Former Medicare chief Donald Berwick was present both on and off the screen for a Thursday Martha’s Vineyard showing of a new film on the health care system. Berwick, who spends part of his summer in Chilmark, was fresh off an interview with WBUR’s On Point call-in show. So, he was ready to comment on the Medicare voucher plan proposed by Republican Vice Presidential candidate Paul Ryan.
Berwick thinks the addition of Ryan to the ticket will be good for the debate over the Medicare budget.
“You see Romney trying to explain the Ryan plan. I think it will help clarify the difference in viewpoints,” between the two parties, he said.
At the same time, Berwick noted that issues surrounding Medicare are complicated – he admited that he had study up on some technicalities when he took over the national health plan for the elderly for a year. So, voters are already hearing a lot of “irresponsible rhetoric” and one-liners, he said.
As it turns out Romney and Ryan were also in New England this week– talking about Medicare during yesterday’s campaign stop in New Hampshire. The Boston Globe reported that Ryan said he invites a debate on the plan. He characterized Obama’s approach this way:
Mitt Romney and Paul Ryan, campaigning in a state with a median age higher than Florida’s, criticized President Obama on Monday morning for his health care law and said the Republican ticket would be more likely to put Medicare on sounder financial footing.
“Medicare should not be a piggybank for Obamacare!” Ryan said.
Romney and Ryan charge that the health reform law takes $750 billion from Medicare to pay for the new health law. Berwick said that’s “not really true.” The changes in payment are designed to promote changes in the way care is delivered, he said. “It doesn’t take a nickel away from beneficiaries. The Ryan plan is the one that takes money away from beneficiaries by putting them at risk. “
The Ryan plan cuts Medicare by setting up a voucher system, he said. Instead of a guaranteed benefit, the approach would become a guaranteed payment in the form of a voucher. It cuts the budget, Berwick noted, by telling beneficiaries – “It’s your problem now.”
Interest in the topic drew a full house to see Escape Fire: The Fight to Rescue American Health Care in a small viewing room in Edgartown’s Harbor View Hotel. (The title refers to a method firefighters use to avoid being burned by a wildfire.) The movie offers a beginner’s overview of the problems facing the health system, as well as three engaging stories of people coping with them. The subjects – interspersed between talking heads — include a doctor, a soldier and a victim of grossly excessive treatment for heart disease. Judging from the gasps from members of the audience, familiar facts about problems like medical errors were new to them. “Disturbing,” one woman leaned over and whispered to the companion.
Besides Berwick and Steve Nissen of the Cleveland Clinic, the commnetators in the film did not represent the usual suspects. Most people associate Andrew Weil and Dean Ornish with healthy lifestyles, not systemic change. Still, they spoke to the need from more preventative care. (The audience seemed to agree. A heart attack patient opening a can of Vienna sausages and smoking a cigarette generated the loudest groans.)
Berwick also offered something different. Instead of demonizing doctors and drug companies, he doesn’t blame any of the players, who are working within the system as it stands.
“They’re just doing what makes sense,” he said. “We have to change what makes sense.”