Sunday, December 4, 2011

Doctor Donald Berwick's Parting Shots

The mind travels faster than the pen; consequently writing becomes a question of learning to make occasional wing shots, bringing down the bird of thought as it flashes by.

E.B. White, The Elements of Style, Macmillan, 1992

December 4, 2011 - As I read the title of Robert Pear’s NYT’s piece, “Health Official Takes Parting Shot at ‘Waste”, I thought of E.B. White’s comment on style.

Like White, Donald Berwick, forced to resign this week by Republican opposition as administrator of CMS, is a notable and quotable stylist. He has written a number of memorable books and speeches filled with eloquent thoughts- pro-government, pro-patient, pro-hospital safety, and anti-market - which he says were wrongly used against him.

His admirers consider him the American health system’s potential savior; his critics as its potential destroyer, the apostle of “socialized medicine.”

Here are some of Doctor Berwick’s parting shots on the “extremely high level of waste,” as exemplified by overtreatment of patients, failure to coordinate care, administrative complexity, burdensome rules, and fraud.

• “Much is done that does not help patients at all,” Dr. Berwick said, “and many physicians know it.”

• “I came with an agenda, I wanted to try to change the agency to be a force for improvement, covering one out of three Americans.”

• It’s a complex, complicated law. To explain it takes a while. To understand it takes an investment that I’m not sure the man or woman in the street wants to make or ought to make.”

• “We are a nation headed for justice, for fairness and justice in access to care,”

• “We are a nation headed for much more healing and much safer care. There is a moon shot here. But somehow we have not put together that story in a way that’s compelling.”

• “Government is more complex than I had realized. Government decisions result from the interactions of many internal stakeholders — different agencies and parts of government that, in many cases, have their own world views.”

• “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

• Berwick added, “Republicans have completely distorted my meaning. My point is that someone, like your health insurance company, is going to limit what you can get. That’s the way it’s set up. The government, unlike many private health insurance plans, is working in the daylight. That’s a strength.”

Tweet: Dr. Donald Berwick, resigning as administrator of CMS, takes parting shots at government complexities and distortions by Republicans.


Anonymous said...

Berwick's parting shot was obesity counseling.
Now, 15 million obese Medicare patients can see their primary care doctor up to 20 times in one year for face to face obesity counseling. That's potentially 300 million doctor visits a year which is 100 million more office visits then Medicare patients see their doctors now for all reasons. (there are nearly 50 million Medicare patients who see their primary care doctor an average four times a year) Before CMS issued this ruling, they did no cost benefit analysis; no estimate of what the total program or whether this new service can even be delivered. (Isn't there a well known projected shortage of primary care doctors?) I have not read a single news report or commentary that points out any of these small issues.

Richard L. Reece, MD said...

I wouldn't worry too much. Most fat people don't think of themselves as ill, and patients tend to go to doctors when they are sick. But I agree with you. I doubt if the feds did any serious cost analysis. Oh well, the fat's in the fire, and there is not even a fat chance CMS will withdraw its offer.

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