On transparency. Berwick was clearer when it came to transparency. He’s all for it, even though he doesn’t think patients will open Consumer Reports to decide where to go when they have a heart attack. He doesn’t think the country is where it needs to be on the matter of transparency. “If we can make more information more transparent, almost everything will get better, cost and price,” he noted. “I have become more and more a fan of transparency.” Maybe it’s easy to be one when you don’t have the health care establishment (which doesn’t like transparency) pressuring you at every turn.
There were two topics I wish the interview would have touched on—Berwick’s position on the future of Medicare and the underuse of medical services, which exist alongside overuse. It’s a paradox of American health care. Decisions about the shape of the program made this year or next will have far-reaching financial consequences for every American. Knowing what the ex-head of Medicare thinks might be helpful. Does he think vouchers or premium support are a good idea? Then there’s the matter of underuse of medical services. In mid-November, I checked with Berwick’s agency to find out whether seniors were getting preventive care benefits available from Medicare. 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.
Berwick said he would “not knowingly turn down any request for an interview from press that I know about.” Spoken like a battle-scarred politician. Who, then, will he talk to next?