Barack Obama - Health Care Czar - Donald Berwick

Summary

On July 7, 2010 President Obama used a recess appointment to appoint Dr. Donald Berwick to head of the Centers for Medicare and Medicaid Services (CMS). In this position, Dr. Berwick is not only in charge of Medicare and Medicaid, but he is also in charge of overseeing the implementation of the 2009 health care reform legislation, which will include adding 16 million people to Medicaid. 

The appointment of Dr. Berwick to this position is controversial because:

• Dr. Berwick has openly advocated for redistribution of wealth through health care
• Dr. Berwick has openly called for "justice in health care" according to race
• Dr. Berwick has openly stated that "excellent health care is by definition redistributive"
• Dr. Berwick has called for reduced care in certain areas
  • Reduced Neonatal
  • Reduced Organ Transplantation
  • Reduced High Tech Imaging

It is unchallenged that Dr. Berwick does not believe that the US system of health care is not the best available, and that he believes that a single payer system is superior. What is controversial, is that Dr. Berwick is not simply seeking a more efficient manner of ensuring that all Americans can afford health care, and Dr. Berwick is not seeking to bring the level of care for all Americans to a given minimum level. Dr. Berwick views the capitalist system as unfair when applied to health care, and believes that the system has been put in place by people with an interest in protecting that unfairness. Dr. Berwick argues that the system is not simply mechanically unsound or bureaucratically inefficient, but is morally flawed and structurally skewed against people of color and people without wealth. He argues that the system must redistribute wealth to the poorer communities in order to be considered "just, fair, and equitable." Dr, Berwick argues not for an improvement to health care for, but for an equitable health care system which increases the care of those he sees fit to improve and decreases the level of care for those he believes are not justified in receiving the care.

Dr. Berwick seeks a system similar to the single-payer one in place in Britian, and has argued that elected officials running a government program is more moral and just than one like the American system.

Redistribution of Wealth in Health Care

When delivering a speech in 2008 to a group of British doctors, Dr. Berwick made a series of comments extolling the virtues of the British Health care system (the NHS) and lamenting the moral vacuum of the American system.

Dimensions of Quality

In the discussion below, Dr. Berwick discusses the results of a paper that lists six dimensions of quality. Among those dimensions are equity.

• Safety - do no harm
• Effectiveness - matching science to care
• Patient Centeredness
• Timeliness
• Efficiency
• Equity - Justice in Health care

Escape Fire

In his book, Escape Fire, Dr Berwick states the following:

Most metropolitan areas in the United States should reduce the number of centers engaging in cardiac surgery, high-risk obstetrics, neonatal intensive care, organ transplantation, tertiary cancer care, high-level trauma care, and high-technology imaging.

References

[1] Website: CBS News Article: Donald Berwick's Recess Appointment Draws Ire from Republicans, Support from Democrats Author: Stephanie Condon Accessed on: 09/20/2010

[2] Website: Time.com Article: Donald Berwick, Obama's Controversial Medicare Chief Author: KATE PICKERT Accessed on: 09/21/2010

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