Berwick: "Starry-Eyed" About State-Run Health Care

Cross-posted from Critical Condition on National Review Online.

Bob Goldberg, vice president of the Center for Medicine in the Public Interest, has an excellent blog entry over at The American Spectator on Donald Berwick, President Obama’s nominee to head the Centers for Medicare and Medicaid Services. You should read the whole thing, but here are some excerpts:

Berwick not only has a role model picked out for a role that sounds a lot like what he would be doing at CMS, he has a soulmate: For the past 15 years he has consulted for — or, in his words, been “starry-eyed” over — Britain’s National Health Service. In 2008, at a 60th anniversary celebration of the creation [of the] NHS, he told a UK crowd, “I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country.”

Berwick complained the American health system runs in the “darkness of private enterprise,” unlike Britain’s “politically accountable system.” The NHS is “universal, accessible, excellent, and free at the point of care — a health system that is, at its core, like the world we wish we had: generous, hopeful, confident, joyous, and just”; America’s health system is “toxic,” “fragmented,” because of its dependence on consumer choice. He told his UK audience: “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.”

While most European health-care systems involve government-run health insurance, the British actually go farther than most in that the state also runs the nation’s hospitals and primary care centers. In essence, Britain is the model of what Berwick would call “integrated care”: the idea that, by centralizing control of both the funding and the provision of health-care services in the hands of government technocrats, we can achieve the best health outcomes. Unfortunately, OECD statistics and other landmark studies show that Britain ranks near-to-dead last in the developed world on many metrics of health quality, such as cancer survival rates and hospital wait times. Goldberg concludes:

Berwick described how NHS rations care this way: “you plan the supply; you aim a bit low; historically, you prefer slightly too little of a technology or service to much too much; and thenyou search for care bottlenecks, and try to relieve them.” Relieve them? In 2008 the system Berwick believes is an example for healthcare worldwide denied cutting edge cancer drugs to 4,000 people, forcing thousands to remortgage their homes to pay for treatment. Love is blind. With regard to Dr. Berwick’s devotion to the NHS, it’s deaf and dumb as well.

UPDATE: Health Affairs, helpfully, has made Berwick's contributions to the journal freely accessible on its web site, for those who want to learn more.