Donald Berwick - Nomination and Controversy

Nomination and Controversy

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 because of 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 service. 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 that 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 made Berwick stay evasive and avoid defending his past statements on the British health service, spending caps and high-technogy care.

Critics point to statements such as this: "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."

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. Conservatives criticized 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 that "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 Berwick against "phony assertions" and accused Republicans of trying "to crank up the attack machine and 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.

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 US 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.

Berwick resigned his position at CMS on December 2, 2011. In a speech on Wednesday, Dec. 7, 2011 in Orlando, Florida, at a meeting of the Institute for Healthcare Improvement, an organization he once led, the long-time patient-safety advocate gave a stirring account of his time in government service and the where he believes the future of healthcare is going.