A history of silence on key issues? That may mark the ideal Supreme Court nominee, but it scarcely characterizes the new administrator of the Centers for Medicare and Medicaid Services (CMS).
Donald Berwick, MD, MPP, nominated to the post by President Obama in April and then placed in the job through a controversial July 6 recess appointment, has been pondering health policy questions for years — occasionally in the pages of MANAGED CARE.
Here’s Berwick — longtime CEO of the Institute for Healthcare Improvement — on the record, from our past articles:
Not A System
“Our so-called health care ‘system’ is designed to fail, not to work. We don’t even have a real system of care. We have fragmentation to the point that the public remains without the basic information necessary to either demand what it needs or to get it.”
—2004, quoted in a feature article titled “Do We Really Have the Best Health Care in the World?”
“Suppose you went to the senior executive suite at Boeing and you listened to what they’re talking about. Many of them today would be talking about mergers and Wall Street and capital. But they’d also be talking about airplanes. The leadership is knowledgeable about … the actual core product. In health care, when you go into the executive suite, especially on the lay side, you often find that the conversations are not about care, they’re not about the core product, they’re about deals. Patients may not even be mentioned. That’s a disabling characteristic.”
—1999 “Q&A” interview
Leaning Too Much on Docs
“The more I study the subject of quality, the more I become concerned that a major problem in our health system is the fragmentation of care that results in part from overreliance on physician discretion. Involving patients more deeply adds value to care. Outcomes are better, and patients are more satisfied.”
—2004, in an article titled “Plans Go Directly to Patients, Describing Treatment Options”
Just What Is Managed Care?
“I have no idea what it means. Whenever you’re in a conversation with someone about managed care, you’d better spend about half the conversation defining your terms. Otherwise you’ll be lost. In the United States, we have a breed of well-led, prepaid organized systems. The traditional ones are staff- and group-model HMOs, the Kaiser Permanentes and Harvard Pilgrim Health Care, Fallon, Group Health Cooperative. In our work in the institute, we are always looking for the best we can find. We search the country and the world for the best care of back pain we can find, the best asthma care, the best intensive care units or the best obstetrical management. It is exceedingly rare that, after picking a topic and searching hard, we don’t end up with some of the famous and important managed care systems in the country on our list of the best we can find. I think it’s no accident. I think they’re the places that had the leadership and information and systems. The best of managed care is often the best we have. Many people don’t seem to realize that.”
—1999, “Q&A” interview