PrintJune 6, 2010
'Leader with a Plan' Invites a Health Care Nightmare
The American people are too simple to choose from "an array of products" in "a system as massive and complex as health care. That is for leaders to do."
Behold the words of Donald Berwick -- doctor, Harvard professor, and Obama's nominee to run the Centers for Medicare and Medicaid Services (CMS), arguably the most powerful position in U.S. medicine, directing the flow of almost one trillion dollars a year.
Speaking to a British National Health Service (NHS) audience in 2008, Berwick said that people must not believe in "market forces." Instead, "leaders with plans" should design the people's health care system. The high-minded tone comes as no surprise, considering that the doctor was chosen by the highest-minded leader with a plan ever elected to the American presidency.
Speaking to a British National Health Service (NHS) audience in 2008, Berwick said that people must not believe in "market forces." Instead, "leaders with plans" should design the people's health care system. The high-minded tone comes as no surprise, considering that the doctor was chosen by the highest-minded leader with a plan ever elected to the American presidency.
Elitists with plans cannot resist issuing haughty statements to adoring audiences. To set the tone for the NHS speech, Berwick teased, "If you're a cynic, you'll want to go get a cup of tea about now. I am going to annoy you, because I am not a cynic. I am romantic about the NHS; I love it."
The amorous Dr. Berwick wants American health care to mimic the NHS, which, according to Cato Institute's Michael Tanner, has three-quarters of a million patients waiting to enter hospitals. The U.K. had hoped to achieve a wait time of less than eighteen weeks by 2008. The deadline now passed, the NHS hopes to improve on an abysmal 30 to 50 percent of patients seeing specialists within eighteen weeks. Shockingly, each year, 50,000 queued-up NHS patients become too sick to undergo what might have been life-saving surgeries.
In early 2009, at one hospital alone, Britain's Healthcare Commission reported 1,200 deaths attributable to "appalling standards of care," "patients left for hours in soiled bedclothes," unattended injured people "covered in blood and without pain relief," and patients receiving wrong or no medication. Also in 2009, London's Daily Telegraph documented nearly 400 deaths a year at two hospitals that lacked "basic nursing skills" and made a habit of parking untreated patients in emergency areas for ten hours.
To clear thinkers, gruesome statistics dissolve any inclination to romance the NHS. But Berwick's love is blind. In recognition of NHS's sixtieth anniversary, the doctor told a July 2008 NHS audience,
The only sentiment that exceeds my admiration ... is my hope for the NHS. I hope that you will never, never give up on what you have begun. I hope that you realize 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 is, at its core, like the world we wish we had: generous, hopeful, confident, joyous, and just.
Then the angels sang.
Part of Berwick's monologue captures Progressivism 101 in six words: "the world we wish we had." Hopenchange would also have fit nicely into the passage, but Berwick is no Obama, only a fellow traveler. The doctor does, however, exhibit the Obamaesque detachment from reality, the same glassy-eyed notion of wishing the world to run as dreamers dream. To progressives, how a concept feels is all that's real.
Donald Berwick also holds less emotional, though still fundamentally flawed, reasons for America to emulate the awful British health care system. Observe a talent for utterly misinterpreting reality. The doctor tells the NHS audience that there is "little evidence" that consumer choice and competition create a "healthcare system you want and need." Berwick purportedly studied America's outstanding health care before preaching that people who administer horrific and decaying care have nothing to learn from America. The progressive intellect seems incapable of converting certain sensory inputs to electrical impulses wandering through the cerebral cortex.
Berwick's flawed logic is characteristic of a man obsessed with impossibilities. In 2005, with empirical evidence pointing to precisely the opposite conclusion, Berwick declared that America's health care would improve only if government exerted yet more purchasing influence on provider networks. Because of CMS's heavy leverage on care suppliers -- Medicare and Medicaid account for a third of all health care spending -- insurance companies already tend to use the programs as payment and policy guides. So, then, as head of CMS, Berwick would have power to dictate to the industry and thus force Britain's health care miseries on all of America.
But Berwick sees no misery, only beautiful theory. Our academic president has nominated a dreamer who rejects free-market health care. To the Obamas and Berwicks of the world, the historical success of capitalism, in which competing suppliers have decreased cost and increased quality to satisfy choosy consumers wherever allowed to do so, constitutes no reason to encourage free-market health care. Ideologues with beautiful theories refuse to debate the method for establishing health care policy. Bureaucrats must set budgets and control everyone's care.
Will Americans who aren't even on Medicare or Medicaid tolerate Washington bureaucrats deciding what services doctors can provide? In 2008, Berwick advocated just such a system, including "a cap on total spending, with strictly limited year-on-year growth targets." Government-enforced rationing, pure and simple.
But how to ration? No better way than setting spending limits. Berwick is a calculating nanny-state-lover who uses terms like "extremely effective," "conscientious," and "valuable" to describe Britain's National Institute for Clinical Effectiveness (NICE). Cato reports that NICE "has effectively put a dollar amount to how much a citizen's life is worth. To be exact, each year of added life is worth approximately $44,305 [£30,000]." Dr. Berwick believes that NICE isn't "just a national treasure, it is a global treasure."
Donald Berwick is infatuated with a system that places a dollar value on human life. And we wonder if the doctor treasures dollars more than humans.
Though dollars are involved, control is the progressive's core desire -- Berwick's desire. The doctor once proclaimed, "The decision is not whether or not we will ration care -- the decision is whether we will ration with our eyes open." Very well, then. President Obama has selected as head of Medicare and Medicaid a man who seeks to erase a health care system which, by law, cares for people who cannot pay for care. Dr. Berwick would substitute a system which, by law, must deny everyone care according to rules established by Berwick-minded bureaucrats who treasure control over people more than people.
A writer, physicist, and former high tech executive, Chuck Rogér invites you to visit his website, chuckroger.com. Email Chuck at swampcactus@chuckroger.com.
