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Perhaps we could encourage Dr. Berwick to run for President -- as an Independent, of course. Forget the Dems and Reps.


I do not know anything about Mr. Berwick. However, as I look at his list of 5 things I don't see how any of these 5 things meets his stated goal in the paragraph that immediately preceeded it, namely: "To reduce costs, by reducing waste, at scale, everywhere, now."

1. Putting the patient first is certainly an important goal. But to state that doing so is the only way we will know waste when we see it? Why is that? That doesn't sound evidence based. It sounds a little like wishful thinking.

2. Putting the poor first to meet the moral test? Why is that moral? Should those of means be treated worse than those without? This is a moral judgement and one that doesn't relate to the stated goal of reducing costs either.

3. Start at scale and do everything? So rather than identify areas for improvement he is proposing to radically alter the entire system by "flooding the zone". And what evidence based research suggests that radical change is more likely to be successful than incremental improvement. Mind you we are not talking about a system full of failures. We are talking about a system the provides excellent health care at a higher than average cost. Are we to believe the best approach in that instance is radical change by "flooding the zone" whatever that phrase is supposed to mean?

4. Return the money by making the bill which is paid by all parties fall? Wait a minute. The first rule of definitions is you cannot be self referential. You actually have to propose a means to reduce costs. Saying you are going to reduce costs by making the bill fall is not proposing anything. The fact that such a meaningless statement could make his top 5 list is quite concerning.

5. Act locally. Ok, that may be fine. Not exactly sure what that means so I would need to see more details to see if there is anything here that could be thought to reduce costs. As it stands the idea seems fine but not sure if there is any good reason to believe it is either cost reducing or even possible in a system with so many non-local requirements.

As I said, I am not familiar with Mr. Berwick. He may be everything he has been promoted to be here. If so, this list is far from his best work. However, I certainly wouldn't hire him based on it.


The idea of "cutting costs" threatens to upend the status quo of medical care in America, which is currently awful for the patient, but very lucrative for several other parties. Those parties happen to have a lot of money, which they also happen to contribute to members of Congress. Since those members need the money to get re-elected, it's unlikely we'll see anyone that isn't dedicated to the massive profit margins of insurance companies and medical institutions in that position.


Now Bob, your hope and altruism are showing. I have had a framed cross-stitch piece on my office wall given to me by wife a very long time ago which reads, "The one who says it can't be done should never interrupt the one who is doing it." Or in other words, illigetimi non carborundum. Great post.

David Zinger

Thanks for the heads up on this very moving transcript for Don Berwick's speech. He had so much influence with his 100,000 lives campaign. As a Canadian his principles just make good sense just for the health of it!

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