The Republican Policy Committee has already prepared a memo — which I’ve obtained — that links Berwick to the British health care system and presents him as someone who supports rationing and a government takeover of health care (Download the full memo HERE):
Donald Berwick, President Obama’s nominee to head the Centers for Medicare and Medicaid Services (CMS), has a history of support for government rationing of health care resources on cost grounds. He has spoken favorably about Britain’s National Institute for Health and Clinical Excellence (NICE), which denies patients access to life-saving treatments the National Health Service (NHS) deems too expensive. The American people should have their eyes open to the ramifications of NICE-style rationing in the United States as part of Democrats’ brave new health care world….They may see a Medicare Administrator who explicitly advocates for rationing as indicative of Democrats’ government takeover of health care…
All this is to be expected, particularly since Republicans have pledged to turn the 2010 midterm elections into a referendum on health care reform. But it’s worth pointing out two things.
First, Republicans are deliberately misinterpreting Berwick’s comments about transforming the American health care system from one that pays for the quantity of care into one that pays for value of care. Berwick has built a reputation of finding innovative ways of squeezing value out of every health care dollar and “persuading hospital administrators and doctors to adopt his recommendations.” But his approach — which is based on the idea that “less intensive, less invasive—and less expensive—healthcare can sometimes be more effective than the most aggressive care” — is nothing like the one-size-fits all government-takeover caricature.
Instead, he understands that to find solutions to specific problems, different communities will have to experiment with different solutions. “How could Congress possibly know enough to specify for every community, the exact design for care that is safe, effective, timely, patient-centered, equitable and sustainable?” Berwick asked during a speech in December. “The legislation does contain long sections focusing on quality,” Berwick acknowledged, “and there legislators lay out possibilities. But it is up to health care communities to test, adapt and perfect these strategies in real world.” His focus on improving care quality, while lowering costs has won over some fairly influential admirers. Nancy Nielsen, the immediate past president of the American Medical Association praises Berwick’s “ability to inspire doctors and hospital administrators to work together.” “Don is so widely respected because he has worked in such a collaborative way,” she said.
The second point is that while Berwick will certainly have discretion in running the delivery reform pilot projects in Medicare as well as other liberties, it’s difficult to argue that he’s be able to transform the American health system into NICE. However “radical” his views may or may not be, ultimately he’ll be working within the confines of a fairly conservative law. Even if he is the biggest single payer advocate/socialist in the world, the bill’s managed competition core as well as the obvious need to work with, and to a certain level please, the different health care stakeholders, will naturally prevent the next British invasion.