The eminent appointment of Donald Berwick, MD, as head of CMS (Centers for Medicare & Medicaid Services) may seem like a step in the right direction. After all, Dr. Berwick is well known for championing improvements to health care. “At least he’s a doctor,” some might say. But is appointing a doctor really giving physicians a place at the table? Dr. Berwick is also politically capable. Few could argue the reasons for putting him on the list of candidates. But is that reason enough to make the appointment? Is appointing an MD really a place at the table, or is that allowing a doctor to work as a server for the dinner guests?
It stands to reason that Washington is going to appoint someone who is politically astute. It also stands to reason that President Obama would appoint someone capable of delivering fiery rhetoric. In 2004, he unequivocally stated “I’m losing my patience. Not with the people in healthcare, but the system itself. Healthcare professionals are doing so many things so well; they’re putting actual transformation within reach. Now we need to grab it. The clock is a tyrant, and if you spend too much time ‘getting ready,’ you’re going to lose.” In another campaign, he noted “… the attention of the strategic leaders in healthcare has not been focused on the improvement of care. The strategic objectives have focused on more traditional goals such as growth, marketing and capital development. We need leaders to create a new future, not defend the status quo.” In a keynote speech last year, Dr. Berwick was bold enough to state that anyone who claims the U.S. healthcare system is the best in the world is not looking at the facts. Dr. Berwick is clearly a man of passion, unafraid to challenge the system. Sounds like the perfect man to repair a broken system, doesn’t it? Unfortunately, the White House has not asked us that question.
The problem is that the good doctor’s visions are slanted towards hospital management. He was very astute in earlier observations, and ambitious in the goal of saving 100,000 lives by improving the leadership of healthcare. That makes him an outstanding administrator, and an exceptional leader. It may very well make him a good candidate for Kathleen Sebelius’ job, or something equally broad in its scope, or specifically about hospital care. With so much of Medicare and Medicaid being outpatient care, though, one could reasonably question whether he’s the right man for this impending appointment.
President Obama is seldom (if ever) short-sighted, and he plays his cards very close to his chest. Perhaps the reason behind the choice includes grooming Dr. Berwick for bigger things. While reforming this broken system, though, the right choices need to be made immediately for the immediate position. This is no time for political machinations.
The guest list and places may not be determined by the host, but they’re still subject to his review. President Obama has employed the AMA as co-conspirator in the facade of giving us a place at the table. A real place at the table would have meant the medical community being directly involved in the selection process. There are many appropriate choices for the head of CMS. Want a list? All the White House has to do is ask us. At the risk of sounding like Oliver Twist, though, we really should have more of a say in such matters. Both the medical community and the nation would be better served if appointments to such practical positions were selected by those who are actually in the know. But that would require giving us an actual place at the table.