Opinion VIEWPOINT It could be exciting. The ambitious nation that rallied on the shoals of angry, scientifically uninformed politi- Donald M. Berwick, to create the Marshall Plan, get to the moon first, and cal combat: the proper use of evidence in clinical deci- MD Institute for Healthcare birthMedicareandMedicaiddecidestomovetowardthe sion making, exploring new roles for nonphysician clini- Improvement, Harvard, health care it needs: universal, responsive, and afford- cians,enormousregionalvariationsincareandoutcome, Newton, able. But that task does not unite the nation; it rends it addressing the nation’s obesity epidemic, madden- Massachusetts. into political tatters. Health care reform could have been ingly complex and anachronistic rules for physician and a moon shot, but instead it is a battlefield: red states hospital payment, and much more. against blue, north against south, coasts against the mid- land, and liberals, who trust in government, against con- Causes servatives, who don’t. Thecausesofpoliticalparalysisinmeaningfulhealthcare Forme,thisbattlebecamepersonal.WhenthePresi- reform are many. Some of the largest are these: dent asked me to come to Washington, DC, to lead the Centers for Medicare & Medicaid Services (CMS), I Money in the Status Quo thereby acquired responsibility for implementing much More than $2.7 trillion changes hands in health care. No of the Affordable Care Act (ACA).
JAMA – American Medical Association
Published: Nov 13, 2013