(Cross-posted at Blog of the Century)
Dr. Donald Berwick, administrator, until last Thursday, of the Centers for Medicare & Medicaid Services, has been out doing some great television and radio interviews this week. Heâ€™s come out swinging about death panels, rationing, the need for universal access to care, quality improvement, and other delivery reforms.
But hereâ€™s my question: Why now, after Republican filibuster threats have already chased him out of the Obama administration? Why did we roll the same videotape for Nobel Laureate Peter Diamond? Also filibustered out of a job, Diamond also came out swinging after his credentials to serve on Federal Reserve Board of Governors were publicly deemed inadequate by that noted monetary authority, Alabama Senator Richard Shelby.Â
Again and again, Republicans block superbly-qualified nominees and officials with the most flimsy justification, and Republicans pay little price for it. A few, such as Elizabeth Warren, are prominent outspoken liberals. And of course the problem reflects the larger dysfunction of the United States Senate. Yet the degree of Republican obstruction is striking when compared to reasonable historical norms. And they repeatedly obstruct the appointments of precisely the kind of respected experts we need to operate American government.
For reasons I donâ€™t entirely understand, the Obama administration and Senate Democrats seem to have issued marching orders that quiet their partyâ€™s own people facing the harshest Republican attacks. This isnâ€™t making visible progress in getting people confirmed. Moreover, many of those muzzled are also the most articulate advocates for the Obama administrationâ€™s signature achievements.
Below the fold, for example, is Don Berwick quoted in yesterdayâ€™s Boston Globe. We need more people standing up like this, while they are still in office where they can make the biggest difference:
It is one of the great and needless tragedies of this stormy time in health care that the â€œdeath panelâ€ rhetoric has denied patients the care that they want, denied caregivers the information they need to give that care, and denied our nation access to a mature, open, informed, and balanced discussion of the challenge of advanced illness and the commitment to individual dignity. It is a travesty.
If you really want to talk about â€œdeath panels,â€ letâ€™s think about what happens if we cut back programs of needed, life-saving care for Medicaid beneficiaries and other poor people in America. What happens in a nation willing to say a senior citizen of marginal income, â€œI am sorry you cannot afford your medicines, but you are on your own?â€ What happens if we choose to defund our nationâ€™s investments in preventive medicine and community health, condemning a generation to avoidable risks and unseen toxins? Maybe a real death panel is a group of people who tell health care insurers that is it OK to take insurance away from people because they are sick or are at risk for becoming sick. Enough of â€œdeath panelsâ€! How about all of us â€“ all of us in America â€“ becoming a life panel, unwilling to rest easy, in what is still the wealthiest nation on earth, while a single person within our borders lacks access to the health care they need as a basic human right? Now, that is a conversation worth having.
And, while we are at it, what about â€œrationing?â€ The distorted and demagogic use of that term is another travesty in our public debate. In some way, the whole idea of improvement â€“ the whole, wonderful idea that brings us â€“thousands â€“ together this very afternoon â€“ is that rationing â€“ denying care to anyone who needs it is not necessary. That is, it is not necessary if, and only if, we work tirelessly and always to improve the way we try to meet that need.
The true rationers are those who impede improvement, who stand in the way of change, and who thereby force choices that we can avoid through better care. It boggles my mind that the same people who cry â€œfoulâ€ about rationing an instant later argue to reduce health care benefits for the needy, to defund crucial programs of care and prevention, and to shift thousands of dollars of annual costs to people â€“ elders, the poor, the disabled â€“ who are least able to bear them.
When the 17 million American children who live in poverty cannot get the immunizations and blood tests they need, that is rationing. When disabled Americans lack the help to keep them out of institutions and in their homes and living independently, that is rationing. When tens of thousands of Medicaid beneficiaries are thrown out of coverage, and when millions of Seniors are threatened with the withdrawal of preventive care or cannot afford their medications, and when every single one of us lives under the sword of Damocles that, if we get sick, we lose health insurance, that is rationing. And it is beneath us as a great nation to allow that to happen.