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The Right Prescription
The Fix Is In
The president has just nominated a great admirer of Britain’s National Health Service to run Medicare and Medicaid.
Donald Berwick, CEO of the Institute for Healthcare Improvement, was nominated by President Obama last week to be administrator for the Center for Medicare and Medicaid Services (CMS). Under the Patient Protection and Affordable Care Act, the CMS administrator does more than make sure Medicare and Medicaid pay claims in a more or less accurately and timely fashion. The office defines the quality of health care for every insurance plan, sets reimbursement rates for physicians in Medicare and Medicaid, and decides what treatments are more “valuable” than others.
Berwick will get control of the practice of medicine. Can he or anyone be trusted with such power? Berwick, a former pediatrician, has made safer and patient-centered care his life’s mission. His institute sponsors a lot of pilot projects to promote quality, including one he pledged would save 100,000 lives. (The venture did not demonstrably hit the target.) In a Health Affairs article last year, he “argued “for a radical transfer of power and a bolder meaning of ‘patient-centered care,’ whether in a medical home or in the current cathedral of care, the hospital.”
Berwick also believes consumers are getting horrible care that costs more than it should. He insists, “[U]p to half of the more than $2 trillion that the U.S. spends on healthcare does nothing to relieve suffering.” In fact, “much of it adds to suffering.”
However, his “estimate” is based on the questionable Dartmouth Atlas of Healthcare that claims regional variations in Medicare hospital expenditures are mostly the result of differences in how much care greedy doctors supply and have nothing to do with how sick people are or how well they become. According to the atlas, eliminating that “wasteful care” by cutting Medicare spending to the lowest level and applying the percentage difference (28%) to all healthcare ($2.4 trillion) would “save” $700 billion annually. That’s how Berwick got to $1 trillion, I guess.
You would think a patient advocate would support consumers choosing the care they need through “medical homes” they build and own. Instead Berwick thinks a “commissioner of care” should limit health care spending nationally by dividing the country into health regions (exchanges?). “It could be a small state — or part of a large state… We could start with the current per capita cost,” which he contends could be 20 percent to 30 percent lower.
Berwick not only has a role model picked out for a role that sounds a lot like what he would be doing at CMS, he has a soulmate: For the past 15 years he has consulted for — or, in his words, been “starry-eyed” over — Britain’s National Health Service. In 2008, at a 60th anniversary celebration of the creation NHS, he told a UK crowd, “I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country. ”
Berwick complained the American health system runs in the “darkness of private enterprise,” unlike Britain’s “politically accountable system. ” The NHS is “universal, accessible, excellent, and free at the point of care — a health system that is, at its core, like the world we wish we had: generous, hopeful, confident, joyous, and just”; America’s health system is “toxic,” “fragmented,” because of its dependence on consumer choice. He told his UK audience: “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.”
It may not be joyous or just or configured correctly, but for nearly every disease, particularly cancer, stroke, and heart attacks, Americans live longer and healthier than the English because of better care. Americans spend less time in the hospital, have fewer doctors, and see doctor’s less often per capita than people in Great Britain.
In the past two years the number of people waiting over three months to see a doctor in the NHS has increased by 50 percent. Productivity of the NHS — which was Berwick’s principal mission — declined 2.5 % over the past five years. Last year it cut primary care services and wound up with a 2 billion pound surplus. The NHS spent the money not on patients but on equipment, bonuses, and consultants in an end of the year rush. Meanwhile hospital-acquired infections in the UK remain as high as ever while they decline in “toxic” America.
Berwick described how NHS rations care this way: “you plan the supply; you aim a bit low; historically, you prefer slightly too little of a technology or service to much too much; and then you search for care bottlenecks, and try to relieve them.” Relieve them? In 2008 the system Berwick believes is an example for healthcare worldwide denied cutting edge cancer drugs to 4,000 people, forcing thousands to remortgage their homes to pay for treatment. Love is blind. With regard to Dr. Berwick’s devotion to the NHS, it’s deaf and dumb as well.
About the Author
Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.
Letter to the Editor View all comments (49) | Leave a comment
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Levinite| 4.26.10 @ 6:50AM
I take it this guy doesn't keep a copy of "The Road to Serfdom" on his nightstand.
I (and Hayek) recoil grotesquely.........
Melvin| 4.26.10 @ 7:43AM
All of this Nation's enemies foreign and domestic have seriously underestimated the American public. But there is one thing I like to make very very clear to Donald Berwick, "I don't give a rats backside to how much you are enamored with Euro style health care. Remember this and remember it well. We are not Europeans, we never have and sure as hell as the Sun comes up in the morning never will. This is exactly why generations of Europeans left the damn place to begin with."
Matthew | 5.12.10 @ 3:18PM
This article grossly misrepresents Dr. Berwick's intentions. This "American public" you refer to includes great minds who understand that our nation spends the most money in the world on healthcare and yet has worse health outcomes than most industrialized nations. Dr. Berwick has spent his career trying to reduce unnecessary deaths for all Americans, NOT trying to make our system or anything else in our country like Brittan. This is just another example of slanderous right-wing propaganda that is meant to scare those without access to unbiased information. Please, do all of us a favor and turn off Fox News and get off of this site and look for research done by impartial professionals. Without doing so, you are no better off than being under Communist rule where ONLY propaganda is given to the masses and not unbiased information.
Kris| 7.7.10 @ 10:13PM
I think Matthew needs to heed his own advice to "look for research done by impartial professionals." Where do you get the idea that our nation spends the most money in the world on health care and yet has worse health outcomes than most industrialized nations? That is a lie that I hear parroted all over the place, by others who would rather give up their freedom and be "safe", than be truly free and take risks. It never fails to disappoint at least, but probably to enslave. Matthew, you've convinced yourself that you are right, and that the rest of us should abandon the law of the land, the Constitution, and follow you into tyranny. No.
Howard| 4.26.10 @ 7:59AM
Dr. Berwick is the sort of fellow liberal Democrats love. He is an "expert", he knows more than such messy things as markets. He displays a touch of arrogance. All in all, a good choice. This is good for our side as well; this appointment will further crystallize the difference between statist policies like Obama believes in, and our belief in freedom and markets.
A. C. Santore| 4.26.10 @ 8:50AM
For many years, I have been reading several mainstream British newspapers online daily. One of my reading "targets" has been stories about the N.H.S.
You wouldn't believe the terrible mess the N.H.S. is in - and all because of inept micro-managing from a bunch of bureaucrats!
I suggest that you try it. Go to any of these sites and use their search engine for "NHS" prepared for a shock.
http://www.telegraph.co.uk/
http://www.independent.co.uk/
[AmSpect limits me to two links, so find the links for guardian dot co dot uk, or for bbc dot co. uk.]
Houston Rao| 4.26.10 @ 9:02AM
He told his UK audience: "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."
Music to the ears of politicians and bureaucrats who just love this kind of bs, like Keynesian economics, to increase their hold on power and increase their mooching opportunities.
JOHN MONTE| 4.26.10 @ 10:23AM
Once again; please encourge all to fight to prove the new law is unconstitutional on mandates; taxes fines penalties etc
separation of church and state;
GOD owns your earthly body;
religious teachings and beliefs sin and suffering all cebtered around teh care and abuse of your body.
The statement above confirms it all and shows GOD controls health care suffering.
Berwick also believes consumers are getting horrible care that costs more than it should. He insists, "[U]p to half of the more than $2 trillion that the U.S. spends on healthcare does nothing to relieve suffering." In fact, "much of it adds to suffering."
Petronius| 4.26.10 @ 11:09AM
May the first family to lose a member to his short sighted policy of with holding necessary treatment sue Dr. Berwick and every politician in Congress who saddled us with his horrible dictatorship.
My friends in the UK who have suffered under their National Health and one who works for it warned me often enough of this. And anybody who wants to know what British patients go through, just go on to Drudge and read the London Daily Mail on any given day.
Carolyn| 4.26.10 @ 12:01PM
Berwick described how NHS rations care this way: "you plan the supply; you aim a bit low; historically, you prefer slightly too little of a technology or service to much too much; and then you search for care bottlenecks, and try to relieve them."
Oh yeah, that'll work really well in a nation of 305+ million people. Maybe after 20 years the tweaks and adjustments to the bottlenecks (aka suffering and deaths) may, or may not, take place. My guess is .... *not*. Well, it's a great way to ensure the very sick and elderly die without decent treatment costing actual money. Then it can be better spent on government boondoggles, strong-arming your political opponents Chicago-style, oh, the list of perks with taxpayers' money "saved" is endless. Yippee.
Frank| 4.26.10 @ 12:24PM
Wait a sec. How come it's terrible when Britain's NHS "denied cutting edge cancer drugs to 4,000 people, forcing thousands to remortgage their homes to pay for treatment" but it's okay when the same thing (bankruptcy as a result of medical bills) happens in the USA? Because in Britain, it happens under the auspices of the NHS, but in the USA it happens under the auspices of Mr. Market?
Even if ObamaCare is repealed, a day of rationing is coming.
Howard| 4.26.10 @ 7:41PM
Even if you take at face value your assertion about thousands of bankruptcies caused solely or predominantly;y by medical expenses (I have my doubts), so what! At least here these people have a fighting chance to live. I'll go bankrupt any day, if it means that i live a longer fuller life.
Radegunda| 4.26.10 @ 11:08PM
NHS says you may not have it. "Mr. Market" never tells you that you may not have something that's actually on the market.
Your insurance company may say "we won't pay for it because it's not in your plan"---but that isn't the same as the government saying the TREATMENT is not available to you.
IRISH22| 4.26.10 @ 4:09PM
Not a fair comparison NHS (read centrally planned) versus Mr. Market (market screwed up by political bunglers). FREE THE MARKET!!!!
Kris Lepine| 4.26.10 @ 7:03PM
Everyone better hope and pray we don't get cap and tax along with this nightmare. One of the ways they immediately saved money in Canada when they socialized their medicine was to limit major testing, surgery and long term treatments (like radiation) to centralized hospitals in their big cities. That means long drives for a lot of Americans and along with that goes the cost of fuel.
Please vote in November and remember we have to have good candidates to vote for so that means voting in the primaries is a must as well.
Darragh| 4.26.10 @ 8:54PM
Berwick has been a god in health care for many years. Yet there is no evidence at all that "quality improvement" in health care saves any money or improves efficiency. None. Check out the "Quality Counts" web site in Maine--what have they actually achieved? Look at other states. Have the "collaborative care" models--based on Berwick's ideas--achieved anything at all--except pay the high salaries of those who espouse them?
Radegunda| 4.26.10 @ 9:52PM
In a nutshell: government bureaucrats not only dictate what medical care we the citizens may receive, but also arrange the system so that there will never be enough of it (just to make sure we don't get "too much").
Lib-trolls, please explain what is "generous, hopeful, confident, joyous, and just" about that formula.
Eric(OfConservativeMind)| 4.27.10 @ 3:33AM
I second this. Ezekiel Emmanuel, who is Obama's Health Czar, also believes in crap like this; As well as putting people on a point system that attempts by some formula to determine their quality of life. Since I have asthma, I'm already considered sub-par without any other points being assessed against me.
Under his ideal system, I could be denied care or have a prolonged waiting period compared to someone who was healthier than me and of more use to the State; As conditions like asthma make people potentially less physically productive workers. Can't have any of that, now, eh?
Yosemeti Sam| 4.27.10 @ 12:09AM
Um, this Donald Berwick - a member in the
Kevorkian EMPATHY philosophy club?
BillCC| 4.27.10 @ 5:53AM
In my hospital, two-thirds of the patients are under Medicaid. We live and die by the dictates of CMS (Center for MediCare and Medicaid Services) and Joint Commission. This has resulted in massive administrative bloat. We must have individuals available to read, interpret (not easy) and implement all dictates, individuals to document compliance, and individuals available at a moment's notice to put on a PowerPoint dog and pony show for auditors who may show up at any time.
More resources to administration, fewer to actual healthcare. As one of our surgeons put it, "There are more people watching me do what I do than helping me do what I do."
Meanwhile the thin red line of actual healthcare providors is continuously saddled with additional time-consuming requirements for documentation, further diluting healthcare resources.
Great article from the Institute for Liberal Values of New Zealand (http://www.liberalvalues.org.nz/index.php?action=view_journal&journal_id=248) describing an expensive initiative to reduce waiting times. It actually did reduce waiting times_by kicking people off the wait lists! Where'd the money go? More administrators!
Is this our future, or is it already our present?
brock2118| 4.27.10 @ 9:13PM
It will eventually happen this way. After the health insurance companies go belly up, the single payer government system will pay all PCP's on a capitation basis. Everything will be fair, and the doctors, not the death panels will withhold care. This will be because the cost of every test, surgery and procedure will come out of your PCP's pocket. What they haven't figured on is that in socialism, it isn't what you know, it's who you know. Who could deny Mrs Smith, who is a millionaire and gives the doctor the keys to her ski chalet in Colorado every year the right to her gallbladder resection or arthroscopic replacement even when she doesn't meet the strict criteria. Mrs. Hoi Polloi Jones on the other hand will need to wait her turn...and it could be a long turn at that, and she most likely won't see the doctor but the nurse practitioner. I think you could read Cancer Ward to see how this will all eventuate in the future.
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file bankruptcy | 4.5.11 @ 2:05AM
It is a shame that the medical industry in this country is so screwed up. Medical bills is a major reason why people would have o file for bankruptcy protection. Now with Berwick's leadership, hopefully things can start to turn around.
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