Why Medicare Chief Nominee Don Berwick Hasn't Inspired Opposition -- Except From Knee-Jerk Republicans
I've written before about why Don Berwick, president of the Institute for Healthcare Improvement (IHI) in Boston, is an inspired choice to run the federal agency that oversees Medicare and Medicaid. But what's really striking -- despite all the Republican criticism about Berwick's views on "rationing" and healthcare in the U.K. -- is how much support he has from the healthcare sector. That says something important about his nonpartisanship and his dedication to making healthcare better.
As Republican Senate leaders plot a way to kill Berwick's nomination, his organization continues to work for higher-quality, safer care in hospitals. Ninety hospitals across the country, for example, have joined IHI's campaign to track readmitted patients and find out why they were hospitalized again. While hospital interest in the issue is directly related to the fact that they'll be penalized for high readmission rates under the Affordable Care Act, IHI launched this initiative before that legislation passed in March.
Largely because of pressure from IHI, 700 hospitals across the country have at least tried a surgical safety checklist that has been shown to reduce complications from surgery, and 300 other facilities have committed to doing so.
Berwick and IHI have made hospital safety a top priority. Their "5 million Lives" campaign and the earlier "100,000 Lives" effort involved thousands of hospitals. IHI says that more than 100,000 lives were in fact saved as a result of changes in care processes that many of these facilities introduced during the first initiative. These are common-sense ideas like taking steps to prevent infections when central lines are inserted into patients and making sure that patients receive prophylactic antibiotics before surgery.
In light of the fact that Berwick has repeatedly said that up to half of U.S. healthcare is wasteful and could be safely eliminated, you might expect many doctors and hospitals to recoil from the idea of him running the Center for Medicare and Medicaid Services, or CMS. Similarly, many providers might have a problem with the idea of Berwick -- an outspoken advocate of healthcare budgeting and an admirer of the U.K.'s National Health Service -- being placed in charge of the $780 billion CMS budget. They might not be thrilled at the prospect of this "revolutionary," as one healthcare executive called him, supervising hundreds of billions of dollars in Medicare cuts and supervising a Medicare Innovation Center that could very well upset their apple carts.
Yet the fact is Berwick's nomination hasn't inspired any of the ire you might expected. None of the news coverage I've seen has quoted a single healthcare executive or practicing physician who was critical of the pediatrician and Harvard professor. As anybody who has ever heard Berwick speak at a medical convention or at one of IHI's annual conferences knows, the man commands universal respect.
Why, then, are the Republicans targeting him? They don't like the government (except when they need it), and they want to resuscitate the debate over healthcare reform. Berwick's remarks about rationing and the failure of free enterprise in healthcare undoubtedly haven't endeared him to members of the minority party, either. But what's remarkable about Berwick's writings and speeches over the years is that he's no longer a voice crying in the wilderness -- he's mainstream. It's the opposition that's out of touch with current health policy thinking.
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