Don Berwick

The Boston Globe reported today that Republicans will oppose Don Berwick’s nomination as the head of the Centers for Medicare and Medicaid Services (CMS) by accusing him of being “an advocate for rationing care.”

Nothing could be further from the truth.  

In most industries, it is well accepted that the highest quality requires minimizing waste.   However, in health care there has been a real divide between those who devote their careers to improving quality, and those who devote their careers to minimizing waste.    That’s starting to change, and the Institute of Medicine defined quality as Safe, Timely, Effective, Efficient, Equitable and Patient Centered.  That’s a good sign indeed.   

Don Berwick is a pioneering prophet of quality who recognized early that controlling waste, and keeping health care affordable, is critical to quality.  He has written (eloquently) about the “triple aim” of improving the experience of care, improving the health of populations, and reducing per capita costs of health care.”   His organization, the Institute for Healthcare Improvement, has helped spread knowledge, best practices, and the gospel of reducing errors and complications to save lives (and money).

We clearly need a CMS Administrator who cares deeply about quality, and who also understands the centrality of reining in our out-of-control costs.  It won’t be an easy job, because unnecessary costs in one person’s eyes are income to someone else.   Don Berwick can do this job.  We’re lucky he’s willing to try.

We must all agree that to guard our country's future financial health (and decrease the future deficit) we must control health care costs. Demagoguery accusing anyone who cares about costs of rationing, or death panels won't help. 

Berwick was prescient in Health Affairs in 2008 when he wrote:

WHETHER OR NOT THE TRIPLE AIM is within reach for the United States has become less and less a question of technical barriers. From experiments in the United States and from examples of other countries, it is now possible to describe feasible, evidence-based care system designs that achieve gains on all three aims at once: care, health, and cost. The remaining barriers are not technical; they are political. 

6-9-10: Addendum. Doctors For America (offshoot of Obama's election committee) has a petition in favor of Senate confirmation at 

It's also worth reading his essay "My Right Knee," available free at the Annals of Internal Medicine web site.