Dr. Donald Berwick has his coming out party today in Washington. After President Obama snuck him into office during a recess appointment as the head of the second largest health insurance company in the world- CMS (Center for Medicare and Medicaid Services) without so much as a single hearing, Senators finally have an opportunity to meet him during a Finance Committee meeting. The prepared transcript of Berwick’s remarks at first glance, conveys a sense that he is a strong patient advocate and champion of patient rights. Were we to take these statements at face value, there would be much to look forward to during his tenure leading CMS. However, the spoken word in Washington is not to be trusted, and nowhere more so than in this case. We need simply go to You Tube or the internet and find the Berwick speeches and articles that portray a very different man.

The Donald Berwick that we have come to know, has stated his positions clearly and they are very different from what he is now trying to convince Senators and the American people that he supposedly stands for. There is no ambiguity about how Berwick feels about the sanctity of the doctor patient relationship. In his book “New Rules” he writes: “Today, this isolated relationship (between doctor and patient) is no longer tenable or possible… Traditional medical ethics, based on the doctor- patient dyad must be reformulated to fit the new mold of the delivery of health care…Regulation must evolve. Regulating for improved medical care involves designing appropriate rules with authority… Health care is being rationalized through critical pathways and guidelines. The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized decision making.”

Berwick is in a position to fulfill his agenda, of transforming our healthcare system into one that resembles the British system, with its rationed care and inferior outcomes, unchecked and accountable to no one. This is a system to which he has professed his love and admiration. He has a dislike of our system of healthcare and disapproves of it. Here are some other “pearls” that have come directly from Dr. Berwick. “I cannot believe that the individual healthcare consumer can enforce through choice the proper configurations of a system as massive and complex as healthcare. That is for leaders to do.” “Please don’t put your faith in market forces. It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can.” “The U.K. has people in charge of its health care- people with the clear duty and much of the authority to take on the challenge of changing the system as a whole. The U.S. does not”

Dr. Berwick’s lack of respect for the doctor- patient relationship cannot be masked by a cool sounding Harvard accent. In fact, that accent brings to mind the famous and particularly apt aphorism of William F Buckley Jr. that he would rather be ruled by the first 300 names in the Boston phone directory than by members of the Harvard faculty. Dr. Berwick has always viewed himself as a “leader” who needs to radically change American health care; he cannot now suddenly alter these years of radical opinions about how terrible American healthcare is by giving a hopeful speech about his plans for Medicare. This is a man who has stated that healthcare by definition involves wealth redistribution, and he intends to make good on his promises.

Dr. Berwick finally gets his Senate hearing, but unfortunately all that this can be is political theatre at this point, unless Senator Grassley or another member of the committee have the courage to ask publicly, some probing questions that have already been raised. In a letter sent to Dr. Berwick this summer by Sen. Grassley, he was asked to respond to questions regarding conflicts of interest regarding donors to his Institute for Healthcare Improvement which may make him vulnerable regarding policy decisions that he has to make. In lieu of confirmation hearings, these questions are legitimate and something that every American has the right to know.
One other rich area of exploration for the senators concerns what Dr. Berwick knows about the white house decision to thwart the constitutional prerogatives of the Senate. Which is why a question to Dr. Berwick like this might prove very productive:

“Dr Berwick, Presidents have made other recess appointments like yours but only after the Senate had at least been given the courtesy of holding a nomination hearing. You never even appeared at such a hearing. Can you describe to us your discussions with the White House and who to your knowledge was in on the decision to thwart the Senate in its constitutional duty? What role was played by the president, chief of Staff Rohm Emanuel and his brother Dr. Ezekiel Emanuel and David Axelrod? Who has been advising you at the White House to downplay your radical views in your recent speech and in your appearance here today before the committee?”

Dr. Berwick’s appointment was a final episode in the story of tawdry, backroom dealing and the-people- be- damned politics that rammed Obamacare through Congress and on Election Day cost so many members of Congress their jobs. Dr Berwick’s role in this episode and the disdain he has shown for the prerogatives of the US Senate speak to the same problem his views on health care show – an avarice for personal power that is deeply at odds with a system of government that places that power in the hands of elected representatives and ultimately in the people themselves.

Dr. Scherz, a pediatric urological surgeon at Georgia Urology and Children’s Healthcare of Atlanta, serves on the faculty of Emory University Medical School and is president and cofounder of Docs4PatientCare.