Medicine

The Wit & Wisdom of Dr. Donald Berwick, Your New Medicare-Medicaid Jefe

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Paging Dr. Giggles!

Ladies and germs, meet your new bureaucratic head of Medicare and Medicaid, Dr. Donald Berwick, Harvard's latest train wreck of an appointee:

"Please don't put your faith in market forces," he said (italics in original).  "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 healthcare system you want and need. In the US, competition is a major reason for our duplicative, supply driven, fragmented care system."

Berwick argued that purposely provided an inadequate supply of health-care—as Britain's health-care system does—is superior to allowing the market to provide an excess.

"In America, the best predictor of cost is supply; the more we make, the more we use—hospi­tal beds, consultancy services, procedures, diagnostic tests," Dr. Berwick wrote.  "… Here, you choose a harder path. 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."

That's from a 2008 journal article praising Britain's NHS, the public-sector equivalent of K-Mart.

And there's this, too, which reads like a blurb on the Big Book of British Smiles or the tag line to the Nanny McPhee sequel:

"Cynics beware, I am romantic about the National Health Service; I love it. … The NHS is one of the astounding human endeavours of modern times."

More here.

NEXT: Free Trade and the Deregulation of Genetically Modified Foods

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  1. I find little evidence that market forces relying on consumers choosing among an array of products, with competitors fighting it out, leads to the healthcare system you want and need.

    Translation: I have not bothered to look for the evidence, thank you very much; my mind is already made up.

    1. No, he’s thought about it. The key is the phrase you want and need
      people want everything, and they want it for free. He is correct, the market cannot provide that.

    2. Citation, please.

      Show me your vaunted “evidence”. In particular, I am interested in evidence that adverse selection will not completely FUBAR private health insurance.

      1. Chad,

        Adverse selection is only a problem when insurers are either unable to gather sufficient medical information on applicants, or are required to set premiums for groups of applicants rather than individuals.

        In either case, there will be discrepancies between the insured’s actual risk (known only to himself) and the premium charged. Those discrepancies will be exploited by applicants who will opt in or out depending on their situation.

        A free market would allow insurers to screen everyone individually and set individual premiums based on that specific individual’s risk factors. No information asymmetry, no pricing discrepancies, no adverse selection.

        1. To add to that, plenty of low risk people will still purchase health insurance, although they may never need it, which helps to cover those who do.

      2. And since you asked for evidence of unrestricted consumer choice and a competitive industry delivering healthcare outcomes which achieve both quality and accessibility…

        I present to you the highly successful laser vision correction industry.

        Since its introduction laser vision surgery has operated entirely in a free market, and has served millions of satisfied customers (myself included), while prices have fallen consistently due to innovation and competition.

        1. Because all medical care responds in the market just like an elective procedure available as a luxury to those who can afford it.

          1. Do you have a right to those elective procedures and paying for them with other people’s money? Do you have a right to my labor if you have a hernia in need of repair?

          2. Vision correcting surgery is a good example because vision correction–in a manner that requires the continuous purchase of new lenses is NOT elective–it’s a covered expense.

            The surgical procedure is getting better and cheaper with every passing year…yet insurance companies only cover the procedure that addresses the symptom rather than the one that addresses the problem.

  2. So I have to ask…

    How much damage can one administration do? Even if the Repubs gain in November, shit looks like it will still get worse.

    This is starting to become absurd.

    1. “This is starting to become absurd.”

      Has Harvard always produced such grossly incompetent alumni? This administration raises serious questions about intellectual standards there.

      1. My sister works at Harvard Med – she got her Ph D. elsewhere.

        The answer to your question is YES. She told me of one doctor in her 70’s that was an adviser there until recently. She told my sister: “The gross incompetence at this place has become institutionalized and is now unfixable.” She now serves on MIT’s advisory board.

      2. My grandfather is spinning in his grave at the thought of incompetent “Hahvahd” alumns.

        (fun fact) Hell, the guy who invented the red igniter button on grills was a Harvard student.

      3. Has Harvard always produced such grossly incompetent alumni?

        You raise a good point….the rule of thumb was that Harvard produced grads who went on and fucked the business/private sector while Yale produced grads who went on to fuck up the public sector.

      4. TR, FDR, JFK, GWB, BHO. Not a good track record.

  3. In America [sic], the best predictor of cost is supply [sic]; the more we make, the more we use [sic] ?hospi?tal beds, consultancy services, procedures, diagnostic tests,” Dr. Berwick wrote.

    Supply is not a predictor of cost.

    1. Do you think people were ordering MRIs for headaches in 1972?

      In ’72, you got a history, a neurological exam, and a painkiller.

      Now that there’s more to do, more gets done. Medicine has moved from cheap and largely ineffective to expensive and moderately more effective, largely through an increased supply of diagnostic and theraputic options.

      1. Re: Oswald Acted Alone,

        Do you think people were ordering MRIs for headaches in 1972?

        That has nothing to do with the availability of MRIs. There is no denying there’s a big supply of pizza, yet how many pieces can a person eat without getting sick? Cost is a fuction of demand, not of supply.

        1. I can only eat 4 pieces of pizza.

          That’s why I tell the pizzeria to cut the 18″ deep dish pizza I order into quarters.

          Perhaps if I told them to cut it into 72 pieces they could charge me 24 times as much because the supply of pieces is so much larger.

          1. …because medicine has not become more effective in improving outcomes during the last century?

            1. …but it has? So your point is fucked? Yes?

          2. Don’t be silly. You could eat four pieces, but there’s no way you could eat 72 pieces. [Channeling Yogi Berra]

            1. 7 times 13 equal 28, and I can prove it two different ways.

              1. Hey! Those are MY proofs, you lousy piece of shit! Some partner you are. I’m never doing that stupid-ass “Who’s on first” bit with you again, asshole.

        2. Cost is a fuction of demand, not of supply.

          Actually, cost is a function of both. You remember all those cute little macroeconomic graphs where the supply of butter line crosses the demand for butter line, don’t you?

          And the demand for some things is functionally unlimited. How long do you want to live? How healthy do you want to be?

          The answer to both being, for the vast majority, as long and as healthy as possible.

          1. Well, I do know that my Harvard economics degree tells me that:

            1.) You mean price, not cost. Cost is a function all its own. In essence, the market supply curve is a derivation of the individual cost curves of the individual producers in the market

            2.) You mean microeconomics. Macro is shit like interest rates and taxes and aggregate demand and foreign trade the like

            3.) The demand for certain health care treatments is not the same thing as demand for health. Conflating the two a big source of our troubles today (i.e. insurance isn’t healthcare isn’t health)

            4.) The word you are looking for when you say “functionally unlimited” is “elasticity”

            Otherwise, that’s an outstanding economic analysis there. Please stick around and enlighten us some more.

          2. Pricing mechanisms are microeconomics.

            So ya.

            Guns and butter is a production possibility example.

            1. I should read the posts after and I won’t repeat what others have said.

        3. Cost is a fuction of demand, not of supply.

          So you’re saying increasing supply won’t result in lower prices?

          Decreasing supply won’t result in higher prices?

          Huh?

      2. Well fuck me. I’m going to start producing t-shirts by the billions. I’ll be a millionaire in not time as long as I keep producing them and the supply continues to grow.

        God my forehead can’t take posts like this.

        1. I’ve found that a nightly exfoliation will decrease the incidence of acne formed from repeated facepalms.

        2. Healthcare is not a t-shirt. Everyone gets ill and dies, and everyone wants to prevent that outcome as long as possible.

          1. Everyone owns a t-shirt. The t-shirt market is huge, think of the supply I can build up that will drive the price through the roof!

            You are either confusing the effect of technology on price with supply or have some new understanding of economics that no one else has stumbled upon. I’m leaning toward the former.

          2. Healthcare is not a t-shirt. Everyone gets ill and dies, and everyone wants to prevent that outcome as long as possible.

            Sure,

            But run that whole increased supply doesn’t lead to lower prices thing by me again.

            I mean,
            Yeah, everyone wants the great healthcare, no doubt.

            If that is provided by only 20 doctors in all the land then only Bill Gates and his crew will be able to afford those doctors.

            With 2 million doctors the price will be affordable by more people.

            With 100 million doctors, prices would be quite cheap.

            1. No, no, no.

              Health care isn’t like anything else we buy. I have a right to the best health care available because the people I help elect to office tell me so!

              Supply? what’s that got to do with anything? Gimme, gimme, gimme!

            2. Not if all 100 million doctors believe they should be rich regardless of the deman for their services. Herein lies the true issue…

            3. So you intend to pay for training that million doctors ? Or do you plan to pass out diplomas and let the market sort them out ? Cost of education has gone up 100 times since I graduated from medical school. We are now close to the point where the personal economics don’t work for kids who would like to be doctors.

              I have a niece who could have gotten accepted to medical school but she didn’t want the debt. She is a very good and very well educated nurse right now. The system is about to collapse and Obama just gave it a big shove.

              Berwick is a very smart man but he has never, never (!) worked in a private setting. He thinks every doctor gets his/her salary from a university, or something.

          3. Everyone except for suicidal types.

      3. In ’72 the doctor wasn’t sued because the 1 in a million headache patient went on to have a brain tumor. Now we do 1,000,000 MRIs to help prevent a lawsuit.But hey, we don’t want tort reform, the tort lawyers are the largest donors to the Progressives if you don’t count union scum.

      4. Doctors don’t order an MRI for your headache because the hospital has an MRI, rather because in the 1 in 10,000 event that your headache is a symptom of something horrible that might be caught by the MRI, failure to order one will become “incompetence” and “malpractice” later on.

        In other words, doctors order MRIs for headaches because juries are stupid.

  4. Yeah we got healthcare perfect in the USA. Yay US!

    2x per capita for worse results, obviously we are on the right track.

    1. Soon to be 3x no doubt . . .

      1. Oh no, no, no…reducing supply while increasing demand *always* brings down costs, right?

        1. Yes because as we learned up thread price is set by supply.

          I’m going to be fucking rich!

    2. Let’s just ignore cultural factors which account for the difference in health outcomes!

      1. and genetic factors.

    3. What worse results?

      When you normalize for the higher murder rate, more sedentary life style, and exclude the premies that other countries leave out of infant mortality stats, and the U.S. starts looking pretty good.

      And all this despite the insane restrictions on supply thrown up by the FDA & AMA dominated state medical boards & the regulations & tax incentives that add massive unneeded costs to the mix.

      If I poured sugar into your car’s gas tank the engine would not last very long; If I used its failure as an indictment of gasoline powered engines, you’d probably think me a self serving fool.

      Only in the politics of medicine are the wreckers held to be wise.

      1. and exclude the premies that other countries leave out of infant mortality stats

        My understanding is that this point stopped being true some time ago. I cannot recall the author’s name now, but I kept hearing about this infant mortality discrepancy and finally tracked down the original paper that made this claim. If memory serves, the metric for what to count as a live birth had been normalized across countries sometime between the original publication and present day. If I recall, the US still had a higher infant mortality rate.

        1. What is the percentage of black females in those countries I wonder.

          1. Iatrogenic death is one reason why America’s state of health is so poor. Shouldn’t death by allopathic medicine, physician fuck ups, nurse fuck ups, etc. be a dispositive factor in assessing the performance of a society’s health?

            1. Oh jeez -> nobody practices ‘allopathic’ medicine anymore; There is science based medicine and woo.

              The only people I hear bleating about modern medicine are the magical distilled water swillers aka homeopaths.

            2. Iatrogenic death is one reason why America’s state of health is so poor.

              I hope you can come up with something better than those shitty IOM studies to support that statement.

        2. With two “if memory serves” and a “my understanding is”, forgive me if I don’t accept your recollection at face value. Link, cite, or it’s not true. Besides, I seriously doubt it’s just a paper that made that claim — that information is verifiable or refutable with a very simple search of public records.

          And unless other countries count late-term miscarriages as infant deaths, there’s no way to correct for the higher rate of premies delivered in the US.

          1. The exclusion of any high-risk infants from the denominator or numerator in reported IMRs can be problematic for comparisons. Many countries, including the United States, Sweden or Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to United States Centers for Disease Control researchers,[6] some other countries differ in these practices. All of the countries named adopted the WHO definitions in the late 1980s or early 1990s,[7] which are used throughout the European Union.[8] However, in 2009, the US CDC issued a report which stated that the American rates of infant mortality were affected by the United States’ high rates of premature babies compared to European countries and which outlines the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[6][9][10] However, the report also concludes that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.[10]
            http://en.wikipedia.org/wiki/I…..lity_rates

            Not to mention that just calculating the longevity numbers excluding homicide victims changes the numbers substantially. And finally, because the death of an infant or child has a much greater affect upon ypll (years of potential life loss) and longevity, using longevity as a surrogate for health care performance is fraught with circumstances that would be contrary to good sense (e.g., changing the definition of a live birth in the US).

      2. Only in the politics of medicine are the wreckers held to be wise.

        There, better.

    4. Yet another maroon who thinks the US healthcare system is some sort of pure free market, and any problems it has are due to that.

      1. It’s just the most free market. And not coincidentally the worst.

        If you need a perfect free market before you can show results, then I’ll take an imperfect socialized system, since that’s far more likely than your fairy tale world ever coming to pass.

        1. then I’ll take an imperfect socialized system,

          You’ve already got it… pre-Obama.

          1. Exactly. And “the worst” is ridiculous. It ignores, among other things, medical innovation and the fact that people come here from all over the world for medical treatment.

        2. Its not close to being the most free market. And we don’t need a perfect free market to show results, because we can point out examples in this country where the market for certain health services is freer, and work well. And we can point to specific policies that manipulate the market and show how they have fucked up and reduced demand and raised costs and killed people.

          Now fuck along and go die, you little piece of flamboyant shit.

    5. Yeah we got healthcare perfect in the USA. Yay US!

      2x per capita for worse results, obviously we are on the right track.

      You know it’s really funny how progs love to denigrate US healthcare on those grounds, despite it being the best in the world.

      Yet I never hear any similar complaint about our education system. Which is horribly expensive (DC’s up to 20,000 per kid per year) and absolutely crappy.

      Why do you suppose that is?

      1. They run the schools so spectacularly well, they think they deserve a stab at running the health care system.

  5. I can’t decide which I hate more, this guy’s opinion itself, or the end-run that kept his opinion from getting more media exposure before he was appointed…

  6. This nation is being run by madmen.

    1. It’s not polite to call the mentally challenged mentally ill. That isn’t very PC.

      1. This isn’t mentally challenged – I’d wager every one of them would score about 1400 on an SAT. This is delusion, an absolute belief in something that isn’t true.

    2. Unelected madmen.

  7. Romantic about the NHS? The NHS won’t even provide a reach around.

    1. Yes, I will. You just have to get on the waiting list with the others.

  8. “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”

    I hereby nominate Dr. Donald Berwick for the Nobel Peace Prize for Friggin’ Insanity.

  9. That’s funny, I find little evidence that “leaders” with “plans” will lead to the healthcare system that I want and need. Namely, one that provides high-quality services on demand, where I can arrange to finance my health care as I see fit.

    Name one country where this has occurred, Berwick. Just one.

    1. don’t look here

    2. “leaders with plans”… that quote could be applied with so much derision to so much of what government does.

      I’m putting that one in the tool belt.

  10. At least he’s gone in 2011. That doesn’t mean Obama can’t find worse by then.

    1. Only if he fails to get confirmed after a two year incumbency all the while Obamacare gets popular by handing out “free” (your) money.

  11. Fuck yeah! He’s perfect. And brilliant: consumer choice and competition haven’t provided for any of mankind’s wants and needs. What blind fool would suggest such a silly notion. As I look around the room at everything constructed and produced (almost all of it with that evil Devil’s liquid pertoleum no less), I think free markets are for suckers. This new Hope and Change is kick ass.

  12. Big Book of British Smiles

    A book with no teeth, that.

    1. Ha! The glorious NHS is to blame for bad British teeth? Who woulda thought?

      The weird thing is, whoever wrote that blurb sounds oddly proud that NHS dentists are only concerned with preventing your teeth from rotting out of your head.

      1. Aren’t crooked teeth harder to clean and thus more likely to rot out of you head?

      2. It’s all a cunning plan to keep bureaucrats from reproducing.

  13. a harder path

    Or maybe a march of some kind.

  14. Maybe this passage from the article explains better why he gets a free pass by the administration:
    “You could have protected the wealthy and the well instead of recognising that sick people tend to be poorer and that poor people tend to be sicker, and that any healthcare funding plan that is just must redistribute wealth,” he said. “Britain, you chose well.”

    Is this bumper-sticker reasoning really what passes for the best of academia? Or is this all some big practical joke?

  15. “”? Here, you choose a harder path. You plan the supply; you aim a bit low; you prefer slightly too lit?tle of a technology or a service to too much; then you search for care bottlenecks and try to relieve them.””

    At least the administration is starting to be honest about deliberately creating bottlenecks.

    1. Bottlenecks are good.

      1. Especially when they’re jagged and being jammed into your fat little throat.

  16. 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.

    If there 100 ready buyers of life saving widgets and we restrict the production of widgets to 90, we will select 10 buyers who will not get the widgets.

    1. Yes, and those 10 who don’t will wish they’d joined a lobbying group that had given me money.

      1. Absolutely, instead of rationing based on the fairer notion of your ability to pay, it will now be based on a politician’s or bureaucrat’s willingness to pay for you. That’s comforting…

        1. You can trust me to make the right decision.

          1. We’re working on a solution.

            1. You mean a final solution?

    2. By amazing coincidence, the 10 buyers who will not get the widgets failed to vote for me, or are bitter clingers, or live in the wrong state.

  17. “then you search for care bottlenecks and try to relieve them.”

    As long as he promises to try, that’s all we can ask.

  18. Ahh yes, the perils of “wasteful competition.”

    Where have I heard that before?

    “All our industries will receive their motive power from a common source, capable of supplying them all adequately. This will eliminate wasteful competition in the quest of fuel, and place manufacturing enterprise on a sound economic footing, without which we cannot hope to achieve a full measure of interchange of essential products in accordance with Communist principles.”
    – V. I. Lenin
    http://marxists.anu.edu.au/arc…..eb/20b.htm

    1. Once we’ve eliminated all the wastefully redundant railroads, we’ll charge a commission with studying how to make the handful of remaining trains run on time.

  19. Barack, Barack, Barack! We’ve been frew this a dozen times. I don’t have any weapons of mass destwuction, OK Barack?

  20. “Cynics beware, I am romantic about the National Health Service; I love it. ? The NHS is one of the astounding human endeavours of modern times.”

    Oh man, this guy is fucked in the head.

    What is the curriculum at Harvard? Maybe a frontal lobotomy, followed by four years of ass raping, and disassociative drugs.

    Jeezuuss, I would call these Harvard fucks retards, but that would be an insult to retards. The Ivy League is just a repository of trust fund mental deficients, an expensive government experiment to provide jobs for the idiot sons of the rich.

    1. At least most people who praise the NHS claim to like it despite it’s shortages, not because of them.

    2. As the father of a retarded kid, I really appreciate that. And I can’t think of a more deadly appointment as far as my girl’s concerned.

      1. It’s freaking scary that they let these dull minded twits out of academia and into positions of real power.

        They really think that their pedigree affords them a superior moral wisdom which justifies the meddling into the affairs of us proletarians.

        Someone with a disabled child has every reason to be afraid of these eugenics loving freaks.

    3. Well, don’t want to sound like a dick or nothin’, but, uh… it says on your chart that you’re fucked up. Uh, you talk like a fag, and your shit’s all retarded.

      1. Fuck off, coward. If you can’t reply with an handle that you use all of the time then move to Britain, and get HIV, see how well they treat you…chickenshit honkey.

        AIDS would be to good for you, you coward(yes, I repeat myself). How about Cushing’s syndrome for you and any progeny you are lucky enough to spawn. Yes, I hope your children are terminally ill fat freaks…now go and google Cushing’s syndrome. Idiot.

        I hope your hiding behind a spoof handle ass dies a horrible death, motherfucker.

        Excuse my language, as I am a proletarian and that is the parlance of my station…bitchface.

        1. Hi. Have you seen me?

          1. See directly below, spoofy.

            1. yes, right here ?

      2. Ah, fuck you spoofy…

        Don’t worry, scrote. There are plenty of ‘tards out there living really kick-ass lives. My first wife was ‘tarded. She’s a pilot now.

        Took me awhile.
        I don’t hope that you get HIV, but I am serious about the kids and Cushing’s.

  21. as a regular lurking but rare poster I’ll step into it.

    I like and respect Dr. Berwick for what he’s done in the quality field.

    We’ve (health care) certainly seen demand go up as the supply of (hospital beds, MRI’s, orthopedic surgeons ..) increases.

    Now, of course, unlike T-shirts the “customer” doesn’t pay for the (hospital bed, MRI …). Its not a “normal market”. But of course we’ve apparently gone “too far” to transfer all of the costs of healthcare to the customer.

    Will Berwick improve Medicare? Who knows? But I would hope that he considers having Medicare not pay for things that are clearly ineffective. Unfortunately, the regs are such that the doc and patient can’t easily agree to a financial arrangement in such a case.

    1. gods you’re dumb.

      “We’ve (health care) certainly seen demand go up as the supply of (hospital beds, MRI’s, orthopedic surgeons ..) increases.”

      Let’s ignore the idiotic mistakes in grammar, diction, and syntax for now.

      If people are infected with disease X, and someone develops a cure Y. The amount of Y that you produce(supply) will not cause the number of infected people to increase(demand).

      Causality’s a bitch, ain’t it? Yes, if you look at a graph, both supply and demand increase, without a time reference, you can’t tell which is driving which.

      Just because the price of a lobotomy drops by 50% doesn’t mean that I’m going to want one…

      1. Just because the price of a lobotomy drops by 50% doesn’t mean that I’m going to want one…

        The way things are going, I might consider that a deal…

        ignorance is bliss, and I’d love me some bliss right now.

      2. If people are infected with disease X, and someone develops a cure Y. The amount of Y that you produce(supply) will not cause the number of infected people to increase(demand).

        Life. A sexually transmitted disease that is 100% fatal.

        In all seriousness, though, you’re not quite right. What happens is that medical technology does not just influence treatment, it influences diagnosis. When you proliferate diagnostic technologies knowledge, you proliferate therapies as well. And as each therapy becomes more targeted, it becomes more expensive. A drug developed to treat millions is going to cost much less per pill than one that treats thousands. Macular degeneration is an excellent example of this. Another would be the various types of myeloid leukemias, which have differing treatments based on a number of factors including cell membrane proteins, morphology, and cytogenetic alterations. A diagnosis that could be made on a $2 blood smear fifty years ago (and then treated with a handful of minimally effective drugs) now costs several thousand dollars, with a proportionate increase in the therapy bill. Specialization scales with treatment and technology, and then drives further scaling.

        …and that’s without touching on the fact that doctors tend to do more procedures when they have income competition…

        1. Ok, you told me that we can diagnosis and treat more people with better technology. That’s great, but it’s not the issue.

          The issue is how those procedures are paid for. And as someone pointed out above, creating different TYPES of treatments, etc doesn’t increase SUPPLY, it just increases available options.

          The purpose of my argument above is to illustrate that there’s a cap on the number of sick people, suffering from any medical issue, that we are not in control of – no matter how many MRIs we can run, tests we can do, vaccines we can administer, etc.

          1. “there’s a cap on the number of sick people,”

            Except when we make up new illnesses like “low T”, have wonderful new (though a tad expensive) pill for it and insurance coverage to soften the blow.

            1. And Medicare shouldn’t cover a pill for “low T”

              1. “I have ‘Low T’ and I VOTE!!”

      3. “If people are infected with disease X, and someone develops a cure Y. The amount of Y that you produce(supply) will not cause the number of infected people to increase(demand).”

        Your equating healthcare utilization with disease. The “my patients are sicker” rationale hasn’t generally panned out.

    2. Of course increased supply makes demand go up when consumers and suppliers can get someone else to pay for it. The problems of American medicine aren’t due to the “free market,” they’re due to government interference and the tragedy of the commons.

      Also, note that the country somehow managed to survive for quite a while before Medicare was invented.

      1. Of course increased supply makes demand go up when consumers and suppliers can get someone else to pay for it.

        Well, yes, this is the rub. But I’m sure Berwick knows it.

        Also, note that the country somehow managed to survive for quite a while before Medicare was invented.

        And your point is? You’ll find few people here longing for an 18th century standard of living.

        1. If medicare is repealed, it’s not like medical advances disappear, au contraire, the incentives to innovate will increase.

        2. You’ll find few people here longing for an 18th century standard of living.

          Dude, you’re a fucking brick.

          Medicare is not the cause of medical innovation. Medicare is just another inefficiency in the system. The healthcare industry would exist irrespective of Medicare and all of the innovations from the past 100 years would still be here.

          Holy shit.

          1. True. And how much better and cheaper would medicine be if providers had been competing on price and service for the last 45 years, instead of assuming insurance companies and government would pay for it?

            (Note to Oswald A.A.: Medicare is from the 1960s, not the 1700s.)

    3. “We’ve (health care) certainly seen demand go up as the supply of (hospital beds, MRI’s, orthopedic surgeons ..) increases.”

      Perhaps the demand was always there. Which would indicate that the supply is still too restricted to meet that demand. Which means there’s a huge pool of potential customers looking to purchase your goods and services, or those of your competitors. This is a “problem” most industries dream of having.

  22. This is insane. He is actually arguing for socialism- not in some watered-down European sense, but full-on central planning.

  23. There is NO evidence that we have increased supply.

    We have more TYPES of tests, more TYPES of consultancy, more TYPES of procedures. The TOTAL SUPPLY has DECREASED, in part because there are fewer doctors and fewer hospitals per capita.

    This PIECE OF SHIT loves the NHS because it pay incompetent doctors more money for less work. I suppose the less work incompetent doctors do, the better, but paying them more won’t make them go away.

  24. It looks like you have to be a subscriber of BMJ.COM to get the context of Berwick’s quotes. You’re assuming if was referring only to government supplied health care.

    1. Oops. if > he. That was in reply to c3.

  25. “I am romantic”. He ain’t all bad.

  26. But does the NHS have a KWash or a K-Cafe?

  27. I demand an apology, from someone, for this sentence:

    “Berwick argued that purposely provided an inadequate supply of health-care?as Britain’s health-care system does?is superior to allowing the market to provide an excess.”

    1. Yeah, does this person have an editor? Maybe their editor went to Harvard.

    2. It’s amazing how a sentence changes with the (im)proper application of commas.

    3. Change “provided” to “providing” and it works.

  28. “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….”
    This is a truly *amazing* comment from someone who (I guess) was conscious as the Soviet Union imploded and the ChiComs admitted the failure of their central planning approach.
    Further, where does he think the advances leading to the current state of medical science came from? Pixy dust?

    1. I don’t think he’s talking about the entire economy. And the research into many of those advances was in large part paid for by the government.

      1. Yesss, tax the shit out of the economy, divert soem of the taxes into scientific research, thereby crowding out private funding sources for research, then point to that state of affairs to demonstrate we need government for research to continue.

        By that argument, Jaycee Dugard should be grateful to her kidnapper – without him she wouldn’t have had any children…

  29. I retract any previous statements on this thread until H&R’s own “Dr. Giggles” chimes in with his twisted wisdom.

    I’m lookin’ at you, Groov.

    1. Thanks cap l. Twisted? Hmmm…

      I think, however smarmy Dr. Berwick comes off, and he is definitely of the statist doctor variety (in my experience, pediatricians are very paternalistic and statist prone: who else could effectively vaunt the phrase “think of the children” with more efficacy?), Obama made a good choice here.

      Yes, this is the real Dr. Maximus, so pick yourself off the floor and allow me to clarify my statement. CMS is going broke, simply put. In a true free market providing medical care, not everyone will have access to high level care and the market will cater to those who can find a way to pay, by either OOP or private third pary insurance. And by insurance, I mean you purchase a policy before you get sick. FDR, LBJ, and Teddy Kennedy have done their evil work well by insulating and divorcing patients from the true cost of care; and the crony colleagues that came before me, in collusion with lawyers, who bilked CMS with bogus claims, padding DRGs (diagnosis related groups), and other fraud should have been a red flag then. Dr. Berwick, however monstrous I personally find his view of the delivery of medical commodity (and yes, all you “right to health care” types, it is a commodity) he brings home a very cogent point, although I don’t think it was intentional.

      “In America, the best predictor of cost is supply; the more we make, the more we use?hospi?tal beds, consultancy services, procedures, diagnostic tests,” Dr. Berwick wrote. “? Here, you choose a harder path. You plan the supply; you aim a bit low; you prefer slightly too lit?tle of a technology or a service to too much; then you search for care bottlenecks and try to relieve them.”

      I give credit where credit is due, this guy is at least honest and upfront about his socialist wet dreams; however, what Dr. Berwick fails to consider here is the market is indeed the best allocator of resources to the greatest number of people; Dr. Berwick has inadvertently exposed that markets work, just not the way he wants them to. What Dr. Berwick (and I very strongly suspect that Dr. Ezekiel Emmanuel is not far from this scene; Dr. Berwick makes for a much more palatable spokesperson and czar) essentially realizes is that dispensation is only part of the equation here. Attrition of the elderly and greatest users of healthcare is the immediate response, but must be coupled with “preventative care” e.g., the state (according to Elena Kagan is entirely permissible) tells you what you can and can’t put into your body, thus enforcing compliance with a given TX regimen. It is all about control, not what you and your doctor (and your insurance company, may you continue to rot in hell Teddy “HMO” Kennedy) decide is the best course of TX for your chronic disease process, should you have one.

      If I had the opportunity to ask Dr. Berwick three questions, I would ask:

      1) “Dr. Berwick, please explain in detail to me why MassCare is a success and why you truly believe we should emulate it nationally? Please justify cost overruns.”

      2) “Dr. Berwick, as a practicing physician, would you demonstrate good faith by immediately enrolling both you and your immediate family, as well as the entire body of both this administration and Congress in such a scheme and foregoing any and all access to private care?”

      3) “Dr. Berwick, as I am practicing physician who no longer accepts CMS, would you force me, by proxy of the state medical board, force me to treat CMS patients and infringing upon my private practice?”

      1. Very good analysis, and questions.
        Though this is how I suspect Dr. Berwick would answer:

        1.) Masscare has increased health coverage to x% of the popullation in that state. The problem we have is people gaming the system. For this, I would advocate a cradle to grave government healthcare system such as the NHS, or increased penalties up to and including jail time for people who refuse to purchase health insurance.

        2.)As it stands now, no I wouldn’t, because of the obstructions of various political factions, and lobbyists, in this country implementing a fair system of treatment has been impossible. If the right elected officials were to implement a plan in the U.S. similar to the NHS, then I would happily enroll my family into such a system.

        3.)Yes, at the point of a gun.(but with more obfuscation and evasion)

        1. “Obama made a good choice here.” Must be your Canadian girlfriend working her magic on you. “..who no longer accepts CMS”. For Christ sake, your “I am leaving CMS” countdown was annoying enough

          1. Well then, far be it from me to offend or annoy anyone of the Reason commentariat. My Canuckette works magic, but good here is in the context of exposing both the true intentions of this administration and the fallacy of Obamacare. Perhaps you have heard of damning with faint praise, no?

      2. who no longer accepts CMS

        Missed this, Groov…congrats are in order. Here is an internet beer.

        1. Don’t worry about it, he’ll remind you every post…

          Global warming is a fraud, and I’m no longer accepting CMS

          War on drugs is idiotic, and I’m no longer accepting CMS

          Paul Krugman is an ass, and I’m no longer accepting CMS

          Obama is a disaster, and I’m no longer accepting CMS

          1. Well, you ice imp from from a freezing hell, at least you are both accurate and consistent!

      3. 3) “Dr. Berwick, as I am practicing physician who no longer accepts CMS, would you force me, by proxy of the state medical board, force me to treat CMS patients and infringing upon my private practice?”

        By refusing to treat CMS patients, you are interfering with interstate commerce. See Wickard v. Filburn.

  30. This guy must be the Joe Arpaio of the medical proffesion. He has that mixture of smarminess and arrogance that makes bile start to collect in my throat.

  31. Come on people, Obama promised everyone health care coverage, not health care services.

    1. A friend once said to me that assured coverage is worth dying for.

    2. You mean “coverage” like the sheet they cover you up with at the end of the line?

      1. And you get a free tag for your toe.

  32. Sounds reasonable to me dude.

    Lou
    http://www.web-anonymity.au.tc

  33. Wow. The guy is a supposed “rationist” and cost cutter and libertarians jump his ass for it.

    Medicare needs to be chopped free of fat.

    1. No, it needs to be chopped free of freeloaders.

      1. Better yet, and consistent with your assent to my assertion that we need to just be done with all those who seek to lord over us, it just needs to chopped dead.

    2. Hmmmm with him making statements such as any healthcare funding plan that is just must redistribute wealth, you wonder why?

      1. But that is the truth.

        Look at private health insurance. Benefits are redistributed from the healthy payors to the ill payees.

        1. Yes, it’s called voluntary risk pooling. You’re betting that your health costs will be greater than your payments. The insurance company is betting the opposite.

          Until recently, I could choose whether or not I wanted to play.

          Medicare/cade, OTOH, is simple wealth redistribution at the end of a gun. You don’t get to choose to play.

          1. True – but they are not going away.

            Instead. I deal with reality.

            If this site were about nothing but 0% taxes and no federal spending then reality has become a victim to libertarian fantasy.

            Which – is probably true to many of the disillusioned here.

            1. Hey shriek, would you mind reading some Lewis Carroll poetry out loud for me, maybe Jabberwocky? I have this feeling that you have the perfect tone for it.

              I bet you have a vorpal sword.

              1. Brillig !

            2. True – but they are not going away.

              Instead. I deal with reality.

              Good for you. You win a cookie.

              Seeking to end a wasteful and immoral system such as Medicare is not unrealistic. It’s only at odds with the current politcial reality.

              I deal with realistic and actual solutions instead of magic hand waving and upside-down thinking, such as in the case the esteemed Dr. Berwick, to make the problems go away.

              You don’t make an evil system only a little less evil and pat yourself on the back for a job well done.

              1. You’re nuts if you think ending Medicare is realistic.

                As a Darwinist I even give you the “immoral” part.

                But you hit your head on the deep end.

                1. “Hey folks! We nibbled around the edges and changed pratically nothing! But we claimed that it was historic reform.”

                  Yeah, you’re a fucking hero of reality, shriek.

                2. You’re nuts if you think that hope and change can provide for Medicare into eternity. News: It IS going to end– through reform or through collapse (guess which I hope for), it mathematically cannot be sustained.

                  1. No. Our (mostly elderly GOP) voters will sustain Medicare via the ballot box.

                    Its the last demographic the rancid GOP can count on.

                3. I’ll tell you why I bother. Because sometimes I change somebody’s mind. A real change where they see that this country has immense potential locked up in it’s individuals. That Government stiffles the talents of the People, through regulations that make no sense, Government programs where the Governmant has no business, unjust drug laws, out of control police, to name a few problems.

                  I don’t argue for no Government, but a Government that plays by the rules laid down. Historically, it was just a blink of the eye since men decided they were the best ones qualified to live their lives, and for the first time threw off the yoke of despotism and declared themselves free.

                  We’ve backslid over the years. Had good times, better times and worse times. But if I can make just a few people aware of what I see, then over time things can change. It took thousands of years the first time. I don’t expect change tomorrow, but eventually.

                  I want to leave The U.S. a better Country.

                  I believe in the immense power of the American People acting in a socially and economically free manner.

                  1. @ Cunctator 10:01PM

                    *stands up, starts slowly clapping

            3. @shrike
              So you admit that your philosophy is only that which because “they are not going away”?

              Insanity..

        2. You mean the same way auto insurance takes money from safe drivers and “gives” it to drivers who’ve had accidents?

          What is this “insurance scheme” anyway?

    3. You really don’t understand what a libertarian is, do you?

      1. shriek doesn’t understand what sanity is, so asking him to understand what a libertarian is is probably asking too much.

      2. But we are stuck with Medicare.

        The libertarian position is to rightly kill it. Instead I prefer to deal with political reality.

        You may join the libertarian circle jerk at the 2% party line.

        1. shrike|7.7.10 @ 8:43PM|#
          “But we are stuck with Medicare….”
          Until the money runs out….

        2. Everyone dies eventually.

          Yeah, I love my sister, and the ethical position would have been to respect her human worth and autonomy. Instead, I prefer to deal with situational reality– she wouldn’t stop whistling, so I shot her in the face.

          Principals be damned.

        3. I too, deal with political reality.

    4. shrike|7.7.10 @ 8:08PM|#
      “Wow. The guy is a supposed “rationist” and cost cutter and libertarians jump his ass for it….”
      Yeah, and Obama was “supposed” to be a centrist.
      But to lefties, any appearance or intent is superior to *any* result.

    5. When he chops your medical care, see how happy you’ll be.

      That is, if you are around to see.

  34. I own stock in Dendreon. Its prostate cancer drug costs $93,000 and only extends life an average of 16 months.

    Should Medicare pay for it?

    I don’t know the answer but as a lobbyist for DNDN I would say yes.

    1. You really don’t understand what a libertarian is, do you?

      1. His roommate in college read part of the first chapter of “Atlas Shrugged” and they talked about it once, so he figures he’s got it covered

      2. But Berwick might say NO to the $93k of taxpayer expense which would then provide support to the paranoid right-wing death panel freaks.

        And that would be the libertarian position (on Medicare) – to cut costs!

        Yet you’re too much of a pussy to agree with that.

        1. I should know better…

          And that would be the libertarian position (on Medicare) – to cut costs!

          No, it would be to kill it and leave that decision to the market, a real market, and not the clusterfuck that the pols have deigned to give us.

          Yet you’re too much of a pussy to agree with that.

          You’re just too insane to agree with that.

        2. No, you really don’t get it. The actual libertarian position is a free market in health care and no such thing as government run, market distorting, wealth transferring programs like Medicare. But you’re too much of a pussy to come to even imagine that.

          1. Medicare sucks.

            But you live in fantasyland where there is no Medicare.

            Grow up.

            1. I was born into and lived in a USA without Medicare for many years, and can well remember how it was. Most of the history of this country happened prior to Medicare. It is not unthinkable, or unwishable, that we will someday (even someday relatively soon) no longer have Medicare. Reality is what it is, but people changed it to bring us Medicare, and people can change it again to scuttle that program and replace it with something better — preferably a real free market in health care products and services.

              Everyone thought the Soviet Union would last forever, too. But one day, it was gone.

              1. But, But…PET scans!

                Ha! You lose.

                This^ is what we are working against, and losing.
                Life is sad.

              2. So which will happen first?

                End of Medicare? Or fixing costs?

            2. I wont get a chance to “grow up,” because this guy will see to it that we get “Medicare for All!” And then, I’ll die. Because, I’m a guy who got well over $1 million worth of heart surgery for congenital defects while on PRIVATE insurance from a series of entry level hourly wage jobs just out of college. I paid my premiums and co-pays (about $5000) and they took care of the rest. I was treated by some of the best physicians in the country, and I got to live past 30 without going bankrupt, thanks to those HMOs and PPO’s. That system, screwy as it is, worked for me.

              And while I’m in great shape now, the surgery I had was invented only the year I was born, and no one is sure quite how long these valve repair and replacements will last. Some people’s are still ticking right along 30 years later. Others have required repeated replacements over the years. This guys wants to make sure that there’s not enough supply to allow me to get that care if I need it when I’m say, 60. He wants to look at people like me and say “well, we can’t fix EVERYTHING, and you’re pretty old now and not going to have taxable income much longer, so sorry, we can’t afford your operation.”

              That’s the menace of government run and rationed healthcare. That’s what “cutting costs” means. They’ll take my money by force my whole life, and then when I need something more than a band aid, I’ll get the shaft. If there’s even a heavily regulated market alternative still available by then, I might be able to get the care I need if I can access my retirement savings and then only if there’s enough left in there after IRS withdrawal penalties to pay the tremendous taxes that this guy is planning to levy against private health care on top of the doctor’s fees. But then I’ll be broke, but I’ll have subsidized this bastard’s “romance” with central planning. At least in that scenario, I wont have anything left for the damned death tax to take.

              1. “He wants to look at people like me and say “well, we can’t fix EVERYTHING, and you’re pretty old now and not going to have taxable income much longer, so sorry, we can’t afford your operation.””

                Plus, you’re unlikely to vote for his ilk, living or dead. The people who have been receiving tax revenue from you to subsidize their health care will. The cynicism never stops.

              2. We might have to let you die. It’s all about taking the hard path.

        3. shrike|7.7.10 @ 8:50PM|#
          “And that would be the libertarian position (on Medicare) – to cut costs!
          Yet you’re too much of a pussy to agree with that.”
          And you’re too much of a brain-dead ignoramus to even make a comment about what a libertarian position would be.

    2. So will all the gov’t employees.
      Hell, it increases their turf.

    3. I own stock in Dendreon. Its prostate cancer drug costs $93,000 and only extends life an average of 16 months.

      Should Medicare pay for it?

      I don’t know the answer but as a lobbyist for DNDN I would say yes.

      We say no.

      1. Death panels!

        1. Both of you need to be put on an ice floe.

          1. Administered by Progressive Flo.

      2. Just to expand on the “altered market’ of healthcare, let me juxtapose the above issue (“What’s the value of a drug that cost $93,000 per year for one extra year of life) with this issue from last year:

        The US Preventative Services Task Force reviewed the literature and concluded that routine screening mammography for women under 50 didn’t provide significant benefits. The hue and cry that ensued included comments such as “anti-women” and “death panels” but the one that caught my ear was “a government agency getting between a doctor and his/her patient”. Now the USPSTF has no authority to recommend payments based on their findings but lets say that all insurance companies decided, based on their data, that they would no longer pay for routine screening mammography for women under 50. I’m sure the demand would continue. I’m equally convinced that the price would easily drop to around $50. And son of a gun, that cost would virtually eliminate any insurance entity (public or private) getting “between a doctor and her patient regarding a personal health decision”

        So in the case of the expensive end of life drug and the relatively inexpensive screening test the third party payor “protects us” from making decisions based on how we individually value them.

    4. “Should Medicare pay for it?”

      No

    5. Ask yourself this question, shrike:

      Would you be willing to use all the money your child had saved for a down payment on his house, and his entire 401k, so that you could live an extra (likely miserable) 16 months? Becuase in reality, either you use the money, or someone of your child’s generation does.

      If you are a big enough asshat to screw your kid like that, you deserve the cancer. I will just die gracefully.

      1. The better question is: do you think one year+ of life with prostate cancer is worth $100K? If you do, you should fork over the money. If you don’t, then you should forgo the treatment and roll the dice.

      2. Chad 2009: “Death panels are a lie!”

        Chad 2010: “Why can’t you just die gracefully?”

      3. Ask yourself this question, cock knocker:

        Whose decision is that to make; mine and my parents or some petty tyrant that we’ve never even met?

      4. I am in favor of dying gracefully. But it is only graceful if you are allowed to make the choice yourself without any outside limitations or coercion. I agree that making the choice to forgo treatment to benefit your children is a decent thing to do. To force someone to do so is not.

  35. And he’s moved to ban outdoor smoking on Harvard’s vast med school campus/

    1. This is because he thinks it ‘should’ be banned and the market hasn’t done it.
      See?

  36. I think there’s a youTube floating around where this bloke also demands wealth redistribution.

    He’s a perfect fit for the administration.

    1. The irony is that when Joe the Plumber first raised the issue of redistribution he was viciously attacked for letting the cat out of the bag. It turns out that Joe was right.

  37. wtf is up with the drugfreeworld ads, Reason?

    1. It’s not Reason. It’s Google. Google has decided that you have a problem.

      1. It’s those webcams. They’re watching you all the time.

  38. This is the rebuttal to Chris Matthews ridiculous predictions from this video.

    What is MSNBC’s Chris Matthews Thinking? http://mittromneycentral.com/2…..-thinking/

    Once you watch this video, you’ll be wondering the same thing. It’s baffling.

    1. Mitt would be a great candidate.

      He should run against O in the Dem primaries.

  39. “You plan the supply; you aim a bit low; you prefer slightly too lit?tle of a technology or a service to too much”

    WHAT! This just makes my head f’in hurt. Do these people have some sort of genetic disorder? I really can’t comprehend that level of stupidity. Thank good he’s not in charge of my booze supply. I’ll need as much as I can get having to listen to these morons.

    1. There is some sense to that, if you’re getting diminishing returns. The most expensive medical technology rarely adds much in either length or quality of life; there always being notable exceptions.

      1. Except today’s expensive technology is tomorrow’s aspirin.

      2. None of those concepts (e.g., diminishing returns, expensive) means anything without a market process/context from which they can emerge.

      3. I wonder if he plans to use that paradigm for the President’s medical care.

        “Sorry, Mr President, we need to do an MRI to figure out where the internal hemorrhage is, but the waiting list is three months long.”

  40. “Cynics beware, I am romantic about the National Health Service; I love it. ? The NHS is one of the astounding human endeavours of modern times.”

    No one that has ever had their family treated of the NHS wrote this sentence.

    1. Man, I hope one day we can look back and thank our lucky stars that no one with any brains was actually given power over us…as it made the revolution that much easier.

      Or, we will live in a suffocating dystopian nightmare.

      Yeah…probably the latter, who am I fooling?

    2. Actually, nearly everyone I know who lives or has spent time in the UK has mostly good things to say about the NHS. Not that that means that the US should imitate it. But the fact is that quite a lot of people that use the NHS are quite happy with it.

      1. I have mostly good things to say about my personal experience with the US health care system. Why? I only deal with it every five years.

        I’m sure if I were sicklier, I would have plenty of complaints. I suspect that’s the case for your British friends, too.

        1. I am sure you are right. I was just responding to
          “No one that has ever had their family treated of the NHS wrote this sentence.”

  41. How much damage can one administration do?

    An unprecedented, historic amount.

  42. So how do we vote this guy out of office? Which senator confirmed him?

  43. That’s from a 2008 journal article praising Britain’s NHS, the public-sector equivalent of K-Mart.

    No, the public sector equivalent of the Post Office.

    Oh wait.

  44. I went looking for the full British Medical Journal article (dated 07/17/2008) but it’s behind a pay wall ($30 for one day’s access). But he also gave a speech at the NHS using what looks to be nearly identical text a couple of weeks after the article was posted. The speech is here:
    http://www.wales.nhs.uk/sites3…..;pid=32953

    Among the many ridiculous passages, here is the complete text to the one where he warns the NHS away from “market forces”:

    “Fifth, 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. I do not agree. I find little evidence anywhere that market forces, bluntly used, that is, consumer choice among an array of products with competitors’ fighting it out, leads to the health care system you want and need. In the US, competition has become toxic; it is a major reason for our duplicative, supply-driven, fragmented care system. Trust transparency; trust the wisdom of the informed public; but, do not trust market forces to give you the system you need. I favor total transparency, strong managerial skills, and accountability for improvement. I favor expanding choices. But, 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.”

    He really, genuinely believes that “leaders” (e.g. central planners) can do health care better and, critical to his thinking, with superior morality, than the market.

    1. “…trust the wisdom of the informed public; but, do not trust market forces to give you the system you need.”

      But, but, but… The informed public making their own individual decisions about what they need with that wisdom of theirs, IS THE FUCKING MARKET!

  45. Love Your Life
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  46. Something old
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  47. He really, genuinely believes that “leaders” (e.g. central planners) can do health care better and, critical to his thinking, with superior morality, than the market.

    Let me be clear.

    Dr. Berwick is The Right Man For The Job.

  48. The result of what this guy is saying is that we are not going to spend as much money as nesecary to care for the poor and elderly. As long as your not releying on the government for your healthcare this plan will trim the spending. As a tax payer this seems like an OK thing. At least until washington can take over all healthcare spending.

  49. In the US, competition is a major reason for our duplicative, supply driven, fragmented care system.

    I love how real life is converging to Atlas Shrugged. How many times did Wesley Mouch and the rest complain about wasteful duplication of services?

    1. I have been kind of thinking that since I reviewed the book about a year ago. Everything from the Orwellian double-speak and bizarro naming of laws to guys like this advocating full-on central planning, it really does seem like we’re at the precipice of a huge national choice – liberty or central planning.

      Sadness.

  50. Still think I’m too dumb to be prez?

    At least I know all these ivy league jerkoffs that O loves couldn’t find their own ass with both hands.

    Best and brightest?

    More like the smug and douchiest.

    1. Yes. Yes I do.

      Sorry – one variety of moron currently having power isn’t a good reason to allow another variety of moron into power.

      1. But she could be a leader with a plan.

      2. When in doubt, choose the moron most other morons hate.

        1. How about I choose “none of the above” and select someone who isn’t actually a moron at all?

  51. OK makes sense to me dude.

    Lou
    http://www.web-anonymity.au.tc

    1. I expect more from you, Anon-bot. You can do better, I’ve seen it.

  52. Let me be clear: Fuuuuuuck!

    I honestly don’t even know what to say anymore. Maybe I was too optimistic, but I never thought I’d be afraid for the future of this country. Apparently, I couldn’t see the writing on the wall.

  53. What a fucking cunt. Why do people allow harvard douchebags any credibility?

  54. I can find little evidence that we even have a duplicative, supply driven system, with all the market restrictions in place. Limits on amount of doctors, “certificates of need”, FDA over regulation, state mandates on insurance plans.

  55. Here is the most critical thing to keep in mind:

    The only reason he would claim that “excessive supply” is a problem is because the government has intruded upon the health care market to directly pay for or heavily subsidize health care consumption.

    Nobody worries about “excessive supply” or “duplicative services” in, say, the manufacturing of computers or cars. No one talks about “excessive costs” when talking about the manufacturing of computers or cars.

    Because everyone is paying for their own computer or car, having a lot of production and a lot of consumption of these things is not seen as a problem. In fact, it’s seen as a desirable state of affairs. “Yay! The economy is growing!”

    If we stopped saddling the taxpayer with the cost of health care, we would no longer have to worry about other peoples’ costs. In fact, dramatic increases in the production and consumption of health care would become a GOOD thing. “Look at the huge GDP increases we’re seeing from the health care industry!”

    As soon as the state starts paying for health care, every dollar expended on health care is seen as a loss. That is the lesson here. And it’s appropriate that they put this guy in charge, because he is at least intellectually honest enough to acknowledge that up front.

    1. Damn. Good. Point.

    2. very good point.
      charles hugh smith has a site I occiasionaly read, and he posted a bill from a maternaty ward from the late 1940’s. Seemed pretty reasonable prices (even in light of the fact that wages were far lower) because like any service or good, it made no sense to charge more than the market could bear. Now, with the backstop of gubermint, all the things medical science can think can be done, will be done because someone else pays for it.
      Whether it be denistry or lasik surgery, there are plenty of free market examples that provides what is necessary to most people. But in trying to make it perfect, rules will be made that will result in ridiculous outcomes, which is always the case with bureacracies. Procedures that are unnecessary will be reimbursed, and things that are critical will not be covered.
      And just as BP shows, there is an overwhelming goverment ethos to lie – not becuase the gubermint is evil – its much more banal – its government’s overwhelming urge to be liked, or act like it can solve problems.

      Government and BP “We’re in charge!” “We’re fixing it!” “We’re making BP fix it!” “We told BP to take the cap off!” “No we didn’t!!!”

  56. Apparently, Dr. Berwick has never entered a CVS or Walgreen’s drugstore. There are hundreds, maybe thousands, of examples of successful free market healthcare items in those stores.

    Or perhaps Dr. Berwick never heard of laser eye surgery, much dentistry, or most cosmetic surgery in which the free market has done an admirable job with no government interference or the need of costly health insurance.

    1. Those are just frivolous extravagances. You don’t need them. Take the hard path.

  57. “Leaders With Plans”…that could be a name for a band. Question is, what kind of music would they play? Glorious songs about the eventual triumph of socialism?

    1. I hear a stimulus grant request coming.

    2. Small minded fool. Leaders With Plans wastes no time with fragmented, duplicative services: They play only ONE song.

  58. In evaluating the virtues of the NHS, you have to distinguish between minor acute medical problems and major life threatening illnesses. For minor problems such as a routine bladder infection or bronchitis you may be seen promptly by a nurse practitioner and empirically prescribed a cheap antibiotic. You won’t get a fancy 4th generation drug with fewer side effects, just run of the mill amoxicillin or cipro or Bactrim. On the other hand, if you have cancer, it’s a different story. You may need to wait 6 weeks for a CT or MRI scan, 4-6 months for surgery or radiation therapy and certain types of chemotherapy may not be available. When you have a serious illness, you become a cost liability to the system and bureaucrats make the final decision about your care, not your physician. That’s what rationing is all about. Delays in initiating cancer care in the UK and Canada do have an impact on outcomes and survival. That is supported by published studies in the medical literature.

    1. That fits perfectly with what Berwick described:

      Here, you choose a harder path. You plan the supply; you aim a bit low; you prefer slightly too lit?tle of a technology or a service to too much; then you search for care bottlenecks and try to relieve them.

      Searching for care bottlenecks = just let some people die while waiting for treatment. Bottleneck, removed.

    2. That’s a good political strategy: gain the votes of a thousand flu sufferers, lose the vote of one cancer patient.

      1. Don’t worry, when we get universal single-payer Obamacare all those dead cancer patients will be voting Democrat. Win-win.

  59. One TRILLION dollars of health care costs are directly attributable to people who refuse to do what their doctors advise them to do, and/or they do not take their medicine.

  60. Let us not forget — this is about Obama and who he wants in this position as much as it is about the man in the position.

  61. In favor of the NHS, it does reasonable job of handling major life threatening problems. It is the intermediate stuff that is more difficult: problems that are painful, but not immediately life threatening often have long wait times. Fortunately, you can always “choose” to “go private” (meaning you pay out of your own pocket) to get better treatment, which does create a two-tier medical system.

  62. For minor problems such as a routine bladder infection or bronchitis you may be seen promptly by a nurse practitioner and empirically prescribed a cheap antibiotic. You won’t get a fancy 4th generation drug with fewer side effects, just run of the mill amoxicillin or cipro or Bactrim.

    This is no different from the US system, except that you might have a small copay for the visit and the amoxicillin prescription. The vast difference in aggregate costs between the US and other systems occurs in those with more serious illnesses.

    1. You might have a copay for the visit, but the antibiotic will cost just $4.

  63. Good thing Obama isn’t a socialist, huh? Can you imagine the people he might appoint if he was?

  64. Feast your eyeballs on some Newspeak comedy gold from the White House website:

    The new tasks and deadlines put in place by the Affordable Care Act call for exactly the kind of vision that has earned Dr. Berwick this bipartisan praise. His experience challenging health care institutions to improve makes him the right Administrator to set up the new Center for Medicare and Medicaid Innovation ? which will harness new ideas to strengthen seniors’ care while reducing the deficit and slowing the growth in costs.

    The Obama administration should update the slogan of their never-ending campaign to MAKE IT SO.

  65. True – but they are not going away.

    Instead. I deal with reality.

    Hitch your ride with a winner!

  66. It is outrageous that someone with Dr. Berwick’s long paper trail and expressed support for nationalized health care wasn’t subjected to public hearings. Another good commentary I’ve seen on this is at http://wlflegalpulse.com/2010/…..recess-2/.

  67. So, is Dr. Donald Berwick volunteering to be the one for whom there is just a little too little supply?

    If not then we know that what he really wants is less care for other people. because he’s so much more compassionate than evil capitalists, no doubt.

  68. I’m a social worker. I work with people with developmental disabilities. That includes things like: mental retardation, autism, cerebral palsy, etc. My clients were born with these conditions. They didn’t cause it and they can’t change it. They can’t provide for themselves. What shall we do with them?

    They require anywhere from $20,000-$400,000+ worth of care each year. That figure only represents their Medicare spending, it does not include their Social Security Disability benefits. They are a financial drain on society. They are (mostly) unable to do even minimum wage work. They represent an expenditure of resources with no clear return. Their families would never be able to pay what it costs to keep them alive, healthy and safe. They will never get better. They will just cost money every day of their lives. (My oldest client is 92 and has been a ward of the state since she was 6 years old.)

    I came across a fascinating paper tracing historical social attitudes in Germany leading up to the Nazi era. It discusses the origin of the phrase “life unworthy of life” and the mass killings of the disabled that ultimately resulted from that line of thinking. I HIGHLY recommend reading it. It’s 14 pages of dense text but I believe that it will be invaluable if you wish to participate in public discussions on rationing.
    http://www.regent.edu/acad/schedu/uselesseaters/

  69. I’ve already encountered the kind of thinking I’m describing here. One of my clients was a 60 year old with mentall retardation and schizophrenia. He needed heart surgery. He was living in a group home with 24 hour staff, so there was no concern about following the doctor’s orders. He was otherwise healthy and his local primary care doc told us that if the surgery was successful he would be likely to live another 10-20 years. He said that without the surgery he would likely only last a few months.

    He was sent to a larger hospital in a nearby city. The heart surgeon told his guardian that he (the surgeon) had an obligation to “preserve scarce medical resources” and that due to his diagnoses of retardation and schizophrenia that he would not be considered a candidate for surgery.

    I was horrified. This man wanted to live. He had a good quality of life and many friends. I was ready to go nuclear but he died of a medication reaction before I was able to take further action.

    While researching the medical ethics involved, I made anothe disturbing discovery. A significant percentage of organ donation programs consider a diagnosis of mental retardation to be an absolute contraindication for organ transplantation. Meaning that if Bob has a low IQ he’s just SOL if he needs a new kidney.

    Organ donation is an area of medicine where explicit rationing necessarily already occurs. It’s instructive to read what different attributes can be used to justify excluding people from those programs.

    It might be an interesting legal question to see how the government might square the Americans with Disabilities Act with any rationing decisions. Of course the DOJ enforces the ADA so I wouldn’t hold my breath. Though it will probably prevent them from being too blatant about it. They probably won’t have death panels. They may not have any panels. If the system is designed to include bottlenecks and delays then they can realize cost savings through the attrition (death while waiting) of the some of the most expensive users. The beauty of this is that they can claim that the “problems” were unexpected teething problems and that they’re working to solve the delays. After several years of symbolic attempts to “fix” the problem, the public will be resigned to it.

  70. BURWICK IS CERTIFIABLELY INSANE!

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