Dr. Don Berwick: Consumers, community health leaders must push for change in health care

Dr. Don Berwick’s critics have vilified him for making comments favoring the United Kingdom’s national health plan and have cast him as a proponent of health care rationing. To his supporters, however, he is the chief cheerleader for changing health care in the country, providing impassioned reminders to those working to implement the complicated Affordable Care Act about what they are shooting for: better health care and lower costs.

Berwick left his role as administrator of the Centers for Medicare and Medicaid Services last week, after about 17 months on the job, and returned to his Newton home after Republican senators said they would block his confirmation and prevent him from serving beyond the end of the year. He said in an interview today that the nation needs more advocates for the law.

“The law is just a framework,” he said, in an interview given just after he received an award at the annual conference of the Cambridge-based Institute for Healthcare Improvement, which he led for nearly 20 years. “Health care in America can’t improve and it can’t become sustainable without a tremendous amount of community involvement.”

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President Obama has a role in that, he said. So do health care consumers who should push health care leaders to rethink the way they work, he said. Increasingly, though, that advocacy role is falling to physicians, nurses, and hospital executives.

“We need their voices, because they know the system can’t go on the way it is,” he said.

Berwick, who was appointed by President Obama during a recess, said he regrets not having a confirmation hearing before the Senate Finance Committee, not because he thinks he would have won over his critics, but because it would have provided an opportunity to defend a policy he believes in.

“I think that a lot of the public concern about that law and a lot of the congressional criticism is ill-founded and based on myths,” he said. “I think any chance to air publicly, with conversation and even debate, matters of such concern is healthy.”

Berwick said he would not second guess the decision by the White House not to push for a hearing. He declined to say whether he made an appeal to Obama directly, saying his conversations with the president and his staff are confidential.

Back in Massachusetts, Berwick said he is excited that the state is “entering an experimental period” as it grapples with how to curb health care costs. The governor has proposed a plan, pending in the Legislature, that would dramatically change how hospitals and doctors are paid.

Just as it led the way with providing coverage for nearly all residents, Massachusetts will be “learning for the nation” about how to control costs, Berwick said.

He said he worries about the future of Medicaid, as budget pressures at the state and federal levels threaten cuts to the program for the poor and disabled.

“Unfortunately there is sometimes a false concern that it’s zero sum—if the poor get help the elderly won’t,” he said. “Better care will help everybody.”

During a visit to Boston Monday, Deputy Health and Human Services Secretary Bill Corr called Berwick “one of our nation’s most outstanding leaders.”

“He’s envisioned how you take all these tools in the Affordable Care Act and you really use them to the maximum extent to really improve health and to lower costs,” he said.

Corr has confidence in Berwick’s replacement.

Marilyn Tavenner has been named acting administrator, pending Senate confirmation, and Republican leaders so far have received her nomination with little fanfare.

The role is familiar for Tavenner, who Berwick called a “methodical, disciplined and very broad-band operating leader.” She was named acting administrator of the agency in February 2010 then handed the reins to Berwick that summer. Previously, she oversaw health and human services in Virginia under Democratic Gov. Tim Kaine and was an executive for the Hospital Corporation of America after starting her career as a nurse.

Berwick said he is looking forward to spending time with his family, including two young grandsons and his wife, Ann Berwick, who is chairwoman of the state Department of Public Utilities. He has not made any decisions about what’s next for him, including whether he will assume a role at the Cambridge institute.

“I’m excited by how much is in motion in health care right now,” he said. “It’s an incredibly interesting and promising time with many risks, and I want to stay thoroughly engaged in reshaping American health care into the high-performance, sustainable system I know it can be.”

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