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

Are the views of Obama’s new CMS administrator really so extreme that he actually approves of a health care system that rations care so callously? Absolutely. In fact, the word “approve” is something of an understatement. Berwick has publicly stated that he loves it, a sentiment that he has also put in writing: “I am romantic about the National Health Service; I love it.” Even worse, he goes on to say that his affection for Great Britain’s socialized medical system is inspired by his loathing for its American counterpart: “All I need to do to rediscover the romance is to look at health care in my own country.” This doesn’t leave much doubt about where Berwick stands on rationing and what sort of rationing he favors.

Which brings us back to the good doctor’s personal coverage. Before Obama picked him to be our new Medicare czar, Berwick was the chief executive officer of an outfit he founded called the Institute for Health Care Improvement (IHI). IHI bills itself as a nonprofit charity, but it seems to do an awful lot of work on behalf of for-profit entities. As CEO of this enterprise, Dr. Berwick earned a cool $2.3 million in 2008. But, more to the point, IHI will provide him with private health care coverage during his declining years: “The Institute created a postretirement health benefit plan for its chief executive officer (CEO). It provides the CEO and his spouse medical insurance from retirement until death.”

In other words, Dr. Berwick has made sure that he and his wife will never be subjected to the tender mercies of Medicare, the health care program for seniors over which he now has control. Thus, even after he has implemented rationing programs modeled after those of NICE, he won’t have to worry about his wife suffering for lack of drugs deemed too pricey by some obscure comparative effectiveness calculation. You and I, on the other hand, won’t be so lucky once we’re on Medicare. If we contract deadly diseases requiring treatment that costs more than our lives are “worth,” we’re toast. This is why the Berwick appointment matters -- even more than the nomination of a mere Supreme Court justice.