• Donald Berwick and the lack of professionalism in American government

    To no one’s surprise, Donald Berwick resigned this week. He’s been a bureaucratic dead man walking for almost a year, certainly since 42 Senate Republicans signed a letter opposing his confirmation. I’ve written about this before. I don’t have much to add to what I’ve said.

    Like Peter Diamond and Elizabeth Warren, Berwick is a highly qualified professional deemed unacceptable to the president’s political adversaries in a remarkably partisan process. As described here, he is a leader of the health care quality improvement. His methodical research and practice have saved many thousands of lives. He is a visionary figure with a fingertip understanding of many organizational issues at stake in health reform. He’s also a doctor, who can say things that need to be said to other doctors about quality improvement, cost containment, and other matters.

    Unlike some other Obama administration officials thwarted by the Senate confirmation process, Berwick is a technocratic figure who isn’t especially identified with partisan Democratic causes. One could easily imagine him serving in a Republican administration. His was an available scalp in the crusade against ObamaCare. I must add that Berwick was poorly served by the Obama administration and by some Senate Democrats, who let Republicans shoot too many wounded officials at too little political cost.

    One can also imagine Democrats responding to his shabby  treatment by kneecapping figures such as Mark McLellan, Gail Wilensky, or Greg Mankiw in the next Republican administration. I hope they don’t do this. Collecting more scalps within the executive branch won’t advance any progressive cause or the cause of good government. It will just turn the wheel one more time in a broken and astonishingly unprofessional confirmation process that deters excellent people in both parties from serving.

    • I think it is a shame that Dr. Berwick has been forced (politically)to step down. I have read many of his papers and several of his books. I disagree strongly with his promotion of government solutions to improve healthcare access and quality, but as best as I can tell, he is a man of sincerity, integrity and significant intelligence. His grasp of quality improvement has been and could continue to be a valuable contribution to the care of patients and the progress of medicine. I agree he has been poorly treated by his opponents and abandoned by his allies. He brought a difficult message to the health care debate, one that needs to be heard and dealt with, but instead of serious engagement, too many chose to shoot or run away from the messenger. The loss of such a contributor is an unfortunate side effect of the politicization of medicine–a fact that must be dealt with if we are to be able to work together in spite of our disagreements.

    • Nice comment.

    • Having had private insurance via Cobra for $1200 a month and now Medicare Advantage for $225 a month
      and hading had major surgeries under each coverage, Medicare wins hands down, walking away, con contest.
      Thinking that private insurances is a better deal is, from my experience, ludicrous and unfounded.
      From real life experience.

      Regards, Cheers, and Happy Holidays


    • While I agree with your sentiments, what does game theory predict if one party hinders appointments while the other part does not?


    • Here’s a little history.


      It’s a little disingenuous to think that someone with his record of provocative, simplistic, and inflammatory statements on subjects that would be central to his responsibilities would not have to give account for his positions in a confirmation process. This suggests the kind of illiberal and antidemocratic attitude that informs the entire enterprise.

      • What simplistic statements did Berwick make? He is, beyond doubt, qualified, so what did he say that made him not a good candidate?


    • Will is a perfect example of Steve’s point. People who share Will’s views will not stop at blocking the next expert technocrat for political reasons. If only one side shows restraint, what is the story for how it ends well (assuming anything less than a total victory for Republican control of government counts as “ending well”)? Do you just wait for them to somehow punch themselves out? We’ve been drifting rightward since 1980, with huge affects for equality and economic development (more outside healthcare than within it).

    • Sorry, Will, based on your comment and a misreading of the URL as for National Review, I thought you were promoting a partisan hack piece. The National Affairs article certainly is not that, though in its efforts to be even-handed it does miss some important history and misses some of the forest for the trees.

      The obstruction on nominations for this administration has been vastly higher than any previous. And it isn’t just the result of an upward trend. Nearly twice as many Clinton appointments were forced to a cloture vote as Bush II.

      I couldn’t find an updated chart showing the numbers after a few minutes of googling, but I know I’ve seen one about a year ago.