Obama's Unconfirmed 'Recess' Appointee to Run Medicare Advocated Rationing, Redistribution of Wealth
Berwick, a professor at Harvard Medical School and CEO of the Institute for Healthcare Improvement (a think tank), has expressed his disdain for free-market medicine and his “love” for Great Britain’s government-run health-care system, while advocating health-care rationing and using the health-care system to redistribute wealth.
The directorship of CMS normally requires confirmation by the Senate, which currently has a 59-member majority of President Obama’s party (counting Sen. Joe Lieberman, the Connecticut Independent who caucuses with Senate Democrats).
Obama initially sent Dr. Berwick’s nomination to the Senate in April, where it was assigned to the Senate Finance Committee chaired by Sen. Max Baucus, the Montana Democrat, who had worked closely with the Obama White House in developing the national health-care law that President Obama signed in March. Baucus had not yet scheduled a confirmation hearing for Dr. Berwick.
“It’s unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes,” President Obama said in a Wednesday statement announcing the recess appointment of Berwick and two other officials. (These were Philip E. Coyle, nominated to be associated director in the Office of Science and Technology Policy--under director John P. Holdren--and Joshua Gotbaum to be director of the Pension Benefit Guaranty Corporation.)
Berwick is known for his staunch defense of Great Britain’s government-run National Health System (NHS)—which he has hailed as a model for the world-- and his penchant for comparing the U.S. health-care system unfavorably to the British system.
In the July 26, 2008 issue of the British Journal of Medicine (BMJ), Dr. Berwick published an article praising the NHS on its 60th birthday and urging Great Britain to reject free enterprise in health care. In the United States, he argued, competition among rival health-care providers had produced an excess supply of health care.
“Please don’t put your faith in market forces,” he said (italics 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 US, competition is a major reason for our duplicative, supply driven, fragmented care system.”
Berwick argued that purposely provided an inadequate supply of health-care—as Britain’s health-care system does—is superior to allowing the market to provide an excess.
“In America, the best predictor of cost is supply; the more we make, the more we use—hospital beds, consultancy services, procedures, diagnostic tests,” Dr. Berwick wrote. “… Here, you choose a harder path. You plan the supply; you aim a bit low; you prefer slightly too little of a technology or a service to too much; then you search for care bottlenecks and try to relieve them.”
“Avoid supply driven care like the plague,” Dr. Berwick advised the Britsh (italics in original). “Unfettered growth and pursuit of institutional self interest have been the engines of low value for the US healthcare system. Oversupply has made care unaffordable and hasn’t helped patients at all.”
Dr. Berwick argued that redistribution of wealth is an absolutely necessary component in any just health-care system and that the British had made the right decision in nationalizing their system.
“You could have had the American plan. You could have been spending 17% of your gross domestic product and making health care unaffordable as a human right instead of spending 9% and guaranteeing it as a human right. You could have kept your system in fragments and encouraged supply driven demand, instead of making tough choices and planning your supply,” he wrote.
“You could have protected the wealthy and the well instead of recognising that sick people tend to be poorer and that poor people tend to be sicker, and that any healthcare funding plan that is just must redistribute wealth,” he said. “Britain, you chose well.”
In an interview published in the June 2009 issue of Biotechnology Healthcare, Dr. Berwick defended the Federal Coordinating Council for Comparative Effectiveness Research, a federal bureaucracy funded by last year’s $787-billion stimulus law--a bureaucracy that some critics argue will become the command center for rationing health-care under the new national health care law.
In the same interview, Dr. Berwick also defended what he views as the necessity of rationing health-care itself--assuming as he did so that it would be "taxpayers" and not private consumers who would be paying for health care. (Under the new health-care law, Americans earning up to 400 percent of the poverty level--or $88,200 for a family of four--will receive federal subsidies to buy health insurance, which they will be compelled by law to buy.)
When the interviewer for Biotechnology Healthcare said to Dr. Berwick that critics had said that federal Comparative Effectiveness Research would “lead to rationioning of healthcare,” Berwick responded: “We can make a sensible social decision and say, ‘Well, at this point, to have access to a particular additional benefit [new drug or medical intervention] is so expensive that our taxpayers have better use for those funds.’ We make those decisions all the time. The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.”
In his BMJ article celebrating the 60th birthday of Britain’s government-run National Health System, Berwick said: “Cynics beware, I am romantic about the National Health Service; I love it. … The NHS is one of the astounding human endeavours of modern times.”
Berwick expressed his belief that it was important for the NHS to continue because it was the model health-care system for the world.
“The only sentiment I feel for the NHS that exceeds my admiration is my hope,” he said. “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.”