Paul Greenberg

Buried in the mass of directives issued by the new head of the Center for Medicare and Medicaid Services was a little ol' regulation putting the government in the business of end-of-life consultations. Or what Sarah Palin in one of her unseemly flights of candor referred to as "death panels." But as soon as this regulation came to light, and the public reacted, not at all favorably, it was the regulation whose end had to be hastened.

It's not just that the new provision was issued without the approval of Congress -- indeed, Congress refused to pass it after strenuous objections were voiced -- but the official who issued it, Dr. Donald Berwick, didn't have to win congressional approval himself.

Dr. Berwick's was a recess appointment, which means he didn't have to subject his record to the kind of scrutiny other presidential appointees get. So his views didn't attract much public attention until he had taken office and started issuing edicts like this one. Call it a stealth regulation from a stealth appointee.

Daniel Henninger of The Wall Street Journal went through a number of the good doctor's speeches, and came up with a number of quotes that would surely have raised warning flags if they'd come to public attention in the course of confirmation hearings. But there were no hearings. If there had been, the good doctor's ideas about how to improve American health care would have appealed only to those who believe in government of, by and for experts. Consider these gems:

"I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do."

"Indeed, the Holy Grail of universal coverage in the United States may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per-capita costs."

"A progressive policy regime will control and rationalize financing -- control supply."

"Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy."

The emphasis in all these statements is certainly not Dr. Berwick's. Indeed, by avoiding confirmation hearings, he avoided emphasizing any of his views. Just as he kept this new Medicare regulation under his hat till he was ready to spring it on the country. Why let the rest of us know? It's only a matter of life and death. And when it comes to such things, doctor knows best. At least if he's the doctor.


Paul Greenberg

Pulitzer Prize-winning Paul Greenberg, one of the most respected and honored commentators in America, is the editorial page editor of the Arkansas Democrat-Gazette.