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Sneaking in Berwick


Location: Unknown

The passage of President Obama's health-care plan in March was really just the beginning. Over the coming months and years, federal agencies will be writing the rules and regulations to implement the new law. One of the key figures in this process will be Dr. Donald Berwick, whom President Obama recently appointed to serve as administrator of the Centers for Medicare and Medicaid Services (CMS).

Normally, the Senate Finance Committee would hold a public hearing to consider the President's nominee to lead this agency, which provides health coverage to 100 million Americans with an annual budget exceeding $800 billion. Unfortunately, President Obama denied the Senate this opportunity and appointed Dr. Berwick in a special procedure when Senators were working in their home states in July. There were no hearings on the nomination, and there were no votes. Even Democrat Senator Max Baucus, the chairman of the Senate Finance Committee who helped shepherd the health-care bill through Congress, objected to the President's abuse of process.

The "recess" appointment of Dr. Berwick, however, shouldn't be a surprise. The administration couldn't afford to have him air his views in a public setting like the Finance Committee. The American people might tune in.

According to a July 12 Rasmussen poll, 53 percent of Americans want to repeal the new health-care law, and I suspect that number would skyrocket if they heard what the man who will be implementing the law has to say.

During the health-care debate, we were assured that there would be no rationing of care under the new law. Dr. Berwick supports rationing and hasn't been afraid to admit it. "The decision is not whether or not we will ration care--the decision is whether we will ration with our eyes open," he said in a 2009 interview. Essentially, he is saying that he and other bureaucrats, not patients and doctors, would make the health care decisions.

Dr. Berwick's views leave little room for doctors to treat patients as individuals. In a speech 10 years ago, he said, "I would place a commitment to excellence -- standardization to the best-known method -- above clinicians autonomy as a rule for care." Ultimately, standardization of care, or a one-size-fits-all approach to medicine, could be used by the government to reduce health-care costs by allowing only certain kinds of treatments, drugs, or services.

Dr. Berwick's views track nicely with the way health-care is administered in many European countries. He has lauded the British national health-care system, which routinely denies and rations care, as "extremely effective" and "conscientious."

"I am romantic about [Britain's National Health Service]," he gushed in 2008. "I love it."

I wouldn't describe the British model in quite those terms. According to the non-profit, non-partisan National Center for Policy Analysis, breast cancer mortality in the United Kingdom is 88 percent higher than in the United States, prostate cancer mortality is 604 percent higher, and colorectal cancer mortality is 40 percent higher. Americans spend less time waiting for care than patients in the U.K. British patients wait about twice as long -- sometimes more than a year -- to see a specialist, have elective surgery like hip replacements, or get radiation treatment for cancer.

Nevertheless, Dr. Berwick believes "The National Health Service is one of the truly astounding human endeavors of modern times."

I would have liked to ask Dr. Berwick about these and other comments he has made during his long career during a hearing before the Finance Committee in full view of the public. Thanks to President Obama, no Senator will have that chance.

For now, it will be important to monitor closely the actions taken by CMS, with the ultimate goal of repealing the health-care law and replacing it with reforms that preserve the sacred doctor-patient relationship and ensure access to the highest quality of care.

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