“The true rationers are those who impede improvement, who stand in the way of change, and who thereby force choices that we can avoid through better care,” Berwick said in a farewell .

“It boggles my mind that the same people who cry ‘foul’ about rationing an instant later argue to reduce health care benefits for the needy, to defund crucial programs of care and prevention, and to shift thousands of dollars of annual costs to people — elders, the poor, the disabled –who are least able to bear them,” he said, according to a copy of his remarks.

Berwick didn’t specifically cite congressional Republicans but clearly was referring to to reduce the nation’s budget deficit, such as capping annual federal funding to states for Medicaid. That proposal could result in billions of dollars in cuts, which critics have said would lead to .

Berwick made his comments at the annual conference of the Cambridge, Mass.-based , which he led for nearly 20 years before becoming administrator of the Centers for Medicare and Medicaid Services in July 2010.

After Republicans said they would not confirm his appointment, President Obama appointed him during a congressional recess, which would mean he could serve only for 18 months. .

Berwick avoided using the term “rationing” during his 16-month tenure but made it a focal point of his address Wednesday:

“When the 17 million American children who live in poverty cannot get the immunizations and blood tests they need, that is rationing. When disabled Americans lack the help to keep them out of institutions and in their homes and living independently, that is rationing.  When tens of thousands of Medicaid beneficiaries are thrown out of coverage, and when  millions of seniors are threatened with the withdrawal of preventive care or cannot afford their medications, and when every single one of us lives under the sword of Damocles that, if we get sick, we lose health insurance, that is rationing.”

Berwick also jabbed at Republicans who inaccurately said the federal health law included so-called “death panels.”

“If you really want to talk about ‘death panels,’ let’s think about what happens if we cut back programs of needed, life-saving care for Medicaid beneficiaries and other poor people in America,” he said. “Maybe a real death panel is a group of people who tell health care insurers that is it OK to take insurance away from people because they are sick or are at risk for becoming sick.”

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