As Dr. Donald Berwick President Barack Obamas recent appointee to lead the Centers for Medicare and Medicaid Services takes office, many questions still remain unanswered about his views on health care. Most importantly, lawmakers would like to understand what Berwick meant when he argued that federal bureaucrats should ration with eyes open.
Rationing care involves denying or limiting treatment options based solely on cost. Personal treatment decisions should be made by patients and physicians, not unelected government bureaucrats who have no right to make such value judgments.
During my career as a heart surgeon, I treated thousands of patients who would be curious about Berwicks meaning, too. Throughout my practice, I listened to each of my patients, and the doctor-patient relationship we developed allowed me to provide meaningful care. Working with my patients, we decided together on the best course of treatment.
Instead, in his book, Escape Fire, Berwick writes, The heroic image of individualist physicians each doing the best he or she can and each bearing full and personal responsibility for the care of the patient cannot possibly suffice.
Berwicks writing suggests he does not believe that kind of individualized care is either possible or beneficial. If true, seniors and low-income families who depend on Medicare and Medicaid deserve to know what kind of care Berwick envisions for them. Unfortunately, Obamas recess appointment of Berwick prevents any public vetting from taking place.
Senators likely would have asked Berwick to clarify his previous positions and how he planned to implement much of the presidents massive new health care law. The new law gives broad power to CMS and its parent, the Department of Health and Human Services. As administrator, Berwick will be responsible for overseeing how the new rules are written and enforced.
One of Berwicks chief tasks will be to rein in costs for Medicare and Medicaid. According to CMS actuary, the new health law cuts more than $500 billion from Medicare. To lower costs, will Berwick block seniors and doctors from treatments they might determine are best?
Additional questions remain about Berwicks opinions on government-run health care systems, such as Great Britains National Health Service. In 2005, Berwick remarked that the National Health Service can be an example for the whole world an example, I must say, that the United States needs now more than most other countries do. The NHS routinely prevents Britains elderly from receiving treatment based on cost per quality adjusted life year. Unelected bureaucrats should not be able to make similar life-or-death decisions for Americas seniors.