Overnight, Doctor Donald Berwick became one of the most powerful men in America. Moreover, he did it without Americans knowing just how controversial he is. Earlier this year President Obama used a recess appointment to promote him to be the head of Medicare and Medicaid. It allowed him to exist under the radar, without ever having to be publicly answer questions from Congress. Now, four and a half months later, Republican Senators are salivating at the chance to question Mr. Berwick face-to-face. Later this week Dr. Berwick will make his first appearance on Capitol Hill, testifying before the Senate Finance Committee at the request of Sen. Max Baucus (D-MT). Although much of the testimony will center on the implementation of healthcare reforms, this will be an opportunity for Republicans to question Berwick about a litany of damning comments that disparage the ability of individuals to successfully make healthcare choices and advocating elite-controlled rationing of medical care.
For instance, Berwick has stated,
“I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for our leaders to do.
Who are our leaders in these issues? Are they career bureaucrats who could care less what happens to the country as long as they get paid, politicians who are most adept at securing corrupt backroom deals, or are they academics who have no clue how a non-theorized world works? The market, made up of millions of individual consumers, is exactly the kind of complex social organism that is capable of crafting the exact healthcare configuration that best serves the needs of the consumers. Of course, as first argued by economist Ludwig von Mises, this is exactly why a centrally planned economy fails. There is simply no way for the planners to acquire the information (comparative values, costs, etc) needed for a coherent economy. The same applies to the healthcare system.
Of course Berwick has an answer to such criticism. He would argue,
“Please don’t put your faith in market forces. It’s a popular idea: that Adam Smith’s Invisible Hand would do a better job of designating care than leaders with plans can.”
Ok, well as Ronald Reagan would say,
“Whether we believe in our capacity for self government or whether we abandon the American Revolution and confess that a little intellectual elite in a far distant capital can plan our lives for us better than we can plan it ourselves…The more the plans fail, the more the planners plan.”
The fact is market forces are the only thing that can accurately and successfully deliver healthcare to the people who need it most. If you believe that a Washington bureaucrat can successfully predict, plan, and respond to developing changes then I dare you to find me an example. In reality, the course of history tells us the opposite. We need look no further than the federal government’s involvement in the mortgage crisis to prove it.
Over the past several decades the federal government has pushed policies to encourage home ownership, even to families without the economic foundation to support it. The Fed, completely overlooked the developing economic bubble. Then Fed chairman Alan Greenspan said that the sharp rise in home values was “not enough in our judgment to raise major concerns.” Even until 2007 the Fed said to “not expect significant spillovers from the subprime market to the rest of the economy.” The plan failed. In response, the government passed a financial reform bill granting broad new oversight powers to the Fed in order to prevent future bubbles. The more the planners plan.
One of Berwick’s plans is to promote universal care over quality care. In his words,
“Any health care funding plan that is just equitable civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”
In this vein he touts the British National Health Service which he has labeled a “global treasure” and an “example” for the U.S. to follow. Dig through the superlatives and you’ll find that the NHS is no different than any other government run monopoly. The NHS is slow, inefficient, and monopolistic. Look at the quality of the care given to the elderly, some of the most frequent participants of the system. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) led an investigation that “highlighted poor nutrition, failings in pain management, and delays in surgery” as some of the primary problems for the elderly after admission into hospitals. Bertie Leigh, chairman of the NCEPOD, called the report “unbelievable,” and “depressing.” Of 820 elderly patients who died within 30 days after having surgery only 37.5% of the elderly patients were “assessed has having received good care.” The NHS impeded access to adequate specialists, only a third of elderly patients were given access to specialist care teams before surgery.
The good news doesn’t stop there. For all patients young and old, 52% of them have to wait over 18 weeks for treatment. Some waits are in excess of one year. 50,000 surgeries are canceled every year because the patient becomes too sick on the waiting list to proceed.
These exorbitant wait times are but one result of the centralized government’s attempt to save money. In the United States we call that rationing, a phrase Dr. Berwick accepts wholeheartedly. He has said that,
“The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.”
Rationing is the restriction of the consumption of a relatively scarce commodity. When it comes to healthcare rationing it is a false scarcity only created by government involvement. In a free market there are plenty of willing healthcare providers assuming the price is right. When the government makes centralized healthcare decisions for us, it decides what procedures are too expensive, how much doctors should be paid, and what kinds of treatment are available. The attempt to conserve money inevitably leads to the rationing of care.
Too see this theory in practice, one only needs to take a quick peek at our northern neighbor, Canada. Due to the fact that there is only one health care provider in Canada, there is no incentive to reward innovation, since innovation is what creates profits, and the health care system in Canada is designed to exist without the variable need for profit. If you have non-Hodgkins Lymphoma and live in Canada there is a good chance that you will have to go to the US to get the life-saving drug Rituxan, since the healthcare bureaucrats in Canada decided not to make it available under the national health care (examples like this exist in abundance in the NHS system too). Under a government rationing health care system, you can say goodbye to medical miracles that are made possible by American innovation.
Dr Berwick is an advocate and apologist of the not-so-nice British NICE (National Institute for Clinical Excellence). NICE is the “rationing arm” of the NHS. NICE uses an algorithm to determine the quality-adjusted life year’s measurement (QALY). When determining viable treatments, NICE takes into account the QALY score and the cost effectiveness of a particular regimen. Cost effectiveness, according to NICE, is “measured as ₤ per QALY.” So under those guidelines, Britain will not spend more than (US) $22,000 to extend a person’s life by six months. Thanks to NHS, there is no viable private alternative. They’ve put a price on your life, literally. But President Obama seems nonplussed at the thought:
“The chronically ill and those towards the end of their lives are accounting for potentially 80% of the total health care bill out here… there is going to have to be a very difficult democratic conversation that takes place.”
Fortunately, with Berwick taking the stand in the Senate this week, we may finally be able to have that difficult conversation with Dr. Berwick.
by Brandon Greife, Political Director of the College Republican National Committee