• The Heritage Network
    • Resize:
    • A
    • A
    • A
  • Donate
  • Calling Doctor Berwick: We Have A Mild Case of Rationing

    Dr. Donald Berwick may not be a household name yet, but if he is confirmed as the head of the Center for Medicare and Medicaid Services, the position for which he was nominated by President Obama, he may soon determine the direction of health care of millions of Americans.

    So what’s the big deal about that?  Earlier this week, a Washington Post editorial attributed the ongoing hold-up in Berwick’s confirmation hearing to “partisan politics”, claiming that, “Republicans are seizing on the Berwick nomination as an opportunity to relitigate the health-care debate, latching on to a few of Dr. Berwick’s statements to wage their campaign.” The Post misses the point.

    Don Berwick is not being scrutinized for political reasons, but rather due to his beliefs.  Dr. Berwick has gone on the record—several times—as a passionate supporter of socialized medicine, including the cost-containment decisions that come with it. Whether to allow the government to ration or allow individuals to make their health choices isn’t even a question for Berwick—he claims that “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”

    It is not the sound bites which are important here—it is the vision for the U.S. health care system that Dr. Berwick has made crystal clear in his numerous writings and interviews.  In a 2009 interview, Dr. Berwick outlined the three most important levels of knowledge to guide medical decision-making.  First: whether a health intervention is effective at all.  Second, whether it is more or less effective than comparable treatments.  And third, whether the benefits of a more effective treatment outweigh additional cost. None of this is exceptional. There are limited resources, and ordinary Americans realize that there must be trade-offs and tough decisions. Individuals and families, in consultation with their physicians, are the ones who should be making those decisions, not government officials.

    Beyond that, most ordinary Americans are not in favor of denying care to the sick because of the cost of providing it. This was abundantly evident with the public outcry against government rationing during committee consideration, including the defeat of anti-rationing amendments, of earlier versions of the Democrats’ health care overhaul. While the final bill signed by the president in March contains significant safeguards against this in its creation of the Patient-Centered Outcomes Research Institute, which will conduct comparative effectiveness research (CER), that does not settle the issue. .

    The reason: the limitations are not sufficient to ensure the correct use of CER.  CER alone would address the second tier of Berwick’s decision-making scheme: determining which among several treatments for an illness are most effective.  This information would provide a useful tool for care providers to offer better care to their patients.

    But the inclusion of cost information could open the door to denying coverage based on cost.  Indeed, Sec. 6301 of the PPACA claims that the limitations put on the Patient-Centered Outcomes Research Institute “shall not be construed to…limit the application of differential copayments under [Medicare] based on factors such as cost or type of service…”  And that brings us back to Dr. Don Berwick. With Dr. Berwick at the helm of the two largest public health programs, Medicare and Medicaid, the likelihood of CER being used to deny coverage based on cost becomes ever more worrisome.  In his own words, the United States may one day find itself making health decisions based on the question of whether a health intervention “is so expensive that our taxpayers have better use for those funds.”

    In June of 2009, President Obama told the American Medical Association that “identifying what works is not about dictating what kind of care should be provided.” Moreover, the president has assured the public time and again that the government will not get between patients and their doctors.  His nomination of Don Berwick for Director of CMS, however, tells a different story.

    The fight over Berwick is thus not just about partisan politics. Rather, it is the fight to create a health care system where a patient and doctor decide what is best for the patient, rather than a system where bureaucrats determine what treatment will give them the most bang for their buck.

    This post was co-authored by Joshua Wade. Wade is a member of the Young Leaders Program at the Heritage Foundation. For more information on interning at Heritage, please visit: http://www.heritage.org/about/departments/ylp.cfm

    Posted in Obamacare [slideshow_deploy]

    20 Responses to Calling Doctor Berwick: We Have A Mild Case of Rationing

    1. Robert Grim says:

      A Fight over Berwick's appointment?

      Nope. It's not going to happen. Although, I'm sure what the President is planning on doing will cause a much bigger uproar from all the sky-is-falling crowd.

      > > "President Barack Obama intends to use

      > > the congressional recess to bypass the

      > > Senate and appoint Dr. Donald Berwick…"

      > > "The appointment was to be made Wednesday,

      > > with lawmakers out of town for their

      > > annual July Fourth break, White House

      > > communications director Dan Pfeiffer said

      > > in a post on the White House blog."

      Thanks for wonderfully composed article but the air has been taken out of this balloon.

    2. Pingback: President Obama to Recess Appoint Dr. Berwick as Adminstrator of Medicare & Medicaid | Blue Wave News

    3. Pingback: Meredith Jessup: Obama’s Political Appointments Continue to Make Controversial Waves | MorallyRight.org

    4. Melvin Jones Bowie, says:

      The Post doesn't "miss" the point. It refuses to even consider the point.

    5. Harper, Spirit Lake, says:

      NOW .. the obvious solution to the pending conflict between individual rights and government take over of our personal liberities is for every American citizen to learn to be self sufficient in taking care of their own health. To that end I highly recommed every citizen read "The Biology of Belieft" by Bruse H. Lipton, PH.D

      "…. Lipton is a former medical school rofessor and research scientist…….

      "The imlications of this research radically change our understanding of life. It shows that genes and DNA do not control our biology; but instead, DNA is controlled by signals from outside the cell, including the energetic messages emanating from our positive and negative thoughts."

      Taking charge of our own health is the only real solution to the mess created by our government.

    6. Drew Page, IL says:

      Socialized medicine is fine until you, or one of your children, or your mom or dad need a life saving organ transplant at the same time a politician or one of his/her kids need that same organ transplant — and there is only one matching organ available.

      Do you think it will really matter who is on the waiting list first? If you do, you are delusional.

      Of course this never entered the minds of those politicians who voted for health care reform WHO WOULD REMAIN COVERED UNDER THEIR OWN PRIVATE INSURANCE PLANS.

    7. Pingback: Morning Bell: The Rationer-in-Chief | Cycaster News

    8. William Jackson, Val says:

      Impeach the whole bunch! How long is it going to take before we put a stop to these idiots Destroying America. We have a lot of Legal foundations,that are bring acctions against this Regime. Why don't we pool our resources as we are gathering our people? Strength is Always in Numbers!

    9. Barbara (RN Quality says:

      This is a really good appointment. Donald Berwick will do a tremendous job!

    10. B & T FLYOVER CO says:

      Well, I fought against the health care "reform" ever since President Obama was chosen as the nominee. No one wanted to listen to me when I made calls to American Cancer, American Heart, AARP, Council on Aging, Right to Life warning them what was coming. All thought I sounded like a nice person, but, a little too alarmist.

      So — here is the rationer in chief.


    11. Pingback: The Rationer-in-Chief | Fix Health Care Policy

    12. Joseph F. Ryan, Bost says:

      Let's hope that Dr. Berwick is the first one to need life-saving treatment that is too expensive and therefore not permitted.

    13. Pingback: The Rationer-in-Chief | Bud Hunt Site

    14. Karen D says:

      I do not approve of what the president has done from the start. I do not approve of any of his choices for OUR offices in OUR govenment. I'm saddned for this woman and her family that was denied life saving medical treatment. But mostly I'm very sad to see my country and yours destoryed while we all sit around and sing "God Bless America."

      The Muslims peacefully blocked the streets in NYC while we sit in our comfy homes and write how angery we are. Where is Martin Luther King Jr., well we know. Anyone that protests this govenment will not be listened to or protected. However, I bet the president was smiling then, you can bet America on it!

    15. Pat Donnelly Clarkes says:

      William Jackson from Vallejo, Ca. You are 100 per cent correct. They are ruining our beloved country as fast as they can. They are plotting while we sleep. Americans need to wake up.

    16. Pingback: Start getting prepared for rationing… « RightChick.com

    17. Loyd Eskildson, Scot says:

      U.S. healthcare costs are destroying America's future – 17% GDP, vs. 6.5% in competitor Taiwan, slightly more in Japan. The excess amounts to about $1.5 trillion, and WILL NOT BE RECLAIMED WITHOUT GOVERNMENT HELP. Further, Dr. Berwick and his initiatives for quality improvement have saved an estimated 120,000 lives by reducing hospital errors. We need people like Dr. Berwick in government, and Heritage fear-mongering against him is irresponsible.

    18. Richard Scoville, No says:

      I agree with Mr. Eskildson.

      The author of this article has evidently never met Dr. Berwick, heard him speak, or read his writings beyond the one interview cited. The US health care system is suffering from profound problems: high cost, perverse incentives, poor coordination, slapdash methods, the list goes on and on. Inflammatory rhetoric about 'socialized medicine' and 'rationing' ignores these problems for purely partisan purposes. Dr. Berwick has spent his career attempting – with considerable success – to actually understand those problems and push his colleagues toward solutions. He is the kind of pragmatic leader that this country desperately needs – and if the right cant acknowledge that, then we are really, really in serious trouble.

      Is the author arguing that cost should never be a consideration when care decision are made? Traditional private insurance has allowed to US consumers to operate under precisely that assumption for the past 60 years. The result? A system in which about 30% of expenditures are wasted. One that costs twice as much per capita as the next most expensive in the world, yet delivers poorer services and results.

      Anyone who has watched their premiums rise at three times the inflation rate over that past several years, or has experienced capricious, shocking charges for 'routine' services knows in their heart of hearts that cost must be contained. Things cannot continue as they have. Care will be 'rationed', it's only a matter of how: By your insurance company? By your net worth? By the services provided for free at a community health center?

      Dr. Berwick has been the leader of a vigorous national movement to devise rational solutions to these difficult problems. I wish him the greatest success.

    19. Pingback: Hysterical Attack Machine in Full Force Targeting Ryan Plan | The Foundry

    20. Swovae says:

      If some one wants to be updated with newest technologies then he must be pay a visit this web site and be up to date every day.

    Comments are subject to approval and moderation. We remind everyone that The Heritage Foundation promotes a civil society where ideas and debate flourish. Please be respectful of each other and the subjects of any criticism. While we may not always agree on policy, we should all agree that being appropriately informed is everyone's intention visiting this site. Profanity, lewdness, personal attacks, and other forms of incivility will not be tolerated. Please keep your thoughts brief and avoid ALL CAPS. While we respect your first amendment rights, we are obligated to our readers to maintain these standards. Thanks for joining the conversation.

    Big Government Is NOT the Answer

    Your tax dollars are being spent on programs that we really don't need.

    I Agree I Disagree ×

    Get Heritage In Your Inbox — FREE!

    Heritage Foundation e-mails keep you updated on the ongoing policy battles in Washington and around the country.