Donald Berwick, the recently departed head of the Centers for Medicare and Medicaid Services (CMS), delivered a harsh rebuke of his critics during a speech delivered Wednesday at the 23rd annual National Forum on Quality Improvement in Healthcare, hosted by the Institute for Healthcare Improvement in Orlando, Fla.
Berwick left his post on Dec. 2, about 16 months after he had been appointed by President Barck Obama during a congressional recess, because Republicans had promised to block his permanent appointment. He was replaced by Marilyn Tavenner, who had served as a deputy administrator at CMS. Berwick was the president and CEO of the Institute for Healthcare Improvement for nearly 20 years before taking his post at CMS.
According to a copy of his remarks, provided by Kaiser Health News, Berwick criticized political opponents who alleged that the Affordable Care Act would lead to a rationing of health care and, in more extreme examples, death panels. He warned of a cynicism that had gripped Washington and its politicians.
"Let me give you an example: the outrageous rhetoric about 'death panels; – the claim, nonsense, fabricated out of nothing but fear and lies, that some plot is afoot to, literally, kill patients under the guise of end-of-life care. That is hogwash," said Berwick in his written remarks. "It is purveyed by cynics; it employs deception; and it destroys hope. It is beyond cruelty to have subjected our elders, especially, to groundless fear in the pure service of political agendas."
Instead, Berwick said, the emphasis should be on patients.
"The truth is...that patient-centered care demands that the ways in which a person is cared for ought always to be under his or her control," he said. "The patient is the boss; we are the servants. They, not others, 10 should direct their own care, and the doctors, nurses, and hospitals should know and honor what the patient wants."
He also alluded to plans previously proposed by Republicans that would result in significant changes in Medicare and Medicaid.
"If you really want to talk about 'death panels,' let’s think about what happens if we cut back programs of needed, life-saving care for Medicaid beneficiaries and other poor people in America," Berwick said. "What happens in a nation willing to say a senior citizen of marginal income, 'I am sorry you cannot afford your medicines, but you are on your own?' What happens if we choose to defund our nation’s investments in preventive medicine and community health, condemning a generation to avoidable risks and unseen toxins?"
Berwick was frequently critical of the political atmosphere in Washington. But he also called the Affordable Care Act "the most important health care policy of our time" and "a majestic law."
Towards the end of his remarks, Berwick referenced success stories such as Denver Health, health-care organizations that improved services while cutting costs. He then challenged the audience of providers, policymakers and other health professionals to embrace five principles: put the patient first; among them, put the poor and disadvantaged first; start at scale, instead of relying on pilot programs; lower costs for all stakeholders and lighten the burden of costs on patients; and act locally.
"The only question left is: Will you do it?" he said.