Of Death Panels and Rationing

Don Berwick’s messy confirmation

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.”

That’s worth remembering the next time some member of Congress talks about the government rationing health care. The last time I checked, employers (through the policies they offer workers) and insurers (in carrying out what their customers—the employers—want) already limit the care Americans receive. Such rationing will continue big time in a post-reform world, and that’s what Berwick was talking about. Reporters following Berwick’s confirmation may want to review our interview with Andrew Dillon, and consider what the anti-rationing crowd is really saying next time they’re tempted to scribble down some quote meant to further someone’s political agenda.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.