A very brief post on Berwick

The summer is not a good time for blogging. Vacations and conferences divert my attention from the news and force me away from my computer, as they should. Meanwhile, actual work–that for which I am paid–backs up. Family and work get top priority. Blogging never will.

I never could say something about everything, even in health care. Over the summer I’ll say even less. Thus, I don’t have much additional to add about Berwick beyond what has already been said by other excellent bloggers. (You should be reading Jon Cohn and Ezra Klein, among others.)

My very brief comments about Berwick that I haven’t seen made elsewhere (like I said, I’m not keeping up at the moment, so I may have missed it) are these: his role is to run the Centers on Medicare and Medicaid Services (CMS). As such, he will be very influential in how CMS implements Medicare and Medicaid related health reform initiatives. So his purview is large, but not unlimited. He’s not in charge of other aspects of health reform outside of those two programs.

That’s not to say he cannot be more broadly influential. He already has been and will continue to be. But his influence competes with other voices, and there are more of them as one goes beyond CMS.

With respect to Medicare, Berwick’s power is checked by a huge political force, the voting power of beneficiaries of that program, mostly senior citizens. As I’ve written dozens of times before, politics matter in policy. And no politician is unaware of the importance of senior citizens at the polls. Berwick can’t go too far too fast or the Administration will react to enraged beneficiaries and kick him out. (Need I invoke the memory of the Catastrophic Coverage Act revolt?)

At the same time, if he implements changes in Medicare that beneficiaries accept and that save money and/or increase quality, why should I complain? There will be spillovers, and they could affect my receipt of health care. But if the extremely health policy sensitive senior citizens think they’re OK, I bet they are, broadly, just that: OK. (I reserver the right to argue otherwise when I see what is proposed.)

That’s my two cents on Berwick. You’ll have to find the other 98 elsewhere. His summertime, recess appointment may have been appropriate, but it isn’t convenient for this blogger.

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