PRESIDENT BARACK OBAMA was adamant: His health-care overhaul would not put Americans on the road to British-style, government-run medicine. Speaking to the American Medical Association last June, the president dismissed as "scare tactics and fear-mongering" all talk of "socialized medicine and government takeovers; long lines and rationed care; decisions made by bureaucrats and not doctors." A few weeks later he reiterated the message: "I don't believe that government can or should run health care."
"I am romantic about the (British) National Health Service. I love it." -- Dr. Donald Berwick, President Obama's choice for director of the Center of Medicare and Medicaid Services.
"I am romantic about the National Health Service," Dr. Donald Berwick, the president's pick for director of the Center for Medicare and Medicaid Services, told a British audience in 2008. "I love it." Not only does he love the NHS, he extols it as "an example for the whole world -- an example ... that the United States needs now."
From all accounts, Berwick, a pediatrician, is respected by his peers. He is the founder of the Cambridge-based Institute for Healthcare Improvement, and an expert on making patient care safer and more efficient. Among his supporters are Bill Frist, a physician and former US Senate majority leader, and several previous directors of the Center for Medicare and Medicaid Services.
But if Berwick's credentials cannot be doubted, neither can his ideological commitment to centralized state power over health care, or his disdain for the ability of markets and competition to improve the quality and lower the cost of medical services.
He has publicly saluted Britain's socialized National Health Service for rejecting the "immoral" American system and "the darkness of private enterprise." He declares that "the Holy Grail of universal coverage" cannot be achieved with consumer-centered health care, but only through "collective action overriding some individual self-interest."
And he embraces health-care rationing. "The decision is not whether or not we will ration care," he said in a 2009 interview, "the decision is whether we will ration with our eyes open." This is a view Berwick has held for a long time; more than 10 years ago he wrote that "limited resources require decisions about who will have access to care and the extent of their coverage." Accordingly, he praises the NHS for "making tough choices" about the care it administers -- unlike the American system, in which the supply of medical care is not artificially restricted. "Here, you choose a harder path," he said in Britain two years ago. "You plan the supply; you aim a bit low; you prefer slightly too little of a technology or a service to too much; then you search for care bottlenecks and try to relieve them."
But those who have to live with the NHS and its "bottlenecks" don't always find them quite so admirable. For months, the British press has been reporting horror stories about the realities of government-run health care. Some recent headlines give a sense of the coverage:
No one would deny that America's health care system is flawed in many ways. But when it comes to the standard that matters most -- the quality of health care provided -- our haphazard, expensive, insurance-based system towers above the NHS.
"In Britain 36 per cent of patients have to wait more than four months for non-emergency surgery," wrote journalist James Bartholomew in The Spectator. "In the US, a mere 5 per cent do." By one metric after another -- cancer survival rates, performance of diagnostic tests, availability of CT and MRI scanners, consultation with specialists -- US health care is superior. "British state-run healthcare," Bartholomew concluded, "is so amazingly, achingly, miserably, and mortally incompetent."
That's the system that leaves Berwick feeling "romantic" -- the system he proclaims an "example" for the United States. And Obama wants him to run Medicare and Medicaid? Let us hope at least 51 senators say no.
(Jeff Jacoby is a columnist for The Boston Globe).
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