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Health Care Rationing: A Love Story

July 13, 2010 By: Scott Spiegel Category: Health Care

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Image by Scott Spiegel via Flickr

What kind of benevolent dictator would declare his love for Britain’s stingy, depressing, complicated, cold and arbitrary National Health Service by describing it as “generous, hopeful, confident, joyous and just”?

That would be Harvard-based pediatrician Donald Berwick, who recently received a recess appointment as Administrator of the Centers for Medicare and Medicaid Services by the benevolent dictator who describes his pessimistic and stale vision for America as “hope and change.”

Recess appointments are an executive procedure used, for better or for worse, when the Senate gives a presidential appointee a difficult time during confirmation hearings—for example, when they filibuster a nominee.  Obama’s appointment of Berwick bears the distinction of having been given without a confirmation hearing having even been scheduled.

It’s as though Obama decided that the very requirement that his nominee appear before a Democratic-controlled Senate constituted an unreasonably difficult hurdle.  This isn’t a recess appointment—it’s a vacation to Bermuda appointment.

As the Wall Street Journal noted, “Circumventing Senate confirmation to appoint the new Medicare chief is part of the same political willfulness that inflicted ObamaCare on the country despite the objections of most voters.”  CBS News observed, “The debate over Berwick’s recess appointment makes clear what the White House knew all too well—Berwick may not have survived the Senate confirmation process, which would have turned into a proxy debate over health care reform.”

Berwick, who will be put in charge of the health care of 100 million Americans without so much as a public query about his plans in office, has been quoted saying, “I am romantic about the N.H.S.; I love it.”  He has called himself “an American fan” of the system, “distant and starry-eyed.”

In his London speech commemorating the N.H.S.’s 60th birthday, Berwick delivered such pro-American pronouncements to his audience as “Do not trust market forces to give you the system you need…  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.”

When it comes to Berwick’s affection for health care systems centered around use of death panels, apparently absence makes the heart grow fonder.  After returning home and mooning over the UK’s National Institute for Health and Clinical Excellence, the operational arm of the N.H.S., Berwick realized that “All I need to do to rediscover the romance is to look at health care in my own country.”

That country would be the United States, which has the greatest health care system in the world, and would be a profound source of inspiration for anyone who truly loved medicine.  Berwick’s own place of employment is Harvard Medical School, where you would think there would have been a few medical advances in recent years to set his heart aflutter.

But no—Berwick’s passion is for euthanasia counseling and quality-adjusted life years.

Berwick of course has never had to live under the jurisdiction of the N.H.S.  You might call his affair with the British health care system a long-distance relationship.

Describing the supposed British backlash against American conservatives’ depiction of the N.H.S. during the health care reform debate last summer, the New York Times gushed, “A Twitter campaign, We Love The N.H.S., is still going strong, with supporters sending messages about their own good experiences.”

In fact, said campaign didn’t even last 30 days from its first Tweet to its last, and has attracted a piddly 520 followers internationally.  This is despite such helpful but unheeded administrative prompts as “What do you love about the nhs?” and “Please Retweet: 10,000 supporters visualised.”

Admittedly, the riotously popular N.H.S. does have a Facebook fan page with 3,500 members.  Then again, an ill-worded N.H.S. sign implying that contraception would be facilitated by anal rather than vaginal intercourse has a Facebook fan page with 124,475 members.  So perhaps fan counts are not such a flattering measure of the N.H.S.’s popularity.

Even the New York Times admitted that Brits “complain endlessly about the National Health Service…  They deplore the system’s waiting lists, its regional disparities in treatment, its infection-breeding hospitals and its top-heavy bureaucracy.”  I guess the grass is greener on the other side of the pond!

If Donald Berwick wants to swoon over endless waiting lists, fatally protracted wait times, diminished access to specialized care, craven efforts to shield patients from learning about or acquiring costly life-saving drugs, dismal heart attack and cancer survival rates, depersonalized patient treatment, and centralized bureaucratic decision-making about individual health care options, that’s his prerogative.  But forgive the rest of the U.S. if we aren’t quite as smitten as he is.

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Just Make Sure It’s Not a Blue Moon Belgian White

July 26, 2009 By: Scott Spiegel Category: Racism

President Obama has invited Sergeant James Crowley and Professor Henry Louis Gates, Jr. to the White House for a beer to clear up hard feelings over Crowley’s arrest of Gates for disorderly conduct two weeks ago.

Notice how, now that the facts have come out, no one is taking Gates’ side anymore; those who initially sided with Gates are arguing that both men are at fault and that we should all “learn from this incident” and move on.

If anyone still cares, the fact is that both sides are simply not at fault.

Here are a few myths about Crowley’s arrest of Gates:

Crowley overreacted in arresting Gates.

Not according to the Cambridge Police Department; the Cambridge Police Patrol Officers Association; the Massachusetts Municipal Police Coalition; the Cambridge Multicultural Police Association; mixed-race police unions across the country; Sgt. Leon Lashley, the black cop who accompanied Crowley; or black public figures such as Bill Cosby and Juan Williams.  Other than that, the experts are unanimous—he overreacted!

Gates’ behavior was not an arrestable offense; Crowley should have walked away after establishing his identity.

According to police protocol in such an incident, you leave the scene only once all actors are quiet and issues have been resolved to everyone’s satisfaction.  You do not slip away while one party is still unhinged, screaming like a lunatic, insulting a police officer’s mother, badgering officers, and frightening neighbors who have gathered out of concern.  If the object of investigation shows no signs of calming down, it is not police procedure to leave such a raving maniac poised to cause additional mayhem.  The police have seen too many cases in which angry residents have gone on to cause further trouble; it’s foolish for anyone to second-guess the Cambridge cops and pronounce that they should have known what Gates would do next.  Gates had dozens of opportunities to cooperate with Crowley’s attempts to defuse the situation and back away, and every time he chose not to.  That is why he was arrested.

As a public servant, Crowley should have been more respectful of Gates.

Gates’ wealthy Harvard neighborhood had experienced a rash of break-ins in recent months, including Gates’ own home.  The job of a public servant in Sgt. Crowley’s position is to forcefully protect property owners—once they are definitively identified as such, which Gates made difficult to accomplish—from those who would aggress against them and their property.  That is what Crowley was trying to do.  Had Gates lived in a poor neighborhood and the two men trying to break in been real burglars, and had Crowley let the men get away without proving they lived there, his department would no doubt have been faulted for ignoring “black-on-black crime.”

Crowley arrested Gates for “disrespecting” him.

Crowley did not arrest Gates because Gates “dissed” him—he acted lawfully in response to Gates’ disorderly conduct, which involved Gates’ following Crowley to the porch, yelling epithets about Crowley’s mother, and startling pedestrians.

Crowley engaged in “racial profiling.”

Ignoring the fact that “racial profiling” does not, by definition, take place when an officer has been called to a resident’s home to investigate a burglary, there’s far more evidence that Gates is guilty of “class profiling”—singling out a working-class cop for abuse because he thought Crowley wasn’t powerful or confident enough to stand up to him.

Both men are prejudiced toward those from different backgrounds.

I can’t say how Gates feels about working-class cops, but Crowley had been hand-selected by a black police commissioner to teach a course on avoiding racial profiling, which he has done for the past five years.  I think that gives him just a smidgen of credibility in claiming he does not go around engaging in egregious on-the-job racial discrimination.

It’s Crowley’s word against Gates’.

Not having been there myself, I’ll nonetheless trust the judgment of a universally praised sergeant who taught an anti-racial profiling class for five years; the black sergeant who accompanied him in the arrest; the Harvard University Police officers who appeared as backup and witnessed the scene; the Police Department who trained Crowley and tracked his implementation of protocol; and Emergency Communications and 911 Center staff who received updates on the incident in real-time.  All of those parties support Crowley.

The police dropped the charges against Gates because their case was weak.

The prosecutor’s office, not the Cambridge Police Department, decided to drop the charges, most likely because of Gates’ status in the community and because he raised such a stink about it.  The Cambridge Police Commissioner has since publicly stated that he wishes the charges had not been dropped and Gates were forced to defend his actions in court under a strict examination of evidence.

Obama should have criticized both men for their behavior.

Obama should have refrained from making a summary judgment on a local case until he knew the facts.  He is President now, not a rabble-rousing community activist “promoting awareness” of social ills.

Crowley reports to the mayor of Cambridge, the governor of Massachusetts, and the President of the United States, and should have accepted their criticism without question.

Crowley was backed up by his superiors and his department.  He does not report directly to the mayor, the governor, or the President, and he is not contractually prohibited from speaking up and defending himself against spurious allegations by citizens he is protecting.

In any event, it appears that Crowley was big enough to agree to meet Gates and Obama at the White House.  In the meantime, he can look forward to the audiotapes of the arrest being released and clearing his reputation.

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