Thursday, July 15

constraining democracy

Every President uses recess appointments.  It's like pulling a fast one on Congress.  Bush did it with John Bolton. But it's rare that a recess appointment comes without any type of Congressional hearings, without the public airing of views.

President Obama's recess appointment of Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services is a big deal because of the controversial nature of Berwick's beliefs, beliefs that run counter to the great majority of Americans:
"I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do."
"You cap your health care budget, and you make the political and economic choices you need to make to keep affordability within reach."
"Please don't put your faith in market forces. It's a popular idea: that Adam Smith's invisible hand would do a better job of designing care than leaders with plans can."
"Indeed, the Holy Grail of universal coverage in the United States may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per capita costs."
"It may therefore be necessary to set a legislative target for the growth of spending at 1.5 percentage points below currently projected increases and to grant the federal government the authority to reduce updates in Medicare fees if the target is exceeded."
"A progressive policy regime will control and rationalize financing—control supply." 
"The unaided human mind, and the acts of the individual, cannot assure excellence. Health care is a system, and its performance is a systemic property." 
"Health care is a common good—single payer, speaking and buying for the common good." 
"And it's important also to make health a human right because the main health determinants are not health care but sanitation, nutrition, housing, social justice, employment, and the like." 
"Hence, those working in health care delivery may be faced with situations in which it seems that the best course is to manipulate the flawed system for the benefit of a specific patient or segment of the population, rather than to work to improve the delivery of care for all. Such manipulation produces more flaws, and the downward spiral continues." 
 "For-profit, entrepreneurial providers of medical imaging, renal dialysis, and outpatient surgery, for example, may find their business opportunities constrained." 
"One over-demanded service is prevention: annual physicals, screening tests, and other measures that supposedly help catch diseases early." 
"I would place a commitment to excellence—standardization to the best-known method—above clinician autonomy as a rule for care." 
"Health care has taken a century to learn how badly we need the best of Frederick Taylor [the father of scientific management]. If we can't standardize appropriate parts of our processes to absolute reliability, we cannot approach perfection." 
"Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy." 
"Political leaders in the Labour Government have become more enamored of the use of market forces and choice as an engine for change, rather than planned, centrally coordinated technical support." 
"The U.K has people in charge of its health care—people with the clear duty and much of the authority to take on the challenge of changing the system as a whole. The U.S. does not."
No wonder Obama doesn't want Americans to hear Berwick. He had to sneak him through, pull a fast one, the same way Democrats rammed Obamacare through Congress against the will of the people.

0 Comments:

Post a Comment

Links to this post:

Create a Link

<< Home

Copyright 2004-2013, RightFromLeft.blogspot.com. All Rights Reserved. All materials contained on this site are protected by United States copyright law and may not be reproduced, transmitted, displayed, published or broadcast without prior written permission. 0