This week President Obama appointed Donald Berwick to be director of Centers for Medicare and Medicaid Services. This is the federal government unit charged with managing the Medicare program and the federal portion of the Medicaid program. Because those two programs capture such a large segment of the health care enterprise, they have a huge impact on the system as a whole, including private providers and hospitals. This appointment has been loudly criticized, mostly but not exclusively by those opposed to Obama's agenda. The appointment was made during a Congressional recess, and thereby avoided Senate approval, which was unlikely because conservatives would have filibustered and killed the nomination. This is a sad commentary on the current state of our political system, which seems to be only about winning elections rather than making the country better through effective use of government processes and structures. I digress.
Our current health system is broken and fiscally unsustainable. In spite of spending substantially more per person than any other nation, we rank relatively low in outcomes among the modern, developed countries. This is a national disgrace. In the 1980s there was a national scandal surrounding military purchasing and the expenditures of the Department of Defense. The $600 hammer became notorious as emblematic of the abuses in the system. There is a very similar pattern which happens every day in the health care system. Costs are incurred and paid by either government or the private sector, which are either unjustifiable high, disconnected from any objective standard of value, and many times even unnecessary at all. The Tea Party advocates are loud opponents of what they consider excessive and unnecessary taxes, but don't seem to mind being scammed by market-driven health care.
Into the picture comes Donald Berwick. His claim to fame can be summarized by "increasing quality of care." How boring, yet if the ideas he promotes were implemented, we could save thousands of deaths and hospital days each year, save hundreds of millions of dollars of health care expense, and efficiently cover all Americans with basic health care without increasing budget deficits and the national debt. I hope he is successful in bringing about change to the extent permitted by the limits of the CMMS position.
Overlayed on this can be thoughts about prevention. The old adage is "an ounce of prevention is worth a pound of cure." Partly true, partly not. The health care proposals passed this year include provisions for preventive care and health promotion. Some of those ideas will save money, but many of them will improve health without necessarily saving money. Here is the reason. In a humane society, we should use all the tools we have to prevent people getting influenza. There are about 35,000 flu deaths in a typical year, not counting pandemics like swine flu or bird flu. If every person was immunized, most of those deaths would not occur. However, the cost of universal immunization may be greater than the cost of treating the people who get sick. Prevention of flu may cost more money than it saves, but will improve quantity and quality of life. Various prevention and health promotion practices can be analyzed in this way.
Usually individuals can save money by simple lifestyle measures of eating healthfully, being physically active, getting regular sleep, avoiding tobacco and excess alcohol, safe driving, and so forth. It is more complicated when prevention becomes a society-based effort or a service of the health care system.
The thing that Donald Berwick brings to health care reform is a dogged insistence that what we do is informed and guided by data and evidence - not a knee-jerk response: government bad, unfettered market-driven good.
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