The conservative attack on health care reform has always been a highbrow-lowbrow combination. The lowbrow route attacked health care reform as a draconian cut in health care benefits, wantonly slashing costs and denying care to the elderly. The highbrow attack took the opposite line, insisting that health care reform was doing nothing whatsoever to control costs and blaming the Obama administration for its lack of steel. The two lines of attack worked in concert -- when Democrats responded to cries of rationing, they opened themselves to charges of profligacy, and when they responded to charges of profligacy the opened themselves to cries of rationing.
Since the passage of the Affordable Care Act, the highbrow line that reform will do nothing to reduce costs has come to the fore. But the nomination of Donald Berwick to run Medicare and Medicaid gives Republicans a chance to revive the lowbrow attack:
President Obama’s nominee to run Medicare and Medicaid, Dr. Donald M. Berwick, is a man with a mission, a preacher and a teacher who has been showing hospitals how they can save lives and money by zealously adhering to clinical protocols for the treatment of patients....
The Senate Republican leader, Mitch McConnell of Kentucky, describes Dr. Berwick as an “expert on rationing.” Senator Pat Roberts, Republican of Kansas, calls him “the perfect nominee for a president whose aim has always been to save money by rationing health care."
The truth is that there is an enormous amount of waste in the medical system, and even modest nudges to encourage efficiency ought to help control costs without sacrificing quality. But the ordeal of health care reform shows just how politically toxic it can be to introduce more efficiency into the system, and the Berwick nomination fight will be another case in point.