Progressive Voices

Doctors, hospitals, insurance companies, and patient advocates don't generally agree on everything. But almost everyone thinks that Dr. Don Berwick is an inspired choice to lead the Centers for Medicare & Medicaid Services. Everyone, that is, except extreme partisans.

Who is Dr. Berwick? He is a pediatrician and co-founder of a nonprofit called the Institute for Healthcare Improvement (IHI). IHI works with hospitals and other health care organizations to improve their systems of care to promote quality and improve patient satisfaction.

Partisans who oppose Berwick make several arguments against his appointment. They say that President Obama's use of a "recess appointment," instead of going through Senate confirmation hearings, is a way to hide Berwick's views. They note that Berwick has praised the British National Health Service. And they claim that he supports "rationing" needed health care services.

It's disappointing that some Senators promised a drawn out confirmation fight, which necessitated the recess appointment. This had little to do with Berwick and everything to do with rehashing the health reform debate. Medicare has gone for years without a permanent chief, and it needs guidance now more than ever. It would have been great to hear Berwick, with his calm physician's demeanor, explain his ideas about patient-centered medicine to the assembled Senators. But those Senators would have consumed months with scheduling delays, poll tested talking points, and windy speeches, while Medicare sailed toward health reform implementation, rudderless.

During a speech in England about that nation's National Health Service, Berwick did indeed say some nice things about the system. That's only polite given that he was a guest in the country and since he would spend most of the speech talking about how to fix the shortcomings of the NHS. Some credit is also due a system that is so popular that even England's Conservative Party leaders heap huzzahs on it.

And to claim that Berwick advocates rationing is to turn his entire philosophy upside down and inside out. Berwick believes that the patient is always right. At a keynote before the International Forum on Quality and Safety in Health Care, Berwick described his fear of that inevitable day when he will be a patient. He is afraid, he said, because patients are so powerless in our current system. Given the content of his address, I will let Berwick speak for himself. Here is how he ended the speech:

"It scares me to be made helpless before my time; to be made ignorant when I want to know; to be made to sit when I wish to stand; or to be alone when I need to hold my wife's hand; or to eat what I do not wish to eat; or to be named what I do wish to be named; or to be told when I wish to be asked; or to be woken when I wish to sleep. You can call it patient-centeredness if you choose, but I suggest to you that this is the core. It is that property of care that welcomes me to assert my humanity and my individuality and my uniqueness. And if we be healers then I suggest to you that that is not a route to the point, it is the point."

I, for one, want this voice guiding a significant section of our health care system during the great task of reform.

Adam Linker is a Policy Analyst at the North Carolina Health Access Coalition

 Email This Post  Print This Post

This entry was posted on Tuesday, July 27th, 2010 at 2:53 pm and is filed under Progressive Voices. You can follow any responses to this entry through the RSS 2.0 feed.