Let’s be honest. President Obama’s recess appointment of Donald Berwick as the Medicare and Medicaid director was a ploy to get a controversial character past any scrutiny by Congress and the citizens of the United States. He didn’t want a confirmation hearing because he didn’t want Berwick’s views to be heard. Surprise, surprise.

It shouldn’t be, notes the WSJ upfront, not for anybody following Obama’s handling of his social agenda.

White House respect for the public’s health-care views dropped another notch yesterday, if that’s possible, with its recess appointment of Donald Berwick. Circumventing Senate confirmation to appoint the new Medicare chief is part of the same political willfulness that inflicted ObamaCare on the country despite the objections of most voters.

Even [Democrat] Max Baucus, the Senate Finance Chairman, issued a statement critical of this end-around. President Obama claimed Republicans were stalling the appointment “for political purposes,” but Mr. Baucus hadn’t scheduled hearings and the nomination paperwork wasn’t even finished 11 weeks after he was named.

So the stall was in the Democratic controlled Senate, though even Baucus didn’t wind up having the control he thought.

Mr. Obama’s real calculation was to dodge a debate in election season over Dr. Berwick’s frequent praise for European health systems that ration care. The last thing most Democrats want now is to reprise the ObamaCare controversy.

Too late.

It raises serious concerns that never went dormant in the first place.

“As if shoving a trillion-dollar government takeover of healthcare down the throat of a disapproving American public wasn’t enough, apparently the Obama administration intends to arrogantly circumvent the American people yet again by recess-appointing one of the most prominent advocates of rationed healthcare to implement their national plan,” McConnell said.

McConnell criticized Democrats for not holding a confirmation hearing for Berwick and said they were avoiding the tough questions about the pro-abortion health care bill and its rationing components and Berwick’s views on them…

Also, pro-life Sen. John Barrasso of Wyoming called the move “an insult to the American people” that makes “a mockery of [Obama’s] pledge to be accountable and transparent.”…

Michael Tanner, a senior fellow at the Cato Institute, wrote about the problems with Berwick in an opinion column at the Daily Caller in May.

Recalling that opponents of the government-run health care bill were blasted for bringing up “death panels,” Tanner writes: “But if President Obama wanted to keep a lid on that particular controversy, he just selected about the worst possible nominee.”

In his comments lauding the British health care system, Tanner says “Berwick was referring to a British health care system where 750,000 patients are awaiting admission to NHS hospitals.”

“The government’s official target for diagnostic testing was a wait of no more than 18 weeks by 2008. The reality doesn’t come close. The latest estimates suggest that for most specialties, only 30 to 50 percent of patients are treated within 18 weeks. For trauma and orthopedics patients, the figure is only 20 percent,” he writes.

“Overall, more than half of British patients wait more than 18 weeks for care. Every year, 50,000 surgeries are canceled because patients become too sick on the waiting list to proceed,’ he continues.

“The one thing the NHS is good at is saving money. After all, it is far cheaper to let the sick die than to provide care,” Tanner adds.

Berwick has said as much, though in more nuanced and convoluted terms.

In an influential 1996 book “New Rules,” Dr. Berwick and a co-author argued that one of “the primary functions” of health regulation is “to constrain decentralized, individual decision making” and “to weigh public welfare against the choices of private consumers.”

Read this closely. And get this…

He then recommended “protocols, guidelines, and algorithms for care,” with the “common underlying notion that someone knows or can discover the ‘best way’ to carry out a task to reach a decision, and that improvement can come from standardizing processes and behaviors to conform to this ideal model.” And guess who will determine the “best way”?

Those who calibrate the algorithms for care, presumably.


There isn’t a single “ideal model” in a world of treatments tailored to the genetic patterns of specific cancers, or for the artificial pancreas for individual diabetics, or other innovations that are increasingly common.

This is nonetheless where Dr. Berwick, in his bureaucratic wisdom, will look for his “savings.” It is also where his personal view of the “public welfare” will have the power to trump the mere “choices of private consumers.”

He has presented his personal views more starkly than in that book. He is candid and assertive, too.

Berwick specifically looks to the National Institute for Clinical Excellence in Britain as a model, with its measure of “quality adjusted life years.” In Britain, they estimate that a year of your life – adjusted for “quality,” (i.e., meaning how sick you are), is worth about $45,000. If you’re too old or too sick to justify the cost, you’re denied treatment.

Berwick said of this system: “Cynics beware, I am romantic about the National Health Service; I love it. All I need to do to rediscover the romance is to look at health care in my own country. The NHS is one of the astounding human endeavors of modern times. Because you use a nation as the scale and taxation as the funding, the NHS is highly political.”

Not only does he love rationing, but he rhapsodizes about politicizing health care decisions.

So this comes up in a White House press conference when

a reporter from CNS News wanted Gibbs to respond to a question about whether Obama was really confident about Berwick given some of his comments.

Berwick said in a speech delivered on July 1, 2008 that “Excellent health care is by definition redistributional.”

“Among the controversial comments that he’s made in the past that would have come out in a Senate confirmation hearing are that ‘excellent health care is’—‘excellent health care by definition is redistribution,” said CNSNews.com. “Some of the others were mentioned. Does the president actually agree with that comment?”

Gibbs evaded the question, saying, “Look, this is somebody who is uniquely and supremely qualified to run an agency that is important to our government, it’s important to seniors, it’s important to implementation of the new health care law.”

The reporter persisted.

“But does the President agree with the previous statement?” asked CNSNews.com in a followup, but Gibbs again avoided answering and accused the reporter of playing politics.

“I know that this is the exact type of political game that the American people have come to understand dominates Washington and doesn’t actually make their health care more affordable,” he said.

Diversionary tactic, that. Not a fine exchange for this administration and its spokesman.

“You just read comments,” said Gibbs. “Is there like a secret comment book that somehow you got that nobody else got, and you just read a couple of them to me–and somehow they wouldn’t have come out? Did he say things like, ‘rationing happens today; the question is who will do it’? Did he say that? Did he say that?”

In triumphal conclusion…

Gibbs then claimed the comment was made by pro-life Rep. Paul Ryan, a Wisconsin Republican who is a leading critic of Obama’s health care scheme.

Hold the ‘ta-da’.

However, Ryan was asking a question in a Washington Post interview, saying he worried government would ration: “Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?”

But who’s fact-checking?

As the Journal noted, health care rationing is a given.

The White House doesn’t bother to disagree. According to a “topline message points” document on his nomination that we obtained, “The fact is, rationing is rampant in the system today, as insurers make arbitrary decisions about who can get the care they need. Don Berwick wants to see a system in which those decisions are transparent—and that the people who make them are held accountable.”

The people who can write such things with a straight face believe there is no difference between rationing through individual choices and price signals and rationing through politics and bureaucratic omniscience.

There’s a big and consequential difference.

We should be able to honor human dignity and provide access to health care for all, eliminating no one. But that’s the idea, that a moral society eliminates no one in order to provide health care to the rest.

Sheila Liaugminas

Sheila Liaugminas is an Emmy award-winning Chicago-based journalist in print and broadcast media. Her writing and broadcasting covers matters of faith, culture, politics and the media....