Sister Carol Keehan, president and CEO of the Catholic Health Association, came under fire from some quarters when she vocally supported this year’s congressional reform of the health-care delivery system.
Now Sister Carol, a member of the Daughters of Charity, is being criticized for her support of Dr. Donald Berwick, a professor at Harvard Medical School who received a recess appointment from President Obama to be administrator of the Department of Health and Human Services’ Centers for Medicare and Medicaid Services.
Sister Carol spoke to Register correspondent Joan Frawley Desmond about her support of the Berwick appointment.
Why did you choose to issue a statement of public support for Dr. Donald Berwick?
Dr. Berwick’s whole professional life has been focused around quality care. He developed the Institute for Healthcare Improvement, a nonprofit organization, with the goal of saving 100,000 lives from medical errors. He was one of the prophets, one of the first people who said, “We’ve got to do a better job on quality of care and consistency of quality of care.”
I happen to believe that quality care is not only the best care, but less expensive as well. If you prevent an infection in a patient, you make their hospitalization shorter, less dangerous and less expensive. If you manage a pregnancy so that the mother does not deliver early and she delivers a healthy baby that never needs to go into the ICU, you have given great care, protected the baby and mother; that family can take the baby home, and you’ve saved a ton of money. When I say that I support what he’s doing, that’s what I’m talking about.
Dr. Berwick has been criticized for advocating the rationing of health care. Have you received any feedback from the U.S. Conference of Catholic Bishops or your members since you issued your statement supporting his appointment?
One or two blogs that don’t like anything I say or do have responded.
Judging by press reports and public statements, Dr. Berwick strongly prefers the British health system and believes that the private sector doesn’t really belong in health care. What are your concerns about government-run health-care systems like the British system?
Dr. Berwick said something nice about the British system, but he didn’t sound like he was in love with it.
I don’t have excessive concerns about the record of government-run systems, but I am concerned about the regulations that will be developed now in this country. We all want to give input so that regulations will drive quality care and fairness.
A recent study issued by the Commonwealth Fund reported that the United States comes in last of all the industrialized nations in quality of care and outcome, with twice the GDP. The British system may not fit our psyche, but it fits their psyche, and they get good outcomes.
British-style systems include health-care rationing, and that worries the pro-life movement and many other Americans. For example, patients in wheelchairs are deemed less qualified to receive certain services in Britain.
The danger of a rationing approach would be to lose sight of the dignity of human beings. Some of the rhetoric and fear-mongering has gotten wonderful people concerned. But a man whose whole career is championing the principle that everyone deserves quality of care is not in danger of doing that.
Restructuring our health-care system, to some extent, needs to be a partnership of providers, payers and patients. As long as all those voices are at the table, we have the ability to keep the focus where it should be. Each group has something important to give to the discussion. We need to listen to voices who say, “Be careful — you don’t want to imply that someone isn’t qualified to get care because of age and infirmity.”
But we know that today there is overuse of diagnostic modalities, and they don’t bring any benefit to the patient. So we want to be certain that patients are getting quality of care. If we use quality data to make decisions, we have to ask: Does it have any potential to help the patient? Will it make them uncomfortable? Does the patient want that?
I don’t worry about us rationing — deciding that you can’t have a hip replacement or dialysis. But if we just talk about how health care has gotten too expensive, and we indiscriminately cut costs and reimbursement, then we affect the quality of care. We undermine the infrastructure of our system if we don’t have checks and balances.
As Dr. Berwick moves forward, and regulations are formulated, what role do you hope to play in the discussion? What special concerns do you want to bring to the table, from the standpoint of your members?
As they build the regulations, they should structure patient-care systems that reward quality, not volume. They should look early on to the most vulnerable who have nothing, and work quickly to get them into the system. Some of the most vulnerable have health problems that are not insurable. They will build a structure whereby these patients will be able to buy health insurance.
They’re also working on preventing insurance companies from denying children because of pre-existing conditions. This is why we supported health-care reform.
What about addressing concerns of specific interest to your membership — conscience protections, for example?
We will be alert regarding any conscience issues. But I don’t foresee them. We anticipate that the commitment of the president, the leader of the House and of the Senate to no federal funding of abortion will be kept.
But, from the pro-life perspective, we hope that those people — the patient who cannot afford to be pregnant — will be covered early and well.
Many Catholics — bishops and pro-life activists — are still angry about your vocal support for the health-reform bill.
We spent untold hours with Congress, the White House and the Department of Health and Human Services to make sure there would be no federal funding of abortion and there would be safeguards to validate that. Once we were convinced of that, and that we could help people who were pregnant and 32 million of the uninsured, we were conscience-bound to support it.
Where do things stand between you and the USCCB?
We are in constant dialogue with the USCCB, with Cardinal George, and with other bishops. There is no freezing out.
So you would say the reconciliation process has moved forward?
I can move forward, but others will have to speak for themselves. I have enormous respect for the bishops of this country, and many are close personal friends, even in the midst of this disagreement.
Joan Frawley Desmond writes from Washington.
Note from Joan Frawley Desmond. After this interview was conducted, breaking news led me to e-mail Sister Carol, now traveling in Haiti, and ask her a follow-up question: Are you aware of reports alleging that the Department of Health and Human Services is providing $160 million to the state of Pennsylvania to establish a new high-risk insurance pool program that would cover any legal abortion in the state? What does this say about the staying power of President Obama’s executive order?
She did not comment, but referred me to a statement by HHS spokeswoman Jenny Backus on the HHS website:
Statement on the Pre-Existing Condition Insurance Plan Policy
As is the case with FEHB plans currently, and with the Affordable Care Act and the President’s related Executive Order more generally, in Pennsylvania and in all other states abortions will not be covered in the Pre-existing Condition Insurance Plan (PCIP) except in the cases of rape or incest, or where the life of the woman would be endangered.
Our policy is the same for both state and federally-run PCIP programs. We will reiterate this policy in guidance to those running the Pre-existing Condition Insurance Plan at both the state and federal levels. The contracts to operate the Pre-existing Condition Insurance Plan include a requirement to follow all federal laws and guidance.