(Editor's note: CNSNews.com first published this report on Dr. Donald Berwick on June 2, 2010. Obama plans to put Berwick in charge of Medicare and Medicaid Services through a recess appointment on Wednesday, July 7.)
(CNSNews.com) – Dr. Donald Berwick, nominated by President Barack Obama to run Medicare and Medicaid, praised the government-owned British National Health Service (NHS) for not letting their health care system “play out in the darkness of private enterprise.”
Berwick, a Harvard pediatrician and a Knight Commander of the British Empire for his decades-long work with the NHS, made the comments in a 2008 speech wishing the NHS a happy 60th birthday.
Berwick, who said that Britain “chose well” in establishing a health care system completely controlled by the government, contrasted the NHS with the American health care system, which he derided as being dominated by private doctors, hospitals, and insurers instead of the government. (Click here, scroll down and click on “Speech Don Berwick” in video box.)
“You could have kept your system in fragments and encouraged supply-driven demand, instead of making tough choices and planning your supply,” Berwick said. “You could have made hospitals and specialists, not general practice, your mainstay.
“You could have obscured – obliterated – accountability, or left it to the invisible hand of the market, instead of holding your politicians ultimately accountable for getting the NHS sorted,” Berwick said.
“You could have let an unaccountable system play out in the darkness of private enterprise instead of accepting that a politically accountable system must act in the harsh and, admittedly, sometimes very unfair, daylight of the press, public debate, and political campaigning,” he added.
Berwick continued, calling the American system “monstrous,” because it did not use the “tax base” to pay for health care. Berwick also said that any “just” health care system “must” redistribute wealth from richer to poorer.
“You could have a monstrous insurance industry of claims, rules, and paper-pushing, instead of using your tax base to provide a single route of finance,” he said.
“You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any health care funding plan that is just, equitable, civilized, and humane must – must – redistribute wealth from the richer among us to the poorer and less fortunate,” Berwick added.
“Excellent health care is, by definition, redistribution,” said Berwick, who was nominated by Obama in April to run the Centers for Medicare and Medicaid Services, which oversees Medicare.
Berwick – who said that he found “little evidence” that “Adam Smith’s invisible hand” could do a better job of creating an economic system than “leaders with plans can do” – admitted that the NHS has problems.
Instead of offering solutions on how to fix the structural difficulties created by multiple leaders with multiple plans, Berwick advised the British to stop trying to fix their system and allow “the good, smart, committed people of the NHS” to find ways to work within it.
“There comes a time, and the time has come, for stability, on the basis of which, paradoxically, productive change becomes easier and faster, as the good, smart, committed people of the NHS find the confidence to try improvements without fearing the next earthquake,” he explained.
“The NHS,” he said, “is a bridge – a towering bridge – between the rhetoric of justice and the fact of justice.”
Berwick has earned the endorsement of his boss-to-be, Health and Human Services Secretary Kathleen Sebelius, who called him “absolutely” the right choice.
“I’m really pleased that the president nominated Dr. Donald Berwick,” Sebelius told CNSNews.com on May 26.
“He’s known nationally as an enormously competent physician and an enormously passionate health care provider and someone who, I think, is incredibly well-suited to help increase the quality of health care delivered to the 40-plus million Americans who rely on Medicare services and also the 30-plus million on Medicaid services,” she said.
“I think he’s absolutely the right leader for this time,” said Sebelius.