The White House announced on Tuesday, July 6, 2010 that President Obama will bypass Congress and appoint Dr. Donald M. Berwick, a health policy expert, to run Medicare and Medicaid. In April, President Obama nominated Dr. Berwick to be the administrator of the Centers for Medicare and Medicaid Services (CMS). The agency has been without a permanent administrator since October 2006.
The White House said that the recess appoint is necessary because there is much work to do to implement the healthcare reform law. This is a little fishy because the Senate is in recess for less than two weeks and senators were still waiting for Dr. Berwick to submit responses to some of their requests for information from his April Nomination.
Dr. Berwick, a pediatrician, is president and co-founder of the Institute for Healthcare Improvement, a nonprofit organization in Cambridge, Mass. He is also a professor at Harvard Medical School and the Harvard School of Public Health. As a professor of health policy Dr. Berwick has championed the interests of patients and consumers. However, at the same time, he has spoken of the need to ration health care and cap spending, has supported efforts to “reduce the total supply of high-technology medical and surgical care” and has expressed great admiration for the British health care system. For these reasons he was facing an uphill battle for nomination. Because he is a “recess” appointment, his term will expire at the end of the next session of Congress, in late 2011.
This sneaky appointment to someone who is philosophically aligned with Obama’s ultimate desire for total socialized medicine is quite scary. Many of us were worried that Obama’s “reform” will result in rationing. This seems to validate that thought. A review of the British’s health care system that he loves is quite informative. Britain’s National Institute for Health and Clinical Excellence (NICE) provides guidance, sets quality standards and manages a national database to improve people’s health and prevent and treat ill health.
NICE believes in rationing. On its website http://www.nice.org.uk/ it explains that “choices have to be made.” Thus, “It makes sense to focus on treatments that improve the quality and/or length of someone’s life and, at the same time, are an effective use of NHS resources.” NICE uses 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. When a decision is made to treat or not to treat, the cost effectiveness is considered. Cost effectiveness is expressed as £ / QALY.
Dr. Berwick is an academic with no real experience as an administrator or chief executive. This does not bode well for providers or consumers in my view.
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