Don Berwick, something of a folk hero to journos covering health care, had a heart-to-heart with the Association of Health Care Journalists the other day, and the story deserves a close read. The idea apparently was to vent about his short tenure heading the vast agency that oversees Medicare and Medicaid. Berwick, you may recall, had a recess appointment from the president and was up for confirmation in December. But he had no prospect of being confirmed; he was largely done in by the favorable remarks he once made about Britain’s National Health Service. Conservatives politicized his comments and portrayed Berwick as someone who would ration health care. Undoubtedly gun shy now, Berwick seemed to hold back a bit, and sometimes he spoke in tangled language. But some of his remarks were spot on. Others raise questions for another Q and A.
On rationing. Berwick tackled the conservatives’ argument that he was in favor of withholding care. “That’s not just slightly inaccurate,” he said. “It’s 180 degrees wrong.” Berwick had talked about rationalizing care—that is, getting the right care to the right people at the right time. Who would quarrel with that? The press, however, missed that notion at the time and instead repeated allegations about how Berwick would let people die on the streets. Berwick said the media should have focused on ways to get people the care they need and want instead of care they don’t need or want. A follow-up, asking for an example, would have helped drive home the point.
On politicizing stories. Yes, Virginia, Medicare stories today are politicized, and Berwick doesn’t like that, citing the contrived controversy over death panels during the health reform debate. “Tragically deceptive nonsense,” he called it, but “it attracts the public’s eye.”
“When something sounds like nonsense like death panels, journalists should be brave enough to say so. When someone says something quite silly, the journalists should say, ‘that’s quite silly,’” he advised. During the death panel brouhaha, reporters were slow to push back on the nonsense.
On health care costs. Stories about reducing medical costs and improving care need to appear more frequently. “I have not seen that grappled with in the way that it really needs to in the media. I don’t think the media has gotten into the more-is-better myth enough,” Berwick noted.
On Medicaid. He thinks the press ignores Medicaid, and he’s right about that. Few editors want stories about the poor and the ongoing saga of their states’ inability to pay for their health care. “Although Medicare inside the beltway attracts the most attention, I lost much more sleep about Medicaid than about Medicare.” He “dearly” hopes the country will continue to “embrace the idea that the most vulnerable people need us to help them.”
On the Affordable Care Act. Here is where the interview got really muddy. Berwick said he did not understand why the administration has not been able to explain what the health reform law can do for people. “I don’t know if it’s a communication strategy failure for which the administration needs a mulligan here, or if there’s something dyadic going on between the administration and the journalistic community that has been unable to explain it,” he said. Whew! I had an editor once who would write “mego” next to a phrase like that. “Mego” stands for “my eyes glaze over,” and mine certainly did. Berwick does not think journalists should sell the law, but he does think “the positive aspect of it has been too sotto voce in the reports.” Huh? So are we intentionally keeping our voices too low on the positives of the law? But, then again, it’s not our job to sell health reform.
Trudy, Don Berwick just talked to me last week for an article I have coming out in Managed Healthcare Executive about 10 ways to fix Medicare. He essentially told me what he thought about Medicare vouchers when I interviewed him in October for my December profile of him in Health Affairs. He essentially said he's against approaches that put the financial onus on seniors to reduce care because he doesn't think the problem is seniors choosing to overuse services; the problem, roughly speaking, is all the incentives for providers to over-order services.
http://content.healthaffairs.org/content/early/2011/11/29/hlthaff.2011.1243
Finally, I disagree with you and agree with Berwick about the overall failure of the media to adequately explain the Affordable Care act. True, it's not the media's job to "sell" the law. But it is the law of the land and it contains many features that media audiences should know about and could benefit from. Two notable examples are the tax refunds for small employers who provide coverage for their employees, and the new, improved state health plans for people with preexisting medical conditions. Lots of people who could benefit from those programs don't know about them because the media generally have ignored them. Berwick is dead right about that.
#1 Posted by Harris Meyer, CJR on Tue 14 Feb 2012 at 12:58 PM
Having had the pleasure of working around Dr. Berwick since 2000, he has the best interests of patients and families at heart. In addition, he understands the link between improved care and lower cost. This link was called the Quality Chain Reaction by Dr. W. Edwards Deming. The foundation has been well established by many world class organizations and we expect to see such results in electronics, automobiles, and services we receive. Some still think quality and cost is a zero sum game. Don knows better and could have made a great contribution to our country. Unfortunately, the political ignorance dominated the science. Relative to the healthcare legislation, when Speaker of the House Nancy Pelosi announced that the "Bill has to be passed so we can find out what is in it," should have been a red flag and a time to reflect rather than vote. Best, Cliff Norman
#2 Posted by Cliff Norman, CJR on Tue 14 Feb 2012 at 04:27 PM
Ms. Liberman, you don't take your own advice most of the time and dig deeper. You say:
"Of the four million or so new beneficiaries who had signed up for Medicare at that point, only 3.6 percent had had their “Welcome to Medicare” exam, and of the more than 40 million seniors already on Medicare, only 1.7 million had had their “Annual Wellness Visit.” Perhaps someone can ask Berwick about that in the next interview."
The reason for this statistic is that the "benefit" is a joke to us seniors. It is NOT, as you might think, a physical. We are all still getting our physicals, not these stupid goo-goo politiciazed office visits where a clerk asks us if we like Obamacare.
#3 Posted by dennis byron, CJR on Thu 16 Feb 2012 at 05:31 AM
I just qualified for Medicare this month, and was delighted at the prospect of a fully covered "Welcome to Medicare" physical (which seems pretty thorough based on the description in the Medicare booklet). The Medical practice I use knew nothing about this new Medicare offering when I called to inquire about it. Furthermore, when, at my request, they called the billing company they outsource to, they were told it was only 80% covered. This is a company that does nothing but billing, and they do not even know this physical is fully covered.
I don't know if this is typical, but if it is it would suggest that little is being done to promote this benefit which might explain why so few people are taking advantage of it.
#4 Posted by Jerry Policoff, CJR on Fri 17 Feb 2012 at 12:44 AM
Yes we can't fix the cost of health care without transparency as to what we are spending our money on now. We need the cost per patient per provider per year posted on the internet. We need to know how many heart caths, MRIs each provider is ordering at least for care that I am paying for with my taxes, Medicaid and Medicare. Sort the data by zip code and specialty and then let the media analyze the information and let the outliers then explain why they are doing so much more. Another alternative is to pay those who are doing more less per unit and collect the difference from the patients willing to pay for their "excellence".
#5 Posted by Hu, CJR on Tue 21 Feb 2012 at 02:18 PM