There has been a lot of questions raised about why the Centers for Medicaid and Medicare Services (CMS) has out of the clear blue, launched a review of Provenge, a review that could ultimately make Provenge unavailable to men on Medicare and Medicaid (see the post:Medicare Funding for Provenge, We Urgently Need Your HELP). There has been speculation on why we are having the review, now an article in the Investors Business Daily may have shed some light on the subject.

They raise the question, has President Obama wandered into the area of health care rationing which has been previously unheard of in the United States?

The president made a recess appointment (with Congress being on recess for the July 4th holiday) of Dr. Donald Berwick, a fan of rationing and Britain’s National Health Service, to direct the CMS. By making this appointment during a congressional recess, is the president intentionally keeping hidden from the American public, Dr. Berwick’s views and its potential impact on our health care delivery system?

Dr. Berwick wrote in an earlier National Institutes of Health publication that “The decision is not whether or not we will ration care; the decision is whether we will ration with our eyes open.” Without a formal nomination hearing, none of which has been scheduled, we will not be able to explore Dr. Berwick’s positions.

The CMS, an agency that oversees a third of all health care spending in the U.S., clearly has a major impact on our health delivery. Now, one must raise the question, is this recess appointment an attempt to circumvent the American public as Senate Minority Leader Mitch McConnell has stated?

Under the rules, Dr. Berwick could serve through 2011 without Senate confirmation. In this position, Dr. Berwick will control one third of the country’s health care costs, a significant portion of the entire American economy, all without giving us the opportunity to explore his views.

Dr. Berwick has praised the U.K’s National Institute for Health and Clinical Excellence (NICE), which he says has “developed very good and very disciplined scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn.”

Last year, NICE unveiled plans to cut annual steroid injections for severe back pain to 3,000 from 60,000. “The consequences of the NICE decision will be devastating for thousands of patients,” Jonathan Richardson of Bradford Hospital’s Trust told London’s Daily Telegraph. “It will mean,” said Dr. Richardson, “more people on opiates, which are addictive and kill 2,000 a year. It will mean more people having spinal surgery, which is incredibly risky and has a 50% failure rate.”

It has been pointed out that breast cancer in America has a 25% mortality rate while in Britain it’s almost double at 46%. Prostate cancer is fatal to 19% of American men who get it; in Britain it kills 57% of those it strikes. These are striking numbers.

The comment from the Investors Business Daily “and here we thought the first rule of medicine was to do no harm,” is particularly poignant.

Dr. Berwick’s comment, “We can make a sensible social decision and say, ‘Well, at this point, to have access to a particular additional benefit (new drug or medical intervention) is so expensive that our taxpayers have better use for those funds,” is a directive for rationing, maybe even a denial of care. In the case in point, could we modify his state to read….Well, at this point, to have access to Provenge is so expensive that our taxpayers have better use for those funds?

Perhaps Dr. Berwick’s beliefs are consistent with what the American public wants, but shouldn’t major issues like these be in the fore front of a national debate? Whether or not Dr. Berwick’s opinions are correct is an issue that deserves a national conversation, but to move in this direction without an honest airing is anti-democratic and totally unacceptable.

Joel T Nowak, MA, MSW