After President Barack Obama installed Dr. Donald Berwick as head administrator of Medicare and Medicaid by recess appointment, Press Secretary Robert Gibbs was asked at the daily press briefing if it would have been politically troublesome in an election year to have all these comments aired out about rationing, redistribution that Dr. Berwick had talked about in the past.
Gibbs was ready for this question, though, and shot back: Did he say things like, rationing happens today; the question is who will do it? Did he say that? The bait laid, the reporter responded: That was one comment. The trap sprung, Gibbs pounced: Actually that was Paul Ryan. That was Paul Ryan. Hes a Republican in Congress. The White House press corps roared with laughter.
Gibbs may have won that round, but today Berwick is scheduled to testify before the Senate Finance Committee, and conservatives will have their first chance to question the bureaucrat in charge of implementing Obamacares many changes to the Medicare system. Hopefully Berwicks past statements will not dominate the hearings but instead serve as a jumping-off point to shine light on the vast new powers Obamacare granted the federal government.
For starters, in June 2009, Berwick told Biotechnology Healthcare: The decision is not whether or not we will ration carethe decision is whether we will ration with our eyes open. And right now, we are doing it blindly. For comparison sake, here is the full version of the Gibbs-truncated Ryan quote from a 2009 interview with The Washington Post: Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?
Notice the fundamental difference between these two quotes? Ryan is asking who should ration care: individuals or the government. But Berwick just assumes the government has to ration care and is only concerned with how best to do it. And why does Berwick just assume that government should be rationing care? Well, here is what he said in July 2008 celebrating the 60th year of Britains National Health Service: 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.
And empowering leaders to enforce the proper configurations of our health care system is exactly what Obamacare does. In a statement to the Senate Republic Policy Committee this September, Heritage Foundation senior fellow Robert Moffit wrote:
Under [Obamacare], there are 123 sections of the law dealing with various aspects of the Medicare program, ranging from changes in fee for service payment for hospitals, skilled nursing homes and home health care agencies, to major reductions in payment for Medicare Advantage plans. As noted, under the original Medicare law, federal officials were explicitly forbidden to interfere with the practice of medicine. With the new law, it is not at all clear how physicians will be able to retain their traditional autonomy in the delivery of care, particularly under new compliance and reporting requirements related to the provision of quality of care, as determined by federal officials, and the existing restrictions on private contracting and balanced billing.
Moffit then goes on to detail how Obamacares Independent Payment Advisory Board, the Physician Quality Reporting Initiative, and the laws directive to move away from fee-for-service medicine all empower Washington bureaucrats at the expense of doctors and patients. Over 60 years ago, Nobel laureate Friedrich Hayek wrote in his essay The Use of Knowledge in Society: This is not a dispute about whether planning is to be done or not. It is a dispute as to whether planning is to be done centrally, by one authority for the whole economic system, or is to be divided among many individuals.
Obamacare is the largest power grab by central planners in Washington away from the many individuals in America in a generation. Health care does not have to be delivered this way. Moffit outlined such a vision in September:
There is a better way: Bottom up. Under this approach, the key element of health care reform would be to restore the traditional doctorpatient relationship and re-arrange the way in which health care is financed. If doctors control the delivery of health care, the patients should control the financing. So, the key ingredient in creating a value-based health care system would be to transfer direct control of the flow of health care dollars to individuals. This would create a patient-centered, consumer driven system. It would be the kind of system, based on real choice and robust competition, that would deliver what is of value, not as value is defined by either government officials or third-party administrators in the private sector, but as desired by the patient in consultation with his physician. Ideally, individuals and families should control every red cent spent on health care, as they do in virtually every other sector of the economy, where consumers make an exchange of dollars for goods and services of value to them.
We can have a bottom-up, not top-down, health care system where individuals have much greater personal choice because they would control their health care dollar. But that system can never come about under Obamacare. If the American people want to be the ones making their own health care decisions, not unelected leaders like Berwick, then priority number one is the full repeal of Obamacare.