Research Briefing

Does The Recess-Appointed CMS Director Still Believe Now What He Believed Then?

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Today, The Senate Finance Committee Holds A Hearing With Centers for Medicare & Medicaid Services Director Donald Berwick.  (Press Release, Senate Committee On Finance, 11/16/10)

QUESTIONS FOR DIRECTOR BERWICK:

1.     Do You Still Distrust The Free Market?

2.     Do You See It As Your Role To Move The American System More Into Line With The British NHS – The “Holy Grail Of Universal Coverage?”

3.     Is It Your Goal To Make Health Care Rationing The New Normal In America?

4.     Do You Believe Giving Bureaucrats More Discretion Over Medical Decisions Will Improve Patient Safety?

5.     Why Won’t You Disclose The Donors To Your Non-Profit Health Care Think Tank, And Provide Full Transparency?

DIRECTOR BERWICK, DO YOU STILL DISTRUST THE FREE MARKET?

"Dr. Berwick Offered A Suggestion To The British: 'Please Don't Put Your Faith In Market Forces.'" (Robert Pear, "Health Agency Nominee Faces Confirmation Battle," The New York Times, 6/21/10)

Berwick Doesn't Trust The Free Market to Improve Health Care. "I think that care will get better much more quickly with a national commitment to learning, putting knowledge about improvement in the public domain, and developing appropriate information infrastructures. I don't think that the market will be sufficient to support the kind of national learning we need about what care has to become. I just don't trust it enough." (Robert Galvin, "'A Deficiency Of Will And Ambition': A Conversation With Donald Berwick," Health Affairs, 1/12/05)

Berwick Is A "Loaded Gun" – Espousing Support for Redistribution of Wealth and Britain's Universal Health Care System. "Administration officials argue that Republicans would have seized on any nominee as an opportunity to re-litigate the health-care debate. But Berwick offered opponents a loaded gun with his talk about rationing, his discussion of health reform as a matter of redistributing wealth, and his effusive praise for the British system." (Ruth Marcus, Op-Ed, "Obama's cynical recess appointment of Donald Berwick," The Washington Post, 7/8/10)

DO YOU SEE IT AS YOUR ROLE TO MOVE THE AMERICAN SYSTEM MORE INTO LINE WITH THE BRITISH NHS – THE “HOLY GRAIL OF UNIVERSAL COVERAGE?”

Berwick Calls The NHS The “Holy Grail Of Universal Coverage” And Decried The American System And “The Darkness Of Private Enterprise.” “He has publicly saluted Britain’s socialized National Health Service for rejecting the “immoral’’ American system and ‘the darkness of private enterprise.’ He declares that ‘the Holy Grail of universal coverage’ cannot be achieved with consumer-centered health care, but only through ‘collective action overriding some individual self-interest.’” (Jeff Jacoby, Op-Ed, “Dangerous To Our Health,” The Boston Globe, 6/16/10)

Critics Have Stated That British Run Health Care “Is So Amazingly, Achingly, Miserably, And Mortally Incompetent.” “By one metric after another — cancer survival rates, performance of diagnostic tests, availability of CT and MRI scanners, consultation with specialists — US health care is superior. ‘British state-run health care,’ Bartholomew concluded, ‘is so amazingly, achingly, miserably, and mortally incompetent.’” (Jeff Jacoby, Op-Ed, “Dangerous To Our Health,” The Boston Globe, 6/16/10)

Under The NHS, Patients “Suffered Appalling Care” That “Would Shame A Third World Country.” “Their comments follow a damning report which estimated that one million patients had suffered appalling care, including neglect and cruelty, at the hands of NHS staff, many of them nurses. Hundreds more people have come forward with their tales of appalling treatment since the report, by the Patients Association, was published on Thursday…..But nurses have admitted that in some cases patients are suffering appalling treatment on wards. Maureen Hamilton, who has been a nurse for more than 40 years, said that the standards of care ‘would shame a third world country’, particularly on wards looking after the elderly.” (Kate Devlin, “Standard Of Care In Some Wards ‘Would Shame A Third World Country,” The Telegraph, 8/29/09)

Under The NHS, In 2007, 239 Patients Died Of Malnutrition And Of All Britons Entering Hospitals, In 2008-09, 10,443 People Left “Worse-Off Nutritionally Than When They Entered.” “In 2007, 239 patients died of malnutrition in British hospitals, the latest year for which figures are available…. A British charity, Age U.K., has been seeking for years to raise awareness of the issue. Yet despite increases in screening, training and inspection programs, the problem has only gotten worse. The charity reports that in 2007-2008 148,946 Britons entered hospitals suffering from malnutrition and 157,175 left in that state, meaning that hospitals released 8,229 people worse-off nutritionally than when they entered. In 2008-2009, that figure was up to 10,443.” (Editorial, “Postcard From The NHS,” The Wall Street Journal, 9/04/10)

IS IT YOUR GOAL TO MAKE HEALTH CARE RATIONING

THE NEW NORMAL IN AMERICA?

Berwick Is A Fan Of “Health Care Rationing” And Believes That Government Will Need To Make “Decisions About Who Will Have Access To Care And The Extent Of Their Coverage.” “And he embraces government health care rationing. ‘The decision is not whether or not we will ration care,’ he said in a 2009 interview, ‘the decision is whether we will ration with our eyes open.’ This is a view Berwick has held for a long time; more than 10 years ago he wrote that ‘limited resources require decisions about who will have access to care and the extent of their coverage.”  (Jeff Jacoby, Op-Ed, “Dangerous To Our Health,” The Boston Globe, 6/16/10)

“‘Using Unwanted Procedures In Terminal Illness Is A Form Of Assault,' He Said At The Annual Conference Of His Institute In 1993. 'In Economic Terms, It Is Waste.'" (Robert Pear, "Health Agency Nominee Faces Confirmation Battle," The New York Times,6/21/10)

"Long Before The Uproar Over 'Death Panels' Last Year, Dr. Berwick Was Urging Health Care Providers To ‘Reduce The Use Of Unwanted And Ineffective Medical Procedures At The End Of Life.’” (Robert Pear, "Health Agency Nominee Faces Confirmation Battle," The New York Times,6/21/10)

DO YOU BELIEVE GIVING BUREAUCRATS MORE DISCRETION OVER MEDICAL DECISIONS WILL IMPROVE PATIENT SAFETY?

Berwick Believes That Health Care Would Be Improved By Giving Doctors Less Discretion. “‘The more I have studied it, the more I believe that less discretion for doctors would improve patient safety.' He then looks down. 'Doctors will hate me for saying that.'" (Neil Swidey, "The Revolutionary," The Boston Globe, 1/4/04)

Berwick Thinks CMS Should Regulate Care Instead of Allowing Individuals to Make Their Own Choices. "So as CMS goes and as Medicaid goes, so goes the system. CMS needs to continue to develop to be the best and possible purchaser of care, on behalf of its beneficiaries. To do that through giving more choice to individuals, as I said earlier, is a very weak lead. To do it as an aggregate purchaser, demanding performance, is a very strong lead." (Robert Galvin, "'A Deficiency Of Will And Ambition': A Conversation With Donald Berwick," Health Affairs, 1/12/05)

WHY WON’T YOU DISCLOSE THE DONORS TO YOUR NON-PROFIT HEALTH CARE THINK TANK, AND PROVIDE FULL TRANSPARENCY?

Berwick’s Refusal To Release The Names Of Donors Raises “Conflict Of Interest” Question About Whether Health Care Companies “Made His Compensation Package Possible In The First Place.” “But Dr. Berwick is declining to say exactly who provided funding to the Massachusetts-based Institute for Healthcare Improvement in response to Republicans who question whether the new Medicare chief could have a conflict of interest if medical-device companies or health plans helped make his generous compensation package possible in the first place.” (Jim McElhatton, "Medicare Director Won’t ID Donors To Think Tank," The Washington Times, 8/29/10)

• Berwick's Nonprofit Received Over $9 Million In "Gifts" Between 2008 And 2009 From Unknown Donors. "Berwick's Institute for Healthcare Improvement received more than $9 million in 'gifts' in 2008 and 2009 from unknown donors, according to Grassley's office, at the same time that Berwick was being paid a $2.4 million salary as CEO. Grassley, a longtime advocate of transparency in healthcare funding, asked for the information several weeks ago."  (Julian Pecquet, "GOP Says Obama Avoiding Questions About CMS Head's Ties To Industry," The Hill's "Healthwatch" Blog, 7/8/10)

Berwick Received Almost $900,000 In Compensation As CEO Of Non-Profit And Left With A Seven-Figure Retirement Plan. “Before he took over the nation's Medicare and Medicaid agency this summer, Dr. Donald Berwick retired from the nonprofit health care think tank he co-founded with a nearly $900,000 compensation package and a seven-figure executive retirement plan.” (Jim McElhatton, "Medicare Director Won’t ID Donors To Think Tank," The Washington Times, 8/29/10)