It boggles my mind that the same people who cry 'foul' about rationing an instant later argue to reduce health care benefits for the needy, to defund crucial programs of care and prevention, and to shift thousands of dollars of annual costs to people - elders, the poor, the disabled - who are least able to bear them.

In this quote, Donald Berwick expresses his frustration with the hypocrisy he perceives in debates about health care. He points out that some people who protest against the idea of rationing health care, which involves limiting or controlling access to services, are simultaneously advocating for actions that would lead to reduced benefits for vulnerable groups. These groups include the needy, elders, the poor, and the disabled, who are already facing significant challenges. Berwick highlights the contradiction between opposing rationing on one hand and pushing for cuts to essential care and prevention programs on the other.

Berwick is calling attention to the moral inconsistency in these arguments. He suggests that by advocating for policies that shift health care costs onto those who are least able to afford them, these individuals or groups are effectively punishing the most vulnerable members of society. The contrast between fighting against rationing and supporting policies that harm those already at a disadvantage reveals what Berwick sees as a lack of empathy or care for those in need.

The origin of this quote comes from Berwick’s extensive career in health care policy and his work as the Administrator of the Centers for Medicare and Medicaid Services (CMS) under President Obama. Known for his expertise in improving health care quality, Berwick has often spoken about the ethical and economic challenges in the system. His quote reflects his belief that health care should be equitable and that cutting essential services for vulnerable populations is both economically harmful and morally wrong.

In a broader context, Berwick’s words critique the political and economic forces that contribute to the disparity in access to health care. He argues for a more compassionate approach, one that ensures that health care systems prioritize the needs of the most vulnerable, rather than exacerbating inequalities. His statement is a call for social justice and a reminder that policies should be designed to lift up those who are most in need, rather than placing additional burdens on them.