Interim CMS Director Steps Down, Problems Remain

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The resignation of Don Berwick as director of CMS didn’t seem to get major press coverage. Dr. Berwick was appointed to lead CMS in July 2010 when Congress was in recess, and thus needed Congressional approval to serve beyond 2011. He quickly became a punching bag for some lawmakers, who attacked his purported admiration of the British National Health Service. He was also subjected to criticism for a prior statement on health care rationing. I previously commented on his exact statement here, and noted that the criticism appeared to distort the factual record.

Realizing that the Senate would not confirm him, he has stepped down.

By all accounts Dr. Berwick is an upstanding physician with a solid reputation. And the problems that he so accurately noted will not be resolved by his resignation. The position of CMS Director increases in importance every day as the government debt pile grows larger, fueled in large part by healthcare expenditures. This problem will not be solved without co-operation from both political parties.
The fact remains that the government has simply promised much more health care than it is capable of providing, and some method of matching these promises with the forces of reality will take place. This can be through price rationing, non-price rationing, large tax increases, or some combination of the three. But what has been happening will not continue indefinitely.

Dr. Berwick may have been criticized for speaking the truth on this matter, but he is no different from a new CFO brought in to aid a struggling business. When the business owner later receives a report saying “Something major has to change or you are headed for bankruptcy.” Should he fire the messenger?

Regardless of who leads CMS, the mathematical problems with Medicare and Medicaid will not go away. Best of luck to the next director!