Anyone reading Dr. Berwick's statements has to be struck by his pervasive suspicion of individual autonomy and his enthusiasm for rule by experts like himself. (Patients just get in the way.) He seems oblivious to the oxymoron inherent in the concept, rational collective action. A mob, after all, is a collective, but that scarcely makes it rational. The doctor slips into euphemism by habit, preferring to control supply rather than ration health care, which is what controlling its supply amounts to.
Dr. Berwick is representative of the Culture of Expertise that abhors individual choice (irrational!) and so would turn over such decisions to an elite of experts. He sounds like the very embodiment of the new paternalism that comes with a populist gloss.
Ortega y Gassett, the Spanish philosopher, essayist and thinker in general, saw all this coming. He called it the barbarism of specialization, and Dr. Berwick's specialty is medical cost-accounting. He is all too typical of a whole bureaucratic class. This species of barbarian has a title on the door, graduated from an Ivy League university, and couldn't write a sentence in clear, simple English prose if his life depended on it. Government offices and the halls of academe are full of such.
As for the elite that Donald Berwick would entrust with decisions about our health care, it need hardly be said that he and like-minded colleagues would compose it, they being the leaders whose business it is to make decisions for the rest of us, the poor uninformed, self-interested multitude. The doctor he brings to mind most is Dr. Strangelove.
Those of us who would prefer to make our own decisions, thank you, only disturb Dr. Berwick's well-ordered, efficient, standardized, rationalized, collectivized and above all impersonal system. His statistical sanitarium is geared to treat the average patient, who doesn't exist. At least I've never met him, any more than I've met that other abstract concept, the average man. Have you?
With Dr. Berwick, it's the numbers that count, not the kind of values that cannot be quantified, however real. Like life itself. There was something neither humane nor human about his turgid new directive. The good doctor is the very model of modern man in that respect, believing that what matters is the system, not the individual. And like modern man, he can be frightening to behold.