The Growing Battle Over Berwick

The Growing Battle Over Berwick

By Hal Scherz - July 27, 2010

Even with last week's Elaine Sherrod -NAACP media uproar, the Obama administration's recess appointment of Dr. Donald Berwick as Medicare czar continued stirring controversy, with Senate Republicans "spoiling for a fight" and "escalating the conflict" according to the Washington Examiner's Byron York.  Putting the unpopular Obamacare measure back on the political front burner just as Democratic candidates were hoping it had gone away, the administration's decision to bypass congressional committee hearings with the Berwick appointment had an angry Kansas Senator Pat Roberts introducing an "abuse of power" resolution and Senate Minority leader Mitch McConnell making it pointedly clear GOP cooperation on even routine Senate business was now in question.

        Beyond just the affront to democratic procedure or Senate prerogatives though, the Berwick matter offers Obamacare opponents a larger political opportunity.  Recent reports and studies by the Congressional Budget Office, HHS and independent groups have discredited last winter's solemn pledges by the president and Democratic Congress that under Obamacare,  everyone could keep their current insurance plan and neither the deficit nor insurance premiums would rise.  Now, six months after calling Republican warnings on rationing "scare tactics," President Obama has anointed and empowered the single most passionate advocate of government medical rationing in America, thus adding the charge of cynicism to already burgeoning credibility problems of Obamacare proponents.

        This most recent move, however, only underscores what most of America's doctors have been stating all along; that administration and congressional cynicism ran deep and was there from the start. The first Stimulus Bill, in fact, began systematically laying the groundwork for a federal takeover of medicine with two major provisions aimed at controlling physicians. The bill set up a Federal Coordinating Council for Comparative Effectiveness Research - a rationing board accountable only to the Secretary of HHS - and the National Coordinator of Health Information Technology as a way to monitor doctors' treatment via medical records.   Subsequently, the Obamacare bill itself in Section 1311 gave sweeping but purposely vague control over all health care decisions to the HHS Secretary and her appointees.  

     Thus, the Berwick appointment neatly dropped into place one of the final pieces of this federal takeover of medical practice, as White House Press Secretary Robert Gibbs tacitly acknowledged last week in telling reporters the administration's time table for setting provisions of the new legislation into motion was a factor in bypassing Congress.

     Yet even with Republican TV spots further frightening (justifiably) millions of Medicare recipients already worried about whether their need for a cancer drug or heart valve will get the approval of the Obama-Berwick rationers, the danger here for those seeking "repeal and replace" of the Obamacare bill is that Democrats will do on the health care front exactly what some just did on the economic issue, by coming out for Republican-sounding tax cuts. Expanding a tactic first begun in last June's special election in Pennsylvania, Democratic candidates may soon be putting distance between themselves and Obamacare in  calling for "reform" of their own health care "reform"  before the summer is over.

    About just this sort of feigned retreat, our own group, Docs4PatientCare, has for some time been warning fellow-physicians.  Having helped engineer a partisan power grab that puts Washington politicians, bureaucrats and lawyers in charge of doctors' offices, some congressional candidates will attempt a cosmetic retreat, allowing them  to go back to supporting their party bosses and kill off "the repeal and replace" move, once the election is over.   As a non-partisan group, we will hold Republicans fully accountable to their pledges to roll back Obamacare. But, in the meanwhile, we are also urging our doctors to talk to their patients about the importance of sending the strongest possible negative message to the Democratic members of Congress this fall.  Without such a November take-down of the Obamacare party, the health care system will never get fixed and the doctor patient relationship will be ruined forever.

     In this endeavor, the Berwick appointment may be for Obamacare opponents, the "gift that keeps on giving". Since its announcement, the storm of criticism in op-ed articles, news accounts, TV and talk-radio commentary has highlighted embarrassing Berwick quotes about his "love" and "romance" with British-style rationing or the advantages of central planning by those like himself he labels "leaders."  The convoluted relationships of Berwick's own policy Institute, IHI, with health-care policy groups, insurance companies and the Medicare office itself (as well as a belief that health care "experts" like himself should be opulently remunerated to the tune of $2.7 million in personal salaries) suggest exactly the sort of conflicts of interest that might have disqualified Berwick from his present post if members of Congress had gotten a chance to ask about them.

     More than anything else, however, Berwick's Orwellian use of language may ultimately become the focus of controversy.  In his talk of "politicalization" of the health care system as a good thing, Dr Berwick says this means "redistributing health care "to the most needy. Yet the reality is that a "politicized" or socialist system marginalizes those without political clout -- the poor, the elderly or those living in rural areas, as studies by Dr John Goodman of the National Center for Policy Analysis show.

       Even more disturbing, is the darker side of Berwick's Orwellian language.  Discussing "an uncomfortable awareness in our mutli-purpose world" that "the social budget is limited" and "a very difficult democratic conversation" needs to take place about rationing drugs and treatments, Dr. Berwick is using the familiar code words of those who seek control over the lives of "the people" whose name they so loftily invoke. There is nothing "democratic" or "conversational" about taking away decisions now made by hundreds of thousands of doctors with millions of their patient s and putting them in the hands of a few bureaucrats in Washington.

    Like the chilling suggestion of administration advisor, Dr. Ezekiel Emanuel, brother of White House chief of staff Rohm Emanuel, about denying particular kinds of treatment, not just to the elderly but even children with certain conditions, the driving force here, as I noted in an earlier article in this space, is not health care at all but a personal avarice for power.  And nowhere is that thrill of autocratic power more keenly felt than when it involves decisions that mean the difference between life and death -decisions that under Obamacare have now been taken away from patients and their doctors and assigned to the federal bureaucracy.
      And while the wave of outrage that has followed the Berwick appointment may have caught the administration off guard, its cynicism on the health care issue may have led to an even larger miscalculation.  What Obamacare advocates and especially Dr Berwick - who hasn't practiced medicine in more than a decade - do not know is that the patient anxiety over Obamacare is likely to grow exponentially as the new Medicare Czar's past statements and the real extent of his purposes become better known.  Which is why sudden calls from frightened congressional candidates for Obamarcare Lite may be too little too late.  An administration that has sparked the Tea party movement and the organization of professional groups like our own does not yet fully realize that not just Senate Republicans but millions of average Americans are "spoiling for a fight" over its usurpation of power and grave endangerment of the  nation's health care system.

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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