Berwick Calls On Foundations To Bring Civility In U.S. Health Care Debate

Oct 26, 2012, 11:16 AM

By B. Japsen

Saying the divisive political environment has “confused medical professionals,” former Medicare administrator Dr. Donald Berwick Friday called on nonpartisan health foundations to spur civility in the effort to improve health and health care in the U.S.

In a keynote address at the Robert Wood Johnson Foundation’s (RWJF) 40th Anniversary Connections conference, the former Administrator at the Centers for Medicare and Medicaid Services said Washington is polarized and little change can be made by government policy-makers.

 In some cases, Berwick said topics like end-of-life care and medical research used effectively in other countries cannot even be discussed in Washington. Meanwhile, agencies like the one he ran as well as the Food and Drug Administration are limited statutorily in their work such as the inability to consider cost comparisons in whether a product can be used or covered.

“A consequence of all of this disarray, and maybe the most costly consequence, is a loss of the shared exploration to discover solutions to the problems we face,” Berwick told attendees in his speech on the last day of the two-day meeting. “We are trying to make health care a human right in America. Curing health care is going to take everybody.”

Unlike elected officials divided by politics, Berwick said nonpartisan foundations like RWJF and others have the ability to spur change. He cited, as one example, RWJF’s role over the last two decades in the area of smoking cessation programs that have educated the public and curtailed cigarette use across the country.

“There is a hunger in this country for a chance to talk,” said Berwick, who in his role at CMS led the implementation of large portions of the Affordable Care Act after it was signed into law by President Obama in April 2010 until he stepped down from his post late last year.

As he did when he led the Centers for Medicare and Medicaid Services, Berwick continues to advocate moving the U.S. health care payment of medical-care providers from a “system of volume to value.”

The Accountable Care Organization effort Berwick led in Medicare under the Affordable Care Act works with the Medicare health insurance program for the elderly contracting with doctors and hospitals through an ACO which, in turn, pushes high quality, less expensive care rather than today’s payment system that often leads to excessive care by paying for each treatment or procedure that isn’t always better. The providers in an ACO are responsible for managing the care of the health plan enrollees and are financially rewarded if the enrollees, or patients, stay out of the more expensive hospital.

 “We are paying for the care of populations,” Berwick said, saying payments for value are a “move in the right direction.”

Berwick, who was accused by conservative Republicans as an advocate of health care rationing because he had praised the British health care system before coming to Washington, urged RWJF conference attendees to seek out ideas and solutions from around the world.

“It’s time for global thinking,” Berwick said. “It is crucial to leave our borders for knowledge. It’s a tantalizing moment.”

Bruce Japsen is an independent health care journalist attending the two-day RWJF event as journalist in residence. He writes a health care business and policy blog for Forbes at He also contributes health care stories to the New York Times, Chicago Medicine magazine and teaches writing at Loyola University Chicago. 

This commentary originally appeared on the RWJF New Public Health blog.