Donald Berwick's Motto? Rationing for Thee, but not for Me

If you’re like most Americans, you had probably never heard of Donald Berwick before July 7, when President Obama installed him as Administrator of the Centers for Medicare & Medicaid Services (CMS). And, unless you’re a health policy wonk, the news that Obama circumvented the normal Senate confirmation process with a recess appointment probably elicited no response beyond a briefly raised eyebrow and a stifled yawn. But this CMS decision deserves another look. Dr. Berwick has been granted the power to reach out and touch you in ways undreamed of by higher profile appointees like Elena Kagan. Whether you’re paying attention or not, he will have a profound impact on the quality of your life.

CMS isn’t some Beltway backwater with a few clerks processing Medicare and Medicaid claims. It’s a gigantic bureaucracy with thousands of employees, a budget larger than the Pentagon’s, and the authority to dictate treatment standards for the nation's hospitals, nursing homes, and clinical laboratories. It also administers policies that directly affect how many physicians are available to provide medical treatment for you and your family. Moreover, Berwick isn’t just another political hack or Ivy League gasbag. He’s an experienced, sophisticated administrator who knows how to get what he wants. And what he wants for Medicare, Medicaid, and eventually the entire U.S. health care system is rationing.

Unlike his boss in the White House, Dr. Berwick has made no secret of his views on this issue, and has never avoided the “R” word. In a 2009 interview for Biotechnology Healthcare, for example, Berwick praised the heavy-handed rationing methods of Britain’s National Institute for Health and Clinical Excellence (NICE) and said, “The decision is not whether or not we will ration care; the decision is whether we will ration with our eyes open.” Unfortunately, the interviewer failed to ask the obvious follow-up question: “Who’s we?” It turns out that what the good doctor really means when he says “we” is “you.” For himself and his wife, he has arranged to opt out of the health care system he plans to impose on the hoi polloi.

But before we get to that, it’s important to flesh out what Berwick has in mind when he talks about rationing. His praise of NICE is significant. The apparatchiks of that soulless health care bureaucracy have, quite literally, calculated how much money a single year of the average Brit’s life is worth (about $45,000). And if a patient needs treatment or drugs that exceed that amount, he’s out of luck. Consequently, the British news media are full of stories like those of Jack Rosser and Albert Baxter, both of whom were denied cancer drugs. The former is only alive today because an American benefactor came to his rescue. The latter killed himself when informed that he would not receive treatment.