The Unnecessary and Stunning Loss of Donald M. Berwick MD, to the US HealthCare System

Donald M. Berwick MD



We need better educated, better informed politicians in the 21st Century.  Americans can no longer tolerate stupid politicians in decision-making, leadership roles.The American dream/legacy is now vanishing fast….Joyce Hays, Target Health Inc.




The New York Times, December 6, 2011  —  Dr. Donald Berwick was already in Massachusetts when I spoke to him Sunday afternoon. He was back in the Newton home where he’d lived for 30 years, being pleasantly interrupted during our conversation by his 2-year-old grandson. His last day in Washington as the administrator of the Centers for Medicare and Medicaid Services had been Thursday. Friday was packing day. Saturday was moving day. And, by Sunday, he was already talking about his too-short, 17-month tenure as the nation’s top Medicare official in the past tense. Which, alas, it was.

Joe Nocera ,Photo Credit: Earl Wilson/The New York Times

Dr. Berwick, I’m here to tell you, was the most qualified person in the country to run Medicare at this critical juncture, and the fact that he is no longer in the job is the country’s loss. Berwick started out as a pediatrician and health care researcher at the Harvard School of Public Health and eventually became vice president of the Harvard Community Health Plan (now known as Harvard Pilgrim Health Care). There, he became enamored with the ideas being promulgated by management gurus like W. Edwards Deming and companies like Toyota, which believed that companies could create processes — and a mind-set — that would allow for both continuous improvement and continuous cost reduction. Indeed, they believed that the two went hand in hand.

Latching onto these ideas, Berwick helped start — and, for the next 19 years, run — the Institute for Healthcare Improvement, which was devoted to applying them to health care. The result would be healthier patients who spent less time in hospitals — and a culture that wasted less money on things that didn’t lead directly to a healthier population.

As the insurer of one out of every three Americans, Medicare is in an enviable position to push for health care improvements, if it chooses to. And with a budget larger than the Pentagon’s — and a consensus that its spending must be brought under control — no government agency has a more urgent need to cut costs. Surely somebody who has spent his career focused on these two issues would seem to be just the ticket.

But there’s one more thing about Berwick: He believes that President Obama’s health care reform is “an important moral step toward universal health care.” As he put it when we spoke: “Because of it, our country is, at last, making health care a basic human right. It is a majestic thing.”

Naturally, this view made him anathema to Republicans, who blocked his nomination in the usual way. They pored through his old speeches and articles, plucked out a few comments they objected to — he once praised the British health care system! — and announced that they would never confirm him.

President Obama was not deterred the way he had been when Republicans objected to Elizabeth Warren becoming the chief of the new Consumer Financial Protection Bureau. Instead, in July 2010, Obama named Berwick to the post in a recess appointment that did not require Senate confirmation. But, like all recess appointments, it was temporary. Berwick left the post just weeks before his appointment was set to expire.

What did Berwick accomplish in those 17 months? A lot — though not nearly as much as he would have liked to. His focus, as it has always been, was on improving the quality of health care and cutting costs. “On my third day,” he said, “I held a staff meeting for all 5,000 members of the staff, and I said, ‘You all think that you are in the business of paying bills. Yes, you do that. But I also think Medicare can be a force for change.’ ” He added, “I tried to reconceptualize it as an improvement organization.”

As Berwick tells it — and others affirm — the Medicare staff had been hungering for such a mission. “We had a triple aim,” he says. “Better health care. Better health for the overall population. And lower costs. I thought that, my goodness, given the resources and the reach — and the great staff, which was a wonderful surprise — we ought to be able to help health care providers do much better.”

Health insurers and hospitals, who had generally thought of Medicare as little more than a stodgy, bureaucratic insurer, began to see it in a different light as well, as Medicare staffers, trained as “improvement coaches,” began to share ideas and push for simple, sensible steps that would, for instance, keep people with chronic medical problems from having to be constantly readmitted to the hospital.

Of course, 17 months is hardly enough time to complete such a transformation, and it is hard to know if Berwick’s emphasis on quality will stick. What he needed, most of all, was more time — precisely what the Republicans wouldn’t give him.

By refusing to confirm him, Republicans won a pointless victory against the president. But, if the day ever comes when they — and the country — truly get serious about reforming Medicare, they may regret giving a pink slip to the best man for the job.


A Short Conversation with CMS Administrator Dr. Don Berwick and Senator Bill Frist


……More about Harvard University Med School grad, and former CMS Head, Donald Berwick MD……

Administrator of the Centers for Medicare and Medicaid Services

In office
July 7, 2010 – December 2, 2011


Barack Obama

Preceded by

Marilyn Tavenner (Acting)

Succeeded by

Marilyn Tavenner (Designate)

Personal details


1946 (age 64–65)
New York City, New York,

Alma mater

Harvard University, BA, MPP, MD


CMS Administrator Don Berwick on Open Enrollment Season

Donald M. Berwick (born 1946) is the outgoing Administrator of the Centers for Medicare & Medicaid Services (CMS). Prior to his work in the administration, he was President and Chief Executive Officer of the Institute for Healthcare Improvement (IHI) a not-for-profit organization helping to lead the improvement of health care throughout the world. On July 7, 2010, Barack Obama appointed Dr. Berwick to serve as the Administrator of CMS through a recess appointment. On December 2, 2011, he left the position, because it was clear that the Republican congress would not confirm him.

Berwick has studied the management of health care systems, with emphasis on using scientific methods and evidence-based medicine and comparative effectiveness research to improve the tradeoff among quality, safety and costs. Among IHI’s projects are online courses for health care professionals for reducing Clostridium difficile infections, lowering the number of heart failure readmissions or managing advanced disease and palliative care.

Berwick said that 20-30% of health spending is “waste” with no benefit to patients, because of overtreatment, failure to coordinate care, administrative complexity and fraud, and that part of this problem was due to CMS regulations.

Berwick’s critics have cited his statements about the need for health care to redistribute resources from the rich to the poor, and his favorable statements about the British health care system. They quote Berwick as saying, “The decision is not whether or not we will ration care – the decision is whether we will ration with our eyes open.”

Berwick said Republicans had “distorted” his meaning. “My point is that someone, like your health insurance company, is going to limit what you can get. That’s the way it’s set up. The government, unlike many private health insurance plans, is working in the daylight. That’s a strength.”

For political reasons, the Obama administration didn’t want Berwick to defend his past statements on the British health care system, spending caps and high-technology care.

Critics point to statements such as, “Any health care funding plan that is just, equitable, civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”


Berwick graduated from Nathan Hale-Ray High School in Moodus, Connecticut. Berwick graduated with a B.A. from Harvard College, and received an M.P.P. from John F. Kennedy School of Government at Harvard University and an M.D. from Harvard Medical School. He completed his medical residency in pediatrics at Children’s Hospital Boston.

Berwick began his career as a pediatrician at Harvard Community Health Plan; in 1983 he became the plan’s first Vice President of Quality-of-Care Measurement. In that position, Berwick investigated quality control measures in other industries such as aeronautics and manufacturing and considered their application in health care settings.[citation needed] From 1987-1991, Berwick was co-founder and Co-Principal Investigator for the National Demonstration Project on Quality Improvement in Health Care, designed to explore opportunities for quality improvement in health care. Based on this work, Berwick left Harvard Community Health Plan in 1989 and co-founded the IHI.


Berwick is Clinical Professor of Pediatrics and Health Care Policy in the Department of Pediatrics at the Harvard Medical School and Professor of Health Policy and Management at the Harvard School of Public Health. He is also a pediatrician, Adjunct Staff in the Department of Medicine at Children’s Hospital Boston, and a Consultant in Pediatrics at Massachusetts General Hospital.

Based in Cambridge, Massachusetts, IHI works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action. Employing a staff of approximately 100 people and maintaining partnerships with hundreds of faculty members, IHI offers programs that aim to improve the lives of patients, the health of communities, and the satisfaction of the health care workforce. IHI’s work is funded primarily through fee-based programs and services, and also through the support of foundations, companies, and individuals. IHI provides program scholarships, research and development, professional education, and initiatives in developing countries.

IHI’s vision for health care is an adaptation from the Institute of Medicine‘s six improvement aims for the health care system – care that is safe, effective, patient-centered, timely, efficient, and equitable:

  • No Needless Deaths
  • No Needless Pain or Suffering
  • No Helplessness in Those Served or Serving
  • No Unwanted Waiting
  • No Waste
  • No One Left Out

Berwick has published over 129 articles in professional journals on health care policy, decision analysis, technology assessment, and health care quality management. He is the co-author of several books, including Cholesterol, Children, and Heart Disease: an Analysis of Alternatives (1980), Curing Health Care (1990), and New Rules: Regulation, Markets and the Quality of American Health Care (1996).

[edit] Nomination and controversy

On April 19, 2010, Dr. Berwick was nominated to be Administrator of the Centers for Medicare and Medicaid, which oversees the two federal programs.

An editorial wrote that his policy ideas could cut health care costs. Conservativescriticized Berwick, based on comments he made about health care being, by definition, redistribution of wealth, rationing care with “our eyes open” and complete lives system.

Berwick advocates cutting health costs by adopting some of the approaches of Great Britain’s National Health Services (NHS) and its National Institute for Health and Clinical Excellence (NICE). NICE evaluates the costs and effectiveness of medical therapy that is covered by the NHS, as guidance for local authorities to decide what to cover. Mark McClellan, who served in the Bush administration, also advocated adopting some of NICE’s methods.

Conservative critics claim, “NICE decides which healthcare people will get and which they won’t.” Philip Klein in The American Spectator dubbed him “Obama’s Rationing Man.” The chairman of NICE called these statements “outrageous lies.”

Senator John F. Kerry defended Dr. Berwick against “phony assertions” and accused Republicans of using an “attack machine [to] make his nomination a distorted referendum on reform.” Former Speaker Newt Gingrich has historically been a Republican supporter of Berwick, however, writing an op-ed in the Washington Post in August 2000 praising Berwick’s work.

Dr. Berwick was installed by recess appointment on July 7, 2010 before confirmation hearings were scheduled by the Democratic-controlled Senate committee. Dr. Berwick could thus serve until the summer of 2011 without a Senate approval. The White House had talked up the possibility of a re-nomination through the fall of 2010; on January 26, 2011, the President re-nominated Dr. Berwick. On March 4, 2011, 42 U.S. Senators wrote the White House and asked for the nomination to be withdrawn. The signers of the letter broke along partisan lines as all were Republicans.


Awards and honors


  • “Some is not a number. Soon is not a time.” (slogan for IHI’s completed 100K Lives Campaign, now slogan for IHI’s 5 Million Lives Campaign in progress)
  • “We are guests in our patients’ lives; and we are their hosts when they come to us. Why should they, or we, expect anything less than the graciousness expected by guests and from hosts at their very best. Service is quality.”
  • “We are not hosts in our organizations so much as we are guests in our patients’ lives.”
  • “Some say that doctors and patients should now be partners in care. Not so, I think. In my view, we doctors are not our patients’ partners; we are guests in our patients’ lives. We are not hosts. We are not priests in a cathedral of technology.”
  • “You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker and that any health care funding plan that is just, equitable, civilized and humane must, MUST redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is, by definition, redistributional.”

The quote “What can you do by next Tuesday?” is frequently credited to Berwick but seems to have been coined by the authors of Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians, which they wrote under the IHI aegis.

Selected publications


2011 MHS Conference: Integrating Delivery Systems – Enhancing the Patient Experience



The HealthCare Bill is not a toy to be played around with by stupid politicians trying to make a name for themselves, at the expense of the American people.


Sorry to have to post this, but we simply cannot have any more ignorant, witless politicians trying to run things, or we’ll all…….yes, ALL (right, left, middle, whatever point of view you have) …..we’ll all, be left out in the cold, as America slips backward instead of striding forward.

…………Joyce Hays, Target Health Inc.



The New York Times, December 6, 2011

Policy Indifference

By Nobel Laureate Economist, Paul Krugman


One crucial thing you need to understand about political journalists is that with some honorable exceptions, they don’t know or care about actual policy. In a way, that makes sense — the skills needed to cultivate contacts, to get the inside scoop on what’s going on in Congressional scheming or campaign war rooms, are very different from the skills needed to interpret CBO spreadsheets. The problem, however, is that all too often political journalists mistake the theater of policy for reality (or don’t care about the difference).

Hence, the awful decision of Politico to give Paul Ryan an award as healthcare policymaker of the year.

Even if you like the thrust of Ryan’s ideas, even if you think privatizing Medicare and turning it into a voucher scheme is fine, what became painfully, embarrassingly clear during the debate over the Ryan plan was that Ryan is, well, incompetent; the plan was a mess, from its invocation of ludicrous Heritage Foundation projections to its crazy assertions about what would happen to discretionary spending. It’s true that the plan “got everyone talking”, as Politico says — but mostly it got people talking about what a mess Ryan’s effort was.

Oh, and it was pretty clear that Ryan wasn’t being honest about his own numbers.

What’s going on here, I suppose, is that Politico is mistaking theater for policy. Ryan isn’t an important health care reformer, or even minimally competent in his attempted wonkery, but he plays a deep thinker on TV. And the people at Politico either don’t understand the difference, or they don’t care.


BSN Headline News for July 25, 2011