Donald Berwick, President Obama’s recess-appointed head of the Centers for Medicare and Medicaid Services, is famously “romantic” about the British National Health Service. While the Brits themselves have buyers’ remorse, UK government health care reflects Berwick’s belief that “the decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.” If he’s right, Americans may have cause to blame the political debts of the Democratic Senate caucus which ignored medical liability reform during the 2009 Obamacare legislation and is now getting a big payoff from trial lawyers.

Remember the trial lawyer fundraiser hosted in Vancouver, British Columbia, for 12 Democratic Senate candidates? The Center for Responsive Politics notes that Sen. Harry Reid, D-Nev., Rep. Michael Bennet, D-Colo., Attorney General Richard Blumenthal, D-Conn., and the other nine Senate candidates supported in Canada had received over $8 million from lawyers and law firms. In fairness to the other candidates, it should be noted that Reid alone received the lion’s share of that money – a whopping $2.8 million. (These numbers are current as of June 30th, 2010, and so do not include funds raised at the Vancouver fundraiser in July.) If he got the most money in absolute numbers, Reid and his colleagues are equally in debt to the trial lawyers, who rank as top two contributors for every candidate on the list (except for Chris Coons in Delaware – lawyers are his third largest donor base.) One of Reid’s largest donors is successful medical malpractice attorney and Baltimore Orioles owner Peter G Angelos, whose law offices gave the Majority Leader $64,000. Similarly, American Association for Justice, the group that hosted the Vancouver fundraiser, emphasizes medical malpractice lawsuits as part of their constituent services; just look at their Legal Research and Exchange.

What does this have to do with Don Berwick and rationing? The special preference shown by the American Association for Justice for Democrat Senators provides a sort of insurance against a possible Republican takeover of the House of Representatives. In over 2000 pages of legislation, Obamacare avoided tort reform, despite its proven record of improving access to medical care. For instance, tort reform was enacted in Texas in 2003. Since then, the number of physicians practicing in Texas has jumped by 10,000, according to the Texas Medical Board, to over 45,530 in-state medical doctors as of May 2010. Writing in 2007, Drew Thornley of the Texas Public Policy Foundation explained the effect of tort reform on patient care:

In May 2003, there were 35,723 in-state medical doctors. Today, there are 6,000 more. The number of doctors is up 52 percent in San Antonio, 51 percent in El Paso, and 46 percent in Houston. The backlog of applications at the Texas Board of Medical Examiners exceeds 2,500. Doctors view Texas as an attractive place to practice. Moreover, at the time of the reforms, much of the state did not have certain specialists. For example, more than 150 counties lacked obstetricians. However, since the passage of Proposition 12, Texas added 195 OB/GYNs, 169 orthopedic surgeons, 554 anesthesiologists, 497 emergency medicine physicians, 110 neurologists, and 36 neurosurgeons.

To bring this back to Berwick and rationing, when medical malpractice lawsuits and high insurance premiums prevent 497 emergency medicine physicians from practicing in a given area (bear in mind that the figure will have increased since 2007), expect there to be long ER waits in hospitals and pressure to ration scarce labor resources, meaning some people get care and others don’t. That’s where Berwick comes in. And now, thanks to campaign finance reports and weekend run to Canada, we know where the loyalties of the Democratic Senators lie as well.