By Amy Goldstein
Don Berwick, the administrator in charge of Medicare and Medicaid, was having dinner in Dupont Circle not long ago with five of his predecessors when the conversation veered to how long he could keep his job.
In the realms of health care, his is a pivotal role: overseeing two entitlement programs that insure nearly one in three Americans, sheperding the profound insurance changes spurred by the new health-care law and serving as chief cheerleader for better care at lower cost.
A pioneer in improving medical quality, but a neophyte in Washington politics, Berwick ran into a buzz saw of Republican opposition over old academic writings when President Obama chose him for the task 16 months ago. A year ago this week, the president slid him into the job without Senate confirmation while Congress was out of town. The “recess appointment” installed Berwick at the helm of the Health and Human Services’ Centers for Medicare and Medicaid Services. But, unless the Senate acts, he cannot stay beyond December.
And so, during the April dinner, he and the former administrators, his “brain trust,” addressed the awkward but central issue: Was there any chance for a confirmation hearing now?
From all five around the table, Democrats and Republicans alike, “the feedback he got was sort of, ‘forget it,’ ” recalled Bruce Vladeck, the Medicare and Medicaid chief under President Bill Clinton and one of three people there who recounted the conversation. The effort would be futile, they said. “Don’t ruin your legacy and make a fight out of it,” one person told him.
As a result, unless something unexpected happens, this 64-year-old pediatrician and Harvard Medical School professor is racing to carry out one of the nation’s biggest health-care jobs with a timer ticking down the months.
Assuming he leaves at the end of the year, Berwick will have overseen large portions of the government’s work on crucial scaffolding for the 2010 law overhauling the health-care system — including regulations due out this week for insurance exchanges that states are expected to create by 2014, as well as rules scheduled for later this year year defining the medical services that health plans in exchanges must cover.
At the same time, Berwick’s departure would remove an intellectual architect of many ideas imbedded in the law he is working to implement — to the dismay of the law’s allies and the delight of its critics.
Berwick has been trying to inject into the sprawling agency a set of big-picture ideas about innovation in health care that he honed as leader of a nonprofit organization, the Institute for Healthcare Improvement, that he founded in Cambridge, Mass., 20 years ago.
His ideas go back to the mid-1980s, when he was vice president of the Harvard Community Health Plan, an HMO. He and the staff felt helpless, he recalled, because the quality of care was static, and they did not know how to make it better. “I tried to quit,” he said. Instead, his boss made an unusual offer: Why not travel the country to examine other leading industries to figure out how to improve?