OP-ED

Op Ed: Dr. No to Run CMS

Let’s do a thought experiment. Suppose you were a U.S. Senator and the President’s nominee to head CMS appeared at his confirmation hearing:

  • Wearing a Che Guevera t-shirt, sporting the image of a psychopath who apparently enjoyed killing people, or
  • Fondly clutching a copy of Quotations from Chairman Mao, written by a man who presided over the genocidal murder of more people than any other person in the history of the world.

When I was at Columbia University, my fellow students did these sorts of things. I soon learned they were not evil. They simply could not think clearly about moral issues involving collectivism. I view Don Berwick in much the same way.

President Obama took advantage of a short Congressional recess to appoint him to run Medicare and Medicaid without even a hearing. Although the President blamed Republicans, even some Democrats were unhappy with his snubbing of normal Senate prerogatives — something Obama criticized George Bush for doing with the appointment of John Bolton as UN Ambassador.

Ordinarily, I think Congress should defer to the President in choosing his own team. Berwick was definitely a poor choice, however.

Berwick’s praise of the British National Health Service (NHS) is similar to the antics of my Columbia classmates. Those who don’t know any better (people who, say, only read the socialist press) believe that patients routinely die in the United States because they cannot afford the health care they need, whereas in Britain they get such care for free.

The reality is exactly the reverse! Britain is the country where people routinely die because they cannot get the care they need and cannot afford to pay for it on their own, while this almost never happens in the United States.

  • Research by Brookings Institution economist Henry Aaron and his colleagues confirms that tens of  thousands of Britons die prematurely because they do not get the care Americans tend to take for granted.
  • According to the World Health Organization (WHO), 25,000 British cancer patients die every yearbecause they do not have access to drugs that are routinely available in the United States and on the European continent.
  • Those who can afford to so go private: about 6 million have private health insurance and roughly 12 million get private health services of some sort every year, paying with their own funds for care that is supposed to be theirs for free.
  • When one cancer patient paid out of pocket for an expensive drug she was being denied, the NHS retaliated by threatening to make her pay for all of her other care out of pocket.

What makes the NHS immoral in my view is that it forcibly takes peoples’ money and spends it on health care services they easily could have purchased on their own, while denying them access to the expensive care for which people really need insurance.

I don’t mind Berwick’s view that rationing of health care is inevitable. I do mind his unwillingness to allow individuals to make their own choices between health care and other uses of money when they are able to do so. I also mind his desire to force people into a system that collectively rations care on a daily basis and allows them to escape only if they have political connections or the ability to pay.

The fact that Berwick thinks the British system is morally superior to our own does not mean that he is a bad person. It means that he is simply incapable of clear thinking on such matters.

What is frightening is that he is going to be making decisions affecting access to care of in excess of 100 million people.

John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis.  He is also the Kellye Wright Fellow in health care. The mission of the Wright Fellowship is to promote a more patient-centered, consumer-driven health care system. Dr. Goodman’s Health Policy Blog is considered among the top free-market health care blogs on the internet where pro-free enterprise, private sector solutions to health care problems are discussed by top health policy experts from all sides of the political spectrum.

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32 replies »

  1. INCONVENIENT FACT
    ” .. There might even be numbers on it right now, but I doubt anyone will remember any of this this in 2 months anyway… except for right-wing reactionaries and people who would never vote for Obama anyway ..”
    Dear Left-Winger and anti-fact reactionary,
    Max-term on recess appointment is 24 months ..
    http://www.senate.gov/CRSReports/crs-publish.cfm?pid=%270DP%2BP\W%3B%20P%20%20%0A
    It will come back to haunt OWE-bama. Even the FBI check hadn’t been completed. Max Baucus (D-Mont.) will give Berwick a haircut, he’ll never forget.
    We’re our brother’s keeper.
    And stupidity, incompetence, waste, fraud, theft, feather-bedding, and BLANK CHECKS do NOT have to be involved.
    Loser?
    Looking forward to Nov. 2. When “health care deform” is DEFUNDED and better plans are reviewed.

  2. Nate, I didn’t see a poll number regarding people’s opinions on the fact that Berwick’s appointment was a recess appointment. There might even be numbers on it right now, but I doubt anyone will remember any of this this in 2 months anyway… except for right-wing reactionaries and people who would never vote for Obama anyway.

  3. “.This is not a Hand out but a Hand up for some 30 MILLION Fellow Americans. So what don’t you understand?”
    Gary we don’t understnad where your getting your numbers. Only 5-7 million Americans can’t get insurance. The others CHOOSE to not have it. So who are these 23-25 Million people we are supposedly helping that don’t exist?

  4. don’t get out much spike do you?
    http://www.cbsnews.com/stories/2010/07/13/opinion/polls/main6675137.shtml
    How Have Barack Obama’s Economic Programs Affected you Personally?
    Now 5/2010
    Helped 13% 13%
    Hurt 23 18
    No effect 63 68
    48% plan to vote R while D is down to 44%. Sorry spike ain’t no one buying what your selling.
    Maggie and Matt you might want to discredit this before claiming support for reform is growing again.
    http://www.cbsnews.com/8301-503544_162-20010453-503544.html?tag=contentMain;contentBody

  5. Luckliy nobody cares how Berwick got there except for people who would never approve him and would never vote for Obama.
    Elections have consequences. For the country, Berwick’s appointment happens to be a good one. For far-right reactionaries, it’s a reminder that your beliefs are far outside the mainstream.

  6. It is more important to harvest our children for wars of want and glutteny than to bring HEALTH Care to our fellow Americans.
    I love the Christain View on this Priviledge Health Care Proposal that everyone seems to whine about. You said it was a privledge and so Now; everyone is privledged to contribute to the cost of sky rocketing Health Care.
    Our ForeFathers would be ashamed of such selffish and unchristain Behavior.This is not a Hand out but a Hand up for some 30 MILLION Fellow Americans. So what don’t you understand?

  7. My final comment for the summer, as I have better things to do than read the pontifications from the usual suspects who are just interested in their own welfare in the end. Per Stella Fitzgibbons, in a column from the LA Times I will link below, but I found THE WEEK summarized perfectly and will replicate here for your reading pleasure (note I will not be returning to read the pathetic dissentions that will just be rationalizing and minimizing what a DOCTOR has written below):
    “I am one of the people responsible for the country’s ever escalating cost of health care. As a doctor at a Texas hospital, I’m under enormous pressure to provide the most expensive medicine in the world, whether or not it prolongs or improves patients’ lives. Consider the case of a patient I’ll call Mr A, an 80 year old admitted to ICU after a massive stroke. He’s too sick to tell us his views on aggressive care at the end of life, but his family insists we do everthing to keep him alive, despite pneumonia and kidney failure, and brain scans that reveal that he will never walk, talk, or feed himself again. The cost of Mr A’s miserable last month of life? Many tens of thousands of dollars. For decades, Americans have been conditioned to demand top of the line treatment, the most expensive drugs and procedures, without regard to cost or benefit. President Obama’s health reform will provide more people with insurance, but it will do nothing to rein in health care costs. They will continue to soar unless we set national priorities, and impose real limits on this gold plated folly.
    http://www.latimes.com/news/opinion/commentary/la-oe-fitzgibbons-health-costs-20100617,0,5183103.story
    You read just this summary and if you have half a brain and some grasp of reality, you have to realize that Obamacare, as it stands, is not just a joke, but a burden that we over 50 years old are literally dumping on our children and others who have better choices and patterns of behaviors than our pathetic boomers have shown these past 30 years, and I am in this group!
    So, as Obama is my age, is he really thinking about the country, or, is he really thinking moreso of his own special interests and in the end, himself?
    Is this what you expect and appreciate of leadership these days? If you really say yes, especially without hesitation, you are just part of the problem, not a solution to it! Sometimes, really true and gutty decisions may screw yourself over, but, if you are thinking of the needs of the many over the few, especially yourself, you are truly the mensch.
    Look that last word up and see if it fits.
    For those who are supporters and allies to what I have been writing here of late, have a nice summer and be well. To those of you who aren’t, I hope you sleep well with your souls.
    Assuming you have one!

  8. The Berwick appointment reminds me of:
    The Federal Reserve Act of December 23, 1913. 103 congressional votes were absent for the holidays when the Federal Reserve became law. The American dollar, along with the reins to our economy, were handed to the bank-families of the Federal Reserve. Not only was the vote to enact the Federal Reserve illegal, the act was also unconstitutional, in direct defiance of our constitution. This was the first major coup d’état by the international banking moguls that would directly impact the economy of the United States.
    Well, due to the partisan controversy created by the media masterminds regarding the Berwick appointment, also enacted during the holiday break, Americans were not looking when medicine and healthcare were handed over by their reins to the banking/insurance industry.
    Berwick is the poster boy for managed care,insurance companies and the banking industry at large. Regardless of ‘who’ was currently president, Berwick would be appointed.It was his time. It is a nonpartisan issue.
    The international banking moguls want to increase their profit margins and stuff their over-flowing pockets at our expense. Every cost-cutting initiative will be trialed. Every aspect of healthcare will be impacted in a negative way. It is ALL about profit. Humans are simply a commodity.
    Great strides can be made during a 5-month period when all of the ‘right’ people are in place. So, sit back, help yourself to some popcorn, and closely watch what happens.

  9. Nate- executive appointments that weren’t confirmed and had huge power over Americans was an issue dating back to Andrew Jackson’s administration. It is nothing new at all.

  10. Wow these debates are fun. Especially when this new health care guy comes in the picture. I wonder what kinds of things he will be doing in order to get his vision of the Health Care system running.
    Only time will tell.

  11. Theyre all the same basically. 1 they dont care about what the public wants or thinks. 2 they glorify in their own wisdom. 3 they are incapable of making substantive changes. 4 they serve the status quo.
    5. they are usually hypocritical and are never frank with the public.

  12. ” What is funny though is that most executive appointments such as this didn’t have to go through Congressional hearings until well into the late 19th or 20th century depending upon the agency or position level.”
    Until the late 19th or 20th century these potitions didn’t exist that had so much power over our every day lives and futures. If we still had a limited federal government that stuck to its roll as defined by the constitution these positions would not exist let alone need scrutniy.

  13. a great blog
    We can have a rational debate about cross-national comparisons and who gets better value for money from their health care systems”

  14. Petty name calling – Check.
    One-sided partisan hackery – Check.
    Far-reaching conclusions that are generally non-supported by any checks in the piece? – Check. Check. Check.
    It was a lousy tactic to push through Berwick through the way Obama did. What is funny though is that most executive appointments such as this didn’t have to go through Congressional hearings until well into the late 19th or 20th century depending upon the agency or position level.
    I am more interested in hearing more about Berwick and his previous experience in dealing with large bureaucracies, his leadership style, and any experience he has had dealing with a difficult/challenging political environment.

  15. Matt need help with those goal post?
    “We can have a rational debate about cross-national comparisons and who gets better value for money from their health care systems”
    When has the US ever been about value? When liberal trial lawyers sue to force insurance to pay for experimental treatments they aren’t after best value.
    When Obama removes annual and lifetime caps and requires coverage for experimental treatment there is no value.
    Liberals states requiring fertility treatment and other lifestyle coverage had minimal value.
    After 45 years of legislating value out of US healthcare the Liberals now want to complain about the lack there of? Your right Matt we do have terrible value, and we have you and your like minded to thank for that.

  16. John is having fun and taking the piss here. We can have a rational debate about cross-national comparisons and who gets better value for money from their health care systems (a debate John would lose), but this isn’t what this piece is.
    What this is, is the bitterness of a loser. And worse a loser deprived by the Administration’s political machinations of being able to shout about it during the confirmation hearings
    But calling the NHS immoral because it’s paid for by taxation? Ha Ha Ha. What about war spending in the US. I failed to notice my “opt-out” clause last April 15.
    But don’t worry John. One area in which we’ll remain clearly superior to the Brits is in having politically motivated “policy analysis” institutes that need highly-paid Presidents & CEOs. And any piece comparing a Democrat to Mao Tse-Tun & Che Guevara will keep those donations flowing…

  17. It’s beyond sad when propagandists from the right resort to demonizing worthy Americans using cheap, indirect name calling. Berwick = Mao or Che? Really? Oh no, Mr. Goodman, you didn’t really say this did you? You just effectively communicated that message using blatant juxtapositioning. Great tactic, to tear down the personal credibility of all with views slightly more moderate than your own intolerant conservatism. Too bad it also further tears down civility in our already battered political discourse. Not that you care about the quality of our country’s democracy, as long as your side wins.

  18. ” The only Americans who take such care “for granted” are those with private insurance or Medicare/Medicaid.”
    That would be 85% of the country Jack. Another 10% choose not to have healthcare cause they think they don’t need it or it is a poor value so they also take it for granted. So only 95% of America Jack take it for granted.
    “even more U.S. cancer patients die every single day because they are unable to afford the incredibly expensive cancer therapies they need and have no insurance to help them.”
    Really jack? More then 25,000 Americans die every day from cancer? That’s 9.1 million Americans a year, care to back that up with anything? You realize that is more people then can’t afford insurance right? Pretty much disproved that entire argument.
    “It speaks to white privilege and a blindness to what is happening around you.”
    You must really lack any sound argument to drop the race card this early.
    “He believes it is wrong to let people die because they can’t afford outrageously expensive health care.”
    You your self just argued that $400,000 was to much and they should die 6 months early. Your debating yourself Jack. In the span of 4-5 paragraphs you manage to take all sides of the argument.
    “Neither the Alps nor the NHS can be transferred to the US.”
    They said the same thing about VAT but the left sure is trying anyways.
    “barring cataclysmic disaster, it will never be.”
    Was it Rahm who said never waste a good disaster? Present policies almost guarantee a financial cataclysmic disaster.
    ” did it ever occur to anybody that wanton rationing, if it really exists, may not be on Dr. Berwick’s top 10 list of NHS features to import into the US?”
    Your right that would be a great question to ask him…..oh that’s right Obama prevented us from ever having that opportunity. When you circumvent debate it’s a little hard to argue alternatives. We will never know the truth becuase the process was aborted.
    “But then again, this is not about the good doctor, it is about revisiting “healthcare” reform,”
    You have the list of questions they where going to ask? Is it not a little presumbuous and convienant of you to dismiss debate on the grounds you know what someone else is thinking and was going to ask?
    If they had held hearings and Republicans did that then a recess appointment would have been called for. You can avoid the questions then attack the right for what they never asked.

  19. Imagine one-sixth of GDP run as efficiently as the US Postal Service with all the Humanity of the Department of Motor Vehicles. Welcome to your future.

  20. No doubt being a politician today is an act of hypocrisy since they are too far removed from the public they are supposed to serve-instead of enlarging and refining the publics wishes and needs they will enlarge their own agenda.

  21. Just like the debate on “healthcare” reform was not about health care, the debate about Dr. Berwick’s nomination is not about Dr. Berwick.
    So Dr. Berwick “loves” the NHS. I love the Alps. Neither the Alps nor the NHS can be transferred to the US. Our care delivery system is not owned by the Government and, barring cataclysmic disaster, it will never be.
    And even if we must analyze this “love” for the NHS, how come we only focus on one aspect of the NHS; rationing? Considering Dr. Berwick’s expressed views regarding the need for the patient to be the ultimate authority on his/her destiny, did it ever occur to anybody that wanton rationing, if it really exists, may not be on Dr. Berwick’s top 10 list of NHS features to import into the US?
    But then again, this is not about the good doctor, it is about revisiting “healthcare” reform, which was really about Republicans’ obsessive need to kick this crop of Democratic leaders out of office at all costs, including the long term infliction of pain, suffering, injustice and generic misery on the vast majority (yes, vast majority) of Americans.

  22. P.s. Jack, 25,000 people do not die A DAY from cancer in the U.S. Do the numbers: 25000 x 365 = roughly over 9 million a year.
    Show me those numbers please? From a reliable source!
    Now maybe from cardiovascular disease, that I could see as a viable stat.

  23. Mr Williams- i concur. Mr Berwick will be made the feudal lord of our health care and will ignore the voice of the public- because he can. Like serfs we wont even be able to plead before our feudal master Mr Berwick to recognize a right we dont have. We wont have a right to make intelligent choices about our care. We wont have to be virtuous in this brave new world of health care. All we have to do as Mr Kant said is “obey”

  24. Let’s play a game, shall we, above commenters. I’ll be transparent about my agenda, and then let’s see if you have the gonads to be a bit honest too!
    I am a board certified physician in a specialty field who does what is moreso primary care type work due to the type of patients I see and the reimbursements I receive. I have been practicing for more than 15 years and have worked in more than 2 states. I have witnessed first hand how insurance, politics, and the internet have trivialized, debased, and minimized the work I spent more than 12 years paying to learn. Per this topic, I have mixed feelings about this Berwick appointment. He should not be appointed without a congressional debate, especially now reading above in the blogger’s column that Obama critized exactly the behavior he duplicates now. And yet, he is right about rationing needs to be seen, ie be transparent.
    Oh, and I have been a registered third party voter in the state I reside for the past 18 years. So, my allegiance politically is to the people, not a party.
    So, to the above three dissenters to this blog author’s position, why do you dissent so vocally? Is it really about a philosophy in health care? Is it about a party affiliation at risk in November? Is it about a personal gain if this legislation maintains traction? Is it sheer clueless devotion to a cause that is followed by supporters who wear blinders that allow 1 foot peripheral vision?
    This is a gray debate, folks, and yet the commenters here who are so voracious in slamming a different opinion do not reflect there are multiple sides to the argument.
    And, why put trust and faith in a man who seems to continually reflect pure hypocrisy in his deeds after being so passionate in his rhetoric to become President.
    Face it, to be a politician in this system these days infers one has to be flawed and unredeeming in the end.
    Makes me want to run, from office!

  25. Two very troubling issues surround this topic:
    1. Dr. Berwick’s professed belief that the government is capable and authorized to make health care rationing decisions. Worse yet, now that he is employed by the government (running an agency with a budget bigger than the Pentagon’s) I suppose it becomes a self-fulfilling prophesy, with Dr. Berwick running the show. “Central planning meets health care” can’t be good.
    2. The manner in which Dr. Berwick was appointed to his position, without input from the people we elected to represent us, bypassing the Advice and Consent clause of the Constitution. Dr. Berwick will hold great authority over us, implementing the terms and conditions of a controversial health care law that will touch the lives of every American, yet the President decided to appoint him while Congress was away on holiday. Controversial health care laws notwithstanding, we should question anyone appointed to govern us with that much authority, installed in a position without the vote (indeed, without so much as a confirmation hearing) of the Senate.

  26. Chris Jacobs just reported the following on this afternoon’s activity from the Senate floor:
    “Senator Kyl just spoke on the floor to correct the claims made by Sen. Durbin this afternoon regarding the Berwick nomination and recess appointment. Sen. Durbin alleged that President Obama “waited patiently for Republicans to give us a chance to vote,” and that Republicans “delayed Dr. Berwick’s nomination by bringing up the same talking points.”
    Nothing could be further from the truth. As multiple sources have reported, Sen. Grassley and Republicans WANTED a hearing, and asked for one weeks ago. NOTHING can stop Sen. Baucus from scheduling a hearing – or holding a Committee vote – or, for that matter, for Sen. Reid from bringing Dr. Berwick’s nomination for a floor vote. Democrats chose not to act.
    Of course, there’s one way to resolve this problem – Democrats can call a hearing on Dr. Berwick’s pending nomination. Will the majority do so, or will they attempt to use the recess appointment – and their inconsistent talking points about Republicans “obstructing” this nomination – to avoid discussing the substance of Dr. Berwick’s controversial views?”

  27. It’s interesting how, for progressives, the argument always boils down to whether the United States’ or the United Kingdom’s Health Care System is morally superior. Why is overt rationing, where the government uses coercion to extract resources and then politicians decide medical priorities, somehow make Britain morally superior to the United States? The politics of medicine means politicians will try to maximize votes by over-supplying care to the well and under-supplying care to the desperately ill.
    I too believe people would be better off deciding their own priorities. Moreover, the convoluted third-party payment system prevalent in the United States has reduced access for the poor since it is more costly than paying cash in a cash-based system.

  28. John Goodman doesn’t do a thought experiment, he does a let’s avoid thinking experiment.
    I agree with Jack.

  29. I’m glad google reader shows the post author clearly, so I can avoid reading any future time-wasting, factually-challenged, right-wing-talking-point blather authored by JOHN GOODMAN. Otherwise I’d simply have to unsubscribe. This is actually worse than re-printing Sarah Palin’s crazy screeds from her FB page — at least those have entertainment value.

  30. I will address your claims point-by-point:
    “…because they do not get the care Americans tend to take for granted.”
    Your use of the Brookings Institute data does nothing to strengthen your argument. The only Americans who take such care “for granted” are those with private insurance or Medicare/Medicaid. Those stuck in the middle take nothing for granted… because they cannot get care without great personal expense and sacrifice… and the very real potential of going bankrupt for many.
    “25,000 British cancer patients die every year because they do not have access to drugs that are routinely available in the United States…”
    Again, the use of such a statement does not strengthen your argument, because even more U.S. cancer patients die every single day because they are unable to afford the incredibly expensive cancer therapies they need and have no insurance to help them. NICE uses cost-EFFECTIVENESS data to make decisions about what to include on its formulary. If a drug is not effective, or not effective enough to make it worth an exorbitant price (sometimes $400,000/year), it doesn’t make it onto the formulary. It is not reasonable to expect taxpayers to pay for drugs that are not effective. And I wish you had provided information to back up the claim that these British patients die because they don’t have access to some unnamed drugs. I wish you had provided data that showed they would not have died if they had been able to take the drugs. Because I suspect they would have died either way. People who have cancer who try to get off-formulary drugs in Britain are generally in a situation where they really can’t expect to live very long, although a drug might lengthen their lives by 6-months… at a cost of $400,000 to taxpayers. For that one person. Who may have been 89 years old. Which takes $400,000 away from an infant who might need a different, yet very expensive drug that would keep him/her alive for decades. What would you suggest? That taxpayers foot the bill for a $400,000 drug for an elderly cancer patient? Or would you prefer to let the market handle it and let the patient just pay for all care? Or would you prefer some other alternative?
    “…roughly 12 million get private health services of some sort every year, paying with their own funds for care that is supposed to be theirs for free.”
    Gee, this sounds awfully familiar. The word “Medicare” comes to mind. Are you suggesting that we eliminate Medicare? What is the point of this statement? I do not see that it strengthens your argument and I do not see how it argues against health care reform. It is no different.
    “What makes the NHS immoral in my view is that it forcibly takes peoples’ money and spends it on health care services they easily could have purchased on their own…”
    “Easily”? It may be easy for some people to purchase health care on their own, but there is a growing population of people for whom health care is financially out of reach. This is the point of the health care debate. I think your statement is hyperbolic and ignorant of reality. It speaks to white privilege and a blindness to what is happening around you.
    “I do mind his unwillingness to allow individuals to make their own choices between health care and other uses of money when they are able to do so.”
    And how would you propose to help those who are not “able to do so”? Or would you proposed to thin the herd by just continuing to let them die off one by one? Oh, that’s right. You don’t believe people who can’t get care die because of that fact. Again, blindness. You seem to choose your data selectively.
    “…allows them to escape only if they have political connections or the ability to pay.”
    Another hyperbolic statement. What does this even mean? It has no place in your argument unless you support it with details. Otherwise, it looks like emotional, irrational, inflammatory, radical rhetoric. Which it is. Post the relevant statutory text to support this statement and I might think otherwise.
    “The fact that Berwick thinks the British system is morally superior to our own does not mean that he is a bad person. It means that he is simply incapable of clear thinking on such matters.”
    Coming from the world of health care and knowing who Berwick is, what he has achieved in his lifetime and what he could do for our country, I am going to assume you have very little knowledge of any of that. Because if you did, you would realize how incredibly ridiculous your statement is. Berwick believes a country that does not let people go without health care just because they can’t afford it is morally superior. He believes it is wrong to let people die because they can’t afford outrageously expensive health care. If you disagree with this and would rather let people in-need die instead of helping them, you, sir, are the one who is morally bankrupt.
    I, as a taxpayer, pay for the education of the children around me even though I have no children of my own. I’m OK with that. However, I would be much happier giving my hard-earned cash to pay to save lives than to pay for someone to learn to read… which they are perfectly capable of doing on their own nickle.
    Your argument goes nowhere with me. It is radical Conservative hyperbole. You should focus on matters that don’t … matter so much. This issue is too important to discuss at your level.

  31. Mr Goodman- once again your pespicacity shines thru. Obviously the moral issues with regard to this issue were overlooked by those who believe in machine logic and technicism. They also cling to the belief that experst are the “golden hammer ” to all societies problems and that the beliefs, values and conations of “non-experts” are unimportant.
    As Justice Holmes friend Harold Laski wrote- government by experts is government for experts. I hope soon the feudal mischief of experts will be spent and the people restored to right reason. But for now the Berwick debate is a red herring for the real issue is whether or not the public should continue to be relegated to moral vagabondage by the experts in health care and government or whether the experts will cede some power for the collective good.

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