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."
And they get to play Robin Hood in lab coats. "You could have protected the wealthy and the well," he said, "instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any health care funding plan that is just must redistribute wealth."
Berwick explained that there are three steps to "comparative effectiveness research." The first is to determine whether a therapy works or not. The second is to determine how well the therapy works compared to other therapies. The third is to do a cost-benefit analysis.
"If a new drug or procedure is effective, and has some advantage over existing alternatives," Berwick said, "then does the incremental benefit justify the likely additional cost?"
Now, in a free country where people freely chose to pay for their own health care with their own money, this is a good question for any prudent consumer. It is exactly that "free market force" that Berwick implored the British socialists not to put their faith in.
But in a country where the government has taken regulatory and fiscal control of the health care system -- where the state is subsidizing most people's care -- and where government bureaucrats make the decisions about who gets what treatment, this question is not the animating moving force behind the invisible hand of the market, it is the dark materialistic spirit behind the iron hand of a life-and-death tyranny.
In the socialistic health care system that Berwick envisions -- and that President Obama signed into law two months ago -- life-and-death rationing is inevitable.
"The decision is not whether or not we will ration care," Berwick told Biotechnology Healthcare, "the decision is whether we will ration with our eyes open."
President Obama has nominated Berwick to be administrator of the Centers for Medicare and Medicaid, the federal agency that runs these two massive proto-socialist health care programs. If confirmed, he will oversee the massive cuts that Obamacare mandated in Medicare.
He will do the cost-benefit analysis on your life or on the life of a loved one.
Unless, of course, too many incumbent senators make the self-diagnosis that a vote to confirm would result in the premature end of their sickly political lives.