Monthly Archives: July 2010

Who is Donald Berwick?

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Well, I’ll tell you. On July 7, President Obama appointed Dr. Donald Berwick to be “Administrator of the Center of Medicare and Medicaid Services,” aka, the Medicare Czar. Obama did so while Congress was in recess, thereby bypassing the Senate confirmation hearing, requisite for the position. Now, why would he do that?

President Obama wanted to slide Berwick into his position with little fanfare, as Donald Berwick is a radical leftist with a radical vision for America, with a certain affect for centrally socialized health care.  Berwick, like most leftists these days, has an impressive resume, topped off with a degree from – and subsequent stint at – Harvard University, and as such, is of the President’s ilk. To the dismay of the President, Berwick’s nomination ignited such an uproar within the conservative community that Obama relented and will indeed send Berwick to the Senate for confirmation. I say, let the games begin.

Herein I wish to expose this fellow, Donald Berwick, so you, the reader, can get to know him, because, in any other circumstance of “getting to know him,” it may be too late.

Berwick’s Views

Like the President, Donald Berwick must be smarter than you and me. I mean, just look at his resume!  He must know better than us dummies. So, what do dummies like you and I actually know about Medicare?

Well, we know Medicare comprises 20% of the federal budget.  We know Medicare now constitutes an unfunded liability of $36 trillion.  We also know Medicare has a “high-risk pool” that has been declared “underfunded,” much more than the $5 billion estimated by Congress.

Hmm.  What would Berwick do with the expensive portions of Medicare?  Besides being an accounting trick used to hide the true costs of Medicare, “high-risk pools” are at “high risk” as targets for cutting costs.  As Medicare is mandatory, this surmounts into a sinister scenario, characterized by the term “death panels,” i.e., a board which determines the “metrics” as to whether or not your “pool” will be funded.

“Wait!  Death panels again?!”  Methinks thou doth protest too much.  Fine – allow me to justify my assertion.

For starters, just look abroad; countries where government has complete control of health care inevitably have to ration, particulary when facing tough decisions over debt. In America, conservatives fear rationing in both Medicare and Medicaid due to these impending economic shortfalls due to our enormous unfunded liabilities. Liberals say rationing already occurs, compliments of the insurance companies.  With private health insurance, however, you still have the abilitiy to shop around.  The public sector lacks the profit motive that keeps industries – if not businesses – afloat.  Costs are hidden and neglected for years.  Without these market forces, how will our government pay for Medicare’s inherent inefficiencies?

Enter Comparative Effectiveness.  The definition of this term, provided by Wikipedia, is as follows:  “Comparative Effectiveness Research is the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms.”  Thus the interventions deemed unnecessary will be eliminated, regardless of whether the patient wants it or not, or is able to pay for them independently.  Those of you familiar with ethics studies will recognize this as a sort of “health care utilitarianism,” in which the greatest good is sought for the greatest number.

You can call it Comaparative Effectiveness, collectivism, or utilititarianism; it facilitates rationing.  Berwick, said so himself, when he said in an interview about “Comparative Effectiveness Research” with the American National Institute of Health:

Interviewer: “Critics of CER have said that it will lead to the rationing of health care.”

Berwick: “We can make a sensible social decision and say, ‘Well, at this point, to have access to a particular additional benefit [new drug or treatment] is so expensive that our taxpayers have better use for those funds.’ The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”

Berwick’s ambitions for American health care, however, don’t stop with rationing.  Heck, they don’t even stop at health care.  His slobbering – I mean, glowing – speech to Great Britain’s National Health Service (NHS) helped illuminate Dr. Berwick for what he is:

“You (Great Britain) could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker and that any health care funding plan that is just, equitable, 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.”

Donald Berwick is also a big supporter of ”Patient-Centered Care.”  Sounds good, right?  This term usually deals with palliative, or end-of-life, care.  In Berwick’s world, this care takes place in medical ‘homes,’ deemed appropriate for Medicare payments, therefore minimizing “rehospitalizations” while cutting costs.  Could these, or would these, nursing homes be mandatory for everyone on Medicare?  What kind of quality of life would be expected at these facilities?

Enter QALY.  In his praise for Great Britain’s National Institute of Health and Clinical Excellence (NICE), Berwick commended NICE, who “developed very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn.”

These “models” Berwick speaks of are controlled by Quality-Adjusted Life Years, or QALYs, and are described on the NICE website:

To ensure our judgements are fair, we use a standard and internationally recognised method to compare different drugs and measure their clinical effectiveness: the quality-adjusted life years measurement (the ‘QALY’)…  A QALY gives an idea of how many extra months or years of life of a reasonable quality a person might gain as a result of treatment (particularly important when considering treatments for chronic conditions)….  A number of factors are considered when measuring someone’s quality of life, in terms of their health.  They include, for example, the level of pain the person is in, their mobility and their general mood.

Cost effectiveness, is in this regard, would be measured in units of “Dollars per QALY.”  This rationing method is implemented in Great Britain, and Dr. Berwick would wish to bring it to America’s palliative care facilities.  But Donald Berwick’s Postmodern Socialist views don’t end with Medicare, or health care, for that matter.  In the same speech to the NHS, he denounced profits as immoral:

“Our insurance companies try to predict who will need care, and then to find ways to exclude them from coverage through underwriting and selective marketing. That increases their profits. Here, you know that that is not just crazy; it is immoral.”

Berwick decided to take his denunciation of the free market a step even furtherBerwick said, “Don’t put your faith in market forces” - instead, trust “leaders with plans.”

Dr. Berwick, as the newest and most ambitious member of America’s Ruling Class, will be calling the shots (or lack of shots) for Medicare.  Then what?  Remember, statists like this are never satisfied with simply a taste of power.  They eventually want it all.  He sees himself as “a leader with a plan,” for you and your family.

What It All Means

If you’re like me, you first heard of Berwick a couple of months ago when Obama nominated him, as he was controversial even waaay back then, four months ago. Like I said, Obama had to use a recess appointment, which is, albeit deceptive, Constitutional (Article II, Section II, Clause 3).  The minority has little power to prevent recess, and no power to prevent recess appointments.  They will have power in the confirmation hearing, though, and it will interesting to watch our new “Rationer-in-Chief,” or as others are calling him, a “One Man Death Panel,” try to defend his stances on health care and socialism.

So, on a macro-level, we know that full implementation of Obama’s agenda for health care would result in the abolition of private health care.  I won’t get into that now.  The fact that he tried to slide Berwick in under our noses – and then had to rescind when both Republicans and Democrats protested – illuminates something greater happening here.

In the wake of Obama’s election, Americans were generally filled with one of three emotions:  Hope on the Left (and in the center); Apathy among some; and Despair on the Right.  As time went on, and as a Progressive wave of legislation is at writing washing over this nation, both Hope and Despair are beginning to be displaced by Cynicism and Apathy.  Nobody believes the Administration anymore, illustrated by the lack of faith in Obama’s Orwellian “Summer of Recovery.”

In his heart, Obama believes he can glorify his Administration and demonize his opponents with carefully leveraged speeches.  Admittedly, combatting Obama’s Trotsky-meets-Alinsky campaign methodology of “Permanent Revolution” will be difficult in both 2010 and 2012.  Systematically, that battle has already begun, at the behest of the wings of the liberal establishment.  More on that later.

Until then, don’t get distracted by their flagrantly false arguments aimed to marginalize your energy.  Remember their plans for America.  Remember their disdain for the tenets of individual freedom.  Remember their incompetence.  Remember their deceptions.

Remember November.

“It is vain to talk of the interest of the community, without understanding what is the interest of the individual.”

~ Jeremy Bentham, early advocate of utilitarianism

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Filed under Health, News
Jul 22, 2010

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