Central Planning’s Bad Medicine
President Barack Obama has nominated Dr. Donald Berwick to a position largely unstaffed during the Bush administration: head of the Centers for Medicare and Medicaid Services, which oversees the two Great Society programs.
Berwick has decades of experience in health policy and, on paper, would seem a perfect candidate for the job. But he has fallen into the trap of many intellectual elites, which we might call the Harvard Disease: assuming that a government committee can guide one-sixth of the national economy into efficiency.
In many ways, the Harvard professor represents all that is wrong with the Obama White House’s approach to health-care reform. As an unabashed admirer of Britain’s National Health Service, he sees only one solution: a 10-point plan, with more micromanagement by clever elites.
But British cancer outcomes don’t just trail U.S. results; they rival those of Eastern European nations. Wait lists plague every aspect of care. Britain’s postal code lottery - patients receiving access to specialists because of geography and not need - is a chronic problem.
Nowhere are the deficiencies of government health-care management more clear than in Britain’s creation of the National Institute for Clinical Excellence, established in 1999 by Prime Minister Tony Blair. NICE’s mandate: Save money by spending health dollars more efficiently. Using complex formulas, NICE has targeted high-end surgical procedures, medical devices and, especially, drugs.
In 2008, NICE sparked criticism for its rejection of the drug Sutent to treat kidney cancer, despite evidence the drug could significantly extend patients’ lives. That same year, NICE was forced to reverse its decision to limit coverage for Lucentis, an anti-blindness treatment. In 2009, a coalition of doctors and patients proved that NICE’s analysis of an Alzheimers drug was incorrect. In 2010, with an election looming, NICE agreed to postpone all reviews.
The United Kingdom’s Rarer Cancers Forum blames up to 20,000 premature deaths on NICE decisions.
But last June, Berwick said NICE has “developed very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn.”
A core feature of Obamacare is a Medicare panel modeled after NICE. The most refractory problem in health care, it seems, can be solved with some data and a new five-year plan - fun and games with central planning.
There exists just one alternative to Berwick’s vision: What we do in the other five-sixths of our economy. With individual choice and competition, costs fall and value rises. U.S. health care doesn’t need NICE even if it’s run by a sparkling intellect like Berwick. It needs a dose of market reforms.
This piece originally appeared in The Boston Herald
This piece originally appeared in The Boston Herald