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Berwick on Medicare Free Plunder System

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Initial post: Dec 5, 2011 6:41:40 PM PST
I would not be surprised if some influential members of Congress are getting a piece of the "20 percent to 30 percent of health spending [...] that yields no benefit to patients."

<<If his estimate is right, Medicare and Medicaid could save $150 billion to $250 billion a year by eliminating waste, which he defines as "activities that don't have any value.">>

Health Official Takes Parting Shot at `Waste'

Published: December 3, 2011

WASHINGTON - The official in charge of Medicare and Medicaid for the last 17 months says that 20 percent to 30 percent of health spending is "waste" that yields no benefit to patients, and that some of the needless spending is a result of onerous, archaic regulations enforced by his agency.

The official, Dr. Donald M. Berwick, listed five reasons for what he described as the "extremely high level of waste." They are overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud.

"Much is done that does not help patients at all," Dr. Berwick said, "and many physicians know it."

In an interview on Thursday, his last day on the job, Dr. Berwick reflected on his successes, failures and frustrations in trying to engineer a rapid transformation of the health care system while beating back criticism from Republicans in Congress.

President Obama nominated Dr. Berwick to be the administrator of the Centers for Medicare and Medicaid Services in April 2010. While the Senate was investigating his qualifications, Mr. Obama circumvented Congress by giving Dr. Berwick a temporary recess appointment, a shortcut that infuriated Republicans and irked some Democrats. The appointment was due to expire at the end of this year.

Dr. Berwick said he had not sought the job. Indeed, he said, "I did not even know if I was fit for it." He took the post, he said, because he sensed that "tectonic shifts" were occurring in the health care delivery system.

"I came with an agenda," Dr. Berwick said. "I wanted to try to change the agency to be a force for improvement, covering one out of three Americans."

Asked why Americans were still deeply divided over the new health care law, signed 20 months ago, Dr. Berwick said: "It's a complex, complicated law. To explain it takes a while. To understand it takes an investment that I'm not sure the man or woman in the street wants to make or ought to make."

But, Dr. Berwick said, just as Americans supported manned missions to the moon without knowing the details of rocket science, they ought to support the new law because of its ultimate destination.

"We are a nation headed for justice, for fairness and justice in access to care," Dr. Berwick said. "We are a nation headed for much more healing and much safer care. There is a moon shot here. But somehow we have not put together that story in a way that's compelling."

Dr. Berwick, a soft-spoken pediatrician, received his own Medicare card in September when he turned 65. As Medicare chief, he has pushed doctors and hospitals to adopt electronic health records, merge their operations and coordinate care to eliminate medical errors that kill thousands of patients each year.

If his estimate is right, Medicare and Medicaid could save $150 billion to $250 billion a year by eliminating waste, which he defines as "activities that don't have any value."

Dr. Berwick sounded like a professor of political science or a visitor from a foreign country when he recounted his efforts to fathom Washington's ways.

"Government is more complex than I had realized," he said in an understatement. "Government decisions result from the interactions of many internal stakeholders - different agencies and parts of government that, in many cases, have their own world views."

Before coming here, Dr. Berwick was president of the Institute for Healthcare Improvement, a nonprofit group in Cambridge, Mass., that trains medical professionals. "I was used to moving very, very fast," he said. "We could decide on Monday to start a program and have it in existence on Wednesday."

As a federal official, Dr. Berwick was sometimes impatient with colleagues in the government and with the health care industry. "I wish they could go faster," he said. But, he added, "I don't think you want government to be impulsive."

During his tenure, Dr. Berwick testified at only two public hearings, and he said he "loved them" both, even though Republicans tried to skewer him.

He said some members of Congress had "deep knowledge" of health care - he mentioned two Democratic senators, Sheldon Whitehouse of Rhode Island and Sherrod Brown of Ohio.

Dr. Berwick often found himself in an awkward position.

Republicans called him evasive. For political reasons, the administration did not want him to defend past statements in which he had extolled the virtues of the British health care system and had suggested a need to cap total health spending and limit the supply of costly high-technology medical care in the United States.

Dr. Berwick said most of the criticism by Republicans, who warn of a government takeover of health care, was "purely political, a world of sound bites." In the interview, he lashed out at Republicans who depict him as an advocate of rationing health care.

In 2009, he told a biotechnology journal, "The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open."

Dr. Berwick said Republicans had "completed distorted" his meaning. "My point," he said, "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."

A version of this article appeared in print on December 4, 2011, on page A23 of the New York edition with the headline: Health Official Takes Parting Shot at `Waste'.
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Initial post:  Dec 5, 2011
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