WASHINGTON — As a physician and thinker, Donald Berwick was known as one of the nation’s leading health care innovators. As President Barack Obama’s Medicare chief, he’s been a mystery man — until Wednesday.
The 64-year-old pediatrician appeared before the Senate Finance Committee four months after his appointment as the only Medicare administrator to assume the post without Senate confirmation. But the tightly orchestrated hearing left Republicans complaining they were only given a nibble at his record.
Berwick told senators he’s opposed to rationing of health care, and even people who are near death have a right to treatment. As a matter of principle, he said he believes patients should get “all the care they want and need, when and where they want and need it.”
Health care savings should be squeezed by avoiding medical mistakes, eliminating waste and duplication, and helping people with chronic illnesses manage better so they can stay out of the hospital, he said.
Finance Chairman Max Baucus, D-Mont., introduced Berwick as Obama’s point man on health care overhaul. The law makes Medicare the laboratory for new models of care, such as turning primary care practices into “medical homes” that use nurses to keep close tabs on frail patients in the community. Berwick is also responsible for Medicaid and children’s health insurance, programs that together with Medicare cover 100 million Americans.
Before his nomination, Berwick taught at Harvard and headed the Institute for Health Care Improvement, a hands-on think tank that promotes coordination in a fragmented health care system. Republicans had raised questions about his praise for the British health care system, saying it revealed a bias toward big-government approaches that could lead to rationing here. They did not revisit the issue at Wednesday’s hearing.
Democrats say Obama went around Congress to appoint Berwick because the White House did not want a key player sidelined for months by partisan wrangling.
Berwick asserted Wednesday that he doesn’t think a one-size-fits-all approach works in a country as diverse as the United States.
GOP senators were skeptical of Berwick’s assurances. Sen. Orrin Hatch, R-Utah, who next year will be the committee’s senior Republican, said the 90-minute hearing did not allow enough time to explore complicated questions. “This is pathetic,” said Hatch.
One question that barely got mentioned is a looming 23 percent cut in Medicare payments to doctors, the result of a 1990s cost-control law gone awry. The cut will go into effect Dec. 1 if Congress fails to stave it off, and doctors are warning they’ll stop taking new Medicare patients.
Berwick said he supports waiving the cuts, and Baucus said lawmakers are working on it. Democratic and Republican aides said lawmakers are negotiating over a one-month reprieve, with the understanding they would come back in December and try to work out a longer fix.
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