Don Berwick: Giving Patients More Control Over Health Spending “Vicious Idea”

Published April 11, 2012

It didn’t take long for Don Berwick, the controversial former head of the Centers for Medicare and Medicaid Services under President Obama, to start being honest again about his anti-market views once he left the administration.

In a forum with health care policy expert Jim Capretta, Berwick reacted strongly to the idea that patients should be given price signals for health care costs or have a greater say in how that money is spent:

Dr. Don Berwick, former administrator of the Centers for Medicare & Medicaid, and Jim Capretta, who serviced as associate director at the White House Office of Management and Budget under President George W. Bush, took sharply different stances on what shifting costs to patients could mean during a wide-ranging debate last night hosted by the Pioneer Institute.

Berwick, now a senior fellow at the Center for American Progress, called the idea of giving patients more “skin in the game” a “vicious idea.”

“Most people do not use health care as a recreational good,” he said.

But Capretta, a fellow at the Ethics and Public Policy Center, said the idea has had dramatic results in some cases. He cited Stanford University’s success in moving employees to a less expensive managed care plan by offering financial rewards to those people who made that choice.

“When it gets right down to it, that is real delivery system reform,” he said.

As Avik Roy points out, this is consistent with Berwick’s previously stated views – first reported here at Heartlandregarding markets and health care:

“You could’ve kept your system in fragments and encouraged supply-driven demand, instead of making tough choices and planning supply… You could have let an unaccountable system play out in the darkness of private enterprise instead of accepting that a politically accountable system must act in the harsh and admittedly sometimes very unfair daylight of the press, public debate, and political campaigning.”

It’s also consistent with this other part of the speech, where Berwick endorses “leaders with plans” over market forces.  See how honest a man can be when he’s working for the Center for American Progress instead of the taxpayers?

Berwick was also morbid about the prospects of health care reform should President Obama’s law be struck down as unconstitutional, saying “If this law goes down, we’re going to be set back for a long time, badly, in my view.” Let’s hope he’s as wrong about that as he is about everything else.