The Right Prescription

Dr. Berwick and Mr. Hide

Was that sly creature who visited Capitol Hill last week really the celebrated medical maven?

By 2.18.11

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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.

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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.