OP-ED

Why Berwick Matters

Two cover stories in this week’s Time magazine debate a provocative question: Is America in decline?

Both the yes and no arguments are made persuasively, and I found myself on the fence after reading them, perhaps leaning ever-so-slightly toward the “no” side (optimist that I am). Sure, times are tough, but we’ve got the Right Stuff and we’ve bounced up from the mat before.

Then I considered the political fracas over Don Berwick’s appointment as director of the Centers for Medicare & Medicaid Services (CMS), and decided to change my vote, sadly. Yes, America is in decline, and this pitiful circus is Exhibit A.

Berwick, as you know, is a brilliant Harvard professor and founding head of the Institute for Healthcare Improvement. He is also the brains and vision behind most of the important healthcare initiatives of the past generation, from the IOM reports on quality and safety, to “bundles” of evidence-based practices to reduce harm, to the idea of a campaign to promote patient safety.

President Obama’s selection of Berwick to lead CMS last year was inspired. In the face of unassailable evidence of spotty quality and safety, unjustifiable variations in care, and impending insolvency, Medicare has no choice but to transform itself from a “dumb payer” into an organization that promotes excellence in quality, safety and efficiency. There is simply no other person with the deep knowledge of the system and the trust of so many key stakeholders as Don Berwick.

But Berwick’s nomination ran into the buzz saw of Red and Blue politics, with Republicans holding his nomination hostage to their larger concerns about the Affordable Care Act. In the ludicrous debate that ultimately culminated in Obama’s recess appointment of Berwick, the central argument against his nomination was that he had once – gasp – praised the UK’s National Health Service. Interestingly, without mentioning Berwick by name, Fareed Zakaria pointed to this very issue to bolster his “decline” argument in Time:

A crucial aspect of beginning to turn things around would be for the U.S. to make an honest accounting of where it stands and what it can learn from other countries. [But] any politician who dares suggest that the U.S. can learn from – let alone copy – other countries is likely to be denounced instantly. If someone points out that Europe gets better health care at half the cost, that’s dangerously socialist thinking.

I’ve argued that President Obama was right to use his recess appointment power to install Berwick as CMS director, and hoped – naively perhaps – that Don would win over his critics by the time his appointment expired in December 2011. And, in his eight months in the role, Berwick has done a terrific job. As always, his speeches on healthcare reform have been articulate and thought provoking (though one can see a heavy bureaucratic hand tamping down Don’s characteristic flair and penchant for provocativeness). He has appointed excellent people to key leadership positions, fleshed out some of the new CMS programs such as Value-based Purchasing and the Innovations Center, and will announce a major initiative in patient safety in the near future. Impressively, Berwick has accomplished all of this with at least one hand and several fingers of the other tied behind his back: doubt about his own future at CMS, uncertainty about the fate of the Affordable Care Act, and an unrelentingly hostile reception by the Republicans in Congress.

But my hopes were dashed by this week’s statement by Sen. Max Baucus (D-Montana) that Berwick’s is simply not confirmable by the Senate. This announcement followed a letter sent to the White House last week by 42 GOP senators, who argued – disingenuously – that Berwick’s “lack of experience in the areas of health plan operations and insurance regulation raise serious concerns about his qualifications for this position.” If the White House pulls the plug, he is likely to be replaced by his deputy, Marilyn Tavenner, a nurse administrator who ran two suburban hospitals for HCA and was Virginia’s Secretary of Health. The American Enterprise Institute blogger Joseph Antos praised her, sort of:

Tavenner has a reputation for making the trains run on time…. More importantly, [she] would not act as if she has a mandate to upend the health system, because she doesn’t.

In all likelihood, Tavenner would sail through her confirmation hearings, precisely because she won’t cause a stir.

But we need a stir!

From the moment of his nomination, Berwick’s plight has been a sad spectacle. I was particularly disheartened by the way he was treated during his testimony before the House Ways and Means Committee. It is too long and painful to watch the whole thing; if you’ve taken your Compazine, try a 5 minute stretch that begins precisely an hour into the testimony, as Representatives Davis and Reichert bait Berwick with a combination of hyperbole and rhetorical foolishness (“I’m not interested in an academic salon answer…”) that would make a middle school playground argument seem positively Shakespearean.

In the face of this kind of nonsense, I know of several superb physician-leaders who were offered positions in CMS – for roles that should have been once-in-a-lifetime opportunities to shape national policy – but turned them down. “Who needs this?” one told me. And they’re right.

The smart money is that the White House will fold on the Berwick appointment. The legendary Lucian Leape emailed many of Don’s colleagues yesterday, including me, asking that we sign on to a letter to the president in support of Berwick. Lucian wrote:

Watching the hearings and reading the statements being issued by the Republicans on this matter has been both disappointing and disgusting as we see our eminently qualified colleague disparaged by those who have no appreciation for what he has done and can do for our health care system.

I gladly signed this letter, and I hope you’ll do what you can to turn this around. Please contact the White House, your senators and representatives, and the media, and tell them that Don Berwick is the best hope we have to improve our healthcare system. Tell them that the Senate should hold hearings on his appointment, letting the chips fall where they may. Tell them to start acting like grown-ups.

If this good and great man is thrown under the bus, you’ll have all the evidence you need that our society is, in fact, in decline. Let’s not let this happen without a fight.

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SuperbugJamesEvyNeil VerselMaggie Mahar Recent comment authors
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James
Guest
James

I believe that Mr. Berwick would most likely have been confirmed had he been able to have a hearing. In the end, most of the time congress will defer to the chief executive on matters relating to picking their “team”.

Neil Versel
Guest

Obama threw Berwick under the bus instead of letting him have his day in front of the Senate. The Senate Democratic leadership (quite an oxymoron) has done nothing to help. Harry Reid wouldn’t know leadership if it smacked him across the face. On the other hand, a hearing likely would become a political circus, fueled by national media that are either too afraid or too lazy to look beyond the superficial mudslinging. As a journalist myself, I’m ashamed that the national media was so bad in reporting about health reform that they’re complicit in the public’s thinking that health insurance… Read more »

Superbug
Guest

I bet he has changed his mind since he has had recent failures and problems.

James
Guest
James

I said at the time (and posted it, as I recall) that the decision to side-step confirmation with a recess appointment would do a long-term disservice to Mr. Berwick. It was a short-term gain, but came at a cost later. It would have been better to hold the hearings when the appointment was first proposed, let Mr. Berwick answer any criticism in public, and then vote.

nate ogden
Guest
nate ogden

” Don Berwick is revered among health care professionals who have worked in health care improvement–which involves improving efficiency, lowering costs, improving quality, and increasing accessibility of health care services.” What does this have to do with CMS? CMS is not a health care provider, they are a health care payor. He has no experience or qualifications to run a health care payor. ” Sure, CMS is a payor,” a payor? They are the largest payor in the world. Its also their primary and most important duty. Your not talking about some side business or related company that generates a… Read more »

Evy
Guest
Evy

While Obama was hyped up to be more than he was, I still prefer him over McCain/Palin. Obviously, this is a political preference and I don’t intend to convince you. On the other hand, Don Berwick is revered among health care professionals who have worked in health care improvement–which involves improving efficiency, lowering costs, improving quality, and increasing accessibility of health care services. He has NEVER played in politics. Perhaps there are other people who have qualifications to do this job, but no one is as good for the job as Dr. Berwick; he is a visionary leader in health… Read more »

nate ogden
Guest
nate ogden

Same people claiming Berwick is the best person for CMS and the country would be terrible if he doesn’t get the job said the same thing about Obama and look at the joke he turned out to be. Unqualified, unable to perform his duties, unless you call him the golfer-in-chief, and scared to actually make any decisions. Obama is a perfect example of someone put into a job they don’t have the qualifications for, Berwick is no more qualified to run CMS then Obama was to be President. And don’t miss the latest heart warming story out of Berwick’s NHS… Read more »

Bruce
Guest
Bruce

Maggie Mahar has it right about everything except that ‘Congress rejected Berwick.’
That hasn’t formally happened yet. I hope that enough of those mistakenly opposed to his confirmation change their minds to vote for something good for America—the confirmation of Donald Berwick as the CMS head.

Neil Versel
Guest

I wrote a similar commentary about Berwick this week. http://www.meaningfulhitnews.com/2011/03/14/berwick-political-saga-is-attack/

How the person who’s probably done more to save lives than anyone else alive today gets vilified as a granny killer and uninterested in anything but socialism is beyond me.

Maggie Mahar
Guest

Bob–

Thanks for witing this.

It isgood to be reminded that people who actually know Berwick– and understand the problems in our health care system– recognize what a loss this is.

As you suggest, the fact Congress rejected Berwick says something about where this country is at this point in time. Berwick is too honest, and too intelligent to be accepted by Washington. And very few people of his calliber are willing to serve in a government ruled by the politics of hate.

saç kaynak
Guest

nice article, thank you so much…

Bruce
Guest
Bruce

Where’s the civility, folks?

Margalit Gur-Arie
Guest

I have no doubt that Dr. Berwick would be an appropriate candidate to lead CMS, but I have no doubt that there are probably several dozen others that would be as appropriate. What is happening now in DC is not personal, it’s business, the business of obstructionist politics on both sides. If we really want a talented person to run CMS, it will have to be someone pre-vetted by both sides, someone who is equally liked and disliked by both sides. Does this imply compromise on quality for this clearly political appointment? Probably not, since I do believe there should… Read more »

Paul Levy
Guest

Janice, Why do you feel it necessary to attack Bob and me for the work going on in our hospitals (or, in my case, my former hospital)? I don’t think either of us has ever claimed perfection. I do think we have both claimed that we have learned a lot about quality, safety, and process improvement over the years; and that we are always happy to share what we have learned. Indeed, both of our blogs are full of examples of both what has worked and what has not. And why do you use language like “Dandy Don” in such… Read more »

Janice Reverson, RN
Guest
Janice Reverson, RN

Berwick has failed the citizens in the United States because he promotes the EMR and CPOE as the savior of safety, when those instruments of care are intrinsically unsafe. To make matters worse, they have never been evaluated for safety, efficacy, and usability. He has gone along with the sham the HIT vendors have perpetrated on the US. Dandy Don would be welcomed if he demanded accountability of the devices that are directing the care of the patients he cares so much about. If Paul Levy is promoting transparency, let’s hear about the debacles and more simply the errors of… Read more »

BobbyG
Guest

“EMR and CPOE … those instruments of care are intrinsically unsafe.”
___

And, YOU know this with empirical precision precisely how? Enlighten us.