Berwick emphasized that the three pharmaceutical companies he named "are not doing anything illegal. They're playing by the rules. But that's my point. Not everything that's legal is proper."
He called the drug companies actions that resulted in higher costs for necessary drugs both for the public and the taxpayer, "a take the money and run behavior," and said "a civil society is going to have to give politicians and regulators tremendous courage to follow through and say, "No. That's not okay.' "
6. Resist innovations that don't help. At a major convention last year, Berwick was escorted through an exhibit hall with 6,000 vendors, one for each of the 6,000 participants. "There was fiber optic this and robotic that, ceramic this, and disposable everything. And I am absolutely sure that somewhere in the acreage of innovation there was something that could help patients that was definitely worth the money.
"But every instinct I have is telling me that what is offered as innovation in healthcare is certainly not always and maybe not even mostly truly helpful, but adds complexity and risk and we need to tell the difference."
7. Expand roles and scopes of practice for non-physicians. "We need to support new models of care that provide expanded roles for non-physicians." However, he says, the legacy payment systems don't encourage these changes. We need help from the (professional) guilds, not their opposition," but he said, many "are fighting the change."
8. Defend the poor. This monster, Berwick said, is causing him to lose sleep because the nation fails to regard healthcare as a human right. "The social safety net is vulnerable and the will to protect" social services for the poor "needs constant reinforcement that government can't provide without hospitals' support.
9. Palliative and end of life care. Berwick blasted what he called "cruel rhetoric" that equated sensible discussion of advance directives and preferences with "death panels." "But the rule in Washington favors never ever mentioning end-of-life or palliative care, or advance directives. Not in government. That is a tragic silence and it has to stop."