Berwick

President Obama came Donald Berwick a recess appointment to head Medicare and Medicaid, even though the appointment was not stalled, in order to avoid public scrutiny for his radical views. The Wall Street Journal has compiled a handy list of some of those views. (I can’t speak to the context of these statements, but given Berwick’s other statements, we have every reason to believe they are not out of context.)

For central planning, and against individual autonomy and markets:

  • “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”
  • “The unaided human mind, and the acts of the individual, cannot assure excellence. Health care is a system, and its performance is a systemic property.”
  • “Please don’t put your faith in market forces. It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can.”
  • “Indeed, the Holy Grail of universal coverage in the United States may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per capita costs.”

For rationing:

  • “It may therefore be necessary to set a legislative target for the growth of spending at 1.5 percentage points below currently projected increases and to grant the federal government the authority to reduce updates in Medicare fees if the target is exceeded.”
  • “A progressive policy regime will control and rationalize financing—control supply.”
  • “One over-demanded service is prevention: annual physicals, screening tests, and other measures that supposedly help catch diseases early.”
  • “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.” [This one is from here, not from the list.]

Health care should be run by bureaucrats, not doctors:

  • “I would place a commitment to excellence—standardization to the best-known method—above clinician autonomy as a rule for care.”
  • “Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy.”

Those last two are possibly the most chilling. Berwick is saying that we must provide one-size-fits-all care, and not give doctors (let alone patients) the power to do what they think is best.

This is the man who is now running Medicare and Medicaid.

But Berwick himself has no stake in the program; he has made arrangements never to need Medicare. His foundation, the Institute for Healthcare Improvement, has pledged to give him and his wife health care from retirement until death.

Berwick wants to ration care and to standardize care, but for everyone else, not himself.

POSTSCRIPT: Berwick’s foundation is a funny thing. In 2008 (the most recent year available), it received $12.2 million in revenue. (Republicans would like to know where that money came from, but since Democrats avoided holding a hearing for Berwick, they never had the chance to ask.) In that same year, it compensated him $2.3 million in pay and benefits. That’s nearly a fifth of the foundation’s entire revenue.

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