The Harvard disease--Control freak medicine

David Gratzer:

President Barack Obama has nominated Dr. Donald Berwick to a position largely unstaffed during the Bush administration: head of the Centers for Medicare and Medicaid Services, which oversees the two Great Society programs.

Berwick has decades of experience in health policy and, on paper, would seem a perfect candidate for the job. But he has fallen into the trap of many intellectual elites, which we might call the Harvard Disease: assuming that a government committee can guide one-sixth of the national economy into efficiency.

In many ways, the Harvard professor represents all that is wrong with the Obama White House’s approach to health-care reform. As an unabashed admirer of Britain’s National Health Service, he sees only one solution: a 10-point plan, with more micromanagement by clever elites.

But British cancer outcomes don’t just trail U.S. results; they rival those of Eastern European nations. Wait lists plague every aspect of care. Britain’s postal code lottery - patients receiving access to specialists because of geography and not need - is a chronic problem.

Nowhere are the deficiencies of government health-care management more clear than in Britain’s creation of the National Institute for Clinical Excellence, established in 1999 by Prime Minister Tony Blair. NICE’s mandate: Save money by spending health dollars more efficiently. Using complex formulas, NICE has targeted high-end surgical procedures, medical devices and, especially, drugs.

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NICE has become the British acronym for a "death panel." They decide whether a treatment to saves lives is worthy of the patient or vice versa. The NHS has developed a "killer" health service providing dirty hospitals and inattentive overworked staff, many of whom do not comprehend the English language. The cases of negligence and abuse would not be tolerated in a facility that is trying to make a profit and compete with other facilities.

Fundamentally, no one is smart enough to manage a program of this size. It is like the analogy I use often, of a committee trying to decide how many eggs and slices of bacon are needed in New York City everyday. No one has that knowledge, but the market figures it out everyday. When you multiply the problem by trying to figure out how many eggs and slices of bacon are needed in the US everyday you begin to see the complexity of trying to manage and ration health care.