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Berwick Pick Highlights GOP's Rationing of Health Care

July 7, 2010

Back in February, Wisconsin Republican Paul Ryan defended his "Roadmap for America's Future," which among other things would privatize - and inevitably ration - Medicare. "Rationing happens today!" Ryan revealingly protested, "The question is who will do it? The government? Or you, your doctor and your family?" Of course, he omitted the real culprit, private insurers. Now with President Obama's long overdue recess appointment of the highly respected Donald Berwick to head the Centers for Medicare and Medicaid, Republicans are furious at Berwick for reaching the same inescapable conclusion.
First, a little background. That health care is rationed in the United States is indisputably true. Roughly 50 million people have no health insurance; another 25 million are underinsured. (Their ranks are swollen by the insurer's routine practice of rescission to drop coverage for diseases like AIDS and breast cancer.) One in five Americans are already postponing needed care due to its spiraling costs, while a staggering 62% of personal bankruptcies in the U.S. involve medical expenses. Studies estimate that as many as 45,000 Americans unnecessarily die each year due to a lack of insurance. And while Republican leaders including Mitch McConnell, Tom Delay and George W. Bush insist "no American is denied health care in America" because "you just go to an emergency room," ER capacity is actually declining.
Nevertheless, Republicans throughout the contentious health care reform debate cited not today's health care horror story but a mythical future nightmare to demagogue the Democratic initiative. As McConnell repeatedly put it:

"All of us want reform, but not reform that denies, delays, or rations health care."

So it should come as no surprise that Republicans are now blasting Berwick for stating the obvious in 2009. The latest installment of right wing fury comes in response to this truism from the physician, Harvard professor, president and CEO of the Institute for Healthcare Improvement and key adviser to Britain's National Health Service:

"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."

That was too much for Kansas Senator Pat Roberts, who on May 19 denounced Berwick and the Obama administration. When the White House simply explained that "The fact is, rationing is rampant in the system today, as insurers make arbitrary decisions about who can get the care they need" and "Don Berwick wants to see a system in which those decisions are transparent- and that the people who make them are held accountable," Roberts saw the dark hand of the government at work:

"This is really a fascinating response. Instead of flat out denials of government rationing we have excuses.
And if you read between the lines you will notice that for the first time ever in this debate the Obama White House is admitting that their health care plan will ration health care."

As Ezra Klein of the Washington Post noted in April, Donald Berwick's outspoken views and evident pride in his role in reforming the UK's NHS guaranteed that "the chances that Berwick moves smoothly through the process is next to zero." But as Klein also concludes, Dr. Berwick is also widely viewed an ideal pick to lead the Centers for Medicare and Medicaid Services (CMS), a critical post now vacant for over a year:

"Berwick is about as good a choice as you could hope for (indeed, the health-care community was excited when he was the rumored pick six months ago). As head of the IHI, he has been a pioneering advocate for quality improvements in health care. That's an important distinction: He's not a health-care economist whose main focus is cutting costs. He's a health-care expert whose main focus is improving quality by reducing infections and complications and increasing the use of good evidence and best practices."

Of course, words like "evidence" and "best practices" are rarely found in the Republican prescription for health care or any other social ill.
For his part, Republican Roberts called out Dr. Berwick, "I know that socialized medicine and death panels have become loaded terms, but if that is what you are for you should just say so!" But as Pat Roberts also made clear, the Republicans' real target is the new Obama health care law, one which will cover 32 million Americans while trimming the national debt:

"And now it is beyond a shadow of a doubt that this law will ration health care."

Sadly, Roberts' claim is a fraud. But the utter falsehood of a statement is no barrier to a Republican uttering it, especially where Americans' health care is concerned.
Of course, the de facto rationing of health care has been the Republican position all along. And as the 2010 midterm elections approach, the health care reform passed this spring is getting more popular with the American public, prompting Democrats to dig in their heels even as the GOP calls for "repeal and replace." Because for Republicans, rationing of health care is just fine, especially if we do it blindly.
UPDATE: Over at the Washington Post, Ezra Klein explains "the conservative case for Don Berwick."

One comment on “Berwick Pick Highlights GOP's Rationing of Health Care”

  1. This is a good article, written in more detail. Government should be the main work is the development of the economy and improving people's lives and protecting the security of the state and people. This is the most important.


Jon Perr
Jon Perr is a technology marketing consultant and product strategist who writes about American politics and public policy.

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