Q&A: Don Berwick Reflects on Healthcare Reform, Part II

A year after leaving his position as administrator of the Centers for Medicare & Medicaid Services, Don Berwick, MD, talks with HealthLeaders about death panels, the challenges of implementing healthcare reform, and Medicare and Medicaid fraud.

5 comments on "Q&A: Don Berwick Reflects on Healthcare Reform, Part II"
RK (12/11/2012 at 4:48 PM)

Where can we learn about how the future story of health care is being told? Of strategies referred to in communities in the US, Singapore, and New Zealand that improve community and individual care.
dr. dre (12/10/2012 at 5:51 PM)

Re: "DB: Right. Right now, with $2.7 trillion in play, the status quo is very, very loud, and very well funded, and heavily connected to campaign finances, because lobbyists have earned entry into the politicians' doors. They speak loudly, and they do not always defend the interests of the poor. The importance of making sure that medical treatment actually works, the toxicity of overtreatment, the need for better valuation of clinical practices[INVALID]all of those things don't have the voice that the status quo has. HLM: Which lobbyists are you referring to? DB: Anyone whose job depends on the status quo, and for whom changes are painful. They would rather see things continue or even get more support for what they do." This is a breath-taking assault on free speech. He would deny stakeholders the right to voice their opinions? Assuming he was correctly quoted, this is frightening.
mike stebbins (12/10/2012 at 1:03 PM)

the VA already makes "death panel" like decisions. They decided that since I was 52 year old diabetic they wouldnt fix a serious stenosis at C5-C6 because, "you arent going to live long enough to enjoy the benefits of the procedure" my terminal illness? Well controlled diabetes and otherwise in good health. If the VA can make those kinds of decisions with impunity, what is to stop CMS for doing the same?
Dan Ross (12/10/2012 at 10:41 AM)

Everything Dr. Berwick highlights makes sense, however the PPACA seems to contain "poison pills" making the creation of lean operating environments unattainable? For example, how can "lean" exist with a heavily unionized workforce? Possibly one of the most life threatening places on earth is being an elderly patient residing inpatient in an UK hospital! How does the US avoid the UK's outcome? How can the law make patients accountable for following evidence based care protocols? Lastly, how can the government's rule making ever allocate capital and care better than the free marketplace? (Today's system is not the free market}
Jonathan Lauer (12/10/2012 at 10:23 AM)

I always enjoy and generally agree with what Mr. Berwick has to say and this article is no exception. His comments about end-of-life care, demagogued" during the ACA debate, are spot on. However, in the final paragraph (pessimist vs. optimist), he leaves out any mention of risks associated with the huge consolidation among providers. With local market power among hospitals and physician groups rising, pricing power is increasing and there is potential that costs will rise as a result. How does this anti-competitive effect compare with the positives he mentions in that paragraph at the local level?


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