Dr. Donald Berwick may not be a household name yet, but if he is confirmed as the head of the Center for Medicare and Medicaid Services, the position for which he was nominated by President Obama, he may soon determine the direction of health care of millions of Americans.
So what’s the big deal about that? Earlier this week, a Washington Post editorial attributed the ongoing hold-up in Berwick’s confirmation hearing to “partisan politics”, claiming that, “Republicans are seizing on the Berwick nomination as an opportunity to relitigate the health-care debate, latching on to a few of Dr. Berwick’s statements to wage their campaign.” The Post misses the point.
Don Berwick is not being scrutinized for political reasons, but rather due to his beliefs. Dr. Berwick has gone on the record—several times—as a passionate supporter of socialized medicine, including the cost-containment decisions that come with it. Whether to allow the government to ration or allow individuals to make their health choices isn’t even a question for Berwick—he claims that “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”
It is not the sound bites which are important here—it is the vision for the U.S. health care system that Dr. Berwick has made crystal clear in his numerous writings and interviews. In a 2009 interview, Dr. Berwick outlined the three most important levels of knowledge to guide medical decision-making. First: whether a health intervention is effective at all. Second, whether it is more or less effective than comparable treatments. And third, whether the benefits of a more effective treatment outweigh additional cost. None of this is exceptional. There are limited resources, and ordinary Americans realize that there must be trade-offs and tough decisions. Individuals and families, in consultation with their physicians, are the ones who should be making those decisions, not government officials.
Beyond that, most ordinary Americans are not in favor of denying care to the sick because of the cost of providing it. This was abundantly evident with the public outcry against government rationing during committee consideration, including the defeat of anti-rationing amendments, of earlier versions of the Democrats’ health care overhaul. While the final bill signed by the president in March contains significant safeguards against this in its creation of the Patient-Centered Outcomes Research Institute, which will conduct comparative effectiveness research (CER), that does not settle the issue. .
The reason: the limitations are not sufficient to ensure the correct use of CER. CER alone would address the second tier of Berwick’s decision-making scheme: determining which among several treatments for an illness are most effective. This information would provide a useful tool for care providers to offer better care to their patients.
But the inclusion of cost information could open the door to denying coverage based on cost. Indeed, Sec. 6301 of the PPACA claims that the limitations put on the Patient-Centered Outcomes Research Institute “shall not be construed to…limit the application of differential copayments under [Medicare] based on factors such as cost or type of service…” And that brings us back to Dr. Don Berwick. With Dr. Berwick at the helm of the two largest public health programs, Medicare and Medicaid, the likelihood of CER being used to deny coverage based on cost becomes ever more worrisome. In his own words, the United States may one day find itself making health decisions based on the question of whether a health intervention “is so expensive that our taxpayers have better use for those funds.”
In June of 2009, President Obama told the American Medical Association that “identifying what works is not about dictating what kind of care should be provided.” Moreover, the president has assured the public time and again that the government will not get between patients and their doctors. His nomination of Don Berwick for Director of CMS, however, tells a different story.
The fight over Berwick is thus not just about partisan politics. Rather, it is the fight to create a health care system where a patient and doctor decide what is best for the patient, rather than a system where bureaucrats determine what treatment will give them the most bang for their buck.
This post was co-authored by Joshua Wade. Wade is a member of the Young Leaders Program at the Heritage Foundation. For more information on interning at Heritage, please visit: http://www.heritage.org/about/departments/ylp.cfm
