Praise for UK-style health system vindicates spurned nominee

Introduction

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.”

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 of 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 in 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.