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Top Health Reform Player Berwick’s Overhaul Vision Draws Praise, Rebuke

August 11, 2011 at 12:00 AM EDT
As a leading player in the implementation of President Obama's health reform law, Donald Berwick has come under fire for his vision of fundamental changes to the U.S. health care system. Health correspondent Betty Ann Bowser reports on the controversy surrounding Berwick and his goals.
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MARGARET WARNER: Finally tonight, a profile of one of President Obama’s leading players in implementing health care reform.

Betty Ann Bowser, our health correspondent, has our look at the man and the controversy surrounding him.

BETTY ANN BOWSER: Dr. Don Berwick is arguably the most important figure in health care reform today.

As head of Medicare and Medicaid, he’s in charge of the health care of over one in three Americans. Equally important, he’s a key person charged with implementing the federal health care reform law. A Harvard-trained pediatrician and reformer, Berwick has spent the past 30 years analyzing the American health care system. And he doesn’t like what he sees.

DR. DONALD BERWICK, Center for Medicare and Medicaid Services: We built health care in American in fragments, hospitals, doctor’s offices, pharmacies, labs, ambulances. And we pay for it in fragments as well.

So we build systems. And people know it, what I mean, that they get forgotten, they get lost. No one seems to know what’s happening to them. You go to five doctors and you have tell your story all over again. We don’t need that.

BETTY ANN BOWSER: Berwick says what the country does need is a new way to pay doctors, one that rewards them for quality and not how many services they perform.

Berwick thinks a way to do that is to practice more evidence-based medicine. That’s a concept where doctors base their treatments on what science has shown works. But Berwick has alienated many conservatives with that view. They say it would lead to what they call government-run death panels that would ration care to seniors.

Berwick has also taken fire for supporting Britain’s National Health Service. This is a YouTube excerpt of a Berwick speech to a British medical group in 2008.

DR. DONALD BERWICK: … that any health care funding plan that is just, equitable, civilized and humane must — must — redistribute wealth from the richer among us to the poor and the less fortunate. Excellent health care is, by definition, redistribution. Britain, you chose well.

BETTY ANN BOWSER: That led to reactions like this one from talk show host Glenn Beck.

GLENN BECK, “Glenn Beck”: The second most dangerous man in America, his name is Don Berwick. Here is Berwick on rationing — quote — “The decision is not whether or not we will ration care. The decision will be whether we ration care with our eyes open.”

BETTY ANN BOWSER: But Berwick says the criticisms are a distortion of his views.

DR. DONALD BERWICK: I don’t want to withhold a single piece of care from anybody that needs it. I don’t want to cut costs by harming a hair on anyone’s head. My whole belief system is that we can improve. We’re smart enough, we’re good enough, we’re wise enough to improve our way to better care.

BETTY ANN BOWSER: As Medicare chief, Berwick has moved quickly to implement major portions of the health care reform law, especially provisions designed to improve medical outcomes.

He’s spearheading an ambitious effort to cut the number of hospital-acquired infections and errors in half.

But his critics say Berwick’s ideas will not save money, especially on huge programs like Medicare.

DR. DONALD BERWICK: We have to get health care costs under control. I mean, nobody disagrees with that premise anymore.

But there are two ways to do that. The simple way, the easy way, the wrong way is just to cut stuff, withhold benefits, take things away from people, even cut some people out of care. That’s seductive because it’s so quick and it sounds kind of easy and, well, why wouldn’t you do that?

But there’s a better way. There’s another way. I have for 30 years, my entire professional career, worked on the other way to do it, which is improve, improve. The computer you use today has probably 10 times the functionality of the computer you could have had five or eight years ago, and it costs less.

That’s because we are improving the way we make that device. Most of what you do in your life is better today and less expensive because we have figured out a better way to do it. The same applies in health care.

BETTY ANN BOWSER: One of Berwick’s better ways is creating accountable care organizations. That’s where doctors and hospitals form teams and bring all care under one roof.

Supporters say it will save money and improve patient care. However, that idea has also gotten a chilly reception from many of the nation’s doctors, who say the rules put out by the federal government on this are too expensive and onerous.

Is this concept, this whole idea of doctors joining together to treat patients, work together and try to reduce costs, is this whole idea in trouble?

DR. DONALD BERWICK: The idea that we are going move our health care system toward coordinated, seamless care, with high degrees of cooperation and teamwork, really, really patient-centered, that’s not an idea in trouble. That’s the idea that we’re — that’s — that’s the future. We’re going to move there.

The Affordable Care Act gives many, many mechanisms for encouraging that, supporting that. To do that, we have to overcome a fragmented payment system. We have to move from paying for volume, how much you do, to paying for value, how well you do. We should be paying health care like we pay any other sector, for how well you do, how well the patient does in this case.

BETTY ANN BOWSER: Although Berwick’s job entails implementing hundreds of minute provisions in the law, he says the hardest part of his job is a larger issue: convincing the medical establishment to change the way it’s been doing things for decades.

DR. DONALD BERWICK: It’s a tremendous opportunity, this — this act.

What’s difficult is, it’s change. We’re talking about moving the American health care system into a new age, highly reliable, where every doctor and nurse can be proud all the time of the work they do, and where every patient can count on excellence, no matter where they are. That involves changes.

From my father, I learned the image of health care that I still cherish.

BETTY ANN BOWSER: Berwick came to his job with a presidential recess appointment last year, because the White House knew he could not survive the confirmation process.

And if he’s to continue past December, he will now have to pass muster with the Senate, where Republicans say they have enough votes to make sure that won’t happen.