Don Berwick

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Surprise In Mass. Primary: 21 Percent For Single-Payer Candidate Berwick

Note to politicians: Backing “Medicare for all” is looking less and less like electoral poison. If, deep in your heart, you believe American health care would be better off with a Canadian-style, single-payer system, you might now consider coming out of the closet. (In Democratic primaries in blue states, at least.)

That’s my suggested takeaway from the striking Massachusetts Democratic primary showing of Dr. Donald Berwick, who rocketed from near-zero name recognition among general voters to 21 percent at the polls. Catch him saying forcefully in the video above: “Let’s take the step in health care that the rest of the country hasn’t had the guts to take: single payer. Medicare for all.”

Now, Vermont not only has a mainstream politician who backed a single-payer system — Gov. Peter Shumlin — it’s actually translating the idea into practice as we speak. But let’s put it this way: This seems to be the first time that a candidate in a mainstream political party in a state that is not a verdant utopian duchy has run on a single-payer platform. And though he did not defeat the longtime familiar faces, he did surprisingly well.

“The term I’ve used, and it’s a bold term, but it’s confiscation.”
– Dr. Donald Berwick

Of course, we knew that Massachusetts voters tend to like the idea of single payer. As recently as 2010, 14 fairly middle-of-the-road districts voted in favor of a non-binding ballot measure calling for “creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts.”

Analysts projected that the results meant a statewide majority in support of a single-payer system. The single-payer idea had polled well in non-binding ballot measures before, as well. But now we’ve seen that sentiment translated into support for a candidate.

Other politicians, including President Obama, have backed the general idea of a single-payer system, but they always add a “but,” said Dr. Steffi Woolhandler, who helped found Physicians for a National Health Program.

“And the ‘but’ usually has to do with the political situation,” she said. “But it’s actually important to say what’s the right thing to do and to really work toward the right solution, and that’s what Don [Berwick] has been willing to do, to say, ‘We need single payer and skip the ‘but,’ let’s just say we need single payer and that we need to start working toward it.’”

Will Berwick’s strong showing change the playing field for other candidates? Dr. Woolhandler says yes: “Politicians understand votes. Unfortunately, they also understand money. But they do understand votes, and I think other politicians will see that voters are behind the idea of single payer.”

I asked Dr. Berwick about the reaction to his single-payer position in his many campaign-season travels, and he said the biggest surprise was how positive the response had been from voters who would likely not call themselves progressives. They either already agreed with the idea, he said, or responded instantly after one sentence of explanation with, “That sounds right to me. Let me tell you my story.”

“I remember a carpenter in Hingham,” he said. “I don’t think he would have said he was a progressive — he was a somewhat older carpenter struggling to make ends meet, sitting on a sofa at a gathering, a meet-and-greet, and I started talking about this, and I guess — embarrassingly, to me — I was expecting some pushback. But he immediately said, ‘I’ve got to tell you a story.’ And he told me about his struggle to get health insurance.

“He very carefully went through the policy options, he had picked one that had a maximum deductible that was pretty stiff, and he was ready to swallow it. And he did, he signed up for that plan. And then, the problem was that he had three major illnesses the following year. And he discovered — to his dismay — that the deductible did not apply to the year, it applied to each separate episode. So this guy, who’s working with his hands and trying to just get through and have his family’s ends meet, suddenly found himself tens of thousands of dollars in debt, because of the complexity [of health insurance.] And he said, ‘Enough of this!’ He immediately understood and was fully on board, and that kind of experience has been pretty constant for me.”

Overall, Dr. Berwick said, “The response has been extremely positive beyond anything I would have anticipated. Continue reading

Primary Cheat Sheet On Mass. Governor Candidates’ Health Care Positions

Judging by your presence at this url, you are, perhaps, not entirely indifferent to health care? And you may, in fact, live in the lovely Bay State, according to the results of an unscientific reader survey we did once. So, in case you plan to vote in the 2014 state gubernatorial primaries, we’ve compiled a health care cheat sheet. We requested brief position statements from the five candidates facing a primary contest. In alphabetical order, and with a link to the full campaign site on each name:

Charlie Baker:
Massachusetts had a health care system that worked, with nearly every citizen having access to the high quality care they preferred, but the disastrous Health Connector website launch and the burdensome federal health overhaul disrupted that for far too many Massachusetts families. As Governor, I will fight for a waiver from the federal health law to protect Massachusetts’ exemplary health care system. I have also proposed a plan to improve the quality of health care, increase transparency and reduce costs for families. My proposals will allow patients to act as informed consumers, prioritize primary care – giving patients with multiple illnesses better treatment – and protect Massachusetts’ health system from federal burdens.

Don Berwick:
Massachusetts needs a Governor who understands how good care could be, what better payment systems look like, and how to reorganize care with patients at the center. Don is a pediatrician and an executive who has spent 30 years working to make health care work better, at a lower cost. He is the only candidate for governor supporting single payer health care – Medicare for all. Health care is now 42% of our state budget, up 59% in the last decade alone. Every other major line item in our budget is down. Single payer health care would be simpler, more affordable, more focused on the patient, and it would be a huge jobs creator.

Martha Coakley:
As Governor, Martha will have three goals for our healthcare system: expanding access, maintaining quality, and driving down cost. She has already taken the lead on controlling costs, publishing a series of groundbreaking reports that shed light on the cost-drivers in our system, and going forward she will focus on investing in proven prevention, promoting the role of community health centers, and increasing transparency. She is especially committed to improving care for those struggling with mental and behavioral illness and substance abuse; she has called for higher reimbursements for community-based services, more coverage from private insurance, and incentives for greater coordination of care. She believes we must end the stigma associated with mental and behavioral health.

Mark Fisher:
Did not respond but his campaign’s Web page on health care is here.

Steve Grossman:
We need to revolutionize the delivery of health care services to reduce or eliminate health disparities, primarily by significantly increasing our commitment to and investment in community hospitals and health centers. We must also use every appropriate tool to rein in excessive price increases at our largest medical institutions that could severely undermine achieving the goals of Chapter 224. That’s why I oppose the Partners HealthCare deal Martha Coakley has negotiated, which according to the Health Policy Commission, would raise costs by tens of millions of dollars and harm Massachusetts families and businesses. As governor, I plan to lead a serious conversation with the people of Massachusetts concerning single payer as a vehicle for reforming our health payment system, a conversation that the Boston Globe described in its editorial endorsement of me as “precisely what’s in order.”

Note: We don’t include the independents because we focused on the candidates running in the primary.

Christopher Lydon Is Back On WBUR — And Talking Health Care

Christopher Lydon

Christopher Lydon

Mark your calendar (that is, set a smartphone alarm) to tune your dial (that is, set your tablet to livestream WBUR.org) tonight. It’s old news that the lively intellect of Christopher Lydon is back on WBUR, but the fresh news is that tonight, he’s going to be talking health care, with some lofty interlocutors (uh oh, my anticipation seems to be making me channel his vocabulary…) From Radio Open Source:

We’d love to begin the show with some vox pop, as we call it. Please call 617 353 0692 and leave a short message that we can use at the top of the program. Here’s the question: Speaking as a patient, and think of your own health, how is the modern “miracle” medicine working for you?

Our guests in this conversation (9 p.m. Thursday, January 16th on WBUR, Boston at 90.9 FM) will include Dr. Tom Lee, former CEO of Partner’s Healthcare, professor at Harvard Medical School and author of “Eugene Braunwald and the Rise of Modern Medicine”; Dr. Don Berwick, pediatrician and candidate for governor in Massachusetts; and cardiologist Eugene Braunwald.

The Rise of Modern Medicine: do you think of the miracle tech that has made death by heart attacks a rarity? Or do you think of a money-driven industry that’s made heroes out of hospitals at a huge price to patients and the national economy? Dr. Tom Lee makes it a history lesson that unfolded over the last 50 years in Boston. What happened to health in healthcare?

The conversation has already begun in the comments, including this one:

I’ve been in the healthcare business for 25 years as a sales representative. The buildings keep getting bigger, the administrations more dense, the regulation more arcane…There is so much money thrown at healthcare; how could this NOT happen?

Listeners, would love to hear afterward what you think.

What Makes Berwick Run: Spurned Medicare Chief Seeks To Lead Massachusetts

Dr. Donald Berwick (Jesse Costa/WBUR)

Dr. Donald Berwick (Jesse Costa/WBUR)

Dr. Don Berwick — pediatrician, health care improvement guru, Anglophile, Obamacare booster — has a really, really great bedside manner. He leans in; he listens. He’s deeply thoughtful about seemingly intractable problems (Medicaid expansion, for instance, or the way doctors get paid) without being alarming. In short, he’s the guy you want in the exam room when your kid falls off the jungle gym.

And if you live in Massachusetts, he wants to be your governor.

The last time you probably heard about Berwick, a Democrat, he was being lambasted by certain (Republican) members of the U.S. Senate who vowed to block his confirmation as President Barack Obama’s designated Administrator of the Centers for Medicare and Medicaid Services. Berwick served as the head of CMS for 17 months, and then, with regret but little discernible bitterness, he returned home to Newton, Mass., and decided to run for governor. (Before heading CMS Berwick served as the director of the Institute for Healthcare Improvement, a nonprofit in Cambridge.)

We spoke with Berwick mostly about health care on his way to more far-ranging interview on Radio Boston. In a 30-minute discussion, Berwick talked about the “majestic” Affordable Care Act and compared re-inventing health care to throwing a hat over a very tall wall and climbing over to retrieve it. Here, edited, is some of our (very long) interview:

So, overall, how is your campaign going?

I’m thrilled by how things are going. Of course, people are interested in health care, it’s a very big issue for our country and our state. We have to get this right. I keep saying the truth, which is that the eyes of the country are on Massachusetts. We’re, what, five years ahead of the country in broadening coverage. Health care is a human right in the state now, and you can’t say that in any other state, and that’s what began in 2006. So we’re kind of pioneers for the country. Now, in order to make that possible, we have to reform health care.

Health care has to meet people’s needs better, at lower cost, without harming anyone, but by making health care better, that’s the best way to improve, to contain costs. That’s the journey we’re on, since the cost containment enterprise is now started, and everyone’s watching, everyone’s watching. Continue reading

Essay: Patient’s Death Highlights Medicine’s Promise, Failure

(bogelo/flickr)

By Jonathan Adler, Ph.D.
Guest Contributor

A new class of doctors entered the world this spring: medical school graduates, who will join the legions of caretakers we turn to for insight and comfort and rescue. Among the most elite of this new group of caretakers are those who graduated from Harvard Medical School in May. Their graduation speaker was Dr. Donald Berwick, the former Administrator of the Centers for Medicare and Medicaid Services. His speech, reprinted in a recent issue of the Journal of the American Medical Association, eloquently highlighted both the “glory of biomedical care” and its blind side. Dr. Berwick dedicated his address “To Isaiah,” as he told the story of one of his patients from many years ago whose life and death touched him and stands as a call to action for what the medical profession ought to be about.

Dr. Berwick met Isaiah when he was 15 years old, a rough kid from a rough neighborhood, living with his mother, his brothers, and his mother’s ten foster children in a third-floor walk-up in Roxbury. Isaiah had a bad case of leukemia and a worse case of despair. As Dr. Berwick put it, in the sanctity of his clinic at Children’s Hospital, “the glory of biomedical care came to Isaiah’s service” and over time Isaiah was cured of leukemia. But years later, Isaiah was found convulsing on a street corner, brain dead as the result of uncontrolled diabetes. He never came out of this state and died two years later, at age 39. As Dr. Berwick said, “Isaiah, my patient. Cured of leukemia. Killed by hopelessness.”

Dr. Berwick gleans two lessons from the sad story of Isaiah. First and foremost, doctors must vociferously attend to their patients’ illnesses, no matter who their patients are. And second, that doctors must also seek to cure the injustice that Dr. Berwick believes was the true cause of Isaiah’s death. Continue reading

GOP Pounds Berwick In Hearing On Health Care

It would be no surprise if Don Berwick, at one time an even-tempered Harvard pediatrician, is now questioning his decision to become the administrator of the Centers for Medicare and Medicaid Services in the rough-and-tumble era of national health reform.

Today, according to a report in The Boston Globe, Berwick got “pounded” by House Republicans who finally got their chance to grill him during testimony at a Ways and Means Committee hearing on health care. Here’s an excerpt of the exchange, in which Berwick staunchly defends the new law:

Under pointed questioning, Berwick was unflappable and sounded enthusiastic, even while frustrating Republicans by refusing to offer a “yes” or “no” answer to many questions.

In one exchange, Committee Chairman Dave Camp, a Michigan Republican, pressed Berwick repeatedly on Berwick’s past praise for the British health care system.

“Is the British health care system a good model?” Camp asked.

“The American health care system needs an American solution,” Berwick replied.

Camp persisted, asking: Do you still think a government-run single payer system is the best option?

“I believe the Affordable Care Act is the right solution for America,” said Berwick.

“If I could have a simple yes or no answer?” said Camp.

He didn’t get one.