Erase any thought you had of Donald Berwick, MD, breezing through the Senate confirmation process and into a corner office at CMS HQ. He's received support from Democrats and medical associations, but Republicans are mounting opposition to his bid for CMS administrator.  

Sen. John Barrasso, MD, (R-Wyo.) took to the Senate floor April 21 and warned Americans that Dr. Berwick supports rationing patient care. "He has a history of support for government rationing of health care resources on the grounds of cost," said Sen. Barrasso, who is a trained orthopedic surgeon. "Not on the grounds of quality, not on the grounds of survivability but on the grounds of cost. And he has said, as recently as last June, ‘the decision is not whether or not we will ration care.' he said, ‘the decision is whether we will ration with our eyes open.' So here we are, the newly nominated person has said, I'm going into this to ration care." [emphasis added, CF]

A memo from the Republican Policy Committee being passed around Washington features the quote emphasized above. The quote is taken from an interview with Biotechnology Healthcare. The main topic of the interview was comparative effectiveness research (CER), which is a billion dollar component of last year's stimulus bill. Here's the full Q & A from the interview:

Biotechnology Healthcare: Critics of CER have said that it will lead to the rationing of healthcare.

Dr. Berwick: 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." We make those decisions all the time. The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.

Dr. Berwick appears to say the U.S. healthcare system already rations care and he supports CER to make informed decisions regarding coverage policies.

There is more opposition out there to CER, and opposition arguments usually involve the word "ration." But support for CER and the funding for efficacy research in the stimulus bill is out there, too. Groups such as MedPAC and the American Academy of Family Physicians (AAFP) have supported research in order to give physicians comparable alternatives.

"As a long-time supporter of the need for [CER], we would like to express our support for the $1.1 billion included in the stimulus package," the AAFP stated in a letter supporting the stimulus bill in 2009. "We need to spur the development of data in which drugs, devices and therapies used to treat the same conditions are evaluated for their relative safety, effectiveness and cost. [The research] has great potential to improve health care quality and patient outcomes, while assuring patients receive the best care at the best value."