The nation’s health system can’t be transformed by rationing medical care, President Barack Obama’s new Medicare chief said Monday in his first major speech. Dr. Donald Berwick’s appointment earlier this summer without Senate confirmation was contentious because some Republicans accused him of being willing to deny care to save on costs. Since then, the administration has kept Berwick out of the limelight, turning the otherwise well-known medical innovation guru into something of a mystery man in Washington.
Berwick broke his silence Monday, telling an audience of health insurance industry representatives that pushing back against unsustainable costs cannot and should not involve “withholding from us, or our neighbors, any care that helps” or “harming a hair on any patient’s head.” Berwick also said he doesn’t think federal bureaucrats have all the answers when it comes to remaking the system. “A massive, topdown, national project is not the way to do this,” he told a conference hosted by America’s Health Insurance Plans, the industry lobbying group.
“Some Republicans accused.” No, he said it himself. As the story points out:
Republicans have seized on previous comments from Berwick, such as this one from an interview last year: “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.” They say that raises questions about what Berwick really thinks of rationing. Berwick’s supporters counter that rationing already takes place, through actions of insurance companies, and all he wants is to bring the medical decision-making process into the open.
That’s not the same thing at all as “not harming any hair on a patient’s head,” and in fact, endorses explicit rationing. Besides, Berwick is also on record as applauding NICE and the NHS’s top-down, rationed care approach, as I pointed out at this SHS post, in which he extolled the NHS for “planning supply,” (e.g. rationing) and “redistributing wealth,” and also stated:
‘I am a romantic about the NHS; I love it,’ and ‘the NHS is not just a national treasure, it is a global treasure.’”
It’s melting down! People are denied important medical services. Hospitals are filthy. People are left waiting in ambulances before going into the ER. Cancer patients and others are denied efficacious treatment based on QALY quality of life bean counter analyses. (Just do a search on this site under “SHS Meltdown” to see scores of stories I have carried here.)
Berwick can pretend to change his spots. But we know what he really believes. And next year, when his temporary appointment ends, he will most likely be out of a job.
