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Berwick and the NHS

A lot of the conservative opposition to Don Berwick appears to come from a speech he gave on the eve of the British National Health System's 60th birthday. In the speech, which you can read here, Berwick both praises the system lavishly, and offers up 10 ideas for reform.

And that seems about right to me. Conservatives have spent a lot of time and energy demonizing the British system, but the simple facts of the program endure: The British pay about 40 percent of what we do and get comparable results. As Berwick says, they hold costs down by constraining supply beneath what it should probably do, while the United States lets oversupply drive costs up. But it's hard to find much evidence that it's affecting their outcomes. Meanwhile, the system is wildly popular in Britain -- so much so that David Cameron, leader of the country's conservative party, said, “Tony Blair once explained his priority in three words: Education, education, education. I can do it in three letters — NHS.” As with Medicare in the United States, no politician -- including Margaret Thatcher -- dares suggest termination.

At the same time, Berwick's criticisms of the system seem correct, and his calls for reform seem to target many of the aspects of the system that concern conservatives, notably its tendency to let experts and bureaucrats tell patients what's best for them. Here's his first recommendation:

1. First, put the patient at the center – at the absolute center of your system of care. Put the patient at the center for everything that you do. In its most helpful and authentic form, this rule is bold; it is subversive. It feels very risky to both professionals and managers, especially at first. It is not focus groups or surveys or token representation. It is the active presence of patients, families, and communities in the design, management, assessment, and improvement of care, itself. It means customizing care literally to the level of the individual. It means asking, “How would you like this done?” It means equipping every patient for self-care as much as each wants. It means total transparency – broad daylight. It means that patients have their own medical records, and that restricted visiting hours are eliminated. It means, “Nothing about me without me.” It means that we who offer health care stop acting like hosts to patients and families, and start acting like guests in their lives. For professionals made anxious by this extreme image, let me simply remind you how you probably begin every encounter when you are following your best instincts; you ask, “How can I help you?” and then you fall silent and you listen.

And here's his third:

Strengthen the local health care systems – community care systems – as a whole. What you call “health economies” should become the core of design: the core of leadership, management, inter-professional coordination, and goals for the NHS. This should be the natural unit of action for the Service, but it is as yet unrealized. The alternative, like in the U.S., is to have elements – hospitals, clinics, surgeries, and so on – but not a system of care. Our patients need integrated journeys; and they need us to tend and defend those journeys. I believe that the NHS has gone too far in the past decade toward optimizing hospital care – a fragment – and has not yet optimized the processes of care for communities. You can do that. It is, I think, your destiny.

Conservatives have convinced themselves that the NHS is a terrible system, which I guess is their right. But insofar as Berwick is actually offering recommendations to government-run health-care systems -- and that's what he's doing here, and what he'll be doing at CMS -- his guiding principles seem fairly inoffensive.

By Ezra Klein  |  July 7, 2010; 12:42 PM ET
 
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Next: Majority rules?

Comments

The Post reports that he was nominated in April (http://www.washingtonpost.com/wp-dyn/content/article/2010/07/07/AR2010070700394.html?hpid=topnews), but a hearing was never scheduled. Any idea why there was a hold up? I assume that the Democratic Senate majority could have scheduled a hearing and that the hearing itself can't be filibustered?

Posted by: jnc4p | July 7, 2010 1:11 PM | Report abuse

As one step towards putting "the patient at the center," should we refrain from eliminating the "Patient Protection" portion when citing the PPACA? If it is wrong to call the PPACA "ObamaCare" or "the Obama/Pelosi Socialized Medicine Plan", why is it also not wrong to call the act by any other unassigned name?

Words -- such as those from Berwick -- seem so hollow when not matched with actions. We talk of putting the patient first, but instead put government and the will of the "majority" ahead of individual preferences, just as we talk of long-term deficit reduction while doing nothing to thwart overreach by the central authority.

Posted by: rmgregory | July 7, 2010 1:12 PM | Report abuse

I would like to see you address this point, whether you agree with it or not:

"5. Fifth, please don’t put your faith in market forces. It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can. I do not agree. I find little evidence anywhere that market forces, bluntly used, that is, consumer choice among an array of products with competitors’ fighting it out, leads to the health care system you want and need. In the US, competition has become toxic; it is a major reason for our duplicative, supply-driven, fragmented care system. Trust transparency; trust the wisdom of the informed public; but, do not trust market forces to give you the system you need. I favor total transparency, strong managerial skills, and accountability for improvement. I favor expanding choices. But, I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do."

Seems to be the complete opposite of Paul Ryan's approach.

http://voices.washingtonpost.com/ezra-klein/2010/02/rep_paul_ryan_rationing_happen.html

Posted by: jnc4p | July 7, 2010 1:25 PM | Report abuse

The problem with the idea of socialized medicine, and all other Utopian reforms, is they idealize the situation with the insane notion everyone will be working for the greater good. If that were so, there would be no such thing as reform, or need for it, in any aspect of life or in society.

It is common sense that some people in power will attempt to exploit that power to benefit themselves. While such is the case, and it shall remain so as long as man walks the earth, there will never be a true commune-ist society that works. It all looks great on paper: "put the patient first". But why should you have to set up government reform programs to accomplish this? Shouldn't the Hippocratic oath cover this? Shouldn't a work ethic provide most able-bodied people with money to go to the doctor if doctors don't charge too much? Shouldn't we just do it out of the kindness of our hearts if we are such an advanced society that we can regulate "care" (as in the feelings one human has for another). To "care" is something that cannot be regulated, no matter how big or democratic a government claims to be. It is an ideology that is fantastical and unrealistic.

Our government is trying to institute compulsory philanthropy, which is impossible. To whatever degree this could have been accomplished, in the form of the New Deal and welfare programs, it has nearly run its course with the patience of the American people.

To attempt to remain oblivious to what the American labor force (the people who pay the taxes and support the larger portion who don't, remember?) is concerned with is fallacious on the part of the representatives of said laborers. There is a time for reckoning coming up in the fall for those who have needlessly and shamelessly squandered our resources and set us upon this path to what seems like inevitable societal collapse.

We did not produce 'the Greatest Generation' out of this sense of mass apathy and lackluster national pride. The country will either go back to its roots and find a strength born of God-fearing patriotism and a reckoning with what we have become and what we must return to, or we will fall.

Posted by: TrinaLGrant | July 7, 2010 1:40 PM | Report abuse

"Conservatives have convinced themselves that the NHS is a terrible system, which I guess is their right."

I often get labeled as a conservative here (although sometimes I am a liberal zealot depending on the issue), and I don't think the NHS is a terrible system.

I'd prefer to have a minature version here as opposed to Medicare/Medicaid/SCHIP, provided there was a constitutional amendment which kept its budget fixed as a percent of GDP.

Open ended entitlements are taking federal and state budgets up (and then over) a cliff. I'd much rather the federal government fund state operated health care systems, at, say, 4.5% of GDP fixed now and forever. This would be $675 billion or so for 2010, or $2,180 per capita, which isn't all that far off of what the NHS spends per capita in the U.K.

If you wanted to (or had to due to limited resources) rely on the public hospital system, you'd have a robust one available. It wouldn't be perfect. But it would be expected that people who wanted and could afford private health care would have it, with the proportion ultimately settling out based on the proportion of the population that 4.5% of GDP could serve.

Health insurance would lose its tax deductibility status, and mandates (both the individual mandate and madates on what is covered), and the only regulation I would expect is some sort of restriction on bogus recission that prevents insurance companies from dumping sick policyholders into the public hospital system.

Posted by: justin84 | July 7, 2010 1:53 PM | Report abuse

What planet did you land from? The NHS is the third largest employer in the world. Terrible system. Poorly run. Despised by most reasonable people on both sides of the Atlantic. This is from a Physician with 35 years in practice in BOTH places. Possibly as bad as the Canadian system. You have been reading through rose colored glasses. Wake up.

Posted by: jwhitemd | July 7, 2010 2:09 PM | Report abuse

What this seems to prove to me- the finding that less health care is probably just as effective as more health care is a *completely* ignored aspect of this debate. If you follow Robin Hanson at all, his numerous dives into the ineffectiveness of much medical care, when compared to placebo, is quite convincing.

Instead of insulating people from the real costs and real effectiveness of medicine, and many people seem to be demanding a system where they just don't have to think about how much some drug or procedure costs, we should be exposing and publicizing the costs and let a population that demands Wal-Mart prices put on their value hunting, integrated coupon organizer fanny packs and set off finding cheaper healthcare.

Posted by: staticvars | July 7, 2010 2:25 PM | Report abuse

Dr. Berwick's goals are easily accomplished. If we created the inter-state highway system of Healthcare IT. Cost control can done through IT automation. By creating a public-private open-source Healthcare Information Technology process between HHS and the Healthcare Industry and using the best evidence based-medicine from around the world come up with “Best Medical Practices (BMP)” diagnostic and treatment interactive-electronic-medical-workbooks using: XML, XML schema, XForms, Dita and web-services which are IETM Class V compliant documents that when each step is filled out is checked for accuracy and completeness in real-time and saved to one of the telecoms (third-party). Savings OMB Director Orszag's 700b a year using BMP, since your insurance is based on BMP it could be fully automated, savings Senator Sanders 400b a year in administrative costs, since the workbook format is public the HHS like the IRS could offer rewards to independent programmers savings 60b a year in fraud. Like Newt Gingrich has said if you're using BMP, a malpractice case should never go to court savings 100b a year. Your personal EHR is also at the telecoms secure with bio-metrically audited access and no name or address attached, from anywhere in the world. The DOD, IBM, and many others are already using these technologies.

Posted by: no_body | July 7, 2010 2:47 PM | Report abuse

staticvars,

"What this seems to prove to me- the finding that less health care is probably just as effective as more health care is a *completely* ignored aspect of this debate. If you follow Robin Hanson at all, his numerous dives into the ineffectiveness of much medical care, when compared to placebo, is quite convincing."

This is a very important point. It is a strong reason why I'd prefer to get government healthcare spending down to a small percentage of GDP, and fixed constitutionally from there on out. To blow up the government's (and taxpayers') budget on ever increasing amounts of marginally ineffective care would be a tragedy.

The only way I would expect liberals to get on board is if it were an NHS-lite style system, and the only way you could get conservatives on board is with the understanding that the majority of the population would have access to private healthcare in a largely deregulated market. I'm not sure this would ever fly in real life, but in theory it seems appealing to both liberals and conservatives.

Posted by: justin84 | July 7, 2010 3:01 PM | Report abuse

So, we find out after Jake Tapper from ABC expends a little shoe leather that the White House LIED about the GOP obstructing Berwick's nomination. No GOP Senator put a hold on his nomination. In fact, they looked forward to the hearings and the exposition of Berwick's radical philosophy. Turns out that with the mid terms fast approaching, the Dems did not want to relitigate Obamacare. What a bunch of lying criminals!

Posted by: sladenyv1 | July 7, 2010 3:29 PM | Report abuse

The British pay about 40 percent of what we do and get comparable results.....

Unless you compare cancer survival rates, then there is no comparison. If you get cancer you are MUCH more likely to die under their system.

Isn't it great how someone like Klein can bury a (false) key assumption in the middle of a column and use it to make the rest of column (seem to) make sense.

Hey, Ezra!

Shame on you!

There is a good argument to be made that we should go to a British like system. There is NO good argument to be made for arguing dishonestly.

Posted by: TECWRITE | July 7, 2010 3:40 PM | Report abuse

Republicans wanted the good doctor brought before the committee and the democrats had no intention of letting that happen. The white house didn't want the debate on obamacare to resume. Who can blame when recently polled 60% of americans wanted repeal of obamacare.

Posted by: dugedug62 | July 7, 2010 3:46 PM | Report abuse

WaPo, we would all read your paper more if you fired this no talent loser.

Posted by: petmal1212 | July 7, 2010 3:51 PM | Report abuse

I stopped reading when I got to "while the United States lets oversupply drive costs up..."

Very few would make a statement as ignorant as that...

Any idiot who knows anything at all about economics understands that supply doesn't drive up costs but, in fact, drives down costs.

Perhaps I can be a little more understanding. Did by oversupply, he mean an oversupply of people in need of health care, which is actually not supply at all but demand. Which would make sense, since he supports a man who wants to restrict that demand by government fiat. Unless you fit the right criteria, no medicine for you!

Then again, Mr. Klein, you are truly are an idiot.

Posted by: robert_c_gladstone | July 7, 2010 3:54 PM | Report abuse

Whenever a liberal presumes to tell conservatives what to think, I stop reading.

Posted by: theduke89 | July 7, 2010 3:58 PM | Report abuse

ezra klein should know better than this:
"The British pay about 40 percent of what we do and get comparable results"

This statement was exposed for the falsehood it is during the debate. The opposition to Obamacare was spurred in part by the fact that the NHS cannot perform nearly as well as the system we have now.

Of course if the liberals can convince themselves that the reaction to Obamacare was solely based on race, well then they don't have to face the fact that they are advocating second rate care.

Posted by: skipsailing28 | July 7, 2010 4:10 PM | Report abuse

It is interesting that sladenyv1's comment here appears to be word-for-word the same as a comment posted by CincinnatiRIck under Ezra's post entitled "Majority rules?"

Nice to see that the parrots all have their talking points.

Posted by: Patrick_M | July 7, 2010 4:16 PM | Report abuse

Ezra, you are a pathetic excuse for a columnist. What about the markedly higher cancer death rates in Britain compared to here? What about the atrocious sanitary conditions at many NHS facilities? Fine, I get it that you're a leftist but at least have the guts to acknowledge reality. I do credit Mr. Berwick for that. He's a Marxist and he makes no bones about it. You, on the other hand, hide behind the shield of "objective" journalist to spout your nonsense. If Obamacare isn't repealed, a lot of seniors are going to die unnecessarily. Period. (125,000/year if we get what Berwick wants.)

Posted by: fmcdermott1 | July 7, 2010 4:36 PM | Report abuse

Conservatives would certainly take issue with the notion that the British "hold costs down by constraining supply." That is quite opposite of what the laws of supply and demand -- which we experience all the time -- predict.

Posted by: bpartlow | July 7, 2010 4:53 PM | Report abuse

Ezra: as w/ others, increased supply drives costs down, lesser supply drives costs up you nitwit.

Doesn't WaPo require a modicum of understanding from writers? Who edits this nitwit.

Fear not Ezra, idiocy is your civil right be grateful. BTW, Berwick guarantees care will be rationed by the bureaucracy. thanks for that little slice of heaven Odumbo voters. Since the election, the US has gone from sugar to sh** in a hurry.

Posted by: JohnLeeHooker1 | July 7, 2010 5:17 PM | Report abuse

robert_c_gladstone,

You said,

"I stopped reading when I got to "while the United States lets oversupply drive costs up..."

Very few would make a statement as ignorant as that...

Any idiot who knows anything at all about economics understands that supply doesn't drive up costs but, in fact, drives down costs."

When Ezra says oversupply drives up cost, there is an assumption he is using which he doesn't explicitly state.

This assumption is that price mechanism in healthcare is broken. You have third party payment for most procedures accounting for the lions share of total health spending.

When the buyer isn't picking up the bill, new supply can generate more demand. If we all had universal car insurance (which took care of maintenance as health insurance does), the existence of a new auto garage might mean that people get their oil changed every 3,000 rather than every 5,000 miles - after all, they aren't paying for it, and hey, the lines are now shorter! Those universal car insurance premiums are getting a bit pricey though...

So new supply under this condition can create new demand - new doctors are around, and they want to be busy so all else being equal they lean towards doing more tests, shorter intervals between checkups, etc. Since demand is relentless, not only does supply create more demand, but in turn demand continues to create supply - and due to increasing marginal costs, this demand draws in more supply at ever higher prices.

So, from Ezra's point of view, if you offer nearly free healthcare there are two options. One is that you limit supply. The other is you just accept that demand will grow crazy and allow ever more supply into the system to meet it, even as it drives up costs.

I'm of the view that you let liberals spend a sizable (3%, 4%, 5% of GDP) but fixed amount on free healthcare, and let the rest of the system operate as close to a free market as possible. As things are right now, we're funneling unconstrained dollars into the third party payment trainwreck (Medicare, Medicaid) and that contributes to the cost problem and worse it could easily bankrupt the government.

Posted by: justin84 | July 7, 2010 5:24 PM | Report abuse

It is truly sad that so many commenters fail to grasp what is actually being said about "supply" and "costs." The pertinent quote is:

"The British pay about 40 percent of what we do and get comparable results. As Berwick says, they hold costs down by constraining supply beneath what it should probably do, while the United States lets oversupply drive costs up."

Since the NHS is the single provider (and the direct employer of every health care professional in the system), OF COURSE when NHS holds down the supply of services, it reduces costs to itself.

If you supply your child with one bicycle, your costs will be lower than if you supply your child with two.

This is different than saying that if there are two million excellent but identical bicycles for sale, that model bike will fetch a lower price than if there are only two of them available on the market.

Posted by: Patrick_M | July 7, 2010 5:36 PM | Report abuse

Berwick is a liar. He has not been a practicing physician, but instead is a lobbyist paid $900,000 per year. His professor titles are honorary, not real or earned. He has been sold as a good guy, when he has stated that any illness that costs more than $22,000 to prolong life is not allowed.

This guy is a whackadoodle, and the vetting has only begun. Drudge will keep the UNCENSORED readers up to date on the truth, while the PR - DNC campaign at the WaPo continues to be the joke of media.

Posted by: Cornell1984 | July 7, 2010 5:41 PM | Report abuse

justin84,yes, but...you're arguing semantics...and what you're describing is more akin to an inflationary spiral of cheap money causing inflation...which is essentially what the idiot Klein was talking about...which should scare us all...basically treating doctors and health care as a commodity to be controlled from above...Klein uses his supply side analogy in an attempt to fool people into buying into his premise by saying we're not really going to control your demand, just their supply...outrageous.

Posted by: robert_c_gladstone | July 7, 2010 5:42 PM | Report abuse

Sarah Palin meet Mr. Death Panel.

They said she was crazy.

Posted by: Cornell1984 | July 7, 2010 5:45 PM | Report abuse

The fundamental point that Leftists like Ezra CANNOT grasp is that our govt (i.e. the civil service/technocrats) is literally unable to execute any program with anything close to an acceptable level of effectiveness or cost efficiency. The Executive/Legislative branch can write the most beautiful legislation immaginable...the govt will NEVER be able to execute it. This has been proven over and over since the 1960s. So....go ahead an make whatever "wunnerful" utopian plans you want. At the end of the day we'll be taxed to oblivion and stuck with rube goldberg govt programs that DO...NOT...WORK.

Posted by: JohnR22 | July 7, 2010 6:01 PM | Report abuse

Justin84:
I can agree with you a little bit. Other than automating the process, as I mentioned earlier, we in fact do need free market participation in the process for reasons you mention. The patient makes the decision on which treatment option is best for them based on the effectivity, prognosis and cost in real-time of the treatment options. The insurance company than has a base line cost that you payed for as a premium, but if your treatment selection is below what they targeted, you should get a rebate. For instance, if you're willing to go to Costa Rica for that hip replacement surgery, you should get a rebate. This would allow free choice and keep costs in check beyond automation.

Cornell84:
Sarah Palin is not crazy, but you are for believing anything she says! Make sure you keep close watch on your pocketbook/wallet, when she's around!

Posted by: no_body | July 7, 2010 6:04 PM | Report abuse

Normal people are seldom afflicted with the compulsion to meddle in the affairs of people they do not know. Meddlers tend to be control freaks who view themselves as “just trying to help” and who have little or no understanding of their deeper and less noble motives, e.g. the will to power.

It is unfortunate but inevitable that the most meddlesome among us generally possess the least understanding of whatever they are trying to meddle with – for not only do normal, reasonably mentally healthy people lack the urge to stick their noses into matters that do not concern them, they are also sensible of their shortcomings and of the complexity of matters themselves. Meddlers see themselves as virtuous, rational, disinterested, altruistic – and also as knowing what they are doing. This is a dangerous mixture that seldom leads to expected or desirable results.


It is perfectly clear that Dr. Berwick is a congenital meddler, someone who will never be content unless he is sticking his nose into other people’s business and trying to control their thoughts, choices and actions. Of course he, like all congenital meddlers, imagines that he is only doing this for the benefit of those whose business he is determined to mind for them, regardless of whether they want his help or not. People like Dr. Berwick are serenely confident that even people who loudly protest their desire to be left along, who express in the most vehement possible manner their disinclination to be helped by him, would, if they truly understood the situation, desire and even be grateful for his help. It is quite impossible to reason with such control freaks. In a certain narrow and specific way one could even say such people are insane. In any event, they are going to meddle and help other people, no matter what.


All of the nonsense and fantasy meddlers like Dr. Berwick and others bring to the table is nothing but a sort of cloud-cuckoo-land of their imagination with little or no relation to reality. The Berwicks of the world draft papers, write regulations, hire staffs, expand bureaucracies to the limit of funding and beyond, complicate everything, patch up patches, and when allowed to do so, generate a Ptolemaic monstrosity of a bureaucracy with cycles and epicycles and all manner of add-ons, adjustments, plugs, corrections, corrections to corrections, and so on ad infinitum. There is something wild and potentially neoplastic about the fantasy world of such control freaks. They will run out as much line as they are given and strain for still more.


This man has no business in a position of responsibility. It is a grave mistake to entrust someone like this with power and influence over others. If he is appointed, he will certainly make a mess of everything and will have to be removed at the first opportunity when Republicans regain control.

Posted by: Teleologicus | July 7, 2010 6:54 PM | Report abuse

George Orwell once said: One has to belong to the intelligentsia to believe things like that: no ordinary man could be such a fool.

Obviously we can count Ezra as a member of the intelligentsia.

Posted by: Tully1 | July 7, 2010 7:54 PM | Report abuse

I like those 5 little blurbs on the left-hand side that remind us all what a crappy country we are.

Posted by: Mick9 | July 7, 2010 8:37 PM | Report abuse

When the Democratic chairman of the committee that should have held hearings regarding such an appointment objects to a recess appointment by Obama, you really should suspect that there is something fishy going on. That has happened here. Max Baucus has pointedly criticized the appointment. But, there is good reason to smell fish, and very rotten ones, here. One of the things Mr. Klein neglects to mention is that Berwick also said that good health care is inherently redistributive, and that the wealthy must pay up, as it were. And there was more. Among other things, Berwick has indicated he has no problems with rationing health care. So, as a Democrat (who is liberal in the older sense, and definitely not a progressive), I have problems with Berwick's recess appointment. It smacks of an agenda that Obama knows will be unpopular, but intends to ram down our throats despite that fact.

Posted by: darkmatter1 | July 7, 2010 9:06 PM | Report abuse

Yes, Ezra, we have a right to deem the NHS a terrible system, though to put the word "terrible" in conservative mouths is a straw-man tactic and typical of your tendencies toward the spurious. Let's just say the NHS is a terrible model for the U.S. to emulate.

As to Berwick, your defense of him is completely dishonest. Your cleverness once again leads you to devices such as invoking David Cameron as a "conservative," when he is nothing of the sort as understood in American parlance, and then ignoring the fact that both right *and left* believe Cameron's shallow and careless defense of every last corner clinic in the U.K. is a dangerous fantasy. You then proceed to quote platitudes from Berwick to suggest he's a patient-focused moderate. In truth, he's not a practicing physician to any meaningful degree. He's a public policy zealot with a penchant for top-down control, so he should fit right in with the Obama team. Even the first point you quote is off base, in that asking every patient, “How would you like this done?” will not be remotely possible if Obamacare survives in anything close to its current form.

But there seems to be good news shaping up for the country's healthcare future: Pres. Obama is about as popular as Tony Hayward right now. If he gets enough of a brushback in November and then defeated in 2012, it's entirely possible that the flawed Berwickian (and Kleinian) vision for the nation will be thwarted. That's a big "if," but at least it's enough to give me hope.

Posted by: Imperfections | July 7, 2010 9:37 PM | Report abuse

As TR said, "It is a mistake for any nation to merely copy another; but it is even a greater mistake, it is a proof of weakness in any nation, not to be anxious to learn from one another and willing and able to adapt that learning to the new national conditions and make it fruitful and productive therein."

When did we become so sure of our superiority in all things, that it is considered unpatriotic to even notice when other countries are doing things better?

Posted by: cmhmd | July 7, 2010 9:40 PM | Report abuse

So "conservatives" have nothing to fear from Berwick? Well, what do Democrats and the President have to fear from him? They are willing to circumvent the political process so no one concentrates on how this guy thinks. Why is that? Where is the Washington Post on this? How is it possible that Obama can do a recess appointment on someone who hasn't been filibustered, whose name was submitted in April and was still in the vetting process and who no hearings were scheduled for, all processes of the Democrats in Congress?

Once again, our "free press" fails to do it's job. We have people dying in wars to protect news organizations and our free press and they squander their responsibilities like this. You should all be ashamed of yourselves.

Posted by: bflat879 | July 7, 2010 11:22 PM | Report abuse

Questions for Ezra:
1. Have you ever been to England?
2. Do you know anyone who has ever been to England?
3. Have you ever seen the quality of care provided by the NHS?
4. Have you ever been to a hospital?
5. Do you understand the downward sloping demand curve?(i.e., when price equals zero, demand is infinite).
5. What do you plan to do when you grow up?

Posted by: pointguard | July 8, 2010 12:18 AM | Report abuse

Wow, the floodgates have been opened for a lot of crazy comments. I wonder how many people posting here have ever been to an IHI meeting or know anything about IHI. The whole goal of Don Berwick and his organization is to improve quality of health care. It's pretty obvious to anybody in the medical field that despite huge expenditures the United States still has a long way to go in improving overall patient quality. We spend two times or more than other developed countries on a per capita basis, and yet our outcomes are still not much better or even worse than these countries. I think Berwick is less concerned about the type of we have than he is about the quality that system delivers, and good quality doesn't necessarily mean increased costs.

Posted by: lesgoog | July 8, 2010 3:29 AM | Report abuse

Wow, the floodgates have been opened for a lot of crazy comments. I wonder how many people posting here have ever been to an IHI meeting or know anything about IHI. The whole goal of Don Berwick and his organization is to improve quality of health care. It's pretty obvious to anybody in the medical field that despite huge expenditures the United States still has a long way to go in improving overall patient quality. We spend two times or more than other developed countries on a per capita basis, and yet our outcomes are still not much better or even worse than these countries. I think Berwick is less concerned about the type of we have than he is about the quality that system delivers, and good quality doesn't necessarily mean increased costs.
Posted by: lesgoog | July 8, 2010 3:29 AM |
===================================================

The floodgates have indeed been opened, not to crazy comments, but to opinions with which you do not happen to agree.

Just because people express opinions contrary to your own does not necessarily mean that they are insane. It does not, stranger still, even necessarily mean that they are wrong. It is possible, at least in theory, that you yourself might sometimes be wrong about something.

The whole goal of Don Berwick and his organization is to improve quality of health care? Really? Are you quite certain of this? How would one be certain about such a thing?

Do you suppose it is a normal thing for someone to get out of bed each morning with the express intent of improving the quality of health care? Where exactly would such a desire -one might even call it a drive, so powerful does it seem to be in the Berwicks of the world- come from? How many people go around trying to think of ways to improve the quality of health care for millions, tens, hundreds of millions of people? Is this a healthy way of thinking?

Are we to assume that Dr. Berwick and his pals are motivated only by the highest, noblest, purest, most disinterested, rational and scientific views? That they are not human beings subject to the mixed motives, cross currents, eddies and vicissitudes of human passions and agendas, but Vulcans, Spocks, creatures of pure reason, computing machines? That they are saying and doing what they do for no other reasons than that they are, unaccountably but genuinely, seized by some sort of permanent enthusiasm to improve the quality of health care?

Others may think so - but as for myself, I find this hard to swallow. I find it ludicrous. I do not believe it for an instant - though I have no doubt Dr. Berwick and people like him believe it. Such people do not understand themselves and they do not understand other people. They are the last people on earth to be given power over others and entrusted with a credit card with no spending limits. The very best to be said of them is that in most cases they believe that they mean well. But they do not altogether mean well.

Posted by: Teleologicus | July 8, 2010 7:14 AM | Report abuse

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