Intended for healthcare professionals

Observations Yankee Doodling

The rise and likely fall of Don Berwick

BMJ 2011; 342 doi: (Published 14 March 2011) Cite this as: BMJ 2011;342:d1640
  1. Douglas Kamerow, chief scientist, RTI International, and associate editor, BMJ
  1. dkamerow{at}

Failure to reappoint the Medicare chief will be a disappointment. What can be learnt?

Democrats have given up hope of saving Donald Berwick, the current director of the influential and costly US Medicare and Medicaid health insurance programmes. He is now likely to lose his job at the end of the year. It is a disturbing and discouraging development, worth reviewing for possible lessons learnt.

The Centers for Medicare and Medicaid Services (officially abbreviated, incorrectly, as CMS) is the proverbial 800 pound gorilla of US healthcare. Its Medicare programme pays for care for Americans aged 65 or older, and its state based Medicaid programme covers uninsured poor people. More than 100 million US citizens have CMS administered insurance. The administration asked Congress for just under $850bn (£530bn; €615bn) to fund CMS next year, and its programmes are growing as the United States ages and more poor people are covered under the health reform’s Affordable Care Act.

In addition to its direct role in paying hospitals and doctors for care, CMS has a huge influence on private sector insurance as well. Because of its size, …

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