The atrocious sanitary conditions and high death rates at NHS hospitals in Britain have prompted Prime Minister David Cameron, in a strange twist, to call on the doctor who self-describes as "romantic about the NHS; I love it," to help fix the problem. Dr. Donald Berwick, former head of the U.S. Centers for Medicare and Medicaid is a Fellow of the Royal College of Physicians in London and was honorarily knighted in 2005 for his work with the National Health Service.

Berwick's unabashed adulation of NHS was well documented when President Obama installed him at CMS in 2010 during a congressional recess. And in 2008, while patients at NHS hospitals were apparently wallowing in their own filth, left without food and water, and denied medication to name a few of the atrocities, Berwick spoke at the 60th anniversary of the National Health Service. Before the doctor waxed poetic about the Great Britain's single-payer system, he took time to denigrate the United States healthcare system. Here are some of the highlights:

First, thanks for letting me work with you for almost 15 years; this has been one of the most satisfying journeys of my entire career.   Second, thanks for what the NHS does as an example for health care worldwide... I am romantic about the NHS; I love it.  All I need to do to rediscover the romance is to look at health care in my own country.

You could have kept your system in fragments and encouraged supply-driven demand, instead of making tough choices and planning your supply.  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 marketed. 

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 unfair, daylight of the press, public debate, and political campaigning

You could have chosen an easier route. My nation did.  It's easier in the United States because we do not promise health care as human right.  Most of my countrymen think that's unrealistic. In America, they ask, "Who would assure such a right?"  Here, you answer, "We do, through our government."

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.

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 that we wish we had: generous, hopeful, confident, joyous, and just. Happy birthday!

...I believe that the NHS has gone too far in the past decade toward optimizing hospital care...

So, Berwick in 2008 believed the NHS went overboard in "optimizing hospital care," but "the NHS did not pay enough attention to quality of care because it was too focused on targets." Well, what did Berwick think was going to happen when he looks at patients' values in terms of the bottom line?

Thus, Cameron had to issue an apology before  the House of Commons for the horrific abuses noted in a Healthcare Commission report which examined conditions in one NHS hospital from 2005-2009. The 3,000 page indictment of NHS' government-run healthcare cited the hospital's push to balance its accounts against the interests of the patients and meeting "health-service targets" rather than administering first-rate patient care.

IOL News also reported on the NHS scandal. Their account offered quite a contrast to Berwick's closing remarks at the 2008 anniversary celebration noted above. 

The deaths of hundreds of hospital patients, left without food or water in filthy conditions, exposed an urgent need to change the culture of Britain's National Health Service (NHS), a report said on Wednesday.

Between 400 and 1 200 patients are estimated to have died needlessly at Stafford Hospital in central England between January 2005 and March 2009 in one of the worst scandals to hit the NHS since it was founded in 1948.

"There were patients so desperate for water that they were drinking from dirty flower vases," Prime Minister David Cameron told parliament in a statement on the report.

Describing events at Stafford Hospital as "a despicable catalogue of clinical and managerial failures", Cameron apologised to all the families affected on behalf of the government and the country.

The author of the 3 000-page report, lawyer Robert Francis, said: "This is a story of appalling and unnecessary suffering of hundreds of people."

Cameron has enlisted Berwick to institute a "zero-harm agenda" in putting patients first. The Telegraph also disclosed the existence of an 84-page unpublished report "secretly commissioned" by the Department of Health in 2008 to look into the quality of care in England. Berwick's own Institute of Health Improvement authored the report which supposedly stated '"quality of care had become "patchy" although there were "islands of excellence.'"

For all of Berwick's romanticizing about the NHS, wouldn't you think it was the best system in the world?

Read more M. Catharine Evans at Potter Williams Report