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White House Caves on Berwick’s End of Life Counseling

by Benjamin Domenech on January 10, 2011

How long will Donald Berwick last as head of the Centers for Medicare & Medicaid Services if the White House continually silences and overrules him? That’s the question I’m asking after the White House did exactly that, it appears, on Berwick’s pet end-of-life counseling project. Writing for Time magazine, reporter Kate Pickert outlines what happened:

“Well, this week, it looks like the Administration let politics guide policy once again, deciding to scrap a provision quietly inserted into new Medicare regulations that would have paid doctors to talk to patients about end-of-life care. … After the dustup became a ‘death panel’ firestorm, the provision was dropped, only to be quietly inserted again a few months ago by newly installed Medicare and Medicaid chief Donald Berwick. Doctors, hospice groups and advocates who new [sic] about the reinsertion supported the move. To the Administration’s dismay, the New York Times found out about the end of life counseling regulation – which was posted publicly in November but not in a way public comments could be accepted – and published a story about it on Dec. 25, 2010. Less than two weeks later, it was gone again.”

The rule had been issued by Berwick, effective January 1 (along with several other provisions of Obama’s law), and it has been for many years the kind of rationing-based approach which he favors. 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 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.

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