Donald Berwick


The Anatomy of a Hostile Government Takeover

During the long national debate over the future of American health care, President Obama frequently chastised his opponents for launching exaggerated attacks on his plan for “reform.” He took particular exception to the criticism that the changes he was pushing amounted to a government takeover of the whole health sector. He knew full well that this kind of criticism might derail the entire effort in Congress, because most Americans recoil at the thought of a distant and bureaucratic federal government running the health-care system for everyone. So Obama vigorously denied that his program would lead to any such thing. In his August 8, 2009 radio address, he described the “takeover” accusation as “outlandish” and characterized his approach as a mainstream and moderate attempt simply to reform the nation’s private health-insurance system.

It’s now been six months since Congress passed Obamacare — not a long time given the sweeping nature of the legislation and the long phase-in schedule for its most significant provisions. Even so, it is already abundantly clear that Obamacare’s critics were dead right: The new health law has set in motion a government takeover of American health care, and a very hostile one at that. The Obama administration’s clumsy and overbearing behavior since its passage proves the point.

First, there are the heavy-handed statements coming out of the Department of Health and Human Services (HHS). Two weeks ago, HHS secretary Kathleen Sebelius sent a letter to the nation’s insurers with a plainly stated threat: Either the insurers conform to the political agenda of the administration and describe the reasons for premium increases in terms acceptable to the Democratic party, or they will be shut out entirely from the government-managed insurance marketplace. What could possibly have provoked a cabinet secretary to launch such an indiscriminate broadside against an entire industry? Simple: A handful of insurers had dared to utter the truth, noting that the new law has imposed costly insurance mandates that will raise premiums for everyone. For that offense, the federal government has essentially threatened to put the truth-telling insurers out of business. And what’s truly astonishing, and telling, is that the new law almost certainly gives the HHS secretary the power to do so if she really wants to.

Then there is the matter of Dr. Donald Berwick. Recall that President Obama took more than a year to settle on Dr. Berwick as his nominee to head the Centers for Medicare and Medicaid Services (CMS) — and then moved in a matter of weeks to put him in place without Senate confirmation. The president tried to blame Republicans for this blatant end-run around constitutional checks and balances, even though Democrats control the Senate and could have held a hearing and a vote if they had wanted to. The truth is that Democrats didn’t want Dr. Berwick to be confirmed in the Senate. They wanted him on the job, for sure, because he is an ardent government-takeover enthusiast, and is prepared to use all of the levers at his disposal to advance that objective. The president and his Democratic allies just wanted to get Dr. Berwick in place without the public’s really noticing. So they chose to circumvent the normal process and put him in the CMS position with a time-limited recess appointment. For the next year and a half, Dr. Berwick is free to use CMS’s enormous new powers to force doctors and hospitals to conform to his vision of effective health care, and he is essentially accountable to no one but the president.

To distract the public from these power plays, the administration decided to launch a series of “information” campaigns that are plainly political and filled with all manner of distortions. HHS sent a letter to the nation’s Medicare beneficiaries supposedly explaining what the new law will mean for them. Somehow, it failed to mention that the law will cut Medicare by half a trillion dollars over a decade, and cut the value of Medicare Advantage by an average of 27 percent by 2017. HHS followed this up by putting the same distortions on television, in the form of an expensive advertising campaign featuring Andy Griffith.

In the meantime, busy beavers in various corners of the federal bureaucracy are laying plans for new fiefdoms. Thousands of new employees are planned for various offices in HHS, including the new office to regulate private health insurance nationwide. The IRS is gearing up both to enforce with tax penalties the requirement that everyone carry government-approved insurance, and to help administer the massive new entitlement program that will require income verification on tens of millions of applicants. States will also be forced to build new bureaucracies to carry out the scores of tasks the federal government will be ordering them to perform.

Massive bureaucracy. Disinformation campaigns. Blatant power plays. The politicization of decisions that should be made with a focus on patient care. The use of government power to threaten citizens and their livelihood.

This is what Obamacare has brought us. And that’s just in its first six months.

[Cross-posted at NRO here.]

posted by James C. Capretta | 11:48 am
Tags: Kathleen Sebelius, Donald Berwick, Andy Griffith, Medicare Advantage
File As: Health Care

The Cowardice of His Convictions

The reason the health-care debate has been so polarizing is that there is a deep and fundamental divide over what should be done to fix the problems in American health care, especially with regard to rapidly rising costs.

On one side of the debate are those who advocate a decentralized, market-based reform program. Congressman Paul Ryan is among the leaders pushing for such a consumer-driven solution.

On the other side are what you might call the “governmentalists.” The governmentalists believe the way to “bend the cost-curve” is with a centralized, government-led effort to micromanage the entire $2.6 trillion health sector from Washington, D.C.

President Obama, his top aides, and his allies in Congress are all quite clearly health-care governmentalists. The evidence for this is on full display in the bill they jammed through the legislative process. It is filled to the brim with provisions that shift power and authority away from states, individuals, employers, and the private sector to the federal government.

The federal government is now the nationwide regulator of all private health insurance. Federal bureaucrats can pick and choose which insurers are allowed to sell to customers in government-managed “markets.” The federal government will determine what health benefits every citizen and legal resident must secure to avoid paying a punitive tax. The federal government will also decide the appropriate level of cost-sharing for government-certified insurance products.

The new law is also filled with provisions which the sponsors contend will slow cost growth with “delivery-system reform.” The federal government has been put in the driver’s seat of a sprawling effort to force doctors and hospitals to quite literally change how they care for patients and conform to the federal government’s view of what constitutes cost-effective medical practice. Medicare’s administrators will be using new authority to reward those who toe the government’s line and hit budget targets, and punish those who don’t. Government reimbursement will be used to prevent the introduction of medical technologies considered excessively costly.

Although President Obama is quite clearly a committed and enthusiastic health-care governmentalist, he has never admitted as much in public, nor is he ever likely to. He avoids engaging in direct debate over the merits of his position with the market-based reformers. Instead, he argues, as he did at the so-called “bipartisan summit” back in February, that there is no great disagreement over substance; it’s just that those dastardly Republicans are against progress on his watch.

In a way, it’s hard to blame him for ducking the fight. The entire governmentalist reform program is based on the assumption that the federal government has the capacity to nimbly manage the health sector and to cut out unnecessary spending without harming the quality of care. Let’s just say that’s a hard sell with most of the public. The federal government has been running public-insurance programs for almost half a century. The only way it has ever cut costs is with arbitrary, across-the-board price setting. These price controls cut reimbursement rates for all providers of services, without regard to what it will mean for patient care. That’s the norm in government-run systems around the world as well. And the end result is not more efficient health care. Artificial, government-set cost limits simply drive out willing suppliers of services, and eventually lead to access problems, queues, and government-driven rationing of care.

Truth be told, this is a debate President Obama has always known he couldn’t win, and so he never wanted to engage in it.

Which brings us to the administration’s recess appointment of Dr. Donald Berwick as administrator of the Centers for Medicare and Medicaid Services (CMS).

Unlike the president, Dr. Berwick hasn’t hid his worldview.

The White House says Republicans were planning to obstruct the nomination. Republicans haven’t obstructed anything. All they did was signal an eagerness to engage in a spirited debate over Dr. Berwick’s vision for health-care cost control. The reason Dr. Berwick’s nomination hasn’t moved forward is because he hasn’t yet submitted responses to relatively routine questions posed by the Senate Finance Committee — questions that would have been asked of any nominee, from either party, given the same set of facts and circumstances.

Some have speculated that the White House chose to make the recess appointment because the answers to some of those questions might cause some problems for the nomination or the administration. Perhaps. But it seems more likely that the primary motivation for the recess appointment was to avoid a clear and transparent fight over the merits of the competing visions of health care reform. Dr. Berwick is an unvarnished governmentalist of the first order. The debate over his nomination would have been the perfect opportunity to present clearly to the public the consequences of handing over so much power in the health sector to the federal government.

The decision to bypass a confirmation fight may have avoided some short-term pain for the administration. But the long-term problem remains. The president jammed his health-care bill through Congress without a full debate and public consent. Voters don’t want the federal government put in charge of cost control, and yet that’s exactly what the new law will do. In time, that fact will become obvious to everyone. At which point, those who sponsored and passed this new reality into law will be held accountable for what they have done.

posted by James C. Capretta | 9:53 am
Tags: Donald Berwick, governmentalism, Centers for Medicare and Medicaid Services, cost control
File As: Health Care