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New Medicare chief says don’t ration health care

By Ricardo Alonso-Zaldivar


The nation’s health system cannot be transformed by rationing medical care or by a series of mandates handed down by the government, Donald Berwick, President Obama’s new Medicare chief, said yesterday in his first major speech since his contentious appointment in July.

By naming Berwick as a recess appointment, Obama bypassed what was shaping up as a bitter Senate confirmation process. Some Republicans accused him of being willing to deny care to save money. Since then, the administration has kept Berwick out of the limelight, turning the otherwise well-known medical innovation guru from Harvard University into something of a mystery man in Washington.

Berwick broke his silence yesterday, telling an audience of health insurance industry representatives that pushing back against unsustainable costs cannot and should not involve “withholding from us, or our neighbors, any care that helps’’ or “harming one hair on anyone’s head.’’

Berwick also said he doesn’t think federal bureaucrats have all the answers when it comes to remaking the system. “A massive, top-down, national project is not the way to do this,’’ he told a conference hosted by America’s Health Insurance Plans, the industry lobbying group.

Berwick, 64, a pediatrician and professor before he came to government, has long advocated what he calls “patient-centered care,’’ coordination of services to provide better quality.

The choice of the insurance lobby for his speech was unusual because the administration continues to trade verbal potshots with the industry. Last week Berwick’s immediate boss, Health and Human Services Secretary Kathleen Sebelius, warned insurers not to try to blame rate hikes on the new health overhaul law.

The administration wants to use Medicare and Medicaid as laboratories to test the main ideas about quality improvement and cost control ideas in the health care law.

These include “medical homes’’ in which a primary care doctor assumes responsibility for patients’ overall health, following up on whether people take their medications and encouraging common-sense prevention.

Another idea is “accountable care organizations,’’ networks of doctors, hospitals, nursing homes, and other providers that would figure out themselves how to best allocate resources to provide quality care.

Berwick said he wants a “full partnership’’ with the insurance industry, because tens of millions on Medicare and Medicaid already receive health care through private insurers. But he also indicated he would be tough on those who resist change.

The industry’s top lobbyist, Karen Ignagni, responded after the speech, “We intend to work with you to get it right.’’

Republicans have seized on previous comments from Berwick, such as this one from an interview last year: “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.’’

Berwick told the insurers he has three objectives: better care for individuals; better care for groups of people, such as diabetics or the poor; and reducing per capita costs by eliminating waste and duplication. — AP

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