Don Berwick on Health Care
"I feel the ACA is a massive step forward--a tremendous achievement. But we are still left with a system that fails to solve many problems," said Berwick. "Even with the law, we still have a complex system that is highly expensive to maintain and somewhat captive to the status quo. It lacks teeth to push back on costs."
The ACA's limitations compelled him to run for governor of Massachusetts in 2014 on a campaign fueled by his staunch advocacy of single-payer health care. "On his first day as governor of Massachusetts, Berwick promises to set up a commission tasked with finding a way to bring single payer to the Bay State," reported Talking Points Memo, describing him as "ObamaCare's Founding CEO."
A: I was recruited to the first HMO at Harvard Community Health Plan to run their quality systems and quality of care. We had an unlimited budget to measure anything we wanted that related to care. So we were watching patient satisfaction and infant mortality, and I kept noticing that everything stayed the same. We were okay, but there wasn't improvement.
[I looked at] how other industries deal with improvement; we studied modern approaches to improvement. We began some experiments and then started a national demonstration project in the late 1980s, with 21 hospitals using these then-new quality-improvement techniques from outside healthcare. And it worked. It was unbelievable. It was so exciting. They were addressing problems that had been chronic for decades with just a little bit of help from people who understood quality. We brought in experts from other industries; a lot of them made breakthroughs.
Berwick said on his first day in office, he would put together a task force of health care stakeholders to review the state's 2011 cost containment law to identify places it could be improved upon.
Berwick doubled-down on his flirtation with the idea of a single-payer system in Massachusetts, saying the time has come to see if it could result in a better, less expensive health care experience. "It is time to explore seriously the possibility of a single payer system in Massachusetts. The complexity of our health care payment system adds costs, uncertainties, and hassles for everyone--patients, families, doctors, & employers," Berwick said. "I will work with the Legislature to assemble a multi-stakeholder Single Payer Advisory Panel."
Democrats initially pushed for a single payer system in the national Affordable Care Act but the language never made it into the final bill that passed in 2010. Supporters of a single payer system argue that it would simplify the billing process and reduce overall costs, in part, due to increased preventative care. Opponents, however, argue government is not efficient enough to be in charge of such an undertaking, and with public officials at the helm of the health care system, the quality of care and the overall health care system would diminish.
In 2010, communities across the commonwealth approved a non-binding ballot question endorsing a single payer system.
Don followed in his father's footsteps and became a pediatrician, when he learned that caring for Massachusetts' children also meant improving the hospitals, health systems, and communities that families depend on. In 1991, he helped found the non-profit Institute for Healthcare Improvement, where for 20 years he led scores of projects and massive campaigns--credited with saving hundreds of thousands of lives. Don has been named to the list of most influential health care leaders in the country every year for more than a decade. In 2011, he ranked #4 on the list--just after President Obama.
In 2010, the President asked Don to go to Washington to lead the Medicare and Medicaid programs.
The toxic politics of Washington cut short Don's time there. Right-wing pundits attacked his commitment to equity and care for all. Glenn Beck labeled him the "second most dangerous man in America." Senate Republicans vowed to filibuster his confirmation. In the face of the same Republicans who blocked Elizabeth Warren's confirmation to head the Consumer Financial Protection Bureau, Don was forced to step aside after only 17 months leading Medicaid and Medicare.