Thursday, July 8, 2010

The Healthcare Rationer Cometh

President Obama has just made a recess appointment that, in my opinion, confirms what many of us have been saying for quite a while: That the current administration is committed to, and is acting to implement, a ghoulish system of government deciding who will receive medical treatment and who will go without.

The pieces of the puzzle continue to fall into place, most significantly having Zeke Emanuel as senior healthcare advisor behind the scenes. Emanuel and some of his colleagues suggested several years ago that it made the best economic sense to concentrate the vast majority of healthcare dollars on those older than 15 (because they have their whole productive life ahead of them) and those younger than 40 (because thereafter medical care generally starts to become more expensive all the way to the end of your life).

After a presidential campaign that went to great lengths to spin public perception away from healthcare rationing and socialized medicine while vilifying the opposition, now the truth emerges. The President’s recess appointee, Dr. Donald Berwick, is an unabashed fan of healthcare rationing.

Berwick has just been appointed (in recess because the President is well aware that getting this appointment approved by congress wouldn’t happen) to head the Administrator of the Centers for Medicare & Medicaid Services.

Here’s what we’re getting, in Berwick’s own words:

In an interview last year in Biotechnology Healthcare:

The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom and also, to some extent, the Institut National de La Sante in France have developed very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn. . . . Indeed, those organizations are functioning very well and are well respected by clinicians, and they are making their populations healthier and better off.

And, in the same interview, referring to NICE:

NICE is extremely effective and a conscientious, valuable, and — importantly — knowledge-building system. The fact that it’s a bogeyman in this country is a political fact, not a technical one.

And just in case you miss the point, Berwick goes on to say:

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.

And here’s what Politico reported:

His comments on Britain’s NHS are drawing the most scrutiny. Berwick calls the system “far” from perfect, but he also describes it in glowing terms, citing elements that the American system lacks: universal coverage, “centralized stewardship” and guaranteed care regardless of income.

“I fell in love with the NHS,” Berwick said in a 2008 speech of the system that he had worked on since the 1990s. “To an American observer, the NHS is such a seductress. ... Like any lover, it took me a while to see the blemishes of my beloved, though I soon had help from people quite willing to point out the warts. . . .The NHS is one of the great human health care endeavors on Earth,” Berwick said in the speech on file with the Senate Finance Committee and circulated by Republicans. “It can be an example for the whole world — an example, I must say, that the United States needs now more than most other countries do.”

Uh-huh.

Only one problem: The UK’s National Health Service is a healthcare nightmare, where in the name of making healthcare equitable, people die unnecessarily by the hundreds of thousands, where many hospitals are only a step above cesspools, and is too often the last haven of many incompetent medical personnel.

We’d better wake up before we have to get in line for months for critical care, or be denied treatment because we’re too old, or too young, or just because the government won’t let us have it.