Wednesday, July 14, 2010

Britain's Healthcare System Praised by Donald Berwick

Having lived in Great Britain for two years and seen firsthand what a disaster Britain's system was like, I was stunned to hear it praised in recent years by Dr. Donald Berwick, Obama's choice to become the new Administrator, Centers for Medicare and Medicaid Services.  My brother Tim had him as a professor at BU in his graduate program, and he is thrilled with this appointment.  I hope Tim, who is actually involved as a health care administrator at IHC knows what he's talking about, but I'm not seeing it (yet).  I can always be persuaded otherwise, hope always springs eternally within me.

Obama made this appointment without any Senate hearings to confirm him while Congress was out for the 4th of July recess.  It's no wonder, when you examine his socialist leanings and his determination to end the "dark night of private enterprise."

In 2004, The Boston Globe did a story on Berwick. They called him "The Revolutionary." They went on to say, "The deeper Berwick has gotten into the problem over the last decade, the more radicalized he's become. . . His conclusion — to save the health care system, it first needs to be blown up."  Tim's been out of school for a long time since Berwick was his professor, so maybe he isn't aware of Berwick's radical shift to the left.

When you're done watching the 2008 clip from Berwick's speech in Great Britain, click on another clip from Mark Levin

Berwick's not interested in solving the Medicare and Medicaid problem — it's the whole health care system. It first needs to be blown up. How? That's like, to save the free market, I've got to abandon the free market. Oh, that one is working out well, isn't it?

So not only does he want to blow up the best health care system in the world — not perfect, but the best in the world — his idea of a fix is to make our system just like Great Britain's health care system.  I'm wondering to myself, "Let's see, which alternate universe have I just entered?"

There is one other possibility -- he simply doesn't believe what he told his audience or he was lying through his teeth for their adulation. 
I hope that's what he was doing over there, because if true what will he do here?


  1. Would like to know what years you lived in GB and some specifics, factual as well as anecdotal, on why their system is wrong for them and us. Perhaps an effort at a "pro and con" analysis would be helpful. I'd like to know what might be good in their system.

    To me, this is just about today's most maddening issue. There is so much smoke but so little light. I'm just an 'average' citizen, I don't have the answers, you probably don't either, but if you have dug into this, perhaps you can shed some light.

    I know some very good people who are one little misfortune away from making a choice between total financial ruin and living as invalids for the remainder of their lives. His condition is congenital, it's no fault of his own. Has raised 6 adult children, a private businessman, hard-working, God-fearing, the salt of the earth. He's only 55 but he already moves like an old man. His condition, scoliosis, makes it so that both desk work and manual labor are very painful after an hour. Because of the economic downturn, he let go of everyone but his son. So his insurer of 16 years dropped his group plan and refused him an individual policy. The doctors don't want to operate on him yet, but it'll be soon. His wife is trying to hurry up and finish her degree so she can get hired by a school district. Hopefully, that will cover them, but who knows.

    It just seems insane that in this land of abundance, people like this must choose between financial bondage and incapacity. We need to do something, but what?

  2. I had an e-mail exchange with my brother over this issue. His point as a healthcare professional is that we should all just ignore the rhetoric from the right (which is what I do best). He thinks the system is broken worse than any of the rest of us have any idea. He's probably right.

    My anecdotal reflections can be traced to my experiences as a missionary serving in England between 1967 - 1969 when England was gripped with socialism in all its "abundance." The system was "free" -- anyone who wanted to see a doctor had access and it was all paid for without any out of pocket expense. Care was rationed because there was simply too many patients. Some waited for months and months to see a doctor, but everyone "could" in theory see a doctor. Emergencies were prioritized and treated based upon severity. Even American missionaries who needed treatment were given "free medical care." However, the quality of care was questionable. The NHS of England was awful in my experience. I have no idea what Berwick's frame of reference is when he lauds it. The only thing I can surmise is from his own statments that condemn him in my opinion. I don't care what Glenn Beck, Sean Hannity or Rush Limbaugh have to say about it. I just looked at the man himself and have concerns.

    My brother Tim says we already have rationed care at a very high cost, and he's right. Private enterprise insurance companies, rather than government agencies are dictating that rationed care presently. They exclude poor medical risks to make certain they remain profitable. No doubt the kind of treatment your friend is getting is happening -- I've seen it in my own family. Get sick, get treated, run up the expense to the carrier, and when you come up for renewal you'll be dropped. Rationed care.

    However, as I pointed out to Tim last night, when indigents, immigrants, and the poor among us go to an emergency room in the United States, they will be treated whether insured or not. Everyone knows that and that segment of society is overburdening the system. On the other side, when IHC treats someone who can't pay the cost is written off and that person's bill slips into the "charitable care rendered" category and assures their non-profit status is thus secured. It would be interesting to know what the percentage currently is between reimbursed costs paid by Medicare, Medicaid, and other government programs, versus how much income flows from insurance companies. Then compare those income sources to the outlays in the charitable categories. It's been awhile since I drilled down on those numbers.

    Here's another anecdotal experience. My father worked for (created) IHC when it was divested from the Church back in the 70s. He's now 88 years old. Dynamite health care plan, right? He's had Several years ago he had an angioplasty procedure to open clogged arteries, a total knee replacement, then eventually two very expensive stents that were inserted into arteries feeding his weakening heart. The apex of his heart prior to the stents was totally atrophied, and post-surgery it revived itself and sprung back to life. He's also had surgery on his back (twice) to relieve the stenosis that has set in as a result of his scoliosis. Before all that he had cataracts removed and new artificial corneas inserted. He surely would have died years ago without all that work. As it is, today he is hobbling around, barely able to navigate on his legs.

  3. Part Two:

    I'm certain he doesn't want his medical history trumpeted all over the Internet, but his case is typical. People are living longer, life expectancies are going up and up, and with all that the associated medical costs.

    It is a laudable goal, I believe, to make this kind of care available to those who can't afford it -- the "uninsurables" -- but at what cost to society through redistribution of wealth? Are we willing to keep pushing the envelope further and further out there?

    I'm not certain when people come to the end of cutting off their surgical options. Today, Medicare and Medicaid are picking up those costs for those who qualify and are old enough. Many are postponing required surgeries because they can't afford it privately, knowing Medicare will pay for it. Obama is trying to contain those skyrocketing costs, admirable, but again at what cost?

    When I saw the COB's numbers this week, I became convinced it's a sham. So what's the answer? I'm certain I don't know. What I do know is that England's solutions are not desirable except from a cost containment perspective. To say they are dispensing quality care stares in the face of reason for those of us who have lived there and seen it firsthand. Why do we see folks from England and Canada coming to the U.S. for care if their system is so spectacular?

    Those are my observations for what it's worth. The debate rages on. Once again, without seeking Senate confirmation of Berwick's appointment we are being told we don't know better than the administration. Maybe we don't, but at least we are humble enough to admit it.

  4. Part Three:

    Tim was kind enough to remind me that our father's treatment costs came in 30-40% LOWER than what they might have been anywhere else because of the cost containment protocols they have employed at IHC in recent years. He sent me an article from the NY Times, highlighting IHC's wonderful work, particularly in the area of cardiac care.


    President Obama cited IHC's work as an example of best practices in his State of the Union address. The article explains: "Wennberg, the Dartmouth researcher, argues that Intermountain is fundamentally different from other oft-cited models of high-quality, lower-cost care, like the Mayo Clinic and the Cleveland Clinic. These places, including Intermountain, share certain traits, like having a large number of doctors who receive fixed salaries rather than being paid piecemeal for each treatment. Partly as a result, these hospitals do fewer tests, treatments and operations than other hospitals and still get excellent results. What sets Intermountain apart, Wennberg says, is that it is also making a rigorous effort to analyze and improve bedside care."

    Bottom line for me is to keep an open mind. As long as private efforts like IHC's can be replicated across the spectrum, I'm on board. It's heavy-handed government administration that repulses me most. It will be interesting to see how the ongoing debate unfolds, but what is certain is that the government deficits and the debt must be curtailed.

    Why does it seem so hard for this administration to recognize that it has a willing and able partner in free enterprise like IHC that can solve these problems?