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Berwick: The Progressive Choice

By Clifford M. Marks

A crowded field of Democratic candidates seeks the corner office in Massachusetts this fall—all of them accomplished, all with left-leaning policies. So a progressive voter might be forgiven for giving the contenders a cursory glance and concluding that one is as good as the next.

But for those committed to progressive goals—to making health care accessible and affordable, to eradicating poverty, and to ensuring a quality education for all children regardless of race or class—only one candidate possesses both the moral commitment and the management experience to realize these long-held dreams.

That candidate is Don Berwick ’68.

Berwick does not come from politics—he was a pediatrician first, trained at Harvard Medical School, where he also taught for many years (and where I met him in a course he co-taught on health care quality). His philosophy owes much to medicine’s most noble ideals of service.

In 2010, when Obama appointed him to run Medicare and Medicaid, he brought a sign to place on his desk as a reminder of what should guide his decisions. It read simply, “How will it help the patient?”

When asked what he believes government should do, he often invokes a Hubert Humphrey quote: “The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadows of life, the sick, the needy, and the handicapped.” And he has a concise response to a question about his plans for tackling poverty: “End it.”

All this is well and good—and Berwick is no doubt the most committed progressive running for the Democratic nomination: He is the only one, for instance, to endorse a Medicare-for-all health care system in Massachusetts. Were it just his philosophy, though, I wouldn’t be writing this. But Berwick also possesses a gift far rarer: the ability to lead and change large organizations.

He has shown this amply in health care, where as founder and CEO of the Institute for Healthcare Improvement, he crusaded to introduce quality improvement methods from high performing industries such as manufacturingefforts credited with saving thousands of lives. Indeed, his tireless work helped bring an entire medical culture to the understanding that health care needed to do better by its patients.

In recognition of this vision and efficacy, President Obama named him to run the Centers for Medicare and Medicaid Services—putting him in charge of a budget larger than the Pentagon’s. Though he was pilloried, and eventually blocked, by Senate Republicans for, among other things, having once praised the UK’s National Health Service (indeed, Glenn Beck called him the “second most dangerous man in America”), his brief tenure atop the sprawling bureaucracy was transformative.

He helped change an agency often characterized by sluggish processes and unresponsiveness into one focused on constant improvement, speed, and a relentless focus on the welfare of its millions of beneficiaries. He launched efforts to improve care for patients following hospital discharge and to combat medical errors such as those resulting in hospital-acquired infections. He pushed staffers to leave headquarters and visit providers and patients in the field, and he did so himself. As Health Affairs noted, “It’s difficult to find any health care stakeholder groups that express anything less than glowing praise for Berwick’s performance at CMS.”

In short, Berwick began to make this bureaucratic behemoth with a budget an order of magnitude larger than that of Massachusetts into a governmental ideal: compassionate, efficient, and effective. I believe he would do the same with government in Massachusetts—the same thing he’s been doing for decades—transform cultures and organizations for the benefit of those they serve.

There’s one other thing that compels me to voice such strong support for Dr. Berwick’s candidacy, and it’s a logic not confined to Massachusetts’ borders. Not for decades has the need for effective, efficient, and compassionate government been so apparent. Income inequality is widening, and industries that once provided middle-class incomes are disappearing, abandoning millions of Americans to bleak employment prospects. It has been 50 years exactly since this nation declared war on poverty, and still, one out of seven Americans struggles on in its clutches.

But this too is true: Never in our nation’s history has government been so distrusted. Half a century ago, three in four Americans said they trusted the federal government; today, just one in five does. This state and this country need government to be its best self, but they also need to see that such a self is truly possible. So if progressive government is to flourish in this state, it needs a leader who will not only direct governmental energies against poverty, illness, and racism, but who will do so tirelessly and effectively.

John Winthrop, one of the first governors of Massachusetts, famously shared his dream that the then colony would be an example that people elsewhere might look on, and say of their own lands, “May the Lord make it like that of New England.” In its long and storied history, Massachusetts has so often lived up to that dream—in education, gay rights, and environmental stewardship.

With the right leadership—Don Berwick’s brand of leadership—it can continue to do so.

Clifford M. Marks ’10 is a former Crimson managing editor.

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