Dr. Donald Berwick of the Harvard Medical School does not like free enterprise, but he does like rationing.
Two years ago, in England, he delivered a talk celebrating the 60th birthday of Great Britain's National Health Service, the bureaucracy that runs that nation's socialized medical system. He apparently entertained some fear that day that the Brits might turn back to free enterprise. So, in his address (as reprinted in the July 26, 2008, edition of the British Medical Journal), and as reported this week by Matt Cover of CNSNews.com, he offered British socialists some words of advice.
"Please," he told them, "don't put your faith in market forces -- it's a popular idea: that Adam Smith's invisible hand would do a better job of designing care than leaders with plans can. I find little evidence that market forces relying on consumers choosing among an array of products, with competitors fighting it out, leads to the health care system you want and need. In the U.S., competition is a major reason for our duplicative, supply driven, fragmented care system."
To Berwick, America's health care system is not the model for the world. Great Britain's is. In his view, it is vital for the Brits to hold high the flame of socialized medicine so the world can follow its lead.
"I hope you will never, ever give up what you have begun," said Berwick. "I hope you realize and affirm how badly you need -- how badly the world needs -- an example at scale of a health system that is universal, accessible, excellent and free at the point of care -- a health system that, at its core is like the world we wish we had: generous, hopeful, confident, joyous and just.
"Happy birthday," the ebullient doctor told the British health care socialists.
If you have not noticed already, this man has a crush on collectivism. "Cynics beware," he said. "I am romantic about the National Health Service; I love it."
This love extends to approbation for rationing health care and using the health care system to redistribute wealth.
"You cap your health care budget, and you make the political and economic choices you need to make to keep affordability within reach," Berwick told the Brits. "You plan the supply; you aim a bit low; you prefer slightly too little of a technology or a service to too much; then you search for care bottlenecks and try to relieve them."