Opinion Column

London Fog: Berwick and Britain’s NHS

This column is a collaboration between KHN and The New Republic.

He’s a socialist! He’ll redistribute wealth! He wants to pull the plug on grandma!

That’s what Republicans said about President Barack Obama back in 2009, while he was trying to make health care reform bill law. Now they’re saying it about Donald Berwick, the man Obama has appointed to help make health care reform work.

Who is Berwick? He’s one of the nation’s well-respected and best-known authorities on our health care system. A Harvard-trained pediatrician, Berwick has spent the last two decades studying how to make medical care more efficient, then spreading the word on how to do it. That work took him across the country and, sometimes, across the ocean.

Among the places he visited was Britain. Two years ago, he spoke at a 60th anniversary celebration of Britain’s National Health Service. And that’s where he got himself into trouble.

Berwick made the great error of declaring himself a “romantic” about the NHS. He praised Britain for making health care a right, rather than a privilege–and bemoaned the fact that the U.S. had not done the same. He talked up the British focus on primary care–and applauded its willingness to scrutinize technology for effectiveness rather than to simply pay for anything the drug or device industry conjures up. 

You might think these are perfectly sensible positions. You would be right. In fact, most respectable health care experts would say the same thing, whether they are liberal or conservative. 

Mark McClellan and Gail Wilensky both praised Berwick’s nomination. McClellan ran Medicare and Medicaid under President George W. Bush. Wilensky held the same position during the administration of Bush’s father. That’s the same position for which Obama nominated Berwick, so you might think their opinion counts for something.

Evidently, it doesn’t. Senate Minority Leader Mitch McConnell, of Kentucky, said he was “alarmed” by Berwick’s admiration of the NHS. Senators Jon Kyl of Arizona and Pat Roberts of Kansas say Berwick advocates the “rationing” of care. Of course, as Berwick pointed out, our system already rations care by income and medical status. Apparently this is not so alarming to McConnell and the rest of the GOP.

Even if these Republicans can’t stop Berwick’s confirmation, they can delay it. And the longer it takes Berwick to take that job, the more difficult implementing the new health care law will be. Remember, taking the helm at Medicare and Medicaid isn’t simply about running those two government insurance plans–although, to be sure, that’s a hugely important job by itself. It’s also about using the government’s insurance plans to induce system-wide changes in the way doctors and hospitals do business. It’s these changes, in theory, that will eventually make medical care less expensive over time.

But delayed implementation isn’t the only reason the campaign against Berwick is worrisome: It’s also yet another troubling sign about our public discourse.

The strengths Berwick saw in the NHS are real, particularly when it comes to primary care. On a visit I made to London a year ago, a family doctor demonstrated to me how the NHS used information technology to make sure diabetics get proper routine care. It was light years ahead of what I’d seen in the U.S.–and not atypical. A 2009 survey from the Commonwealth Fund (which also underwrote my reporting trip to England) found that 89 percent of British doctors have advanced electronic medical record capability in their offices, compared to just 26 percent in the U.S.

Still, the NHS has some real flaws. Relatively low cancer survival rates trouble patients, physicians and policymakers. Waiting times for specialists have come down in the last few years, but they remain higher than much of the country would like. Berwick actually mentioned this in his speech. You wouldn’t know it from listening to Fox News, which has replayed excerpts of the speech, but the tribute he gave was nuanced–not to mention smart. A lot of the advice he gave the Brits would work here, as well.

That’s not to say Berwick is right about everything–whether the subject is British health care or its American counterpart. I’m sure McClellan and Wilensky have their differences with him, as do their more liberal associates. 

A confirmation process that aired out this debate, both to educate the public and hash out some of the finer points of implementation, would be a true public service. But such a debate seems unlikely now. It’s hard to have a serious conversation on policy when one side refuses to be serious.