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. . .and his work just started

Another casualty in the right wing assault on the government's challenge to improve health care came earlier today when CQ broke the news that Dr. Donald Berwick will leave the Center for Medicare and Medicaid Services (CMS). At a time when Republican efforts to roll back the Affordable Care Act remains a conspicuous priority, it is yet another reminder of lawmakers' intent to block Barack Obama's health reform goals.

Berwick was a recess appointment made necessary after lawmakers refused to call a vote on the confirmation of a pediatrician whose name has become synonymous with improving systems, saving money, putting patients at the center of medical care. Great expectations, and commensurate praise from the medical world, accompanied the announcement that he would head CMS. By virtue of its budget and the numbers it serves, CMS could potentially affect substantial systemic change.

The nomination became hostage to senseless ideological battles. It was doomed, some believed, because he publicly praised Britain's National Health Service at the celebration of its 60th anniversary.

Opponents attempted to discredit him with a false dichotomy pitting individual choice and market-place fee-for-service against loss of autonomy and systemic government intrusion. It seemed to work in-so-far as it contributed to a debate permitting stupid innuendo about "death panels" that ignored the sorry truth that the United States has been consistently falling behind in the Western world based on universal measures of life expectancy, infant mortality, preventable diseases, access to services. His success with this in the private sector, at IHI, was dedicated to restructuring health services to cost less to while producing measurable improvements contributed to his qualifications to head the agency.

Announcing Berwick's resignation effective Dec. 2, HHS Sec. Kathleen Sebelius, wrote:

His unwavering passion and dedication to this work have put the nation on a path that is already making a meaningful difference to millions of Americans. Don has led the agency as we have launched exciting new programs that are saving money, fighting fraud, transforming our health care delivery system, providing new benefits to people with Medicare, holding insurance companies accountable to consumers, and working to establish Affordable Insurance Exchanges.

The most recent innovation of his short-lived administration was the creation of a center called, not surprisingly, the Health Care Innovation Center. The Center is now in the process of considering how to fund "the most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP, particularly those with the highest health care needs." Mental health care was included in this agenda for reform.

Without waiting for the results of initiatives in the field, or the accumulation of evidence from its launch underway, Republican Sens. Orrin Hatch (Utah), Mike Enzi (Wyo.) and Tom Coburn (Okla.) challenged the need and the purpose of the Innovation Center. It "will place unnecessary financial strains on the nation's health care entitlement programs, further threatening their future solvency," they wrote.

With a consistent defiance absent programmatic initiatives, and calling for a Government Accounting Office (GAO) investigation, the ranking Republicans on the Senate's Committee on Health, Education, Labor and Pension, wanted to learn how the Center's budget was being used. They noted that as of Nov. 10, it had "yet to produce recommendations or implement a single systematic change or reform to the programs."

The deadline for submitting a letter of intent for proposals is Dec. 19, 2011.

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Phyllis Vine

Consider This

by Phyllis Vine

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