The Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Donald Berwick this morning is expected to testify before Congress in his first appearance since a controversial recess appointment in June. He will talk before the Senate Finance Committee.
President Barack Obama’s controversial decision to sidestep protocol and appoint Berwick has been magnified by media coverage of Berwick’s publications and speeches that supported highly centralized health-care systems. While a respected health policy analyst, Berwick has what he calls “romantic” views on the United Kingdom’s National Health Service, which rations care based on the cost-effectiveness of treatments. Likening Britain’s system to a “global treasure” has many senators concerned that Berwick will take the same viewpoint while implementing the new health law.
But Berwick’s past statements should not obscure the real opportunity of today’s hearing—to shine the light on the power that Obamacare has granted to the Health and Human Services Department and its agencies, including CMS.
Heritage Foundation senior fellow Robert Moffit prodded members of the Senate Republic Policy Committee to keep this mind during a hearing in September:
[A]ttention on Dr. Berwick and his views on rationing or the performance of the British National Health Service misses a much larger and far more consequential point. The personality of the CMS Administrator or the Secretary of HHS is of secondary importance to the legal framework that Congress itself has erected over the years through thousands of pages of statutory text, which has generated tens of thousands of pages of regulatory interventions into the financing and delivery of health care.
The Patient Protection and Affordable Care Act is a major expansion of federal bureaucracy which will dramatically alter traditional fee-for-service Medicare. In 2013, Medicare will offer different reimbursement rates to hospitals, based on performance quality indicators set up by HHS Secretary Kathleen Sebelius. This will encourage stricter conformity with arbitrary performance measures, even though research has shown that this kind of compliance does not improve the quality of patient care.
Obamacare also strengthens the Physician Quality Reporting Initiative, which requires doctors to report specific quality data or face a pay cut. “[I]t is not at all clear how physicians will be able to retain their traditional autonomy in the delivery of care—particularly under new compliance and reporting requirements related to the provision of quality of care, as determined by federal officials—and the existing restrictions on private contracting and balanced billing,” Moffit warned in his testimony.
Further cause for concern that should be addressed in Berwick’s hearing is the creation of the Independent Payment Advisory Board, which will look for ways to lower per-capita spending in Medicare. Most likely, this board will push for significant cuts to health-care provider reimbursements in the program, causing greater risk to seniors’ access to care.
Obamacare also created in CMS the Center for Medicare and Medicaid Innovation, which will oversee demonstrations and pilot programs for future delivery system changes. Strategies can be implemented nationwide by Berwick as Administrator of CMS without further congressional action.
These boards and changes show a top-down approach to containing health care costs that will, as Clete DiGiovanni, MD, and Moffit write, “challenge the autonomy of physicians to treat patients as they think best, undercut the freedom of physicians to remain in private practice, and threaten the continuation of fee-for-service medicine regardless of the preferences of doctors and patients.”
The only way to avoid these outcomes is to repeal Obamacare and replace it with health reform that is patient-centered and consumer-driven. Moffit explains this approach creates a system based on choice and competition that “would deliver what is of value, not as value is defined by either government officials or third party administrators in the private sector.”
You can read Moffit’s full testimony here.