Long, full and joyous: Don Berwick and the pursuit of health

On Monday, Pres. Obama formally nominated Dr. Donald Berwick to be the Administrator of the Centers for Medicare and Medicaid Services.

At a recent conference of the Institute for Healthcare Improvement, Don described health care as a means to an end. "Health care has no intrinsic value, none," he said. "Health does. Joy does. Peace does….The best health care is the very least health care we need to gain the long, full and joyous lives that we really want. The best hospital bed is empty, not full. The best CT scan is the one we don't need to take. The best doctor visit is the one we don't need to have."

This was a tough message to hear for the hospital leaders who comprised most of his audience. But Don has never shied away from delivering tough messages clearly. That quality makes him a good choice for this impossible job. Perhaps Don's greatest virtue in this context, however, is his single-minded focus on a single vital aim.

Health in its fullest sense is our goal. Health is far from the absence of disease, which is usually the way it has been defined in medical care settings.

Even early detection isn't good enough. Better is the prevention of conditions that leaves us whole, without the need for medical procedures like biopsies. That will take an enormous transformation of our healthcare system. Don, I salute you, and I'm reporting for duty!

Thanks to Robert Pear for the source story in the April 20 issue of the New York Times.

Donald Berwick as head of CMS

Pres. Obama has just nominated Dr. Donald Berwick to lead CMS, the Federal government agency that runs the Medicaid and Medicare programs. Don has stellar qualifications. Equally important are his experiences as an advocate during his father's period of declining health, and his own experiences as a patient with a botched knee operation. Years ago, at his speech to the Institute of Healthcare Improvement's National Forum, he movingly described his frustration and inability to get the proper treatment, and an appropriate wheelchair, for his father, himself a doctor. At the most recent December Forum, he described his definition and vision of his own health, and showed the large gulf separating that from the absence of illness, as doctors usually define good health in practice. He did this by encouraging people to ask, What do you really want? Then to ask again, What do you really, really want? And to ask a third time, which elicits the true vision of one's ideal health.

What do I really, really, really want? For the Senate to confirm my friend and colleague Don, and give him the keys.