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Q&A: Don Berwick Reflects on Healthcare Reform, Part II

Cheryl Clark, for HealthLeaders Media, December 10, 2012

A year after leaving his position as administrator of the Centers for Medicare & Medicaid Services, Don Berwick, MD, talked with HealthLeaders Media. Berwick discussed death panels, the challenges of implementing healthcare reform, Medicare and Medicaid fraud, and the improvement movement. This is the second part of the interview. Part I is here.

HLM: Let's talk about the huge bulk of Medicare spending at the end of life—one in four Medicare dollars spent in the last year—some of which would be avoided if (Medicare or health plans) required patients to sign an advance directive to say what they would want. Do you think we can revisit this issue with common sense?

DB: First the whole death panel thing was a travesty, demagoguery at its worst that really harmed patients, building things out of thin air that had no relationship with reality, and it was tragic for our country. It made end-of-life care a 'third-rail' topic, with people on both sides of the aisle reluctant to discuss it.

But the big piece of this does not have to do with saving money. It has to do with people having control of their own lives.

We know for certain that as people approach end of life, not only are they costly, but they're in pain, they suffer from shortness of breath, and symptoms that can be helped with proper treatment. They're isolated from families, put into intensive care units, hooked to machines when most of them don't want that, yet we do it anyway.

What we need is choice. Do they want to be at home or in an ICU? With their loved ones or with lots of nurses and doctors?  If someone wants every machine and every tube, I'd say sure, it's your life. Of course you can get that. But if they don't, that's hurting people, and what we have to get away from.

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5 comments on "Q&A: Don Berwick Reflects on Healthcare Reform, Part II"


RK (12/11/2012 at 4:48 PM)
Where can we learn about how the future story of health care is being told? Of strategies referred to in communities in the US, Singapore, and New Zealand that improve community and individual care.

dr. dre (12/10/2012 at 5:51 PM)
Re: "DB: Right. Right now, with $2.7 trillion in play, the status quo is very, very loud, and very well funded, and heavily connected to campaign finances, because lobbyists have earned entry into the politicians' doors. They speak loudly, and they do not always defend the interests of the poor. The importance of making sure that medical treatment actually works, the toxicity of overtreatment, the need for better valuation of clinical practices[INVALID]all of those things don't have the voice that the status quo has. HLM: Which lobbyists are you referring to? DB: Anyone whose job depends on the status quo, and for whom changes are painful. They would rather see things continue or even get more support for what they do." This is a breath-taking assault on free speech. He would deny stakeholders the right to voice their opinions? Assuming he was correctly quoted, this is frightening.

mike stebbins (12/10/2012 at 1:03 PM)
the VA already makes "death panel" like decisions. They decided that since I was 52 year old diabetic they wouldnt fix a serious stenosis at C5-C6 because, "you arent going to live long enough to enjoy the benefits of the procedure" my terminal illness? Well controlled diabetes and otherwise in good health. If the VA can make those kinds of decisions with impunity, what is to stop CMS for doing the same?