When I read that Donald Berwick had
resigned from the Centers for Medicare & Medicaid Services
(CMS), I nearly shouted for joy. The cheer died on my lips,
however, when my eye caught the following headline among those
retrieved when I sent my search engine after more information:
“Gingrich-Endorsed Health Care Expert Don Berwick Forced to
Resign.” Surely, I thought, the gods cannot be this cruel. But they
are, of course, as another search confirmed. Newt has indeed lauded
Berwick as a pioneer in the quest to improve American health care.
The former Speaker is already on record as a supporter of insurance
mandates, and it has lately come to light that he endorsed
stepped-up end-of-life counseling. Combined with those afflictions,
Gingrich’s praise of Berwick will send his health care credibility
straight to Forest Lawn.
The Berwick boost was included in an
opinion piece that Gingrich wrote in August of 2000 for the
Washington Post. The column begins with an absurdly
over-the-top metaphor equating day-to-day hospital operations with
a Concorde crash that had occurred a week earlier: “Imagine that we
had an airline crash every day, taking the lives of more than 250
Americans… a tragedy of similar proportions is occurring right now
in American hospitals.” Gingrich based this grotesque analogy on a
highly questionable report by the Institute of Medicine titled, “To
Err is Human,” which claimed that as many as 98,000 preventable
deaths occur in U.S. hospitals each year. This study, which is
still cited by Obamacare supporters, was
denounced at the time by the Journal of the American
Medical Association as “exaggerated” and “shrill.”
That Gingrich accepted this highly controversial study at
face value is bad enough, but his response to its questionable
conclusions was even more naïve. He wrote that the unnecessary
slaughter allegedly occurring in American hospitals could be
stopped by implementing what is often referred to in the hospital
industry as the “automagic” solution. The basic idea is that
automation can be used to impose a manufacturing approach to
quality control in health care. That’s where Newt’s praise of
Berwick comes in: “Don Berwick at the Institute for Healthcare
Improvement has worked for years to spread the word that the same
systematic approach to quality control that has worked so well in
manufacturing could create a dramatically safer, less expensive and
more effective system of health and health care.”
If that passage didn’t inspire a head palm moment, this
will: Gingrich has also been on the wrong side of the
“end-of-life-counseling” controversy. In 2009, he wrote another
Washington Post column in which he
echoed a refrain often heard from people who believe we should
ration care to the elderly: “More than 20 percent of all Medicare
spending occurs in the last two months of life.” Rationing
advocates like Berwick typically bring this particular datum up to
demonstrate how much money we can save by not providing expensive
treatment to people who are soon going to die anyway. Oddly, they
rarely mention the inconvenient fact that many people receive the
same expensive treatments and live for far longer than two months,
or even two years. Gingrich’s column also fails to note this
reality.
Though hardly a supporter of the draconian rationing
regimen favored by Berwick, his column did recommend the
“successful end-of-life” approach used by the Gundersen Lutheran
Health System. “The Gundersen approach empowers patients and
families to control and direct their care.” Unfortunately for
Newt’s current political prospects, Gunderson aggressively promoted an
Obamacare provision that was later yanked from the bill pursuant to
public indignation about “death panels.” Essentially, it would have
provided extra payment for physicians who “engage patients and
their families regarding end-of-life planning.” About a year ago,
the soon-to-be ex-administrator of CMS attempted to slip the
provision back in via regulatory fiat, but was forced to back down
when faced with a new public outcry.
Newt’s endorsement of Gunderson’s program, combined with
his praise of the egregious Dr. Berwick, creates problems for him
that are only exacerbated by his long-standing support for
insurance mandates. As Quin Hillyer recently
put it, “Gingrich has supported an individual mandate for
almost 18 years, has written in favor of it as recently as 2008,
and even several times this year has defended it in concept.”
Indeed he has. He put it most clearly in the Des Moines
Register: “Personal responsibility extends to the purchase of
health insurance. Citizens should not be able to cheat their
neighbors by not buying insurance… and expect others to pay for
their care when they need it.” He made matters worse when he
explicitly added that any large-scale health reform legislation
should contain an “individual mandate.”
This affinity for mandates might not be so deadly if
Newt’s health problems ended there. However, when combined with
comorbidities such as his seeming endorsement for
government-financed end-of-life counseling and the accolades he has
given the man most Obamacare opponents consider public enemy number
one, it is probably fatal. When these things become generally
known, and the “news” media will assure that the word gets out,
even his long history as a conservative leader will probably not
render him immune from erosion in his support among rank-and-file
Republicans, particularly the Tea Partiers. Even if Newt survives
long enough to get the GOP nomination, he will have no more
credibility on health reform than Mitt Romney. And, if he can’t go
after the President on Obamacare, he will lose the
election.
