Berwick’s Evasions on Single Payer
Under questioning from Chairman Camp, CMS Administrator Don Berwick refused to admit whether or not he remained “in love” with Britain’s National Health Service – and whether or not he agreed with his prior statement defining a “a single-payer mechanism as the only sensible approach to health care finance I can think of.” He tried to evade the question by claiming that each country needs its own solution on health care, and that he favored a “uniquely American” approach. The only problem with that statement is that Dr. Berwick has a LONG history of positively comparing the British single-payer health care system to American health care – and frankly denigrating the US health care system. (A sample of those quotes follows below.)
If he can’t answer a simple question whether or not he is “in love” with single-payer, why should any American be reassured that Dr. Berwick – who now controls (directly or indirectly) the health insurance coverage of EVERY American – will be able to keep their current plan, or won’t be subjected to top-down diktats from federal bureaucrats in Washington?
“In the US, we need to think about populations, about teamwork. It is an uphill battle because we are so individualistic and have built such fragmented systems. When I go to the NHS, I see a kind of dream.”[1]
“Both the UK and the US are struggling to improve their troubled healthcare systems. Which is more likely to succeed? The two countries are strikingly similar in the problems they face, and equally dissimilar in their plans of action. I am a fan of both but, when bets are place, my money will be on the UK.”[2]
“The cost of health care…has been maintained in the United Kingdom at a remarkably low level…Though it has taken its share of criticism for its queues and rationing choices and for the development of a privileged private care market, the NHS remains overall a system that compares favorably to the American system in its commitments to equity of access and cost control.”[3]
“As for my optimism about the NHS—sorry, Richard, I simply can’t help it. I do meet many leaders, in whom I have great faith, but I also meet many of the dedicated staff and patients, almost all of whom continue to be incredibly loyal to a pathfinding system of care that the United Kingdom started a half century ago. They are smart enough to know a good thing when they have it, even while they demand that it get better. I would trade the UK’s NHS, warts and all…for my nation’s health care chaos any day.”[4]
“I lose friends on this, but I think a lot of the other systems around the world, in the UK, Canada, Scandinavia, they’re far better models than we have. They consolidate payment, they make public plans for progress, they’re able to make changes and they’re able to move resources around more easily than we can.”[5]
[1] “A Case of US and Them—The HSJ Interview: Don Berwick” by Paul Dempsey, Health Service Journal April 10, 2003
[2] “The Improvement Horse Race: Bet on the UK” by Donald Berwick, Quality and Safety in Health Care 2004; 13, p. 407.
[3] “Quality Management in the NHS: The Doctor’s Role—I” by Donald Berwick et al., BMJ January 25, 1992, p. 235
[4] “Would the NHS Benefit from a Single, Identifiable Leader? An E-mail Conversation” by Donald Berwick, Chris Ham, and Richard Smith, BMJ December 20-27, 2003, p. 1424
[5] “Re-Engineering Health Care” by Pat Kiernan, CNNfn, June 6, 2002