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Standing in the Way of Progress – The Stifling of Donald Berwick

By Dr. Nilesh Kalyanaraman
. 1 Comment(s)

Dr. Mark McClellan
B.A./B.S. - University of Texas, Austin
M.D. - Harvard-MIT
PhD. - MIT
M.P.A. - Harvard
Internal Medicine Residency - Brigham and Women’s
Director, Program on Health Outcomes Research – Stanford University
Commisioner – FDA

Dr. Donald Berwick
B.A. - Harvard
M.D. - Harvard
M.P.P. - Harvard
Pediatrics Residency - Children’s Hospital Boston
Vice President of Quality of Care Measurement – Harvard Community Health Plan
Co-founder – Institute for Healthcare Improvement

Above are the resumes for the last two appointed administrators of the Centers for Medicare & Medicaid Services (CMS). Mark McClellan was the administrator (the equivalent of ‘director’) from 2004 to 2006 and was appointed by President Bush. Donald Berwick was recess appointed as administrator in mid 2010 by President Obama because Congress wouldn’t confirm him. If you can’t remember which resume belongs to which man, don’t worry, they both have exemplary careers, remarkably similar backgrounds and have demonstrated a deep commitment to improving health care in America.

So why won’t Congress confirm Dr. Berwick? Well, the 42 Republican senators who wrote a letter urging the President to withdraw his nomination are standing in the way of his nomination. And what was Dr. Berwick’s transgression? It was voicing admiration for Britain’s National Health Service and expressing a desire for “rationing with our eyes open”.

Any physician or public health official whose goal is universal health care cannot help but appreciate the health care systems of countries that guarantee universal coverage. Praising Britain’s National Health Service is an acknowledgement that they have achieved universal care at a relatively low cost. I can respect those who may disagree with the way in which they provide health care in Britain but to be dismissive of the goal is to be dismissive of the fundamental right to health and well being.

The phrase, “rationing with our eyes open,” is simply the truth. We do ration care in this country; we ration it by wealth. If you’re rich you get fantastic health care. If you’re middle class you probably can get health care and when you do you hold onto it for dear life. If you’re the working poor then tough luck but you’re not getting care until it’s too late. I too wish we could distribute health care on the basis of far more rational criteria, such as effectiveness and cost.  It’s immoral for a country as wealthy as ours to use the ability to pay as the determinant for whether one gets health care or not.

Let’s face it, Dr. Berwick isn’t the only person who can do this job but he is exceptionally well qualified for the position. Simply speaking one’s mind and acknowledging reality are apparently sins that can prevent you from being confirmed by Congress. This uncertainty diminishes the ability of CMS to perform its mission to the fullest extent. More importantly, it dampens the enthusiasm of others who are interested in government service but see that politics trump the truth.

For a more detailed look at this issue took a look at this article by Harold Pollack and Chris Lillis in Kaiser Health News.

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  1. Ryan Buchholz, MD

    Thank you, Nilesh, for voicing the plain truth about Dr. Berwick's ample qualifications to lead CMS. We need his humble leadership, his dogged determination, and his underlying interest in what is best for patients whatever the methods. Indeed, his quest for quality health care mirrors, arguably more than any other method, the principles espoused by Toyota in creating reliable cars more than they parallel anything else.

    Let's stand up as Doctors For America and show that we have a spine -- let's call the pure political posturing (standing in the way of his potential confirmation) for what it is! We need Don Berwick now and in the future at the helm of CMS. He has been heartily supported by President Bush's Director of CMS (Dr. Mark McClellan, whose qualifications you listed above).

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