As somebody who has spent some time writing about and debating health care policy, my jaw hit the floor when I read the following in the Wall Street Journal from Donald Berwick, Obama's recess-appointed administrator of the Centers for Medicare and Medicaid Services:
Improving quality while reducing costs is a strategy that's had major success in other fields. Computers, cars, TVs and telephones today do more than they ever have, and the cost of these products has consistently dropped. The companies that make computers and microwaves didn't get there by cutting what they offer: They achieved success by making their products better and more efficient. We can do the same when it comes to health care.
(via Jeffrey Anderson)
Why is it so shocking to read these words coming from Berwick? The crux of the health care debate between the right and left involves how best to control costs. Conservatives and libertarians argue that we need to have an actual free market for health care with real choice and competition so that active consumers will motivate providers to improve quality and reduce costs, just like how it works with every other good and service in the economy. But liberals typically respond that health care doesn't work like a regular market, and medical goods and services can't be compared to other consumer goods. Therefore, liberals argue, we need a central board of independent experts to decide how to spend money most efficiently, by making judgments about which treatments are the most effective and provide the best value.
So it's utterly bizarre that Berwick, a noted proponent of the latter approach who infamously professed his “love” for the socialized British health care system, would make an argument for improving quality and reducing costs by citing televisions, telephones, computers and cars. What all of those markets have in common is that consumers have choices, they know in advance how much things cost and they have an incentive to save money – all things that are denied to American consumers of health care. The changes Berwick cites didn't happen because government-appointed experts sat around and decided what types of cars and TVs to make, which is the Obama-Berwick approach to health care.
While Berwick was attempting to make a case against Rep. Paul Ryan's approach to reforming Medicare, he actually made a good argument as to why we should support Ryan's efforts to take the broken system and inject choice, competition and incentives to economize.
I think over in Britain this is what they'd call an “own goal.”