Episode #133: An ethical perspective on healthcare in America as a human right and public good – with Don Berwick MD, President Emeritus & Senior Fellow at the IHI

Friends,

Our topic today is an overview of some of the most serious and consequential challenges facing our healthcare system and our public health, as shared with us by one of the most erudite, accomplished and ethically driven leaders of our era, Dr. Don Berwick. As always, our focus will not be on what’s wrong with American healthcare, but rather on solutions – on what is actually being done to reframe and recreate healthcare. We’ll also get a preview into some of Don’s recent thoughts and a recommendation that he is planning to publish.

Donald M. Berwick, MD, MPP, FRCP is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement (IHI), an organization that he co-founded and led as President and CEO for 18 years. An elected member of the Institute of Medicine (IOM), Dr. Berwick served two terms on the IOM’s governing Council, and was a member of the IOM’s Global Health Board. He also served on President Clinton’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. Dr. Berwick contributed greatly to the landmark 2001 IOM report – Crossing the Quality Chasm; as well as the landmark, To Err is Human report. Dr. Berwick served as vice chair of the U.S. Preventive Services Task Force and chair of the National Advisory Council of the Agency for Healthcare Research and Quality. In July, 2010, President Obama appointed Dr. Berwick to the position of Administrator of the Centers for Medicare and Medicaid Services (CMS), which he held until December 2011. A pediatrician by background, Dr. Berwick has served as Clinical Professor of Pediatrics and Health Care Policy at the Harvard Medical School, Professor of Health Policy and Management at the Harvard School of Public Health, and as a member of the staffs of Boston’s Children’s Hospital Medical Center, Massachusetts General Hospital, and the Brigham and Women’s Hospital. He has co-authored over 160 scientific articles & six books. In 2005, Dr. Berwick was appointed “Honorary Knight Commander of the British Empire” by Queen Elizabeth II, the highest honor awarded by the UK to non-British citizens, in recognition of his work with the British National Health Service. 

In this interview, we’ll hear:

1. The core issue that Dr. Berwick believes is corrupting American healthcare – imminently threatening public health, public trust in healthcare and the Medicare Trust Fund.
2. A brief on some of the critical threats to public & global health, such as global warming and worsening health disparities.
3. The global and governmental agencies, and governments that are solving issues such as early childhood development and elder care.
4. A recommendation for an interdependent “all government” approach at the Federal level, as well a specific action plan for healthcare system leaders.
5. One of the most revealing exposes on the Medicare Advantage payment model.

The fundamental ethical perspective Dr. Berwick holds is that healthcare should be considered a human right and a public good – not an industry controlled and driven by private sector profit. Another fundamental belief is that healthcare should be patient-centered – that all decisions and actions should be in the best interest of the patient and their family, as understood and articulated from their perspective. 

Another point that Don Berwick elaborates on is that public health, our health, is greatly impacted by broader socio-political and ecological issues. Issues such as climate change, racism, early childhood development, voter rights, and the marginalization of vulnerable segments of the population. In order to tackle these issues, he advocates for an integrated, multi-sector, all of government approach.   

And while Dr. Berwick opens up this interview with the statement that he’s deeply concerned about the future of healthcare in America, he does not dwell on the problem. Instead, he shares the abundance of potential as well as concrete solutions and efforts that are already in place. In this interview, and throughout his career, Don exhibits the attributes of a master community organizer – moving swiftly from problem to solution to action. 

Over the last few years, in his published articles and public talks, Dr. Berwick has begun to lay bare some of the ethical and moral hazards within our healthcare system; and to call for the specific, critical actions that must be taken to address them. He writes, speaks and acts with intellectual integrity, originality and rigor; with a powerful sense of collaborative, empathic leadership; and with a practical down-to-earth sensibility – no ego, no ulterior motive and no self-serving agenda. Dr. Berwick has become the truth-bearer of American healthcare as well as, perhaps, its ethical lightning rod. He has transcended to a meta-position of value-based leadership that I can not adequately label or describe. As with all transcendent leaders, it’s a bit unsettling but also compelling. I’ve been told that integrity of character is a magnetic force. If so, Dr. Berwick’s values, vision and mission are the true north we should all set our professional healthcare compasses to.  

Until Next Time,
Wishing you Integrity

Zeev Neuwirth, MD