For awhile it looked like Don Berwick was the perfect candidate to run the Centers for Medicare and Medicaid Services (CMS), the gigantic agency that’s largely responsible for making a go of health reform. Berwick came highly recommended, with a good medical pedigree and a track record of trying to make health care safer and better. That’s exactly the stuff politicos of all stripes talked about during last year’s debate.
But in this case, many Congressional Republicans seems to be focused on fighting the reform fight all over again. At least that’s what supporters like HHS Secretary Kathleen Sebelius and AARP executive vice president John Rother maintain. “In ordinary times the nomination of somebody with Don’s record and standing in the field would not be controversial,” said Rother.
But it is. A piece published this weekend by McClatchy reporter David Goldstein sported this headline: “Bitter feelings over health bill could sink Medicare nominee.” The McClatchy story got right to the point. Critics are complaining that Berwick “lavished praise on Britain’s government-run National Health Service which makes them nervous. It’s also fuel for continuing the Republicans’ claim that the health care law amounts to socialism.” Critics are down on Berwick, Goldstein reported, because they say he “supports rationing medical treatment evoking last summer’s controversy over ‘death panels,’” which some in the public still believe exist.
Republican senators are out for Berwick’s scalp and have begun using the specter of medical rationing as the way to turn him into a headhunting trophy. They like to bring up Berwick’s statements, like this one:
The decision is not whether or not we will ration care. The decision is whether we ration care with our eyes open.
Goldstein’s piece noted that opponents usually omit the last sentence of this quote: “And right now, we are doing it blindly.” Goldstein then added more context, telling readers what Berwick actually said at the annual conference of the Institute for Healthcare Improvement which he helped found twenty years ago as a way to make American health care better:
Over the next three years, reduce the total resource consumption of your health care system, no matter where you start, by 10 percent. Do that without a single instance of harm, without rationing effective care, without excluding needed services for any population you serve.
GOP critics are also trying to stir the pot by resurrecting other remarks Berwick has made about the British National Health system. “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,” Berwick said in July 2008. Politico reported that, in May, Kansas Sen. Pat Roberts read his quote on the Senate floor and then asked, rhetorically: “Why is this important? Because the NHS rations health care.”
Uh oh! Here we go again. If the past is any precedent, we’ll soon see Fox News dueling it out with MSNBC over Berwick’s professed love for the NHS, and another round of tardiness from MSM in refuting falsehoods about the NHS, rationing, or death panels as they come up. As we reported in the March/April 2010 issue of the Columbia Journalism Review, when the discussion of death panels made its way into the media, the press let right wing ideologues set the agenda and spread misinformation, allowing weeks to pass before refuting their false claims. By then it was too little too late.
This time, we’d like to see the media act as leaders instead of followers. For starters, they can begin to quote Berwick accurately, following Goldstein’s example. None of this business about selective quotes that opponents will inevitably use. This may also be a good time to review exactly what the NHS does, and how Britain’s National Institute for Clinical Excellence (NICE) actually offers evidence-based guidelines for doctors, so reporters don’t fall into the trap of misrepresenting what it does. As Andrew Dillon, the head of NICE, told Campaign Desk last year, “No country can afford to fund anything and everything every citizen might feel they should have. All countries place limits on what is made available. Governments do, employers do, insurers do.”
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This piece is ingenuous (disingenuous?). More of Lieberman's obsession with attacking Republican critics, rather than actually refuting them. Obamacare is 'socialist'? Well, it's not, but so what if it is? Public libraries are 'socialist', too. Berwick (who sounds a bit daffy in the stereotypical starry-eyed middle-class American liberal fashion) wants to push toward an NHS system? Well, he doesn't, but so what if he does? Their system is better than ours, of course. (No mention of the army of stout Labour supporters of the NHS who are found using private beds - Denis Healey comes to mind - when their own loved ones need care. Let alone an inquiry into why this is.) Those evil GOPsters charge that there will be rationing? Well, of course they are crazy, as always, but so what if there is 'rationing'? We have rationing of care now, only it's by insurers, not an elite administrative class of political appointees. The latter is assumed to be superior.
We have 'rationing' of food and housing, too, by this formula. Lieberman plays dumb by pretending that 'rationing' is not accepted shorthand for 'government rationing', backed by the force of law and policing. Otherwise, we wouldn't refer to World War II food rationing the way we do - by the Lieberman framing, food is rationed at all times. The debate, which Lieberman wishes to sidestep, is whether rationing by queue line and political influence is superior to rationing by price and private administration.
So why not declare a 'food crisis' and have the government directly take over the provision of food? Silly question. Conservative critics of Obama care and the ginned-up 'health care crisis' are said to be motivated by ideology: Berwick, Lieberman, and the Democrats, of course, are too darn selfless to have the idea of granting 'entitlements' reap political benefits even cross their minds. If Lieberman applied the same level of criticism (I thought this was a journalism review, not an auxiliary of The Nation magazine) to proponents of more politics in health care that she does to its critics, her work would be more valuable. But she is obviously motivated by her politics, and preaching to the converted. I still have read very little treatment of the tough questions asked by the critics of Obamacare and such, even though it is obvious that there is widespread public skepticism.
#1 Posted by Mark Richard, CJR on Tue 15 Jun 2010 at 09:26 AM
Mark Mark Mark.
This is about conservative character assassination, not about actual politics.
http://www.ombwatch.org/node/10460
Democrats can't get anyone left of Cass Frickken Sunstein confirmed without delays and obfuscations about their record and words. Conservatives still grouse about Bork and Clarence Thomas's confirmation hassles but kick dirt up over nearly every one of Obama's nominations, which results in him having to rely on appointed positions such as czars, which gives the Beck/McArthy crowd something to froth over.
The type of rationing being discussed is superfluous treatment, medical prescriptions and tests that produce no benefit for the patient. They produce profits for private administration.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
The private insurance industry does this all the time and conservatives never complain even when the goal of private insurance is to reduce expense to the company and not necessarily to benefit the patient.
This has nothing to do with expanding the socialized health care system, this has to do with having a qualified person making sure that the socialized health care system you have is making effective purchases.
Would you prefer that it didn't? Do you prefer it to continue to waste taxpayer dollars? Instead of a qualified person, would you prefer an unqualified Bush era hack like Michael Brown or Ken Salazar? (I don't spare Obama blame for putting bad people in powerful positions)
There's a difference between legitimate oversight and obstruction, and republicans crossed that line a few dozen filibusters ago.
#2 Posted by Thimbles, CJR on Tue 15 Jun 2010 at 09:21 PM
Thimbles - Politics ain't beanbag. I don't have any problem with Dems going after Bork or Thomas or Ashcroft if you don't have any problems with the Repubs doing the same. By the standards applied here to Berwick, there are many analogous treatments of GOP nominees. You seem to believe the Dems are still just too darn nice to 'obstruct' as the Repubs do, by singling the latter out . . . that's not the way I remember 2006-2008, particularly on nominees to federal courts. And while there was partisan warfare in the 1995-2001 period of Dem Clinton in the WH and Repub control of Congress, the latter was not characterized much, if you recall, as 'obstruction' of Dem nominees.
#3 Posted by Mark Richard, CJR on Wed 16 Jun 2010 at 08:35 AM
Bork, Thomas, and Ashcroft, AND Alito, AND Gonzales AND so on were radicals. Conservative radicals often get nominated and often get confirmed despite their radical past and their disingenuous confirmation hearings before congress. I would love if the democrats had a pair and stopped the idiots like Michael Brown and radicals like John Roberts from getting into positions where they can do some damage but no, the opposition gives up most of the time to preserve comity and executive prerogative and so on with the expectation that the favor will be returned.
Which it isn't.
http://www.washingtonmonthly.com/archives/individual/2010_03/022639.php
Republicans are putting holds on confirmations and filibustering legislation to a level without parallel and, though you try to bring up democratic examples in the past, those examples are meagre compared to now. The difference between then and now is that conservatives whined and cried and demanded democrats to stop their obstruction of radical before they were forceds to launch THE xNUCLEAR OPTION, so the he said she said press aired widespread reportage that on that angle.
The Democrats are different:
From the nytimes
"Administration officials have shied away from publicly criticizing the slow pace of confirmations, for fear of angering the same senators who they are hoping will remove their holds. “We’ve made great progress in confirming nearly 500 of the president’s nominees this year,” a White House official said..."
They aren't saying anything, thanks Rahm-you idiot, and so while republicans are doing triple the amount of obstruction, nobody knows because the press needs someone to say the truth in order to report it . .
http://www.washingtonmonthly.com/archives/individual/2007_09/012097.php
"As things stand, though, Republicans will largely avoid blame for their tactics. After all, the first story linked above says only that the DC bill "came up short in the Senate" and the second one that the habeas bill "fell short in the Senate." You have to read with a gimlet eye to figure out how the vote actually broke down, and casual readers will come away thinking that the bills failed because of some kind of generic Washington gridlock, not GOP obstructionism."
I have no problem with executive oversight. This is abuse. When supposed dignified elders of the senate like Richard Shelby throw blanket holds on 70 nominations just because he can, the party responsible is dysfunctional and deserves to be reported as such..
#4 Posted by Thimbles, CJR on Wed 16 Jun 2010 at 11:04 AM
Head cold medicine, hell of a drug.
What I should have wrote:
"The difference between then and now is that conservatives whined and cried and demanded democrats to stop their obstruction of radicals before "we're forced to launch THE NUCLEAR OPTION". Therefore, the he-said-she-said press aired widespread reportage that on that angle.
The Democrats are different:
http://www.nytimes.com/2009/12/28/us/politics/28nominees.html
"Administration officials have shied away from publicly criticizing the slow pace of confirmations, for fear of angering the same senators who they are hoping will remove their holds. “We’ve made great progress in confirming nearly 500 of the president’s nominees this year,” a White House official said..."
They aren't saying anything, thanks to Rahm-the-idiot-Emmanuel, and so while republicans are doing triple the amount of obstruction, nobody knows nor thinks it's unusual because the press won't report the truth unless someone says it.
They claim, "It's not our role"
http://www.salon.com/news/opinion/glenn_greenwald/2008/12/29/gregory
"
I'm feeling a bit better now thanks.
#5 Posted by Thimbles, CJR on Thu 17 Jun 2010 at 02:51 AM
I used to love the British NHS. It actually took care of me for 2 years. I haven't had health insurance in the US for the past 3 years. There's a lot to be said for access to healthcare, and not having to worry about being bankrupted by disease.
But I can say that the NHS, like any monopoly, is complacent and can't match a system with at least two players, both of whom are competing for the consumer's patronage.
Although I published how to prevent 90% of kidney failure in 2002, neither Medicare, which is a Single Payer for dialysis in the US, nor the British NHS, Single Payer for dialysis in Britain, had any interest in eliiminating the disease. It supports too many bureaucratic salaries.
NICE said it wasn't the right agency to consider my paper, even though everybody else in Britain said it was.
So much for a spirit of innovation in the NHS.
Right now, America's two healthcare sectors, the public and the private, compete on how to spend more money while ignoring outcomes. A simple yet elegant way to get this horrid system working for the patient is merely to mandate the reporting of patient outcomes, something no health system in the world currently does, not even the vaunted NHS.
Details are at http://tinyurl.com/healthcrime and http://tinyurl.com/DavidWashingtonMoskowitz.
#6 Posted by David Moskowitz MD FACP, CJR on Mon 5 Jul 2010 at 05:30 PM