If President Barack Obama had any intention of dispelling fears about his overhaul of American health care he could have done better than to nominate the outspoken Dr Donald Berwick to head the Center for Medicare and Medicaid Services. Berwick previously confessed to be “romantic” about Britain’s infamous National Health Service (NHS).
The Obama Administration narrowly passed health-care reform in March amid staunch opposition from Republicans and wild accusations from the far right. Some warned of “death panels” while others cried “communism!” On the left, proponents spoke of “civilization” and the president himself described the effort as “another stone firmly laid in the foundation of the American Dream.”
“Obamacare” as opponents have dubbed the plan does in fact represent an assault on individual rights but doesn’t condemn Americans to Soviet-style rationing just yet.
Rationing however is part of the reason why Berwick prefers the “politically accountable” British system. He described the NHS’s rationing board, the National Institute for Clinical Health (or NICE) as “not just a national treasure” in 2008. According to Berwick, “it is a global treasure” that may well cure the currently “bloated” American health-care system.
Berwick was openly disdainful of the then still relatively free American health insurance market, describing health care in the United States as being trapped in “the darkness of private enterprise.” The British model, on he other hand, was “generous, hopeful, confident, joyous, and just.”
In all fairness to Dr Berwick, in spite of the rather communist qualities of the NHS, it manages to operate at a lower cost per capita ($2,560, compared to $6,096 for the United States in 2007) while providing better care (PDF). But “generous”? Tell that to the 750,000 or so Britons awaiting admission to NHS hospitals. “Hopeful”? Not for the 50 to 70 percent of patients who can’t get treatment before the government’s own deadline of eighteen weeks. And “joyous”? Unless you’re among one of the 50,000 people who’s surgeries are canceled every year because they’ve become to ill on the waiting list to proceed.
And how “just” is NICE really when it comes to rationing care? According to its own mandates, each year of added life is worth approximately $44,000 (or £30,000). NICE Chairman Michael Rawlins boasts that at times, his agency has approved treatments costing over $70,000 (£48,000) per year of extended life but the principle remains unchanged — NICE puts a price tag on life. A principle that is readily endorsed by Dr Berwick.
“The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health-care bill out there,” said Berwick. He predicted the need of what he called “a very difficult democratic conversation” without elaborating all too explicitly of course on what it would entail. But he did announce this: “The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.”
Just what does “eyes open rationing” mean? Dr Berwick has yet to answer that question. What’s obvious though is that according to the future Medicare and Medicaid chief, the chronically ill and elderly are taking up more than their fair share of America’s health-care supply. It’s the government’s job to remedy that injustice.
“Any health-care funding plan that is just, equitable, civilized and humane, must redistribute wealth from the richer among us to the poorer and the less fortunate,” according to Berwick. Good health care, he stressed, “is by definition redistributional.” He added: “The simplest way to reach these goals is with a single-payer system.”
President Obama once expressed enthusiasm for the single-payer system as well but felt compelled to abandon the notion in the face of mounting opposition from both moderate Democrats and Republicans.
To refute the supposed injustice of income inequality would distract too much from the discussion at hand. It is worth considering Jason Sagall’s health-care parable in this regard though for it concisely describes what’s wrong with collectivized health care: the brazen assumption that those in “need” are entitled to the help of others.
The NHS institutionalized this “right” in Britain by promising health care to all people, “regardless of wealth.” Need, not ability is now the standard according to which care is distributed.
Many may take this “right” for granted today but imagine for a moment that the law were to grant people a right to much more basic needs as food and shelter. No such laws exist of course, for if people were entitled to food and shelter, others should provide for them at their own expense.
Granting people a right to health-care demands that others provide it, for free if need be. Only a government can allocate care under such conditions for few individual doctors and nurses would go about their work unpaid any more than a supermarket would remain in business for long if it is to satisfy peoples’ “right to food.”
This doesn’t particularly concern Berwick no matter that the American government was already heavily involved in regulating health care before the Democrats passed their bill. In good interventionist fashion, Berwick’s answer to failing regulation is more regulation because, as he put it, “rational collective action overrid[es] individual self-interest.” Evidently, even when it comes to caring for one’s own health, a bit of self-interest is absolutely disgraceful.
Dr Berwick effectively elevates the doctrine of sacrifice to new height, demanding of Americans that their health care be rationed in favor of “rational collective action” — which, of course, is to be set by Berwick himself!