By Jane M. Orient, M.D.,

Transformer-in-Chief Obama is rolling right over Congress to appoint his pick to head CMS, the agency that runs Medicare and Medicaid, without opening a discussion of the New health care agenda.

Dr. Donald Berwick is not a newcomer; he’s been hovering with the academic elite “reformers,” biding his time, for more than a decade. His book New Rules, with coauthor Troyen Brennan, was published in 1996.

The Old Rule, in the Oath of Hippocrates, is that each physician should prescribe for the good of each patient, according to his own best judgment. The New Rule is that medicine is an industry, doctors are assembly-line workers, and patients are interchangeable widgets.

On an assembly line, individual craftsmen do not trim individual wheels and axles to fit. Any wheel taken off the shelf must fit any axle. Allowing individual workers to solve problems at the point of production would cause variation and waste. Hence, the workers’ behavior must be standardized, Berwick writes.

To his dream of using the industrial model of Total Quality Management to standardize medical care, the biggest impediment is the old-fashioned doctor. Such a doctor wants to tailor the treatment to the patient, for the maximum benefit of the patient, not jam the patient into a protocol, for the good of the collective. The decision making of independent physicians, Berwick says, is the “critical element in health care inflation.” In other words, caring about patients costs too much.

In addition, with its emphasis on individuals, America “lacks sufficient redistributive impulse to guarantee access to care for the poor.” That means we need to take care away from those who are getting “too much” to give to others deemed more needy or worthy.

Does it appear that ObamaCare will drive independent doctors out of business? That’s the whole idea. Berwick wants us all in an “integrated” institutional model, which some call “an HMO on steroids.” This is designed to shift the power from physicians—and their patients—to a higher level.

Berwick likes the view from 30,000 feet. He can’t bomb the system from there and start over, as he reportedly has advocated, metaphorically speaking. From the pinnacle of CMS he can, however, shift resources around to eliminate “disparities,” demand mountains of electronic data on his desired “outcomes,” and use the data to “cull” the noncompliant or “outliers”—the patients and doctors who don’t fit into the Plan.

From this height, one can rhapsodize about the “fair” and “scientifically grounded” 60-year-old British model without seeing the ugly details: blood-soaked patients lying in the accident room unattended for hours; elderly patients literally starving to death on hospital wards because nobody feeds them; or cancer patients undiagnosed for months and denied the latest treatments.

It isn’t quite accurate to call Berwick “Dr. Death.” That sounds like Dr. Kevorkian, who “helped” give lethal injections to individuals when they decided they wanted to die. Berwick’s method is to redistribute the patient’s life support, including wealth that might be used to buy medical care, to others, when Berwick, or his scientific calculator, decides the appropriate time has come.

Maybe he should be called “Dr. Pain.” The rationing agency of the British National Health Service—which he calls a “global treasure”—decided last year to cut annual steroid injections for severe back pain to 3,000 from 60,000. That takes pain shots away from 57,000 patients.

Berwick knows that rules and regulations stymie innovation, and generate a huge burden of meaningless busywork, without any proof of better quality or safety. His prescription, nonetheless, is more regulation. Only this time, the regulation will be “responsive”—he never says to whom. But now he won’t have to respond to congressional inquiries before he gets installed.

As a book reviewer pointed out in the New England Journal of Medicine in 1996, the New Rules can’t pass their own tests. They are not evidence based.

That is, there is no evidence that they will decrease costs or improve care.

But transform society? If there was any doubt about the true agenda for “health care reform,” Berwick’s appointment has erased it. The New Rules will bring about the New System that Berwick’s ideological comrades have been trying to force on America since the 1940s—with government dependency and subjugation for all.

Jane M. Orient, M.D., Executive Director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University of Arizona College of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943. Complete curriculum vitae posted at www.drjaneorient.com.