Former Medicare Chief Says the Upper Valley Can Be Health Care Model
Don Berwick, founder of the Institute for Healthcare Improvement, and a former administrator of the Center for Medicare and Medicaid Services, delivers his keynote speech on health care reform to an audience at the Hanover Inn in Hanover Saturday, May 31, 2014. (Valley News - James M. Patterson) Purchase photo reprints »
Rick Mills, executive vice president of Dartmouth College, waits for an opportunity to ask a question of Don Berwick, founder of the Institute for Healthcare Improvement, and a former administrator of the Center for Medicare and Medicaid Services, during a forum on health care reform at the Hanover Inn in Hanover Saturday, May 31, 2014. (Valley News - James M. Patterson) Purchase photo reprints »
Linda Wilkinson, coordinator of patient and family care at DHMC, left, and Elliott Fisher, director of the Dartmouth Institute for Health Policy and Clinical Practice, middle, point out an audience member with a question to Don Berwick, founder of the Institute for Healthcare Improvement, and a former administrator of the Center for Medicare and Medicaid Services, right, during a health care forum at the Hanover Inn in Hanover Saturday, May 31, 2014. Berwick was the keynote speaker at the event for OSHER, Dartmouth's life long learning program. (Valley News - James M. Patterson) Purchase photo reprints »
Hanover — A former Obama administration official left the campaign trail in Massachusetts, where he wants to be governor, to pay a Saturday visit to the Upper Valley, where he encouraged local-level efforts to fix a broken health care system and sought to raise money.
Don Berwick, a long-time advocate for a greater role for government in providing universal insurance coverage while cutting health care costs and maintaining quality, hailed Dartmouth College and its affiliates as an “intellectual center” for reform and encouraged efforts to implement its ideas locally.
“You have a chance to do something special,” he said.
Publicity for Saturday’s symposium at the Hanover Inn asked whether the Upper Valley could be “a National Model” for reform. Berwick gave a green light.
“Don’t wait for Washington,” he told a largely well-heeled and gray-haired audience of about 100 at an event sponsored by the recently re-branded Osher@Dartmouth adult education program and the Dartmouth Institute for Health Policy and Clinical Practice. “The chair is available,” Berwick said. “The seat of leadership is open.”
In response to a questioner who focused on Dartmouth-Hitchcock’s role in unfolding reform here, Berwick said that successful reforms would have to extend beyond academic medical centers, and into homes and communities.
Sara Kobylenski, executive director of the Upper Valley Haven, a social service organization in White River Junction, said a local health care reform initiative, tied to a nationwide program called Rethink Health, began with an April 2013 meeting of about 80 people at Alice Peck Day Memorial Hospital that was intentionally convened away from the medical center affiliated with Dartmouth.
“It had to be about the whole community,” Kobylenski said. “It had to have a feeling of inclusion, of place and space that was accessible to everyone and anyone.” The initiative supports efforts to promote healthy behavior, improve coordination and communication among caregivers and patients and reform payment systems, and is working on setting up a formal leadership body, she said.
Elliott Fisher, a Dartmouth professor and executive director of The Dartmouth Institute, said Dartmouth-Hitchcock’s board had embraced reform efforts, in particular by committing to “making this the healthiest community in the country” and moving to more rational payment models. That board is committed to “get out of the fee-for-service rat race,” he said, referring to a system that critics say boosts wasteful medical spending by tying hospital and doctor income to the volume of care and materials provided.
Fisher planned to host at his house a Saturday night fundraiser for Berwick, a pediatrician, health policy expert and first-time candidate who announced his run for governor in June 2013.
In November 2011, he ended an abbreviated, 17-month tenure as director the federal Centers for Medicare and Medicaid Services, which oversee about $500 billion in annual federal spending on health care programs, after he became a lightning rod for opposition to Obama’s Affordable Care Act and it became clear that Republicans would block his confirmation by the Senate.
An April poll by the University of Massachusetts showed that Berwick had attracted the support of only 3 percent of the likely voters among registered Democrats surveyed.
Attorney General Martha Coakley led the five-way race, at 39 percent, with 44 percent still undecided. To get on the ballot in the September primary, a candidate must win the backing of 15 percent of the delegates to the June 14 Democratic state convention.
But Berwick hasn’t wavered in his support for health care reform. An extended run-up in health care spending, which now consumes 18 percent of United States gross domestic product, has resulted in “a vast transfer from other uses of funding, public and private, to health care,” he said.
“We have to change the system to something else,” Berwick said. He then compared lawmakers and policymakers in Washington, D.C., who are unable to acknowledge that a better system exists, to inhabitants of “a primitive island in the South Pacific (who say) ‘machines can’t fly.’ ”
Moving to a single-payer system of health insurance could eliminate hundreds of billions of dollars of wasteful spending on payment administration and create “a common pool” of resources that could be allocated effectively and efficiently, he said.
“Suppose the money was in one pool. And that pool was under good management. Wouldn’t that make sense, to have accountability to the public?”
In an interview, Berwick said he didn’t think the current controversy over delays and mismanagement in the health system of the Department of Veterans Affairs would erode public support for health care reform.
As to responsibility for the long waits for care at the VA, he said, “much of it falls to Congress for underfunding” the VA.
With partisan deadlock in the capital, “mature dialogue” about health care reform will have to be found elsewhere, he added: “The time has come for localities — towns, cities, regions — to take lead and show the nation what health care can become.”
But even at the local level, health care reform remains a daunting task that, Berwick warned, will ultimately require a confrontation with a range of social ills rooted in poverty. He told about caring for a 15-year-old African-American boy from Boston’s Roxbury neighborhood who received four years of world-class care to cure his leukemia but died at a relatively young age after repeated episodes of addiction, incarceration and unemployment.
The boy “had two lethal conditions, leukemia, which we cured, and he had something else that killed him. I think it’s called poverty, or vestiges of racism.”
Rick Jurgens can be reached at firstname.lastname@example.org or 603-727-3229.