Don Berwick spent 18 months as the administrator of the Center for Medicare and Medicaid Services, making him the point man for the Obama administration’s implementation of the Affordable Care Act. He began in the post in July 2010 and resigned last November, in the face of Republican pledges to block his nomination in the Senate. Republican legislators seized on remarks he made praising Britain’s National Health Service as an “example” for the United States to follow. Many accused him of supporting the “rationing” of services, a claim Berwick has rejected.
On Friday, the two-year-anniversary of the Affordable Care Act, Berwick announced he would be joining the Center for American Progress as a senior fellow. His position at the liberal think tank will include, among other responsibilities, defending the health-care law and ensuring its successful implementation.
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Berwick spoke with The Washington Post about how the Affordable Care Act has changed the health-care system, what challenges it faces in coming years and why his time as Medicare administrator may be his only stint in government service.
What follows is a lightly edited transcript of the discussion.
Question: The Affordable Care Act has hit its two-year anniversary. Tell me how you think it’s changed the health-care system over the past two years.
Berwick: It’s profoundly changed the conversation for the good. The momentum in the country toward an expansion of coverage is underway. I think people have an understanding of how important that is, to have insurance be accessible. The second part of that, the improvement of our health-care delivery system, is going to be slower for people to notice. It will take time to build and have people understand how its changing.
It’s also not only the programs contemplated within the law that are changing and gaining momentum. I definitely see reflections of what we want to see in health care. There’s faster progress in the private sector. I think the Affordable Care Act has changed the mentality of the nation, toward one where we realize we can provide better care.
You spent 18 months at Medicare, and made a lot of trips across the country to visit health-care providers. What’s one that had a big impact on you and gave you a sense of where our health-care system is headed?
One of the most impressive visits was a rural road trip I did with the regional Medicare staff in Seattle. It was a bunch of us in a van, playing U2, and it really was quite fun. I visited western Oregon and was traveling down the coastline visiting these tiny hamlets that have critical access hospitals that were having a really tough time in this economy. You had primary-care doctors there who impressed the heck out of me. You had a hospital that was recruiting retired dentists from the area, putting them in a van, and setting up a mobile clinic. I think that’s really related to the goal of health reform: figuring out a better way to deliver health care.
Reflect on your experience in Washington working for the Obama administration. Republicans opposed your confirmation as Medicare head, and there were a lot of accusations about you wanting to “ration” health care. What’s the climate like for discussions about health policy here?