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The most important health-care reformer you've (probably) never heard of

Aside from the secretary of health and human services, the presidential appointee with the most power over the future of the American health-care system is the director of the Centers for Medicare and Medicaid Services. Medicare and Medicaid are the country's largest insurers, and reforms and ideas that begin in their shops often spread through the rest of the system. That's a big part of the theory behind the independent commission empowered to reform Medicare: Good ideas that work in Medicare will quickly migrate to the private insurance market.

But CMS has been leaderless for the past year. That was a bit weird, because it's an important job entering a critical time. The Obama administration, however, is finally announcing its choice for the position, and Don Berwick, head of the Institute for Healthcare Improvement, is getting the nod.

Berwick is about as good a choice as you could hope for (indeed, the health-care community was excited when he was the rumored pick six months ago). As head of the IHI, he has been a pioneering advocate for quality improvements in health care. That's an important distinction: He's not a health-care economist whose main focus is cutting costs. He's a health-care expert whose main focus is improving quality by reducing infections and complications and increasing the use of good evidence and best practices. As you can see in the video clip above, he's also aggressively committed to reforming the patient's hospital experience, which evidence suggests is a bigger deal than we tend to recognize.

For more on Berwick, see Maggie Mahar, who's pretty thrilled. But before you get too excited, think forward to the nomination fight: With Republicans furious over the passage of health-care reform, the chances that Berwick moves smoothly through the process is next to zero.

By Ezra Klein  |  March 29, 2010; 10:30 AM ET
Categories:  Health Reform  
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Obama should recess appoint him. He's already done 15, what's #16 going to hurt? Just throw it in there. "Oh, yeah, and him, too."

Posted by: Kevin_Willis | March 29, 2010 10:47 AM | Report abuse

CHIEF JUSTICE ROBERTS: And the recess appointment power doesn’t work why?

Posted by: JkR- | March 29, 2010 10:59 AM | Report abuse

@JkR: "And the recess appointment power doesn’t work why?"

It does now. And Republicans are enraged that this thing they are pretty sure they have never done, ever, is now being done to them.

Posted by: Kevin_Willis | March 29, 2010 11:26 AM | Report abuse

I agree with the previous three comments. Recess appoint the gentleman and get him working. His confirmation request can be left in the Senate, but that's no reason why this appointment should not proceed.

Posted by: valkayec | March 29, 2010 11:34 AM | Report abuse

Just a great appointment. Berwick is someone more Americans should know, and now will.

Posted by: steveh46 | March 29, 2010 11:57 AM | Report abuse

"He gazed up at the enormous face. Forty years it had taken him to learn what kind of smile was hidden beneath the dark mustache. O cruel needless misunderstanding! O stubborn, self-willed exile from the loving beast. Two gin-scented tears trickled down the sides of his nose. But it was all right, everything was all right, the struggle was finished. He had won the victory over himself. He loved Big Brother."--George Orwell

Posted by: jhr1 | March 29, 2010 12:09 PM | Report abuse

I want to hug someone.

Posted by: ThomasEN | March 29, 2010 12:17 PM | Report abuse

This is an inspired selection. Now watch some mouth breathing neanderthal senators put a "hold" om him or more likely the whole GOP senate gang ussing his confirmation hearings to spout off about how THEY think the new law is A)unconstitutional B) a government takeover of healthcare C) isn't bi-partisan D) going to result in cuts to Medicare (yes, by adopting the most successful, proven treatments)E) Wonder where and when the Death Panels will be held........ Confirm him and let's get going !
Confirm him and move forward

Posted by: jmsbh | March 29, 2010 12:21 PM | Report abuse

Berwick's nomination is about as good as news can get.

If Republicans oppose him (on what grounds I cannot imaging) I will write them off entirely.

He is all about quality, excellence, safety, and good medicine.

Posted by: JoeT1 | March 29, 2010 12:21 PM | Report abuse

Obama is playing the recess appointment game close to perfect right now. Are Republicans really going to go to the mat because people are put into slots at Treasury, Homeland Security and the Office of the Trade Representative, that the EEOC is actually staffed up with a couple of Commissioners and a General Counsel? Oh yeah and here is Becker, you had a chance to shoot him down under Regular Order and blew it.

And Obama can do this over and over. If Republicans are going to play silly appointment games he can use every recess to put in eight or nine non-controversial people while also including a Dawn Johnson or Don Berwick.

Republicans have a choice here. If they want to debate Health Care Reform or Torture in the course of a nomination fight on the floor of the Senate then great, in the Civics textbooks they call that process 'democracy'. But if they want to play games then Obama should be prepared to exploit every rule in the book. Starting with recess appointments. Because these threats of 'non-cooperation' are fricking hilarious in context.

Plus I don't even recall many instances of Obama pulling out the big gun. Presidents should they choose can do a lot of big things through Executive Orders. Personally I don't see a lot of that even being Constitutional but God knows Republican Presidents established plenty of precedents.

Posted by: BruceWebb | March 29, 2010 1:00 PM | Report abuse

If he was rumored 6 months ago, why in hell did it take that long to nominate him? Our governance is screwed up. This is the most important single appointment Obama will make.

Posted by: bharshaw | March 29, 2010 1:26 PM | Report abuse

I have known Don Berwick for many years now and he is one of the true pioneers in the area of clinical quality and patient safety in hospitals. He is an inspiration to all who have heard him speak so passionately about how health care delivery has failed to deliver on their promise of excellence. President Obama's selection of Dr. Berwick to head CMS is a truly inspired choice!

Posted by: doctorlenfriedman | March 29, 2010 2:28 PM | Report abuse

It seems as though that our president Barach Hussein Obomba has a keen dislike for our former friend and ally the Israels.
His politics are in fact anti Israel.It seems almost impossible for his sudden love for the Iranians and hate for the Israels.God help us.

Posted by: rvaw120 | March 29, 2010 2:38 PM | Report abuse

"If he was rumored 6 months ago, why in hell did it take that long to nominate him? Our governance is screwed up. This is the most important single appointment Obama will make."
It was held up, like all of the other presidental nominees, because of the deliberate obstructions of the GOP.

Posted by: jtisch | March 29, 2010 4:25 PM | Report abuse

"...Now watch some mouth breathing neanderthal senators put a "hold" om him"

hey now! Lighten up!

Be nice to Neanderthals (who DID NOT breath through their mouths), after all, some day we'll all be extinct too! (And if any of our history survives, surely the next species to rule the planet--human or otherwise--will be cracking homo sapiens jokes.)

Posted by: Denswei | March 29, 2010 4:28 PM | Report abuse

wow... finally we have a President with brains and one that actually works. It seems like an eternity since the last Texan sheriff came to town ... I love America.

Posted by: ginda | March 29, 2010 4:35 PM | Report abuse

Thank you, Ezra. In the heat of this battle over health care it has been lost that there are sane responsible people out that who have something to contribute. We need people who can attack the problem at both ends. We need those who can address waste in the system and mistakes that ultimately add to our costs.

The feeling I got in reading your comments and watching the videos was that the problem here is the same as what happened in the financial sector: A failure of oversight and responsible management.

Posted by: Reesh | March 29, 2010 4:44 PM | Report abuse

bharshaw & jon

Berwick wouldn't take the job until health care reform legislaiton had passed. (This was reported with the first strong rumor last week-see HealthBeat Friday.

I also believe that the administration (wisely) didn't want to appoint someone to head Medicare until they finished with the legisaltion.

For months, I've been writing that they want someone very strong for CMS, and strong means controversial (for conservatives and lobbyists--everyone else is delighted.)

The administration realized that they didn't want to fight a confirmation battle while fighting the war for reform.

The Senate would have tried to turned Berwick into a pawn in that game.

Now, the confirmation hearings will no doubt be very unpleasant, but with reform a done deal, I think that moderate Dems will support Obama's candidate.

Berwick himself is totally articulate, charismatic, won't be rattled.

Think Atul Gawande with white hair.

Posted by: mahar1 | March 29, 2010 5:18 PM | Report abuse

Had the pleasure of speaking with him seeral weeks ago at the Institute for Healthcare Improvement conference. A great soul, wise, unassuming, funny, excellent communicator, experienced pediatrician, not to mention founder and visionary leader of our most effective national improvement organization. For me, as a patient who’s experienced a life-threatening illness, healthcare provider, and writer about redesigning care delivery this is very hopeful and exciting.

Posted by: shouck1 | March 29, 2010 6:54 PM | Report abuse

Great speaker but did he ever manage more than five people at IHI?

Posted by: bill_baar | March 29, 2010 6:57 PM | Report abuse

If you happened to watch the excellent PBS movie, "Money Driven Medicine" then you would know exactly who Dr. Berwick.

It was featured on Bill Moyer and has had a few free runs on the web and hospitals are using it for teaching. It is a real eye opener and where I first heard about Dr. Berwick and how he sees healthcare and is not adverse to change, he supports it along with patient involvement all the way.

I made a post over the weekend and referenced Maggie Mahar who wrote the book and created the movie as well. Anyone can benefit and learn from watching the movie as they talk to doctors in "real life". I recommend.

Posted by: MedicalQuack | March 29, 2010 7:07 PM | Report abuse

Another inflammatory choice by our (Peter) principled President---

First of all, I'm sure Dr. Berwick is a nice person, does not kill kittens, is kind to his wife, children, friends, colleagues, we know the Queen likes him etc.

But--not only is this man a pediatrician----

He is simply not qualified---no large scale health care deployment or administrative experience--he is a what is referred to, in real life, as a "staff person", and euphemistically, when visiting DC from out of town, a consultant.

And he appears to be a great consultant, has a lot of good ideas, but then he should be consulting to the CMS head, not be it.

And a pediatrician for god's sake, to administrate the agency for senior health care----couldn't the WH find one qualified person who has deployment/administrative and medical experience with geriatric health care, combined with compassion for their fragility and lack of economic resources---

---someone reassuring---- who can balance and even dispute the future across the board cuts to good and bad suppliers alike, cuts that will mostly leave the "bad" suppliers intact---cuts that are mandated by the unaccountable Medicare Rationing Board aka the Medicare Closing Committee, aka APAB.

Someone that does not make the elderly's heart stop when they hear about his/her background, which is what will happen when they hear about Dr Berwick's association with Britain's NHS---the very NHS which has been recently accused of systematically causing unnecessary and early deaths in the elderly and the very ill. .

Here are a few sentences from Dr Berwick's ode to NHS in 2008:

"Let me begin with thanks – twice. First, thanks for letting me work with you for almost 15 years; this has been one of the most satisfying journeys of my entire career. My colleagues in the Institute for Healthcare Improvement feel the same. Second, thanks for what the NHS does as an example for health care worldwide.

If you’re a cynic, you’ll want to go get a cup of tea about now. I am going to annoy you, because I am not a cynic. I am romantic about the NHS; I love it. "

Posted by: johnowl | March 29, 2010 9:23 PM | Report abuse

PART 2 Again, I'm sure Dr. Berwick is a nice person, does not kill kittens, is kind to his wife, children, friends, colleagues, we know the Queen likes him etc.

Here is the heartstopper for seniors------the NHS that Dr Berwick "loves", has instituted an "efficient" so called "palliative" protocol called the Liverpool Care Pathway, where " Medical experts have warned some patients are being wrongly labelled as close to dying when they still have months to live."

Here is a letter that H. Millard, Emeritus Professor of Geriatrics University of London and other health care experts wrote about the NHS in September 2009:

"SIR – The Patients Association has done well to expose the poor treatment of elderly patients in some parts of the NHS (report, August 27). We would like to draw attention to the new “gold standard” treatment of those categorised as “dying”. Forecasting death is an inexact science.

Just as, in the financial world, so-called algorithmic banking has caused problems by blindly following a computer model, so a similar tick-box approach to the management of death is causing a national crisis in care.

The Government is rolling out a new treatment pattern of palliative care into hospitals, nursing and residential homes. It is based on experience in a Liverpool hospice. If you tick all the right boxes in the Liverpool Care Pathway, the inevitable outcome of the consequent treatment is death.

As a result, a nationwide wave of discontent is building up, as family and friends witness the denial of fluids and food to patients. Syringe drivers are being used to give continuous terminal sedation, without regard to the fact that the diagnosis could be wrong.

It is disturbing that in the year 2007-2008, 16.5 per cent of deaths came about after terminal sedation. Experienced doctors know that sometimes, when all but essential drugs are stopped, “dying” patients get better. "

". H. Millard
Emeritus Professor of Geriatrics University of London
Dr Anthony Cole
Chairman, Medical Ethics Alliance
Dr Peter Hargreaves
Consultant in Palliative Medicine
Dr David Hill
Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons
Dr Elizabeth Negus
Lecturer, Barking University
Dowager Lady Salisbury
Chairman, Choose Life"

More at "Sentenced to death on the NHS"

So does Dr Berwick believe in that same kind of algorithmic decisions about elderly health care--- such as Liverpool Care Pathway that is responsible for many of these unnecessary and/or early deaths in Great Britain?

I sure hope someone at the Senate hearings asks Dr. Berwick just what he does "love" about NHS policies besides its efficiency--- and if that includes the Liverpool Path Care Pathway for the elderly.

Again, another inflammatory disappointing choice by our President---

Posted by: johnowl | March 29, 2010 9:39 PM | Report abuse

Thank you, johnowl, for your comments. It's seems that Don Berwick is the right person for the death panels Obama has been planning for seniors.

Obama and his comrades denied the death panels, but the ruling death panel had already been funded in the stimulus bill!

"It can be found in SECTION 9201 of the Stimulus bill. It sets up a 15 member Comparative Effectiveness Board, modeled after the UK's "NICE" board. Obama has appointed the members of this board and one of the members is DR. EZEKIEL IMMANUEL.

In socialist doublespeak, Obama and his comrades may call Obama’s death panels "life panels,” but lies do not change Obama's pro-abortion and pro-infanticide (late-term abortion) stand, nor the aberrant stands of Obama's Health Care Czar Ezekiel Emanuel and Science Czar John Holdren.

Obama's Health Care Czar Ezekiel Emanuel, rightfully called "Doctor Death," would make Dr. Kervorkian proud.

Dr. Emanuel has said that "Medical care should not be given to those who are irreversibly prevented from being or becoming participating citizens."

As per Dr. Emanuel, your mother suffering from Alzheimer’s or your child diagnosed with Down’s Syndrome SHOULD NOT receive medical care.

And Obama's "Science Czar" John Holdren has called for population-control policies such as forced abortions, mass sterilizations, and mandatory population controls.

Lies do not change the FACT that we are broke and Obamacare will further destroy our economy, our future and the future of our children and grandchildren.

Lies do not change the FACT that Obamacare is another scam to enslave us.

Posted by: AntonioSosa | March 30, 2010 1:14 AM | Report abuse

Interesting. When Bush went and did recess appointments, all these Leftist Media hacks were all over it like white on rice, and that was simply a few judges. Now that the Anointed One, the Sainted and infallible Barack Hussein Obama does it, "Oh Happy Days."

Can you say HYPOCRITES?

Just one more reason the November election is going to be a bloodbath for the so-called "Progressives". Taking America back from the liars and thieves.

Posted by: Norm56 | March 30, 2010 11:47 AM | Report abuse

For the record--I do not believe for a second that Dr Berwick will bring in "Death Panels", in fact it looks like he has been trying to do just the opposite, to make sure more patients live longer, e.g., with his work in cleaning up hospitals.

I was questioning his credentials, as an administrator of a huge agency, his background is as a consultant---I was questioning whether his medical expertise is relevant, which is pediatrics, not geriatrics, and whether he would be a "champion" for the elderly.

I believe a champion for the elderly is greatly needed, to balance the gerontophobic attitudes in the Obama administration, in DC politics and journalism right now.

But I would like to know what he does value about the NHS---- and what his attitude is about the NHS's less than friendly policies concerning elder care--- that if implemented here in America, could have fatal consequences for the fragile seniors.

I guess I am just hoping one good thing for the elderly could come out of this awful HCR bill ---

and it would be wonderful if Dr Berwick was the person who stepped up and defended this impoverished group of citizens from the draconian policies that Obama has put in motion.

Posted by: johnowl | March 30, 2010 6:51 PM | Report abuse

It seems that the republicans are soo hell bent on objecting that when the mid terms come they wont have a clear message besides we said no to everything Obama wanted. You have to have your own message, that people actually believe you believe in. Republicans message is Obama must fail at everything for us to win so thats what we are committed to. Making him fail. Also the GOP must not forget that we know that Bush did over 170 recess appointments so they can save that argument of being outraged over recess appointments seeing that Obamas recess appointments are still under 20. I guess they are counting on our ignorance once again.


America has always stood with Isreal, thats why we get attacked along with you.

Posted by: ged0386 | March 31, 2010 2:21 PM | Report abuse

Donald Berwick is a most excellent choice. I salute Presdent Obama for considering Dr. Berwick. I could have written "hats off" to the President but I wear a turban! []

Donald is an enlightned and motivated individual with all the wisdom, knowledge, skills and abilty required to advance the Nation's objective to provide value for money in healthcare. The Nation needs leaders with sharp minds, with their hearts in the 'right palce'. Healthcare must address the three vital dimensions of ALL: body, mind and spirit.

This internationally respected person is the right one, in my view, for taking on this challenge.

Posted by: gurdevSingh | April 2, 2010 12:22 PM | Report abuse

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