Is NHS Style Rationing Headed Our Way?

In case you've become so consumed by the debt debate and need something else to read about, check out this post from The Heritage Foundation.  Obama really hopes we get so distracted by all these other disasters emanating from his administration that we forget about Obamacare by the time 2012 comes along.

Not a chance.

Keep in mind that Obamacare desperately wants to be like the British NHS; Obama's Medicare Czar, Dr. Donald Berwick, was widely quoted (including on this blog) lauding the NHS. From Robert M. Goldberg's American Spectator article last year (emphasis mine):

Berwick not only has a role model picked out for a role that sounds a lot like what he would be doing at CMS, he has a soulmate: For the past 15 years he has consulted for -- or, in his words, been "starry-eyed" over -- Britain's National Health Service. In 2008, at a 60th anniversary celebration of the creation NHS, he told a UK crowd, "I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country. "
 
Berwick complained the American health system runs in the "darkness of private enterprise," unlike Britain's "politically accountable system. " The NHS is "universal, accessible, excellent, and free at the point of care -- a health system that is, at its core, like the world we wish we had: generous, hopeful, confident, joyous, and just"; America's health system is "toxic," "fragmented," because of its dependence on consumer choice. He told his UK audience: "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."

With that in mind, look at the rationing currently going on in the British health care system:

* 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

Heritage points out that we now have the framework in place to go down the same dark path as Britain.

Think that health care rationing isn’t possible in America? Think again. Under Obamacare, a board of unelected bureaucrats known as the Independent Payment Advisory Board (IPAB) is tasked with reducing the growth in Medicare spending. With the powers IPAB has under current law, the Board can make changes—without congressional input—that would indirectly reduce seniors’ access to providers and services.

We can see the writing on the wall already. Consider, just as an example, the breast cancer drug Avastin:  just last week the National Comprehensive Cancer Network voted overwhelmingly in support of Avastin as a viable therapy drug for breast cancer yet last month the FDA pulled its support of the drug.  The drug can cost up to $90,000 a year for patients.

Medicare still currently covers Avastin but how long do we realistically expect that to last given the FDA position and Berwick's love of the NHS rationing system?  The same argument applies to the drug Provenge which supposedly is a vaccine against prostate cancer at the cost of $93,000 per course.

Rep. Phil Gingrey (R-GA) has expressed concern over the potential for rationing in the power vested in the Independent Payment Advisory Board (IPAB):

Rep. Phil Gingrey, R-Ga., recently reignited the debate by saying that under the presidentially appointed IPAB, "a bunch of bureaucrats decide whether you get care, such as continuing on dialysis or cancer chemotherapy."

"I guarantee you when you withdraw that, the patient is going to die," he said. "It's rationing."

And with Berwick in charge, who can doubt that it's coming?

Drug shortages are already becoming a bigger problem than ever before.

Heritage Foundation points out:

Americans are generally appalled to hear stories of rationing, but what many don’t realize is that under Obamacare, IPAB is empowered to take actions that could lead us down that very road. There is a better way to lower health care costs and deliver a higher quality of care: introducing competition and consumer choice through the reforms outlined in Heritage’s Saving the American Dream plan.

Despite Obama's hopes that we forget the disaster that is Obamacare by 2012, we won't forget.    The rationing headed our way, however subtle, won't let us.

Update:  Related:  Health Industry Fears Double Whammy in Medicare Cuts

Dr. Death Panel Testifies Today

Dr. Donald "Death Panel" Berwick is scheduled to testify before the Senate Finance Committee this morning but I'm not expecting any fireworks.  According to Politico, the meeting will be an abbreviated one:

Senate Republicans speculated Tuesday that CMS Administrator Don Berwick’s hearing is likely to close after one hour this morning, and they’re not happy about it. The hearing is scheduled to begin at 10 a.m., and Senate votes are tentatively scheduled to start an hour later– a convenient reason for Democrats to gavel the hearing out. After waiting this long to hear from Berwick, Republicans want some more time with him. 

Convenient for the Dems, no dobut.  Berwick, as you recall, was given a recess appointment and has not been grilled by Senate republicans on his policies, plans, or love of rationing as of yet.


His testimony today is scheduled for 10 ET.

Related:

Red State:  Rationer-In-Chief of ObamaCare
American Spectator:  Don Berwick's Death Panel?

Dr. Death Panel Gets a Recess Appointment

Dr. Death Panel gets a recess appointment - who is surprised?

The most transparent administration ever has decided to circumvent Senate confirmation hearings on Dr. Donald Berwick, Medicare Czar, and "deem" him confirmed, at least through next year.

Yes, it's true that presidents on both sides of the aisle have used recess appointments and by definition they are controversial.  However this country has never been faced with such a massive power grab as Obamacare and now the American people aren't going to hear Dr. Berwick answer questions about he'll administer his part of it.

Transparency!

Team Obama is concerned that confirmation hearings would reopen the health care debate right before the fall elections, as if we've forgotten, so we'll just skip that part until after the elections.  I have not forgotten.  I'll  be lots of Americans haven't forgotten.  In fact, according to Rasmussen, 60% of Americans polled favor repeal of Obamacare.

You will remember that Berwick said,

"The more I have studied it, the more I believe that less discretion for doctors would improve patient safety." He then looks down. "Doctors will hate me for saying that."

Less discretion for doctors implies MORE discretion for bureaucrats.  This is not good when you're referring to health care.

Berwick also said that

"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."

He's a known advocate for rationing and gets starry eyed when talking about the British NHS, a system fraught with rationing, overcrowding, inferior care, and horror stories.

Berwick speaks out against private enterprise.  In fact, he criticizes "the darkness of private enterprise instead of accepting that a politically accountable system must act in the harsh and admittedly sometimes very unfair daylight of the press, public debate and political campaigning."

I guess that "politically accountable system" that "must act in the harsh and admittedly sometimes very unfair daylight of the press" and "public debate" doesn't apply to his appointment or to the Obama administration.

John Kerry Defends Dr. Death Panel

To the surprise of no one, John Kerry is standing up to defend Dr. Donald Berwick, Obama's pick for Medicare czar.  At the end of a day when several Republicans took to the floor of the Senate to criticize Berwick, Kerry said (emphasis mine),

“We need better than phony assertions that he’d ever set up death panels in Medicare, or interfere in personal health care decisions made between patients and their doctors,’’ Kerry said. “Frankly, we need a more honest debate than we had over health reform itself, which didn’t serve anyone well. It’s time to permanently retire these ridiculous accusations from politics and thoughtfully consider our nominees so that first rate experts won’t shy away from public service.’’

 That doesn't exactly jive with what Berwick has said previously:

"The more I have studied it, the more I believe that less discretion for doctors would improve patient safety." He then looks down. "Doctors will hate me for saying that."

That sounds to me like he plan to set up a system that comes between doctors and patients.  A system that takes "discretion" from your doctor who knows you, knows your history, and place it in the hands of a bureaucratic system.

Not that anybody listens to John Kerry, anway.  Just sayin'.

Obama's Medicare Czar: It's Worse than You Thought

(Thanks Michelle Malkin for the link! )

(See also:  Dr. Death Panel Gets a Recess Appointment)

Here is Obama's pick for Medicare czar, Dr. Donald Berwick, explaining how the ideal medical system should act.  He is speaking to a British audience in 2008 about how wonderful their national health care system is.  He applauds them for choosing their system over a "simpler, less ambitious, less troubled plan than the NHS; you could have had the American plan.  You could have been spending 17% of your GDP to make health care unaffordable as a human right instead of spending 9% and guaranteeing it as a human right."

Yes, Berwick loves the NHS.  In fact, he criticizes "the darkness of private enterprise instead of accepting that a politically accountable system must act in the harsh and admittedly sometimes very unfair daylight of the press, public debate and political campaigning."

Berwick says you should use "your tax base to provide a single route of finance" instead of a "monstrous insurance industry of claims and rules and paper pushing."

He says the NHS recognizes that "sick people tend to be poorer and that poor people tend to be sicker."

And the kicker:

Berwick says that "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."

Hear it for yourself:



The buzz is building against this guy.

Red State had a detailed article about him yesterday.

Here are my earlier posts on Berwick here and here and here.

American Spectator also has some informative posts on Berwick by Robert Goldberg and Philip Klein. 

Mark Levin is all over this guy and I'm sure Glenn Beck must be too, although I don't watch him.

Naturally The New York Times does not report any of his controversial opinions; in fact, they conclude:

Dr. Berwick could help shield the White House from Republican charges that Mr. Obama’s policies would lead to the rationing of care or even a government takeover.

Their piece on his selection is here.

Berwick must be confirmed by the Senate.  Start making your phone calls now!

In Swoops Dr. Death Panel to Ration Your Care

Philip Klein at American Spectator has taken notice of Dr. Death Panel, aka Dr. Donald Berwick, who is Obama's pick for Medicare Czar.  This is the guy, you may remember, who is "starry eyed" over the NHS - the British Health Care system.  I researched several of Berwick's articles here.

At American Spectator this morning, Klein points out Berwick's tilt toward rationing:

In his writings and speeches, Berwick has defended government rationing and advocated centralized budget caps on health care spending. 

It is inevitable, of course.

"(T)he 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," Berwick wrote in an article for Health Affairs he co-authored in 2008.
 
He went on to write that, "The hallmarks of proper financial management in a system… are government policies, purchasing contracts, or market mechanisms that lead to a cap on total spending, with strictly limited year-on-year growth targets."

So goes capitalism and the free market. It was nice knowing you.

And so, while everyone is worried about Elena Kagan's total lack of a paper trail or whether or not she's gay, Dr. Death Panel swoops in under the radar.  Is the mainstream media, now out of love with Obama, going to cover this one?  

Don't hold your breath.

Read the whole thing. 

"Less discretion for doctors would improve patient safety" Says Obama's Pick for CMS

I posted earlier in the week on Robert Goldberg's American Spectator piece about Dr. Donald Berwick.  Since then I've been doing some research on Berwick, which is to say that I've been reading articles he has written.  It's quite an eye opener, as Goldberg suggested in his piece.

Berwick was recently appointed by Obama to be administrator for the Center for Medicare and Medicaid Services, formerly known as Health Care Financing Institution.  The CMS is, of course, a federal agency and comes under the Department of Health and Human Services.  The agency also oversees HIPAA and quality standards in nursing homes.

According to Wikipedia (a source I'm always dubious of but is sometimes reliable), CMS employs around 4,100 with most of those at its headquarters in Maryland.  As Goldberg explained, it's a huge job with much power.

So, what does Berwick actually stand for, or believe?

Goldberg's focus was primarily on Berwick's admiration for and obsession with Britain's National Health Service.  We've all read the horror stories over Britain's health care system, as well as the abbreviated life expectancies for patients with serious illness such as cancer.

 Berwick has made other observations and suggestions about revolutionizing the American health care system which we should make note of.

By all accounts Berwick is a personable man and delivers a powerful speech.  As Alex Gibney wrote in The Atlantic, "He is not an ideologue. He is a pragmatist, armed with data, real-life experiences and a determination to make things better. Even more important for this job, he is a great communicator who does not harangue; he persuades."

He apparently has a "folksy" good humor and  can spin a good yarn.  He hails from Connecticut and is a Harvard grad.  He practiced pediatrics and later founded the Institute for Healthcare Improvement.

What is troublesome is his affinity for the British NHS and its methods.

In 2004, in an article for Quality and Safety in Health Care, Berwick compared the British health care system to its American counterpart.  He explained that "Equity and excessive cost are far more urgent problems in the U.S., which timeliness ranks at the top of the NHS improvement agenda."

Timeliness indeed.  The stories of inferior care, refusal to fund certain drugs and long waits for care or appointments are rampant.  Yet our new CMS administrator is enamored with this system.

In the QSHC article, Berwick also said that one advantage of the UK system is that "the UK has people in charge of its health care -- people with the clear duty and much of the authority to take on the challenge of changing the system as a whole.  The US does not.  When it comes to health care as a nation, the US is leaderless."  He went on to say that the most important resource for the UK system "has been the consistent focus of government, emanating from the Prime Minister personally on raising the bar for NHS performance."

This is what we now have in America with Obamacare.  The government in charge of health care decisions. 

Not one to shy away from dissing those in the medical profession, Berwick explained that one problem in our current health care system is the inadequate training of our health care professionals.  These people are emerging from school

"...ill prepared to help.  The education of health professionals generally lacks focus on the skills in systems thinking, statistical thinking, measurement, cooperation, group process,teamwork, and pragmatic ‘‘real time science,’’ to name but a few disciplines that provide the foundation for effective citizenship in improvement."

Honestly, I'd rather have my doctor trained and experienced in say biology, cardiac care, internal medicine, pulmonary care, orthopedics, or whatever the case may be, rather than "systems thinking" or "group process teamwork."   Maybe that's just me.

In an article at The Boston Globe, Berwick is quoted as saying,

"The more I have studied it, the more I believe that less discretion for doctors would improve patient safety." He then looks down. "Doctors will hate me for saying that."

Less discretion for doctors?  And more for government, I presume?  Scientific protocols?  Death panels,anyone?

Another aspect of American health care that Berwick criticizes is what he calls "quantity over quality."  This basically seems to mean that doctors perform lots of unnecessary tests because they get paid for them.  Didn't I hear this before?  Hmmmm.  Anyway,  listen to Berwick explain this:


Don Berwick #1: "Is American Healthcare the Best in the World?" from Century Foundation on Vimeo.

 I've not yet found anything where Berwick addresses tort reform or frivolous lawsuits which might bring down the need for some of those unnecessary tests.

Berwick will undergo a confirmation hearing, but Maggie Mahar at Health Beat isn't worried.  "kcan handle himself," she said.  That may be so, but it may also be time for the rest of us to take a look at what he really stands for and how drastically he wants to revolutionize American health care.

How Much Do You Know About The Guy Who Is About to Make Your Health Care Choices for You?

Maybe I've been oblivious but it doesn't seem like this story is getting as much play as it should:  check out Robert M. Goldberg's piece at The American Spectator regarding Obama's appointment of Donald Berwick as administrator for the Center for Medicare and Medicaid Services.  Goldberg writes:

Under the Patient Protection and Affordable Care Act, the CMS administrator does more than make sure Medicare and Medicaid pay claims in a more or less accurately and timely fashion. The office defines the quality of health care for every insurance plan, sets reimbursement rates for physicians in Medicare and Medicaid, and decides what treatments are more "valuable" than others.

Yikes!  That's a lot of power!   Sort of makes one want to know more about Mr. Berwick, doesn't it?  Goldberg has it:

Berwick not only has a role model picked out for a role that sounds a lot like what he would be doing at CMS, he has a soulmate: For the past 15 years he has consulted for -- or, in his words, been "starry-eyed" over -- Britain's National Health Service. In 2008, at a 60th anniversary celebration of the creation NHS, he told a UK crowd, "I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country. "
 
Berwick complained the American health system runs in the "darkness of private enterprise," unlike Britain's "politically accountable system. " The NHS is "universal, accessible, excellent, and free at the point of care -- a health system that is, at its core, like the world we wish we had: generous, hopeful, confident, joyous, and just"; America's health system is "toxic," "fragmented," because of its dependence on consumer choice. He told his UK audience: "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."

Oh.My.God.   

Read the whole thing.