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The Right Prescription
Dr. Berwick and Mr. Hide
Was that sly creature who visited Capitol Hill last week really the celebrated medical maven?
In Robert Louis Stevenson’s famous novella about the duality of human nature, a minor character describes Mr. Hyde thus: “There is something wrong with his appearance; something displeasing, something down-right detestable. I never saw a man I so disliked.” It is difficult to avoid similar feelings of revulsion watching the C-SPAN video of Dr. Donald Berwick’s alter ego testifying at the February 10 hearing of the House Ways and Means Committee. His disingenuous opening remarks, evasive answers, and transparent contempt for congressional oversight revealed Obama’s recess-appointed administrator of the Centers for Medicare & Medicaid (CMS) as a grotesque changeling. Gone were the bold statements about rationing, Britain’s socialized medical system, and the perils of the market. The celebrated visionary, Dr. Donald Berwick, has been completely subsumed in the sly apparatchik, Mr. Hide.
The Dr. Berwick with whom we have become all too familiar was a vocal advocate of health care rationing. In a 2009 interview for Biotechnology Healthcare, he gushed with enthusiasm for the heavy-handed rationing regime of Great Britain’s National Institute for Health & Clinical Excellence (NICE) and advised his interlocutor that “The decision is not whether or not we will ration care; the decision is whether we will ration with our eyes open.” When the good doctor’s alter ego appeared before the Ways and Means Committee, however, he told a different story. Mr. Hide, it seems, has always been a vehement opponent of rationing. When asked by Tom Price, M.D. (R-GA) about the above-quoted remark and a variety of similar public statements, he stunned the committee with the following answer: “I abhor rationing…. My entire life has been spent fighting rationing.”
Had this astonishing assertion been made anywhere but inside the Beltway, it would have immediately elicited the following outraged query: “What have you done with Dr. Berwick?!” But, being Washington politicians, the committee members betrayed only minimal annoyance at this sudden reversal of a widely publicized position. Indeed, most of the Democrats among them seemed positively delighted with the answer. Rep. John Lewis quite literally declared that he “loved” the Orwellian testimony. After the hearing, Mr. Hide held a brief news conference with a variety of obsequious “reporters” who deferentially allowed him to accuse committee Republicans of deliberately creating a false impression by using out-of-context passages from lengthy public statements and writings: “A lot of the quotes represent misconceptions.… They are selected — small lines from long papers …”
In keeping with this low Republican conduct were the indelicate questions posed by some committee members concerning Dr. Berwick’s romantic attachment to Great Britain’s socialized medical system. Chairman Dave Camp (R-MI) actually had the effrontery to ask, “[R]egarding the British National health service… you said and I quote ‘I fell in love with the NHS…to an American observer, the NHS is such a seductress.’ Are you still in love with the NHS?” Mr. Hide was not, however, inclined to discuss the good doctor’s love life. Adopting a “don’t ask, don’t tell” policy concerning this well-publicized romance, he responded with a non sequitur about medical delivery systems in general: “There are strengths and weaknesses in every healthcare system around the world, and they have a lot to learn from each other, but the American health care system needs an American solution.”
This answer was characteristically evasive, but it did provide a handy segue to another line of questioning the Republicans were anxious to pursue. Any genuinely “American solution” would, of course, have a strong market component. But Dr. Berwick has often expressed an aversion to the free market, particularly as it relates to health care. In the venerable British Medical Journal he implored health care reformers in the UK, “Please don’t put your faith in market forces. It’s a popular idea… that market forces relying on consumers choosing among an array of products, with competitors fighting it out, leads to the healthcare system you want and need.” Thus, Chairman Camp asked his opinion of competition in health care. “Competition certainly has a place in our health care system,” replied Mr. Hide, “and I think the Affordable Care Act strikes a superb balance between public and private sector investment in better care.”
The “Affordable Care Act” does no such thing, of course. In fact, ObamaCare provides strong incentives for the creation of huge regional health care monopolies that will inevitably stifle competition. This process will be accelerated by “Accountable Care Organizations” that will render the independent medical practice obsolete. More to the point, however, is the difference between the respective opinions of Dr. Berwick and Mr. Hide on the value of free market competition. For the former, “competition is a major reason for our duplicative, supply driven, fragmented care system.” But his alter ego told the House Ways and Means Committee, “It’s the American way to excellence in many forms.” True enough. But such thoughts will be expunged from Dr. Berwick’s psyche when he returns to his CMS laboratory and swallows the antidote that banishes Mr. Hide until he is needed for the next congressional hearing.
Meanwhile, like Stevenson’s mortified characters shuffling irresolutely outside of Dr. Jekyll’s laboratory door, we voters argue endlessly among ourselves about what should be done about those sinister noises emanating from inside the Beltway. But time is running short. The shrill outbursts from within are the sounds of U.S. health care being transformed into something very scary indeed. Inevitably, we must force our way in and stop the madness.
About the Author
David Catron is a health care revenue cycle expert who has spent more than twenty years working for and consulting with hospitals and medical practices. He has an MBA from the University of Georgia and blogs at Health Care BS.
Letter to the Editor View all comments (27) | Leave a comment
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Ken (Old Texican)| 2.18.11 @ 7:41AM
Mr. Catron,
were the Republicans ever able to penetrate his lies?
ENOUGH ROPE| 2.18.11 @ 12:20PM
Recognize that Obama is a saboteur who wants America to become a third world country. Obama regards America and its upper and middle classes as oppressors of the world and the poor in the same way that European colonial powers exploited their colonies.
Obama is an HABITUAL LIAR in order to bankrupt and destroy America. He is a SMILING COBRA.
Tina B| 2.18.11 @ 7:53AM
Or did they just bob their heads up and down and smile, like the Pep Boys, and allow it all to roll on, roll on.
Claire B| 2.18.11 @ 8:45AM
Exactly! Why even ask questions if you are not going to insist on truthful, precise answers? Let me get up there and ask...they won't be let go until they give the answer to the question I asked. Idiots! It's all for show..none of them care.
Pecos Pete| 2.18.11 @ 7:56AM
To paraphrase an esteemed member of Congress at a state of the union speech by Mr. obama, "Mr. Berwick, you lie!"
Sorry, I can't use the titles President and Doctor for the above two named people. They don't deserve either title.
hardcard| 2.18.11 @ 7:59AM
hitler had his complient doctors also.
JimH| 2.18.11 @ 8:32AM
Any non infinite resource is rationed. The only questions are how and by whom.
Ken (Old Texican)| 2.18.11 @ 8:44AM
Jim, fascinatingly enough, you are wrong. You are thinking zero-sum nonsense. Read my words, then go to Mr. Homnick's column here today.
See, one seed in good ground can produce 100 fold
which can in turn produce 100 fold less the number of seeds one eats.
That is the miracle of capitalism.
JimH| 2.18.11 @ 8:53AM
OVer time you may be correct. In a market economy demand can increase supply. But at any instant the supply of something is finite. Otherwise it would be free. Price is an indicator of both demand and scarcity.
Notary Sojac| 2.18.11 @ 10:39AM
Are there available untapped resources in capitalist America today to provide every single American with all the health care services that he or she desires to consume?
If "yes" then there must be a straightforward way to distribute those services to the consumer... conservatives and liberals are warring needlessly.
If "no" then somehow there must be a way to determine who will get fewer services than they desire. The market can do it in the case of private enrollees, the government must do it in the case of its enrollees. When Berwick says, "The decision is not whether or not we will ration care; the decision is whether we will ration with our eyes open." he is speaking an obvious truth.
Jack London| 2.19.11 @ 7:21AM
Don't expect any of the far right sickos here to recognize a truth if it came up and whacked them on the nose.
John Navratil| 2.19.11 @ 3:32PM
The answer to your rhetorical question is, of course, "No." All life is about scarcity or no one would need to work and we'd all be driving Rolls-Royce's to the Country Club. Of course, we'd need a lottery to get a tee-time - gee! it seems we just can't get away from the scarcity thing, can we?
So, on to the "no"answer you provide... What happens if the government is NOT involved? We get back to the cash allocator. Now look what we have today in MedicAid. With doctors no longer accepting such patients we have scarcity and Obamacare hasn't yet been implemented. Do not expect it to get better, just more Canadian.
John Navratil| 2.19.11 @ 2:12PM
JimH,
Whenever there is a scarcity, the scarce resource must be allocated. Rationing is the wrong term to use as it provides an allotted amount. We do not all need healthcare in the same amount at the same time in our lives.
Allocation of scarce resources can, of course, be handled in any number of ways. Mommy can dole out the candy at the birthday party and Berwick can dole out healthcare as he sees fit. In the market, cash is the allocator of scarce resources. Certainly, as evident by other country's attempts, a better system has not yet been found. Perhaps you have one.
MikeD| 2.18.11 @ 8:51AM
While this article certainly highlighted the lies and distorsions spewing from berwick's lying lips, it does not say a word about whether anybody (Other than the terminally partisan and unendingly racist Rep. lewis.) actually believed a word of it. I expect that the Republicans understood the duplicitous nature of the alleged doctor (Who seems to have either forgotten, or never believed, the Hippocratic Oath.) and will move accordingly to get his lying a$$ out of any public position having anything to do with medicine or health care. (Except for some position involving methods of commiting suicide accompanied by 'real life' videos of berwick doing himself in.)
There are millions of us waiting for the public discrediting of berwick and his ceremonial ride out of town on a rail while he is covered with a healthy amount of hot tar and very fresh feathers.
Barry the muslim needs to understand that "...elections have consequences." And HE lost the last one.
Yukon Jack| 2.18.11 @ 9:00AM
Obama @ Berwick.
Hitler @ Mengele.
JeffT| 2.18.11 @ 1:27PM
Republicans will never be able to match Democrats in nastiness and name-calling. They don't have the guts to call these liars on the carpet. Give the Devil his due, the Democrats know how to get their man/woman. They don't care what people think about them. Civility never stopped Ted Kennedy in his vicious attacks on Bork or Thomas. If you don't want to get dirty, don't fight with the dogs. If you do, be in the fight to win.
St. Thor| 2.18.11 @ 7:05PM
The response to Berwick is not, "What have you done with Dr. Berwick?, but rather, "You Mister, are a liar. The only question is whether you lied then or are lying now." This matter will be referred to the appropriate authorities for investigation of charges of lying to Congress. You are excused.
Nite| 2.18.11 @ 11:49PM
Dr. Berwick is a dangerous man. He loves the British Healthcare system and bases his guidelines on eugenics. The very young and the old will be worthless under his guidelines and little care will be wasted on them. The individuals who will receive care will be those who fit his guidelines of worth to society. Seniors and parents with handicapped children or adults should be very concerned about this idiot. If he is not confirmed by the Senate, Obama will try to do a recess appointment with him again. Scary!
proreason| 2.19.11 @ 1:28PM
I'm having a hard time understanding why Republicans don't jump all over the tsunami of lies and illegalities from this administration.
To me, it is the strongest evidence that we haven't rousted enough of the Republican ruling class yet.
Linda Joy Adams| 2.19.11 @ 5:11PM
1990 review of a federal workers case file: don't return this person to work until a full assessment is done . recommend to send to a an Internist.
you were right, but the agency officials who had already committed so many civil and criminal violations just had to keep covering up and count all of us as collateral damage. Abuses of power have not ceased.
There may be some policy issues to debate; but putting live of workers at risk and denying proper medical care should never exist. I got sent back to work and nothing was done that was recommended or even promised. The constitutional seemed to 'die' for me on that day. Thanks for trying to bring the govt contractors under HIPPAA where the real abuses are occurring. And thanks to your general counsel who was honest with me that Medicare's contractors can continue stealing the taxpayer monies until Congress decides they can again be investigated or even internally audited as any one can be when overwhelming evidence shows wrong doing. Civil rights can get 'inside' but not in Dallas region where they 'disappear' after being filed. its only a $4 million dollar theft of the intermediaries and their RICCO cohorts from stealing my claims and id and pocketing the extra pays according to 500 witnesses who completed fraud reports at 1-800-Medicare and Mac Curtis refused to forward to you per vangent's contract so you even know how bad it is. Thanks for your forthright testimony last week in front of Congress. i It is worse than what you were lead to believe when you accepted the job .You can only deal with the laws that Congress and President sends you. Please do your best for the country and we, citizens, will continue to 'petition' our elected officials to send you better laws to carry out. Linda Joy Adams
kissufim| 2.19.11 @ 7:24PM
We need to look at Catron's greater point when he says, "Meanwhile, like Stevenson's mortified characters shuffling irresolutely outside of Dr. Jekyll's laboratory door, we voters argue endlessly among ourselves about what should be done about those sinister noises emanating from inside the Beltway. But time is running short. " The shrill outbursts he talks about are all the subterfuge and distractive arguments that the fools in Washington are squawking about in ever confusing speed. We simply must take action as a people and demand that the truth be told. There is no time left.
firebrand| 2.20.11 @ 12:19AM
Maybe if we leave Obama alone, he will dismantle the monster, Health Care, he created. He has made a good start with some 900 waivers and now, whole states! I am having a bumper strip made,
"WAVE IF YOU HAVE A WAIVER!"
Or maybe he is just doing what his heart tells him, waive those who can't pay and make the rest of pay for the waived.
PattyMor| 2.20.11 @ 3:32PM
Are the Republicans that stupid or just that corrupt that they can't seem to attack when they have the wining arguments? Dr. Berwick can be so smug about rationing of care because he was given private insurance from his previous employer.
Reebok | 8.11.11 @ 3:19AM
is good
العاب بنات | 4.11.12 @ 5:00PM
thank you is good