Says Don "death panel" Berwick, who'll count on his connections to make sure his family gets the best, while the unwashed masses (ie you and me) get the dregs. As Ralph Waldo Emerson said: "The louder he talked of his honor, the faster we counted our spoons."

Hey thecpt, what are you talking about? Unfortunately, many (most?) of the comments in the Globe are increasingly written by no nothing Republicans...

Dr. Berwick is correct that money is being spent on the wrong things and belongs somewhere else. This is a shift in the right direction. However since this movement is sideways there is no net reductions in cost. To do that requires efficiency. What it actually means is that the Health Care Industry is overloaded somewhere with unnecessary personel. The most logical point to begin with a bureaucracy that tries to deny care, engages in complex negotiations with providers, sets burdensome rates unevenly for the same services, and divides the risk pool instead of taking advantage of including all subscribers in the same system. The latter makes sense since their premium contributions are holding up the health care system as a whole, not in pieces. No one is carving out a chunk of care for themselves or their families. It goes towards the human actors and equipment to have treatment at the ready when it is needed. Of course eliminating unnecessary care is essential but, unfortunately, it does not save any money since the professionals and their support staff remain in the same numbers.

It is always interesting to read the bean counters discuss health care. What does it say of a society that dishes out health care in a for-profit manner. You say it is the description of a society that is devolving as opposed to evolving. Health care like education in fact like many things should be done by individuals who are rewarded by the very work itself not the wealth it may accrue. Now this may seem contradictory to human instincts yet one must wonder when exactly does the evolution of human consciousness catch up with his intellectual abilities. If wealth is to become our cornerstone of values then fixing the health care system or the educational system or anything that relates to human improvement will never be possible. Whether it strikes at the core of some odd belief or not we must at some point ask the question just when is enough comfort enough and when do we act out of a desire to improve life.

Dr Berwick if we are truly going to cut what is of no value in health care why didn't you mention the health insurance industry? It doesn't add any value to patient care. It sucks a huge amount of money out of the system to support itself. It forces providers to hire large numbers of people and spend hours away from patient care to meet its ridiculous administrative requirements. Yet any discussion of cutting this cost is completely off the table. Perhaps if you stopped being a pure academic/administrator and got back in the trenches you would realize how your so called quality indicators are easily gamed and actually decrease the quality of care in the vast number of areas that are not measured. During your tenure at CMS you came up with some really bad ideas. holding hospitals responsible for readmission when they don't have police powers to control patient compliance and ignoring that Medicare's prospective payment system penalizes a hospital if the patient is inpatient too long. Then there was the initiative that encouraged hospitals to spend millions on consultants to make sure people would say the right words to patients. Sorry Dr Berwick but I think you are completely out of touch with the area you claim to be an expert on.

I spent three days at a local (West Roxbury/Roslindale rehab center this time last year after a shoulder replacement. The care was so bad I signed myself out after three days. When I reviewed the discharge notes I thought for a minute I was reading someone else's notes; the entry physical, given by yje Medical Direcotr ( recently named to a Super Duper Medicare panel), decribed tests I never, had parts of my body as normal that were not, I never received prescribed medications "We can't find them,"; the staff smelled so strongly of perfume, to which I have a severe allergy that they gave me a private room,I had practicaally NO physical therapy (but I'm sure they billed for it)...and this is only the tip of the list.