Obama Bypasses Senate to Install Controversial “Rationing Czar” at Medicare Center

Fri Jul 9, 2010 - 12:15 pm EST

By Peter J. Smith
WASHINGTON, D.C., July 9, 2010 ( – Performing an “end-run” around the Senate confirmation process, President Barack Obama has installed Dr. Donald Berwick, an enthusiast for medical rationing and an unabashed admirer of the United Kingdom’s socialized health care system, as head of the Center for Medicare and Medicaid Services via a recess appointment.

The move means Berwick may take charge of the Center for the next year, without first having to go through Senate approval. This will allow him to have an influence on the CMS’s $800 billion budget and the myriad regulations that must be drafted for the national health care reform, the Patient Protection and Affordable Care Act (known by its critics as “ObamaCare”), before it takes full effect in 2014.

Burke Balch, director of National Right to Life Committee's (NRLC) Powell Center for Medical Ethics, called the appointment “disastrous news for the vulnerable, especially the elderly and the sickest of American patients."

Republicans expressed outrage, saying that the president was avoiding a public debate on a man whose advocacy of rationing is way outside the mainstream.

“Democrats held no hearing, allowed no public testimony, and called no votes on this nomination,” said U.S. Rep. Tom Price (R-Ga.), Chairman of the Republican Study Committee. “In short, they did everything to hide Dr. Berwick’s radical views and made absolutely no effort to follow the regular, established process for confirming a presidential nomination. Clearly, they did not want Berwick’s adamant support for rationing health care debated in the light of day.”

Obama justified the recess appointment of Berwick, alleging that Republicans were stonewalling the process "for political purposes" – even though the GOP with its 41 votes in the Senate is hardly in a position to delay confirmation hearings.

Reports have indicated that Democrat Sen. Max Baucus of Montana, the Senate Finance Chairman, had not even scheduled hearings and lacked the nominee’s complete paperwork.

Berwick has made many glowing statements in favor of rationing, stressing repeatedly his belief that the collective interest of the state must trump the individual’s right to seek the kind of health care that he wants.

Berwick went on record with the journal Biotechnology Healthcare last year saying, “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”

An editorial in the Wall Street Journal pointed out that Berwick co-authored a 1996 book entitled “New Rules,” in which he argued that government health regulations had a primary duty "to constrain decentralized, individual decision making" and "to weigh public welfare against the choices of private consumers."

Berwick repeated this utilitarian attitude toward health care in the May/June 2008 issue of Health Affairs, saying that "rational collective action overriding some individual self-interest" is necessary to reduce per capita patient costs.

Berwick has also gone on record stating that government should "approach new technologies and capital investments with skepticism” and place heavy burdens of proof on those offering medical innovations.

"Donald Berwick is a one-man death panel," said Dr. David O'Steen, NRLC’s executive director. "While Americans may not remember the agency he heads, he will quickly become known as Obama's rationing czar."

Obama’s new CMS chief has described his passion for the United Kingdom’s National Health Service (NHS) – notorious for its rationing practices – in amorous detail.

In 2008, on the NHS’s 60th anniversary, Berwick gushed, “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.”

The NHS’s National Institute for Clinical Excellence (NICE), which determines what treatments and how much the NHS will pay per patient, Berwick has described as having "developed very good and very disciplined ... models for the evaluation of medical treatment from which we ought to learn."

He has additionally stated, “The N.H.S. is not just a national treasure; it is a global treasure" and has elsewhere praised the British people for having socialized medicine and rejecting  “the darkness of private enterprise.”

However, critics of the U.K.‘s socialized system have pointed out that the numbers don’t paint the system in a kindly light.

A study published in 2007 in Lancet Oncology showed that England's 5-year cancer survival rate for men is only 45%, lagging far behind the 66% rate in the U.S; England’s survival rate for women stands at 53%, compared with 63% in the U.S. Both figures, say opponents of Berwick and socialized medicine, indicate that the “darkness of private enterprise” may not be so dark after all.

Additionally, in the U.K. patients are limited to a maximum of £30,000 per capita for their treatment each year by NICE, as a way to cut costs. This limit, however, poses a serious problem for the development of new treatments, which often take the form of extremely expensive experimental drugs.

Senate Republican Leader Mitch McConnell blasted Obama’s decision to appoint Berwick.

“As if shoving a trillion-dollar government takeover of healthcare down the throat of a disapproving American public wasn't enough, apparently the Obama administration intends to arrogantly circumvent the American people yet again by recess-appointing one of the most prominent advocates of rationed healthcare to implement their national plan," McConnell said.

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