We live in a time when optimism is in short supply. Large majorities of voters believe the country is on the wrong track. We don't trust insurance companies, Wall Street, or the news media, and we especially don't trust the government. The Pew Research Center characterizes it as "a perfect storm of conditions associated with distrust of government - a dismal economy, an unhappy public, bitter partisan-based backlash, and epic discontent with Congress and elected officials." But ratings "are just as low for the impact of large corporations (25% positive) and banks and other financial institutions (22%). And the marks are only slightly more positive for the national news media (31%) labor unions (32%) and the entertainment industry (33%)."
It was refreshing, then, for me to hear a committed public servant today tell the ACP's Board of Governors that "optimism is the crucial resource" in improving the American health care system. The public servant is Dr. Don Berwick, the administrator of the agency (CMS) that runs Medicare and Medicaid and that is responsible for much of the implementation of the Affordable Care Act.
Dr. Berwick described his vision of CMS as an agency that supports innovation by the private sector - "we have to do this together." He spoke of "partnerships" with physicians, nurses, hospitals, pharmacists and patients to design systems to achieve the "triple aim" of better care, better health, and lower per capita costs. (To learn more about Berwick's triple aim, see this Health Affairs blog from April 20.)
He said that top-down mandates from the federal government won't work. Instead, he spoke of an unparalleled opportunity for physicians to be leaders in designing systems to improve care and the heath of the population, and to reduce health care costs. Cost reductions, he argued, can be achieved "without ever harming a single hair on the patient’s head," if we commit to eliminating treatments that have no benefit to the patient. He sees the government playing a supporting role by providing funding and re-aligning incentives to support innovation at the community-level. His optimism is ground in the many examples where physicians have been leaders in building better systems to reduce fragmentation, improve patient safety, and reduce costs.
But Dr. Berwick also suggested that there needs to be an authentic commitment by all involved to creating a better health care system and that those who instead want to repackage the status quo will not serve the public interest. He praised ACP for its leadership in proposing ways to reduce ineffective care while improving the care of patients and the overall health of the population. ACP's Board of Governors reacted very positively to Dr. Berwick's remarks, with many of the governors offering ideas on how to achieve his triple aim.
Now, I anticipate that given the intense levels of distrust of government, some who read this blog will react to my description of Dr. Berwick's remarks dismissively. You'll probably tell me that ACP is being taken in by yet another "bureaucrat" who heads an agency that, in the minds of many physicians, exemplifies big and unresponsive government - even though this goes against the grain of everything that Dr. Berwick has said and written about how change must come from the bottom-up.
The question in my mind really isn't whether we can or should "trust" the government to do the right thing, even when led by good people like Dr. Berwick, but whether we have confidence in ourselves. Confidence that the can-do spirit that has made America such a great country still lives. Confidence in our own capacity to build a health care system that achieves Dr. Berwick's triple aim of better care, better health, and lower costs. If we can regain such confidence in ourselves, then there is every reason to be optimistic about the future of American health care.
Today's question: How optimistic are you that we can build a better health care system that achieves Dr. Berwick's triple aim?