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The conservative case for Don Berwick

Let's get the obvious out of the way: If not for health-care reform, Don Berwick's nomination to head the Center for Medicaid and Medicare Services would not be so controversial. As Thomas Scully, who headed CMS under George W. Bush, says: "He's universally regarded and a thoughtful guy who is not partisan. I think it's more about ... the health-care bill. You could nominate Gandhi to be head of CMS and that would be controversial right now."

But conservatives are making a serious mistake by forcing the administration to rely on a recess appointment for Berwick. Ultimately, what weakens Berwick weakens them, as Berwick, whether they know it or not, is one of the best friends they could have in the administration. That's because insofar as Berwick is a radical, he's a radical in favor of a patient-centered health-care system -- a position that has traditionally been associated with conservatives, not liberals.

This has escaped notice because political activists don't pay much attention to questions of delivery-system reform. Of the three legs that balance the health-care reform stool -- cost, access and quality -- cost and access have traditionally been at the forefront of the issue, and are both politically polarized topics. Quality, however, is a demilitarized zone: Conservatives aren't for high rates of post-operative infections, and neither are liberals.

More than any other individual in the country, it's been Berwick who has pushed to see quality occupy roughly equal billing with cost and access. His organization, the Institute for Healthcare Improvement, is principally known for gathering health-care providers and distributing information on how to do things such as "reduce Methicillin-resistant staphylococcus aureus (MRSA) infection." This involves a lot of information on proper hand hygiene. It's not a terribly ideological crusade.

Which is not to deny that Berwick himself is an ideological guy. He admits he's an "extremist," actually. The shame for him is that his manifesto -- "What ‘Patient-Centered’ Should Mean: Confessions of an Extremist" -- is behind the paywall at Health Affairs. Conservatives who can find themselves a password, however, will find much to like.

Insofar as Berwick is a radical, he's a radical in believing that vastly more power has to be devolved to the judgments, preferences and desires of patients. "An overarching aim for an ideal practice [is] that its patients would say of it, 'They give me exactly the help I need and want exactly when I need and want it,' " writes Berwick. He means it. When a patient wants someone in the room and the doctor doesn't, Berwick believes the patient should win. Here's his list of proposed reforms:

(1) Hospitals would have no restrictions on visiting — no restrictions of place or time or person, except restrictions chosen by and under the control of each individual patient. (2) Patients would determine what food they eat and what clothes they wear in hospitals (to the extent that health status allows). (3) Patients and family members would participate in rounds. (4) Patients and families would participate in the design of health care processes and services.18 (5) Medical records would belong to patients. Clinicians, rather than patients, would need to have permission to gain access to them. (6) Shared decision-making technologies would be used universally. (7) Operating room schedules would conform to ideal queuing theory designs aimed at minimizing waiting time, rather than to the convenience of clinicians. (8) Patients physically capable of self-care would, in all situations, have the option to do it.

"I suggest that we should without equivocation make patient-centeredness a primary quality dimension all its own, even when it does not contribute to the technical safety and effectiveness of care," he says.

This view is traditionally associated with conservatives, not liberals. Liberals tend to believe that the doctor is, and should be, the primary decision maker, and so the way to reduce costs across the health-care system is to change the doctor's incentives, give her more information about the efficacy of treatments, give her fewer financial incentives to err on the side of expensive interventions rather than watchful waiting.

Berwick doesn't agree: He believes the focus should be on giving the patient the information, incentives and ability to make their own decisions in consultation with their doctor. But his emphasis comes clear in the section where he asks what happens when a patient's informed desires conflict with the evidence. "Should patient ‘wants’ override professional judgment about whether an MRI is needed?" He asks. "My answer is, basically, 'Yes.' "

Senate Republicans have used past quotes of Berwick -- like his admission that "the decision is not whether or not we will ration care; the decision is whether we will ration with our eyes open” -- to hang Berwick with the dreaded rope of rationing. Mitch McConnell, who never settles for a light touch when he can find a giant stick, calls Berwick an “expert on rationing.” Of course he is. All health-care policy experts are experts on rationing. The question, as Paul Ryan told me, isn't whether we ration, but who rations, and how.

And on those questions, Berwick is something of a bulwark against the sort of rationing conservatives fear. He wants patients elevated above either government or providers. He wants to start by improving quality so we can get rid of what we don't want before we're forced to decide what we truly need. He believes a greater focus on individuals will take the health-care system to a more sustainable place. In general, liberals have opposed consumer-driven medicine, thinking it a way to simply ration by income. Berwick is attempting to rescue it, presenting it instead as a way to create a more humane health-care system.

None of this is to suggest that Berwick is a Reaganite. But there is much in his vision that conservatives will find appealing. The reality of the situation is that Barack Obama just put an advocate for a patient-centered health-care system in charge of much of health-care reform. Conservatives have scored a big win here, even if they don't know it yet.

But that shouldn't obscure the fact that government has suffered a major loss. If Berwick cannot find a smooth confirmation, then no industry leaders who are nominated in a time of political polarization can. And that'll mean, in the long run, that the best people will hang up the phone when they get that call from the White House, as they don't want to see their past quotes pulled out of context and picked apart, and they don't want to spend a year in limbo only to settle for a recess appointment, and they won't be under any illusions that respect from both sides of the aisle and an unimpeachable record will be armor enough.

By Ezra Klein  |  July 7, 2010; 11:15 AM ET
Categories:  Health Reform  
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Comments

I would have no problem if Obama used a recess appointment if the confirmation vote was being held up by a fillabuster or other excessive delays after there was a confirmation hearing. However, not even giving the Senate an opportunity to hold the hearing and have a vote because the nominee may be politically embarrassing isn't a sufficient justification, especially given that this is a Democratic majority Senate. Comes the next Republican administration this precedent will come back to haunt the Democrats.

The way things are going, we should see the first recess appointment of a Supreme Court Justice sometime soon.

Posted by: jnc4p | July 7, 2010 11:28 AM | Report abuse


Leftist Wapo hack Klein pretends to make the conservative case for the conservatives.

Klein you loathsome WaPo hack didn't your good buddy Dave Weigel who you recommended to the Post just get fired for being a leftist pretending to cover the conservative viewpoint?

Posted by: screwjob17 | July 7, 2010 11:36 AM | Report abuse

Ezra Klein's comments are excellent. Especially that "All Health Care policy experts are experts on rationing". The term rationing derives from the root for rational meaning, essentially, the use of thought in deciding how to allocate resources. I would distrust anyone who believes that thought should not be used to allocate resources and I would certainly not lend them money!
The USA is extremely fortunate to have someone like Don Berwick to work in government at all and it is most unfortunate that his appointment should be used as part of a partisan squabble. Nobody whose concern is the provision of a fiscally prudent, sustainable health care plan for elderly or disabled Americans could ask for a more capable and thoughtful appointeee.

Posted by: jaberwok301 | July 7, 2010 11:41 AM | Report abuse

The back door is the only way to get Berwick confirming all those warnings of rationing. Berwick loves the British system which is pathetic. You can smell a British hospital a block away. I have had two residences in Britain in my past and have viewed first hand this system's sad state. If you need dialysis after 65 you are out of luck unless you can pay out of pocket. 65 is just not that old in this day and age and quite frankly for too many that would be a death sentence.
This bill needs to be repealed. The Obama administration's radical agenda has been nothing but disappointing and in this case downright dangerous.

Posted by: greatgran1 | July 7, 2010 11:48 AM | Report abuse

"The question, as Paul Ryan told me, isn't whether we ration, but who rations, and how."

This appears to be exactly what Obama and the Senate Democrats are trying to avoid discussing with this recess appointment.

Part of the problem with this approach is the "messaging" that the Democratic position is too unpopular to prevail in the debate, therefore they need to avoid the debate. This is typically not a recipe for victory in mid-term elections. See 2002 when the Democrats tried everything to avoid having a national security debate with the Republicans and passed the Iraq Use of Force resolution as quickly as possible to get back to discussing the economy.

Posted by: jnc4p | July 7, 2010 11:48 AM | Report abuse

Dr. Berwick was nominated in April. The Republicans are stalling. CMS hasn't had a permanent administrator since 2006. Good for Obama for going ahead with a recess appointment.

Posted by: steveh46 | July 7, 2010 11:51 AM | Report abuse

The missing piece here is patient directed care *within a budget*. If patients have to pay more to request more care, then it is fine. If they get to request more care, but I have to pay for their hypochondria and excess of faith in the latest high priced medical procedures, it is a disaster.

This is the crux of the problem with ACA- it forces individual plans to cover treatments that some individuals would never request. It should be called the Unaffordable Care Act, because it forces people to buy services that they can't afford.

Posted by: staticvars | July 7, 2010 11:53 AM | Report abuse

You fools . Rationing IS going on right now and has been for years--it's being done by insurance companies. I would MUCH rather have someone like Dr Berwyk developing RATIONAL protocols for effective QUALITY care than a bunch of profit driven insurance clerks.

Posted by: jmsbh | July 7, 2010 11:54 AM | Report abuse

Well this is very interesting.

As a healthcare professional I have to laugh at the naieve description of "patient centered care". Much of what Mr Klein touts as being somehow innovative have been bandied about in the business for decades. Most of it was implemented by the better hospitals quite some time ago.

but what Mr Klien neglects to mention is the straight jacket that the congress has placed on the healthcare industry. It is a shame but we must ignore the lofty "principles" of Mr Berwick and focus on simple survival. As an example, Medicare recently announced significant cuts in payment for out patient therapy, things like Physical, occupational and speech therapy. The changes will cost providers millions and they will respond by switching to lower level providers, limiting the number of Medicare patients they see and focusing on teaching the patients how to treat themselves, rather than doing the treatments themselves.

Mr Berwick's bona fides as a champion of the patient won't matter when there is no money to fund care.

Posted by: skipsailing28 | July 7, 2010 11:56 AM | Report abuse

Good on Obama for excluding the Vermin from the equation. He needs to do this far more often.
Americans don't have the time to sit around and wait for the Republi&ucks to play games with our country's future.

Power to the people, you Right Wing scumbags.

Posted by: captainkona | July 7, 2010 12:05 PM | Report abuse

The thought of a healthcare system wherein the patient is advised by a physician and/or healthcare providers, chooses their own, well informed, path is a welcome change to me.

If more Americans would take the time to educate themselves regarding healthcare decisions, they would then be responsible for their own outcomes and the malpractice problems would work themselves out then too. "Informed consent" has been a joke to a large degree because it has only been half-heartedly implemented.

We, as American citizens, should take the initiative and decide what and when we receive treatment. The cost savings involved would be tremendous as well.

I did not like everything in the healthcare bill as it was enacted, but was grateful that we have begun to make some of the necessary changes that were long overdue. It will be tweaked and amended for decades to come and will produce positive results if we can all just commit to keeping an open mind regarding the issues and invite open, honest debate of them as they arise.

Posted by: trachkids | July 7, 2010 12:07 PM | Report abuse

Republicans know perfectly well that Berwick doesn't favor denying care to grandma because she's too old. He's for paying for what works best, and penalizing for poor outcomes. That really is conservative, free market economics. This is all about posturing, not anything Berwick actually stands for. Obama outsmarted the Republicans who wanted hearings just to reargue health care and dredge up nonexistent "death panels" as we approach the mid-terms, and they are throwing silly tantrums as the next best thing. pathetic. Berwick is the real deal, and those of us in the health care field all know him to be as good as it gets. what's amazing is that he would even take the job.

Posted by: JoeT1 | July 7, 2010 12:09 PM | Report abuse

"and focusing on teaching the patients how to treat themselves, rather than doing the treatments themselves."

If most "medical professionals" are quacks like yourself then I'd much rather learn to treat myself anyway.
I don't need to waste time and money so someone like you can tell me to take Asprin.

If you don't like the changes, go bag groceries for a living.

Posted by: captainkona | July 7, 2010 12:10 PM | Report abuse

I guess the "normal" appointment process isn't convenient for the administration--just like doing health care in the open, as promised, wasn't convenient. What happened to the promise of a transparent government? Obama showed his true colors immediately, when he didn't veto the pork-filled "stimulus" bill in early 2009, despite his campaign promises to do just that. Like every other politician, Obama lied to get elected. That's why I won't be voting for him again.

Posted by: Fletch_F_Fletch | July 7, 2010 12:11 PM | Report abuse

LAUGHABLE

Berwick is RECORDED, saying he wants HIGHER TAXES.

Anyone who thinks the NON-SOCIALISTS will stand by for this, you're out of your SOCIALIST mind.

Just laughable.

Posted by: russpoter | July 7, 2010 12:11 PM | Report abuse

LAUGHABLE

Berwick is RECORDED, saying he wants HIGHER TAXES.

Anyone who thinks the NON-SOCIALISTS will stand by for this, you're out of your SOCIALIST mind.

Just laughable.

Posted by: russpoter
______________________
last time I checked, the House is responsible for taxes, not CMS. Berwick's feelings on taxes are no more relevant than Sec. Gate's views on regulation of derivatives.

Supporting having the government pay for quality and value from providers of care instead of fixed payments for quantity regardless of outcome is about as conservative, free market, capitalistic as it gets.

quit spouting talking points and check some facts, then think.

Posted by: JoeT1 | July 7, 2010 12:23 PM | Report abuse

What an amusing article by a partisan left wing "reporter". Really? You're really arguing a conservative viewpoint?

Sorry bud ... an independent thinker would find your article so slanted to the left that to infer there is any "conservative" thinking involved is hard to believe.

Posted by: playfair109 | July 7, 2010 12:29 PM | Report abuse

Berwick doesn't "love" the British system. He favors one aspect of it, which is attention to figuring out what works best before doing it. It's called evidence based medicine, and it means we don't pay for stuff just because a doc who owns an MRI machine or a surgeon who wants to operate decides to order an MRI or operate. It means that if one course of treatment achieves better outcomes with less pain and better mobility than another, that's the one you pay more for. Almost everyone in the health care industry, left, right, and center, agrees. That part of the health reform bill, by the way, was bipartisan. Republicans favored the payment reforms involving penalties for excessive infections, readmissions and other quality failings, just as Berwick has been advocating for years.

Klein is right, if Berwick, one of the industry giants, can't get nominated in this environment, no one of any quality with an original thought can. Einstein couldn't get confirmed for Secretary of Energy without a Republican tantrum.

Posted by: JoeT1 | July 7, 2010 12:31 PM | Report abuse

"last time I checked, the House is responsible for taxes, not CMS. Berwick's feelings on taxes are no more relevant than Sec. Gate's views on regulation of derivatives."

Thank you. Why does every conversation regarding politics these days always prompt a "socialism/marxism" comment from people that seem to simply want to revolt and rebel against any government.

Doesn't matter which party controls the government, certain individuals just want an excuse for anarchy.

Posted by: trachkids | July 7, 2010 12:32 PM | Report abuse

The CURRENT Medicare system pays a first year resident the same for a given procedure as the most gifted surgeon in the world. Now that's socialistic. Berwick and Obama are in favor of paying more for quality and value. That's capitalism at its core.

Up is down and down is up. Facts just don't matter to some folks who just want to rant.

Posted by: JoeT1 | July 7, 2010 12:36 PM | Report abuse

Ezra Klein is the king of the anti-conservative listserv than got the man WAPO hired to cover conservative issues fired(heaven forbid that WAPO hires a genuine conservative to do that, much like they have genuine liberals covering everything else, including, liberal issues).

Anything Mr. Klein suggests that might make sense for conservatives is highly suspect and not to be taken seriously. Perhaps if many more legitimate voices from the right were in the paper, many more people would read the paper.

Posted by: SameOldTiredThinking | July 7, 2010 12:37 PM | Report abuse

I think Ezra is a little confused hre. Do conservatives really want "patient-centered care"? Not is she wants an abortion. Not if the family wants to withdraw life support from a comatose family member. Certianly not if the patient hyas no money. Medicine is just another arena for forcing other people to follow conservative values.

Posted by: Mimikatz | July 7, 2010 12:40 PM | Report abuse

"But conservatives are making a serious mistake by forcing the administration to rely on a recess appointment for Berwick."

How are conservatives forcing this "Transparent" administration to rely on a recess appointment for Mr. Berwick? Who has the majority votes? This "MOST TRANSPARENT ADMINISTRATION EVER IN THE WHOLE WORLD" should be begging for hearings so that we can get an idea how Mr. Berwick thinks in regards to managing Medicare and Medicaid. I don't care what Erza Klein or all of the lovers of Mr. Berstwick have to say, this decision affects millions of lives and a hell of a lot of taxpayer money. Obama and his transparency charade consists of nothing more than smoke and mirrors. How is the leak in the Gulf doing, or jobs or the host of other issues you claim to have a laser focus on BHO? Now we have SCOTUS hearings going on and this poser POTUS throws this major decision in the mix. Smoke and mirrors!

Posted by: wiseintulsa | July 7, 2010 12:46 PM | Report abuse

"But conservatives are making a serious mistake by forcing the administration to rely on a recess appointment for Berwick."

How are conservatives forcing this "Transparent" administration to rely on a recess appointment for Mr. Berwick? Who has the majority votes? This "MOST TRANSPARENT ADMINISTRATION EVER IN THE WHOLE WORLD" should be begging for hearings so that we can get an idea how Mr. Berwick thinks in regards to managing Medicare and Medicaid. I don't care what Erza Klein or all of the lovers of Mr. Berstwick have to say, this decision affects millions of lives and a hell of a lot of taxpayer money. Obama and his transparency charade consists of nothing more than smoke and mirrors. How is the leak in the Gulf doing, or jobs or the host of other issues you claim to have a laser focus on BHO? Now we have SCOTUS hearings going on and this poser POTUS throws this major decision in the mix. Smoke and mirrors!

Posted by: wiseintulsa | July 7, 2010 12:47 PM | Report abuse

Sorry about the double post.

Posted by: wiseintulsa | July 7, 2010 12:49 PM | Report abuse

...check some facts, then think.

Joet1 you are asking way too much from the right wing posters on this site.

Posted by: srw3 | July 7, 2010 12:57 PM | Report abuse

Every warning against the health care reform is proving to be true. Obama denied that there would be rationing. Berwick says it's inevitable. Berwick has also stated that the health care bill IS a distribution of wealth. He believes in the UK system of health which limits the expenditure in the last six months of life.
The promise that you can keep your plans is also proving to be false. Our health care costs are going up, not down. This whole "reform" game was always designed to transition into government run health care.

How much more damage can this administration and congress cause before they are stopped. Remove every representative who pulled this scam on the American people.

Posted by: bethg1841 | July 7, 2010 1:15 PM | Report abuse

Yeah, I really believe you Klein, not. He's about as conservative as your buddy Dave Weigel is.

I'm amazed that you apparently haven't learned your lesson yet. This tired old dishonest schtick of yours only ends up getting people into trouble!

Posted by: GoNatsGo | July 7, 2010 1:19 PM | Report abuse

"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."

http://www.wales.nhs.uk/sites3/page.cfm?orgid=781&pid=32953

There is no way you can characterize this as a conservative approach. Please stop trying to do so. The contrast with this approach and Paul Ryan's is stark and can't be reconciled.

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

Posted by: jnc4p | July 7, 2010 1:20 PM | Report abuse

Ezra Klein is not qualified to make the conservative case for anything. Only the predictably liberal readers of his column think he can.

Posted by: TheLastBrainLeft | July 7, 2010 1:28 PM | Report abuse

Is this the guy who believes rationing care??? Think so!

Posted by: Jimbo77 | July 7, 2010 1:30 PM | Report abuse

You fools . Rationing IS going on right now and has been for years--it's being done by insurance companies. I would MUCH rather have someone like Dr Berwyk developing RATIONAL protocols for effective QUALITY care than a bunch of profit driven insurance clerks.

Posted by: jmsbh | July 7, 2010 11:54 AM | Report abuse


Before you call someone a fool you may want to consider spelling the good Dr's name correctly.

Posted by: visionbrkr | July 7, 2010 1:35 PM | Report abuse

"conservative case" for this Marxist?
Only if written by an Orwellian shill for Obozocare.

Posted by: HoaxChains | July 7, 2010 1:36 PM | Report abuse

Thank you, jmsbh, for stating the obvious. Rationing is going on whenever the "clerks" you refer to get bonuses for turning down claims. I'm amazed at how people can be in denial about how broken the current system is. Berwick wants us to sit down like adults and discuss rationing out in the open, which has not been done in a system where private insurers make all those decisions as they see fit. The Republicans have shown over the last 2 years that they are not capable of sitting down like adults to discuss anything. That they have used their powers to sit on this nomination for 3 months is proof.

Posted by: ciocia1 | July 7, 2010 1:37 PM | Report abuse


You fools . Rationing IS going on right now and has been for years--it's being done by insurance companies. I would MUCH rather have someone like Dr Berwyk developing RATIONAL protocols for effective QUALITY care than a bunch of profit driven insurance clerks.

Posted by: jmsbh | July 7, 2010 11:54 AM
------------------------------------------
Try again. Medicare denies a higher percentage of claims than those evil private insurance companies.

From the American Medical Associations (AMA)2008 Health Insurer Report Card:

Payer - % claims denied

Aetna - 6.80%
Anthem - 4.62%
CIGNA - 3.44%
Coventry - 2.88%
Health Net - 3.88%
Humana - 2.90%
Medicare - 6.85%
UHC - 2.68%

Overall, the average combined claim denial rate of the private insurance companies was 4.05%. Medicare is at 6.85%. If the heartless private insurance firms are running "death panels" what is the gov't operating with Medicare? Not only is it going broke, it performs worse than the "hated" private companies.

Full report here:

www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf

Any more fantasies?

Posted by: kohnfjerry | July 7, 2010 1:38 PM | Report abuse

Conservatives aren't for high rates of post-operative infections

At least, not until they find out what the liberal position is.

Posted by: vagueofgodalming | July 7, 2010 1:44 PM | Report abuse

Berwick's own words say he supports the pathetic British system. Government is going to now get between you and your doctor. They will have a committee telling your doctor what procedures you may or may not have. Have you seen the faces of those birds dying in oil. The longing look for help. The government is going to take care of you about as well as they have helped those birds and sea life. They are going to manage your care about as well as they have protected the border. Scared yet? You should be. We need to get these radical liberals out of office before they have destroyed this entire nation.

Posted by: greatgran1 | July 7, 2010 1:47 PM | Report abuse

Republicans want to call expecting good care for your dollar "rationing." Because the Democrats want to save money by streamling billing/records, quit paying for 12 gall bladder removals on the same patient, or on corpses, Republicans say, "rationing!" That's because excessive fees and fraud are the stalwarts of the Republican voter. If they can't lie, cheat, or steal, they feel things are unfair. Bravo for Obama! Bravo for Berwick. Obstruction for the sake of obstruction has consequences. At least there is some small remedy for the brokenness of Senate. When the rules are changed to make the filibuster, secret hold and denial to do everyday business out spite, things of the past, then naysayers will have some legitamacy. Where are the complaints from the right about these anti-democratic mainstays of the current crop of Republicans? (and no, when the the Democrats were in the minority, they did not refuse to do business or invoke record filibusters).Dirty rules call for even honest brokers to play dirty to accomplish anything.

Posted by: wd1214 | July 7, 2010 1:55 PM | Report abuse

Republicans want to call expecting good care for your dollar "rationing." Because the Democrats want to save money by streamling billing/records, quit paying for 12 gall bladder removals on the same patient, or on corpses, Republicans say, "rationing!" That's because excessive fees and fraud are the stalwarts of the Republican voter. If they can't lie, cheat, or steal, they feel things are unfair. Bravo for Obama! Bravo for Berwick. Obstruction for the sake of obstruction has consequences. At least there is some small remedy for the brokenness of Senate. When the rules are changed to make the filibuster, secret hold and denial to do everyday business out spite, things of the past, then naysayers will have some legitamacy. Where are the complaints from the right about these anti-democratic mainstays of the current crop of Republicans? (and no, when the the Democrats were in the minority, they did not refuse to do business or invoke record filibusters).Dirty rules call for even honest brokers to play dirty to accomplish anything.

Posted by: wd1214 | July 7, 2010 1:55 PM | Report abuse

in response to this:
==========
"and focusing on teaching the patients how to treat themselves, rather than doing the treatments themselves."

If most "medical professionals" are quacks like yourself then I'd much rather learn to treat myself anyway.
I don't need to waste time and money so someone like you can tell me to take Asprin.

If you don't like the changes, go bag groceries for a living.

==============

First, I have noticed that the ability of liberals to actually argue a position has faded into a distant memory. The above is a perfect example of the lack of debate skills common among those who inhabit the left.
But let's talk facts for a moment. Suppose that a patient is refered to a physical therapy practice for the treatment of radiculopathy. In the current environment goals would be set, a specific number of treatments would be scheduled and progress would be monitored.

Now remove a third of the payment that the provider is currently getting. The incremental margin derived from treating Medicare patients sinks to zero and patients will recieve far less care.

As I pointed out, the dynamic will be shifting from, for example, physical therapists to therapy aides. They make less, but have less education.

Instead of treating the patient the provider will teach the patient a series of stretch exercises and send them on their way.

That's the practical aspect of "rationing". And yes it is going on right now.

How many here know that Medicare places caps on the amount they will pay for out patient therapy? Since the reg already exists it is noooooo problem to simply ratchet it down.

Name calling won't change the facts. But it will demonstrate the lack of insight into a complex system.

Posted by: skipsailing28 | July 7, 2010 1:56 PM | Report abuse

Berwick is disturbing nonetheless.

Frankly all of my personal problems in obtaining first class medical care at any time I wish would be resolved simply by removing Democrat recipients from the system.

Whatever anyone else might think of that as a solution, it's the sort of rationing I can live with.

If you want me to deal with some other sort of rationing, I don't think that would be as fair ~ nor would it serve my own interests as well.

Posted by: muawiyah | July 7, 2010 2:10 PM | Report abuse

The conservative (GOP - Goofy Old Men) look to the antics of a rotten spoiled two-year-old having a temper tantrum.

No matter what Obama wants or whom he picks -- THEY WILL BE AGAINST IT!

And, Obama is against something -- THEY WILL BE AGAINST HIM BEING AGAINST IT!

With these troglodytes, you can not win. . .

Posted by: chamateddy | July 7, 2010 2:19 PM | Report abuse

Conservatives accepting advice from Klein regarding the appointment of a radical seems rich. Wasn't it Klein who strongly advocated Weigel as a "Conservative" voice among weenie Post hacks? Didn't that sham become obvious to everyone's embarrassment? Why should anyone right of center pay attention to Klein?

Posted by: ecrutle | July 7, 2010 2:21 PM | Report abuse

I was ready to get in line with other conservatives and trash Ezra on this. It gets old hearing proggers tell us what is in our interest. I mean, that's their DNA -- to tell EVERYONE what is in his or her interest, and then to find a way to put muscle behind the telling. But I digress. He actually makes a lot of sense on this. I hope the next time a Miguel Estrada gets gummed up in the works, he will tut-tut the Dems, too. Not that I expect it. But I digress again. Anyway, the appointment system is broken and the lack of discipline beyond party discipline is embarrassing. Especially with relatively minor posts. We should let presidents have their way. So we can be treated to a NASA chief promoting Islamic outreach, or to some other official saying something that is so ideological and so patently clueless and stupid that it reflects on the judgment and illuminates the agenda and priorities of the people doing the appointing. That's how you get good government: by allowing bad government once in a while. The Republic will survive Berwick even if he's an extremist. I'm not sure how long it can survive if no administration can get a team in place unless said team is comprised of empty suits with no paper trail, no interesting ideas and no visible ideology. Probably we should begin by reducing the number of confirmable positions.

Posted by: mgyoung | July 7, 2010 2:21 PM | Report abuse

This fellow Berwick is a proponent of rationing (ala the British National Health Service) and a mortal enemy to any (thinking) senior citizen. Putting him in charge of Medicare is akin to the fox guarding the henhouse.

Posted by: CincinnatiRIck | July 7, 2010 2:24 PM | Report abuse

Good for the President and CMS. The Good doctor Berwick was nominated in April and this is July 7th. The Repubs were stalling as they have been doing all year. At least there is a person in place to get working on behalf of the people. How many recess appointments did Bush make?

The conservatives love to trash talk about that which they little or no knowledge, just email delivered "talking points." Of course, DEMs' talk crazy too at times. But folks, "a little knowledge is a dangerous thing."

President Obama and his team have work to do...the Repubs just have to worry about regaining control of Congress, but to do what for the majoroty of the people?
What will they do about run-away insurance costs? Will we again be penalized for having pre-existing conditions? Will insurance still be allowed to "kick" us off our insurance when we have a castrophic illness?

Can we think about the people and not about "being in control" to do they "whatever."

Posted by: mslauria1 | July 7, 2010 2:33 PM | Report abuse

UTTER LAUGHABLE

God, this is so funny.

Hey, WaPo -- where's the BOTTOMLESS PIT of money (D) to pay for Dr. UTOPIA'S (D) world?

When a large % of medical costs are due to OVER-EATING, SMOKING, DOPE and booze?

Answer: it doesn't exist. Duh.

God, the stupidity of SOCIALISTS, liberals, and Commies is extraordinary.

-----

Supporting having the government pay for quality and value from providers of care instead of fixed payments for quantity regardless of outcome is about as conservative, free market, capitalistic as it gets.

quit spouting talking points and check some facts, then think.

Posted by: russpoter | July 7, 2010 2:34 PM | Report abuse

MORE LAUGHS

Uh .. Einstein, did you think, the AMA ($$$$$) are the ones GRABBING the TAX-money?

That it is their interest to just GIMME, GIMME, GIMME -- auditors, be gone?

Yeah, yeah -- duh.

AMA should be paid fairly. It is NOT a blank check.

-------

Full report here:

www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf

Any more fantasies?

Posted by: russpoter | July 7, 2010 2:44 PM | Report abuse

Good for the President and CMS. The Good doctor Berwick was nominated in April and this is July 7th. The Repubs were stalling as they have been doing all year. At least there is a person in place to get working on behalf of the people. How many recess appointments did Bush make?

The conservatives love to trash talk about that which they little or no knowledge, just email delivered "talking points." Of course, DEMs' talk crazy too at times. But folks, "a little knowledge is a dangerous thing."

President Obama and his team have work to do...the Repubs just have to worry about regaining control of Congress, but to do what for the majoroty of the people?
What will they do about run-away insurance costs? Will we again be penalized for having pre-existing conditions? Will insurance still be allowed to "kick" us off our insurance when we have a castrophic illness?

Can we think about the people and not about "being in control" to do they "whatever?"

Posted by: mslauria1 | July 7, 2010 2:45 PM | Report abuse

Just what conservatives need - the left- wing media's advice on what is good for us. No thanks, Mr. Klein.

Posted by: treedbrent | July 7, 2010 2:45 PM | Report abuse

If you remember Sarah Palin's comments about "death panels", you'll realize that she is now being proven to be correct.

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

Kudos for Klein.

Right winger's knee jerk reactions have left many republicans effectively supporting run away healthcare spending and declining measures of national health & well being.

The hysteria of labeling common-sense measures (such as telling granny that she has the the choice of dying with dignity after 6 months of hospice care versus dying with much suffering after 8 months of expensive, invasive, and painful procedures), as "death-panels" is just one example of the current idiotcy infecting our political system.

Posted by: Denswei | July 7, 2010 3:06 PM | Report abuse

Berwicks ideas are not patient centered. They are purely cost containment centered. Most, if not all his so-called ideas exist in healthcare in America today and have for years. Incidentally they occured without his prodding. This egg head loves the British NHS in that rationing is integral to their system. Berwick also believes in redistribution of dollars from the wealthy to the poor, pure socialism. The reason the Republicans should love this pick is because he touts this disaster Obama has wrought on America. Berwick is clear as a bell, a socialist and none of his quotes or stances have been misinterpreted.

Posted by: davispope | July 7, 2010 3:13 PM | Report abuse

Ezra Klein is out lying for the OilBama administration again today. Conservatives didn't force OilBama to make a recess appointment, conservatives wanted a hearing a month ago and Reid never scheduled it. They have never blocked this guy.

OilBama lies and the Washington Post covers for him, go figure.

Posted by: robtr | July 7, 2010 3:31 PM | Report abuse

When I lived in Europe I had the misfortune of experiencing socialized health care first hand. Trust me, we don't want it. I lost my child due to the incompetence, red tape, inferior technology and lack of care due to overcrowding. It was a nightmare. I wouldn't wish it on anyone. The seniors aren't the only ones that will suffer when they cut 1/2 trillion out of Medicare. Everyone will.

Posted by: IamOverit1 | July 7, 2010 3:45 PM | Report abuse

When I lived in Europe I had the misfortune of experiencing socialized health care first hand. Trust me, we don't want it. I lost my child due to the incompetence, red tape, inferior technology and lack of care due to overcrowding. It was a nightmare. I wouldn't wish it on anyone. The seniors aren't the only ones that will suffer when they cut 1/2 trillion out of Medicare. Everyone will.

Posted by: IamOverit1 | July 7, 2010 3:45 PM | Report abuse

When I lived in Europe I had the misfortune of experiencing socialized health care first hand. Trust me, we don't want it. I lost my child due to the incompetence, red tape, inferior technology and lack of care due to overcrowding. It was a nightmare. I wouldn't wish it on anyone. The seniors aren't the only ones that will suffer when they cut 1/2 trillion out of Medicare. Everyone will.

Posted by: IamOverit1 | July 7, 2010 3:46 PM | Report abuse

hmm.... on one hand Klein presents direct quotes from Berwick clearly supporting giving patients more say in their treatment (even if it costs more money); on the other hand, vitrolic accusations of socialism, egghead-ism, democratism, etc, from the talking head parrots(without evidence or logic)

Klein scores for the presentation of factual evidence; clueless commentators score for tedious parroting.

Posted by: Denswei | July 7, 2010 4:19 PM | Report abuse

Has anyone else noticed that smears have gone up considerably on this forum since listserv?

Posted by: 3speedbike | July 7, 2010 4:28 PM | Report abuse

captainkona; You worry about Republicans playing games with our future? Where is your cave?
Odumbo is trashing the economy, our security, the private sector, the constitution, and our social values, and you think Republicans are playing games?
You have to be an idiot or a liar to make accusations like that.
Back to your coloring books and crayons.

Posted by: LarryG62 | July 7, 2010 4:33 PM | Report abuse

Seriously Larry?
http://farm5.static.flickr.com/4072/4668683929_77773d55ff_b.jpg
http://tinyurl.com/2fc9ftq

Things are bad, but getting better. That's better than what things were pre-Obama, right?

Posted by: Chris_ | July 7, 2010 5:21 PM | Report abuse

Ezra ---Puhhhlease never try and make a conservative argument ever again. You make yourself seem like such a dolt---or at the very least, you make yourself seem like some arrogant elitist who thinks we're all dolts.

Simple question: If Rush Limbaugh ever said, "the liberal argument for Paul Ryan's fiscal policies", how would it make you feel?

Posted by: FastEddieO007 | July 7, 2010 5:23 PM | Report abuse

Ezra ---Puhhhlease never try and make a conservative argument ever again. You make yourself seem like such a dolt---or at the very least, you make yourself seem like some arrogant elitist who thinks we're all dolts.

Simple question: If Rush Limbaugh ever said, "the liberal argument for Paul Ryan's fiscal policies", how would it make you feel?

Posted by: FastEddieO007 | July 7, 2010 5:30 PM | Report abuse

"Why should anyone right of center pay attention to Klein?"

I believe Ezra Kein is in direct communication with the White House on a daily basis and gives a greater leading indication of how Obama & Pelosi plan to radicalize our nation through horrible policies.....thats why!!!

If we could get our hands on Ezra's JournoList---the list that keeps AP & Reuters in line from reporting Obama's ridiculous support of Manuel Zelaya's attempt to turn Honduras into a Chavez-aligned Marxist state, and Van Jones open support of Communism, Anita Dunn's teaching high school kids to worship Mao's committment to getting good policies--even when it takes genocide to accomplish it, etc.,.etc.,.

Posted by: FastEddieO007 | July 7, 2010 5:51 PM | Report abuse

The off-his-meds FastEddieO007 version:

"...Anita Dunn's teaching high school kids to worship Mao's committment to getting good policies--even when it takes genocide to accomplish it, etc.,.etc.,."

The actual facts (from Wikipedia, which has the citations):

"...Glenn Beck played on his show a portion of a speech Dunn gave at a high school graduation, during which she referenced Mao Tse-Tung and Mother Teresa as two of her "favorite political philosophers." Beck stated that the speech revealed Dunn as a Maoist, while Dunn stated that her reference was meant to be ironic, and was a quote borrowed from Republican strategist Lee Atwater."

3speedbike inquires:

"Has anyone else noticed that smears have gone up considerably on this forum since listserv?"

Yes, it is wingnut heaven around here lately, as this thread so amply demonstrates.

Posted by: Patrick_M | July 7, 2010 6:13 PM | Report abuse

Listen to Anita Dunn clip directly....

http://www.youtube.com/watch?v=Fi1zg2NOCn8

You decide what it all means yourself..."ironic" huh!?!

Posted by: FastEddieO007 | July 7, 2010 6:29 PM | Report abuse

Lee Atwater once quoted Mao in the same way many quote other megalamanics to make a point:

"Political power grows out of the barrel of a gun." - Mao Zedong

That is not a statement of praise of Mao---it is an indictment of him.

Anita Dunn called Mao one of her favorite political philosophers who she turns to most...on par with Mother Theresa's selflessness...

That is a compliment and Anita Dunn should be flogged for teaching this to High School Students.

It is an anecdote which reveals more about the horrors of Obama's own ideology than almost anything else.

Posted by: FastEddieO007 | July 7, 2010 6:35 PM | Report abuse

"Anita Dunn called Mao one of her favorite political philosophers who she turns to most...on par with Mother Theresa's selflessness..."

FastEddie, in the first place, Dunn was not "teaching high school students" anything about Mao or Mother Teresa, she was speaking to an audience of high school graduates.

Secondly, YES, mentioning Mother Teresa alongside Mao IS ironic precisely BECAUSE the two have such different histories. Duh.

The young adult high school graduates could appreciate the irony and the humor of the remark, but evidently you and the rest of the Glen Beck audience don't quite have the same level of knowledge and intelligence as the 17 year olds, and so irony and humor sails right over your conspiracy-addled heads.

Posted by: Patrick_M | July 7, 2010 6:49 PM | Report abuse

Patrick_M - The video simply says it all.

Anita Dunn was praising Mao, specically for remaining committed to his radical ideology, which we all know required the implementation of genocide in order to successfully get started....

That is to say, he didn't let a pesky moral conscience from implementing a radical Marxist government that was supposed to deliver a system of government with no class, but instead left the most radical and perverse case of a small class of elitists brutally dominating the massed.

Just ask that young man who stood up to the tank in Tiannamen Square how classless Mao's China is....oh wait you can't...that poor guy was worked to death in Chinese torture camps specially designed for political prisoners.

Mao achieved Bill Ayer's vision of re-education camps. The left who runs this country today use it as a model to follow!

Posted by: FastEddieO007 | July 7, 2010 6:59 PM | Report abuse

Here is Obama's neighbor from Chicago and co-worker in Obama's last private sector job:

http://www.youtube.com/watch?v=HWMIwziGrAQ

Posted by: FastEddieO007 | July 7, 2010 7:04 PM | Report abuse

I'm sorry the man speaking is not Obama's neighbor and co-worker, but merely a man who worked with Bill Ayers.

Posted by: FastEddieO007 | July 7, 2010 7:06 PM | Report abuse

An FBI informant who infiltrated Bill Ayer's first political project (i.e. before Bill Ayers took on launching Obama into public service).

Posted by: FastEddieO007 | July 7, 2010 7:07 PM | Report abuse

Poor Eddie. Nowhere in the quote does Dunn "praise" Mao. The quote is Mao's explanation of how he won the war against Chiang Kai-shek by ignoring conventional wisdom and by inventing a strategy that was uniquely his own. We can all agree that Mao's totalitarian and murderous policies after taking over as the leader of China were terrible, but that does make the quote any less worth hearing. Bad people sometimes express interesting (and even valid) thoughts, and thinking adults can hear them without being damaged.

The actual Dunn quote...(note that the IDEA in Mao's quote is praised, but Mao is not):

"In 1947, when Mao Zedong was being challenged within his own party on his plan to basically take China over. Chiang Kai-shek and the Nationalist Chinese held the cities, they had the army, they had the air force, they had everything on their side. And people said, "How can you win? How can you do this? How can you do this, against all of the odds against you?" And Mao Zedong said, you know, "You fight your war, and I'll fight mine." And think about that for a second. You don't have to accept the definition of how to do things and you don't have to follow other peoples choices and paths. Ok? It is about your choices and your path. You fight your own war, you lay out your own path, you figure out what's right for you. You don't let external definition define how good you are internally, you fight your war, you let them fight theirs. Everybody has their own path."

Lay out your own path. Invent your own life. Don't get trapped by other people's belief that success is beyond possibility. Hearing that simple message does not turn the new graduates into commies, or teach them that genocide is ok, Eddie.

Have a good evening, and please take your meds.

Posted by: Patrick_M | July 7, 2010 7:26 PM | Report abuse

sorry, I meant to say:

"...but that does not make the quote any less worth hearing..."

bye again -

Posted by: Patrick_M | July 7, 2010 7:35 PM | Report abuse

If the president was not the poster boy for the disingenuous he would have the guts to show the U S citizens his slavish support of elitism...

Here comes the all out war on middle class America and the dissolution of all we hold sacred as a unique democratic Republic.

Ben Franklin was right "A republic, if you can keep it"... can we keep it the socialists, communists and anarchists have been trying to subvert it for centuries and now some smooth talking slug is on the verge.

Posted by: DrMysterious | July 7, 2010 7:39 PM | Report abuse

Klein really believes he can be a spokesman for conservatives. He is so far left, he cannot even see folks on the right, much less understand why we don't like Berwick -- he likes the British system of health care! That means that Berwick is Ok with long waits for service, being faced with a lack of proper equipment for tests like MRI, etc., etc.

How can conservatives like a socialist-leaning Obama appointmentee who Obama wants to hide -- not have an open discussion on. So Obama pulls a recess appointment for the man who will head up a huge bureaucracy overseeing 1/6 of our economy -- and most of all -- our health.
\
Soon, Obama will be going to Saudi Arabia for his medical care. Those of us who cannot afford the expense will hope that our age doesn't handicap us.

Britain doesn't like to spend money on folks on people over 65 -- and that means millions of Americans. Hang on folks, November 2, 2010 is not too far off now.

Posted by: RonKH | July 7, 2010 8:36 PM | Report abuse

Ezra, explain to us how Republicans "forced" this recess appointment. Was there a hold on the nominee? No. Did they filibuster the nominee? No. Did they somehow obstruct the confirmation hearing? No, none had been scheduled (I understand Democratic Senators were still waiting for responses to their written questions and, in any case, they were far from eager to have a contentious hearing on a controversial nominee in advance of the election). And, besides, the Republicans don't have that kind of power.

No, the president made a recess appointment because he didn't want Senators asking Berwick a lot of inconvenient questions.

mslauria1: "Good for the President and CMS. The Good doctor Berwick was nominated in April and this is July 7th. The Repubs were stalling as they have been doing all year. At least there is a person in place to get working on behalf of the people. How many recess appointments did Bush make?"

Once again, how were the Republicans "stalling?" Republicans don't have that kind of power on Senate committees. They can request delays, but the Chairmen have no obligation to grant them. At this point in his presidency, Bush had made 15 recess appointments and Democrats complained bitterly about his "abusing" the privilege. To date, Obama has made 18.

Posted by: SukieTawdry | July 7, 2010 10:36 PM | Report abuse

SukieTawdry,

Bush made 171 recess appointments, until 2007, when the Senate began holding pro forma sessions during times of recess just to stop the constant end run the Bush White House did around the confirmation process. Obama's got a mighty long way to go to come anywhere near George W. Bush.

Do you not think the White House and the Democratic leadership in the Senate were able to count heads and see that the 60 votes were not there, and that the Republican plan was to stall the nomination during an election year and to demonize the nominee? Knowing that, what is the purpose of going through the charade of trying to advance a nomination through a process you know the opposition will shut down?

The office of Administrator of Centers for Medicare and Medicaid Services has been vacant for four years, there is urgent work to be done, and the nominee is a respected leader in his field, praised by the last person to hold the office under George W. Bush, among many others. The recess appointment is perfectly appropriate.

All the faux outrage here is amusing. This is a one day "controversy" that will be completely forgotten in a week, and Berwick will quietly go about the business of improving the delivery of care to Medicare and Medicaid recipients until his short recess appointment expires at the end of 2011.

Posted by: Patrick_M | July 7, 2010 11:13 PM | Report abuse

Wow, narrow minded and self-centered politicos ! Get over yourselves. Dr.Don Berwick was one of the first genuine champions for higher quality patient care within the limitations of our flawed "non-system" of healthcare. He understands that care is rationed every day in America but that good doctors and hospitals can do a great deal to mitigate those system shortcomings. Let's be clear: Berwick gets it. Now, only if Congress did!

Posted by: Rac2u | July 8, 2010 2:20 AM | Report abuse

Anybody who has ever attended an IHI meeting, or who knows anything about IHI and Don Berwick is well aware that he is above everything else a champion of quality of care. I don't think he really cares what the structure of the health care system is, just so long as it delivers high quality care.

Unfortunately, our current system as a whole delivers relatively mediocre health care despite huge expenditures. We routinely come in near the bottom of health care quality when compared with other developed nations. Berwick and others at IHI have devoted their careers to reversing these trends.

Posted by: lesgoog | July 8, 2010 3:16 AM | Report abuse

I find it amazing the number of idiots posting who don't want to admit the insurance companies are currently rationing everything in the system.

Perhaps it's because they listen to the insurance lobby's water boy --- Mitch McConnell. Nothing more dangerous to the Republic than fools following someone like McConnell.

He's a man who knowingly lies, then not remembering which whopper he's told, believes his own lies.

Posted by: JohninConnecticut | July 8, 2010 8:06 AM | Report abuse

I agree this is more about the healthcare bill than it is about who heads CMS. I have been attending IHI meetings (I am a family doctor in a management position) for a number of years and I find the meetings inspirational. I can go back to my organization believing that in some small way that the efforts of our organization are making the whole system somehow better, even if it is incremental. Don is a rare individual. I can't think of a better person to head CMS. There are so many things wrong with the current system that it is overwhelming to even think about how to fix all of the defects. We need more visionaries like him in health care. Republicans are picking on the wrong guy. The irony, knowing Don, is that he was likely reluctant to take the job. As a Republican I am no fan of the current administration, but this time I think the administration did something right.

Posted by: dmoard | July 8, 2010 9:50 AM | Report abuse

Thanks Patrick_M!

"You fight your war, and I'll fight mine."

Words that George Soros political faction lives by....as Nancy Pelosi's banking buddies were slushing toxic high risk mortgages into their banking assets while Republicans were fighting the war to liberate 27 million human beings from Saddam's brutal oppressive authority and then from Abu Musab Zarqawi's campaign of beheading and bombing to try and provoke a civil war.

I actually think McCain & Bush were correct to stay committed at bringing a democracy into the middle east----the only real cure to religious radicalism. As young Arabs gain a peaceful way to change the policies of their governments.

In a more perfect world, McCain and Bush would have also been able to stop George Soros and Pelosi's banking ponzi scheme which has empowered them to inflict more misery onto the free world...but that battle is fought right now and Ezra Klein's JournoList propaganda is the FRONT LINES of That battle!!!

Posted by: FastEddieO007 | July 8, 2010 10:50 AM | Report abuse

Listen to Anita Dunn clip directly....

http://www.youtube.com/watch?v=Fi1zg2NOCn8

No one can listen to this clip and not think that Anita Dunn is not trying to get young impressionable high school graduates to consider the merits of Mao Tse Tung in the same way most people in the world find merits in Saint Mother Theresa's selfless devotion to helping the poor.

It is an abomination.

Patrick_M is in denial, or is deceptively casting spin to guise the radicalism amongst us.

Go watch the videos of G20 protests and you will see pictures of Mao. And if you go carrying pictures of Chairman Mao you ain't going to make it with anyone anyhow!

Posted by: FastEddieO007 | July 8, 2010 11:14 AM | Report abuse

JohninConnecticut - Insurance companies did ration care----b ut they had a financial interest in doling out as much care as possible. The number of customers is directly proportional to the amount of care they can spread out to as many customers as possible. The more customers the more money. But as costs spiral from the problem of decoupling payer from payee everyone suffers.

Now government is holding the reins to rationing, and they benefit from saying no as much as possible.

How is that any better. I think it is far worse because unlike competing insurance companies, there is absolutely no motivation for the government to make it any better---the simple solution is to say NO. And that is what Berwick says he'll do.

Posted by: FastEddieO007 | July 8, 2010 11:23 AM | Report abuse

These guys don't care about policy! Do you still believe that?

They care about screwing up 'obama care', that's all.

I am shocked that we still can't simply be honest about this. They want the country to fail in every possible way, so they can win elections.

Heck, they don't even care about the country doing well when they are in charge!

Posted by: rat-raceparent | July 8, 2010 11:36 AM | Report abuse

It is outrageous that someone with Dr. Berwick’s long paper trail and expressed support for nationalized health care wasn’t subjected to public hearings. Another good commentary I’ve seen on this is at http://wlflegalpulse.com/2010/07/08/cms-administrator-appointed-will-patient-care-take-a-recess-2/.

Posted by: LegalObservor | July 8, 2010 12:30 PM | Report abuse

Dr. Berwick has it right when he emphasizes patient involvement but he takes the issue in the wrong direction; particularly if the goal is to reduce the cost of care. The reality is we have not had a free market in medicine since the late 1960's. Consequently the failure of the health care system is caused not by markets but by a mildly socialistic approach to health care hidden in a cloak to make it look like a market solution. Medicare/Medicaid destroyed the market forces the kept prices under control. The disproportionate impact of the Fed programs created a unrelenting force that dragged private insurance plans down the a similar road. In order to gain control of the spiraling cost of HC, we must return to a true market. We must have patient involvement right up front in all phases of care. Study upon study reveals that unless patients have to make a value judgment regarding the cost of treatment, both they and their doctor will choose therapy at the upper end of the cost spectrum regardless of expected outcome. You are the cost controller, not doctors or the government. Any solution that fails to incorporate this essential element in favor of federal paternalism is doomed to failure from a patient perspective. Politicians will love such a system because it will ensconce them as the distributor of health care favors to their constituents. The late Senator "Sheets" Byrd had a heyday dolling out traffic lights in West Virginia. Imagine what he could have done with controlling the distribution of health care!

Posted by: ssm59 | July 8, 2010 1:14 PM | Report abuse

Oh Patrick_M please do respond with another contrived distancing of you and Mao....

As if WH Communication Director Maoist Indoctrination weren't enough here is what NYTimes Liberal (and the type of whacko that Ezra Klein will look like in 15 years) Thomas Friedman says about China:

http://www.nytimes.com/2009/09/09/opinion/09friedman.html?_r=1

"One-party autocracy certainly has its drawbacks. But when it is led by a reasonably enlightened group of people, as China is today, it can also have great advantages. . . . Our one-party democracy is worse."

Posted by: FastEddieO007 | July 8, 2010 5:06 PM | Report abuse

Klein is a bit of an idiot.

Posted by: JCM-51 | July 8, 2010 6:45 PM | Report abuse

FastEddie:

Thanks for your attention and the ongoing multiple posts with disconnected and unrelated incoherent conspiracy babbling. You are a proud spokesman for the modern right wing fringe, and a bastion against every non-existent threat that Glenn Beck can dream up to profit from the numerou rubes.

I would love to hear you tell us your thoughts on the hidden meaning of the artwork on the walls of Rockefeller Center. Please share.

1. "WH Communication Director Maoist Indoctrination" has already been debunked by the transcript. If you think that telling high school graduates to follow their own path in life is "indoctrination" to Mao era Chinese communism, that I am sorry you read the quote, because that means you must now be "indoctrinated" and turned communist too. Rational people can consider ideas from many sources on their own.

2. What does an idea in a Friedman column have to do with anything relating to the Obama adminsitartion, Berwick, or anything else? Do you think one party rule is a good thing in a democracy? What are you babbling about?

Have a most pleasant evening. Take your meds.

Posted by: Patrick_M | July 8, 2010 9:34 PM | Report abuse

For the record, I do NOT think telling high school graduates to follow their own path in life is "indoctrination" to Mao era Chinese communism.

But I DO think that telling High School graduates THIS is:

The third lesson and tip actually comes from two of my favorite political philosophers: Mao Zedong and Mother Theresa -- not often coupled with each other, but the two people I turn to most to basically deliver a simple point which is: you're going to make choices; you're going to challenge; you're going to say why not; you're going to figure out how to do things that have never been done before. But here's the deal: These are your choices, they are no one else's. In 1947, when Mao Zedong was being challenged within his own party on his plan to basically take China over. Chiang Kai-shek and the Nationalist Chinese held the cities, they had the army, they had the air force, they had everything on their side. And people said, "How can you win? How can you do this? How can you do this, against all of the odds against you?" And Mao Zedong said, you know, "You fight your war, and I'll fight mine." And think about that for a second. You don't have to accept the definition of how to do things and you don't have to follow other peoples choices and paths. Ok? It is about your choices and your path. You fight your own war, you lay out your own path, you figure out what's right for you.


How would YOU feel if someone tried citing a generic quote from a Hitler speech to make a point to high school students "to follow their own path"?

Posted by: FastEddieO007 | July 8, 2010 10:18 PM | Report abuse

Mao Zedong said, you know, "You fight your war, and I'll fight mine." to describe a rather duplicitous act of turning his armies guns against his fellow countrymen as they defend their homeland....he shot them in the back in order to grab power.

Get it?

Posted by: FastEddieO007 | July 8, 2010 10:23 PM | Report abuse

"How would YOU feel if someone tried citing a generic quote from a Hitler speech to make a point to high school students "to follow their own path"?"

I don't know what a "generic" quote is. This was a specific quote that can be evaluated as such. But of course Hitler was not only an evil tyrant (like Mao) but also a losing military leader (unlike Mao). So a specific quote from a successful general might be worth hearing. If you don't think cadets at West Point study brilliant generals who founded bad regimes, you ought to broaden your tin-foil-hat horizons.

Adults often explore the strategic thinking of successful strategists, even when those strategists have been pursuing enemy causes. It is possible to understand that Mao achieved success against the old regime by fighting his "own" war, without turning into a Chinese communist because of that knowledge.

My apologies if hearing that quote made you into a communist. I myself still am loving making nice green American money in a capitalist society, cheering for the Red Sox, and driving my big nasty doomed V-8 American cars. I guess my power of thought is more resilient than yours, because I can hear what a dead communist leader has said without being "indoctrinated."

G'night comrade Eddie.

And please, Glenn Beck called to say:

Take. Your. Meds.

Posted by: Patrick_M | July 9, 2010 12:10 AM | Report abuse

So you object to teaching kids the merits of Hitler because he was a failure and not because he advocated extermination of Jews, Gays, and others?

In many ways, Mao was a worse human beings because of his success. To this very day, elderly women die in torture camps at the red hand of Mao's Chinese tyranny:

http://faluninfo.net/article/1065/

Anita Dunn and Thomas Friedman should be ashamed of themselves and every single American has to make a big deal when dangerous ideas are mischaracterized in an attempt to influence?

Posted by: FastEddieO007 | July 9, 2010 7:06 AM | Report abuse

Patrick_M - I hear crickets?

No comment on your reasoning that no one espouses Hitler quotes or political philophy because he failed rather than because he espoused genocide?

I still contend that it is irresponsbile for ANYONE to characterize Mao Tse Tung's committment to enact a communist totaltarian state even though it required genocide of his fellow countrymen to get started and to this day results in poor old women dying in torture camps.

We should all demand Anita Dunn and Thomas Friedman be called out for their despicable betrayal of humanity.

There is absolutely no difference between Anita Dunn and Thomas Friedman's praise for Mao's way of doing things than those who might praise Robert Byrd for his recruitment of young white West Virginians to go around and lynch young black men for daring to be free.

Lets never shy away of calling evil by its name!!! No hesitation. No second-thoughts. No moral equivalence. No end justifies the means...Evil is evil!

Posted by: FastEddieO007 | July 10, 2010 9:46 AM | Report abuse

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