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Jun. 3 2010 - 3:18 pm | 58 views | 0 recommendations | 1 comment

GOP puts politics ahead of competence on health care reform, again

Politico informs me that having largely lost out on financial reform and not having a leg on which to stand regarding the Gulf oil spill, Republicans are looking to double back to safer and more fertile ground for their rankling: health care reform.

The object of their ire this time is Obama’s proposed nominee for the administrator of the Centers for Medicare and Medicaid — a post that has been vacant for four years — Donald Berwick.

Berwick’s grievous sin? He openly admires Britain’s National Health Service,

Berwick has called Britain’s National Health Service “one of the greatest health care institutions in human history” and “a global treasure.” He once said it sets an “example” for the United States to follow. And his decade-long efforts to improve the NHS were so well-regarded that Queen Elizabeth granted him an honorary knighthood in 2005.

Responding, Sen. John Cornyn describes Berwick as, “bad news” and seems to be gearing Senate Republicans up for a fight to challenge Berwick’s nomination, as Politico describes it, “just in time to resurrect the brutal yearlong health reform battle ahead of the midterm elections.”

Quoth the Church Lady, how convenient.

Of course, Cornyn and the Republicans probably won’t mention that Berwick has tempered his admiration with a recognition of the problems inherent in Britain’s NHS,

“I fell in love with the NHS,” Berwick said in a 2008 speech of the system that he had worked on since the 1990s. “To an American observer, the NHS is such a seductress. … Like any lover, it took me a while to see the blemishes of my beloved, though I soon had help from people quite willing to point out the warts.”

And in that same speech (available in full only to members, sadly), Berwick lists ten ways that the NHS could be improved. In a shorter article on the topic, Berwick, along with Sheila Leatherman, offers some suggestions that should be music to conservatives ears (italics mine),

The increase of 30% in funding the NHS over the next five years should provide the needed capital to modernise undercapitalised facilities and fund investment in information systems. Adding more capacity is critical in a system widely recognised as understaffed. But we caution NHS planners not to overshoot. Oversupply has been shown to correlate with higher rates of hospitalisation and procedures in health care that are clinically unexplained.

Specific performance improvements should be targeted and pursued system wide. We believe that national aims—such as improving cancer outcomes, improving care for heart disease, and improving mental health interventions in crisis—are helpful in establishing focus and coordinating national resources. We suggest developing centralised “big picture” aims, while nurturing innovative and pluralistic local initiatives to realise gains “on the ground.” The NHS wastes its most promising resource—the talent of its people—when it discourages clinicians and managers from initiatives that would improve care locally.

Emphasise learning over regulation as the linchpin strategy for improving care. The NHS Plan calls for increased levels of measurement and accountability throughout the NHS. These are important. But more important for the long haul is the NHS’s capacity to learn from its own best practices and innovations and spread those good ideas throughout the nation. That requires the system to develop and maintain world class educational and training opportunities for its staff and clinicians.

Depoliticise the NHS as much as possible. A side effect of nationalised health care is that it becomes interwoven with national politics. This can garner resources and propel change, but it can also confound constancy of purpose. Reform fatigue and scepticism are real dangers in the NHS, particularly when too many people start to believe that the political agenda is driving the health agenda. Britain’s political and health care leaders need to maintain the long term view and the discipline to assure that NHS modernisation will be shaped by the simple and abiding values of equity, efficiency, and effectiveness.

At the end of the day, though, Berwick’s admiration and support for the NHS is a re herring. The real reason that Berwick’s nomination is so important is that he has expertise that speak directly to the biggest problem facing US halth care: cost.

Again from Politico,

Berwick, a physician with three Harvard degrees, founded the nonprofit Institute for Healthcare Improvement in 1991. In this capacity, Berwick has traveled the country and the world, pressing his theory that doctors and hospitals can boost care and reduce medical errors while saving money. Admirers — a group that includes a few Republicans who headed CMS — have described his work as “revolutionary.”

From the Institute’s website,

We aim to improve the lives of patients, the health of communities, and the joy of the health care workforce by focusing on an ambitious set of goals adapted from the Institute of Medicine’s six improvement aims for the health care system: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity. We call this the “No Needless List”:

No needless deaths
No needless pain or suffering
No helplessness in those served or serving
No unwanted waiting
No waste
No one left out

IHI works with health professionals throughout the world to accelerate the measurable and continual progress of health care systems toward these bold objectives, leading to breakthrough improvements that are truly meaningful in the lives of patients.

We will be a recognized and generous leader, a trustworthy partner, and the first place to turn for expertise, help, and encouragement for anyone, anywhere who wants to change health care profoundly for the better.

As Kevin Drum noted back on May 27, with massive rate hikes looming, cost is where conservatives and Republicans really need to train their lasers,

If conservatives want to avoid the specter of federally funded single-payer healthcare in the United States, this is what they need to come to terms with. Canada provides high quality healthcare for everyone — including small businesses and the elderly — for a cost per person of about $4,000 per year. Ditto for France and the Netherlands. Britain and Japan do it for about $3,000. Ann Terranova is being asked to pay more than $6,000 per person — and that’s for three working-age employees.

One way or another we have to deal with this. This year’s healthcare reform bill takes some small strides toward reining in costs, but they’re not nearly enough. We need to do far more, and if the private market won’t do it then eventually public opinion will force us to adopt a European-style system. If conservatives really understood this, they’d take the problem more seriously. But they don’t seem to.

In this regard, Berwick’s nomination holds the potential to tap someone who has a wealth of experience from all around the world in containing costs, while at the same time maintaining and improving quality of care. And that is the key point to bear in mind vis-a-vis President Obama’s nomination of Berwick.

Berwick stands to address the fundamental issues facing American health care. Republicans; however, are poised to offer opposition to Berwick’s nomination on the grounds that it could score them a quick political buck while striking yet another blow for the unsustainable corporate status quo they worked so hard with industry lobbiest to maintain over the past year.

Ultimately, this latest move by Republicans serves as further evidence that they care more about their own political fortunes than a system of health care that benefits the country as a whole. In other words, nothing much has changed.


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    About Me

    I'm a Canadian blogger who spends far too much time reading and writing about US politics. I've been involved in various forms of political organizing for the past decade, some of which has earned me recognition and other of which has earned me the title of "no good punk".

    I also blog at The League of Ordinary Gentlemen, the Commons, Beams and Struts, and The Washington Examiner's Opinion Zone.

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