in by presidential cowardice. And therein lies a microcosm of everything that’s been wrong with Obamacare.
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Let’s review the history. In April 2010, President Obama nominated Berwick, a decorated triple-graduate of Harvard and dean of the liberal health-policy community, to run the agency known as CMS. Berwick, who has tenured faculty appointments both at Harvard Medical School and the Harvard School of Public Health, also founded a think-tank called the Institute for Healthcare Improvement, which focuses on improving health-care delivery, and where Berwick collected compensation of nearly $900,000 in 2009. Berwick has had his admirers on the right; Newt Gingrich once saluted Berwick for seeking a “dramatically safer, less expensive, and more effective system of health care.”
Berwick was knighted by Queen Elizabeth II for his involvement in Tony Blair’s ill-fated efforts to improve Britain’s National Health Service. It was during this period that the NHS set up its notorious health-care-rationing board, the National Institute for Clinical Excellence, which routinely stymies the use of life-saving treatments in order to save money. Speaking at the NHS’s 60th anniversary in 2008, Sir Donald extolled the NHS as far superior to the American health-care system, a system veiled by the “darkness of private enterprise.”
“Please don’t put your faith in market forces,” said Berwick. “It is a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can do. I do not agree. I find little evidence anywhere that market forces, bluntly used, that is, just consumer choice among an array of products with competitors’ fighting it out, leads to the health care system that you want and need. In the US, competition has become toxic. . . . Do not trust market forces to give you the system you need. . . . I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.” Berwick, as head of CMS, sought to be one of these “leaders with plans.”
Berwick deserves credit for his intellectual honesty. Unlike the president, who repeatedly tries to describe his health-care agenda in chin-strokingly centrist tones, Berwick embodies what that agenda is really about: an attempt to move America in the centrally planned direction of Britain, a move that Berwick is “romantic” about.
When it comes to health care reform, another "honest" liberal is Paul Krugman.
In columns on health care he wrote earlier this year, he went beyond most other American liberals in that he demanded that America implement a full NHS-type system in which all private hospitals are taken over by the government and run by the government.
Most other American liberals favored a Canadian-style single-payer system, where the insurance is public but there are still doctors and hospitals in private practice. Krugman doesn't think that's enough. He wants all hospitals to be run by the government like VA clinics. (The fact that VA clinics aren't teaching hospitals didn't bother him, just like other uncomfortable facts about America's economic history never bother him.)
The need to ration in Medicare will not go away with Dr. Berwick. I appreciated him for his willingness to state the truth: collectivized medicine requires rationing. Unfortunately, as described in this commentary, Dr. Berwick's message continues to be evaded by politicians on both sides of the aisle.
No Beth, it is not truth, it is preference. His message is false in that it suggests a small group of leaders ever has enough information to make prudent decisions. Govt has been screwing up health care since medicare's creation. There is no value equation for consumers or providers to solve. Providers get paid to do more and patients have no incentive to quit asking for more. In the govt system Dr. Berwick relishes the only change is that now the providers have no incentive to provide while customers/patients have great incentive to consume. Hence shortages and rationing to levels even our own system couldn't begin to comprehend in its worst moments.
Health care is a good like any other, and we have made it increasingly expensive by asking "insurance" to pay for more stuff that the individual should take care of on their own. Insurance is more like prepaid healthcare.
Berwick, for all his training is a fool. He was not put up for confirmation because he was going to get drilled by the GOP on subjects for which the good doctor has no answers. Not answers of hard truth that are difficult to hear, but the exposure of a desire to centralize and control the lives of everyone, with no evidence it will provide a single improvement, but with a history of misery, and shortages, and death.
Here are two statements about health care. 1) Boldly stated by Mr Berwick, Mr Krugman and Mr Riech: If you collectivize ie give “free” healthcare out, you have to ration it. 2) If you are a free people, you should be able to make your own health care decisions, ie you should be able to use your own resources to buy expensive and extensive care if you want to. The problem is not that either of these statements is false – the problem is that they contradict each other if you throw in the further assumption that everyone has to have the same care. The way out is simple: A free market, open system with a safety net. Safety nets are ALWAYS rationed. You cannot allow people on food stamps to have a blank check to eat truffles and filet mignon every night if they want to. The entire controversy arises from people who lust to have absolute leveling in which government experts take all the choice out of the system.
Good riddance to this guy, a Socialist, Central Planner. Why did he not want to defend Britain's Health Care "NICE" system? Send him to the UK or better yet Cuba, they need him there.
"... system as massive and complex as health care. That is for leaders to do.” Berwick, as head of CMS, sought to be one of these “leaders with plans.” "
This is the problem. Health care is a "system" precisely because of centralized government meddling in subsidies and insurance "regulation". Its interference has inflated prices way beyond actual costs because the markets are chained and supressed by Medicare/Medicaid arbitrary payments and requirements. They have effectively done equal if simpler injury to higher education.
It occurs to me that, with few changes, the premise of this article could apply to virtually ANYTHING this President's is up to: he "repeatedly tries to describe his . . . agenda in chin-strokingly centrist tones", while the people who work for him "embody" attempts to "move America in (a) centrally planned direction" that we don't want to go in.
Don Berwick assumes that there are one or more "proper configurations" of the American healthcare system, and he does not credit that the consumers of health care have the intelligence to implement a "correct" configuration. His comments highlight the hubris of the social planners: the belief that a politically appointed committee of "really smart poeple" can design a plan for the rest of us that will somehow regulate a system of almost infinite complexity, and then implement it with fairness. The genius of our system is that millions of rational healthcare choices made by individuals having their own best interests in mind RESULTS in a "correct configuration" for healthcare--it is not imposed upon us by the state. Over time, that system's defects, as the become clear, are fixed by the processes of free choice and rational decision making.
In all seriousness, what this country needs is a law-- or a constitutional amendment --barring anyone with a connection to Harvard-- faculty, student, or administration --from serving in any government position. This principle, which perhaps should be extended to all Ivy League institutions, would do more good for the U.S. than any other single measure I can imagine.
Remember the "military-industrial complex?" Nowadays, the evil giant standing in the shadows goes by the moniker "academic-liberal morass."
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