Why Donald Berwick is Dangerous to Your Health

Why Donald Berwick is Dangerous to Your Health

By Hal Scherz - May 26, 2010

President Obama's nomination of Donald Berwick M.D. to head HHS's Center for Medicare & Medicaid Services (CMS) eliminates any lingering doubt he seeks to impose state-run medicine and a European style health care system on America. But before Dr Berwick gets an official nod of approval for the federal government's most important health care appointment -- the CMS covers over 100 million Americans, has an annual $800 billion budget that is larger than the defense department's and is the 2nd largest insurance company in the world, the US Senate may want to consider the nominee's remarkable and quite literal attachment to the socialist health-care model.

"I am romantic about the NHS. I love it." Dr Berwick says about probably the best-known case of socialized medicine -- Britain's National Health Service (NHS). "All I need to do to rediscover the romance is to look at healthcare in my own country," he says about a US health care system that is "bloated," runs in "the darkness of private enterprise," and has "tremendous excess capacity."

Rationing -- Dr Berwick uses the "r" word himself -- is why he much prefers the "politically accountable" British system. About Britain's rationing board, The National Institute for Clinical Health Excellence (NICE), Dr Berwick says: "NICE is not just a national treasure; it is a global treasure"

In using "quality adjusted life years" per British pound to make treatment decisions, NICE mandates that Britain cannot afford to spend, except in unusual cases, more than $22,000 to extend a life 6 months. But despite its Orwellian acronym and properly polite British exterior, NICE harbors a deep bureaucratic aversion to extended care for the elderly and those with chronic disease, an approach which Dr. Berwick explicitly endorses.

"The chronically ill and those toward the end of their lives are accounting for potentially 80% of the total health care bill out there. There is going to have to be a very difficult democratic conversation that takes place. The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open."

This sort of "eyes-open" endorsement of rationing by government panels, especially for the chronically ill and those (Sarah Palin call your office) who are "towards the end of their lives", has about it chilling echoes of an earlier controversy over similar views held by Dr. Ezekiel Emanuel, the brother of White House chief of Staff .

But even if Dr Berwick does see America doing too much for the elderly and the chronically ill, his vision for health-care change hardly stops with just one demographic.

"Any healthcare funding plan that is just, equitable, civilized and humane, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent healthcare is by definition redistributional".

Indeed, lest there be any doubt about the range of Dr Berwick's schemes for "redistribution" - code for transferring power to the government -- he makes clear how grand his vision for statist health care.

"There needs to be global budget caps on total healthcare spending for designated populations (ie-rationing)" Dr. Berwick says. "The simplest way to reach these goals is with a single payer system."

But if Dr Berwick leaves little doubt who is going to be in charge of the redistribution, global caps, and the single payer systems, he shows with his use of words like "politically accountable" or "democratic", the sort of verbal tic that betrays his own understanding. He seeks not broad-based, bottom-up decision-making but top-own edicts from elite panels of enlightened and, of course, "global" thinkers like himself that preempt decisions now made by doctors and their patients.

And that is what those of us who are practicing physicians find so troubling about Dr. Berwick's nomination. We see him as a White House Rose Garden, photo-op doctor with a borrowed white coat; an academic who runs a $58 million institute, who analyzes numbers and reports and theories about populations but is now totally out of touch with his former peers and the patients that they treat every day. And this is the sobering point-- Dr Berwick will not be there with us at the patient's bedside looking them in the eye and telling them that the life saving treatment that they need is not approved because they don't fit into the right demographic.

So, US Senators might ask Dr. Berwick why he "loves" and is "romantic" about a British health care system that institutionalizes such moments. A health care system where patients have little or no choice about their provider and little access to specialists. A health care system where waiting lists for visits to specialists and for surgery can sometimes last a year, 40% of cancer patients never see an oncologist, rationing for kidney dialysis and open heart surgery is open and explicit, and minimum wait times have been instituted for hospital admission (of 122 days) to reduce costs, leaving 750,000 people on wait lists.

"The cult of the state is dying" Ronald Reagan said in 1982. "The Era of Big Government is over" Bill Clinton declared a decade later. Both presidents were only acknowledging the progress of modern economics and its insight that government panels - because they lack the information built into market-based systems-- make far less wise decisions than individuals making their own choices and benefiting competition. The failure of "global" and "redistributive" thinkers like Dr Berwick to see any of this is compelling evidence that in the end they are not about better health care but an avarice for power.

Dr. Scherz, a pediatric urological surgeon at Georgia Urology and Children's Healthcare of Atlanta, serves on the faculty of Emory University Medical School and is president and cofounder of Docs4PatientCare.

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