Donald Berwick, the new and controversial head of Medicare and Medicaid, has a bum knee.
The trouble started about 40 years ago when Berwick, playing soccer, suffered a painful partial dislocation of his kneecap. He underwent surgery, which was unsuccessful and followed by a second surgery, and he later developed a terrible case of osteoarthritis.
Beyond the pain, the whole incident troubled Berwick because the first knee surgery was later discredited for his injury. "In retrospect, a brace and some exercises would almost certainly have been enough," he wrote in a 2005 journal article describing the experience. "My first knee operation may well have been done not because my knee problem was there, but because the knee surgeon was there."
The story epitomizes the controversy surrounding Barack Obama's new top health care official, named to his job in July. His critics think he wants to ration all health care. His fans believe he understands better than anyone how hospitals and physicians operate inefficiently and profit from unnecessary procedures when less invasive, simpler and cheaper remedies can sometimes work as well or even better.
It is hard to know for sure because Berwick has been all but invisible since Obama installed him via a recess appointment as the head of the Centers for Medicare and Medicaid Services (CMS). Still hoping to keep Berwick and criticisms of health reform out of the spotlight, the White House has declined to make him available for media interviews. "Apparently," quipped one health care policy expert, "they have him in a cave somewhere."
But not for long. Berwick will give the first public speech of his tenure on Sept. 13 at a Medicare and Medicaid conference in Washington, D.C.
Interest in his remarks will be high because Berwick is perhaps the single most powerful person in American health care, overseeing a 2011 budget of $759 billion larger than the Pentagon's and a bureaucracy that includes 4,500 employees providing health coverage for some 100 million Americans. As part of the new Affordable Care Act, Berwick will begin the process of cutting some $500 billion from Medicare largely by eliminating subsidies for the private insurance program known as Medicare Advantage and lay the groundwork for adding 16 million Americans to the Medicaid rolls. He will also head up an effort to reform Medicare through a series of pilot projects that hold perhaps the greatest hope for slowing the runaway health care spending that has the system and the country on a path toward financial ruin.