War & Peace Quote by Donald Berwick

“Competition makes things come out right” is the kind of market mantra that sounds self-evident until you drop it into an ICU. Berwick’s move is to take that slogan literally and let it embarrass itself. If competition is the cure-all, then the logical prescription is “more”: more hospitals, more doctors, more drugmakers. He stacks these “mores” like a chant, then flips the frame with a jarring translation: “We set up war.” It’s not polite policy talk; it’s an indictment of what happens when we import winner-take-all logic into a domain where the “consumer” is often frightened, in pain, and in no position to comparison-shop.

The subtext is that health care is structurally hostile to the conditions competition supposedly needs: transparent pricing, informed choice, easy switching, and low stakes. Instead, competitive pressure often expresses itself as duplicative facilities, branding, billing games, and risk selection - strategies that look efficient on a spreadsheet but feel predatory at the bedside. “War” isn’t just metaphor; it implies collateral damage, escalation, and a mindset where someone must lose for someone else to win.

Berwick, a physician and former head of CMS, is also speaking from inside the machine: a public servant who has watched incentives shape behavior. The closing line - “Wait a minute, let’s talk about the patient” - is a rhetorical brake. It exposes how quickly policy debates drift from care to combat, and insists that the metric isn’t market share. It’s whether people get better without being financially or emotionally wrecked.