DON BERWICK looks like a Norman Rockwell portrait of a doctor. It’s the annual Center for Primary Care gala at Harvard Medical School, and he’s the invited speaker. With silvery white hair and glasses, he’s moving about the room, talking to dressed-up students and professors. He appears to be seeing lots of old friends. He seems to be at home.
From the front of the room, an event organizer rattles off Berwick’s accomplishments, praising his many publications and leadership of Medicare and Medicaid. At the end of these accolades, Berwick takes the podium to raucous applause. He explains the dire state of American health care, throwing out wonky terms like “fee-for-service” and “accountable care organizations.” He talks about the need for our medical system to focus on the patient; the audience nods and gives murmurs of approval. He’s a preacher in front of his congregation. And you’d never know he’s running for governor of Massachusetts.
On June 17, Berwick announced that he was entering the Democratic primary race. Relatively unknown outside of the health policy community, he touts his experience as “a doctor, an educator, an innovator, and someone who has dedicated his professional career to making things work better and to helping people.” A central message of his campaign is that he can apply his health care expertise towards other fields like infrastructure, education, and business. He wants to rein in health spending to open up the state budget and make the Commonwealth “an example for the country about success in all sectors.”
Medicine, however, has seldom been a proving ground for politicians. Fewer than 6 percent of our representatives in Congress are health care professionals, compared to 32 percent with backgrounds in law and 24 percent from business, and we’ve never had one as president. More pertinent to Berwick’s case, only two current governors have a medical degree, and nearly 200 years have passed since Massachusetts last had a physician for governor — Dr. William Eustis. Even Joe Avellone, another doctor and one of Berwick’s competitors in the race, has opted to focus on his business experience as a qualifier for the job.
From health care providers who have held elective office, we’ve also learned that the qualities associated with these professionals — from faith in science to diagnostic rigor — often don’t translate into the political realm. For example, doctor-politicians have been every bit as likely as their colleagues to follow party lines and pander to their bases, support crackpot theories, and restrict scientific inquiry. If you don’t believe me, look up Dr. Paul Broun, a congressman from Georgia, or Dr. John Barrasso, a senator from Wyoming.
In this respect, Berwick provides an exciting view into the evolution of a candidate; he’s never run for public office and has a fairly clean slate on which to shape voters’ perceptions — a poll in May showed that only 17 percent of Massachusetts voters had an opinion on him, the fewest of any potential contender. What’s more, his campaign strategy flies in the face of abiding trends that say medical professionals rarely ascend to the highest levels of government and, when they do, often fall prey to the ideologies of party politics. The real question is whether Berwick can sustain a sensible approach to statewide office or whether the political landscape will reduce him to the pandering positions and personal prejudices shown by many of his predecessors who left medicine for public service.
Back at the medical school, nestled among the Longwood area’s hospitals and clinics, Berwick is building cadence into the finale of his speech. “We need to rebuild health care in this country,” he says. “The rescue plan for American health care is the rescue plan for American society.” He finishes by challenging the health care community to raise its voice and be heard in the public arena. As he steps away from the podium, he’s met with a rousing ovation and whistles.
For now, Berwick appears to be the strongest voice for the cause. If he can expand his celebrity outside of the medical bubble, he may have a shot at the State House. To do so, he must prove that he can tackle poverty, crime, and the other issues that plague Massachusetts with the same vigor that he approaches health care. It’s an experiment that bears watching.Nathaniel P. Morris is a Harvard medical student.