Obama’s Nominee to Run Medicare: ‘Please Don’t Put Your Faith in Market Forces’
The article, published in the July 26, 2008 issue of the BMJ, compared the U.S. health care system unfavorably to the British system, which Berwick said he was “romantic about.”
The article included a list of 10 suggestions for Britain’s National Health Service (NHS). One of these suggestions was:
“Please don’t put your faith in market forces [emphasis in original]. It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can. I find little evidence that market forces relying on consumers choosing among an array of products, with competitors fighting it out, leads to the healthcare system you want and need. In the U.S., competition is a major reason for our duplicative, supply driven, fragmented care system.”
Berwick also outlined his 10 suggestions for Britain’s National Health Service at a speech he delivered in Wembley, England, on July 1, 2008. In the speech, Berwick said that the health care choices made by “leaders” will be better than the choices that individuals make for themselves.
“I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do,” Berwick said.
Berwick delivered his speech and wrote his article to commemorate the 60th birthday of Britain’s single-payer, government-run health-care system. In his article, in wishing the system “happy birthday,” he urged the British to keep going with their system because the world needed “an example at scale of a health system that is universal, accessible, excellent, and free at the point of care.”
"The only sentiment I feel for the NHS that exceeds my admiration is my hope," said Berwick. "I hope you will never, ever give up on what you have begun. I hope you realise and reaffirm how badly you need—how badly the world needs—an example at scale of a health system that is universal, accessible, excellent, and free at the point of care—a health system that, at its core, is like the world we wish we had: generous, hopeful, confident, joyous, and just. Happy birthday."
Sen. Pat Roberts (R-Kan.), who serves on the Senate Finance Committee, which has oversight over Berwick’s nomination, told CNSNews.com that he believes Berwick misunderstands the American health care system.
“What we have in the U.S. doesn't even approach a real functioning competitive market for health care," Senator Roberts said. “The government is currently the number one purchaser of health care, so government policy already greatly distorts the market shifting costs around and hiding them from consumers. This has led to a tremendous disconnect between the consumer and the purchaser--the very connection that market forces rely upon to increase quality and decrease costs."
"Nobody spends someone else's money as carefully as they spend their own," said Roberts, "and that's what we've seen happening over the last several decades as the government pays for more and more care.”
Roberts noted that Berwick’s “avid support for the rationing system” in Great Britain makes him a candidate to carry out a similar system here in the United States now that President Obama’s national health care plan has been enacted.
“Obamacare will take on payment responsibility for a whole new class of Americans and, predictably, the Administration is searching for ways to contain their newly acquired costs,” said Roberts. “Rationing of health care will be their plan, and Donald Berwick's avid support for the rationing system of the United Kingdom make him the perfect person to implement the plan in the US,” he said.
In a 2009 interview with Biotechnology Healthcare, Berwick said the United States needed to face the inevitability of rationing with “open eyes.”
“The decision is not whether or not we will ration care--the decision is whether we will ration with our eyes open,” he said.