If there is a Mick Jagger of medicine, it is Don Berwick, M.D., America’s health care safety and reform rockstar. More than any other American physician, he has led us to improve safety in health care and led the debate about transforming the American health-care system into something that is just, accessible and affordable for all.
As a result, while I’ve gotten to work a lot of nights, he has been knighted by the queen of England. If there was a Health Care Hall of Fame, he would be in the lobby exhibit, next to the inventors of penicillin and discoverers of DNA.
It should therefore come as no surprise to anyone that when Dr. Berwick came to Maine recently, some 700 of Maine’s health care leaders listened to him speak for an hour, gave him a standing ovation, and would have marched him out in a sedan chair on their shoulders to be anointed King of Maine if given permission to do so. If he’d asked, I’d have personally hot waxed his car.
Maine needs a Dr. Don Berwick, a physician leader with statewide prominence whose sole purpose is to help the rest of us accelerate Maine’s journey toward an affordable health care system that provides care for all Mainers. That physician needs to be dedicated to facilitating our difficult discussions, educating the public and the politicians about the truth behind health reform rhetoric and bringing together the health care stakeholders to compromise and do other difficult work in ways sometimes only a physician can.
Maine has many extraordinary physician leaders, but they are often limited in what they can do either by their stance on issues, their obligations to help run their organizations, or by the competing agendas of those organizations. All of those constraints are legitimate, none completely prevents any of Maine’s current physician leaders from credibly contributing to efforts to improve health care in Maine (and most actively do), but those constraints limit what physician leaders can do for us.
What’s the perfect Dr. Don or Donna Berwick for Maine? Some characteristics are obvious: he or she must be a gifted communicator, be the Ronald Reagan of realpolitik, have the hide of a rhino and more gonads than God gave horses, and be as comfortable in a bait shop as in a boardroom. That’s just to start.
Our Dr. Don or Donna needs to be a health care policy wonk — as boring as that sounds, you have to understand health care policy and policy options to be able to work on them and explain them to others. You must be able to translate simple sentiments such as “health care for all” or “Let the free market work in health care” into workable and working policy. In order to do this job, you have to understand health insurance, brain-deadening topics such as community ratings, and that “CMS,” in the context of health care discussions, stands for Centers for Medicare and Medicaid Services, not Compact Muon Solenoids (the former runs Medicare in Washington, D.C., the latter is a particle physics detector in Switzerland).
He or she needs to be emancipated from the constraints imposed by working for an existing health care organization, because working for one would take up most of Dr. Don or Donna’s time, limit involvement in the reform work or limit what he or she can say or do. At the same time, a credible physician broker of health care issues must understand the diverse and legitimate perspectives of those same health care stakeholders, seek to find the overlap of their needs and pursue that path forward.
Most importantly, our Dr. Don or Donna must do what the real Dr. Don does: see access to health care for all as a matter of justice, put that interest and the best interests of patients above all else, help Maine build a sustainable health care system that insures all of us within the next five years, and have time to pursue that attainable goal.
Maine could afford its own Dr. Don if its health systems, benefactors, businesses and other groups got together and hired him or her, and housed Dr. Don or Donna in a place such as the Muskie School at the University of Southern Maine. He or she would ultimately serve all of us well, and pay us back in spades.
Erik Steele, a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.