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OP-ED | Praise For UK-style Health System Vindicates Spurned Nominee

by | Jun 23, 2014 4:34pm () Comments | Commenting has expired | Share
Posted to: Congress, Health Care, Opinion, Health Care Opinion, Reprinted with permission from the Center for Public Integrity

Former Medicare-Medicaid Chief Is A Fan Of Single-Payer Option

In April 2010, President Barack Obama nominated Donald Berwick, a widely respected physician and health policy expert, to lead the Centers for Medicare and Medicaid Services (CMS). Despite having broad support among other health care leaders and a long history of patient advocacy, most Republican senators were adamantly opposed to having Berwick in charge of one of the country’s largest government agencies.

Obama decided against putting Berwick through the confirmation process after it became clear that the GOP senators would stage a filibuster. Berwick’s sin: expressing admiration for the United Kingdom’s single-payer health care system in a 2008 speech commemorating the 60th anniversary of the U.K.’s National Health Service (NHS).

The headline of a story on the website of the conservative Heartland Institute summed up the GOP’s feelings about Berwick at the time: “CMS Nominee Favors Government-Run Rationing of Health Care.”

The story went on to quote Berwick as having said in England, “I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country.”

wikipedia Obama didn’t give up entirely on Berwick. The Constitution allows presidents to make short-term appointments without Senate approval when Congress is not in session, and that is what Obama did. He appointed Berwick as CMS head when Congress recessed for the July 4th holiday in 2010. He served until December 2011 when his recess appointment was scheduled to expire. Obama decided not to try again to get him confirmed after 42 of the Senate’s 47 Republicans, many of whom had claimed during the health care reform debate that the U.S. had the best health care system in the world, signed a letter of protest over the recess appointment and made it clear they would never vote for Berwick.

Although Berwick could not have transformed CMS into an American version of the NHS even if he had wanted to — the health insurance industry’s friends on both sides of the political aisle in Congress would never have allowed that to happen — Berwick has not backed down from his admiration of the NHS and a single-payer system. If anything, he has doubled-down on it. He has made his pledge to create a single-payer health care system in the U.S. a central part of his campaign for another high-profile job: governor of Massachusetts.

Last week, Berwick got closer to that goal during the state’s Democratic Party convention when he became one of three candidates to qualify for the Sept. 9 Massachusetts primary. State Treasurer Steven Grossman and Attorney General Martha Coakley were the other two qualifiers.

Two days after securing a spot on the September ballot, Berwick got what could be a boost to his campaign, not to mention vindication: evidence that Americans should indeed look to the Brits when it comes to health care.

In a research report by the New York-based Commonwealth Fund that evaluated the health care systems of several countries on dozens of performance measures, the U.K.’s National Health Service ranked No. 1 in the world. The U.S. didn’t come close to the top. It finished dead last.

In fact, since the Commonwealth Fund began assessing the world’s health care systems in 2004, the U.S. has consistently trailed every other country studied.

“Over the past decade, leaders in the United States have begun to recognize that the nation’s health care system is far more costly than any other system in the world and does not produce demonstrably better results,” the researchers wrote. “The claim that the United States has ‘the best health care system in the world’ is clearly not true.”

In order to make it true, they said, “The U.S. must adopt and adapt lessons from effective health care systems both at home and around the world.”

And the one country with the most lessons worth adopting and adapting is the very one Don Berwick is romantic about.

The Commonwealth Fund’s report includes 80 indicators grouped into five dimensions of performance: quality, access, efficiency, equity and healthy lives. The U.S., regrettably, ranked last overall and last or close to last on four of the five dimensions. The only area in which the U.S. even joined the top half of the countries evaluated was quality of care.

The U.K., on the other hand, not only ranked first overall, it also scored highest on quality, access, and efficiency.

The research was conducted before many of the provisions of the Affordable Care Act went into effect, so there is hope the U.S. will move up in future rankings. But for now, if I were Don Berwick, I’d try to get a copy of the Commonwealth Fund report into the hands of every Massachusetts voter. And he might be tempted to send an “I told you so” note to a few folks in Washington.

Former CIGNA executive-turned-whistleblower Wendell Potter is writing about the health care industry and the ongoing battle for health reform for the Center for Public Integrity.

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(16) Archived Comments

posted by: art vandelay | June 24, 2014  12:04am

art vandelay

I give the socialist/progressives credit.  They don’t quit until they get what they want.  Their goal is a single payer system. They now have Obamacare which is the first step. Within a few short years, this nation will be single payer.  The Conservatives have no clue as to how to stop them.

posted by: Politijoe | June 24, 2014  7:28am


Wendell, thanks again for providing wonderful insight and contrast regarding global healthcare systems. The challenge are those in the conservative right like the Senate members referenced in the article that will break out that bag of old tired phrases like “socialism”
“death panels” and “government takeover” instead of educating themselves about the various global healthcare models and allow the U.S to adopt lessons from effective health care systems around the world.

This Yankee-doodle dandy, flag waving American exceptionlisim is a myth. There are some things we do very well and others that simply need improvement. There is no shame in that, however where there is shame is confusing evidence with conjecture and ideology with policy, resulting in the most expensive healthcare system in the world that has poorer outcomes and still doesn’t insure all it citizens.

posted by: GuilfordResident | June 24, 2014  11:42am

The VA has death lists apparently. The reason the progressive elites will win is because they conjured soft despotism and keep a majority of the people dependent upon them. I read some article on the Internet (so it has to be true) that 85-90% of the 1%-ers are progressives. 6 years ago, my insurance was awesome. Now it stinks and my earned income is being stripped away.

posted by: GBear423 | June 24, 2014  3:49pm


It remains amazing to me that some people honestly think that the primary problem in our healthcare system is the solution.
A corrupt inept and massive bureaucracy is not going to run like England’s system.

UK has a population of 63 million all huddled up on the same crappy island with same regional climate.
US has a population of 314 Million spread across a very large region with many variables in climates and health factors. Its not a simple flick of the switch.

I dunno, it seems too tall of an order, and that is even if we all of a sudden have a competent and benevolent govt that would administer it all properly.

posted by: Bulldog1 | June 24, 2014  4:07pm

@Art:  Absolutely single payer.  Just tell me why the so called “socialist states” cover ALL of their citizens at half the price we pay. The US leaves out at least 50 millon out and another 5o million with crap insurance? At twice the price.

And then these damn socialist societies get better health outcomes?  I know you support payiing millions to CEO’s but honestly I don’t see how that adds up to better health care for the ordinary citizen.

And Guilford how does covering all Americans at half the price amount to “soft despotism?”  Rather it might actually stimulate the economy to have the guy on the street have some of the thousands he spends on premiums to spend on something else.  And I realy doubt that 85% of the 1% are progressives.  If so US policies would be quite different.

posted by: OutOfOutrage | June 24, 2014  4:46pm


HAHA! The Commonwealth Fund!?? Every bit as non-partisan as the Cato Institute.  I hope they brought the same scientific approach that they used in their “study” of Romney’s proposed health plan vs. Obama’s plan when they were candidates.  I’m so glad that your articles are no longer just linked to this page.  On this site my comments are actually posted!  You’re right about one thing though. The US health system is an embarrassing nightmare.  Perhaps someday it will be on par with the government’s other heath care system. The VA.

posted by: art vandelay | June 24, 2014  5:04pm

art vandelay

The closest thing this nation has to single payer is the VA System. Is this what we want for this country especially with the IRS administering it?

posted by: Politijoe | June 24, 2014  9:29pm


Bulldog, A well articulated response which is a welcome respite from the usual dead-end thinking on this comment board. What is both frustrating and amusing is the consistent deflection from this low-information anti-everything cohort regarding healthcare reform.
Dismissing the facts our current fragmented employer-based, for-profit healthcare system cost more and delivers less. Or that our healthcare premiums have increased 120% since 2000, about 8% annually even before Obamacare and wouldve been expected to nearly double again in the next decade. Or the fact that healthcare consumers now have protections against pre-existing conditions, junk policies and unwarranted denials and consumers are now eligible  for free pre-screening and wellness visits or that children can remain on parental policies until age 26.  instead they are centered on sophomoric and uninformed positions relating to death panels, socialism, higher costs, government takeover and even the IRS.
If Teapartiers would dismiss their anger long enough and follow the facts they’d conclude their willful ignorance is rooted in a misguided ideology and outdated mythology. Healthcare has never been an ideological issue; it’s a matter of sound governance, fiscal responsibility and sustainability not a government takeover

posted by: Bulldog1 | June 25, 2014  9:00am

@ Politijoe.  And along with the elements of sound governance, fiscal responsibility and sustainability is the notion that with health costs at least predicatble so perhaps we can get on with rebuilding an economy that actually works for ordinary Americans.

@Art:  The VA model is fine.  The lack of accountability by those running the VA is not.  Nor is the unwillingness of the VA or the political class (both sides of the aisle) to dismiss those who are responsible is despicable.  We need to recognize that accountability is essential for any system, public or private, to function properly.

posted by: Politijoe | June 25, 2014  5:00pm


Bulldog, I couldnt agree more or have said it better. lets not allow those who claim to channel the founding fathers to turn this into a false argument based on ideology, conjecture and fear.  Your response regarding the VA was perfectly stated. The VA model is fine. ‘Its the lack of accountability by those running the VA that is not.”  The fact it’s a public agency is no different than if it were Wall Street….same issue….. accountability. It is interesting when facts are presented in a united fashion how quiet the noise and distractions become.

posted by: art vandelay | June 26, 2014  7:57am

art vandelay

My dad was a WWII Vet. As a child my dad would drive by the VA Hospital in West Haven on family trips to NYC. I remember his comments to my mom. He said “don’t EVER send me to this hospital”. The VA was bad in the late 50’s and it’s bad now.  You’re telling me the VA model will be like private hospitals under a single payer system?  God help this country.  I say let the free market manage our health care.

posted by: Politijoe | June 26, 2014  10:33pm


Art, aside from anecdotal experiences statistics indicate a significant majority of patients are happy with the VA, same with the other “socialized” healthcare system in this country-Medicare.

More to the point when comparing indicators, costs and outcomes of global healthcare systems to the fragmented, employer-based, for profit out-of-pocket US system, we rank far below other nations healthcare models.

Therefore, if we are to have an honest dialog about this issue, lets dispense with the anecdotal conjecture and consider just the facts and outcomes, which will lead to the conclusion that the ACA is about fiscal responsibility, fairness and sound governance.

posted by: art vandelay | June 26, 2014  11:45pm

art vandelay

@Politijoe,  I’d like to enlighten you somewhat when it comes to the healthcare system from private vs public perspectives.
I’m currently retired and on medicare with a supplemental policy. I’m divorced from a public school educator.  When I was married I had life threatening major heart surgery. I was diagnosed & treated within a 48 hour period without any questions asked.  I never received any invoices whatsoever for any services rendered. The services provided to me were from private sector companies.  I also was prescribed Lipitor (not generic) of which the insurance company never substituted to a cheaper generic form.  I’m now on medicare administered by the government. The Lipitor has been substituted to a generic form even though my doctors say I need to be on it. I also developed neuropathy and my neurologists prescribed Lyrica. It too was substituted for a cheaper drug which cannot control my symptoms as good as Lyrica can.  Believe my I’d rather be back on my ex-wife’s policy vs Medicare.  I strongly believe that if I had my major heart problem under Medicare I’d now be 6 feet under.  So please do not tell me that Government run health care is better than what the private sector can provide.  I don’t buy it.

posted by: Politijoe | June 27, 2014  9:56pm


Art, you mention a couple of specific drugs but there simply isn’t enough time or space in this forum to delve into the Medicare prescription drug plan, and like the bigger issue you raised regarding public versus private healthcare it is far too broad a subject to address completely in this forum.

However the central point your missing here is that the ACA is designed for those Americans currently without access to affordable health insurance-NOT those with private employer-based healthcare. Much like Medicare, which is designed for those who are priced out of the private healthcare market-typically the elderly.

Therefore one cannot nor should one realistically compare the two because they are intended for very different segments of our population. For what its worth, Medicare has lifted millions of elderly out of poverty since its inception and has been one of the great American success stories.

Now if your argument is the validity of Private versus public healthcare, I believe you present a false premise. No-one is talking about eliminating private healthcare.
However noteworthy your two specific examples with prescription drugs under Medicare are, they simply don’t hold up to the comparisons of global healthcare systems. The US healthcare model is an employer-based, for-profit,
out-of-pocket system which costs more, provides less and still doesn’t insure all of its citizens. Therefore, by default it is an inefficient, unfair model that remains financially unsustainable.

posted by: art vandelay | June 28, 2014  6:03am

art vandelay

@PolitiJoe, If the ACA was established to insure the 19 million or so who had no access to our healthcare system, then why was EVERYONE effected? Why is everyone being FORCED into it? Why wasn’t a program initiated JUST for those 19 million?  The ACA is NOT about insurance, it’s about GOVERNMENT intruding on individualism and freedom of choice.  It’s about SOCIALISM.  The ACA is just a temporary compromise.  Eventually it will be a complete government takeover. Don’t think for one second it is not. During the Wilson Administration the government took complete control over the money supply via the Federal Reserve. It started out small and grew to where it is today.  Same holds true for the income tax and the IRS. Look what the IRS is doing today. In the beginning it only affected 1/4 of 1% of the population.  Today everyone who earns a buck has to file a 1040. Don’t think for one second the ACA will be any different. It’s only a matter of time.  I fear a large centralized government.  It’s now taken over our education system.  This is exactly what our founding fathers feared. It gets worse every time we elect a left wing socialist President Republican or Democrat. I much prefer a pay as you go system. My biggest fear is not the administration of healthcare, but the strides made in medical technology.  Once the profit is removed there is no incentive for medical innovation.  Polio, would NEVER had been eradicated with socialized medicine, nor will a cure for cancer.

posted by: Politijoe | June 28, 2014  4:14pm


Art, your comments are so ridiculous regarding socialisim, death panels and government takeover, etc…I won’t spend any real time responding.

Except to point out some glaring contridictions in your premise. First the ACA doesn’t affect EVERYONE. If you have private employer-based healthcare it hasn’t effected you so that’s nonsense. Secondly this is not about socialism or government takeover of healthcare by a democratic in the White House. This is the same model Republicans proposed in the late 80’s and mid 90’s it’s also very similar to the model Mitt Rommey enacted in Mass The Commonewealth plan. So once again this is nonsense.

When you can look t the facts of the issue and respond with some degree of objectiveness and reason let’s have a conversation. In the meantime, save the dead-end, inflammatory rhetoric for the rest of the uninformed tea drinkers.

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