There is a moon shot here: Don Berwick's exit from CMS & the irrationing of healthcare

In my blog post yesterday, I mentioned the sometimes ridiculously high cost of healthcare, and the resulting lack of coverage for many people.

No one wants rationing of healthcare; rationing connotes a period of barely adequate consumption in a time of war. Yet coming from the same root as "rational," rationing is the product from a conscious effort to equally and fairly share a limited resource.

Our high prices create "irrationing." Think of the harm to Deamonte Driver, a boy with a gap in his Medicaid coverage, who eventually died from an untreated toothache, to Nikki White, a young woman with cancer who was denied benefits by her insurer for her pre-existing condition of lupus, and to Natoma Canfield, an uninsured woman whose cancer was detected far too late, among far too many others. That's irrationing; irrational, needlessly cruel and jarringly wrong for the richest and greatest country on earth.

In 2009, Dr. Don Berwick told a biotechnology journal, "The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open."

Now, as he exited his leadership role over the Medicaid and Medicare programs, Dr. Berwick said, just as Americans supported manned missions to the moon without knowing the details of rocket science, they ought to support the universal health insurance law because of its ultimate destination. "We are a nation headed for justice, for fairness and justice in access to care," Dr. Berwick said. "We are a nation headed for much more healing and much safer care. There is a moon shot here."

Thanks to Robert Pear for his interview in today's New York Times.

Surgeons couldn’t reverse the damage: A healthcare access parable

While his mother was seeking help for his younger brother whose six decayed teeth were causing him pain, Deamonte Driver had a toothache from a single abscessed tooth. A dental abscess is a collection of infected material, pus, resulting from bacterial infection of the center, or pulp, of the tooth. It often is a complication of tooth decay—an untreated cavity.

Bacteria from the abscess spread to his brain. By then, two operations and more than six weeks of hospitalization could not reverse the damage. Deamonte died at age 12, in early March.

Deamonte’s mother worked at several jobs. Even so, the family had to live in a homeless shelter. In changing addresses, they lost Medicaid coverage, which would have paid for the life-saving treatment. US congressmen discussed his case yesterday in hearings. Perhaps hearing his story will ultimately save other children’s lives.

Advice: Let your kids see you brushing and flossing your teeth—you’re their best role model.

Read another dental story, or read Diana Rossetti’s source story.