Donald Berwick

On April 19, 2010, Berwick was nominated to be Administrator of the Centers for Medicare and Medicaid Services, which oversees the two federal programs.[16]

Berwick said, "20 percent to 30 percent of health spending is 'waste' that yields no benefit to patients, and that some of the needless spending is a result of onerous, archaic regulations enforced by his agency."[17] Berwick's critics have cited his statements about the need for health care to redistribute resources from the rich to the poor and his favorable statements about the British health service. They quote Berwick as saying, "The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open."[18][19]

Berwick said Republicans had "distorted" his meaning when he said, "My point is that someone, like your health insurance company, is going to limit what you can get. That's the way it's set up. The government, unlike many private health insurance plans, is working in the daylight. That's a strength."[17] For political reasons, the Obama administration didn't want Berwick to defend his past statements on the British health service, spending caps and high-technology care.[17]

An editorial wrote that his policy ideas could cut health care costs.[20] Conservatives criticized Berwick, based on comments he made about health care being, by definition, redistribution of wealth, rationing care with "our eyes open" and complete lives system.[21]

Berwick advocated cutting health costs by adopting some of the approaches of Great Britain's National Health Services (NHS) and its National Institute for Health and Clinical Excellence (NICE). NICE evaluates the costs and effectiveness of medical therapy that is covered by the NHS as guidance for local authorities to decide what to cover. Mark McClellan, who served in the Bush administration, also advocated adopting some of NICE's methods.[22]

Conservative critics claim, "NICE decides which healthcare people will get and which they won't."[23] Philip Klein in The American Spectator dubbed him "Obama's Rationing Man".[24] The chairman of NICE called these statements "outrageous lies".[25]

Senator John Kerry defended Berwick against "phony assertions" and accused Republicans of trying "to crank up the attack machine and make his nomination a distorted referendum on reform".[26] Former Speaker Newt Gingrich has historically been a Republican supporter of Berwick, however, writing an op-ed in The Washington Post in August 2000 praising Berwick's work.[27]

Berwick was installed by recess appointment on July 7, 2010, before confirmation hearings were scheduled by the Democratic-controlled Senate committee.[28] Berwick could thus serve until the summer of 2011 without a Senate approval. The White House had talked up the possibility of a re-nomination through the fall of 2010; on January 26, 2011, the President re-nominated Berwick. On March 4, 2011, 42 U.S. Senators wrote the White House and asked for the nomination to be withdrawn. The signers of the letter were all Republicans.

Berwick resigned his position at CMS on December 2, 2011.[29] In a speech on Wednesday, December 7, 2011, in Orlando, Florida, at a meeting of the Institute for Healthcare Improvement, an organization he once led, the long-time patient-safety advocate gave an account of his time in government service and where he believes the future of healthcare is going.[30]

Donald Berwick was the lead author of the Berwick Report, a seminal report into patient safety in England, following the Stafford Hospital scandal.[31]

Berwick was knighted in 2005 for his work creating new care models in five trusts in the UK’s National Health Service—acute care hospitals, multi-specialty groups, accident emergency rooms, mental health, and nursing homes.[32]

Don Berwick speaking at the Rappaport Center for Law and Public Service, Suffolk Law School on January 15, 2014

On June 17, 2013, Berwick announced his run for the Massachusetts Governor's office. Berwick framed himself as progressive on major issues and said it was crucial that Massachusetts continue to focus on health care reform and the well-being of children, topics he has focused on during his career. Berwick, who holds three degrees from Harvard, repeatedly emphasized his experience in helping health organizations deliver better care to consumers, an asset he said he would bring to being the state’s chief executive.[33]

Some of Berwick's specific goals for the governorship included focusing on job creation and economic development, instituting single-payer healthcare in Massachusetts, and ending child poverty in the state by the year 2024.[34] Following the conviction of former probation commissioner John O'Brien on corruption charges, Berwick added that rooting out corruption would be another priority.[35]

Although Berwick was seen as the heir to the Massachusetts trend of electing political outsiders to high offices, like Governor Deval Patrick and Senator Elizabeth Warren, pundits raised concerns in the Summer of 2014 that Berwick had failed to gain the traction he needed to succeed in the primary.[36] However, he outperformed nearly all projections and pollsters in the Democratic primary with 21% of the vote, which prompted the recognition of him being a "surprise" in the race.[37]

Berwick conceded the Democratic nomination to Massachusetts Attorney General Martha Coakley on September 9, 2014,[3] who lost to Republican Charlie Baker at the general election.