Berwick avoided senate scrutiny
President Obama used the recess appointment process to appoint Dr. Donald Berwick to head up our government health care systems – Medicare and Medicaid. Presidents in the past have used this constitutional provision. Usually, it is used when the president wants to get his first choice appointed and knows he faces a hostile senate, a senate that would reject the appointment.
The constitution allows recess appointments when Congress is not available to consider giving its consent. In this case, however, it is apparent that President Obama did not want Berwick to face public scrutiny.
Berwick, a pediatrician had a short clinical resume. As a kids’ doc, he has probably never had to deal with the Medicare mess that he now leads. Chances are that he has had at least limited experience with the low reimbursements Medicaid pays to doctors.
Berwick is outspoken and controversial. His more infamous quotes have flown across the newswires and the Internet. Berwick’s praise of England’s National Health Service is particularly troublesome. While he does not favor the NHS’ long wait lines for critical health services and elective surgeries, he like the NHS and “value-based” medicine.
Imagine a hostile U.S. Senator asking, “So Dr. Berwick, are you saying that perhaps here in the United States we should withhold care from a senior citizen if Medicare thinks it is too expensive? If the person would probably die within a short time anyway?”
Pres. Obama knew better not to lay Berwick, the controversial quote-maker, open to that kind of questioning.
My favorite Berwickian quote:
For the past several weeks, I have been using one particular Berwick quote, because I think it sums up the Obama administration’s view of health care management. “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.” [Emphasis Added]
Berwick here lays bare his bias: Mortals cannot manage their own health care. Only leaders have enough savvy to tell we commoners how to care for ourselves. Government, he implies, is the proper authority to control medical caregivers. The quote speaks volumes about Berwick’s attitude toward Health Savings Accounts (HSA) and consumer-directed health care. It appears that in his view, mere mortals could not possibly make health care consumerism work. Yet, consumerism is the one shining star in pre-Obama health care reform that has both reduced spending trends, and helped individuals maintain good health.
Berwick prefers that health “experts” along with academics, researchers, and government leaders lay out what is medically preferable. President Obama appointed him, ergo, Obama believes government is the best arbitrator of individual health care.
At the same time, however, there is a remnant of truth in this Berwick quote. Health care is complicated and difficult for individuals to manage. The complexity of health insurance and the provision of medical care is why Americans seeking advice consult with non-government, private experts rather than government bureaucrats.
Doctors, nurses, pharmacists, therapists, patient advocates, professional insurance agents, insurance company claims specialists, social workers, and a host of other highly trained individuals help health care consumers navigate through medical complexity – with bureaucrats on the sideline.
Berwick implies that the army of private professionals already assisting individuals is not capable of doing what government “leaders” do. Government, Berwick implies, is providing the leadership that we demand, and without which we would certainly waste our health and money. We “need” government as our shepherd as we ponder the health care we think we need. Do not be dismayed, however, because our new health care leaders will make we get the care when they believe we need it, and in the manner they prescribe. “That’s what leaders do.”
Imagine Dr. Berwick trying to explain this to a U.S. Senate panel.
