Sunday, May 16, 2010

Don Berwick and the Cost of Health Care

Don Berwick, Harvard pediatrician and founding executive of the Institute for Healthcare Improvement, has been nominated by President Obama to head the Centers for Medicare and Medicaid Services (CMMS). As its name implies, CMMS is the federal agency in charge of Medicare and Medicaid.

Republicans are already taking aim at the nomination, alleging that Berwick favors rationing of health services. The Berwick appointment requires the advice and consent of the Senate and assumption is that Republicans will use its nomination hearings to renew the debate on health care reform; a strategy they believe will help them in the fall elections.

However politically motivated the Republican attacks, they may have the effect of re-opening the debate on health care costs. Recently, we saw the first skirmish of that debate in the context of health reform legislation, but all parties to it quickly left the field in favor of a focus on health insurance.

In a perfect world, health care costs would be brought under control by eliminating unnecessary services, improving operating efficiency and devising new methods of providing care, all in ways that doctors and patients would find acceptable. But it is not a perfect world and so the measures that end up being taken will leave some people actually worse off and others thinking they are.

So we need to get the issue out in the open and have it out. If the Republicans end up doing that in the Berwick nomination hearings, they will serve a useful purpose, whatever their motivation.

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