I’m very curious to see how long embattled Centers for Medicare and Medicaid Services head Donald Berwick lasts over the next two years, particularly when the White House continues to overrule some of his pet projects for the sake of public relations–the most recent and most significant example being Berwick’s pet project for end-of-life counseling. The New York Times reports:
The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday. The move is an abrupt shift, coming just days after the new policy took effect on Jan. 1… While administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor. The renewed debate over advance care planning threatened to become a distraction to administration officials who were gearing up to defend the health law against attack by the new Republican majority in the House.
The rule had been issued by Berwick, and has been for many years the kind of rationing-based approach which he favors. While inaccurately described as “death panels” (those exist too, but this isn’t one), the end-of-life planning sessions in Britain, expanded while Berwick was consulting for their National Health System, have come under significant criticism in recent years for guiding the elderly toward morphine drips instead of treatment.
The larger question, in my view, is this: will Berwick actually go back to the Senate for approval next year at the end of his initial recess-appointed tenure? With every passing week it becomes clear that the higher ups in the administration are sheltering Berwick from media interaction, preventing him from speaking out on his views except in very controlled circumstances, and in this case, overruling his policy decisions as head of Medicare. How long will an ideologue like Berwick tolerate such disrespect from the White House? I suspect we’ll find out soon enough.