Thursday, July 7, 2011

Health Reform: Request To Comment on Donald Berwick Blog

An editor at The Health Care Blog has asked me to comment
on a July 5 blog on Donald Berwick by Robert Laszewski. Laszewski serves as president of the Health Policy and Strategy Associates of Alexandria, Virginia, an inside-the-beltway think tank.

Laszewski's blog, entitled “The Awful Dichotomy Between Health Care Politics and Policy, “ bewails the imminent departure of Doctor Donald Berwick as administrator of CMS. He praises Berwick for his long career dedicated to improving care and lowering costs.

At the same time, Laswekski admits Berwick sometimes lets his idealism – his penchant for creating such bureaucratic monstrosities as Accountable Care Organizations – get in the way of what is politically possible and operationally workable. In other words, Berwick shoots himself in the foot while putting his foot in his mouth. Over 1500 waivers from Obamacare and a "mystery shopper" program to spy on doctors are other examples of this political foot-in-mouth disease.

In the main, Laszewski admires Berwick, “My sense is that a Republican President, as much as a Democratic one, could have as easily appointed Don Berwick CMS admistrator..but Don Berwick never had a chance in an environment where trying to find the right answers takes back seat to scoring political points.”

Here is the comment I sent to The Health Care Blog.

Winston Churchill said, “If you’re not a liberal at twenty you have no heart, if you’re not a conservative at forty you have no brain.” Berwick’s cardinal sin may have been he tried to be both a liberal and conservative at 64, It’s a combination that does not work well in American partisan politics. Hearts and brains don’t always mix, as I point out in my new book The Health Reform Maze, due out in a month or so (Greenbranch Publishing).

In the book , I devote four blogs to the Berwick phenomenon. These blogs are critical of the massive bureaucracy that will be required to implement the law.

Berwick's political problems, I think , may run much deeper than Laszeweski suggests.

One, Berwick is unabashedly pro-government in preferring top-down solutions directed by government experts to the bottom-up wishes of consumers and physicians.

Two, he is utterly and inalterably dismissive of any market-based solutions, no matter how rational, proposed by Republicans.

Three, he believes “rationing with your eyes wide-open," as determined by government-based outcome and quality measures and enforced by government "systems", holds the ultimate answers.

As Amy Goldstein explains in the July 5 Washington Post “Medicare and Medicaid Chief in Race Against Time, “ Berwick’s role in the scheme of things is huge, “Overseeing two entitlement programs that insure nearly one in three Americans, shepherding the profound insurance changes spurred by the new health-care law, and serving as chief cheerleader for better care at lower cost.” Perhaps this is mission impossible in today's political climate.

Unfortunately for Berwick, he teeters on the left side of the political divide in a center-right nation that is demanding spending cuts for Medicare and Medicaid. The handwriting may be on the wall. Berwick appears to be on his way out. Political realism is trumping idealistic talking points.


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