Healthcare as a Human Right: A Conversation with Obama-nominated CMS Administrator Dr. Donald Berwick

The Covid-19 pandemic has exposed several areas of improvement for our healthcare system, with many hospitalized patients confused and concerned about whether or not their health insurance plan covers their treatment. The pandemic has led many to reiterate their belief that our healthcare system is fundamentally broken. Because healthcare is not available to every citizen as a human right in our country, politicians have been quick to speak about how our largely-capitalistic healthcare system fails amid a crisis. I had the honor of speaking with Dr. Donald Berwick about our nation’s healthcare system, and why he firmly believes that healthcare is a human right. In 2005, Dr. Berwick was appointed “Honorary Knight Commander of the British Empire” by Queen Elizabeth II for his work with Britain’s healthcare system. Nominated by President Obama in 2010, Dr. Berwick served as the Administrator of the Centers for Medicare and Medicaid Services (CMS) where he managed an over $800 billion budget and managed health insurance for over 100 million Americans. Most recently, Dr. Berwick worked with Senator Elizabeth Warren in crafting her healthcare plan during her 2020 presidential campaign. Dr. Berwick is one of our nation’s leaders on healthcare, and he made clear that “no healthcare system will truly work in America until we make the promise to guarantee every citizen health coverage.”

The debate on healthcare as a human right is incredibly divisive, yet many may not be aware of what healthcare could look like if we made it available to all Americans. When I asked Dr. Berwick to share why he believes healthcare is a human right, he began by saying that “as a compassionate society, we all realize that there are some things that we need to do together in order to protect each other and ourselves. That’s why we have firefighters, publicly funded roads, and public education for children. It’s better when we have equal access to some things, and that’s partly because each one of us individually cannot produce the service or item ourselves. Take clean air as an example. We need a social contract that says we will together produce clean air. We will make it a right for people so that when we breathe, we can feel safe. The same is true for healthcare. Most of the time, illnesses that we contract are not a result of things we chose. We may have engaged in behaviors that increase the risk of certain illnesses, but we don’t know who is going to fall sick next, and we can’t assume that everyone will have the ability to fund their own care.” Dr. Berwick’s point on the financial capability of most Americans is true, with over half of Americans having less than $1,000 in savings. The economic hardship experienced by millions of American families explains why medical expenses are tied to over 65% of all personal bankruptcies: most families simply don’t have a comfortable financial safety net if a family member falls ill. 

I asked Dr. Berwick about his thoughts on those who say that we all have a personal responsibility to manage our own situations, to which Dr. Berwick replied by saying “Even if you only care about your own economic situation, you would still want healthcare available to everyone as a right because other people’s illnesses affect you. We can see that very clearly right now during this pandemic, but it’s also true for circumstances outside of this emergency. When people’s health deteriorates, total costs for society go up. And if we make healthcare a right, we can offer people an opportunity to stay healthy and have their diseases treated earlier so that problems such as heart attacks don’t arise later. Then, total costs for society would go down.”

In every developed country, healthcare is a human right… except the United States. When I asked Dr. Berwick about how our current capitalistic system would compare to a single-payer system, in which the government finances all care, he said that “The system we have now is a crazy quilt of different financing systems—numerous private insurance companies, government insurers, and even some state programs—the complexity of billing, payments, and record-keeping drives administrative costs way up.” Administrative costs in the U.S. are indeed absurd, with over $300 billion in administrative waste spent each year. That’s right–$300 billion. And don’t be fooled about where this money comes from… Dr. Berwick says that “every single nickel we spend on healthcare is coming out of the pockets of workers— there is no other source. The money is coming out of workers’ wages-as companies put money towards healthcare premiums instead of their employees’ wages… it’s coming out of the taxes they pay… and it’s coming out of their out-of-pocket expenses, which are steadily rising.” He followed this up with saying, “So, whenever we say we spend $300 billion on administrative costs, remember that every nickel is coming from workers. Instead, if we take a single-payer approach, you can take all the money we spend on healthcare—through employer contributions, tax contributions, out-of-pocket expenses—and create a healthcare system that costs far less than the one we have today. It’s simpler, more responsible, less wasteful, more proactive… and that lowers costs.” 

A traditional Medicare-for-all plan would essentially dissolve very powerful private insurance companies. In one of my previous articles, I spoke with the former CEO of Blue Cross Blue Shield of North Carolina, Dr. Patrick Conway, who spoke on the idea of having a “Medicare-Advantage-For-All” plan. Medicare Advantage is a public-private partnership in which Medicare pays for a healthcare plan, which is administered through private insurance companies. It is considered by some to be the “middle ground” between upholding private insurance and embracing a single-payer healthcare plan. When I asked Dr. Berwick about whether he believes a Medicare-Advantage-For-All program would work well, he said that from what we have seen of the program so far, “it’s a mixed bag.” He continued by saying, “It’s still private insurance, and remember, those private companies are taking profits—the government is not taking a profit—and that’s added costs. So to me, Medicare Advantage does not seem like the most favorable way to tackle the challenge of getting everyone covered.”

Dr. Berwick began working in Washington D.C. just 4 months after the Affordable Care Act (Obamacare) passed in March of 2010, so I took this opportunity to ask him about an interesting discrepancy within the Republican Party in which many Republican voters who obtain health coverage through Obamacare also chant alongside President Trump’s promise to “Repeal and Replace” Obamacare. Dr. Berwick responded by saying that “President Trump has not come up with any effective alternative to the Affordable Care Act. During Trump’s tenure thus far, millions of Americans have already lost their health insurance… If voters think that taking the Affordable Care Act away is a good thing, then they have to explain how over 20 million Americans are going to get the care they need. What happens to prevention benefits? Obamacare expanded prevention benefits to everyone—not just Medicare and Medicaid beneficiaries—so do you want to say goodbye to that? I think that as people became more familiar with the Affordable Care Act, they started to see the benefits. The bill is not perfect, but it is a big step forward for our country”

It’s important to note that about half of us already receive healthcare through government-financed or government-provided care, such as Medicaid (70 million), Medicare (44 million), Tricare (10 million), Veterans Health Administration (9 million), and the Indian Health Service (2 million). As Dr. Berwick says, “The government is already involved in your care in ways that you like. Do you really want Medicare to disappear? Don’t you want to offer our military veterans a promise of receiving healthcare? Be skeptical about this idea that the government is inept or can’t help you.” Despite its drawbacks, a government-funded healthcare system would likely be cheaper and more compassionate. For our extraordinary expenditure on healthcare, we must ask ourselves how much value we are really receiving in return. As the debate continues, however, Dr. Berwick reminded me that “we are one country… and we must make important decisions on how willing we are to be united as one country” on vital issues such as providing healthcare to all Americans.

I had the privilege of speaking with Dr. Donald Berwick, the former Administrator of the Centers for Medicare and Medicaid Services, about how he believes our nation can change healthcare for the better.

The Mayo Clinic Approach to Healing Healthcare

The power of volunteerism and compassion among healthcare workers is evident right now more than ever before. Healthcare workers are showing us the heart of America, and after this COVID-19 crisis resolves, we as a nation will stand taller. The Mayo Clinic, one of the most revered health systems in the world, is working at the front lines of this pandemic through extensive research efforts and preparing their hospitals to accommodate a surge in patients. But Mayo Clinic’s preparedness in this situation is the result of an over 150-year history of building a culture ingrained in employees. So, what makes the Mayo Clinic a symbol of hope to the 1.2 million patients who are treated at their hospitals and clinics each year? I spoke with Dr. Leonard Berry, a distinguished professor of Marketing at Texas A&M and co-author of Management Lessons from Mayo Clinic, to learn more. Dr. Berry’s book, coauthored with Kent Seltman who served as Mayo Clinic’s first marketing director, has sold more than half a million copies worldwide, and the book has been described as “a landmark” in the healthcare field by former Administrator of the Centers for Medicare and Medicaid Services Dr. Donald Berwick. Out of the innumerable positive qualities Mayo Clinic possesses, I want to discuss three that I believe are key to their success: Mayo Clinic’s high-quality doctors, its culture of medical teamwork, and its welcoming environment.

Healthcare is not a want-service, it is a need-service. We all need healthcare, and as Dr. Berry says, “the most important consumer decision you will ever make is choosing your doctor.” Only in the medical field does a patient need to trust their healthcare provider with their most personal and intimate information. From his study of the Mayo Clinic, Dr. Berry identified characteristics of Mayo doctors that help instill such a high level of physician-trust within each of their patients. Dr. Berry found that the ideal physician embraces the following qualities:

  • Confidence — the physician’s assured manner generates trust
  • Empathy — the physician is able to genuinely understand what a patient is feeling both physically and emotionally and is able to communicate this empathy
  • Humane — the physician has a deep level of care for the patient and is not rushed
  • Personal — the physician treats the patient as an individual rather than as “just another patient”
  • Forthright — the physician clearly explains the situation with a patient without beating around the bush
  • Respectful — the physician listens to the patient’s wishes intently 
  • Thorough — the physician explains everything and follows up with a patient’s health

Dr. Berry explains how many Mayo physicians possess most, if not all, of these qualities as do outstanding doctors elsewhere. At Mayo Clinic, doctors hold each other accountable. He says, “the currency at Mayo Clinic is clinical excellence, and employees set a very high standard for one another.” 

Mayo Clinic is guided by the principle of “the needs of the patient come first,” and this is clear in its compensation structure. Mayo doctors are paid by salary. While most doctors around the country are financially incentivized to perform more medical care, this is not the case at Mayo. At Mayo, a physician never has a financial incentive to do an unneeded test or procedure—or a financial disincentive to lend a helping hand to another physician. At Mayo, medicine is a cooperative science, and multiple doctors pool their knowledge and work together to treat a single patient. Dr. Berry explains how more care is not necessarily better care, and can harm the patient while resulting in waste. Dr. Berry summarizes this by saying that “those who need to bask in the starlight of personal recognition or wealth are not a good fit at Mayo and need to work elsewhere.”

I asked Dr. Berry what gives Mayo its competitive advantage among the 6,000+ hospitals in the US, and he discussed how all their medical services are provided “under one umbrella.” Mayo Clinic houses virtually every specialty in medicine, and this is fruitful for both patients and physicians. Often, if a patient has three medical issues, they have to visit four different doctors at four different facilities. At Mayo, patients receive a highly connected, coordinated care plan.

No one wants to be at the hospital, and Mayo Clinic knows this, which is why they have created a hospital environment in which the healing begins as soon as you walk in. Their buildings emphasize natural light, mute noise, and minimize the impression of crowding, just to name a few. Keeping the noise level to a minimum is a top priority, as noise is a significant patient stressor. Dr. Berry says many may not realize that moving a portable x-ray machine near a patient room creates the same level of noise as driving a motorcycle right outside the room. For kids, Mayo has embedded animal tracks in the carpet, guiding their young patients to their rooms. They even have water fountains as low as 18 inches so that not even toddlers feel left out! As Dr. Berry says, “Mayo Clinic is really good at majoring in minors… because the little things add up.” 

Whether there is a public health crisis that shakes the world or a personal health crisis that shakes your world, the Mayo Clinic will always be a symbol of hope. The compassionate culture ingrained in Mayo has created a hospital where employees want to finish the job rather than look at the clock. Stories of exceptional gentleness by Mayo employees are numerous, and each one shows us what is possible when the needs of the patient always come first. To conclude this article, I would like to share one story Dr. Berry includes in his book, describing a 91-year-old woman’s visit to the emergency room after suffering a fall. The elder woman came into the ER with her daughter, a Mayo employee, and they were seen by Dr. Luis Haro. As Dr. Haro examined her, he asked if the woman could stand up and take a few steps. As she took a few steps, she bumped into Dr. Haro. With her wit, she said, “Well, I suppose we could waltz.” To which Dr. Haro replied with “Yes, we could” before taking her into his arms and waltzing a few steps. In her letter to Mayo describing the story, the patient’s daughter says, “My mother was absolutely enchanted as she loves to dance, and I started to cry. The sight of this tiny fragile old woman being waltzed around the room by this most handsome young man was just too much… this is the caliber of doctor we have here, someone whose medical expertise is a given but whose compassion and kindness are extraordinary.” 

I spoke with Dr. Leonard Berry, co-author of Management Lessons from Mayo Clinic, about what makes Mayo Clinic a phenomenal health system.