Critical Condition

NRO’s health-care blog.

Obama Appoints His Rationer-in-Chief


President Obama is making a huge end-run around the American people with his recess appointment of Dr. Donald Berwick.

“This recess appointment is an insult to the American people,” said Sen. John Barrasso (R., Wyo.), a physician and leading Berwick opponent. “Dr. Berwick is a self professed supporter of rationing health care, and he won’t even have to explain his views to the American people in a hearing. Once again, President Obama has made a mockery of his pledge to be accountable and transparent.” Berwick will have authority over an agency with the largest single budget in the entire U.S. government and over implementation of the most sweeping legislative overhaul of our health sector ever — without so much as a congressional hearing!

Berwick will run the Centers for Medicare and Medicaid Services (CMS), giving him control of its $800 billion budget during the crucial months when thousands of pages of regulations will be written, determining how Obamacare will be run. The recess appointment lasts through the first session of the next Congress in 2011, after which Berwick will have to be renominated and would likely face even greater opposition, assuming Republicans make expected gains in the Senate.

The reason Berwick’s nomination was so highly controversial: numerous statements he has made professing his love for socialized medicine.

In speeches and articles celebrating the 60th anniversary of Britain’s National Health Service in 2008, Dr. Berwick said, “I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country.” He not only loves it, he says it is “an example for the whole world — an example…that the United States needs now.”

“The NHS is not just a national treasure; it is a global treasure,” Berwick wrote.

Berwick’s suggestion to the British: “Please don’t put your faith in market forces.”

“In the United States,” he wrote, “competition is a major reason for our duplicative, supply-driven, fragmented care system.”

He has publicly saluted Britain’s socialized NHS for rejecting the “immoral” American system and  “the darkness of private enterprise.” He said that “the Holy Grail of universal coverage” cannot be achieved with consumer-centered health care, but only through “collective action overriding some individual self-interest.”

In an interview last year in the journal Biotechnology Healthcare, he said, “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

Even the New York Times has taken notice of Berwick’s controversial nomination. Robert Pear reported last month: “Long before the uproar over ‘death panels’ last year, Dr. Berwick was urging health care providers to ‘reduce the use of unwanted and ineffective medical procedures at the end of life.’”

Jeff Jacoby, a columnist with Dr. Berwick’s home-town newspaper, the Boston Globe, also took direct aim at Berwick, noting that Obama has been adamant that his health-care overhaul would not put Americans “on the road to British-style, government-run medicine.” Jacoby continues: “No one can deny that America’s health care system is flawed in many ways. But when it comes to the standard that matters most — the quality of health care provided — our haphazard, expensive, insurance-based system towers above the NHS. By one metric after another — cancer survival rates, performance of diagnostic tests, availability of CT and MRI scanners, consultation with specialists — U.S. health care is superior.”

Berwick’s nomination hearings were certain to shine a bright public light on those comments; alas, he is now certain to gain the title of rationer-in-chief, and the president has appointed to implement his health-care plan a man who has a love-affair with the NHS.

“Don Berwick is going to have a tough time at first, but members are going to be calling him for local favors,” says former GOP Hill staffer and current health strategist Alec Vachon. “The best thing he can do is return those calls within ten minutes. It’s the quickest way to build bridges.”

With power over an agency whose budget is larger than all but 15 of the world’s economies, Vachon could be right. But let us hope and pray that he is wrong and that principle will prevail over politics.


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