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Is This The Change We Want?

Stanley Feld M.D.,FACP,MACE

This week Senate Republicans demanded to hear from Dr. Don Berwick, the physician President Barack Obama appointed during the July 4th Senate recess to run the Medicare and Medicaid programs.

Dr. Berwick took office last week.

“Republicans on the Finance Committee, which has jurisdiction over the post, say that not holding a hearing with Berwick would “result in circumventing the open public review that should take place for a nomination of such importance” and “casts a shadow over his legitimacy and authority to serve as administrator during a critical time for CMS.”

President Obama did an end around on Finance Committee Chairman Max Baucus (D-Mont.). Senator Baucus said he was troubled that Dr. Berwick did not have a confirmation hearing.

Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power and protects Montanans and all Americans by ensuring that crucial questions are asked of the nominee – and answered,”

After Dr. Berwick was installed in office, Senator Baucus said, “fully expects" new Medicare chief Donald Berwick to testify before the panel "in the near future."


Does President Obama have enough respect for the Senate or the American people to honor Senator Baucus’ request?

Why all the fuss?

There are two reasons:

1. “Dr. Berwick’s ideas on the design and purpose of the U.S. system of medicine aren’t merely about "change." They would be revolutionary.”

2. “One may agree with these views or not, but for the president to tell the American people they have to simply accept this through anything as flaccid as a recess appointment is beyond outrageous. It isn’t acceptable.”


Problem solving has three components;

a. Goals

b. Philosophy

c. Mechanisms.

All three must be kept in mind when evaluating decisions. There is no question that the mechanical aspects of healthcare and medical care must be changed in order to have a more cost effective, affordable system. I have discussed all of the areas of waste and abuse in the healthcare system previously. Many of these areas are not addressed in President Obama’s healthcare legislation.

Increasing the bureaucracy without developing a system of individual responsibility, individual choice, and individual accountability has not worked historically.

Yet Dr. Berwick’s many public statements reflect a new system that denies these freedoms and subjugates the individual’s freedom of choice to collective government decisions.

I am amazed at how few people are aware of the Dr. Berwick issue. I am again publishing his statements as Daniel Henniger did in order to bring more attention to the issue.

Excerpts are from past speeches and articles by Dr. Berwick:

"I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do."

"You cap your health care budget, and you make the political and economic choices you need to make to keep affordability within reach."

"Please don’t put your faith in market forces. It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can."

"Indeed, the Holy Grail of universal coverage in the United States may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per capita costs."

"It may therefore be necessary to set a legislative target for the growth of spending at 1.5 percentage points below currently projected increases and to grant the federal government the authority to reduce updates in Medicare fees if the target is exceeded."

"About 8% of GDP is plenty for ‘best known’ care."

"A progressive policy regime will control and rationalize financing—control supply."

"The unaided human mind, and the acts of the individual, cannot assure excellence. Health care is a system, and its performance is a systemic property."

"Health care is a common good—single payer, speaking and buying for the common good."

"And it’s important also to make health a human right because the main health determinants are not health care but sanitation, nutrition, housing, social justice, employment, and the like."

"Hence, those working in health care delivery may be faced with situations in which it seems that the best course is to manipulate the flawed system for the benefit of a specific patient or segment of the population, rather than to work to improve the delivery of care for all. Such manipulation produces more flaws, and the downward spiral continues."

"For-profit, entrepreneurial providers of medical imaging, renal dialysis, and outpatient surgery, for example, may find their business opportunities constrained."

"One over-demanded service is prevention: annual physicals, screening tests, and other measures that supposedly help catch diseases early."

"I would place a commitment to excellence—standardization to the best-known method—above clinician autonomy as a rule for care."

"Health care has taken a century to learn how badly we need the best of Frederick Taylor [the father of scientific management]. If we can’t standardize appropriate parts of our processes to absolute reliability, we cannot approach perfection."

"Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy."

"Political leaders in the Labour Government have become more enamored of the use of market forces and choice as an engine for change, rather than planned, centrally coordinated technical support."

"The U.K has people in charge of its health care—people with the clear duty and much of the authority to take on the challenge of changing the system as a whole. The U.S. does not."

Is this what the American people want? If so, that is America’s choice. Americans must be given that choice with a televised transparent confirmation hearing.

Barack Obama cannot deny Americans the understanding of Dr. Berwick’s positions. Thankfully, Senator Baucus has spoken out.

The opinions expressed in the blog “Repairing The He
althcare System” are, mine and mine alone.

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