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Why Dr. Berwick Must Be Confirmed

By Dr. James Burdick

It is critical that Dr. Donald Berwick be confirmed as the permanent head of CMS.   The country cannot afford to lose the singular financial expertise and health care process improvement that he has been contributing.  Problems in U.S. health care are mounting and his recess appointment will only last until January 2012.   Even granted that the attempt to have him confirmed to the post permanently might fail, if Dr. Berwick is sitting in front of Senator Max Baucaus (D, Mont.), the Chairman, and the others on the Senate Finance Committee to testify if it will allow the country to hear his vision for improving our health and national finances.    

CMS had not had a permanent head for years before Dr. Berwick arrived.  Although the dedicated expertise of career administrators there kept Medicare, Medicaid and other CMS responsibilities on track, career administrators do not have the medical background that will facilitate the transformative evolution that present circumstances and the 2010 Affordable Care Act require.  Dr. Berwick is needed for that transformation.   He is a powerful force for change with, as he says, three objectives: better care for individuals, better care for groups of people that have particular diseases or problems in common, and lowering costs by cutting waste and duplication.  The CMS Partnership for Patients is a recent hospital safety initiative led by Dr. Berwick that promises to save Medicare more than $10 billion over three years and in this economy, it is only one in a list of major savings his programs can achieve.  By the end of the year, Berwick will have put in place much of the groundwork that is needed to implement the Affordable Care Act.  In particular, the first “pioneer” tier of Accountable Care Organizations will be underway, and the rules for state insurance exchanges will be under review and possibly finalized. 

These new programs have not been easy to initiate.  One can only imagine the in-house CMS reactions behind the scenes.  And there have been loud, perhaps legitimate, public and professional outcries about some aspects of these regulations.   The background and professional expertise that Dr. Berwick provides is crucial in shepherding these changes through effectively. 

Some say that smart politics both for the Administration and for Dr. Berwick may be to cut and run rather than face a near-certain vote against his confirmation.   After all, last March 42 Senators fired a warning shot across the bow of the White House, cautioning President Obama against his resolve to put Dr. Berwick up for confirmation.  His past laudatory comments about the British Health System have not helped him, particularly since the British might benefit from another Dr. Berwick over there to help solve their health care system problems.  Regardless, the smarter politics for the nation’s future would be to proceed with the confirmation process.  Who knows?   Dr. Berwick is a mighty convincing speaker.  Somehow we have to both save money and improve access to high quality care, and he is the one who knows how to make this happen.           

The clincher is that keeping Dr. Berwick will allow him to engineer savings both for CMS and, by association, private health care.  With total annual health care expenditures in the U.S. rising out of control, Dr. Berwick’s  leadership will be key in the strategy to help solve our country’s looming insolvency.

And if the Senate does not consent to approve his appointment?  Even if Dr. Berwick is not confirmed, at least his testimony will dispel some of the public confusion about what would be best for our health.  Errors in arguments against change could be exposed.                           

America is at a turning point in health care.  These difficult, complicated and politically charged times call for extraordinary leadership.  We cannot afford to let Dr. Berwick leave the national stage if that can possibly be avoided.   

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