Stealth appointee 'loves' Britain's health system

By now, anybody with a pulse is well aware that Barack Obama is not what he said he was when seeking our votes for president. He's not a conciliator, he's an ideologue. His "transformative" presidency is one seeking to transform the American system into a European-style social democracy, with the emphasis on "social." His overarching goal — judging from his actions — is to further expand an already stifling federal bureaucracy into such a monolith that private activity will be unable to escape its control.

This week, the president used what's called a recess appointment, bypassing the Senate confirmation process, to name Dr. Donald Berwick to head the Centers for Medicare & Medicaid Services. Known as CMS, the agency oversees the disbursement of hundreds of billions of health care dollars. In placing Dr. Berwick, a Harvard professor, pediatrician and an expert in patient care, in this post, the president avoids the nasty business of getting him approved by the Senate. The confirmation would probably have happened, but not before Republicans used his appearance to rake him over the coals for statements he has made on health care rationing. The process would also reopen debate about the health care reform bill itself, something the White House dubbed " Washington game-playing."

Recess appointments have been often used by presidents of both parties to place in office controversial nominees. Why is this one particularly troublesome to Republicans? For one thing, Dr. Berwick is an unabashed admirer of the notorious National Health Service in Great Britain. Two years ago, he gave a speech to an NHS audience during which he said he "loved" the system and that "market forces" must not be allowed to dictate health care. Instead, he said, "leaders with plans" should design the people's health care system. He said, "I'm romantic about the NHS. I love it."

What is this thing he so loves? It is a system with no visible costs to its consumers. There is no specific tax that Britons pay for their health care. However, since we all know nothing is really "free," the hidden costs of the system include a number of "gatekeepers" who determine who gets access to the care. The rationing board for the NHS is the National Institute for Health and Clinical Excellence, the acronym for which is NICE. Its goal is positively Marxian: To assure everyone is treated "from each according to their ability to each according to their needs." NICE. There are also the sometimes fatal extended waits for treatment. The Cato Institute's Michael Tanner points out that the NHS has an average of three-quarters of a million patients waiting for admission to hospitals. Tens of thousands of NHS patients die each year because they have become too sick to undergo surgeries that might have kept them alive. Yet the system is said to be popular with the average Brit. To each his own, indeed, but Americans might have a tough time adjusting to this kind of rationing. Not that we'll have a choice.

President Obama memorably promised that under his health reform plan, no one would come between a patient and her doctor, but he was obviously kidding. By mandating health insurance for the tens of millions of Americans without it, the new law means a greatly increased demand for health services. How will this be paid for? By cutting Medicare by $500 billion per year, and by setting spending limits on all patients. In the spirit of all true "progressives," Dr. Donald Berwick believes government should control all things of importance.

In a piece in the American Thinker, Chuck Rogér summed it up aptly:

"Though dollars are involved, control is the progressive's core desire — Berwick's desire. The doctor once proclaimed, 'The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.' President Obama has selected as head of Medicare and Medicaid a man who seeks to erase a health care system which, by law, cares for people who cannot pay for care. Dr. Berwick would substitute a system which, by law, must deny everyone care according to rules established by Berwick-minded bureaucrats who treasure control over people more than people."

Ron Smith can be heard weekdays, 9 a.m. to noon, on 1090 WBAL-AM and His column appears Fridays in The Baltimore Sun. His e-mail is