IHI Forum: Berwick Says 'One of the Problems in Healthcare is Greed'

Institute for Healthcare Improvement president emeritus and co-founder calls for single-payer system in United States.

The focus on profits in U.S. healthcare is "damaging," Institute for Healthcare Improvement President Emeritus and Senior Fellow Donald Berwick, MD, said during this week's IHI Forum in Orlando, Florida.

U.S. health systems, hospitals, and physician practices are committed to addressing the health needs of their patients. But making sure bottom lines are in the black and securing return on investment are also top goals at these healthcare organizations.

Berwick is one of the country's leading authorities on healthcare quality and improvement. The co-founder of IHI served as administrator of the Centers for Medicare & Medicaid Services during the Obama administration. He began his medical career as a pediatrician, serving on the staffs of Boston Children's Hospital, Massachusetts General Hospital, and Brigham and Women's Hospital.

In a meeting with journalists during the IHI Forum, Berwick criticized the financial model of U.S. healthcare. "One of the problems in healthcare is greed. We must address the degree to which the pursuit of profit and the acquisition of money and high valuations and investor-oriented business models has taken over healthcare. It is damaging. It is wrong."

The problem is systemic, he said. "I am not taking the position of people being bad people—it is not for me to judge. But the behaviors are bad on both the payer and provider sides. The pursuit of money is overwhelming the well-being of populations and patients."

Individual patients are being harmed, Berwick said. "At the individual level, this is leading to higher and higher out-of-pocket costs, more and more insurance benefit structures where people have to pay more, and disadvantages to people with lower incomes."

The emphasis on profits limits the ability of healthcare organizations to improve quality, he said. "This is affecting the context in which quality plays out. Our work on improvement depends on a basic foundational structure that can invest in improvement. The distortion in behaviors and the demoralization that results from profit-driven excess is hurting our ability to improve."

Berwick acknowledged that many healthcare organizations have been financially challenged during the coronavirus pandemic, but he said the need for reform remains. "The context is difficult. With COVID, the hospitals are currently in a stressed position, with high labor costs and workforce shortages. They are in the red this year—they are losing money. I understand that, but I don't want to back down on stopping the acquisitiveness in healthcare."

Other countries have established a better business model for healthcare, Berwick said. "I work in many systems around the world, which include single-payer systems in which there is a much stronger sense of collective duty. In many countries, the ministry of health feels responsible for making sure that resources are allocated in a way that will help the population. There is no minister of health in the United States. There is nobody thinking about whether the healthcare system is making sense for people. I remain an advocate of a globally budgeted, single-payer system."