RRD: For those who claim that I am taking Berwick out of context please note that I have linked to the full speech.
Transcript: Dr. Donald Berwick's Speech To The British National Health Service - Kaiser Health News http://www.kaiserhealthnews.org/stories/2010/july/07/berwick-british-nhs-speech-transcript.aspx Dr. Donald Berwick: Here, in the NHS, you have historically put primary care – general practice – where it belongs: at the forefront. The NHS is a bridge, it’s a towering bridge, between the rhetoric of justice, and the fact of justice. No one in their right mind could expect that to be easy. … Here, in England, accountability for the NHS is ultimately clear. Ultimately, the buck stops in the voting booth. You place the politicians between the public served and the people serving them. That is why Tony Blair commissioned new investment and modernization in the NHS soon after he took office, it is why the government has repeatedly modified policies in the search for traction, it is why your government now chartered the report by Lord Darzi. Government action in the NHS is not mere restlessness or meddling or recreation; it is accountability at work through the maddening, majestic machinery of politics. In the United States, we fund health care through hundreds of insurance companies. Any American doctor or hospital interacts with a zoo of payment streams. Administrative costs for that zoo approach 20% of our total health care bill, that’s at least three times as much as in England, maybe more. In the United States, these hundreds of insurance companies have a strong interest in not selling health insurance to people who are likely to need health care. Our insurance companies try to predict who will need care, and then to find ways to exclude them from coverage through underwriting and selective marketing. That increases their profits. Here, you know that that is not just crazy; it is immoral. So, you could have had a simpler, less ambitious, less troubled plan than the NHS. You could have had the American plan. You could have been spending 17% of your GDP to make health care unaffordable as a human right instead of spending 9% and guaranteeing it as a human right. You could have kept your system in fragments and encouraged supply -driven demand, instead of making tough choices and planning supply. You could have made hospitals and specialists, not general practice, your mainstay. You could have obscured – you could have obliterated – accountability, or left it to the invisible hand of the market, instead of holding your politicians ultimately accountable for getting the NHS sorted. You could have let an unaccountable system play out in the darkness of private enterprise instead of accepting that a politically accountable system must act in the harsh and, admittedly, sometimes very unfair, daylight of the press, public debate, and political campaigning. You could have a monstrous insurance industry of claims, and rules, and paper -pushing, instead of using your tax base to provide a single route of finance. You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any health care funding plan that is just, equitable, civilized, and humane must – must – redistribute wealth from the richer among us to the poorer and less fortunate. Excellent healthcare is by definition redistribution. Britain, you chose well. …
The full text of speech, A Transatlantic Review of the NHS at 60 , includes this beginning remark: "I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country."
Transcript: Dr. Donald Berwick's Speech To The British National Health Service - Kaiser Health News http://www.kaiserhealthnews.org/stories/2010/july/07/berwick-british-nhs-speech-transcript.aspx Dr. Donald Berwick: Here, in the NHS, you have historically put primary care – general practice – where it belongs: at the forefront. The NHS is a bridge, it’s a towering bridge, between the rhetoric of justice, and the fact of justice. No one in their right mind could expect that to be easy. … Here, in England, accountability for the NHS is ultimately clear. Ultimately, the buck stops in the voting booth. You place the politicians between the public served and the people serving them. That is why Tony Blair commissioned new investment and modernization in the NHS soon after he took office, it is why the government has repeatedly modified policies in the search for traction, it is why your government now chartered the report by Lord Darzi. Government action in the NHS is not mere restlessness or meddling or recreation; it is accountability at work through the maddening, majestic machinery of politics. In the United States, we fund health care through hundreds of insurance companies. Any American doctor or hospital interacts with a zoo of payment streams. Administrative costs for that zoo approach 20% of our total health care bill, that’s at least three times as much as in England, maybe more. In the United States, these hundreds of insurance companies have a strong interest in not selling health insurance to people who are likely to need health care. Our insurance companies try to predict who will need care, and then to find ways to exclude them from coverage through underwriting and selective marketing. That increases their profits. Here, you know that that is not just crazy; it is immoral. So, you could have had a simpler, less ambitious, less troubled plan than the NHS. You could have had the American plan. You could have been spending 17% of your GDP to make health care unaffordable as a human right instead of spending 9% and guaranteeing it as a human right. You could have kept your system in fragments and encouraged supply -driven demand, instead of making tough choices and planning supply. You could have made hospitals and specialists, not general practice, your mainstay. You could have obscured – you could have obliterated – accountability, or left it to the invisible hand of the market, instead of holding your politicians ultimately accountable for getting the NHS sorted. You could have let an unaccountable system play out in the darkness of private enterprise instead of accepting that a politically accountable system must act in the harsh and, admittedly, sometimes very unfair, daylight of the press, public debate, and political campaigning. You could have a monstrous insurance industry of claims, and rules, and paper -pushing, instead of using your tax base to provide a single route of finance. You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any health care funding plan that is just, equitable, civilized, and humane must – must – redistribute wealth from the richer among us to the poorer and less fortunate. Excellent healthcare is by definition redistribution. Britain, you chose well. …
The full text of speech, A Transatlantic Review of the NHS at 60 , includes this beginning remark: "I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country."
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