Saturday Seconds

It’s a quite Saturday, so you get seconds.

I found this stuff below – here: http://healthcare.nationalreview.com

So it’s worth asking: Who is Donald Berwick, and what would a Berwick-run CMS look like?” CMS is Center for Medicare Services – or now, probably, Medical Services. Who knows what still lurks inside the “health care law”? And it is good to ask, somewhat, for it could be any number of “policy wonks” and politicians and interest groups, big stuff – big groups, big organizations, just big. And each Big (how convenient: big industry group) wants to have its definition of the ideal system – and we get “compromise” — which means we get a Pushme-Pullme of Doolittle fame (how appropriate that name!) And the leaders of Big, the important people, get to live mighty nice on the public dime one way or the other.

So let’s look. The article says: Berwick, a decorated triple-graduate of Harvard with faculty appointments both at Harvard Medical School and the Harvard School of Public Health, embodies the technocratic element of the president’s governing philosophy.

This is not just the president’s governing philosophy. Oh, no, it’s a Big part of our Bigness. There are millions of people with this Big ideals mindset. They flock to DC and state capitals like flies to mush in the sun. But then they flit back to universities, or think tanks, or, well, big industry groups.

As with any decent technocrat, Berwick’s nomination has a good side and a bad side.

Now this is funny. Mostly because there can be no good side so long as there is a bad side. For the desired results (that is, the good side) can never be achieved with the bad side – the technocratic mindset. It’s impossible. If you think, as we shall see in a minute, that this ideal world of health care delivery can be achieved by a few people then there is no way your good intentions can ever surmount the power that you will hold and use. If in the position for which Berwick is up for – well, then, he’s going to implement his ideals – and thus we shall suffer for it. Let’s look at his ideals:

If we could ever find the political nerve, we strongly suspect that financing and competitive dynamics such as the following, purveyed by governments and payers, would accelerate interest in [our policy ideal] and progress toward it: [Think about this. This guy thinks that if the “right” people, those with the political nerve, that is – then he only “strongly suspects” he can do what he wants. But what if his suspicions are wrong? Ooops? Not only that, he says that he’s looking for “competitive dynamics … purveyed by governments and payers.” So we the taxpaying people have to have a competitive dynamic with the government bureaucrat who says “I’m not sure if you are in the right office, but here, fill out this form, take a number, have a seat.” Yeah, right.

But let’s go on into oblivion.

  1. global budget caps on total health care spending for designated populations,[what this means in street English is rationing for those who don’t fit the government’s plans. “You people, you’ve got to go!”]
  2. measurement of and fixed accountability for the health status and health needs of designated populations, [what this means in street English is rationing for those who don’t fit the government’s plans. It basically restates item 1. “You people, you’ve got to go!”]
  3. improved standardized measures of care and per capita costs across sites and through time that are transparent, [wow, he restates items 1 & 2 with alarming bureaucratese. Insert here_______ the comments for item 1 & 2]
  4. changes in payment such that the financial gains from reduction of per capita costs are shared among those who pay for care and those who can and should invest in further improvements, and [Again? Geez, Berwick, get a grip. Say you’re going to ration and be done with it. You’ll get to decide who the designated populations are and the care they shall receive, and no more, and they’ll get to dynamically compete between this or that feddy-state bureaucrat who follows your guidelines of what to spend on any given person for any given reason.]
  5. changes in professional education accreditation to ensure that clinicians are capable of changing and improving their processes of care. [a weak formulation of 1, 2, 3 & 4 above, for by decreeing the number of this or that sort of clinicians then he will be able to ration the amount of care that’s provided. Like, fewer old-people doctors, means longer wait times to see the permissable amount of old-people doctors still practicing, and thus some will die from the rationing while they wait. How convenient, repugnantly so. Even more weird, conspiratorily of course, is that less HIV/AIDS doctors, or less oncologists, and wonder of wonders folks will be dropping like flies, so that money might be more carefully alloted to those more useful to the feddy-state.]

    With some risk, we note that the simplest way to establish many of these environmental conditions is a single-payer system, hiring integrators with prospective, global budgets to take care of the health needs of a defined population, without permission to exclude any member of the population.” [not only not excluding, but forced inclusion, topped with dynamically enforced acceptance of what is doled out according to the Berwick-run system. — getting back to the National Review’s “good side” >> where’s that good side? This man states in bureaucratese that he’s going to ration from here to wherever his fetid beliefs will take him, and he’ll be joined by cronies who think the same, led by a president who believes thusly too. From this will come a sort of benign euthenasia. This man’s comments must lead to rationing, and thus the Big E – not close to Kevorkian, but running down that staircase pretty fast. For if there is a limit on funds and processes, and all the other buzz words Berwick hustles, for designated populations, then it must lead to rationing – you are limiting something – based on what’s spit out of a computer and printed in big reports that no one will ever read. This is the “good side” to this man’s appointment to anything more than grandee of the local lemonade stand.

Now, this too was in the article, but [in brackets I strenghten the original]: “Technocrats may believe they can marshal statistics and analysis to optimize the health-care system, but they are not omniscient. [they’re not even …nicscient of any sort, for they’ll tailor their questions to the responses they want, and/or forget to ask questions that are important to the issue.] Their analyses rely on too many assumptions and on unreliable data. [it’s the only thing their analyses rely on, for there is no other information.] This is [one reason, among others] why government programs always result in colossal amounts of waste, fraud, and abuse. On the other hand, a truly free market for health insurance could efficiently allocate health-care resources to those therapies and tests that patients and doctors most need.” [still for big, eh? Only now it’s big insurance. Even better, if the government wanted to truly “help” it would take those twenty to thirty dollar tax bites out of every $100 earned and put it nice, neat and safely in your very own FDIC insured bank account then in just a short while you’ll have just the money to deal with every day/month/year health care. Then there could be insurance for the really big things. In twenty, thirty and then forty years you’ll have a nice big nest egg to do with as you please, paying for your own health needs by going to the myriad of providers who would enter the market to peddle their services. At most the government is good at gathering the statistics needed for marketing. I really have no problem with the government knowing how many people are in the city. Nor how many are of this or that age. Aggregating this sort of information helps producers and purveyors of every kind of service and product make the decisions about how much to make, sell, ship, and so forth and so on – that is simply what the market will do. There will be a statistic that some 100 out of a thousand people buy aspirin every month – or any other pill – and then the aspirin producers make what they think will sell, and get it to where people will buy it, and then replenish when they think it’s necessary. Oh yeah, that’s right, aspirin producers already do that. Now why can’t any and every other part of the 300,000,000 big health care universe do the same? But one thing for sure – the only way to control the free wheeling decisions of 300,000,000 people is through some form of oppressive control. The fact that it might only be nameless faceless bureaucrats who deny this or that attempt at dynamic competition is sort of beside the point – to coin a phrase, “It’s the control, stupid.”

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