Farewell, Don Berwick

Published December 6, 2011

December brings the end of the controversial tenure of Don Berwick, who will step down as head of the Centers for Medicare and Medicaid Services next week. His resignation is a triumph for online citizen journalism and a rejection of technocratic rule. Both are steps we should laud.

Facing 42 solid votes against him in the Senate, an oncoming Supreme Court decision on the constitutionality of President Barack Obama’s health care law, and the pressure of an election year with that law as a political anchor, the White House saw little political benefit in a renomination fight that would put health care rationing back on the front pages.

Berwick’s shortened tenure is another example of the power of the Internet and the blogosphere to spread and highlight controversial statements by government leaders. Too often the establishment media focus on the online world’s obsession with “gotcha” footage–when a verbal slip or an unimportant gaffe by political leaders is highlighted and shared by millions. But there is a difference between such flubs, which are merely human failings and have no ideology behind them, and truly damning evidence of a strongly held viewpoint on the extremes of the policy spectrum.

When we at The Heartland Institute uncovered video footage of some of Berwick’s most controversial statements, that footage took over the conversation on Web sites and talk radio for weeks. Taken from remarks at a speech celebrating the anniversary of Britain’s government-run National Health Service (NHS) in 2008, Berwick denigrated freedom of choice: “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.”

He spoke of his opposition to consumer-focused solutions to health care problems and said, “Any health care funding plan that is just, equitable, civilized, and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate.” Also: “Excellent health care is by definition redistributional.”

These comments from Berwick in 2009 were equally eye-opening: “The decision is not whether or not we will ration care–the decision is whether we will ration with our eyes open.”

When Berwick testified before Congress for the first time after his recess appointment, his repeated claims he did not support rationing or redistribution fell flat. They had seen the footage and read the comments, shared online by tens of thousands of concerned Americans. They knew what he really believed.

Berwick consistently has expressed belief in the power of technocracy. Before entering government, his work primarily focused on the need for better information about health and procedures–advancing information-sharing and creating more knowledge for doctors to utilize in pursuing the best outcomes. This is a good thing, but it becomes perverted when government steps in and uses such information as a mandate sledgehammer to enforce central planning and rationing and against innovation and patient-directed care.

The technocratic approach presumes bureaucrats can process this data better than doctors and that top-down management is the best (and indeed only) way to achieve desired outcomes. Berwick’s beloved NHS is just such a system of state-controlled rationing that turns treatable diseases into death sentences. Health outcomes for British patients are simply terrible. U.K. cancer survival rates are near the bottom for all of Europe. Women who contract breast cancer in Britain have a 46 percent mortality rate, compared with only 25 percent in the United States. While only 19 percent of American men who get prostate cancer die of it, in Britain it kills 57 percent. The U.K.’s overall cancer mortality rate is more than 38 percent higher than that of the United States while U.K. health spending is growing even faster than ours.

Had he been confirmed, Berwick might have demonstrated what happens when technocrats are given too much power to transform their ideas into mandates. Instead, he is now an example of what happens when the things technocrats say to each other are made known to the public. Central planning, besides its moral failings, simply doesn’t work. The technocrats are always confident they can make it happen, with better charts this time–but they won’t, so long as the American people are paying attention.

Benjamin Domenech ([email protected]) is managing editor of Health Care News and a research fellow at The Heartland Institute.