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The efficiency expert healthcare needs

Only in the topsy-turvy world in which end-of-life counseling services are called “death panels” could a doctor who champions patients’ rights and better medical treatment be labeled a threat to healthcare consumers. Yet that’s what Republicans are saying about Dr. Donald Berwick, a Harvard Medical School professor whom President Obama nominated to run the Centers for Medicare and Medicaid Services — an agency that will play a central role in reforming the U.S. healthcare system. Berwick is well respected and a good choice for an agency that has gone too long without a leader. His nomination shouldn’t be held hostage while the GOP tries to refight old battles over the new healthcare reform law.

Berwick has become a GOP target because he dared to praise Britain’s National Health Service, which is the conservatives’ vision of healthcare hell — a government-run system that caps spending and determines which treatments and drugs to provide. The doctor has been particularly effusive about its universal coverage and its science-based approach to improving care. He’s also criticized the service for being understaffed and underperforming.

Some Republicans in the Senate say Berwick’s comments about the National Health Service are evidence that he wants the government to ration healthcare. This is misdirection at its best. Lawmakers control Medicare’s budget as well as most other aspects of the program. If there’s going to be rationing, that will be their call, not Berwick’s. His main duty would be to implement the enormous changes that the new law calls for in Medicare and Medicaid. Republicans couldn’t stop the bill from being enacted, so they’re trying to stop it from taking effect.

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What Berwick can do — indeed, what he’s exceptionally well qualified to do — is help Medicare and Medicaid deliver more care for the money that’s being spent on them. The new law is replete with efforts to eliminate waste, improve coordination among healthcare providers and align providers’ financial incentives with patients’ interests. Berwick is not only a top advocate for efficiency in healthcare, he’s a world-class expert in ways to improve quality and safety. He’s also known for a patients-first approach that emphasizes giving individuals more information and control — the kind of transparency that’s needed for consumers to effectively manage their own healthcare spending.

The tussle over Berwick is just a warm-up to the real battle over reining in Medicaid and Medicare costs. The growth in those programs isn’t sustainable, and lawmakers will soon have to make even tougher choices about how to save the Medicare hospital trust fund from insolvency. In the meantime, we need to maximize the value we get for our healthcare dollars by cutting back on services that are duplicative or ineffectual. That’s Berwick’s cause. Encouraging doctors and hospitals to give better care at lower cost isn’t rationing, and resisting efforts to make the system more efficient is just irrational.


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