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President Obama, Don Berwick, and the 17.3% Solution

17 May, 10 | by David Stevens

I hear something new every time I listen to Don Berwick—CEO of the Institute for Healthcare Improvement—speak. He is consistently able to adapt innovative ideas to a listener’s context—providing fresh meaning and insight.

Several weeks ago President Obama nominated Don to head the US Centers for Medicare and Medicaid. This position directs a federal agency with a massive budget for the care of the US elderly and poor—$453 Billion for Medicare and $290 Billion for Medicaid in 2010. It’s a considered move with the potential to assert new strategies for healthcare improvement and reduction of waste in a country where fully 17.3% of the gross domestic product went to healthcare in 2009. In spite of this financial commitment, the data show that US healthcare outcomes frequently underachieve when compared to many other countries that spend far less.

But first there’s a political reality. The President has to gain formal approval of Don’s appointment from a US Senate that is deeply divided over the Obama healthcare initiatives.

The culture, context and prior assumptions that go into hearing a speech, or—for that matter—improving healthcare, are very complex. Don’s quotes are making the rounds in newspapers and blogs. One of my favorites recently made it into Robert Pear’s New York Times article about the appointment: “’Health care has no intrinsic value at all, none,’ Dr. Berwick said. ‘Health does. Joy does. Peace does.’” I recall these words when they brought the IHI National Forum audience—6000 strong—to their feet in his plenary last December.

Unfortunately, I can only guess at the ways this comment will be heard in the many contexts where healthcare reform is being debated in the US. Health? Joy? Peace? In the politics of US healthcare, the context itself increasingly seems to shape the news, creating new interpretations of old statements to fit the spirit of the audience.

But, the data arrive wrapped in their own context. Let’s have a show of hands for those who don’t think that 17.3% of the US gross domestic product is a monumental opportunity for better and safer healthcare—plus a whole lot more. Now that’s the context for a discussion I’d like to hear.

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