Right-wing media have launched an assault on Donald Berwick, President Obama's nominee to head the Centers for Medicare and Medicaid Services. Those attacks distort Berwick's statements on the U.S. and U.K. health care systems and ignore fundamental realities about the those systems, as well as Berwick's broad support.
Right-wing media jump on Berwick's innocuous comments to claim he wants to “spread the wealth around”
In a 2008 speech at an event celebrating the 60th anniversary of the creation of the United Kingdom's National Health Service, Berwick stated:
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. Excellent health care is by definition redistributional.
Right-wing media claim Berwick's “disturbing” comments mean he wants to “spread the wealth around.” In an article posted on RedState.com and BigGovernment.com, serial plagiarist Ben Domenech called Berwick's comment “disturbing” and evidence of “his support of using health care bureaucracy to redistribute wealth.” Likewise, on his May 13 Fox News program, Glenn Beck stated, “Now, here is Obama's new nominee for the Centers of Medicare and Medicaid. His name is Donald Berwick. What does he say about redistribution of wealth?” He then aired Berwick's comment. And on his May 13 Fox News program, Sean Hannity said:
HANNITY: All right, senators, pay close attention to this next video. Now, this is the man who could soon become the head of Medicare and Medicaid. Listen to what he really thinks about health care.
BERWICK [video clip]: 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.
HANNITY: Spread the wealth around, spread the wealth around. Where did I hear that before?
But health programs such as Medicare and Medicaid are inherently redistributive
Medicare and Medicaid are redistributive. Medicare and Medicaid -- which Berwick would oversee as Administer of CMS if confirmed -- are federal programs that provide health insurance to the elderly, disabled, and those with low incomes. Medicare is available to everyone over age 65, regardless of their ability to pay for private health insurance, and Medicaid is available to those who would not otherwise be able to afford insurance. The programs are financed out of federal tax revenues, including a 1.45 percent payroll tax on all earnings, and are thus paid for in large part by people who are too wealthy to qualify for Medicaid, as well as people who use Medicare or will in the future but could afford private insurance instead. Thus, Medicare and Medicaid redistribute wealth from those who can afford private insurance to those who cannot.
Medicare and Medicaid are extremely popular. According to a June 2005 Kaiser family Foundation poll, “Nearly three-quarters (74%) of adults say Medicaid is a 'very important' government program, ranking it close to Social Security (88%) and Medicare (83%) in the public's mind.” Similarly, an October 2005 Harris Interactive poll reportedly found that “an overwhelming majority (96%) of Americans 'strongly' or 'somewhat' favor Medicare, the medical assistance program for the elderly and disabled, while 91% say they support Medicaid, the program to assist people with very low incomes.”
Even Laura Ingraham acknowledged that Berwick's comments are “right.” Discussing Berwick's comments on the May 13 edition of Fox News' The O'Reilly Factor, right-wing radio host Laura Ingraham stated: "[O]f course, every safety net, Bill, and you and I are both in favor of there being a safety net where people don't go untreated, where people who need help get help. Obviously to pay for those people, it's obviously going to involve taxes and taxes come from people who make a living and make income. So that part is right."
Domenech takes Berwick comments out of context to suggest he blindly supports NHS
Domenech: Berwick is “great fan” of NHS, as evidenced by 2008 speech calling himself an NHS “romantic.” Domenech writes that Berwich is “a great fan of the NHS, and worked as a consultant on the project under Tony Blair.” He states that "[k]ey to understanding Berwick's views on the NHS is a speech he gave as part of a presentation offered two years ago, in which he shared his thoughts on the NHS and health care generally." And he highlights Berwick's comment from that speech: “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.”
Domenech ignores that Berwick criticized NHS in his speech. Domenech contrasts Berwick's 2008 comments on the NHS with what he calls the UK's “terrible record on heart attacks, cancer, and more.” But in his 2008 speech, Berwick acknowledged that the NHS is “far from” perfect, and specifically cites “cancer outcomes” as an area in which the program has had “less progress” :
BERWICK: Is the NHS perfect? Far from it. Far from it. I know that as well as anyone in this room, from front line to Whitehall, I have had the privilege of observing performance and even to help to measure its performance.
There is less progress in some areas, especially with comparison to other European systems, such as in specialty access, in cancer outcomes, in patient centeredness, in life expectancy and infant mortality for socially deprived populations. In other words, in improving its quality, two facts are true: The NHS in en route, and the NHS has a lot more work ahead.
Berwick then listed “ten suggestions” for how the NHS “can do even better.”
Domenech misleadingly crops Berwick's call to “ration with our eyes open”
Domenech removes context indicating Berwick was saying U.S. system already rations. Domenech wrote that in a 2009 interview:
The interviewer pointed out: Critics of CER have said that it will lead to the rationing of health care.To which Berwick replied: The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open." [emphasis in Domenech's post]
However, Domenech removed Berwick's statement immediately after in which he stated, “And right now, we are doing it [rationing] blindly.”
From the 2009 interview:
Q: Critics of CER have said that it will lead to the rationing of healthcare.
A: We can make a sensible social decision and say, “Well, at this point, to have access to a particular additional benefit [new drug or medical intervention] is so expensive that our taxpayers have better use for those funds.” We make those decisions all the time. 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.
As Berwick was arguing, rationing is already occurring
U.S. insurance companies already ration care. The insurance industry has readily admitted to using cost-benefit analyses in coverage decisions. For instance, during the July 15, 2009, edition of NPR's Morning Edition, WellPoint chief medical officer Dr. Sam Nussbaum told co-host Steve Inskeep that “where the private sector has been far more effective than government programs is in limiting clinical services to those that are best meeting the needs of patients.” Moreover, in Senate testimony, Wendell Potter, a former senior executive at CIGNA health insurance company, detailed ways in which the insurance industry makes cost-based coverage decisions, including how “insurers routinely dump policyholders who are less profitable or who get sick” and “also dump small businesses whose employees' medical claims exceed what insurance underwriters expected.”
U.S. health care also rationed by cost. As Peter Singer, professor of bioethics at Princeton University, noted in a July 15, 2009, New York Times Magazine article, “In the United States, most health care is privately financed, and so most rationing is by price.” He continued:
Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.
Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won't be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money. The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?
Domenech falsely suggests there are no “horror stories” in U.S. health system
Domenech suggests under Berwick, we will see “horror stories” like those in U.K. system “in the pages of American papers.” Domenech writes: "Here are just some of the horror stories from NICE [the U.K.'s National Institute for Clinical Excellence] over the past several years. Under Donald Berwick's authority as the head of CMS, get ready to see stories like these in the pages of American papers in the years to come." Contrary to Domenech's suggestion that there are currently no such stories, here are just some of the horror stories from the U.S. system over the past several years.
Berwick praised by AMA, AARP, health experts, and even conservatives
National Review's Roy: “Berwick is a serious and credible health-care analyst.” In an April 23 post on National Review, Avik Roy wrote that “Berwick's nomination has a good side and a bad side” :
First, the good. Berwick is a serious and credible health-care analyst. In his capacities both as a Harvard professor and as founder and CEO of a Cambridge-based think-tank called the Institute for Healthcare Improvement, he has written extensively about health-care policy in all of the leading scholarly journals. His focus, in most of these writings, is on the quality and efficiency of health care: things like avoiding medical errors and unnecessary spending. He was granted an honorary knighthood by Queen Elizabeth for his role in shaping Tony Blair's (mostly futile) attempts to modernize Britain's National Health Service.
Roy went on to criticize Berwick's support for single-payer health systems.
Fox medical contributor Coomer: Berwick is “one of the best people to” address disparities in health care. On the March 30 edition of Fox News' America's Nightly Scoreboard, Fox medical contributor Dr. Cynthia Coomer called Berwick “one of the best people” to address racial disparities in health care and said “I think he's going to be pretty good” as head of CMS due to his experience at the Institute for Healthcare Improvement.
Former AMA president: Berwick “widely respected.” An April 23 Washington Post article reported: “But the common theme in Berwick's work is 'his ability to inspire doctors and hospital administrators to work together,' said Nancy Nielsen, the immediate past president of the American Medical Association. 'Don is so widely respected because he has worked in such a collaborative way.'”
Boston Globe: “Berwick has drawn praise from health care specialists across the philosophical spectrum.” A May 14 Boston Globe article noted Sen. John Kerry's support of Berwick, who called him a “public servant who is beyond debate a dedicated pediatrician and nationally recognized expert on health care quality.'' The Globe also wrote that ” [a]s president of the Institute for Healthcare Improvement, a nonprofit, Berwick has drawn praise from health care specialists across the philosophical spectrum for his knowledge of the issue and approaches to solving the problem of increasing costs," and noted that Republicans were planning on using the nomination as “a platform to challenge the law Obama signed in March.”
Coburn called Berwick “more than qualified.” In a March 29 Tribune Newspapers article, Coburn reportedly commented that “it's way too early to tell” if Republicans would oppose Berwick and that he “think[s] he's more than qualified ... I want to sit down and talk with him.” [Los Angeles Times, 3/29/10]
AMA has praised and partnered with Berwick. A March 29 Bloomberg article reported: “The American Medical Association, the Chicago-based group for physicians, also praised Berwick. Nancy Nielsen, the association's previous president, said in an e-mailed statement that Berwick is 'well-respected' and doctors 'look forward to working with him at CMS on implementation of the new health- reform law.' ” [Bloomberg, 3/29/10]
In 2008, Dr. Cecil B. Wilson, a member of the AMA's board of trustees, stated during a speech at the Florida Health Care Coalition's annual conference:
One of our efforts is our partnership with the Institute for Health Care Improvement (IHI) headed by Dr. Donald Berwick.
The IHI has promoted the idea that six interventions, done routinely and completely in the hospital setting, could save as many as 100,000 lives in a single year. These interventions include:
- Deploy Rapid Response Team at the first sign of patient decline;
- Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction to prevent deaths from heart attack;
- Prevent Adverse Drug Events by implementing medication reconciliation;
- Prevent Surgical Site Infection by reliably delivering the correct preoperative care;
- And Prevent Central Line Infections and Ventilator-Associated Pneumonia by implementing a series of interdependent, science-based steps for each.
Some or all of these interventions have been adopted by 3000 hospitals across the United States. [AMA website, 3/5/08]
AARP vice president: "[A]ppointment is welcome news to Medicare beneficiaries." Bloomberg also reported that AARP executive vice president for policy John Rother said that Berwick's Institute for Healthcare Improvement saved “lives and money” and that his “appointment is welcome news to Medicare beneficiaries, as it signals that quality and safety will be at the top of the agenda.” [Bloomberg, 3/29/10]
American Hospital Association: Berwick “led a movement ... to provide better, safer care.” Bloomberg further reported: “Rich Umbdenstock, chief executive officer of the American Hospital Association, the Chicago-based trade group, said in an e-mail that Berwick has 'led a movement' through his work at the institute to 'engage hospitals, doctors, nurses and other health-care providers in the continuous quest to provide better, safer care.' ” [Bloomberg, 3/29/10]
AcademyHealth praises Berwick. Tribune Newspapers also reported:
Berwick has spent much of the past 15 years focusing on improving the quality of care in hospitals and his knowledge of them -- coupled with his experience as a practicing physician -- will lend credibility to efforts to coax reforms out of the industry, said David Helms, CEO of AcademyHealth (cq), a professional society for health services researchers.
“I think Don Berwick as a practicing physician will be able to communicate with other practicing physicians in a way that's persuasive,” Helms said. [Los Angeles Times, 3/29/10]
Kaiser Health News praised Berwick as “an inspirational leader.” In an interview republished on March 28, Kaiser Health News reported that Berwick “for two decades has been both a bit of a nag and an inspirational leader encouraging front-line health workers and health care leaders to make changes to reduce hospital deaths and complications as well as making health systems more efficient.” The article went on to report: “Berwick, 63, has been a big promoter of efforts to reduce hospital infections, revamp the Medicare payment system to produce better patient outcomes and make public information on hospitals and doctor performance.”
Berwick received praise from Harvard health policy expert. Bloomberg further reported:
Berwick was one of the first U.S. researchers to introduce industrial quality controls into U.S. health care, said Lucian Leape, a Harvard health policy expert on the board of Berwick's institute.
Close to 3,000 hospitals signed up for the institute's 100,000 Lives Campaign that challenged hospitals to prevent deaths by carrying out measures such as making sure that patients get enough antibiotics before surgery, Leape said.
Berwick was the “intellectual leader” behind the 1999 report from the U.S. government-chartered Institute of Medicine, an advisory body, “To Err is Human,” which found that as many as from 44,000 to 98,000 people die each year because of medical errors. That report brought the issue of medical safety to the attention of the U.S. public, Leape said. [Bloomberg, 3/29/10]
Former editor of Medical Economics magazine: “Berwick is a giant intellect, universally respected in the healthcare field.” In a post on BNET.com, Ken Terry, former senior editor at Medical Economics magazine and author of the book Rx For Health Care Reform, wrote: “If Republicans were able to look beyond the ends of their noses, they would see in Berwick a giant intellect, universally respected in the healthcare field, who is as nonpartisan as they come.” Terry went on to assert that Berwick “has saved countless lives through his organization's work with hospitals to improve their processes in very specific ways, such as reducing central-line infections and ensuring that prophylactic antibiotics are administered before surgery.”
Consumers Union: Berwick is “a spectacular appointment.” The New York Times reported: “Steven D. Findlay, a health policy analyst at Consumers Union, said: 'This would be a spectacular appointment. Don has been an intellectual force in health care for decades. He helped forge many ideas incorporated in the new health care law.' ” [The New York Times, 3/27/10]
Dartmouth health policy center director praised Berwick. The New York Times also reported: “Dr. Elliott S. Fisher, director of the Center for Health Policy Research at Dartmouth Medical School, said Dr. Berwick was 'a visionary leader who can motivate people to change.' ” [The New York Times, 3/27/10]