“If you're a fan of ‘Star Trek'—and I'm a fan of ‘Star Trek'—you may know that Mr. Spock, the Vulcan, said good-bye the Vulcan way: Live long and prosper,” Berwick said, as he offered the Vulcan salute to an audience of suits at the Washington Hilton on Monday. Berwick used those words as a lead-in to explain that the American healthcare system is neither living long nor prospering. Globally, the U.S. ranks about 30th when it comes to lifespan, Berwick said, as the country continues to fight chronic diseases such obesity, diabetes and asthma. And America's healthcare system isn't prospering, as medical costs absorb what Berwick called an “enormous and rising share” of federal and state budgets. So it was a fitting message that served his point.
But after he said it, I realized Berwick could have used the same reference to describe his own situation at CMS. It's highly unlikely Berwick will “live long and prosper” as the agency's administrator because there doesn't seem to be any chance he'll receive the 60-needed Senate votes to be confirmed. There have been rumblings that CMS Principal Deputy Administrator Marilyn Tavenner is a contender for Berwick's job if the administration pulls his nomination. Tavenner, a nurse, spoke at two events—one in Nashville, one here in Washington—last month, which caused me to wonder if she's on the speaking circuit as she prepares for the administrator role. But evidence doesn't seem to support that (not yet, anyway). A list from CMS shows Tavenner has spoken a total of just 16 times in the last year. And those engagements peaked last summer, when she spoke five times in four cities over a 12-day period in June.
After Berwick's remarks to the AHA, I asked him about the latest guidance he's received from the administration about his tenure at the CMS.
“My focus is on the work I'm doing every day,” he said. “What I'm doing is enjoying my job- loving it, getting to come to work every day, and let others worry about that issue for me,” he added. “It's just getting this job done the best I can while I'm there.”
That's not only a good approach for any leader, but especially wise for one whose current job depends on the approval of the U.S. Senate. For that, Dr. Berwick must understand too well the words of Dr. McCoy in Star Trek IV: The Voyage Home when he said: “The bureaucratic mentality is the only constant in the universe.”
—Jessica Zigmond, Washington bureau chief