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Tuesday, March 8th 2011

Admiring Donald Betwick

Don’t let anyone but this blog’s readership know, but, I admire Donald Berwick.

The director of the Center for Medicare & Medicaid Services has dedicated the majority of his adult life to studying and improving the delivery of health care. And he stepped up to one of the highest platforms within health care policy knowing the challenges to acceptance he faced. Not that I would dare that he considred such when Obama asked him to take the position. Still, to only small surprise his well versed and verbalized opinions on what health care could be have hampered his service to the Obama administration.

Several people who work with Dr. Berwick at the Medicare agency said they were disappointed that the White House had not done more to promote him. “Everybody here admires Don and the work he’s done, but he is not going to be confirmed,” a supporter said. “That’s inevitable. The Republicans will block him. There’s not a lot of optimism that the White House can do anything about it.”

Berwick, a pediatrician by training, has made an internationally recognized career of his focus on optimizing the delivery of health care and he has, at times, been frank about what such would entail,

“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 the less fortunate. Excellent health care is by definition redistributional.”

Although many have this particular Dr. Betwick quote it is hard for anyone, looking at the actual data, to refute such a claim. Or Berwick’s many chides that improving health care will entail a more visible and transparent rationing of such. And rationing, publicized rationing, will be the death of meaningful health care reform at present.

Not that Donald Berwick doesn’t have his supporters, but his detractors in Congress will be the end of his tenure at the head of the CMS under a recess appointment from President Obama.

[H]is past record of controversial statements, and general lack of experience managing an organization as large and complex as CMS should disqualify him being confirmed as the CMS Administrator.

I don’t agree with many of Dr. Berwick’s opinions. Not on their merits mind you but on their implications.

And that’s a troubling position from which to argue with someone. The position that I concede your points but I disagree with you nonetheless. Of course, that has been my long held position. Essentially I concede that if you desire to improve the health of this country, by most population based metrics, then reforming the delivery of care to make access more affordable is important. And to improve access will require a better planned (not that our current system is planned at all) rationing of health care; a more visible rationing.

But challenging Dr. Berwick on his credentials is something else.

Managerial skill is something he has proven not only at the IHI but throughout his professional career. And I’m not sure a career government professional is someone we desire, on that merit alone, to head the CMS as the Senate Republican letter to President Obama implies.

Dr. Berwick’s tenure will have been too short, no matter my opinion of his ideas for Medicare, Medicaid and health care in general. 17 months at the helm may be long in the life of a CMS director,

This is a substantial period of time and long enough to have set a tone at CMS and to have recruited key second and third-tier administrators to work on important pieces of the Affordable Care Act. Berwick has already jump-started the Center for Medicare and Medicaid Innovation, the best hope health reformers have for finding smart ways to cut health care spending. Under Berwick’s tenure, the federal regulation of private insurance was also brought under the CMS mantle, a power consolidation that could have long-range implications.

But arguably shorter than the respect he deserved, no matter your politics.