Don Berwick to Head CMS

Don Berwick, whom I'm honored to have worked with in the past, has been appointed by President Obama to head CMS (Center for Medicare and Medicaid Services). Don is a mesmerizing speaker and a wonderful physician and human being who has encouraged an entire generation of physicians to bring industrial quality improvement methods to health care. Don founded and has headed the Institute for Healthcare Improvement since leaving Harvard in the 1990s. He has a broad constituency in medicine across many disciplines. I believe he's an excellent physician who is committed to high quality health care in the U.S. in a non-partisan way, despite my having read that Republicans criticize him for having written positive things about England's national health insurance system. Don has praised England's recent emphasis on quality and performance improvement, and it would be pretty hard to argue with that change, whether one favors a single-payer system or not (I do only if it is structured to preserve competition among and choice of providers based on quality of care).

I am hopeful that Don's insight will help Medicare implement the healthcare reform legislation in a way that will promote and preserve quality of care in Medicare as well as the private insurance system. I am encouraged by Don's background in clinical medicine (he is a pediatrician by training although I don't know when he last practiced), and quality of care. Don is an excellent choice and I hope his philosophy can filter down to CMS' day to day operations. As we know, sometimes leaders of federal agencies don't influence their own bureaucracies too much, because managers of individual departments can subvert the intent of the agencies' directors. Don, however, is an inspiring leader who has been an effective leader in several organizations in the past, and I wish him all the best at CMS.

Medicare: Much Better than Nothing

One of my pro bono patients is about to get Medicare. I am breathing a sigh of relief because this uninsured man with a history of heart problems including valve surgery, a rhythm disturbance known as atrial fibrillation, who often needs dangerous anti-clotting medicines such as coumadin, and who has some serious gastrointestinal problems as well, is finally going to have access to a primary care doctor, a cardiologist, a gastroenterologist etc.

I am so amazed by the beliefs some Americans (Tea Party, anyone?) appear to have that the uninsured have access to health care. What planet do these people live on? Here in the San Francisco Bay Peninsula area, we have a safety net hospital, Valley Medical Center, which is the only place which will see uninsured patients. When this man needed to be seen by a cardiologist immediately and needed a cardioversion procedure (where a device is used to deliver an electrical shock to try to convert the heart from an abnormal to a normal rhythm), Valley was so oversubscribed that it took several months to get the procedure done and several months to get an appointment with a cardiologist.

Why not just put everyone on Medicare? It would cost the taxpayers less in the long run, since when gentlemen like this one cannot afford care and cannot get appointments, they end up in emergency rooms, which is much more expensive, and happened to this man twice in the last several months.