Monday, June 28, 2010

Donald Berwick’s Socialist Utopia

I wanted to draw to your attention a 1992 Washington Post op-ed co-written by Donald Berwick, President Obama’s nominee to head the Centers for Medicare and Medicaid Services.  The article provides a vision about how the theoretical state of “Coltuckin” reformed its health care system.  As such, it nicely encapsulates Berwick’s philosophy towards health care, and the agenda he would bring to CMS.  Positions of note include:

  • A Capped Budget:  “The Coltuckin Medical Society agreed to devise a long-range plan to bring soaring health costs under control…the medical society agreed to negotiate with the [government-chartered] commission a single total sum each year for all compensation for all physicians in the state.  With this leverage, the medical society was positioned to address the widely discrepant payment structure for primary care doctors and specialists.”
  • A Single Payer—with Total Control:  “Coltuckin chose, in the end, to administer its capped total health care budget in the simplest way: through a single payer, the [government] commission.  The savings in administrative costs alone, through simplifying the insurance system, amounted to almost 8 percent of Coltuckin’s entire health care bill…To ensure that all hospital expansion and purchase of major new equipment would be coordinated, it was agreed that all capital budgets would be negotiated with the commission.  Since the commission was also responsible for negotiating with nursing homes, the nurses’ association, and all other groups involved in health services, it was truly in charge of a global budget.”
  • Shuttered Hospitals and Intensive Care Units:  “The Coltuckin Hospital Association coordinated a statewide program to reduce over a four-year period the number of hospital beds.  Except in two underserved areas of the state, all new hospital bed construction ceased.  Two underutilized hospitals were converted to nursing homes.  Second, the hospitals regionalized and consolidated specialized care including neonatal intensive care, cardiac surgery, expensive imaging procedures, transplant surgery, and trauma care.  They thereby minimized duplication of services.”
  • Less Care:  “People began to understand the limits of medical therapy.  They learned more about illnesses and symptoms that improve spontaneously with time, and the hazards of too much medical care, especially the seductive, high-tech variety.”
  • Entitlements beyond health care:  “To reduce excessive infant mortality…the state adopted a set of guarantees regarding infant nutrition, early childhood intervention, day care and job retraining supports for young, single parents.”