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Shock news - unreported foreign loyalties!

Thursday, April 1, 2010

WITH A FINAL, FINAL signature our left-handed President Barack Obama (pictured left) made the health reform package genuinely “law of the land” on Tuesday. That’s despite all the premature media fanfaring of it as such at various late stages before yesterday’s ultimate “fixes”.

Or are are they not really ultimate? Even after Tuesday this isn’t – how could it be, really? – the end. The President has emphasized an already recurring “talking point” among the reform’s progenitors, describing the tweaked legislation as just “a critical first step” and adding, “It's not gonna be the only thing. We're still gonna have adjustments that have to be made”.

As a Brit who’s followed the year-long Congressional odyssey a little incredulously I certainly find the package incomplete. I’m from the home of single-payer provision, after all, and (try as I might to understand) I still see the elimination of just the promised “option” of a some government-provided routes to insurance coverage as well-nigh inexplicable.

 

I’ll confess to deep self-interest in my support for such state aid. My home-country’s earliest steps in ensuring a universal health system - back in the centrist political consensus of the 1950s - provided me and millions of children like me with free milk and free orange juice, and I’ll be eternally grateful for the healthy start in life they gave us.

This British background brings me to a man who’s in the America media’s sights now – since he’s reportedly (by the Associated Press) being nominated to run the federal Medicaid and Medicare programs. He’s Dr Don Berwick (above right) the New York-born son of a general practitioner who rose to be first a well-regarded pediatrician and now runs the Boston-based Institute for Healthcare Improvement. Even before any formal White House announcement, this presumed nominee is already coming under considerable, but still incomplete, scrutiny.

He’s not among the choices (long delayed in their confirmation) with whom Obama is making a recess-period end-run around Senate Republican by simply appointing them - which George W Bush did too, as we know, to howls from the minority, then Democratic of course.

So Berwick will be undergoing confirmation hearings – and when the legions of American opponents of British-style health get to learn of Berwick’s British connections, I expect we'll see great Senatorial and right-wing media conniptions.

  

 

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NO AMERICAN MEDIA HAVE SO FAR delved into this aspect of Dr Berwick’s exemplary history, beyond noting that in 2005 he was made a Knight Commander of the British Empire, one of those arcane and archaic - and faintly ridiculous - titles with which British society rewards civic service (– and incidentally the highest one that can normally be accorded a non-Brit).

His Institute has been instrumental in various overhauls to the UK’s much-maligned, but still internationally enviable National Health Service, introduced by the Clement Atlee-led Labour government in 1948 – and subjected to many corrective adjustments since then, most recently by the Tony Blair and Gordon Brown Labour governments in the last decade. One of the Institute’s measures (applied in many countries where Berwick and his colleagues have acted as consultants) concluded interestingly that Britain’s administrative costs as a proportion of its total healthcare spending are less than a third of what the US spends on administration ( - 6% as opposed to nearly 20%). Tell that to “big government” critics who scream about its alleged inability to control costs.

Berwick’s factual observations have led him to some baldly expressed value-judgments, too. And here is where he may well fall foul of (oh, just for instance) Senator Lamar Alexander, who’s the top Republican on the committee that has to vet this nomination.

I can imagine such dyed-in-the-wool opponents of government-managed programs turning apoplectic over what Berwick is on record as saying (again just for instance) to a recent healthcare summit - not in Blair House, Washington, but in the north London suburb of Wembley. Addressing UK healthcare professionals on the 60th anniversary of the NHS - as the service is universally abbreviated among Brits - Berwick was not merely a gracious guest being nice to his hosts. He went far beyond mere flattery and waxed decidedly lyrical. “I am romantic about the NHS,” he said. “I love it.” 

And then to add insult to injury for whichever American health-industry leaders might get to hear his brazen message, he went on: “All I need to do to rediscover the romance is to look at healthcare in my own country”.

Berwick’s speech as a whole listed, coolly and analytically, many features of each country’s system, but it wouldn’t be unfair to summarize his final assessment as labeling the American one “fragmentary” and the British one “equitable, civilized and humane”.

Now, given my own admitted biases, that seems to me a wonderful outlook to be expressed by a man tapped to run the healthcare of America’s poor and elderly populations. But in a US Senate committee room, in front of C-SPAN’s cameras, it is not likely to be so welcome.

 

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