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Not NICE

Obama’s pick to head Medicare and Medicaid highlights the choice we face regarding health care: repeal or rationed care.

1:34 PM, Apr 29, 2010 • By JEFFREY H. ANDERSON
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Berwick also likes to talk about “patient-centered health care.”  But this shouldn’t be confused with putting patients in control of their own health care dollars.  Rather, it involves making sure that government-controlled health care is, well, nice, to patients.  Here is Berwick’s published definition of “patient-centered care”: “The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care.”  It doesn’t quite resonate like, “Let patients control their own health care dollars, pick their own doctor, and make their own health care decisions,” does it?

Instead, under Berwick’s notion of patient-centeredness, hospitals would no longer limit who could visit patients, what food patients could eat, or what clothes they could wear; patients and families “would participate in the design of health care processes and services”; and patients and family members “would participate in rounds.”  So, you could wear whatever you want, eat whatever you want, and apparently follow doctors around on rounds.  You just wouldn’t get the drugs or treatments needed to keep you alive. 

In a London paper, Dr. Sarah Anderson, an NHS ophthalmologist, writes of her dad’s battle with the NHS amidst his battle with cancer: “I never for a moment thought that a life could be decided by something as arbitrary.”  She elaborates, “Yet that is what has happened to my father.  And it is only now, sitting on the side of the patient, that I have seen the injustice inherent in our system and the devastation it can cause.” 

NICE refused to fund the drug her father needed.  Her family responded by trying to pay for it out of pocket, but, she writes, “the NHS told us that if we pay for the drug the NHS will not pay for any of his care.  All blood tests, scans and doctors’ visits will have to be paid for as well.  The NHS will wash its hands of him.”  Dr. Anderson concludes, “If Dad should lose his life to cancer, it would be devastating[,] but to lose his life to bureaucracy would be far, far worse.”

In marked contrast, Berwick — who writes that “we know dependence on market forces for constructive change is playing with fire” — gushes that the British “NHS is not just a national treasure; it is a global treasure.”

Now President Obama and Dr. Berwick want to open that “global treasure,” or similar riches, on this side of the pond.  There are really only two reasonable explanations for this:  one, an ideological zeal for centralized planning; two, a personal desire to be in control of that planning.  We hear a lot about the dangers of the “profit motive.”  This is the far more dangerous “power motive.” 

Tocqueville warned of this motive, sagely writing, “One can easily foresee that almost all the ambitious and capable citizens that a democratic country contains will work without respite to extend the prerogatives of the social power, because they all hope to direct it one day.  It is a waste of one’s time to want to prove to them that extreme centralization can be harmful to the state, since they centralize for themselves.”

Thankfully, the real power in America still lies with the people — as it always has.  And five simple and salutary words can free us from Obama’s and Berwick’s destructive designs:  Repeal, and then real reform.

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