If and when a new Congress comes in, the fastest way to
eliminate Obamacare will be by shutting down its “operating system”
the Centers for Medicare and Medicare Services and investigating
its unconfirmed director, Donald Berwick. And it should start by
pulling the plug on Berwick’s Triple Aim Program and the billions
of dollars he has for implementing it.
The Triple Aim Program (TAP) focuses on “improving the
patient experience, improving population health and lowering per
capita health care costs.” Berwick claims that all three are
achievable not through consumer driven healthcare. In various
speeches and slide presentations, Berwick claims there are isolated
examples of private health plans delivering quality care at a lower
cost through something he calls an “integrator.” Berwick believes
that America provides far less health for too few people at twice
the cost as Europe and Canada. The Triple Aim is Berwick’s master
plan to remake American healthcare into Britain’s National Health
Service.
In advancing TAP Berwick often invokes Garrett Hardin’s
Tragedy of the Commons, which held that people seeking
their own self-interest will deplete limited resources.
As Hardin wrote: “Freedom in a commons brings
ruin to all.” In his grand scheme the “integrator” in
TAP will save us from ourselves.
The Triple Aim is the organizing principle of Berwick’s
work at CMS. Indeed, it is rumored he was hard at work with CMS and
other administration officials before the President rammed through
his recess appointment without any confirmation hearing. Absent a
congressional hearing where records, emails, pay stubs, etc., are
made available, the extent of Berwick’s involvement — if any at
all — is unknown.
What is evident is that Berwick arrived at CMS with the
resources and individuals needed to rapidly implement TAP already
allocated according to plan. Over $1 billion was allocated for
comparative effectiveness research. The money is intended to
compare high cost to low cost treatments and identify geographic
differences in spending. The Dartmouth Atlas claims that nearly one
third of all health care treatments are unnecessary. That’s TAP’s
underlying assumption even though the Dartmouth map fails to
control for differences in patient needs or degree of illness.
Indeed, one specific TAP goal is to eliminate regional variations
in per capita healthcare spending by bringing spending down to what
it is in Dartmouth’s lowest spending region.
While there is great debate about the validity of the
Dartmouth approach, there is no CER money for such discussion.
Rather, as is the way of Washington, 90 percent of the $1.1 billion
in CER funding will go to confirming the Dartmouth-TAP ideology.
And 90 percent of the CER money — controlled by Berwick and the
Agency for Health Research and Quality (AHRQ) — is going to
individuals and organizations that have either received it in the
past, help AHRQ decide who gets money, or were part of the Obama
administration’s “expert” panel that determined that CER money
should be spent on, well, what the money is being spent on. Berwick
knows, has worked with, or funded all these individuals and groups
in the past. That is not just collusion requiring investigation of
AHRQ and other agencies funding CER. It also reflects how Berwick,
Team Obama, and various “stakeholders” use federal grants as
patronage to reward “friends” and punish anyone who doesn’t agree
that CER can save the planet.
Initially Berwick and the Medicare bureaucracy will use
CER to reinstate something called the “least costly alternative”
(LCA) policy. This policy — struck down by a federal appellate
court — allowed Medicare to pay for the cheapest version of a
product it regarded just as effective as other products. The court
said Medicare was denying necessary care as defined by the doctor.
Now Medicare wants Congress to rewrite the law to reintroduce LCA
based on CER and through decision-making guidelines developed by
the Dartmouth group (for a huge profit).
Berwick once said: excellent health care is by definition
redistributional. And ultimately, CER will be used to
steer health spending into what Obamacare regards as valuable.
Berwick’s close Dartmouth associate Jonathan Skinner wrote CER can
be used for “reallocating resources from
cost-ineffective treatments for late-stage pancreatic cancer to
cost-effective treatments for diabetes may improve health outcomes
in the aggregate but not for patients with late-stage pancreatic
cancer. “
Under TAP, late stage pancreatic cancer patients will just
have to take one for the commons. That is, unless Congress pulls
the plug on CER, TAP, and Berwick, in that order. Doing so will gut
Obamacare while allowing the development of better approaches to
bringing affordable coverage to those most in need.
