Thursday, April 17, 2014

Berwick DID like the UK system after all

In a remarkable show of disinterest by the mainstream media in Massachusetts, it appears that only the Associated Press cared enough about Don Berwick's proposal for a single payer plan to give it the attention of a reporter. Here's the story:

BOSTON (AP) — Democratic candidate for governor Don Berwick on Wednesday called for a ‘‘single health care payment system’’ for Massachusetts.

Berwick, who headed the federal Centers for Medicare and Medicaid Services for 17 months, is one of five Democrats, two Republicans and three independent candidates seeking the state’s chief executive post.

Speaking at Boston University School of Medicine, he praised President Barack Obama’s health care law and the 2006 Massachusetts law that inspired it, adding that Massachusetts can again lead the nation.

But, he said, the state and country can do better by essentially expanding Medicare, which covers the elderly, to include all residents regardless of age.

‘‘We can create and manage a simplified, transparent, efficient, and fully accountable single health care payment system in Massachusetts and we can make it work for the people,’’ Berwick said in a prepared copy of the speech.

That ‘‘single-payer’’ option has long been a dream of liberal Democrats, but has also been considered a political impossibility in a divided Congress.

It was Berwick’s praise for aspects of the British single-payer health care system that marked him for criticism from congressional Republicans, who said it showed his affinity for big government programs. They blocked his confirmation as Obama’s permanent head of the Centers for Medicare and Medicaid Services after his temporary appointment.

Berwick on Wednesday brushed off the criticism of those he called ‘‘naysayers’’ and said a single-payer system would have less ‘‘waste, confusion, complexity, and opacity’’ than the current system, which he said forces patients and doctors to spend time and money sorting out varying coding systems and billing rules.

By contrast, he said, Medicare spends just 1 percent on overhead.

It is ironic that the case made by lots of Republicans against Don for the CMS job was, in fact, based in part on his position on this issue.  Back then, recall, "Republicans . . . seized on remarks he made praising Britain’s National Health Service as an 'example' for the United States to follow." Of course, the Republicans dramatically overstated the issue and would have found any reason to be against him, but time has shown it to be the case that Don actually does support an NHS-like single payer system.

Now, the question is whether this issue will resonate in Massachusetts.


Ryan E. said...

I am not commenting on Berwick the person, but rather the notion of people heading nonpartisan government agencies that wield large amounts of power than running for political office. Berwick obviously had political leanings prior to his current run for office. I just think it is a shame that people are put in power (without being elected) who have the ability to make policy that clearly is influenced by their political ideology. Speaks to political cronyism in my humble opinion.

Michael Millenson said...

Let's see: a guy who has no chance at all to be governor (he's way back in the Democratic pack) proposes a health reform for Massachusetts that he actually would have NO POWER AT ALL TO IMPLEMENT as governor and it doesn't get press coverage? Because, remember, "single payer" would require waivers from the feds, since "Medicare for all" is not something that the governor of one state can do. Not to mention what the powerful provider community of Massachusetts would think about it.

Serious candidates with serious proposals get serious coverage. But what Berwick said was interesting for health care wonks.

Finally, the Associated Press is a source of news for almost every news organization. If they cover a story, the newspapers and TV stations can pick it up using their coverage. So it's still "on the record." For us wonks.

Chris S. said...

Isn't the UK system gradually being privatized?

Basically they are using GATS's mandates to tear it apart piece by piece.

A single involvement by an multi-national firm arguably makes a market world trade, giving the WTO superior jurisdiction that is accountable to no one or no nation. Giving firms entitlements to remain there forever, which would block single payer and all its savings completely. Its clear that's the goal of the neoliberal Obama administration because as their first act, they picked controversial UK firm, Serco Group to manage the Obamacare rollout. Serco (recently described as "the company that runs Britain") is heavily involved in privatizing hospitals and detention centers /prisons in the UK and financial mismanagement and brutality to detainees in custody has been alleged there.

What we are seeing is a global corruption state emerging- One bad administration can now, using FTAs to exploit their position to extend a mistake indefinitely into the future, basically creating a permanent supranational mess of corporate entitlements to markets, taking key policy decisions out of a country's hands. An entitlement which persists forever, bypassing democracy.

This is a good overview of the global pressure to privatize and who's behind some of it.

This is a good paper on the crucially important WTO/GATS FTA issue:

The potential impact of the World Trade Org anization's general agreement on trade in services (GATS) on health system re form and regulation in the United States (International Journal of Health Services)

Anonymous said...

It would certainly be easy for a single payer system to reduce health care costs.

Three to four years into implementation, Dr. Berwick or his proteges can just retroactively redefine "medical necessity" or "inpatient" and hire the RACs to recoup billions of prior year payments to providers.