By Richard Amerling, M.D.

Since our Imperial President installed Donald Berwick at the head of the Center for Medicare and Medicaid Services (CMS) in the dead of night before the July 4 weekend, bypassing even so much as a hearing, the American people know little about him. They have not been helped by the mainstream press, with a few exceptions.  Yet this man will have a profound effect on how health care is delivered in the years to come. What can we expect from him, and how can we prepare?

We’ve heard his anti-free market, pro-big government sound bites, his “love” for the British National Health Service and their central rationing board, the National Institute for Clinical Excellence (NICE). But what has he actually done that qualifies him for this position and why was the President so eager to grab him?

For one, Donald Berwick is already an accomplished bureaucrat.  He’s been toiling for years as CEO of the Institute for Healthcare Improvement (IHI; www .ihi.org).  Lawrence A. Hunter, Senior Fellow at the Institute for Policy Innovation and Chief Economist at the Free Enterprise Fund reports that Dr. Berwick’s annual  salary averaged $600,000, jumping to $2.36 million in 2008, a year the non-profit ran a >$600,000 deficit! Where was Kenneth Feinberg?

Dr. Hunter writes that IHI receives about $40 million yearly in grants, fees and consulting contracts from managed care companies, academic medical centers, hospitals and healthcare foundations, many of which are “already participating or seeking to influence boards and panels established by ObamaCare to cut Medicare spending, ration new technologies, and only pay doctors when they meet the government’s definition of quality care.” 

Available from the IHI website is a white paper entitled “Reducing Costs Through the Appropriate Use of Specialty Services.”  This document is a roadmap showing where Dr. Berwick and his ilk will be driving us. They begin with the claim that 30% of health costs ($700 billion) can be eliminated without reducing quality!  The source quoted for this claim is a paper presented at the National Quality Forum in 2008 that I will thoroughly deconstruct in a future Op-Ed. For now, let me state that while there certainly are cost savings to be had, the notion that a handful of geniuses could possibly bring this about without loss of quality is beyond arrogant—it’s delusional.

They state, “payment incentives such as fee-for-service are a strong driver of overutilization.”  Well, not exactly. Fee-for-service is what ensures the prompt availability of care, rather than long waiting lines. It is the third party payment system that leads to unrestrained consumer demand and overuse of services. Careful, your bias is showing! The authors decry variability in utilization of services and quote a paper by Atul Gawande, “The Cost Conundrum.” The idea that variations in care and use of services is somehow bad pervades the groupthink of the central planners. There is no evidence for this, just as there is no evidence that applying rigid standardized care improves hard patient outcomes.

How will standardized care be implemented?  One route will be the electronic health record (EHR).  They cite the example of HealthPartners in Minnesota who, in order to cut down on the use of high-tech imaging procedures “incorporated appropriateness criteria for radiological tests into the EMR as a reminder to primary care doctors.” 

There will also be a “primary focus on changing professional practice culture through the engagement of physicians in developing and implementing practice standards. The framework derives partly from known principles and methods of guideline or protocol development.” They suggest starting small with “selective, smaller scale efforts to reduce overuse,” as this will “prepare the local culture for broader changes in the future.”

There can no longer be any doubt that this is what the future holds should ObamaCare survive the dozens of legal challenges. The underhanded recess appointment of this devoted central planner confirms our grim predictions. There is also no question this approach will fail, and fail on a grand scale. There will be shortages, dislocations, more massive bureaucracies, huge cost overruns, and what may be an irreversible loss of quality. Along the way, thousands, if not millions of patients will be harmed.

The only way to prevent this scenario, barring regime change, is if enough patients and physicians abandon this sinking ship and create a true free market for healthcare. This is the safe route to deliver high quality care and control costs.

 Richard Amerling, MD, is a nephrologist practicing in New York City.  He is an Associate Professor of at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center.  Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981.  He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania.  He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians’ Declaration of Independence (http://www.aapsonline.org/medicare/doi.htm).