Berwick political saga is a tragic attack on better healthcare
President Barack Obama has made plenty of mistakes in his first two-plus years in office, but none may be more serious for the future of America than his decision to install Donald M. Berwick, M.D., as a recess appointment to head the Centers for Medicare and Medicaid Services in July 2010.
Berwick really is a great choice to head CMS, but the underhanded nature of the recess appointment has provided fodder for all kinds of uninformed ideologues and assorted nut jobs to attack Obama’s healthcare reform efforts. Just as CMS is gearing up to release widely anticipated proposed regulations for Accountable Care Organizations, we get the sad news that that Berwick’s days are numbered.
After refusing to allow Berwick to testify before the Senate last year, Obama renominated Berwick on Jan. 26. Newly empowered Republicans went on the attack. “The White House’s handling of this nomination—failing to respond to repeated requests for information and circumventing the Senate through a recess appointment—has made Dr. Berwick’s confirmation next to impossible,” the widely respected Sen. Orrin Hatch (R-Utah) said, according to American Medical News.
On March 4, Politico reported that Senate Democrats had given up on the nomination, despite the fact that Berwick had the support of the Medical Group Management Association, the American Hospital Association, the American Public Health Association and, notably, the Republican-leaning American Medical Association and America’s Health Insurance Plans.
How did this happen?
As I wrote last November when Republicans proposed de-funding of the Center for Medicare and Medicaid Innovation, a key element of real reform in the widely misunderstood “healthcare reform” legislation (the main misunderstanding is that insurance is not the same thing as care):
The Patient Protection and Affordable Care Act, widely referred to as “healthcare reform” and mocked by some as a government takeover of healthcare, aka “ObamaCare,” is not popular in Republican circles. That’s no secret.
It’s also well known that, in their drive to repudiate everything Obama, many Republicans, giddy over their victory in last week’s midterm election, have said they want to repeal the PPACA in its entirety, throwing out the baby with the bathwater. (You know, our healthcare system is wonderful the way it is, so we didn’t need any changes in the first place.)
What really got me was the news that some of the more conservative and libertarian elements of the GOP are specifically threatening to pull the $10 billion in funding already authorized for the Center for Medicare and Medicaid Innovation, a CMS program created by the PPACA. This is a center that CMS Administrator Dr. Donald Berwick has called “the jewel in the crown” of the reform bill, and Berwick has unfairly been labeled a socialist, granny-killing pariah by some right-wing zealots who have no idea of his life-saving work at the Institute for Healthcare Improvement.
The new Republican-majority House of Representatives could not make a bigger mistake than defunding the Center for Health Innovation. For years, conservatives have complained of Medicare’s plodding bureaucracy impeding innovation—you know, the very thing the program is intended to foster.
What the PPACA does is allow CMS, via this new innovation center, to try new ideas without having to make sure their experiments are budget-neutral from the start. (The requirement for budget neutrality is why Medicare pay-for-performance and pay-for-prevention initiatives have never really gotten off the ground.) And CMS no longer has to be content with small demonstrations. Instead, the Center for Medicare Innovation is authorized to run wider-scale pilots and then seek congressional appropriations to ramp up any program that proves successful in producing better care for less money.
That’s how you bend the cost curve, a favorite term in policy circles. Killing the Center for Medicare and Medicaid Innovation would just perpetuate the ugly status quo.
That commentary drew five responses on the site, four of which were negative. And every last one of the negative comments were written anonymously. The only commenter to list a name also happened to be the lone supportive response.
I am in no way surprised. Politically motivated lies abound about Berwick, and few of the critics want to be held accountable for misleading the public.
The week before last, I was somewhat critical of the Lucidicus Project and Jared M. Rhoads, who hosted the most recent Health Wonk Review. He did a fine job hosting HWR, but in scanning some earlier posts on the Lucidicus site—hewing closely to confused, angry, misguided ideology of the tea party—I noticed something that got my blood boiling.
On Jan. 27, Rhoads wrote that Berwick was “on a one-way path,” a path that leads to socialism and a government takeover of healthcare. “Without free-market solutions on the table, the one-way march to an NHS-like system will continue. Berwick has just one solution in mind for the problems created by government: more government.”
He also wrote, “Berwick is openly enamored of the U.K.’s National Health Service (NHS) model, in which the government essentially makes decisions for people about the care that they receive, and in which patients can be penalized for attempting to pay for additional care out of their own pockets. The system is characterized by bureaucracy, rationing, and redistribution of wealth and resources.”
At least give Rhoads credit for not cowardly hiding behind a cloak of anonymity.
Yes, it is true that Berwick has publicly spoken of his admiration for the NHS, but it was more about the British decision to make quality improvement a key element of healthcare than it was about a desire to bring an entirely government-run system to the United States. In my post about that edition of HWR, I asked if Berwick hadn’t done more to prevent needless deaths and adverse events than pretty much anyone else alive today.
That’s the same question I asked in an e-mail to the anti-reform (read “crackpot”) group called Docs4PatientCare. Why do I say crackpot? The Atlanta-based organization contacted me last fall with links to a series of videos, including one from group representative Scott Barbour, M.D. According to the original pitch to me, “Utilizing quotes from Dr. Berwick, Dr. Barbour exposed that, ‘He is not interested in better health care. He is only concerned about implementing his socialist agenda.’”
In another video, Docs4PatientCare Vice President Fred Shessel, M.D., said of Berwick, “This is a man who has made a career out of socializing medicine and rationing care for the very young, the very old and the very sick. It is a backdoor power grab. It is dragging our country down the road to socialism and we should resist it.”
I responded to this pitch with a short question: “Berwick isn’t interested in better care? Do you know anything about his work at IHI?” I never got a response. Docs4PatientCare seemingly was trying to hoodwink media that don’t know any better and/or care more about politics than facts.
Here are the facts, from another piece I wrote last year:
A longtime champion of patient safety, Berwick co-founded the Institute of Healthcare Improvement in 1989 and led it until he became CMS administrator by virtue of a controversial “recess appointment” in July 2010, preventing the Senate from questioning him about his views. At IHI, Berwick created and championed the 100,000 Lives Campaign, an effort to prevent that many deaths in an 18-month period by getting thousands of U.S. hospitals to follow simple, preventive safety measures voluntarily. The program later turned its focus to nonlethal adverse events and became the 5 Million Lives Campaign. Berwick is a pediatrician who also holds a master’s degree in public policy.
In kicking off the 100,000 Lives Campaign in December 2004, Berwick made the following audacious challenge to American hospitals: “I think we should save 100,000 lives. I think we should do that by June 14, 2006. 9 a.m.” At that appointed hour 18 months later, he announced that the campaign had prevented 122,300 unnecessary deaths. Berwick was careful not to make IT a prerequisite for participating in either campaign, but he’s come to see the benefits of EMRs and clinical decision support. Now, as head of CMS, he effectively leads the “meaningful use” incentive program. Though the Stage 1 rules were mostly done by the time he took the reins, you can be sure Berwick will be pushing for true quality improvement in subsequent stages of meaningful use.
The key word in the above passage is “voluntary.” There were no mandates when the private-sector IHI encouraged hospitals to do what is right for patients.
Months later, Berwick has indeed been pushing for true quality improvement in meaningful use. I’ll have more on that later in the week.
[…] I wrote last November when Republicans [read complete article]. Uncategorized Will You Stand For Don Berwick? → LikeBe the first to like […]
Anyone can dispute extrapolations or political appointments but the good work done by IHI under Dr. Berwick’s leadership runs across political divide and even national boundaries. I had the good fortune to attend their annual event National Forum soon after their initial goal was met. The event was packed with physicians, nurses, pharmacists of every political flavor and many delegates had travelled internationally to learn. Some of the concepts and techniques that I picked up – such as the “ATAL: All Teach All Learn” sessions – continue to help me today.
More than his work, Dr. Beriwck, with his team at IHI, was able to address key hazard culprits (ventilator-based pneumonia, for instance) and thereby energize the focused exchange among caregivers. As a direct result of his work, many are alive today who otherwise may not have been with us. Many of his teammates have gone to other organizations (such as Kaiser Permananente) where they continue the patient-focused initiatives.
Can’t comment about the politics or the CMS as it is outside my skill set.
We used to say the two biggest lies are “The check is in the mail” and “It won’t hurt a bit.” Now, there is a third biggest lie, which is, “We have the best health care system in the world,” as Bill Clinton and George Bush uttered repeatedly during their respective terms. In truth, all of the standard measures of health care quality points to ours as being “the best substandard price-gouging health care system in the world”. We need to find out what’s really wrong and why no one wants to fix it. Healthcare reform + politics = chaos. http://soulfulthought.blogspot.com
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Last year when Berwick was nominated organizations like American Hospital Association, Medical Group Management Association, America’s Health Insurance Plans and the American Public Health Association came out in support of him http://www.modernhealthcare.com/article/20110307/NEWS/303079921#ixzz1GhNyxfek and have continued to. AARP said
http://www.aarp.org/about-aarp/press-center/info-04-2010/aarp_statement_onnominationofdrdonaldberwicktoheadcentersformedi.html
I hope they would use their political capital (37.5 million members) to support his confirmation now. If not perhaps this is an opportunity for people in the health 2.0 and open government community to work at the grass roots level to get him confirmed without it becoming a partisan issue?
Sherry, has AARP waded into this controversy recently?
Moshe, plenty of people buy that lie about the U.S. having the best healthcare in the world. Glenn Beck said that in his attempt to defeat the PPACA, even after he himself was the victim of a medical error that nearly killed him. (Look it up.)
At least one of my own critics has thrown this argument at me, back about two years ago. I had some fun at his ignorant expense.
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Neil,
Thanks much for your passionate essay. I pretty much agree with everything you wrote–though I’m not ready to declare that a recess appointment of Don Berwick was a mistake. it avoided a nasty fight that might not have succeeded in his appointment in the first place. If the republican”s main objection to him is that he was a recess appointment, then they are being petty and childish. What about his performance as the CMS administrator? Looks pretty good to me. I suspect that his detractors are more concerned that he might make PPACA more successful.
[…] you haven’t already, I encourage you to read the defense of Berwick that I wrote last week so you understand why politics is hijacking better healthcare in […]
[…] you haven’t already, I encourage you to read the defense of Berwick that I wrote last week so you understand why politics is hijacking better healthcare in […]
[…] I have to remind you of who used to be the driving force behind the IHI? That of course would be Dr. Donald M. Berwick, the administrator of CMS that Republicans want to kick to the curb because they think they can […]
[…] I have to remind you of who used to be the driving force behind the IHI? That of course would be Dr. Donald M. Berwick, the administrator of CMS that Republicans want to kick to the curb because they think they can […]
[…] I have to remind you of who used to be the driving force behind the IHI? That of course would be Dr. Donald M. Berwick, the administrator of CMS that Republicans want to kick to the curb because they think they can […]
[…] short tenure as head of the Centers for Medicare and Medicaid Services has been well-documented, including right here on this blog. Berwick got in by a controversial recess appointment because President Obama didn’t have the […]
[…] calls people “nutbars.” Why do I say this about D4PC? A year and a half ago, I wrote this: D4PC contacted me last fall with links to a series of videos, including one from group […]