The Donald Berwick Meme: Often Repeated, Still Untrue

With Dr. Donald Berwick's recess appointment ending last week, the media is full of praise for his common sense approach to Medicare reform, and how his reform of the program was stymied by evil Republicans who refused to confirm him.

Writing today in the New York Times, Joe Nocera repeats the meme in his column today:

Dr. Berwick, I'm here to tell you, was the most qualified person in the country to run Medicare at this critical juncture, and the fact that he is no longer in the job is the country's loss. ...

But there's one more thing about Berwick: He believes that President Obama's health care reform is "an important moral step toward universal health care." As he put it when we spoke: "Because of it, our country is, at last, making health care a basic human right. It is a majestic thing."

Naturally, this view made him anathema to Republicans, who blocked his nomination in the usual way. They pored through his old speeches and articles, plucked out a few comments they objected to -- he once praised the British health care system! -- and announced that they would never confirm him.

Well, this is a story line guaranteed to evoke outrage among liberals...except that it's probably untrue.

While it is likely that most Senate Republicans would not have voted to confirm Dr. Berwick, it is also irrelevant since the President had 59 Democratic votes in the Senate up until November 2010. That means they would only have needed one lone Republican vote to have him confirmed.

And, in fact, Democrats did not even hold a confirmation hearing for him, which would have allowed him to confront and (potentially) persuade his Republican critics.

Instead, it was Democrats' tactical (read political) decision not to hold a confirmation hearing for Dr. Berwick, since the American people might have found his many past statements in favor of rationing or his praise for the British NHS health system (which actively rations access to, among other things, new cancer drugs) deeply problematic in the run up to the November 2010 elections. In fact, that record might have made it very difficult for Senate Democrats in swing states to vote for him - creating a bipartisan vote against his confirmation and a huge embarassment for the Obama Administration.

In other words, revisionist history notwithstanding, Democrats found it inconvenient to actually schedule a hearing and vote for the man who they now say is indispensable for Medicare reform.

This is not to say that much of what Berwick advocates - bringing private sector quality control and managment techniques to Medicare - is at all objectionable. It isn't. What is objectionable to conservatives is his unabashed faith in central planning, a faith that would make any Soviet era bureaucrat blush. My colleague Avik Roy makes this exact point in a recent Forbes column.

What Berwick ignored in his work - and continues to ignore - is that systems that strangle consumer choice and competition are doomed to failure, as David Gratzer and I wrote after he was nominated:

Across the economy, companies thrive by becoming more and more responsive to consumers. Innovation is driven by competition and feedback from the bottom up - the iPhone (and its smartphone competitors) is the result of decades of us demanding better and faster machines.

In contrast, Dr. Berwick (who has professed his love for Britain's government-run National Health Service) thinks that the secret to improving American health care is having experts in Washington dictate prices and force process reforms on thousands of hospitals, hundreds of thousands of physicians, and tens of millions of patients, by sheer dint of ambition and will. Alas, he has fallen victim to the Harvard Disease: the idea that having experts peer through reams of data will lead to system wide improvements.

A record tempered with more humility about the power of top-down managment and more openness to market-based reforms would've not only made Dr. Berwick more politically palatable to his critics on the right, but it would've made him a better reformer.

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