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.