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Don Berwick Steps Down

by Benjamin Domenech on November 23, 2011

As expected, Don Berwick will step down as head of the Centers for Medicare and Medicaid Services next month according to the Associated Press.

Berwick’s controversial year on the job following a recess appointment achieved little compared to his initial ambitions. The administrator, in a final interview with the Washington Post‘s Sarah Kliff, showed that he had much more in mind:

SK: How well do you think this will work? It requires a pretty big paradigm shift by the health-care system, which right now, like you said, doesn’t focus much on coordination.

DB: I am very optimistic. The more I travel, the more I see growing receptivity to this. People know health care has got to transform into something much more. I think times are really different, not absolutely everywhere, but in professional societies there’s a sense of readiness. I think we might be on the verge of better care. And the financial situation adds a new sense of urgency.

Berwick is headed back to the private, or at least the academic, sector of work thanks to simple math. Facing 42 solid votes against his renomination in the Senate, an oncoming Supreme Court decision, and the pressure of an election year which may well see the president’s signature health care law fall to pieces, it was clear there was little opportunity or political benefit for a nomination fight which would inevitably put rationing back on the front page across the country. Berwick will have to be content to support President Obama’s unpopular law without drawing a taxpayer-funded salary.

Berwick’s tenure was shortened thanks overwhelmingly to an awareness of his past statements. These views were expressed over the course of decades in venue after venue, frequently with video of his controversial remarks which made Berwick’s claims that he did not support rationing fall flat. Once again, Berwick provides us an example of what happens when the things polite technocrats say to each other are made known to the American people. We will not miss him.

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Berwick Asserts Federal Oversight of State Medicaid Negotiations

by Benjamin Domenech on September 5, 2011

The Hill reports today on a recent push by Don Berwick and CMS to expand their oversight of state Medicaid rate negotiations, prompting significant pushback from state level health secretaries. As The Hill notes, CMS wants the states to “document the potential impact of proposed cuts to payment rates for doctors and hospitals”, based on concerns about shrinking access to care for Medicaid beneficiaries.

“The idea that Washington has to control everything because states can’t be trusted to act in the interest of their own citizens frankly is an insult to the states,” said Dennis Smith, secretary of the Wisconsin Department of Health Services…

Republican state officials say the proposal would cripple states’ ability to negotiate Medicaid payment rates.

“Ultimately these are (state officials’) decisions to make,” Wisconsin’s Smith said. “If providers know, well I’m going to get whatever I can out of you and then whatever I don’t get I’ll run to the feds to get the rest, it really ties your hands in trying to negotiate in good faith.”

Virginia Secretary of Health and Human Resources Bill Hazel agreed.

“Any regulations on our ability to set rates would essentially be inhibiting the General Assembly’s ability to set rates, which is what they do,” Hazel told The Hill. “What we are faced with now with the new potential regs is a situation where instead of flexibility, we’re being told that you have to do all these studies.”

“It’s the time as much as the process,” he added. “You’ve got a 60-day General Assembly period. Suppose the feds don’t like what you’re trying to do: How does it work?”

This matter is not just of note for Republican states – California, for example, has requested an across-the-board 10 percent cut in Medicaid reimbursement rates. Once again, this is an indication that the administration believes a public shaming is a substitute for good policy.

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Krugman on Berwick

by Benjamin Domenech on April 2, 2011

Any longtime reader of The New York Times‘ Paul Krugman knows he has a tendency to fall back into his most belligerent, partisan voice whenever he writes on the issue areas he knows the least about. Such is the case with Don Berwick, who Krugman uses as an example of his ‘the smartest should rule us’ approach to governance:

Berwick has spoken in favor of evaluating medical effectiveness and has had kind words for the British National Health Service, so he wants to kill grandma and Sovietize America.

So what lies down this road? A world in which key positions can only be filled by complete hacks, preferably interns from the Heritage Foundation with no relevant experience but unquestioned loyalty.

Inconveniently for Krugman, we face an example just this week — a tragic and sad one — of exactly the kind of world Berwick loves (and as we know, this is not an exaggeration): one where patients receive care on the timetable of the government directed system, not when they seek it.

A former NHS director died after waiting for nine months for an operation – at her own hospital.

Margaret Hutchon, a former mayor, had been waiting since last June for a follow-up stomach operation at Broomfield Hospital in Chelmsford, Essex.

But her appointments to go under the knife were cancelled four times and she barely regained consciousness after finally having surgery.

Her devastated husband, Jim, is now demanding answers from Mid Essex Hospital Services NHS Trust – the organisation where his wife had served as a non-executive member of the board of directors.

He said: ‘I don’t really know why she died. I did not get a reason from the hospital. We all want to know for closure. She got weaker and weaker as she waited and operations were put off.’

Mr Hutchon, of Great Baddow, Essex, said his wife, 72, had initially undergone major stomach surgery last June but the follow up procedures were repeatedly abandoned.

Berwick is fond of decrying systems that exist within the “darkness of private enterprise.” Deaths like these are the inevitable consequence of a system that is fundamentally out of sync with the world we live in — exactly the kind that applying Krugman’s musings on the rule of unelected elites in the U.S. would likely create.

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Baucus on Berwick: “Republicans Won”

March 9, 2011

Speaking yesterday on the renomination of Don Berwick, Finance Committee Chairman Max Baucus tells reporters: “Republicans won.” The Senate will never vote to confirm Dr. Donald Berwick as CMS administrator, according to the Senate Democrat leading his nomination. Berwick is currently serving through a temporary recess appointment. Sen. Max Baucus (D-Mont.), chairman of the Senate [...]

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Maggie Mahar on the Fall of Berwick

March 9, 2011

Maggie Mahar — the smartest left-of-center writer on health policy today, in our view — outlines the fall of Don Berwick as charted over the past few weeks in a very thorough post today. Mahar is a health policy expert and a Berwick supporter — not a political insider — and assesses Berwick’s prognosis at [...]

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Politico: Senate Democrats Giving Up on Don Berwick

March 7, 2011

Politico reports that Senate Democrats are “giving up” on Don Berwick, the controversial head of CMS, in the wake of the letter signed by 42 Senate Republicans demanding his nomination’s withdrawal. Citing the GOP letter, a person familiar with the situation said Senate Democrats and the White House “can do the arithmetic” and now see [...]

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Republican Senators: Withdraw Berwick Nomination

March 3, 2011

In a letter today to President Obama, 42 Republican Senators requested the withdrawal of Don Berwick’s renomination to head the Centers for Medicare and Medicaid Services. “Withdrawing Dr. Berwick’s nomination would be a positive first step in rebuilding the trust of the American people. The occupant of this important position, which affects the health care [...]

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