Healthcare

A friendly reminder: Donald Berwick is still an extremist

A friendly reminder: Donald Berwick is still an extremist

Whenever you hear about the Republican Party’s dive over the extremist ideological cliff, it’s helpful to remember that folks like Dr. Donald Berwick exist.

Berwick, who has been lauded as a remarkable mind by Democrats for years, announced today that he’s going to run for governor of Massachusetts. (You can take a gander at some of his lefty bromides here – job creation, for instance, hinges on communities having more “recreational opportunities such as bike paths and the arts” and so on …)

Without allowing a single hearing on his qualifications, President Barack Obama tapped Berwick to run Centers for Medicare and Medicaid Services with one of his recess appointments. Republicans, unsurprisingly, weren’t interested in allowing him to continue his work there.

In a state that sends Elizabeth Warren to Washington this might not be remarkable , but for the rest of us it’s worth remembering that Berwick wasn’t only a player in Obamacare but  famously “romantic” about Britain’s socialized National Health Service. “I love it,” he declared. Berwick goes on about state control of health care as you might about your faith or your spouse , declaring it “generous, hopeful, confident, joyous, and just.” And while the NHS is a decent and moral system, competitive choice-based health care is tragically weighed down by “the darkness of private enterprise.”

Britain may have the worst cancer survival rates in the developed world and it may, as some have accused it, engaged in prematurely ending the lives of thousands of elderly unmanageable patients for much-need space, but Berwick believes it to be the ideal.

A government-commissioned study may have found that 24 disabled people were being killed each week in one region of England through prejudiced presumptions by government – those with disabilities, in fact, were found to be 37 percent more likely to be killed by incompetence or inadequate care, dying an average of 16 years earlier than assumption would lead you to believe —  but we don’t do enough to mimic this system, says Berwick.

“The decision is not whether or not we will ration care – the decision is whether we will ration with our eyes open,” Berwick once explained. Even if we ignore the most egregious accusation against  the NHS, here are some examples of the generous everyday rationing Berwick thinks is so swell:

• Hip and knee replacements only being allowed where patients are in severe pain. Overweight patients will be made to lose weight before being considered for an operation.
• Cataract operations being withheld from patients until their sight problems “substantially” affect their ability to work.
• Patients with varicose veins only being operated on if they are suffering “chronic continuous pain”, ulceration or bleeding.
• Tonsillectomy (removing tonsils) only to be carried out in children if they have had seven bouts of tonsillitis in the previous year.
• Grommets to improve hearing in children only being inserted in “exceptional circumstances” and after monitoring for six months.

How does Berwick deal with these facts? He doesn’t. The man who laments the “darkness of private enterprise” argues that those who stand in the way of progress in health care are the real rationers.

It boggles my mind that the same people who cry ‘foul’ about rationing an instant later argue to reduce health care benefits for the needy, to defund crucial programs of care and prevention, and to shift thousands of dollars of annual costs to people – elders, the poor, the disabled – who are least able to bear them. When the 17 million American children who live in poverty cannot get the immunizations and blood tests they need, that is rationing.

Actually, it’s not rationing to ask people to pay for their own care. We can’t shift the cost to them, only away from them. It’s also a strawman. Americans can discuss helping the elderly, poor and children. We can support more  redistribution or try and create more effective safety nets without also backing a  government-run health care system that throws away all competition, choice and ropes every single person into participation. I’m under no illusions that the American health care system is working for everyone, but that doesn’t mean Berwick’s ideas — price controls, real rationing (allowing each of us a fixed amount of health care, determined by Washington technocrats), coercion — aren’t outlandish. They are.

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Follow David Harsanyi on Twitter @davidharsanyi.

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