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Berwick the Beneficent

What has always made the state a hell on earth has been precisely that man has tried to make it his heaven. Holderlin

A recent article in the Wall Street Journal by Daniel Henninger enumerated a list of Donald Berwick’s political beliefs concerning health care. Dr. Berwick is President Obama’s recess appointee to head Medicaid and Medicare. As a recess appointee, congressional and public scrutiny of Berwick’s writings and speeches may be avoided. The reasons for avoidance are evident.

The list provided by Henninger is like something straight out of F.A. Hayek’s Road to Serfdom. It is almost impossible to reconcile with anything remotely  compatible with American individualism.

  • “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.”

The unabashed hubris of Berwick’s statement is palpable.  Presumably, Berwick is just the “leader” to do this.  He is an unelected, un-vetted, and thus unaccountable, bureaucrat now in charge of billions, if not trillions of dollars of government spending, representing a significant portion of the US economy. For a patient caught in the system (the recently passed health care bill) soon to be implemented by Dr. Berwick, it is your worst nightmare.

Contrary to Dr. Berwick’s disbelief, the 10th Amendment contains no exception for health care. Ours is a government that draws its legitimacy from the people. It was not designed to be deeded to any platoon of experts.

Obviously, Berwick believes decisions regarding something as complex as health care should not be left to the people.

  • “The unaided human mind, and the acts of the individual, cannot assure excellence. Health care is a system, and its performance is a systemic property.”

This call for centralized decision-making by experts (rather than “unaided” human minds) was documented by Hayek 60 years ago:

The conviction grows, that if efficient planning is to be done, the direction must be “taken out of politics” and placed in the hands of experts — permanent officials or independent autonomous bodies.

Berwick believes that people are incapable of making the right choices and by extension, so is the free market. His contempt for the free market is obvious.

  • “Please 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.”

Adam Smith would differ:

The statesman who should attempt to direct private people in what manner they ought to employ their capitals would not only load himself with most unnecessary attention but assume an authority which could safely be trusted to no council and senate whatever, and which would nowhere be so dangerous as in the hands of a man who had folly and presumption enough to fancy himself fit to exercise it. Adam Smith — The Wealth of Nations

There is no limit to his presumptuousness.

Berwick does not hesitate to express, in quasi religious terms, what he views as the ultimate prize of public policy, mandatory universal coverage.

  • “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.”

This fanatical ardor towards universality is what Hayek cautioned of in his warnings about technocrats or “specialists” pursuing centralized planning.

… it unites almost all the single minded idealists, all the men and women who have devoted their lives to a single task.  The hopes they place in planning, however, are the result not of a comprehensive view of society but rather of a very limited view and often the result of a great exaggeration of the importance of the ends they place foremost. …it would make the very men who are most anxious to plan society the most dangerous if they were allowed to do so — and the most intolerant of the planning of others. From the saintly and single-minded idealist to the fanatic is often but a step.

Dr. Berwick advocates standardization placing authority in the hands of experts.

  • “I would place a commitment to excellence—standardization to the best-known method—above clinician autonomy as a rule for care.”
  • “Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy.”

By a slight of his stethoscope worthy of Mandrake the Magician, Berwick the Beneficent equates standardization with excellence. Without the trappings of bureaucracy his meaning is clear:  “one size fits all” health care, never mind that patients’ needs and conditions differ. Doctors and nurses should be trained to ignore such differences.

Berwick is all for rationing health care with “our eyes open”.   He would remove individual economic choice from the equation entirely:

  • “It may therefore be necessary to set a legislative target for the growth of spending at 1.5 percentage points below currently projected increases and to grant the federal government the authority to reduce updates in Medicare fees if the target is exceeded.”
  • “A progressive policy regime will control and rationalize financing—control supply.”
  • “One over-demanded service is prevention: annual physicals, screening tests, and other measures that supposedly help catch diseases early.”
  • “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.” [This one is not from the WSJ list.]

In spite of all his arguments for rational socialized medicine, Berwick himself won’t have to live under the rules he’ll seek to implement.   Berwick’s Institute for Healthcare Improvement (a tax-exempt non-profit) has granted him and his wife health coverage “from retirement until death.”  The institute received $12.2 million in grants, contributions, and revenues in 2008, and paid an astonishing $2.3 million to Berwick in the form of compensation.

To paraphrase Orwell, some of us are more equal than others.  Rationed health care, with eyes open or closed isn’t for Berwick.

At its core, Berwick articulates the same tired old agenda always promoted by the political left, Marxist, socialist or progressive.

In a 2008 speech delivered on the occasion of the 60th anniversary of Britian’s National Health Service he lauded the NHS for recognizing…

…that any health care funding plan that is just, equitable, civilized, and humane must – must – redistribute wealth from the richer among us to the poorer and less fortunate. Excellent healthcare is by definition redistribution. Britain, you chose well.

Is this America’s choice?

H/T to Internet Scofflaw


1 Ben Johnson { 07.09.14 at 8:42 am }

Great article, loved the references to Hayek and Smith. I was searching for “The Beneficent Fist” (my take on the “Beneficent Hand” (still not sure if anybody else has used it though)) and found you. The phrase “Berwick the Beneficent” was both fitting and humorous in this regard.


Martin Reply:

Thanks Mr. Johnson,

We were pleased with that headline and consider it one of our better efforts. So it is nice to have it appreciated. 🙂

Good luck with your research.


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