INSIGHT & INSPIRATION FROM APHA’S 2012 MIDYEAR MEETING

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Survive All In This Friends Prevention, Strategies
& Thrive Together For Health Opportunity & Equity for Health
2012 Midyear Meeting Opening Session:
‘The Biggest Risk Of American Health Care Today Is That It Will Fail The Moral Test’
Donald Berwick, former administrator of the Centers for Medicare &
Medicaid Services, started his opening session keynote address with an
admission: He wasn’t sure how to address the question of how public
health can thrive in today’s changing health care world. The question,
he told attendees, doesn’t have an easy answer.
The Affordable Care Act, he said, does essentially two things: It attempts
to make health care a right, and to make health care sustainable
via improvements in quality and delivery. The question of how to define
what improvement means — and what we should expect — in an era
of health reform is what motivated Berwick as he worked to transform
CMS to align with the goals of the now-famous “Triple Aim:” Better
care, better health, reduced costs. However, the framework also stresses
the importance of equity — an overriding goal of public health work.
According to a 2008 Health Affairs article Berwick co-authored, the “Triple
Aim is an exercise in balance and will be subject to specified policy
constraints, such as decisions about how much to spend on health care
or what coverage to provide and to whom. The most important of all
such constraints, we believe, should be the promise of equity; the gain
in health in one subpopulation ought not to be achieved at the expense
of another subpopulation...A health system capable of continual improvement
on all three aims, under whatever constraints policy creates,
looks quite different from one designed for the first aim only.”
“The biggest risk of American health care today,” he told opening session
attendees, “is that it will fail the moral test.”
Berwick said, in part, it didn’t matter how the Supreme Court ruled on
the health reform law, as the “health care evolution agenda” had already
left the station and is quickly moving toward improved care coordination,
better transparency, patient-centered care and the adoption of
health care technologies. And the opportunity to provide input as health
care evolves doesn’t depend on your ties to Washington, D.C., he noted
— it’s a community affair.
But what does it all mean for public health? Berwick said he wasn’t
entirely sure. Public health faces real challenges, he said, especially
in communicating its value to the public and to policymakers. It’s that
classic problem of how do you tell the story of a person who didn’t get
sick or injured because of a successful public health intervention? How
do we communicate the value of prevention, even if it doesn’t always
save health care dollars?
So, while Berwick began his keynote not sure about what advice he
could offer, he did end with what he called a prescription for public
health: When possible, reduce costs within public health; cooperate and
don’t work in silos; reach out and partner with nontraditional organizations
and systems; get involved in reducing health care costs and waste;
and mobilize support for public health.
“Public health needs mobilization too,” he said. “If there isn’t political
force behind the public health endeavor, it will remain frail.”