Thursday, July 08, 2010

Obama lifts the veil

With the recess appointment of Donald Berwick as head of Medicare, President Obama has told us several things about both how he envisions his health care policy and how he envisions his role as president. Both these illuminations are quite scary.

Donald Berwick is a radical guy who wants to see are system become even more like Britain's. He's spoken about how he loves Britain's health care system and his assurance that we will have rationing saying,
“The decision is not whether or not we will ration care, the decision is whether we will ration with our eyes open.”
And that's not all this guy has said. He's been very open about his desire that we move to a single-payer system.
Berwick has also long advocated a single-payer system, writing as far back as 1996 that “a single-payer mechanism” was “the only sensible approach to health care finance I can think of.” More recently, Berwick said: “If I could wave a wand…health care [would be] a common good-single payer, speaking for and buying for the common good.”

Not surprisingly, Berwick has expressed skepticism of market-driven health care and market-focused reforms. “Please don’t put your faith in market forces,” Berwick wrote in 2008. “It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can. I find little evidence that market forces relying on consumers choosing among an array of products, with competitors fighting it out, lead[s] to the health care system you want and need.”
Those are the statements that Dr. Berwick now won't have to answer questions about since Obama avoided having hearings on the guy's nomination.

All those fine promises from President Obama about how anyone who likes his or her own health care can keep it when you see what this guy believes.
According to a "topline message points" document on his nomination that we obtained, "The fact is, rationing is rampant in the system today, as insurers make arbitrary decisions about who can get the care they need. Don Berwick wants to see a system in which those decisions are transparent—and that the people who make them are held accountable."

The people who can write such things with a straight face believe there is no difference between rationing through individual choices and price signals and rationing through politics and bureaucratic omniscience. In an influential 1996 book "New Rules," Dr. Berwick and a co-author argued that one of "the primary functions" of health regulation is "to constrain decentralized, individual decision making" and "to weigh public welfare against the choices of private consumers."

He then recommended "protocols, guidelines, and algorithms for care," with the "common underlying notion that someone knows or can discover the 'best way' to carry out a task to reach a decision, and that improvement can come from standardizing processes and behaviors to conform to this ideal model." And guess who will determine the "best way"?

Such a command-and-control vision is widespread among America's technocratic medical left, but it is also increasingly anachronistic amid today's breakneck medical progress. There isn't a single "ideal model" in a world of treatments tailored to the genetic patterns of specific cancers, or for the artificial pancreas for individual diabetics, or other innovations that are increasingly common.

This is nonetheless where Dr. Berwick, in his bureaucratic wisdom, will look for his "savings." It is also where his personal view of the "public welfare" will have the power to trump the mere "choices of private consumers."
They want to talk about transparency but don't want to have that discussion in the Senate while this guy's nomination would have been debated.

The reason all this is important is because this guy's job will be to cut spending on Medicare so that he can find money to fund the new health care program.
Without any public vetting, Dr. Berwick will now assume control of a bureaucracy with a budget larger than the Defense Department and that controls 4% of GDP today, hitting 5.9% by 2020 if the Congressional Budget Office is right. His main task will be finding some way to reduce the growth of Medicare from its average rate of 4% over the last two decades to the ObamaCare mandate of 2%, in order to find enough money to fund the new entitlement.
Since he loves rationing and British-style health care, we now know how he is going to set about it.

Tevi Troy explains how the administration, despite being begged to, held off making the nomination for this position until after the health care bill passed. Obama didn't want to show his cards on what his real plans for Medicare were.

The President tried to pretend that he was using a recess appointment for Berwick because the Republicans had been blocking the nomination. That is an outright lie as Jake Tapper explains.
But Republicans were not delaying or stalling Berwick’s nomination.

Indeed, they were eager for his hearing, hoping to assail Berwick’s past statements about health care rationing and his praise for the British health care system.

“The nomination hasn’t been held up by Republicans in Congress and to say otherwise is misleading,” said Sen. Chuck Grassley, R-Iowa, the ranking Republican on the Senate Finance Committee, which would have held Berwick’s hearing.

Grassley said that he “requested that a hearing take place two weeks ago, before this recess.”

Berwick’s nomination was sent to the Senate in April, and his hearing had not been scheduled because he was participating in the “standard vetting process,” a Democratic aide on the Senate Finance Committee told ABC News.
So why the recess appointment for a guy who hasn't even gotten all his paperwork together? It's because the administration didn't want to have a debate about health care again and have this guy's opinions exposed. They know that his views are toxic and the whole debate would just remind everyone about why they despise the Democrats' health care plan.

In fact, Obama's runaround the confirmation process before hearings had even been held was so egregious that Senator Baucus, who chairs the Finance Committee that would have held those hearings and which oversees the Medicare program issued a very critical statement.
"I'm troubled that, rather than going through the standard nomination process, Dr. Berwick was recess-appointed," Baucus said in a statement Wednesday. "Senate confirmation of presidential appointees is an essential process, prescribed by the Constitution, that serves as a check on executive power and protects Montanans and all Americans by ensuring that crucial questions are asked of the nominee — and answered."
Well, that is how Obama views his job. He doesn't need no stinkin' hearings on his nominees. What would the lately sanctified Senator Robert Byrd have said about such a violation of our checks and balances system.

Obama has lifted the veil. Just as was alleged during the debates over health care, he is in favor of rationing and he doesn't mind acting the imperial president to get his guy in office.