Daily Inspiration Quote by Donald Berwick

Rationing is the word American health care debates try to banish, like saying it out loud will summon bureaucrats with clipboards. Berwick punctures that taboo with a clinician-administrator’s calm bluntness: rationing isn’t a dystopian policy choice waiting in the wings, it’s the baseline condition of a system where time, money, staff, beds, and attention are finite. The provocation is strategic. By insisting the real choice is between covert and conscious rationing, he reframes a moralized argument ("government takeover" versus "free choice") into an accountability argument: who gets less, when, and on what grounds?

The subtext is a critique of the comfortable illusion that the U.S. doesn’t ration. We already do, Berwick implies, just not with neat guidelines. We ration by price, insurance design, geography, network exclusions, prior authorization friction, understaffing, and the soft denial of patients who can’t navigate paperwork. That’s rationing with plausible deniability - and it tends to punish the people with the least power.

Context matters: Berwick, a leading quality-improvement voice and former CMS administrator, is speaking from inside the machinery of coverage and clinical policy. His line defends an ethic of explicitness: if scarcity is unavoidable, the least we can do is make the trade-offs legible, contestable, and tied to outcomes rather than status. "Eyes open" is a quiet indictment of willful blindness - and a dare to replace comforting rhetoric with transparent rules that can actually be argued with, audited, and improved.