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Beyond Berwick brouhaha: Medicare chief another step to health-care reform

The White House announcement that President Barack Obama was doing an end run around the U.S. Senate and doing a recess appointment of a new head of the Center for Medicare and Medicaid Services, or CMS, has, not surprisingly, caused something of a kerfuffle.

Donald Berwick, MD, a Harvard medical school professor and president and CEO of the nonprofit Institute for Healthcare Improvement, just become the agency's first permanent chief since 2006. He was nominated for the job months ago, but his appointment was being held up by Republicans, who said that he would impose government rationing - and that he favors socialized medicine. By officially making the appointment while the Senate is in recess, Obama moves past the effort to pillory Berwick and lets him get started on the job.

Still, it's worth noting that despite the efforts to pigeonhole Berwick as some sort of leftwing radical, he doesn't fit that caricature. As noted in an editorial in the Washington Post, he was endorsed by the two previous heads of the agency under President George W. Bush, as well as their counterpart under President George H.W. Bush. The Kaiser Health News Service has created a resource guide page about Berwick that offers a balanced view: It shows that while Berwick has ambitions to overhaul our health-care system, his ambitions are guided by initiatives that are as noncontroversial as apple pie - such as changing medical practices so as to eliminate unnecessary infections in hospitals and prescription errors that cause thousands of deaths each year.

My article in the latest issue of Stanford Medicine magazine may help put what Berwick wants to do in some context. What he and other health reformers are essentially saying is this: Let's get more health care for less money. At first blush, it sounds like a real estate agent offering some beachfront propery in Nevada, but the premise actually embodies what has made our nation so vibrant. Through innovation, we can achieve - and we have done so in the past - greater productivity. The nation's leading hospitals and health-care organizations are all now trying to implement quality improvement campaigns that will deliver better care while reducing costs.

Of course, for every Model T, there's also an Edsel, and so it's certainly not a given that whoever is in charge of the CMS is going to be able to realize such savings. As the agency overseeing Medicare and Medicaid spending, it has the ability to reward certain practices and penalize others, but figuring out how best to do that is no small feat.

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