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.