Dr. Donald M. Berwick is far too intelligent, passionate and brutally honest for Congress to approve him to run the bloated Medicare program. So President Barack Obama made the appointment last week while legislators were out of town.
Berwick takes over in a few days at the Woodlawn-based Centers for Medicare & Medicaid Services. He'll oversee Medicare benefits for seniors as well as coverage for low-income folks and children that, all together, costs federal taxpayers nearly $1 trillion annually and consumes ever-greater portions of the budget and the economy.
In an ideal world, Berwick would be Medicare's Winston Churchill, a prophetic voice who emerges from the wilderness and ends years of appeasement and denial. He tells the truth about federal health care and medicine generally. It's no wonder the Obama administration didn't think the Senate could handle it.
"The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open," he told Biotechnology Healthcare last year.
"I have said it before, and I'll stand behind it, that the waste level in American medicine approaches 50 percent," he told Health Affairs magazine in 2005.
Many lives and dollars could be saved, Berwick believes, by limiting doctors' ability to prescribe treatments that science shows don't work or carry unacceptably high risks.
"The more I have studied it, the more I believe that less discretion for doctors would improve patient safety," he told The Boston Globe in 2004. "Doctors will hate me for saying that."
Republicans hate him for saying that he is "romantic" about Britain's National Health Service and that critics hold "mythological views" about how bad socialized systems are in Britain, Sweden and elsewhere.
Berwick's anger about Big Medicine comes in part from personal experience. When his wife had a severe autoimmune attack on her spinal cord a few years ago, the couple witnessed repeated errors, lost records, clinical incompetence and needlessly enormous bills.
"I can tell you from my personal observation: No day passed — not one — without a medication error," Berwick wrote in an essay.
His wife received MRI scans "over and over again," at $2,000 a pop, for no obvious reason. Pills went for $30 each. Doctors repeatedly ordered drugs that had already been shown to be useless. One attending physician didn't even know what disease she had.
"Before this, I was concerned; now I am radicalized," he wrote.
Berwick, whose spokesman said is not giving interviews until he is sworn in, was described by The Boston Globe as a "revolutionary" who wants to tear down the system and rebuild it in a humane, economically responsible way.
The federal government being what it is, nobody expects that to happen at the Centers for Medicare and Medicaid Services, known as CMS. Berwick faces the additional challenge of what will probably be a limited tenure. As a recess appointment, which doesn't require approval by the Senate, he can run the programs only until the end of 2011.
"He's an inspirational guy," says Dr. Gerard Anderson, a professor of health policy at the Johns Hopkins University's Bloomberg School of Public Health. "He will get the bureaucracy to work much more effectively with the mission to improve quality of care. The challenge that he's got is that he's almost a lame duck."
Even so, Berwick can start to promote the idea that medical costs need to be weighed against their benefits, says Henry J. Aaron, an authority on health care policy at the Brookings Institution in Washington.
"The idea of beginning to inject cost-efficiency analysis into Medicare payment decisions is a frontier that needs to be pushed," Aaron said. "I don't know how much statutory authority the CMS director actually has, but Berwick has made clear that that is a frontier that needs to be pushed."
So the no-brainer idea of reducing useless treatments and tests is a far-out, controversial "frontier." Maybe that says all you need to know about Medicare.
The program is out of control because doctors profit on procedures, so they prescribe procedures whether or not they're worth the money. Patients and families love receiving expensive care and pills because they feel as if "something" is being done. And why not? It's mostly taxpayers' money.
Medicare has grown faster than the economy for decades and now consumes one-eighth of the federal budget — close to $500 billion next year. With aging baby boomers driving costs even higher, the Congressional Budget Office calculated last month that Medicare will account for one out of every 17 dollars spent in the United States economy by 2035.
Even if Berwick won't be the program's Winston Churchill or its Che Guevara, he would do the country a world of service by becoming Medicare's Paul Revere.
jay.hancock@baltsun.com
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