Dr. Donald Berwick has his coming out party today in Washington. After President Obama snuck him into office during a recess appointment as the head of the second largest health insurance company in the world- CMS (Center for Medicare and Medicaid Services) without so much as a single hearing, Senators finally have an opportunity to meet him during a Finance Committee meeting. The prepared transcript of Berwick's remarks at first glance, conveys a sense that he is a strong patient advocate and champion of patient rights. Were we to take these statements at face value, there would be much to look forward to during his tenure leading CMS. However, the spoken word in Washington is not to be trusted, and nowhere more so than in this case. We need simply go to You Tube or the internet and find the Berwick speeches and articles that portray a very different man.
The Donald Berwick that we have come to know, has stated his positions clearly and they are very different from what he is now trying to convince Senators and the American people that he supposedly stands for. There is no ambiguity about how Berwick feels about the sanctity of the doctor patient relationship. In his book "New Rules" he writes: "Today, this isolated relationship (between doctor and patient) is no longer tenable or possible... Traditional medical ethics, based on the doctor- patient dyad must be reformulated to fit the new mold of the delivery of health care...Regulation must evolve. Regulating for improved medical care involves designing appropriate rules with authority... Health care is being rationalized through critical pathways and guidelines. The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized decision making."