Medicare gets the Beltway Shuffle

Dr. Donald M. Berwick who is the Obama Administration’s appointee to head Medicare and Medicaid is leaving government at the end of the year. He was a recess appointee because the GOOP would not approve his nomination, not for any reason, but just to play politics with appointees. Like they do with all appointees.

Berwick in private life was head of the Institute for Health Care Improvement and had a lot of recommendations for fixing Medicare and Medicaid, which he thinks would save us $150 to $250 Billion year. But he can’t stay to put them in place because his recess appointment is up and the GOOP doesn’t really want to fix government. So now Obama will have to find someone else with good ideas to fill a job that a this guy already has because of GOOP resistance to good government.

The most interesting aspect of Dr. Berwick’s government service, however, may be the way the Obama Administration, reacting to its peculiar, beltway-filtered reality, muzzled Berwick in his appearances before Congress. The New York Times writes: “(T)he administration did not want him to defend past statements in which he had extolled the virtues of the British health care system and had suggested a need to cap total health spending and limit the supply of high-technology medical care in the United States.” What’s the matter with defending the truth?

The fact is that the American Medical Association has so successfully lied about the British medical care system in the last 50 years that most American s believe it to be seriously flawed and unworkable. The fact is the British system is efficient, low cost and effectively serves the needs of the British people. Failure to stand up and say that merely supports the lie that has been told for decades. It is unfair to the British and more unfair to the American public which should demand a British system, not run away from it.

Dr. Berwick says there are five reasons why Medicare and Medicaid are so costly. They are, “overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud.” Failure to address the issues of total health care spending and abuse of high technology in the system only handicaps the efforts to attack most of these problems. To his credit, Berwick has been some success with issues of coordination (hospitals and doctors’ offices are beginning to link their computer systems); complexity and rules (regulatory burden has been a primary target of the Obama Administration) and fraud (HHS established a Medicare Fraud Strike Force that has busted hundreds of health care providers).

But issues of over treatment… likely the most expensive and politically sensitive issue … cannot be addressed if we are afraid to rationally discuss the question of health care rationing. The truth is, we ration. Most rationing is done by the insurance companies which are more interested in cutting their costs than providing adequate care. Thus, new drugs are not covered because they are new… old drugs are often only covered if they are generic. Families are not encouraged to make the hard decisions that sometimes require an end to all but palliative care, and physicians have an incentive to continue to provide treatment that may only prolong an inevitable, but lingering and often painful death. (Note, for example, that the Obama Administration retracted a proposed rule that would have encouraged physicians to engage in end of life counseling with elderly patients.)

There are only so many resources in the system, and failure to discuss them only punts to the bean counters and money grubbing insurance companies and for profit hospitals. Letting them dominate the debate is in the best interest of no one.

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