Born in New York City on September 9, 1946, Donald M. Berwick holds a bachelor’s degree in Social Relations from Harvard College (1968), a master’s degree in public policy from the Kennedy School of Government (1972), and an M.D. from Harvard Medical School (1972). After completing his studies, Berwick started his medical career as a pediatrician in an HMO known as the Harvard Community Health Plan (HCHP); eventually (in 1983) he became its Vice President of Quality-of-Care Measurement.
Berwick left his job with HCHP in 1989, in order to teach courses on how to improve medical treatment in the United States. In 1991 he used grant money to establish a Cambridge, Massachusetts-based nonprofit organization known as the Institute for Healthcare Improvement (IHI), where he continues to serve as president and CEO.
In 1997, President Bill Clinton appointed Berwick to the Advisory Commission on Consumer Protection and Quality in Healthcare. From 1999-2001, Berwick chaired the National Advisory Council at the Department of Health & Human Services’ Agency for Healthcare Research and Quality. And he has been a Clinical Professor of Pediatrics and Health Care Policy at Harvard Medical School since 1999.
Opposed to free-market health-care arrangements, Berwick favors a government-run, “single-payer system.” “It’s important also to make health a human right,” he says, “because the main health determinants are not health care but sanitation, nutrition, housing, social justice, employment, and the like.” Berwick is particularly fond of Great Britain’s government-administered National Health Services (NHS) and its National Institute for Health and Clinical Excellence (NICE), a body of bureaucrats who evaluate the relative costs and benefits of various medical therapies in order to determine which procedures the NHS should cover. “I am romantic about the NHS,” says Berwick. “I love it.”
In Berwick’s calculus, America’s healthcare system traditionally has been inferior to Britain’s because of the free-market elements present in the U.S. system. Berwick contends that the American system would be safer if physicians had fewer opportunities to make decisions regarding the treatment of their patients, and were required instead to follow established, formulaic protocols as spelled out by a bureaucracy modeled on the British NICE. “The more I have studied it, the more I believe that less discretion for doctors would improve patient safety,” he said in 2004. Added Berwick on another occasion: “Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy.”
In 2008 Berwick co-authored an article for the journal Health Affairs, where he explicitly advocated the rationing of care according to the recommendations of a bureaucracy similar to NICE: “The hallmarks of proper financial management in a system … are government policies, purchasing contracts, or market mechanisms that lead to a cap on total spending, with strictly limited year-on-year growth targets.” In a June 2009 interview, Berwick stated: “It’s not a question of whether we will ration care. It is whether we will ration with our eyes open. And right now, we [Americans] are doing it blindly.”
In a July 1, 2008 speech at an NHS anniversary celebration in Britain, Berwick likened the U.S. healthcare system to a chaotic “zoo” where hundreds of “immoral” health-insurance companies were recklessly running up administrative costs that were “at least three times as much as in England, maybe more.” Berwick told his audience that American insurance companies “have a strong interest in not selling health insurance to people who are likely to need health care,” and that they “try to predict who will need care, and then to find ways to exclude them from coverage through underwriting and selective marketing” — all in the interest of “increas[ing] their profits.”
Condemning “the darkness of private enterprise” for having made healthcare “unaffordable as a human right” in the United States, Berwick, in the same address. lauded Britain’s NHS for “guaranteeing it as a human right.” He derided those who favored free-market systems as benighted ideologues who had gullibly sworn allegiance to “the invisible hand of the market,” rather than choose what Berwick viewed as the wiser alternative: “using [the] tax base to provide a single route of finance.” “Please don’t put your faith in market forces,” he said. “It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can.”
In his NHS speech as well, Berwick further impugned the American healthcare system for having “protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any healthcare funding plan that is just, equitable, civilized, and humane must – must – redistribute wealth from the richer among us to the poorer and the less fortunate.” “Excellent health care,” he emphasized, “is by definition redistributional.”
On July 7, 2010, President Barack Obama appointed Berwick as Administrator of the Centers for Medicare & Medicaid Services (CMS), which oversee those two federal programs. It was a recess appointment, meaning that Berwick did not come under Senate scrutiny prior to securing the position. To remain in effect, a recess appointment must be approved by the Senate before the end of the next session of Congress, otherwise the position becomes vacant again. Thus Obama formally nominated Berwick for the CMS post in January 2011. But Berwick was unable to garner enough votes for Senate confirmation, and he resigned from CMS the following December.
In June 2013, Berwick announced that he planned to run (as a Democrat) for governor of Massachusetts. On September 9, 2014, he conceded the Democratic nomination to Massachusetts Attorney General Martha Coakley, who subsequently lost the general election to a Republican opponent.
Further Reading: “Donald Berwick” (Ballotpedia.org, Linkedin.com, Center for American Progress); “Obama’s Rationing Man” (Spectator.org, 5-13-2010); “Obama Appoints PHR Board Member Don Berwick to Head Medicare and Medicaid” (PHR.org, 7-7-2010).