Cross-posted at Forbes’ On the Docket

News came from the White House on July 6 that the President used his recess appointment power to install Dr. Donald Berwick as Administrator of the Centers for Medicare and Medicaid Services (CMS).  Dr. Berwick is a Harvard doctor and professor, but of particular interest and concern is his chairmanship of the non-profit Institute for Healthcare Improvement and the platform it has provided for his views on expanding government control over personal medical decisions.

Dr. Berwick has spoken and written approvingly about how nations such as England use health economists and aloof metrics like “quality-adjusted life years” to contain costs and ration health care.  England’s National Institute for Clinical Health and Excellence (“NICE”) applies “comparative effectiveness research” (“CER”) and a complex formula to recommend for or against national health care expenditures.  The Wall Street Journal has written that except in rare circumstances, for instance, NICE dictates that “Britain cannot afford to spend more than about $22,000 to extend a life by six months.”  In an interview last year with Biotechnology Healthcare, Dr. Berwick applauded such antiseptic calculation as “very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments.”

CER is gradually being injected into public and private calculations of which medical products and procedures should be paid for and which should not.  Last year’s federal stimulus law allocated $1.1 billion for government-run CER, and the health care reform law creates a process to institutionalize CER.  By law, CMS is prohibited from doing cost-effectiveness analysis, but as The Legal Pulse has previously noted, the ethic of factoring cost into coverage decisions permeates the agency to the point where its employees have conducted their own, independent research on the cost of certain drugs.

Dr. Berwick has commented on where CER fits into national health care policy. When asked by Biotechnology Healthcare whether comparative effectiveness research will lead to rationing of health care, he responded rather pointedly:

 The social budget is limited. . . .The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.

Rationing, of course, is the hallmark of a government-run health care system, an approach of which Dr. Berwick seems to approve.  He wrote in 2000 in the British Medical Journal , “We think nationalized health care was a wise choice [for England] in 1948 and that it remains so now.” (via Weekly Standard)

Pediatric surgeon Hal Scherz perfectly captured the deep, disturbing flaws this institutionalized approach to health decisions, writing this past May:

 Dr. Berwick will not be there with us at the patient’s bedside looking them in the eye and telling them that the life saving treatment that they need is not approved because they don’t fit into the right demographic.

CMS’s Administrator oversees an agency with an $800 billion budget (larger than the defense department’s), coverage responsibility for over 100 million people, and a primary role in implementing the president’s vision of health care in America.  Does the man now at the helm of this critical government entity still believe that nationalized health care is ideal, or that CER can rightly lead to care rationing?  These are fair, and fairly important, questions which our elected representatives will not be able to ask.  Dr. Berwick can remain Administrator, unconfirmed, until the end of 2011.