July 20, 2010
The old “Dr. Death,” Jack Kevorkian, had the permission and approval of each individual who requested his services. For this, of course, he was incarcerated. Philosophically, I always took that case as the very worst trial of our time. It was the explicit declaration that your life is not yours to decide. If you believe in individualism, or liberty or even just plain ol’ America, it can’t get any worse than that.
But it can. You see, once your life isn’t yours, then it remains to be decided exactly whose it is. And on that point, there can be quite a spectrum. So meet the new “Dr. Death.” His name is Dr. Donald Berwick, and he was just named as the head of the Centers for Medicare and Medicaid Services (CMS), overseeing (at least) an $850 billion budget.
Named? Not nominated? Why no, of course he was just named. It was a recess appointment, you see, while Congress was on a break over the recent holiday. Shockingly (not), the New York Times backed both the appointment and making the appointment during a recess. The paper also advises us that Berwick’s “appointment is backed by the American Medical Association, the American Hospital Association and scores of other health organizations and patient advocacy groups. He has been endorsed by three predecessors who held the same job in Republican administrations.” Hopefully the Tea-Partiers notice that last and will remember this when their gang goes to Washington. It turns out that Americans don’t like socialism, not one little bit, but it remains to be seen how well they’ll cotton to fascism.
So what of Dr. Berwick? What does he believe? Well, for starters you have to know what the “Dartmouth Atlas of Health Care” is. This was a two-bit research report invoked by President Obama in his drive to pass so-called “Health Care” legislation earlier this year. And according to the Times, Dr. Berwick “called it the most important research of its kind in the last quarter-century.” But what is it and what does it say?
What is says, is that health care can be improved by cutting expenditures. What it is, is faulty research using uncorrected data to imply a conclusion that isn’t there. Even the Times, on its non-editorial pages, divulged this as recently as June 2. Here is the full article, as well as a subsequent response to challenges brought by the researchers. This should be sufficient to explain the issue, though many more detailed articles are readily available via search engine.
But never mind implication and inference. Let’s take a look at a series of quotes, all of which were attributed to Dr. Berwick by the Wall Street Journal, in a piece by Daniel Henninger just last week. If you can’t figure out what Dr. Berwick believes, and what he plans to do, by these quotes, then you yourself ought to seek some “health care,” and quickly. Meet Donald Berwick, the new “Dr. Death”…
“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 leaders to do.”
“You cap your health care budget, and you make the political and economic choices you need to make to keep affordability within reach.”
“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 designing care than leaders with plans can.”
“Indeed, the Holy Grail of universal coverage in the United States may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per capita costs.”
“It may therefore be necessary to set a legislative target for the growth of spending at 1.5 percentage points below currently projected increases and to grant the federal government the authority to reduce updates in Medicare fees if the target is exceeded.”
“About 8% of GDP is plenty for ‘best known’ care.”
“A progressive policy regime will control and rationalize financing—control supply.”
“The unaided human mind, and the acts of the individual, cannot assure excellence. Health care is a system, and its performance is a systemic property.”
“Health care is a common good—single payer, speaking and buying for the common good.”
“And it’s important also to make health a human right because the main health determinants are not health care but sanitation, nutrition, housing, social justice, employment, and the like.”
“Hence, those working in health care delivery may be faced with situations in which it seems that the best course is to manipulate the flawed system for the benefit of a specific patient or segment of the population, rather than to work to improve the delivery of care for all. Such manipulation produces more flaws, and the downward spiral continues.”
“For-profit, entrepreneurial providers of medical imaging, renal dialysis, and outpatient surgery, for example, may find their business opportunities constrained.”
“One over-demanded service is prevention: annual physicals, screening tests, and other measures that supposedly help catch diseases early.”
“I would place a commitment to excellence—standardization to the best-known method—above clinician autonomy as a rule for care.”
“Health care has taken a century to learn how badly we need the best of Frederick Taylor [the father of scientific management]. If we can’t standardize appropriate parts of our processes to absolute reliability, we cannot approach perfection.”
“Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy.”
You’ve heard the saying, “The writing is on the wall.”
News flash—you’re the wall and Dr. Berwick aims to be the author.
“You asked for it, brother.”