The Trial of Berwick: Why Socrates Would Approve of Our New CMS Director

One of Plato’s most famous works is The Trial of Socrates, which outlines Socrates’ discourse with his Athenian jurors as he contests the two charges against him: corrupting the youth and impiety. The charges were notoriously vague and served as a mere vessel for a much deeper question – the legitimacy of democracy.

Socrates espoused a belief that was people should not be self-governing. Citizens were like a herd of sheep in need of the direction of a wise shepherd. To that end he argued that “dictatorship naturally arises out of democracy”, as knowledge is not universal and only those who bear it should hold the power to make legislative decisions. Controversial views that turned out to be his downfall. Two of his former students led successful revolts against the Athenian democracy and Socrates began to turn from “lovable town eccentric” to “dangerous and corrupting influence.”

The recent recess appointment of Dr. Donald Berwick to be Administrator of the Center for Medicare & Medicaid Services (CMS) demonstrates a similar conflict raging in today’s society.

Dr. Berwick is Socrates.

He believes that the people should not be the ones to make their health care decisions because frankly, what do they know? Instead, he, like Socrates, argues that people are in need of the direction and guidance of an educated hand. In Berwick’s words,

“I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”

The fundamental mistrust in man’s ability to make decisions for himself stands in stark contrast with not only our Founder’s belief in democracy, but also of the populist tone currently taken by today’s Democrats. Just as Socrates thought that power should be concentrated in the hands of just a few all-knowing leaders, Donald Berwick wants our health-care system to be run by a small cabal of leaders who will design our health care plans. The Thirty Tyrants for a new generation.

Berwick takes things one-step further than Socrates. Not only is he unwilling to put complex decisions in the hands of the masses, he also believes that the decisions of the educated class should supercede the market. Berwick argues that,

“Please don’t put your faith in market forces. It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can.”

Unsurprisingly, in the utopian vision put forth by Socrates and Berwick – they were the “enlightened” ones capable of making the decisions. Socrates argued that “ideals belong in a world only the wise man can understand.” In other words, philosopher’s such as Socrates himself were the ideal people to lead government. Berwick now finds himself, the philosopher, in a position that would have been coveted by Socrates – head of the largest source of funding for medical related services – the Center for Medicaid and Medicare.

Given Berwick’s new post, the lovable eccentric becomes a dangerous and corrupting image. Throughout Berwick’s career he has left many clues as to philosopher’s vision for a utopian health care. Among his ideals:

Standardization over autonomy:

  • “I would place a commitment to excellence—standardization to the best-known method—above clinician autonomy as a rule for care.”
  • “Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy.”

Government over market:

  • “Political leaders in the Labour Government have become more enamored of the use of market forces and choice as an engine for change, rather than planned, centrally coordinated technical support.”
  • In the US, competition has become toxic…Trust transparency; trust the wisdom of the informed public; but, do not trust market forces to give you the system you need

Universal care over quality care

  • “Any health care funding plan that is just equitable civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”
  • “The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.”

Socrates’ governmental ideal is also played out in the method by which Berwick was nominated. Rather than risk defeat at the hands of government officials selected by an uninformed public, President Obama used a recess appointment to promote Berwick. Rather than have to answer questions on high highly questionable views, or incite public debate on their wisdom, Berwick can immediately begin serving a term that lasts through 2011. The democratic confirmation process was tossed aside so that the “enlightened” could continue to shepherd this nation toward their utopian vision for this nation.

It is sad that we, as citizens of an apparently passé Democracy, shall have no say in it.

by Brandon Greife, Political Director (hat tip Alex Hartzband)