Politics & Policy

The Real Face of Obamacare

Once a sleepy federal backwater, the Department of Health and Human Services (HHS) now has primary responsibility for implementing the federal takeover of the U.S. health-care industry, and Pres. Barack Obama proposes to fill a key position there with Dr. Donald Berwick, who exemplifies the worst aspects of the Democrats’ health-care agenda: denouncing the “darkness of private enterprise,” he celebrates the centralization of power, the redistribution of wealth, and the subordination of health-care professionals to political players. Republicans should defeat his nomination.

Although HHS Secretary Kathleen Sebelius probably will remain as the public face of administration’s health-care effort, the HHS staffer who may in fact wield the most power in the unfolding implementation drama is the less visible administrator of the Centers for Medicare and Medicaid Services (CMS). As its name implies, CMS is charged with running the nation’s massive public insurance programs — Medicare and Medicaid — which together already cover about 100 million people and cost more than $1 trillion annually. The new health-care law places another 15 million people under the Medicaid umbrella and requires scores of changes in the way Medicare is run. Further, the CMS administrator is the designated point man in the government’s “bend the cost curve” campaign.

It is to this crucial position that the administration has now nominated Dr. Berwick, a Massachusetts physician and an unabashed believer in centralized governmental power over the health sector. He has spoken and written in glowing terms about the British National Health Service (NHS), mainly because the NHS has a command-and-control structure in which the nation’s physicians and hospitals have little choice but to fall in line with the government’s orders. He boasts of the political power and cost control such a system provides, but papers over the deteriorating capital structure, rationing, and widespread quality problems that predictably follow when impersonal bureaucratic structures call all of shots. He affirms that a system for health-care financing “must — must! — redistribute wealth.”

We generally take the view that presidents deserve substantial deference when picking nominees for important and sensitive administrative positions in the executive branch. No matter which party holds power, someone needs to make sure the trains run on time — and to be held accountable when they don’t. By all accounts, Dr. Berwick is both a respected physician and an acknowledged expert in techniques for improving the quality of American health care with voluntary efforts in the private sector. But it’s also clear that he personifies Americans’ worst fears about the Obamacare experiment. Personnel is policy, and Dr. Berwick gives us an indication of what Obamacare will look like in practice, as opposed to the fantasy with which Americans were presented during the health-care debate.

The White House and Senate Democrats are already accusing Republicans of using the Berwick nomination to re-litigate the health-care fight. They are right in a sense. A fight over Berwick would be a fight over Obamacare all over again. But that is as it should be. The health-care bill was sold to the American public on false pretenses. The president and his allies said they had no intention of pursuing a governmental takeover of American health care, but that’s exactly what the bill they passed will lead to. And now we have a nominee whose public record makes it abundantly clear that is the goal he would pursue if confirmed.

Obamacare has been enacted, but won’t really be implemented until 2014. There is still ample time to change course. But change will require voters sending new leadership to Washington this November and again in 2012. The Berwick nomination is a perfect opportunity to demonstrate to the electorate again what will happen if Obamacare is allowed to run its course. Senate Republicans should not hesitate to seize it, and to defeat this nominee.


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