Who Is Don Berwick and Why Do the Republicans Want to Kill His Nomination?

President Obama's nominee to head up the Centers for Medicare and Medicaid (CMS) is a Harvard physician named Dr. Donald Berwick.

If you haven't heard of him, you will soon. He is awaiting confirmation and the agencies he will head have been waiting for a leader for over four years. Who is this man whom the Republicans are calling a radical but almost every health professional seems to love? (And who says we don't need a radical at CMS anyway!!) One of the major accusations is that he "loves" the NHS, Britain's National Health Service. Ergo, he loves socialism, ergo he is a Marxist.

It is true that Berwick admires the NHS. He does so from having studied it and worked with it to improve care. But most people who criticize the British National Health Service don't know all that much about it. They base their opinion on headlines or a few anecdotes of someone who had to wait to have knee surgery.

In the late 1980s, I took a team of medical auditors to the U.K. to study the quality of health care in the National Health Service. We concluded that the quality of care was equivalent to or even better than the U.S., despite some outdated facilities and half the money the U.S. spends on medical care. I came to admire the NHS for what they were able to achieve despite some significant fiscal challenges.

Admiring what the NHS has accomplished doesn't seem to be all that radical to me. However, will admiration for the NHS kill the nomination of this incredibly well qualified and innovative physician? Hopefully not. Despite Berwick's professed respect for the NHS, he is not blind to its faults and is no centralized planning or top down person. He understands that the revolution we need in health care, in fact, cannot start at the top. And not even at the middle. It needs to start at the bottom, where individual physicians and hospitals struggle to provide the best care for the patient. Doctors and hospitals need a leader who not only understands their dilemmas and challenges but knows how to help them make it better. Berwick's institute for Healthcare Improvement started the 100,000 Lives Campaign in 2004, which drew commitments from more than 3,100 hospitals to reduce by 100,000 the number of deaths from medical errors by June 2006.

Because of his ability to show his fellow physicians how to increase quality of care without sacrificing service, he receives accolades and support from the AMA, the AHA, and health professionals across the spectrum, including conservatives. This Media Matters article provides numerous examples of health care leaders expressing their support for Berwick and his work. And Maggie Mahar of The Health Care Blog sums up why.

...Most who know him describe him a "visionary" and a "healer," a man able to survey the fragments of a broken health care system and imagine how they could be made whole. He's a revolutionary, but he doesn't rattle cages. He's not arrogant, and he's not advocating a government takeover of U.S. healthcare.

If you want to know something more personal about Berwick, though, here is an anecdote that may never come out in this crazy debate. When Dr. Berwick's own wife was in the hospital some years ago, he was at her side day and night. But even with that vigilance - even with his knowledge of health care - he caught errors in her medications several times. Without his oversight, she might have died. Here is part of that story:

There were medication errors. One morning, a neurologist warned that Ann shouldn't get a certain kind of drug. By that afternoon, someone had given it to her. Another medication was discontinued by her doctor on her first day of admission, but the nurses continued to bring it every night for the next two weeks. Later, her doctors decided to put her through chemotherapy to try to stop the deterioration of her condition. "Time is of the essence," her doctor told her. The first dose was given 60 hours later. She was to get a single dose of the extremely dangerous chemotherapy drug daily for five days.
On the third day, the nurse came in and hung up the intravenous bag and started to put it in. "The bag said `Number 2,' " Berwick recalls. "But it was the third dose. I was there. I had seen the others. I told the nurse. She just assumed I was wrong. If I had been 10 years old, she would have been patting me on the head, saying, `I know, I know, don't worry, honey.' I almost wanted to grab her by the lapels and say, `Listen! I know something!' " (The nurse eventually checked the record, and agreed.)

It was this experience, as well as many others, that provide the impetus for Berwick's drive to excellence and his intention to reduce medical errors in hospitals. And that has become his life's work. I'm sure you have heard the oft quoted "fact" that more people die from preventable medical errors than die in hundreds of airplane crashes each year. This Health Grades study, from back in 2004, concludes:

The HealthGrades study shows that the IOM (Institute of Medicine) report (from 1999) may have underestimated the number of deaths due to medical errors, and, moreover, that there is little evidence that patient safety has improved in the last five years," said Dr. Samantha Collier, HealthGrades' vice president of medical affairs. "The equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the U.S.

And in the Medicare population, the data are even more shocking:

-- About 1.14 million patient-safety incidents occurred among the 37 million hospitalizations in the Medicare population over the years 2000-2002.

-- Of the total 323,993 deaths among Medicare patients in those years who developed one or more patient-safety incidents, 263,864, or 81 percent, of these deaths were directly attributable to the incident(s).

We don't have a perfect health care system. The U.K. doesn't either. But don't we want a person at the head of Medicare who is not afraid to learn from other systems yet knows how to work effectively within our own? Now that would be radical.