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The Health Care Spectator
Race Against Reality
Debunking media myths on Donald Berwick.
Reading Amy Goldstein’s breathless puff piece on Donald Berwick may remind people of something Mark Twain said in a speech he called ‘License of the Press.’ Twain observed: “If you don’t read the newspaper, you’re uninformed. If you read the newspaper, you’re mis-informed.”
The intellectual vacuum created by Goldstein’s complete lack of hard reporting is more than filled by her Oprahesque portrayal of Berwick as a unappreciated and misunderstood public servant seeking nothing but the best for every patient. Goldstein describes Berwick and the reason for the rejection of his re-appointment as a morality tale: “A pioneer in improving medical quality, but a neophyte in Washington politics, Berwick ran into a buzzsaw of Republican opposition over old academic writings when President Obama chose him for the task 16 months ago.”
Let’s break down this concise sequence of disinformation:
The Pioneer’s most famous “quality” initiative was both a flop and over-hyped. As I wrote in my first piece on Berwick: His institute sponsors a lot of pilot projects to promote quality, including one he pledged would save 100,000 lives. (The venture did not demonstrably hit the target.) More specifically, here’s what some of Berwick’s supporters said about the 100,000 Lives Campaign: “Although the 100,000 Lives Campaign succeeded in catalyzing efforts to improve safety and quality in American hospitals, the promotion of rapid response teams as a national standard is problematic, and methodologic concerns regarding the “lives saved” calculations make it difficult to interpret the campaign’s true accomplishments.”
Problematic, as in: the rapid response teams were associated with more death, not less. As in: hospitals paid Berwick to participate in and run the 100,000 Lives campaign. The methodologic concern was clear: Berwick essentially measured progress by how many hospitals signed up and promise to be safer.
Now about those “old academic writings.” The speeches, interviews and articles that I discussed were all produced between 2008 and 2009. These ancient tomes were of course written with a quill pen and preserved on birch bark.
Of course Berwick protests that he is not in favor of rationing: “Every bone in my body as a physician, even as a person, is to get everything they want and need to help them at every step. I have gone to the mat to get a last-ditch bone marrow transplant for a child with leukemia…and they are telling me I’m a rationer? They haven’t met me.”
Oh yes they have. Here’s Berwick’s paean to how Britain’s National Health Service ration’s care: “You plan the supply; you aim a bit low; historically, you prefer slightly too little of a technology or service to much too much; and then you search for care bottlenecks, and try to relieve them.”
He said that the NHS health system is “at its core, like the world we wish we had: generous, hopeful, confident, joyous, and just.” America’s health system is “toxic” and “fragmented,” because of its dependence on consumer choice.
If you think that these words were taken out of context, read the whole speech.
Goldstein says that Berwick insists “every nation, he said, must find a health-care system that fits it best.” But that “system” is “the Holy Grail of universal coverage in the United States (that) may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per capita costs.”
It’s a system that would give an “integrator” the power to use “government policies, purchasing contracts, or market mechanisms that lead to a cap on total spending, with strictly limited year-on-year growth targets.”
Thankfully Berwick has done little damage, except to himself. He has a long list of actions that have astonished most and disappointed the rest. Among them, his effort to slip in a requirement that doctors offer end-of-life counseling to Medicare patients each year; the rejection and ridicule of Accountable Care Organizations as money losing Trojan Horses for rationing care; the embarrassment of paying people to pose as patients to snoop on doctors and the year long delay in deciding whether or not to pay for the Provenge, the first vaccine for prostate cancer.
Berwick is now doling out $1 billion for — what else — programs to improve patient safety. Goldstein marvels that in his final days Berwick has a larger canvas for his vision of healthcare. In fact, as Samuel Goldwyn said: “A wide screen just makes a bad film twice as bad.” No better words sum up Donald Berwick’s contribution to health care as his time mercifully runs out.
About the Author
Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.
Letter to the Editor View all comments (32) | Leave a comment
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Melvin| 7.8.11 @ 7:58AM
"Berwick is now doling out $1 billion for -- what else -- programs to improve patient safety. Goldstein marvels that in his final days Berwick has a larger canvas for his vision of healthcare."
Josef Mengele had a vision to.
Groad| 7.8.11 @ 8:18AM
Berwick's vision is shovel ready. Just the rest of the Oborg plans.
masly | 7.11.11 @ 2:07AM
when faced with unlimited wants and limited resources, how will the tough choices be made?
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Tired Taxpayer PRM| 7.8.11 @ 11:19AM
Say it again and again and again until it sinks in the brains of everyone in the land.
When government is the problem, more government is NEVER the answer.
JFGalt| 7.8.11 @ 12:35PM
Sounds like they measure success the same way that they do for education which is measured by dollars spent not more successful students.
IntervRadiol| 7.8.11 @ 4:02PM
Given that you are opposed to Berwick - who do you suggest to lead CMS? Berwick is the most qualified candidate of this generation. Our nation spends more than 2 trillion per year on healthcare and I agree with those who suggest that 30% or more of the funds are spent on purchases that don't add value. Spending 0.5% of 2 Trillion on improving the healthcare system's ability to add value is a good investment. Oh - and I agree, we don't have a true healthcare system, we have a wide hodge podge of interests. No system will ever be perfect but all systems can be improved. Continuous process improvement is a never ending journey. I thank Don Berwick for helping a whole generation of healthcare workers to remember that this is why we went into healthcare. We want to improve the lot for the next generation of patients.
Dan Sudlik| 7.9.11 @ 8:32PM
How about NO CMS
marxfreesociety| 7.8.11 @ 4:21PM
IntervRadiol has clearly been exposed to too much radiation and liberal coolaid! Berwick is but one frightening player in the Obama tragic comedy being played out on the stage which is America. Just waiting for the day when my number is drawn from the HHS super computer for review and ultimate prognosis that "Citizen #250,000,003, you have reached 52 years of age and are hereby notified that you have exceeded your peak age for usefulness to the state and are hereby declared OBSOLETE. Please click on link below to determine your preferred method of extermination." Signed, Lord Berwick, Chief Rationer.
IntervRadiol| 7.8.11 @ 6:25PM
I have voted Republican in every election since 1982 but I am disappointed that the officials I helped elect either fail to recognize that the system is broken or lack the conviction to change it. Marxfreesociety - I suggest you read Victor Fuch's Who Shall Live? on healthcare economics. It does an excellent job of describing the interplay between gov't services and private choice. We constantly run into the same allocation problem - when faced with unlimited wants and limited resources, how will the tough choices be made? Call it economics or rationing, tough choices need to be made.
Danny| 7.8.11 @ 6:34PM
Wow! You want to know how the tough choices will be made? By the free market, silly. When demand exceeds supply, more people will decide to become health care workers. That's how a capitalist economy works. We are fundamentally NOT dealing with "limited resources" --as if we were talking about some tangible substance that is in danger of depletion -- but about human choice, for which there is unlimited expansion.
IntervRadiol| 7.9.11 @ 7:33AM
I agree 100% that individuals not governments will be the ones who need to make the tough choices. Problem is that 17% of GDP is now devoted to healthcare. In order to train all those healthcare workers, feed them, house them, transport them to and from work, etc, we need to have workers in other sectors.
The free market solution is if you want to purchase a product or service, you must decide whether to spend you own savings (or go into debt) in order to purchase that product or service. Families used to face these hard decisions about resource allocation all the time. Either grandpa gets an operation or his grandson goes to college so that he can someday care for someone else's grandfather. Insurance has distorted this decision making process. Not everyone in the insurance pool can expect to draw more out than they put in unless they can convince the next generation to do the same (Ponzi scheme). I agree with your point that the only unlimited resource is human ingenuity but that resource is only available when we educate and invest in future generations.
Dan Sudlik| 7.9.11 @ 8:35PM
One problem is the govt. I am on Medicare and it scares the hell out of me. If what I see is how government runs the other health care options in the country, no wonder it is 17%. Obamacare will NOT lower that number since it is more govt.
Marxfreesociety| 7.9.11 @ 1:18PM
Thanks for the book reference IR. I will read it. With respect to Danny's point about capitalism, i will take my hard earned capitalistic dollars to my concierge physicians and pay a higher rate to get the serivces i want when i want them. Just like i do with my car or other products and services.
IntervRadiol| 7.9.11 @ 9:50PM
Marxfreesociety - agree that we should never have a system that interferes with anyone's ability to spend their own funds purchasing as many healthcare products and services as he/she wishes.
Still, I would expect that you want transparency about the quality of those services and their potential value. That transparency is a key part of what Don Berwick has championed and why he should be allowed to continue his work.
Dan Sudlik - I agree that more gov't doing the same things is not the solution. Healthcare needs to learn how to provide more value with fewer resources. Making such a transition will be difficult and it will have short term costs. The idea behind Don Berwick's Institute for Healthcare Improvement is that healthcare can learn how to improve from other industries and gov't agencies like NASA. Best description of what he has been trying to do can be found in Charles Kenny's book, The Best Practice.
Jack London| 7.8.11 @ 4:27PM
Goldberg is a fake of course - his outfit is a shill for big pharma. 100,000 lives was a great start and recognised as that - we have about the highest rate of surgical and hospital error in the developed world. Goldberg is the epitome of a death panel because he'd bury our failings.
Berwick is one of the most outstanding healthcare leaders we've ever had, which is why the GOP and their ignorant followers want him out, for he exposes their utter contempt for ordinary Americans.
skip| 7.8.11 @ 5:45PM
skip | 6.15.11 @ 5:40PM:
"What is childish , you idiot, is to repeatedly post over lengthy periods of time blatantly unintelligent and blatantly dishonest statements, without ever citing any credible or legitimate source to support any of the unintelligent and dishonest statements, while always ignoring rebuttals that intelligently and honestly refute your statements, you idiot."
Wouldn't it expose me as childish if you were to cite a credible or legitimate source to support your statements about Goldberg and about Berwick?
Jack London| 7.8.11 @ 6:03PM
Don't be lazy Skip - look it up yourself. But you're not interested - any sources I cite you would discount wouldn't you. I could get an endorsement of Berwick by the Pope, the Dalai Lama and Aung San Suu Kyi and you'd think it all a plot to get you.
skip| 7.10.11 @ 3:09PM
You provided no credible or legitimate source in your childish response.
Review this brief back and forth anytime you are at a loss for why I state you are a stupid liar and an idiot.
Occam's Tool| 7.10.11 @ 10:31PM
No, we don't. Check out infection rates in Britain and the US following surgery---Britain is worse. Their survival rate for Cancers is worse, too.
Nite| 7.8.11 @ 10:05PM
Obama could not get Berwick confirmed by the Democratic controlled Senate, and resorted to making two recess appointments. Berwick loves the British Healthcare System, which routinely puts people to death when they pass a set number of days to recover from illness. The British Healthcare System has a higher mortality rate of all types of cancer and heart disease, plus other diseases. This is because they use strictly older medications and those which are not as effective. Berwick does believe in rationing and other limited treatment issues. If some of you want him to be your physician, go for it, but I sure don't, and can't wait for him and the gang of 12 unelected unconfirmed so called experts making treatment decisions for Medicaid and Medicare, to be tossed out on their collective butts.
Jack London| 7.9.11 @ 6:03AM
'British Healthcare System, which routinely puts people to death when they pass a set number of days to recover from illness'
Sure they do Nite. Now you just keep on taking your pills and those nice men in white coats will come and take you to a safe place where you will never have to worry about trying to think ever again.
Dan Sudlik| 7.9.11 @ 8:37PM
That's a sane answer. I ownder how long he will have to wait for those pills under O'Care.
Occam's Tool| 7.10.11 @ 10:30PM
Jack,
unlike you, I was a senior Medical Consultant for an NHS modelled on Britain's.
Shortages of access to imaging were common. Wait time for an MRI for non-emergent back pain (like my wife's agonizing pain) was 1 to 6 months.
The NHS in New Zealand also had no pediatric Oncologists in the New Zealand capital for a time. They also underfunded breast Cancer treatment. In Lakes DHB, at Rotorua Hospital, the patients families had to clean out the toilets on the surgical ward because the DHB didn't budget enopugh money for housekeeping to keep it sanitary. When they replaced their CT machine, the Lakes DHB felt that the replaced model was fit only for Veterinary service.
To have Neurontin, which was generic at the time, prescribed for back pain for you, you had to see a Neurologist, which was in even shorter supply than Psychiatrists.
Incidentally, Jack, the average length of stay for my hospital is 14 days, and my patients are encouraged to have as much autonomy as possible. They do think again.
For more on the New Zealand DHB system, which is modelled closely on Britain's NHS, check out the largest Daily (and uber-liberal) paper in New Zealand, the New Zealand Herald.
Berwick makes a ton of money denying people care. He is a disgrace to MY profession. My colleagues in NZ spent most of their time figuring out how to see as few patients as possible.
Occam's Tool| 7.10.11 @ 10:36PM
In addition, although the Maori had the highest rate of Lung Cancer in the World, and a smoking rate that made Native Americans here seem like Puritans, Buproprion was not covered by Pharmac when I was there (2006-2007). In fact, RURAL Kentucky did a better job of covering anti-smoking interventions for free than did New Zealand's PHARMAC, a point which I drove home in savagely humorous fashion (those who have read me here know both how savage and how funny I can be) at a Grand Rounds out there, pointing out that the Home of the Dukes of Hazard, Kentucky, had better access than the entire country of New Zealand to psychiatric and substance abuse services ( the State and the Country are roughly the same size).
superboy| 7.9.11 @ 3:20AM
when faced with unlimited wants and limited resources, how will the tough choices be made?
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summer| 7.10.11 @ 9:28PM
Berwick does believe in rationing and other limited treatment issues.
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weddingdress | 7.12.11 @ 5:15AM
Berwick makes a ton of money denying people care. He is a disgrace to MY profession. My colleagues in NZ spent most of their time figuring out how to see as few patients as possible.
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