Every once in awhile, those in government actually appoint the perfect person to do an important job at a critical time.
Very soon, President Obama will nominate Dr. Donald Berwick to run Medicare and Medicaid. He is the right man at the right time. He has a passion for improving the quality of health care even as he demands that it be more efficient, less expensive and more attentive to the needs of patients.
A renowned pediatrician, Dr. Berwick also founded the Institute for Health Care Improvement (IHI
) in 1991 to work with doctors and policymakers around the world to find better ways to deliver safe and effective care.
Others have written important portraits of Berwick. One of the best is by Maggie Mahar, the author of Money-Driven Medicine
who offers an extended piece
about him in her essential blog Health Beat.
I know about Berwick because of a film I produced, Money-Driven Medicine
, based on Maggie's book. Berwick is both the head and the heart of that film. He speaks softly but he carries a big stick: a forceful argument that we have allowed our health care system to decline--even as costs increase--because we have a system of incentives that values quantity over quality.
While Berwick understands, admires and appreciates the essential values of the market, he emphasizes that, in the case of health care, if the profit motive is the only value, we will not only lose our health, we will lose our souls.
He is not an ideologue. He is a pragmatist, armed with data, real-life experiences and a determination to make things better. Even more important for this job, he is a great communicator who does not harangue; he persuades. The power of his persuasion comes from the fact that his talk is so clearly informed by his ability to listen.
When so much of our public discourse is polluted by cheap, punch-and-judy sloganeering--"from the left; from the right"--we need pragmatists who can show us how to reduce the cost of care so we can afford it for everyone.
In a recent piece in The New Yorker, Atul Gawande writes about an important piece of the new health care legislation, the Center for Medicare and Medicaid Innovation, which will "free communities and local health systems from existing payment rules, and let them experiment with ways to deliver better health care at lower costs." Imagine that! Instead of centralized, socialized medicine, the Center will encourage innovation at a local level and avoid the purposefully wasteful corporate welfare system that currently puts the needs of pharmaceutical firms, medical machine companies and insurers ahead of the patients they are supposed to serve. As a further example, Gawande talks about how the Children's Hospital in Boston helped to solve chronic asthma problems among poor children by handing out vacuum cleaners which, it turned out, were far less expensive and more effective than medication.
Berwick is just the right man to encourage that kind of innovation. He has been around the world and has discovered fundamental contradictions that must be resolved. In Sweden, for example, hospitals are rewarded for preventive care that keeps hospital beds empty. In the U.S., hospitals are rewarded for keeping hospital beds full. That's the market at work. The question is: should we work for the market or should the market work for us?
Berwick believes that something more fundamental should be at the center of the doctor-patient relationship. I'm with him--and for him--for the sake of all of us.