As Dr. Donald Berwick — President Barack Obama's 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."
[IMGCAP(1)]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 Berwick's 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."
Berwick's 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, Obama's 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 president's 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 Berwick's 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 Berwick's opinions on government-run health care systems, such as Great Britain's 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 Britain's 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 America's seniors.
With last week's recess appointment, we will have to learn Berwick's vision for health care only after CMS decisions are rendered, a far cry from the openness promised by then-candidate Obama. Two other doctors who serve in the House and I recently wrote to Obama objecting to Berwick's proposals that would prevent doctors from practicing in some regions and restrict patients' access to needed medications. These concerns were never answered.
Just four years ago, the editorial page of the New York Times called such recess appointments "a constitutional gimmick" and an "end run around Senate confirmation." However, last week the same editorial page called the same gimmick a "sensible move." Berwick assumes control of an agency in charge of $803 billion in vital benefits so Americans rightly should expect questions to be asked and questions to be answered.
In 2005, then-Sen. Obama suggested a recess appointee lacked credibility because of the truncated term and lack of consensus. Berwick's view of health care and his appointment without any public vetting casts doubt on his term even before it begins.
Rep. Charles Boustany (R-La.), a heart surgeon, is a member of the Ways and Means Committee, with jurisdiction over Medicare and tax policy.