Donald Berwick In His Own Words
Last week President Obama bypassed the Senate and public hearings to appoint Dr. Donald Berwick as Administrator for the Centers for Medicare and Medicaid Services (CMS). Even though the President previously admitted that “an ugly process” surrounding the health care legislation “legitimately raised concerns…that [the American people] just don’t know what’s going on,”[i] his recess appointment means that Dr. Berwick did not face any public scrutiny before assuming control of an agency that provides care to 100 million seniors, children, and low-income and disabled individuals[ii] with an annual budget exceeding $800 billion.[iii]
However, the quotes below highlighting his views on health care—along with another highlighting his self-described greatest defect—provide troubling indications about the policies Dr. Berwick may attempt to impose when running the vast agency now under his control:
Berwick on rationing: “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”[iv]
Berwick on redistributing wealth: “Any health care funding plan that is just, equitable, civilized, and humane must—must—redistribute wealth from the richer among us to the poorer and less fortunate.”[v]
Berwick on Britain’s government-run National Health Service: “I fell in love with the NHS…to an American observer, the NHS is such a seductress.”[vi]
Berwick on extending coverage: “At $5,000 per person per year, we leave 45 million souls without health insurance. At under $3,000 per person per year, the United Kingdom leaves no one out—no one—not even illegal immigrants.”[vii]
Berwick on individual choice in health care: “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”[viii]
Berwick on single payer health care: “I admit to my own devotion to a single-payer mechanism as the only sensible approach to health care finance I can think of.”[ix]
Berwick on closing health facilities: “Most metropolitan areas in the United States should reduce the number of centers engaging in cardiac surgery, high-risk obstetrics, neonatal intensive care, organ transplantation, tertiary cancer care, high-level trauma care, and high-technology imaging.”[x]
Berwick on end-of-life care: “Most people who have serious pain do not need advanced methods; they just need the morphine and counseling that have been available for centuries.”[xi]
Berwick on ultrasound treatments: “As many as 80 percent of hysterectomies are scientifically unnecessary. So are more than a quarter of the drugs used for ear infections, most of the ultrasound tests done in normal pregnancies, and almost half of the cesarean sections in the United States. Isn’t this, with all due respect, some form of assault and battery, however unintended?”[xii]
Berwick on access to new technology: “The need to balance effectiveness against cost has shifted the burden of proof onto the shoulders of those who use or propose to use expensive technologies.”[xiii]
Berwick on Berwick: “I don’t feel like a leader, so it’s very hard for me to project myself into that situation. But inattention to detail is my biggest defect. I’m always leaning forward into something new. I can create a mess. Luckily, I have people who are willing to create the detail around the idea or, if they’re really smart, know which ideas to ignore.”[xiv]
These quotes—a small sampling of Dr. Berwick’s extensive writings over the last several decades—reveal views on issues from ultrasound use in pregnancies to hospital consolidation to single-payer health care that many may find disconcerting. The American people deserve a full explanation regarding his comments and a thorough examination of how his long-held views will influence his critical role in implementing Democrats’ massive new 2,700 page health care law.
[i] Full interview transcript available at http://abcnews.go.com/print?id=9659064.
[ii] Brief Summaries of Medicare and Medicaid, Centers for Medicare and Medicaid Services Office of the Actuary, November 2009, http://www.cms.gov/MedicareProgramRatesStats/downloads/MedicareMedicaidSummaries2009.pdf
[iii] Centers for Medicare and Medicaid Services Fiscal Year 2010 Budget Justification, http://www.cms.gov/PerformanceBudget/Downloads/CMSFY10CJ.pdf, p. 2
[iv] “Rethinking Comparative Effectiveness Research,” An Interview with Dr. Donald Berwick, Biotechnology Healthcare June 2009, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799075/pdf/bth06_2p035.pdf
[v] “A Transatlantic View of the NHS at 60” by Donald Berwick, speech at NHS Live, July 1, 2008; Emphasis original
[vi] “Celebrating Quality 1998-2008” by Donald Berwick, speech at London Science Museum, September 30, 2008
[vii] “Plenty,” speech to 14th annual National Forum on Quality Improvement in Health Care, December 2002, in Escape Fire: Designs for the Future of Health Care by Donald Berwick (Jossey-Bass, 2004), pp. 293-94
[viii] “A Transatlantic View of the NHS at 60” by Donald Berwick, speech at NHS Live, July 1, 2008
[ix] Foreword to Quality in the Veterans Health Administration: Lessons from People Who Changed the System (Jossey-Bass, 1996) by Donald Berwick, p. xi
[x] “Buckling Down to Change,” speech to 5th annual National Forum on Quality Improvement in Health Care, December 1993, in Escape Fire: Designs for the Future of Health Care by Donald Berwick (Jossey-Bass, 2004), pp. 28-29
[xi] “Reforming Care for Persons Near the End of Life: The Promise of Quality Improvement” by Joanne Lynn, Donald Berwick, et al., Annals of Internal Medicine July 16, 2002, p. E-118
[xii] “Why the Vasa Sank,” speech to 9th annual National Forum on Quality Improvement in Health Care, December 1997, in Escape Fire: Designs for the Future of Health Care by Donald Berwick (Jossey-Bass, 2004), pp. 129-130
[xiii] “Techniques for Assessing the Impact of New Technologies in the Neonatal Intensive Care Unit” by Donald Berwick, Respiratory Care June 1986, p. 524
[xiv] “Seeding a Simple Dream: Do No Harm” by Avery Comarow, US News October 30, 2006, http://www.usnews.com/usnews/news/articles/061022/30berwick_print.htm