Saturday, November 22, 2014
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Donald Berwick's departure as Head of Medicare is a loss for the country

Imagine a doctor who has saved over 120,000 lives. His knowledge is so highly valued that over 3,000 hospitals have sought his advice. Experts credit him with revolutionizing the quality of American health care.
The doctor in question is Dr. Donald Berwick. He is widely considered to be the founder of the American health care quality movement. All told, he may be the most venerated physician in the United States. Unfortunately, Dr. Berwick's nomination to head CMS ran into the politics of health reform. Opponents scoured his record to find something, anything, that they could hold against him.

Donald Berwick’s departure as Head of Medicare is a loss for the country

Imagine a doctor who has saved over 120,000 lives. His knowledge is so highly valued that over 3,000 hospitals have sought his advice. Experts credit him with revolutionizing the quality of American health care.

For his accomplishments, he has been honored with numerous awards. He has even received an honorary knighthood from Queen Elizabeth II.

The doctor in question is Dr. Donald Berwick. He is widely considered to be the founder of the American health care quality movement. All told, he may be the most venerated physician in the United States.

For 20 years, Dr. Berwick led the Institute for Healthcare Improvement, a nonprofit group dedicated to reducing the number of patient injuries and deaths from hospital mistakes. With experts estimating that as many as 100,000 Americans die each year from such mishaps, his work could hardly be more urgent or needed.

It’s hard to imagine that anyone could be better suited to lead the Centers for Medicare & Medicaid Services, the agency that runs Medicare and Medicaid. Together, these programs cover almost one out of every three Americans. If he could save over 120,000 lives running a private nonprofit group, imagine what he could do running a government agency that insures close to 100 million people.

That’s the opinion of most of America’s health care leaders. He was endorsed for the position by the American Medical Association, the American Hospital Association, and over 90 other business, labor and health care organizations, including the American College of Physicians, the National Business Coalition on Health, Wal-Mart, the AFL-CIO, and Consumers Union. He even gained the support of the heads of Medicare and Medicare under Presidents George H.W. Bush and George W. Bush.

He is so widely respected across political lines that in 2000, he was praised by Newt Gingrich.

Unfortunately, Dr. Berwick’s nomination to head CMS ran into the politics of health reform, which was the subject of a previous blog post. Opponents scoured his record to find something, anything, that they could hold against him.

What they came up with was hardly a condemnation. They found that he had once made favorable comments about the government-run health care system in England. That positive assessment is shared with most of the people in England, who actually use the system. It is also shared with Mark McClellan, the head of CMS under George W. Bush. But it was still enough to spark a controversy that threatened his confirmation.

President Obama could have used Dr. Berwick’s confirmation hearings to demonstrate the broad bipartisan support that his administration enjoyed, at least on this issue, from the entire mainstream of American health care. Instead, he used a recess appointment, which allowed Dr. Berwick to take office without Senate confirmation but only until the end of 2011. This further antagonized Republicans and virtually assured their opposition to an extension.

Dr. Berwick’s tenure at CMS ended last week. While is it unfortunate for the country that he did not hold the position for longer, he was still able to accomplish a lot.

Most importantly, he launched several new quality initiatives, including one to train and deploy “innovation advisers” to test new models of care delivery and another to award grants to states to streamline care for beneficiaries who are elderly and poor. Another initiative used new technologies to fight fraud. And he spearheaded the massive effort to implement the new health reform law while keeping a focus on improving quality.

Partisan politics has done much to impede meaningful health care improvement in the United States. Its role in cutting short Dr. Berwick’s tenure at CMS is a prime example. Revolutionizing the quality of American health care and saving over 120,000 lives shouldn’t be controversial.

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About this blog

Check Up covers major health events in our region and offers everything from personal health advice to an expert look at health reform. Read about some of our bloggers here.

For Inquirer.com. Portions of this blog may also be found in the Inquirer's Sunday Health Section

Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
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