"You could have let an unaccountable system play out in the darkness of free enterprise..." -Dr. Donald Berwick, on the wise choice of the British Healthcare system, London 2008.

Dr. Donald Berwick: "in the darkness of free enterprise."

So what exactly goes on in the darkness of free enterprise ?

In the darkness of free enterprise, a man has a medical problem. He consults with his doctor and together, with the unique character of the man and his life in mind and a consideration of his means and how he wishes to employ them, they chart a course of treatment.

In the darkness of free enterprise, a high-tech company like Biogen invents a medicine for the treatment of non-Hodgkins lymphoma (a disease diagnosed 50,000 times a year in America alone). The medicine extends and improves the lives of millions of people world wide. In the darkness of free enterprise America opens an ever-increasing gap over Europe in developing new, life-saving medicines and bringing them to the sick and dying.

In the darkness of free enterprise, people have an incentive to spend their medical dollars wisely, doctors have an incentive to provide rational care to their patients and scientists have an incentive to innovate and produce new, live-saving treatments.

So the question that we have to ask is: what about these things constitutes "darkness" for Donald Berwick ?

The answer is simple. To Donald Berwick, darkness is what exists outside the glare of the government's spotlight. For Dr. Berwick, darkness means that government agencies can't regulate it, the IRS can't tax it and he can't control it. According to Donald Berwick, darkness is the place where Big Brother's cameras don't go.

So what does this tell us about where exactly Dr. Donald Berwick sees himself as sitting ?