might want to take a look at Bob Wachter’s post over at Wacther’s World. http://community.the-hospitalist.org/blogs/wachters_world/archive/2010/07/08/why-obama-made-the-right-call-on-berwick.aspx. There, the  Associate Chairman of the Department of Medicine at the University of California, San Francisco, makes the most persuasive and cogent case I’ve seen as to why the recess appointment made sense.

 Wachter writes:  “The very things that make Berwick right for the CMS role also make him a target in today’s political environment, where all serious debate is trivialized and caricatured via talking points and schoolyard name calling.  . . .  Obama did not bypass a substantive airing of Berwick’s qualifications to run the most important healthcare organization in the country. Rather, he avoided a sandbox brawl.”

Berwick could have handled the fight, but I'm glad the American public was spared the spectacle of watching their elected representatives turn themselves into trolls on C-Span. We've already witnessed a year of ugly debate on healthcare reform.

Summary: Don Berwick, who will soon become the head of the Centers for Medicare and Medicaid, has declared himself an “extremist” insofar as he is a passionate advocate of “patient-centered care.” Earlier this week, Ezra Klein used the declaration to make a provocative argument that Don Berwick is, in fact, a conservative.  Congressional right-wingers should be happy, even if they don’t know it yet.

If we accede to patients’ wishes, won’t that mean that they’ll bankrupt the system? No, Berwick observes, experience suggests that informed patients are likely to want less care, not more. 

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A Guest Post By Authors:

Mark E Williams, MD , FACP

Ward K. Ensminger Distinguished Professor of Geriatric Medicine, University of Virginia School of Medicine, Attending Physician University of Virginia Health System 

Nortin M Hadler, MD, MACP FACR FACOEM, Professor of Medicine and Microbiology/Immunology, University of North Carolina School of Medicine And Attending Rheumatologist, UNC Hospitals

Summary:  In the guest post below, Doctors Mark E. Williams and Nortin M. Hadler describe the rise of the for-profit nursing home in the middle of the 20th century, at a time when the “temporal gap” between “retirement” and “death” was much shorter than now.  “Today people spend more time in retirement than in childhood and adolescence combined,” the authors point out, as they question whether the nursing homes of the past make sense in the 21st century.

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Tuesday night the White House Blog explained: “In April, President Obama nominated Dr. Donald Berwick to serve as Administrator of the Centers for Medicare and Medicaid Services (CMS). Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points.

“But with the agency facing new responsibilities to protect seniors’ care under the Affordable Care Act, there’s no time to waste with Washington game-playing. That’s why tomorrow the President will use a recess appointment to put Dr. Berwick at the agency’s helm and provide strong leadership for the Medicare program without delay.”

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Summary: Today, many argue that the traditional relationship between doctor and patient is changing. At one time, the doctor had the information, the patient listened. But today, as more and more patients trawl the Web, researching their own illness, some are bringing valuable information to their doctors. New websites also offer guides to finding “Credible, Reliable, Objective, Health Information on the Internet” as well as tips on “How to Share Information With Your Doctor” efficiently and tactfully. This is all part of the shift toward “shared decision-making.” Rather than passively giving “informed consent” more patients are making an “informed choice” when they agree to a course of treatment.

Of course, not every patient can—or wants to—become his doctor’s partner. Not everyone possesses the skills needed to surf the web and thread his way through a maze of medical information.  Moreover, many patients (including this one) would rather leave the research to a doctor who keeps up with the latest medical evidence by collaborating and consulting with other physicians.

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Summary: Below an excerpt from “Dirty Medicine” which appears in the July/August 2010 issue of Washington Monthly. The article reveals how “group purchasing organizations”( GPOs) have taken control of the medical supply and  device market.

Originally, GPOs were non-profit collectives formed by medical facilities that hoped to keep a lid on prices by banding together to make bulk purchases of supplies and devices at a discount. But in the mid-1970s, reporter Mariah Blake explains, “the model began to shift. Some large hospital chains started to spin off for-profit GPO subsidiaries, which other hospitals could join by paying membership dues, much the way members of buying clubs like Costco pay dues to get bulk-buying discounts. By decade’s end, virtually every hospital in America belonged to a GPO.

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Earlier this month Senator Orrin Hatch (R-UT) spoke for more than a few conservatives when he declared “We’ve been working to dismantle Obamacare. We have to fight this terrible law that’s a threat to liberty itself.”

Over at the New Republic, Jon Chait offers two reasons why this won’t happen: 1) the American people don’t want it to happen and 2) Republicans don’t want to be voted out of office.

 Chait begins: “One of the political benefits to Democrats of passing the Affordable Care Act (ACA), rather than following the crawl into a hole and die strategy urged upon them in all sincerity by Republicans, is that it shifted the debate to favorable terrain. Now Democrats are favoring the status quo, and Republicans are trying to pass a radical change. Indeed, now that the issue is repeal, it's Democrats who are united and Republicans who are divided, rather than the reverse.” http://www.tnr.com/blog/jonathan-chait/75967/republican-health-care-fratricide#comments

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For now, all those physicians who threatened to make a mass exodus from Medicare can take a breather. Last week, the House voted to once again delay the mandated 21% cut in physician fees by another six months; thereby ensuring that the fight over the sustainable growth rate (SGR) will be resurrected sometime around Thanksgiving.

So far, Congress has kicked the SGR can down the road 10 times since 2003—four times just this year alone. The targets have long been considered unobtainable and the mandated physician payment cuts are opposed in Congress by Democrats as well as Republicans and supported by nearly no one. The level of anxiety among doctors continues to escalate every time the issue is raised—even though the cuts have never gone into effect for more than a couple of weeks. Why not get rid of this devilishly frustrating formula once and for all?

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HealthBeat readers may have read about the death of Polly Arango, a nationally known advocate for children with special health needs, earlier this week.

Over at Running a Hospital, Paul Levy, President and CEO of Beth Israel Deaconess Medical Center had this to say: “Learning of her untimely death in a freak one-car accident in Alamosa, Colorado, [on Saturday, June 16], I felt a blow-to-the-midsection loss.”

Levy met her at last year's Institute for Healthcare Improvement (IHI) Annual Forum (picture here) where Arango served as the Forum’s co-chair.  “She made an immediate and wonderful impression,” he recalls. “After the conference, I was curious. Who was this person? It was then that I learned of her extensive accomplishments.”

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Kaiser Health News (KHN) reports that “the nomination of Dr. Donald Berwick to run the agency overseeing Medicare appears to be languishing.”   Friday, KHN’s “Health Policy Week in Review” quoted a story that appeared in the New York Times a few days earlier:

"Hospital executives who have worked with Dr. Berwick describe him as a visionary, inspiring leader. But a battle has erupted over his nomination, suggesting that Dr. Berwick faces a long uphill struggle to win Senate confirmation. Republicans are using the nomination to revive their arguments against the new health care law, which they see as a potent issue in this fall's elections, and Dr. Berwick has given them plenty of ammunition. In two decades as a professor of health policy and as a prolific writer, he has spoken of the need to ration health care and cap spending and has confessed to a love affair with the British health care system." 

KHN also points out that according to The Hill, although Senate leaders are nearing an agreement to allow more than 60 Obama nominees to be approved to begin work, Berwick is not on the list  . "'He will not get unanimous consent,' a spokesman for Senate Minority Leader Mitch McConnell (R-Ky.) told The Hill.

I am not at all persuaded that Berwick’s confirmation is in trouble.

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