Am Heart Hosp J. 2010;8(1):7–8
Lozenge Reference
Editorial
American Healthcare Reform Agonistes Sylvan Lee Weinberg, MD, MACC
I
have invoked a bit of literary license in adding the epithet ‘agonistes’ to the title of this editorial. This is because the word agonistes was historically used following the name of persons who have struggled and suffered, and not as I have done to characterize the potential for struggle and suffering inherent in the radical proposals for changing America’s healthcare system now under way at our highest levels of government. As an aside, the classic and probably the original use of the word agonistes as an epithet was by the great English poet John Milton in his 1671 epic tragic poem ‘Sampson Agonistes’, which recounts the death of Sampson, a blind captive of the Philistines, as “Eyeless in Gaza at the mill with slaves.”
The chief actuary of the Centers for Medicare and Medicaid Services (CMS) has released a statement that the new Obama healthcare law will increase spending in the US beyond already unsustainable limits. However, major healthcare spending and full implementation of the program will not occur until 2014. That not withstanding, unless there is a change in the balance of power in the November congressional elections, a complete takeover of America’s medical enterprise by the Obama administration seems inevitable.
An ominous step has already been taken that is indicative of Obama’s philosophy of how America’s healthcare should be administered and controlled: the appointment of Dr Donald Berwick to head the CMS. There is no question that Dr Berwick’s professional, academic, and intellectual credentials are impeccable: he has a BA from Harvard College, a master’s degree from the Kennedy School of Public Policy, and an MD from Harvard Medical School; he is a Clinical Professor of Pediatrics and Health Policy at Harvard Medical School and a Professor of Health Policy and Management
at the Harvard School of Public Health; he is widely published in medical literature; and he is President and CEO of the Center for Healthcare Improvement.
Based on his CV, it might seem that Dr Berwick is without question a superb candidate to head the CMS. However, there are other factors that cast serious doubt concerning his ultimate qualification to direct the CMS and the havoc he might wreak on access to and quality of American healthcare. Surely these questions must be raised based on his self-proclaimed admiration for the British National Health Service (NHS) and its draconian National Institute for Health and Clinical Excellence (NICE), which acts in part as the rationing arm of the NHS.
This is what Richard Smith, Editor of the British Heart Journal (BMJ), said in 2000 in an editorial about NICE, titled ‘The Failings of NICE’: “One failing of NICE is that it is living a double lie. The first lie, which is as is Orwellian as its name, is for NICE to deny that it is about rationing healthcare, which might be defined as denying effective interventions. Denying ineffective interventions is not rationing; rather it’s what Americans call a ‘no-brainer’.” Smith goes on to say that the second lie is to imply that if the evidence supports an intervention, it is offered, and without the evidence, it is not offered. He denies that it is so simple that these decisions can be made with some data and a computer. He contends, rather, that this lie corrupts the concept of evidence-based medicine, long championed by the BMJ.
Now, to get back to a review of Dr Berwick’s philosophies and how they would influence our access to healthcare, or lack thereof, in view of his avowed devotion to Britain’s single-payer and rationing-prone NHS and NICE, he is quoted as saying: “I am a romantic about the NHS: I love
• From the Heart Institute of Dayton at The Good Samaritan Hospital and The Wright State University School of Medicine • Correspondence: Sylvan Lee Weinberg, MD, MACC, 4555 Southern Boulevard, Dayton, OH 45429. E:
slwjal@aol.com
Summer 2010 American Healthcare Agonists 7
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