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.
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.