By Jane M. Orient, M.D.
Transformer-in-Chief Obama is rolling right over Congress to appoint his pick to head CMS, the agency that runs Medicare and Medicaid, without opening a discussion of the New health care agenda.
Dr. Donald Berwick is not a newcomer; he’s been hovering with the academic elite “reformers,” biding his time, for more than a decade. His book New Rules, with coauthor Troyen Brennan, was published in 1996.
The Old Rule, in the Oath of Hippocrates, is that each physician should prescribe for the good of each patient, according to his own best judgment. The New Rule is that medicine is an industry, doctors are assembly-line workers, and patients are interchangeable widgets.
On an assembly line, individual craftsmen do not trim individual wheels and axles to fit. Any wheel taken off the shelf must fit any axle. Allowing individual workers to solve problems at the point of production would cause variation and waste. Hence, the workers’ behavior must be standardized, Berwick writes.
To his dream of using the industrial model of Total Quality Management to standardize medical care, the biggest impediment is the old-fashioned doctor. Such a doctor wants to tailor the treatment to the patient, for the maximum benefit of the patient, not jam the patient into a protocol, for the good of the collective. The decision making of independent physicians, Berwick says, is the “critical element in health care inflation.” In other words, caring about patients costs too much.
In addition, with its emphasis on individuals, America “lacks sufficient redistributive impulse to guarantee access to care for the poor.” That means we need to take care away from those who are getting “too much” to give to others deemed more needy or worthy.
Does it appear that ObamaCare will drive independent doctors out of business? That’s the whole idea. Berwick wants us all in an “integrated” institutional model, which some call “an HMO on steroids.” This is designed to shift the power from physicians—and their patients—to a higher level.
Berwick likes the view from 30,000 feet. He can’t bomb the system from there and start over, as he reportedly has advocated, metaphorically speaking. From the pinnacle of CMS he can, however, shift resources around to eliminate “disparities,” demand mountains of electronic data on his desired “outcomes,” and use the data to “cull” the noncompliant or “outliers”—the patients and doctors who don’t fit into the Plan.
From this height, one can rhapsodize about the “fair” and “scientifically grounded” 60-year-old British model without seeing the ugly details: blood-soaked patients lying in the accident room unattended for hours; elderly patients literally starving to death on hospital wards because nobody feeds them; or cancer patients undiagnosed for months and denied the latest treatments.
It isn’t quite accurate to call Berwick “Dr. Death.” That sounds like Dr. Kevorkian, who “helped” give lethal injections to individuals when they decided they wanted to die. Berwick’s method is to redistribute the patient’s life support, including wealth that might be used to buy medical care, to others, when Berwick, or his scientific calculator, decides the appropriate time has come.
Maybe he should be called “Dr. Pain.” The rationing agency of the British National Health Service—which he calls a “global treasure”—decided last year to cut annual steroid injections for severe back pain to 3,000 from 60,000. That takes pain shots away from 57,000 patients.
Berwick knows that rules and regulations stymie innovation, and generate a huge burden of meaningless busywork, without any proof of better quality or safety. His prescription, nonetheless, is more regulation. Only this time, the regulation will be “responsive”—he never says to whom. But now he won’t have to respond to congressional inquiries before he gets installed.
As a book reviewer pointed out in the New England Journal of Medicine in 1996, the New Rules can’t pass their own tests. They are not evidence based.
That is, there is no evidence that they will decrease costs or improve care.
But transform society? If there was any doubt about the true agenda for “health care reform,” Berwick’s appointment has erased it. The New Rules will bring about the New System that Berwick’s ideological comrades have been trying to force on America since the 1940s—with government dependency and subjugation for all.
Jane M. Orient, M.D., Executive Director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University of Arizona College of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943. Complete curriculum vitae posted at www.drjaneorient.com.
Don’t blame Obama, doctors–look in the mirror. We (using the medical “we”) allowed this to happen. However, we can take the power of medical decision-making away from the government and give it back to our patients at any time whenever we choose to stop accepting Medicare and Medicaid and all other forms of insurance. Why don’t we get back to cash on the barrel, charity care for those truly in need, spending our time actually healing patients rather than coding and billing, and the practice of medicine the way we envisioned it when we applied for medical school? All it takes is a little fortitude.
May he and his benefactor rot in HELL. As for us patients. we may have to leave this country
Meanwhile, the Telegraph reports:
“Biggest revolution in the NHS for 60 years.” What’s the change? Britain’s doctors are being put in charge of patient care.
See http://www.powerlineblog.com/archives/2010/07/026714.php
Further:
Eletronic medical records for maintaining that mountain of data? My own mother’s been seriously injured as a result of the miracles of this technology – cerebral hemorrhage in an 84 year old secondary to her heart rhythm medication, sotalol, of 8 years being “erased” on recent admission, and doctors then “trusting” the computer. This resulted in Afib and heparinization, and *BOOM*.
If this happens to the mother of a Medical Informatics specialist, who else is it happening to?
For the want of a few $ worth of sotalol, Medicare’s probably paying 100′s of thousands of dollars over the past two months since this iatrogenic catastrophe:
See lower half of my post “Did EPIC CEO Judy Faulkner of Epic declare that ‘healthcare IT usability would be part of certification over her dead body?’” at http://hcrenewal.blogspot.com/2010/05/did-epic-ceo-judy-faulkner-of-epic.html
and
“Health IT and ‘High Regulatory Standards’: Criminal Negligence for Implementing Defective Systems That Put Data in the Wrong Charts?” at http://hcrenewal.blogspot.com/2010/07/health-it-and-highest-regulatory.html
Amen Dr. Gordon! If you are near San Diego or central NJ, (or other venues that are being organized) you ought to be one of the speakers at the National Doctors Tea Party on August 7th. If physicians do not speak up, we are giving tacit approval to all the platitudes and lies that are emanating from Washington. http://www.doctorsteaparty.com
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We do need to blame Washington for the priorities our government is imposing on us. They can waste trillions of dollars on re-election slush funds and funding the unions but deny our citizens the ability to fund their own health care independent of government regulation. This is all about government control, not care for the citizens of our country. We need to restore the Constitutional framework of our country, ration government not health care, and vote the traitors ruining our country out of office.
Unfortunately, in Arizona, and to the detriment of the doctor-patient relationship, the force and face of labor unions have infected, and infiltrated healthcare.
In “right to work” States, it is not cost effective, so toss the ‘run-it-as-a-business’ bunk Berwick!
Already seen in government medical centers, i.e. the VA, where Black Box label drug therapy is the norm, low ball contract bids rule. The guy with the low ball contract offer, from medical healthcare, to cargo of pills from Chinese chemical mills, are employed.
It seems fittingly hypocritical for the good doctor (I’m sure she is a good doctor, just not a very good political commentator) to go off in the “intellectual elite…” You are an M.D.-you ARE the intellectual elite!! Then throw in some fear, a few lies, and it’s a stew perfect for the Tea Baggers and other wing nuts!
berwick is another of the puppet master’s(George Soros) puppet’s, as is obama. We the People will REMEMBER IN NOVEMBER. In the meantime we all should do as much as possible to try and de-rail this mess. Get your friends and family involved and do what ever you can do, i.e. donate(if you can), call your reps & senators, write to the reps and senators, do anything except sit on your butts and do nothing and hope somebody else will jump in and help.Blog, post a sign in your front yard, in your car, on a post somewhere, just do something! If you don’t we are all going to be lost. Watch bozo and get ready for martial law. I am sure he will try this trick before elections.
sweetoldbill333
Why do so-called liberals who say they are opposed to “homophobia” use the gay bashing insult “Tea Bagger?” Aside from your hypocrisy, you and the rest of the Obama Kool-Aid drinkers can never refute the mounting evidence that ObamaCare is a fraud and a coming disaster.
McDonalds is a great company and makes a sizable profit each and every year. They pride themselves (and they should) that a Big Mac is the same here in DC as it is in LA or in Paris or Moscow (although the name may be different). Stock holders of McDonalds’ stock are happy; people who CHOOSE to eat there are generally happy because they can fill up for very little. I just CHOOSE NOT to eat there…its hard enough not to supersize my middle aged body, and just try and get your burger “medium rare”…
I’m a “Country Doctor” (HIPPA-free), thanks to AAPS info.
I accept only cash (or card) at the time of care, so give individuals what they need – not what a czar orders, unseen.
Gov. Mitch Daniels reports Indiana employees save with HSAs (self-managed, high deductible) as does the state (and would Medicare and Medicaid), solving $ crises.
Gov. care increases gov., not patient care.
Howard Long, Family Doctor
SOB333: Are you on disability or applying for same? Oh Maybe a University faculty Doc who smokes a pipe, writes meaningless papers, and doesn’t actually see patients? Real doctors actually treat patients, are in the trenches, put their necks on the line, and make a difference in patients’ lives! Theirs are the ONLY opinions that matter! This new “Czar” is a typical University charlatan-probly hasn’t seen a patient in 20 years and likes to speak about Medicine using high minded platitudes–what a bunch of crap!! Real Physicians know that all patients are different one from another, and require individual care, treatment plans, etc. This ” Cookie Cutter medicine” is lousy practice, is affiliated with Evidence based med, and the aforementioned EMR. Patients are shoehorned to fit into black/white diagnoses, when the best treatment may lie between. All this pig is really advocating is for Medicine to slide into complete mediocrity, with no more doctors, just algorithm following technicians. God help you if you’re a patient on the wrong list!!!!
Great post, Jane. I am astounded (well, not really) that ‘legitimate’ news sources are not reporting the secondary story associated with Berwick’s appointment. He is a poster boy for the insurance/banking industry.IHI is funded almost exclusively by insurance companies, banks, and their fake non profit arms (ie, Josiah Macy Foundation). Berwick’s ‘innovative’ healthcare improvements are recycled Juran-healthcare metrics from the 1990′s. Berwick’s son, Ben, was working closely with Dodd on the Medicine Bank initiative, which has been significantly under-reported. Let’s get the TRUTH out there…the banking and insurance industries want to have complete control of medicine and all associated profits. The international banking moguls who are ultimately calling the shots don’t care how many industries bite the dust in their and consider humanity a commodity. I really do hope that all physicians will rise up and speak up, but I fear it will be too little too late. In another beautiful stroke of genius, the master planners of the coup d’état have disguised the Berwick appointment in a bipartisan cloak to obscure the real issues at hand. Please ask your membership to spend 10 minutes writing to WSJ and NYTs and other main stream news media to at least populate the Internet with pockets of accuracy. The majority of Americans are blind to what is really at stake. Write to your representatives and hope that it might prove a favorable response. Jane, thank you for speaking up in an environment that prefers silence. Here is a good example of the types of information that need to be populated.
http://www.congress.org/congressorg/bio/userletter/?letter_id=5495804526&content_dir=congressorg
Here is information , re: Medical Banks
Medical Banking Project
http://www.mbproject.org/aboutus-emerging.php
A project that Ben Berwick (Berwick’s son) was intimately involved with when he was working for Dodd.
Banks are Health information brokers
MBP will be used to influence government policy and industry practices; and, among other things, to create a “health-wealth” portal through which, for example, consumers could manage health payments, search for charity assistance with bills or shop for health savings account (HSA) services; and, banks could market credit and perhaps, ultimately, even provide infrastructure to support access to electronic health records.
Banks are taking over patient education
More consumers are turning to the Internet for basic healthcare research. Coupled with market demand for digital tools, banks are increasingly linking to health data sources. As they do this, banks may team with well-known brands in the academic world, pharmaceutical manufacturers and others. These organisations will provide high quality, easy to understand information to bank customers. A special feature of this service will enable personalisation and automation of research, “e-clipping” data that an online banking consumer may want for future reference.
Medical banking holds the potential of shaping a broader understanding of “human capital”. This area offers a value-centred view of healthcare as opposed to focusing on cost alone. In this line of reasoning, banks will seek to provide quality health information to account holders for their better lifestyle decision-making. Banks that follow such rationale will retain HSA assets and tend to have larger profits. A report by Booz Allen suggests that major banks will yield over US$ 1 billion in net revenues in part by meeting this key challenge.
Banks are triaging patient care
Banks are scoping out a broader platform to enable robust front end processing for care providers. This type of a system will be used to categorize patients that come into the emergency room, for instance, into an action-driven platform that better co-ordinates care resources in the community.
Sixty per cent or more of the people treated in high-cost emergency room settings are non-urgent cases. The platform will address this issues.
World Bank Involvement in Healthcare
http://www.himss.org/ASP/ContentRedirector.asp?type=HIMSSNewsItem&ContentId=73635
Basically banks want to run the show. I think it is a frightening proposition.
I feel like we have been taken over by the BORG.
If our profession is to survive apart from control of third parties – gov’t and insurers alike – we must stop working for them, which also means we must stop taking advantage of our patients’ ignorance of costs and the lack of real necessity for much of what we provide them these days. From elective surgery for self limiting conditions through avoidance of end of life discussions, we pursue profit by procedure. Furthermore, by accepting lower payments for our services, then increasing volume of tests, prescriptions, and procedures to maintain revenue, followed by hiring substitutes / “extenders” who provide mediocre service, we become complicit in the problem. Of course we despise where medicine is going, but unless we acknowledge our role in the process, i.e. acting like assembly line workers, we cannot expect anything else. Change will come, either we lead or we must follow.
I think that many Americans have no idea of just how fanatical some of these far-left Brits are, especially those who have championed the National Health Service. I am one of the many doc tors who left Britain because we saw no worthwhile future under socialism. We might have returned when Margaret Thatcher restored restored sanity, but perhaps like me our families were well entrenched by then in the school and social systems. A person with Dr Berwick’s ideas is going to be a true disaster, and it is a very poor reflection on the American electorate that you ignored all the warning signs before elec ting Obama.
This is government enforced euthanasia by denying needed medications and/or treatments to the elderly, those with severe health problems and those born with severe disabilities. My elderly Mother received a letter in January telling her that a needed medication would no longer be covered by medicare. She has to pay considerably more for her prescription medications this year. This is how Obama plans to fund his “healthcare plan” if you can call it that. Oh, let’s not forget the free healthcare to illegal aliens. Our government will pay for that but not for it’s elderly and infirm citizens. I am so disappointed in most of those running our government at this time.
To Dr. Boniface-
I could not agree with you more. The practice of medicine is a science, but also an art. Patients are not widgets on an assembly line. IMHO some physicians have lost the finesse required to practice medicine as an art. They are constantly prodded into an ‘algorithm’ mentality. Algorithms serve a purpose, as guidelines, but the doctor still needs to think out of the box on a per patient basis. This concept is something banking moguls, managed care CEOs and bean counters will never understand unless they, themselves, become ill, and with the salaries they earn, I am sure they will have access to the finest medical care available.
sweetoldbill333:
Let’s take a look at the Left in its element, and on Candid Camera:
http://zombietime.com/hall_of_shame/
Truly revolting.
This all seems so incredibly hopeless! I fear for all of us in every way.
At the risk of sounding paranoid…. has any body watched the old movie Solyent Green lately?
This is all simply terrifying!
I have been researching everything I can find concerning the current “administration”, and have found NOTHING positive coming from the White House. Everything that’s happening breaks down into this mysterious spiderweb network involving not only power but money. None of the decisions that are being made currently will affect the people at the top except to make them more powerful over us and much, much richer. We will all be slaves, animals, bugs…to be crushed on a whim! We simply cannot let this terror reign any longer!
Do we even know how to IMPEACH? I don’t think that will even help at this point. The whole bunch, shy of a very few, should be fired. Straight up! We need to be governed by REAL AMERICANS!
When should we start building a wall around the Capital City, with an above ground, air conditioned (to be civil) prison style walkway leading in from both borders. We can afford to let go of that much property can’t we? Then we can establish an “ALL NEW ELECTION” just like our Forefathers did. We can have a Bible study in all of our schools, mandatory for each child and in every grade through College. We can reinstitute morals, principle, and reason once more. Limited governing employees who are just simply proud to serve our great nation.
We’ll give A/C technicians, electricians, maybe a few plumbers, and masons plenty of work building that wall. We’ll also employ converted military men to guard our production. We’ll need planners and surveyors, offices and clerical help… well, you get the picture.
We can be self sustaining. We’ve been sustaining ourselves for a long time with a lot of adversity; all the while sustaining our adversaries. I don’t see why we can’t get together on just this one thing, through vigilant prayer and the help of one another.
Heck, if they get mad enough about it, maybe they’ll try to blow us all up or something… but really what could be worse than what we’re moving toward right now? We are all destined to die at some point; I am unafraid.
We are letting this happen! We The People aren’t doing enough! They’ve been working this plan for nearly 2 centuries now on the sly and they are so confident now that we are entirely ignored and they aren’t even hiding anymore!
In broad daylight and in truth we can reverse this thing much more quickly. I believe we have greater minds and might than anything they might propose.
Yes, vote. But really that seems to me to be useless. It has been for quite some time now. Things just seem to get worse and worse. I want a divorce! The government is not holding up to their promises at all. I say Repeal Everything following the Declaration of Independence and the Bill of Rights and start all fresh. Learn from our mistakes and move forward. What’s really stopping us?
Thanks for letting me rant and I especially thank all you fine Doctors who stand firm on your oath to give good care in a humane and kind way. I love you each and every one! Keep fighting the good fight!