Tuesday, July 13, 2010

Donald Berwick vs. the NHS

David Gratzer and Paul Howard from the Manhattan Institute published a great op-ed over the weekend about Dr. Berwick’s recess appointment.  Like a Wall Street Journal editorial last week, it analyzes Dr. Berwick’s love of the British National Health Service’s “centralized stewardship” and notes that the new Centers for Medicare and Medicaid Services Administrator apparently has “the Harvard Disease: the idea that having experts peer through reams of data will lead to system wide improvements.”  The problem, as Gratzer (a practicing physician) and Howard point out, is that the personalized needs and demands of millions of patients “are simply too complex and fluid for any central committee to second guess them for long,” particularly in an era when treatments are becoming more individualized.

The biggest irony of all is that the NHS itself recognizes this dilemma, and is moving toward a more decentralized, even market-driven, organizational structure.  Here’s the BBC’s report on the “radical overhaul” of the health service in England announced by Britain’s coalition government yesterday:

Hospitals are to be moved out of the NHS to create a “vibrant” industry of social enterprises under the proposals.  And, as expected, GPs [general practitioners] are to take charge of much of the budget.  The move will lead to the abolition of all 10 strategic health authorities and the 152 management bodies known as primary care trusts.

So in the very same week the heretofore monolithic NHS recognized the need to become more vibrant, nimble, and decentralized, President Obama appointed as CMS Administrator someone who praises “centralized stewardship” of health care and equates market forces to “playing with fire.”  The dichotomy is as striking as it is concerning.