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

Cheryl Clark, 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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