Donald Berwick Bows Out
A tale of presidential cowardice.


Avik Roy

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.

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.