Like many others, I am still reeling from the "recess appointment" of Dr. Donald Berwick as the new Director of the Center for Medicare and Medicaid Services (CMS). But unlike others who feel his appointment was a "sneeky move," I would have to admit that it was brilliant political display of "The Chicago Way."
You see in Chicago, if you hold a position of great stature politically, you don't have to ask permission from anyone to do things. You just do them.
Don't like an airport and want it closed? Just call The Boys and have them go out and rip up its runway under the cover of darkness. You just have to have some forward-looking perspective: like a cool $1.4 million a year in revenues that can be gained from the amphitheatre The Boys build there.
When things like this happen here, people kick and scream and fuss and fume, but they're ultimately left powerless to do anything about it, so they just take some money and move on.
And so it is likely to be with medicine.
For quite a while.
Oh sure, we can all kick and scream and fuss and fume, but it would be far better for us understand what we've really just gained.
It is not just the shift from "rescue care" to the philosophy of a "redistribution of wealth" as Mr. Berwick has espoused earlier:
"You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any healthcare funding plan that is just, equitable, civilized and humane must -- must -- redistribute wealth from the richer among us to the poorer and less fortunate," Berwick said in a 2008 speech in London on the virtues of the British healthcare system. "Excellent healthcare is by definition redistribution. Britain, you chose well."No, it is far more sinister.
My concern is that rather than achieving a overt means of health care rationing vetted by the populous, the covert nature of health care rationing will continue via administrative fiat. As such, people and large health care institutions will continue to be given their government payments to "play nice" by the many, many new "rules," or else. In effect, our health care system has the potential to evolve into a macabre reenactment of bloated, bureaucratic system that defines "The Chicago Way."
After all, since Mr. Berwick won't insist on his own appointment be publicly vetted before our elected representatives, what will that mean for the health care decisions that come from his office and costs of the bureaucracy behind it all?