Controversy is mounting over Dr. Donald Berwick, President Obama’s nominee to run Medicare and Medicaid — and for good reason. Berwick’s writings reveal that he would make radical changes — seniors beware.
Berwick laid out his “Triple Aim” plan in an article he co-authored in Health Affairs (May-June 2008), advocating widespread government use of the “medical home” model. The Congressional Budget Office says that’s a version of HMO-style medicine, with a primary-care provider to oversee your access to costly services such as visits to specialists and diagnostic tests. But in Berwick’s plan, many — perhaps most — primary-care providers would not be physicians.
Ever since Medicare was founded in 1965, seniors have been able to call any doctor who takes Medicare, get treatment and have the federal government pay. Not in the future.
The Obama health law will give Berwick wide latitude to make this change. Congress empowered the Health and Human Services secretary (Berwick’s boss, if he’s confirmed) to make vast changes in how care is delivered under Medicare, including setting up pilot programs — such as medical homes — and then expanding them nationwide.
In his Triple Aim plan, Berwick laments that US health care is “designed to focus on the acute needs of individual patients.” He argues for a different focus, social justice.
Instead of doctors making decisions autonomously in the interest of their own patients, he wants a nationwide plan allocating resources “to anticipate and shape patterns of care for important subgroups.” These subgroups — which can be defined by age, disease affliction or socio-economic status — should be the “unit of concern,” not the individual patient.
Will the elderly be a favored subgroup? Not under the Obama health law. An April 22 report by Medicare and Medicaid chief actuary Richard Foster shows that the law nearly doubles Medicaid rolls at a cost of $410 billion over the next decade.
To pay for this, the law slashes future Medicare funding by $525 billion over the same period, when 30 percent more people will enter Medicare as baby boomers age. In short, boomers will get less care than today’s seniors.
Less care is Berwick’s vision. In a speech marking the 60th birthday of the British National Health Service, he praised the NHS for deliberately creating scarcity: “You [the NHS] plan the supply; you aim a bit low; historically, you prefer slightly too little of a technology or service to much too much and then you search for care bottlenecks and try to relieve them.”
Berwick confessed, “I am a romantic about the NHS. I love it. All I have to do to rediscover the romance is to look at the health care in my own country.” He praised the NHS for its central planning, frugality, wealth redistribution and rationing.
Berwick has won accolades for his “100,000 Lives Campaign,” which encouraged hospitals to implement rules preventing infections, bed sores and medical errors. But he is an inappropriate choice to head Medicare.
A fervent ideologue, Berwick puts social engineering ahead of the individual patient’s needs. In contrast, most doctors understand that their duty is to heal each patient who comes to them.
Betsy McCaughey is chairman of the Committee to Reduce Infection Deaths and a former lieutenant gov ernor of New York.