May 25, 2018
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Health care’s new rock star

By Dr. Erik Steele

The closest thing the American health care system has to a rock star is Don Berwick, an unassuming pediatrician most Americans never have heard about. He looks like a guy who would happily spend his days peering into snot-filled little noses, and would not mind if one of your children hurled up Cheerios onto his tie.

Berwick, however, is after scarier things than the contents of a pediatric proboscis; last week he was appointed by President Obama to head the Centers for Medicare and Medicaid Services, or CMS, the federal agency overseeing these insurance programs for more than 70 million Americans.

That makes Berwick the de facto leader of the American health care system and the closest thing the American health care system has to a 500 pound gorilla in a white coat. CMS used to be a sleepy, lumbering federal bureaucracy that did little but pay medical bills. Now it is the single most important driver of change our health system ever has known, and has set about reforming the system by virtue of its market size and grip on the strings of its $800 billion budget purse.

The thought of Berwick with his otoscope now peering up the nose of the American health care system makes a lot of stomachs heave around this country, especially conservative stomachs. He is known to be a fan of the British health care system and has spoken frankly about the need to ration health care in America if we are to be able to afford health insurance for all of us.

But before we toss up our Cheerios on his appointment, we would all do well to focus on Berwick’s leadership for the last 11 years of the Institute for Healthcare Improvement, an organization that has brought us breakthrough changes in patient safety during hospital care. The IHI is dedicated to the same health system goals most of us would want to be priorities of the country’s government: no needless deaths in health care, no needless patient pain or suffering, no unnecessary waiting for care, no waste in care, no one left out of a system of care. It also means Berwick has the same priorities as head of CMS that most of us would want in our own care.

Nor are his ideas on rationing as irrational as some might suggest. He gets what all of us really know; we cannot afford everything we all want in health care. If that’s the case, we must have some system to decide what we will and will not spend our health care dollars on, and that means rationing no matter what we call it. The question is not whether we will ration, Berwick says, but “whether we will ration with our eyes open.” (For a full interview with him on this issue, see the June 2009 issue of Biotechnology Healthcare at

Perhaps more important than his comments on such issues as rationing, however, is the fact that Berwick has a well-earned reputation for saying what needs to be said even when none of us wants to hear it. He talks like a doc who believes in kind and caring honesty for his patients. In his speeches and writing one can hear the voice of the healing profession coming through, whether he might be telling parents their child is eating too much junk food, or telling a nation of patients their care is eating too much of our national wealth.

In naming Berwick to lead CMS, however, President Obama has turned what Berwick says and thinks into what CMS may say and think. That’s a good thing if we want kind, honest frankness in health policy debates, are to accelerate the pace of reining in Medicare and other health spending costs, and want principles such as those of the IHI leading at CMS. It’s also a good thing if we want the leader of the American health care system to have the interests of the patient at the core of his professional soul.

Don Berwick — he’s just the helpful shot in the arse we need.

Erik Steele, D.O., FAAFP is chief medical officer at Eastern Maine Healthcare Systems and interim CEO at Blue Hill Memorial Hospital.

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