Obama Nominates Single-Payer System Advocate to head Medicare and Medicaid Services

DR. DONALD BERWICK IS A SELF-PROCLAIMED “ROMANTIC” OF UK’s NATIONAL HEALTH SERVICES

by Debra Mullins

(Jun. 1, 2010) — During last year’s Congressional health care debate, opponents were excoriated for voicing concerns that if the Patient Protection and Affordable Care Act (PPACA) included a public option, it would lead to rationing, death panels manned by bureaucrats determining who lives and who dies, and ultimately to a single-payer system. The Health Care Research and Quality’s U.S. Preventive Services Task Force (USPSTF), for example, already makes treatment recommendations based on Evidence Based Practice and Outcomes and Effectiveness. These recommendations are used to determine which treatments are available to Medicare and Medicaid patients.

Last summer, during a health care reform town hall meeting in Portsmouth, NH, an attendee worried about a government takeover of health care called out Obama about his shifting position from proponent to opponent of a government-run universal health care system. Obama told the attendee, in part:

I have not said that I was a single-payer supporter because, frankly, we historically have had an employer-based system in this country with private insurers, and for us to transition to a system like that I believe would be too disruptive.  So what would end up happening would be, a lot of people who currently have employer-based health care would suddenly find themselves dropped, and they would have to go into an entirely new system that had not been fully set up yet.  And I would be concerned about the potential destructiveness of that kind of transition.

This contradicts Obama’s position while running for the U.S. Senate. During an AFL-CIO Civil, Human, and Women’s Rights Conference in June 2003, he clearly stated he supported a single-payer system.

While on the Presidential campaign trail, Obama appeared to have moved toward the center and consistently stated he was a proponent of single-payer systems but added qualifiers such as ‘if the system were built from scratch.”

In an interview with the New York Times in April 2009, Obama discussed whether or not persons who are terminally ill should be afforded costly surgeries to extend or improve their quality of life. The interviewer pointed out:  “It’s going to be hard for people who don’t have the option of paying for it,” to which Obama responded, “So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right? I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.”

When asked how to deal with it, Obama responded, “Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place.”

What is Obama’s real position? The answer may be found in his choice to head up the Center of Medicare and Medicaid Services (CMS).  Meet Dr. Donald Berwick. On April 19, 2010, Mr. Obama announced Dr. Berwick as his CMS nominee. Dr. Berwick, a Harvard professor and President and CEO of Institute of Health Care Improvement (IHI), is a leading advocate of a single-payer system and evidence-based medicine. Dr. Berwick has also served on numerous advisory boards, most notably as chair of the National Advisory Council of the Agency for Healthcare Research and Quality (AHRQ) which oversees the aforementioned USPSTF.

He is also the recipient of numerous awards including the 2007 Heinz Award for Public Policy. In 2005, he was appointed “Honorary Knight Commander of the British Empire” by Queen Elizabeth II in honor of his work with the British National Health Service (NHS). Dr. Berwick served as a consultant under Tony Blair during the development of the National Institute of Health and Clinical Excellence (NICE). Not unlike the USPSTF, NICE makes treatment recommendations to the NHS which are used to determine which treatments the agency will cover.

Dr. Berwick’s nomination is not without controversy when compared to the will of the American people who want to preserve their health care choices.  He is a self-proclaimed “romantic” about single-payer systems and views the U.K.’s NHS as the ideal health care model. Dr. Berwick was quoted to have said, “I am romantic about the NHS. I love it. All I need to do to rediscover the romance is to look at healthcare in my own country.”  In a speech given in 2008 during a conference celebrating the NHS’s 60^th anniversary, Dr. Berwick stated:

In the United States these insurance companies have a strong interest in not selling health insurance to people who are likely to need health care. Our insurance companies try to predict who will need health care then find ways to exclude them from coverage through underwriting and selective marketing that increases their profits. Here you know that is just not crazy, it is immoral.

You (the U.K.) could have let an unaccountable system play out in the darkness of private enterprise instead of accepting that a politically accountable system must act in the harsh and admittedly sometimes very unfair daylight of the press, public debate and political campaigning…sick people tend to be poorer, and poor people tend to be sicker and that any health care funding plan that is just, civilized, and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is, by definition, redistributional.

…Please do not put your faith in market forces. It is a popular idea that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can do. I do not agree.

A video of Dr. Berwick’s speech can be found here.

During a June 2009 interview with Biotechnology Healthcare on Comparative Effectiveness Research (CER), the interviewer pointed out that critics of CER believe it would lead to rationing, to which Dr. Berwick replied, “We make those decisions all the time. The decision is not whether or not we will ration care – the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.”

Dr. Berwick’s views are startlingly similar to those of one of Obama’s top health policy advisors, Dr. Ezekiel Emanuel. Dr. Emanuel, an oncologist and Chief of the National Institutes of Health Department of Bioethics, embraces the utilitarian view that health care should be distributed based on one’s value or contribution to society and remaining life expectancy. In a January 2009 article co-authored with former NIH fellow Govind Persad and NIH Senior Research Scholar Dr. Alan Wertheimer, Emanuel wrote that health care allocation should be determined using five core principles:  1) youngest-first, 2) prognosis, 3) saves the most lives, 4) lottery, and 5) one’s instrumental value to society.

Taking the five aforementioned core principles, Emanuel and his fellow peers propose an alternative system referred to as the “complete life cycle system” (CLCS) which operates on a life expectancy curve in relation to one’s potential maximum value or ability to contribute to society. Those between the ages of 15 and 40, for example, would receive medical treatment priority over individuals under 15 and those who are over the age of 40.

The CLCS also takes into consideration young persons who have a poor prognosis who are not likely to live a complete life cycle and the prognosis of persons who have nearly completed their life cycle. Persons who fall into either of these categories are more likely to be denied treatment than those who do not.

Saving more lives is included in the CLCS because it enables a greater number to live “complete lives” rather than fewer. Lotteries would be used between recipients who are roughly equal in terms of their projected life cycle when the demand for a particular medical treatment exceeds supply.

The complete article can be found here.

In an article published by Hillsdale College’s Imprimis, U.S. Representative Paul Ryan (R-WI) wrote:  “Bureaucrats don’t make decisions about health care according to personal need or preference; they ration resources according to a dollar-driven social calculus. Dr. Ezekiel Emanuel, one of the administration’s point people on health care, advocates what he calls a “whole life system” – a system in which government makes treatment decisions for individuals using a statistical formula based on average life expectancy and “social usefulness.”

While Berwick and Emanuel may complement each other and Obama’s vision of health care going forward, Berwick’s appointment must still be confirmed by the Senate. Given the current partisan divide, it could be an uphill battle. Senator Minority Leader Mitch McConnell (R-KY) and Senators John Barrasso, M.D. (R-WY), and Pat Roberts (R-KS), recently met with Dr. Berwick. Senator Roberts was quoted as having said that Berwick “was the wrong man, at the wrong time, for the wrong job.” Roberts, who is a member of the Senate Finance Committee, issued a press release on May 19, 2010 in which he further elaborates his opposition to Dr. Berwick’s nomination.

Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee, hopes to hold the confirmation hearings before the July 4, 2010 recess but offered no guarantees.

If the Senate fails to confirm Dr. Berwick by July 4, will Obama bypass the Senate and use the procedural recess appointment despite what is likely to be stiff GOP opposition to Dr. Berwick?