Donald Berwick, newly appointed to run Medicare and Medicaid, admits that he feels “romantic” about the British healthcare monstrosity, but Telegraph columnist Janet Daley, who presumably has more first-hand experience with the NHS, is a bit less giddy. She is urging the U.S. not to go there. Daley is also glad that economic realities are forcing some rethinking of NHS:

 Having to cut back the power and the expenditure of the state will provide a rationale for dismantling the monolithic, bureaucratic monster that the NHS has become. In his health White Paper, Andrew Lansley will apparently propose sweeping away the command-and-control structure in which clinical decisions are taken and hospital procedures commissioned by Primary Care Trust administrators, rather than by general practitioners who actually come face-to-face with people in need of medical help.

 The U.S. is headed in the opposite direction: towards more bureaucratic control of our private medical decisions. Daley:

US government, meanwhile, is galloping doggedly in the opposite direction, bizarrely determined to occupy precisely the ideological ground which Britain is abandoning. Barack Obama has, indeed, appointed a man as head of the American public health care programmes who professes a passion (no other word will do) for some of the most discredited features of our NHS. Dr Donald Berwick is to head the Centers for Medicare and Medicaid Services, which effectively means that he will be in charge of [implementing the health legislation] – the new universal health care system on which the President has staked his political credibility.

The appointment has created an extraordinary kerfuffle, partly because it was made under highly contentious circumstances – as a “recess” appointment which allowed it to bypass Congressional approval – but primarily on account of Dr Berwick’s widely disseminated statements extolling the virtues of the most disliked aspects of state-funded medical care as we know it.