Heritage: The Rationer-in-Chief

When Linda O’Boyle was diagnosed with bowel cancer, her doctors told her she could boost her chances of survival by adding the drug cetuximab to her regimen. But the rationing body for Britain's National Health Service, the National Institute of Health and Clinical Excellence (NICE), had previously ruled that the drug was not cost-effective and therefore would not be paid for by the government. So O'Boyle liquidated her savings and paid for the drug herself. But this is not allowed under NHS rules. When government bureaucrats found out that O'Boyle had purchased the drug with her own money, she was denied NHS treatment and died within months.

Defenders of Britain's health care rationing system may try to claim that this tragic death is an outlier in an otherwise acceptable government run health care system. They are wrong. It is the point of the system. As socialized medicine and infanticide advocate Peter Singer has argued in The New York Times, the NICE bureaucrats must ration care or else free government health care would bankrupt the British economy. "NICE had set a general limit of £30,000, or about $49,000, on the cost of extending life for a year," Singer writes. Following this logic, Singer supported NICE's decision not to allow British citizens the kidney cancer fighting drug Sutent. As a result of this, and many other rationing decisions Britain, has one of the lowest cancer survival rates in the Western world. While 60.3% of men and 61.7% of women in Sweden survive a cancer diagnosis, in Britain the figure ranges between 40.2% to 48.1% for men and 48% to 54.1% for women. And NICE's rationing has not just hit cancer patients. Doctors have warned that patients with terminal illnesses are being made to die prematurely under the NHS rationing scheme. And according to the Patients Association, one million NHS patients have been the victims of appalling care in hospitals across Britain.

Most Americans would find this harrowing. But not President Barack Obama. Yesterday he bypassed the Senate confirmation process and used a recess appointment to install Dr. Donald Berwick to be the administrator of the Centers for Medicare and Medicaid Services (CMS is the agency that runs the Medicare and Medicaid programs). Dr. Berwick said of Britain's health care system: "Cynics beware, I am romantic about the National Health Service; I love it." And his love for Britain's health care system is not in spite of its rationing, but because of it. In 2009 Dr. Berwick told Biotechnology Healthcare: "NICE is extremely effective and a conscientious and valuable knowledge-building system. ... The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open."

The fact that the White House chose to empower Dr. Berwick by recess appointment is particularly audacious. The recess appointment power was intended to be used for occasions when the Senate is out for moths at a time. The Senate is currently out of session for just 11 days. Worse, the Senate majority has never even scheduled a hearing so that Dr. Berwick's rationing views could be given an "open" forum. In fact, Dr. Berwick has not even returned Senators' written questionnaires. The White House defends the move by claiming "there’s no time to waste with Washington game-playing." But then why did the Obama administration wait until April 2010, a full 15 months after President Obama was sworn into office, to nominate Dr. Berwick? Is it because they did not want Dr. Berwick's well known and public support for rationing health care to affect the debate over Obamacare?

In a 2005 interview with Health Affairs, Dr. Berwick said: "(G)overnment is an extraordinarily important player in the American health care scene, and it has inescapable duties with respect to improvement of care, or we're not going to get improved care. Government remains a major purchaser. ... So as CMS goes and as Medicaid goes, so goes the system." And that was before Obamacare gave far reaching new powers to government bureaucrats.

In June of 2009, President Obama told the American Medical Association that “identifying what works is not about dictating what kind of care should be provided.” Moreover, the president has assured the public time and again that the government will not get between patients and their doctors. His nomination of Don Berwick for Director of CMS, however, tells a different story.

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