On Don Berwick and the Future of Healthcare Reform

Don Berwick, Administrator, Centers for Medicare and Medicaid

I am supposed to be in a thankful mood, but I can’t help feeling that the bah-humbug mood has come early, with the forced departure of Don Berwick, head of the Centers for Medicare and Medicaid Services (CMS). Berwick was Obama’s pick for the head of CMS and for shepherding healthcare reform. Obama appointed him during the summer recess, aware that Republicans promised to veto the appointment. The GOP relentlessly attacked Berwick.

If anyone is emblematic of healthcare reform in this country, I’d say it is Berwick. To the point of this blog, I doubt that we would be talking much about the patient point of view, trying to elicit it, and together build a sane and responsive healthcare system without him. He was not the first to say this, but he definitely believed that “the patient belongs at the table” on all matters pertaining to health.

Berwick acknowledged that the barriers to reform were political, not technical. In his landmark “Triple Aim” paper in the May/June 2008 Health Affairs, he defined the Triple Aim this way, as: “improving the experience of care, improving the health of populations, and reducing per capita costs of healthcare.” Those very ambitions got a rise out of special interest groups and groups wanting healthcare to stay the same. As his ideas galvanized more people, he became a maverick at innovating quality initiatives, suggesting new infrastructures for building a continuously improving, learning healthcare system, and putting value incentives into healthcare. Berwick pushed for science, not opinion, in healthcare, and he wanted a system that rewarded value, not volume of services.

The Urgency of Healthcare Reform

President Obama signs in healthcare reform, March 2010.

We need to amplify the absolute urgency there is for healthcare reform and make sure it is not thwarted. Without reform, universal coverage vanishes, pre-existing conditions are back, and caps on paying out of pocket are kaput. That is just the tip of the iceberg. Without healthcare reform, it is the same old business, lack of access, and questionable value in healthcare.

Healthcare reform stands at a crossroads, with 3 cases now reaching the Supreme Court.  The Reporters Committee for Freedom of the Press, representing several news organizations, submitted a letter Nov. 18 to the Supreme Court, requesting real time audio and video coverage of arguments on healthcare reform. In it, Reporters Committee Executive Director Lucy A. Daiglish writes:

“Federal health-care reform affects everyone’s well-being, and everyone has the right to see and hear the arguments over this important issue made before the highest court in the country. And they have the right to see it and hear it as it happens.”

Further, the Reporters Committee adds: “To be sure, the American public’s access to affordable health care is among the most significant issues to inform public debate in this country and to come before its highest Court in many years…The time has come” for public access to include visual recordings.

It’s time to level with the American people. Let’s make sure that the SCOTUS briefs on healthcare reform are not presented behind closed doors and not manipulated by special interests. Americans ought to see this.