don berwick

Dr. Don Berwick, labeled the “second-most dangerous man in America” by conservative pundit Glenn Beck, spoke at Harvard Law last week.

Dr. Berwick, a pediatrician, founded the Institute for Healthcare Improvement in 1991 in Cambridge, and in 2010-2011, served as Administrator of the Centers for Medicare and Medicaid Services (CMS). Earlier this year, Dr. Berwick announced his candidacy for the Massachusetts governorship.

Dr. Berwick spoke to students about the Affordable Care Act (ACA) and efforts throughout the healthcare system to improve quality of care and bring costs down.

The US has made incredible advances in recent decades in certain parts of the healthcare system, noted Berwick: “There’s quite a majestic story of big hospitals, audacious interventions, and new technology saving lives.”

Unfortunately, according to Berwick, these new technologies and big hospitals don’t meet the country’s main needs in treating chronic illnesses. “A tremendous amount of the possibility of helping people lies” in the areas of mundane but costly health issues such as coronary heart failure, lung disease, diabetes, hypertension, and stroke. “Gleaming hospitals don’t meet this need – you need care coordination.”

Berwick emphasized the pressing need to bring healthcare costs down, for both taxpayers and private employers.

Berwick also pointed to the importance of preventive care, and defended the ACA, arguing that the law both gets more people into coverage and provides new opportunities for reforming different aspects of healthcare delivery. One example of this, he said, is an attempt to move away from the perverse incentives of fee-for-service models to performance-based compensation.

“We actually have [in the ACA] a framework for health care as a human right in this country and a redesign for better care,” said Berwick. “The debate over the ACA right now saddens me because it’s the wrong debate to be having. Of course we should start with fundamental premise of health care as a human right.”

Beyond the ACA, Berwick argued, truly comprehensive healthcare reform would require a major redesign and investment in different forms of care provision. “You can’t get there through hospitals.”

The obstacles to such reform, according to Berwick, are both economic and political. On the economic front, noted Berwick, we don’t have the money and the existing system keeps eating up more of the money that we do have. Politically, said Berwick, Republican politicians have been unwilling to have “rational, ambitious conversations about what a new system of care could look like” and instead, during Berwick’s time at CMS, “were just throwing brickbats.” After Berwick had served seventeen months in the post as a recess appointee, he was forced to leave after Republicans refused to let his nomination come up for a vote.

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