HMS Professor to Leave Top Job at Medicare

Harvard Medical School Professor Donald M. Berwick ’68, a controversial figure in the health care policy field, announced last week that he will step down from his position as chief administrator of the Centers for Medicare and Medicaid Services at the end of this week.

“Don Berwick did outstanding work at CMS,” Jamie Smith, White House deputy press secretary, told the Washington Post last week. “It’s unfortunate that a small group of senators obstructed his nomination, putting political interests above the best interests of the American people.”

Since his nomination to the CMS in April 2010, Berwick has been caught in the middle of the heated partisan debate on Capitol Hill over health care policy.

President Obama nominated Berwick only a month after the 2010 Patient Protection and Affordable Care Act, often derisively called “Obamacare” by opponents, had been signed into law. At the time of Berwick’s nomination, the mood on Capitol Hill remained tense, and ultimately Republicans blocked Berwick’s nomination, strongly objecting to his past statements on health care policy and support of the British National Heath Service.

Detractors pointed to a 2008 speech Berwick gave at the British National Health Service’s 60th anniversary. During the speech, Berwick expressed his support for the British health care system, which is largely government-run, and health care redistribution.

“Any health care funding plan that is just, equitable, civilized, and humane must—must—redistribute wealth from the richer among us to the poorer and less fortunate,” Berwick said. “Excellent health care is by definition redistribution.”

Opponents also claimed that Berwick favors health care rationing. They highlighted an interview Berwick gave with Biotechnology Healthcare in June 2009.

“The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open,” Berwick told the journal. “And right now, we are doing it blindly.”

But Berwick has vehemently denied claims that he is in favor of health care rationing.

“Every bone in my body, as a physician, even as a person, is to get everything [patients] want and need and to help them at every step,” Berwick told the Washington Post in July. “I have gone to the mat to get a last-ditch bone marrow transplant for a child with leukemia . . . and they are telling me I’m rationing? They haven’t met me.”

Conservative opposition to Berwick’s appointment was so staunch that his confirmation hearing was never scheduled. It seemed unlikely Berwick would be confirmed by the Senate, so, in an effort to bypass the Senate, Obama made Berwick CMS chief administrator by a temporary recess appointment in July 2010.

Berwick’s provisory appointment would have expired on December 31, and his term could have been extended through the Senate confirmation process. But many have said that Berwick’s nomination would not have succeeded in the Senate confirmation process since 42 Republican senators signed a pledge to block further consideration of Berwick earlier this year.

As chief CMS administrator, Berwick was responsible for implementing new healthcare policy regulations, many of which stem from the Patient Protection and Affordable Care Act.

It is  unclear whether Berwick will return to Harvard after he leaves his post at the end of this week. At the Medical School, Berwick held a part-time appointment as a member of the Health Care Policy and Pediatrics departments. Berwick also served as the President and CEO of the Institute for Healthcare Improvement, a healthcare policy think tank.

Barbara J. McNeil, chair of the Health Care Policy department at HMS, said she would welcome a chance to re-appoint Berwick.

“We’d be anxious to have him teach health care policy,” McNeil said, adding that Berwick could be a valuable collaborator for professors interested in researching the structure of Medicare and Medicaid.

Obama announced last week that Marilyn Tavenner, CMS principal deputy administrator, will succeed Berwick as the next CMS chief administrator.

Berwick did not respond to interview requests for this article.

—Staff writer Benjamin M. Scuderi can be reached at bscuderi@college.harvard.edu.

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