Former head of the Centers for Medicare and Medicaid Services under President Obama, Donald Berwick, talks with Chris in an exclusive interview – his first since leaving the Obama administration after Republicans blocked his appointment.
-Brett Brownell (@brettbrownell) is video and web producer for Up with Chris Hayes.
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Over the past decade, Americans watched in bafflement and rage as one institution after another – from Wall Street to Congress, the Catholic Church to corporate America, even Major League Baseball – imploded under the weight of corruption and incompetence. In the wake of the Fail Decade, Americans have historically low levels of trust in their institutions; the social contract between ordinary citizens and elites lies in tatters.
How did we get here? With "Twilight of the Elites," Christopher Hayes offers a radically novel answer. Since the 1960s, as the meritocracy elevated a more diverse group of men and women into power, they learned to embrace the accelerating inequality that had placed them near the very top. Their ascension heightened social distance and spawned a new American elite--one more prone to failure and corruption than any that came before it.
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This is soooo good. It should have been on every station while the debates on health care were going on. Every senior should have listened to it. Up with Chris in the morning is a necessity for viewing.
Hello from Milwaukee, WI where tens of thousands of citizens will lose Badgercare coverage soon. I enjoy this show because Chris gets a good amount of time to delve into a topic beyond common talking points. Five-minute segments with a contributor, political analyst/strategist, or radio celebrity are not always informative. Often, superficial news stories are just echoing of a message that is not understood. This is a long segment, 15 minutes, but it does help us get an idea of what the current health care mandate debate is about. It also helps us to realize how much power interest groups have over congress. We have an uphill battle to develop a fair and humane health care system. What we see here is just the tip of the iceberg for what it is so. Our homework, if we truly care about this country, is to move beyond propaganda and talking points and understand what is really happening. Fear is paralyzing and disables our reasoning, but knowledge is mobilizing and empowering to problem solve.
Thank you so much Mr Chris Hayes for cover this story and coming to the defense of such a great public servant that has worked to make all of our lives better through his efforts to improve the healthcare industry. It's obvious that the Fox New slander system, which Newt Gingrich health popularize in the 90's is again allowing the GOP to stray away from the older ideal conservative movement and act as an lobbyists for the giants of Pharmaceutical and Healthcare Insurance industry.
I'm looking forward to President Obama wining re-election and the democrats holding an filibuster proof House and Senate majority. Then, we can hopefully have things balance out again until people get duped into following a social platform again.
Please tell Rachel Maddow that she's also awesome, as you are as well, and congrats on your new baby! Keep up the good work on reporting the truth in a clear and understandable way!
Wow--show stopper, having Dr. Berwick. He is known to me from my past work. Visionary, advocate, interested in quality outcomes, performance improvement measures and metrics. Brilliant intellect. Deranged republicans--fearful of such intelligence and forward thinking have been clearly threatened by him. Inert beings with rancor and animosity, ultimately lacking wisdom for the good of the good. All they have is acrimony. Look at the sad sack that is John Boehner. Ill-tempered, emotional, huffy, easily irritated, embittered, perhaps. Reminds me of this: "Be not hasty in thy spirit to be angry: for anger rests in the bosom of fools."--Ecclesiastes 7:9
Think of how many elderly will survive now that Don Berwick is no longer around to ration away their care. He confirmed Medicare (single payer) is wasting 20-30%. Privatize all healthcare in order to save it.
Incredible. "UP with Chris Hayes" is now my favorite show on TV.
In my view, Dr. Berwick's rejection by House Republicans is probably the best illustration of the problems facing our Democracy today. The best man capable of shepherding the healthcare plan to a place where the quality of our healthcare is the factor that drives costs down, is rejected BECAUSE he's the best man capable of shepherding the healthcare plan to a place where the quality of our healthcare is the factor that drives costs down.
It's a travesty that the welfare of our country is being held hostage by the misguided notion that maintaining a "free market" in our nations' healthcare system somehow equates to "freedom". It's a travesty that armies of insurance industry lobbyists, in collusion with other members of the free market priesthood, are selling this ridiculous, self-serving philosophy to our elected officials as the best method of meeting their mutual goals of both, maintaining the status quo thereby protecting increased profits, and keeping the electorate in the dark about the true nature of the benefits the new healthcare law could bring to the average American.
It's enough to make you want to pick up a broom-stick and staple a big piece of cardboard to it that says:
"we better put a stop to this crap before the scales of justice irrevocable tip away from the basic principals of democracy and towards a new kind of government the world has never seen -a fascist oligarchy"
The comments made this morning were great and yes everyone should have health care; however, the majority of Americas do have health care that want it. Also if you are sick go to your local public hospital where they aren't going to turn away patients. Additionally how are we going to pay for a medicare for all plan when our economy is already being stressed without any relief in sight. If you say raise taxes- I already pay enough. If this was easy we would have already done it.
Hi Brad
If I had posted a comment about universal healthcare three years ago, it would have read exactly like yours. I completely understand where you're coming from.
However, three years ago, during the healthcare debate, I got turned around, 180 degrees, by some very smart people that I respect (my father, my older brother, and a close friend).
Here's how they addressed my concerns: (Please forgive the length. I made it as short as I could.)
".....the majority of Americans do have healthcare that want it."
Nope. 50 million Americans don't have healthcare and most of them want it. Their employer either doesn't provide it or they can't afford to pay the premiums on their own. In fact, its those "50 million" that are, in large part, the main problem. (there are others, but lets start there).
You see, those people who don't have insurance do "....go to your local public hospital where they aren't going to turn away patients." but here's the problem with that. You have to go to the emergency room to receive care and emergency room care is very expensive -about 3 times more expensive than going to a GP at a doctors office. I don't know when the last time you had to go to an emergency room but where I live its about $1200 to $1500 for a basic examination and a prescription for antibiotics. Pretty spendy, but they will see you if you don't have insurance. Now, if you go to a doctors office, that same service will run you about $400 to $450 but, and here's the catch, if you don't have insurance, you have to pay up front. Unfortunately, most people who can't afford insurance don't have 400 bucks just laying around. So, they go to the emergency room and get a whopping big bill and, the sad fact is, that bill tends to take a lower priority in the financial scheme of a minimum wage (or a little above) household. As a result, tens of millions of dollars in unpaid medical bills get added back into the system by hospitals (they're going to get paid one way or another) and passed onto everyone else. This dynamic increases the cost of healthcare for everyone and, it is this dynamic that has been the major force driving the sky-rocketing cost of healthcare in this country. Furthermore, the problem just gets worse as time goes by because the more expensive healthcare gets, the more and more people can't afford it, the more bills go unpaid, the more those costs are passed on....etc. I think you get the idea.
What do we get from this? An often overlooked fact.
You are already paying for the healthcare provided to millions of Americans that can't pay for it themselves. You're paying for it through the high cost of healthcare. So, what do we do to break this cycle?
There are several answers. We could do what the liberals want and institute a "single payer system" like "medicare for all". In this scheme the current money you pay ALREADY (no tax increase) could go into the system and...viola, healthcare for everyone! Of course it's not that simple, and there's a lot more to it, specifically, the need to build structures within the healthcare delivery system (doctors and hospitals) that reward "quality" of healthcare (see Dr. Berwicks' interview above). The idea being that "quality" healthcare drives down costs. And, here's another often overlooked (suppressed) fact,..... it works!
It's not just theory. The US is the only country in the industrialized world that doesn't have a universal healthcare system. We pay the most per person and we are, by any measure you care to use, the least healthy. Life-span, infant mortality, obesity, heart disease...etc. The US is way below the averages in all of these and actually very near the worst in many cases. In fact, out of 30 some-odd industrialized nations we are next to last in both life expectancy and infant mortality. Yet we spend more on healthcare than any other nation. (?)
"If this was easy, we would have already done it".
"EASY" can mean several things. For example, if the medical industry (insurance companies and hospitals) oppose it (which they would of course since the premium you pay now would go to medicare instead of them), legislators listen very carefully to what they say since their lobbyists are frequent, and generous, contributors at their campaign fundraisers. Hmmmm...... So getting a bill through Congress that establishes a single-payer system may not be all that "easy".
That's a "single-payer" system and it's a solution favored by those out on the left.
A more centrist solution lets the free-market play more of a role and doesn't hit health insurance companies so hard. The idea here is to simply get the uninsured into health insurance policies and thereby halt the "unpaid bill" problem. This solution involves a government mandate that everyone must have insurance and places some restrictions on insurance carriers regarding preexisting conditions, covered services, etc. For maximum effectiveness, this system also provides incentives that promote "quality" of healthcare (see Dr. Berwick above)
This "more centrist" option was first proposed by a conservative think-tank, the Heritage Foundation.
This is the option put in place in Massachusetts by its' Republican Governor, Mitt Romney.
It is this option that was enacted into law in the United States Congress in March of 2010 and that is now called "Obama-care" by it's detractors but, it is more accurately known as........
" The Patient Protection and Affordable Care Act"
The bills for my last couple of visits to the emergency room, each no more than a few hours, came to thousands of dollars for each visit. You can stiff the hospital, and they'll still have to treat you, but your credit history will be destroyed.
With the current system Americans pay much more than the other industrialized nations for health care and get worse outcomes.
Your head-in-the-sand attitude is part of the problem.
Talk about Workers Compensation....injuries sustained by workers, who have reported the injury as a work injury...talk about rationing!!!! This is about a worker who is hurt at work and wants care paid for by the employer. Their doctors barely examine you, and if you seek care in emergency room or by a regular physician, you are refused! I needed xrays and tests right away. This is what happened to me.
It was again a wake up call, of years of working but not having heath care because of the expense, and finally having insurance through my employer (in the State of California it takes 3 months), and then flatly being refused when I needed care the most.
It breaks my heart that 'Up with Chris" is just too difficult to watch if you live on the West Coast. I am a big Berwick fan and a long time supporter of his quality movement; nevertheless, even Berwick could not get me up to watch the show at 4:00 AM or even at 5:00 AM on Sunday... It's bad enough having to choose between Rachel and evening news. When will you begin to acknowledge those of us on the other side of the continent do exist ... and really care about these issues?
If you have a broad-band connection, you can watch all these shows at your leisure. They're all on the internet. That's what I do.
It's a national disgrace that Dr. Berwick couldn't even get a fair hearing considering his qualifications. (Though that could be said about many of President Obama's appointees.)
Particularly galling was the clip of Kyl; why he of the "not intended to be a factual statement" fame has any credibility is beyond me.
Craig Casey--why are you here? You are wrong to lasso him with the hackneyed notion of rationing care. He is well regarded in the field. You likely are not. Good luck losing your health care benefits under Republicans. Hope your're absolutely healthy with superlative genes.
I have a feeling you are just a right winger who never worked in health care, psychatric care, geriatric care , or anything related. You know nothing: Tr0//
Sorry for the spelling errors--I was pi$$ed