Berwick and the rationale for rationing

I did a lot of driving around Wisconsin this week and used the time to listen to a lot more radio stations than I would otherwise. Among other stations I listened to NPR, Christian radio, an African American-themed talk show, and right wing and left-wing talk. I find each of those genres mildly annoying to almost unbearable so I flipped around a lot. Music stations played a heck of a lot of songs from the 70s and 80s so it was like going back to junior and senior high school.

One of the things I noticed was the use of fairly extreme words to denigrate political opponents. One conservative station referred to President Obama –and many others– as “socialists,” without ever defining the term. (I guess they mean a really liberal liberal.) “Racist” was another term used by the NAACP and its opponents in the Tea Party. At first I was kind of excited to hear a “progressive” talk show –after all Wisconsin has a long history of progressives– but was pretty disappointed when the host came on and started raving about how we should make outsourcing (I think he meant offshoring) illegal. Crazy stuff.

I’ve been reminded of another bad word recently: “rationing.” That’s a popular one among opponents of health reform. And it’s been thrown around a lot in relation to Dr. Don Berwick, the new CMS administrator. Of course the Wall Street Journal is one of those places. But a letter (In Defense of Dr. Donald Berwick) puts rationing in a different light:

You criticize Dr. Berwick for wanting to “see a system in which those [rationing] decisions are transparent—and that the people who make them are held accountable” and that we must “weigh public welfare against the choices of private consumers.” Your point seems to be that Dr. Berwick does not understand the difference between rationing “through individual choices and price signals and rationing through politics and bureaucratic omniscience.” On the contrary, Dr. Berwick and many others perfectly understand this difference. Their point is that there currently is rationing of health services by both public and private payers based on access to care, coverage and price.

What we need to do is to acknowledge this rationing, make the rationing transparent and understandable to the public, and base this rationing, to the degree possible, on objective scientific evidence, not on politics or bureaucratic omniscience.

In the past words like Queer have been reclaimed by those against whom they have been thrown. Perhaps it is time for Dr. Berwick to grab the rationing bull by the horns and claim it. Actually, I think the proper time is a few years off. The general public isn’t ready to listen yet.

July 16, 2010

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