Plans that include Medicaid block grants -- as Ryan's does -- are 'unsound,' CMS chief said. | AP photo Berwick: Ryan plan is real rationing

The man Republicans have derided as the “rationer-in-chief” charges that Republicans’ own budget proposals would end up rationing care to millions of Americans on Medicare and Medicaid.

“It is paradoxical really that with all this talk of rationing, the proposal we hear about how to fix American health care is to take it away from people. That’s from the very people who are crying rationing,” Don Berwick, the administrator of CMS, said in a wide-ranging interview with POLITICO. “If you look at the proposed withdrawals of support to Medicare beneficiaries and Medicaid, it’s withholding care from the people who need the care. You tell me what that is?”


Berwick has faced intense criticism from congressional Republicans over previous statements he’s made in support of the British health care system, which accusers say “rations” health care. Last month, 42 Senate Republicans asked President Barack Obama to withdraw Berwick’s nomination, indicating it would be difficult to get 60 votes to support his nomination. Berwick refused to answer questions about his nomination, with his spokesman referring questions about the nomination process to the Senate. If no action is taken, Berwick’s recess appointment expires at the end of this year.

In the interim, he’s responsible for an agency that Obama has entrusted with implementing the health care overhaul while saving millions in federal dollars. Obama’s budget proposal calls for $480 billion in savings from Medicare and Medicaid through 2023 and an additional $1 trillion in savings in the following decade.

Berwick, a pediatrician, said those savings should not come from limiting or denying care — even if it is expensive — but rather from improving care so that waste, fraud and medical mistakes are eliminated.

“When I started taking care of kids at the beginning of my career, every leukemic child died. … Now they all live. That costs some money,” he said, listing an expensive array of required treatments. “We shouldn’t give that up as a country. We need to make care better by adding the stuff that really does help.”

Without naming the plan, Berwick argued that Rep. Paul Ryan’s Republican budget proposal, which includes issuing state block grants for Medicaid and “premium support” vouchers for Medicare coverage after 2022, would deny such care.

“When I read proposals for reform that say, ‘Sorry kid, you’re on your own,’ that’s the not the country I want to be in,” he said. “And I don’t think that’s the country the public wants to be in.”

In particular, he said the idea of block-granting Medicaid — an idea endorsed by most of the likely Republican presidential nominees — has short-term attraction as governors deal with crushing budgets but is “unsound” in the long-term.

“Block grants are throwing the states out on their own,” Berwick said. “If we block grant and the next immense influenza epidemic arrives or a major recession comes back, what do we say? ‘Sorry states, you’re on your own?’”

He said new — and typically expensive — health care treatments can be balanced by reducing waste and fraud in the system.

“We afford to do it the way every other industry has done it, doing things right in the first place and by removing waste from products and services and reinvesting the harvest of smart waste reduction.”

But his critics argue that the health reform law requires nearly $500 billion in cuts to Medicare, which far exceeds the waste in the system.

“It’s tough, but it’s not tight,” Berwick said. “The amount of potential improvement in care that we could access nationally given what we know about better care for people is enormous.”

He pointed to health systems that are making improvements in readmission rates or prenatal care, such as Denver Health and Parkland Health and Hospital in Dallas. The challenge for CMS, he said, is to learn from successful programs and expand them nationally.

As health care costs and entitlement programs make up more and more of the nation’s checkbook, the need to improve health care efficiency has increased.

“The need’s never been greater,” he said. “We’ve never had the gravity of economic stakes and the well-being of the whole nation. We’re now connected to the national debt and the federal deficit.”

Berwick argued that the health care overhaul has given CMS the tools to leverage greater savings, pointing to the expansion of medical homes, aligning payment with value, and pilot demo projects.

This article first appeared on POLITICO Pro at 5:39 a.m. on April 25, 2011.