Key Takeaways
- Executives must critically evaluate the financial and operational impact of Medicare Advantage privatization, which is generating up to $100 billion in excess annual costs.
For our Fourth of July Special at The American Journal of Healthcare Strategy, we welcomed Dr. Don Berwick, Senior Fellow at the Institute for Healthcare Improvement (IHI), to cut through the noise. As a former administrator of the Centers for Medicare & Medicaid Services (CMS) and a globally recognized voice in healthcare quality, Dr. Berwick offers not only a front-row view of landmark reforms but a candid, soul-searching assessment of where we’ve advanced—and where we’re in danger of losing ground.
“Find your soulmates, find the people who want to do in the world what you want to do and join up…love and relationship have a role here, way beyond transactional stuff.” — Don Berwick
Below, we break down the major questions tackled in this illuminating conversation, offering actionable insights for today’s healthcare leaders and those shaping the sector’s future.
Dr. Don Berwick is a pediatrician by training, co-founder and Senior Fellow at IHI, and a longtime crusader for healthcare quality improvement. He led CMS during a historic window: the rollout of the Affordable Care Act (ACA).
Why did President @Barack Obama select Berwick? Dr. Berwick’s name surfaced thanks to his pioneering work on patient safety, quality of care, and a track record of building coalitions that deliver lasting change. He explained:
“Half that [Affordable Care Act] law had to do with the quality of care... creating circumstances in which we would focus much more strongly on patient needs, use money more wisely to meet needs for chronic illness... That was my main swim lane.”
Berwick didn’t see his work as heroic, but as the product of effective teamwork—a message echoed throughout his career.
Dr. Berwick outlined his CMS tenure in three essential missions:
1. Running the Railroad CMS insures 110 million Americans. Just maintaining this behemoth, Berwick said, “is a full-time job”—from managing a staff of 5,500 to ensuring uninterrupted payment and access.
2. Implementing the Affordable Care Act (ACA) 70% of the ACA’s implementation fell to CMS under Berwick’s leadership. This meant:
3. Building a Quality-Focused Culture Berwick pushed for a culture shift at CMS:
“Any organization can be focused on need, can be quality-focused. I tried to change the culture there toward modern thinking about quality… I’m proudest that there still is a culture residual from that work at CMS.”
His time at CMS was about more than policy; it was about leading people to embrace innovation and quality as central values.
Has the ACA succeeded? In Berwick’s view, the answer is complex:
“On the coverage end, the Affordable Care Act was working... For the first time in its history, Medicare and Medicaid were covering a vast array of preventive practices.”
But there’s a shadow side:
What’s the threat? Dr. Berwick didn’t mince words:
“The Trump administration has come in and done inestimable damage... The privatization of Medicare—taking public money and giving it to private insurance companies—has proved to be extremely expensive, maybe 80 to 100 billion dollars a year of excess payment.”
Key problems with privatization:
Worse yet, Berwick warns that a rollback of ACA subsidies could strip coverage from 7-10 million people and undermine preventive health investments. He calls out the “attack on science,” noting that cuts to agencies and research will have long-tail effects on population health and innovation.
Why is U.S. healthcare so chaotic compared to Europe? Berwick points to two core issues:
1. A Frail Social Contract Most wealthy countries treat healthcare as a human right. In the U.S., that’s still a point of contention.
“There’s a fundamental values issue here… unless you can rely on that value system, it’s hard to recruit the investments that you’re seeing actually as the norm in every other Western democracy.”
2. The Influence of Moneyed Interests Healthcare in the U.S. is a $4 trillion industry—nearly 20% of GDP. Corporate interests in insurance, pharma, and hospital sectors exert enormous lobbying power to maintain the status quo.
“Sector by sector, it’s all about the money. And until we change that, we’re not going to have the resources to invest where they can make us healthy.”
Why don’t Americans support more public insurance? Berwick separates two concepts:
He asserts: “There’s never been in American history a more popular government program than Medicare. Try to take it away.” But, he cautions, the public doesn’t realize how privatization is slowly eroding this bedrock.
Is value-based care still the future? Berwick is uncertain. He’s optimistic about experimentation but warns of lasting harm from current policy directions:
“I fear we may be naive to think, oh, we’ll just flip a switch and it’ll be rebuilt… I just don’t know.”
He also noted that success will require a return to truth-telling, public investment, and an honest reckoning with the role of money in policy.
Dr. Berwick rejects the notion that government can’t innovate. He cites CMMI, the NIH, the CDC, ARPA/DARPA, and NASA as proof that with the right leadership, government can be an engine for groundbreaking change.
“Government’s a superb innovator. It’s a place where we can concentrate resources and, with proper leadership, change the world.”
But innovation depends on leadership. Bureaucracy isn’t the problem—the absence of bold, visionary leadership is.
Is there hope? Berwick’s answer is that the next generation—equipped with new technologies and a renewed sense of values—holds the key.
“It’s the only place for hope right now… It’s values plus innovation, values plus invention that lead to progress. If not, we’re cooked.”
Advice for future healthcare leaders:
Medicare reform is more than a policy lever; it’s a mirror reflecting America’s values, leadership, and commitment to public good. As Dr. Don Berwick argues, real progress demands that we:
For healthcare executives, policy leaders, and students alike, the call is clear: Don’t sit on the sidelines. Find your allies, cross boundaries, and lead with values. The future of U.S. healthcare depends on it.
<p>So find your soulmates, find the people who uh want to do in the world what you want to do and join up. Uh love and relationship have a role here that uh way beyond transactional stuff. [Music] Hello everyone. This is Cole from the American Journal of Healthc Care Strategy. Really thrilled to bring you a special guest with just an incredible uh array of experience. Uh without really any further ado here, Dr. Don Berwick, who is currently a senior fellow at IHI. Uh Dr.</p> <p>Burwick, please kind of introduce yourself uh and share a little bit about yourself uh with the audience. Uh thanks for having me, Cole. I'm delighted to be talking with you. Yeah, my name is Don Berwick. I'm a pediatrician by training. I practiced for 20 years. um and um became very interested in healthcare policy and in quality of care.</p> <p>And so about 30 35 years ago with a group of friends around the United States, I started a nonprofit organization called the Institute for Healthcare Improvement. That's the IHI you just referred to, which became my uh my major activity. It's now a global organization works in in dozens of countries around the world. Uh a nonprofit that tries to help improve quality of care and that became my and remains my passion. Um, I also became involved in healthc care policy.</p> <p>Um, uh, strong interest of mine. And when President Obama was elected, he asked me to run Medicare and Medicaid. So for a year and a half until the Republicans, uh, ultimately refused final confirmation, I ran Medicare and Medicaid, CMS, the Senator Medicare and Medicaid Services. I a little uh, foray into politics. I ran for governor for the Democratic nomination for governor of Massachusetts.</p> <p>And when that didn't work out the way I wanted, I went back to the Institute of Healthcare Improvement and to Harvard Medical School where I am now. It's so impressive what you've been able to to do throughout your whole career because you of course worked as a pediatrician, but then you founded this or co-founded this organization that has had just a far-reaching and deep impact on health care and on the way that we view care.</p> <p>I know the materials from your organization uh especially the research has impacted many many people uh which is a huge deal. At the same time I have to ask why you know Barack Obama had this this big goal uh to really fix healthcare in the country. It was something that he really ran on. Why do you think he selected you to come on and lead CMS? I'm not really sure.</p> <p>I'd come to know, you may recall the history that the the person who everyone thought would be Secretary of Health and Human Services was uh Tom Dashel's former Senator Senate majority leader and I'd come to know Senator Senator Dashel around healthcare issues and he probably uh brought my name up but I you know I don't know I mean the what the Obama legacy the one that we we talk about in healthcare the Affordable Care Act u was certainly dramatic uh effort effort to extend healthcare insurance to people who uh didn't have it and and it did.</p> <p>22 million people got covered who otherwise were not covered. Um but there's other part of the law. Half that law had to do with the quality of care. It had to do with creating circumstances in which we would focus much more strongly on patient needs. Uh use use money more wisely to to meet needs for chronic illness.</p> <p>there was a big component of it that let us work on patient safety and all of those chronic illness care, quality of care, patient safety, those were those were that was my main swim lane. So somehow those dots got connected and I got to to uh to run CMS which was definitely the the best job in American healthcare. It was an amazing experience. What are some of the things that you worked on while you were at CMS that you're especially proud of or fond of thinking back now?</p> <p>I always thought of it uh there was there sort of I I had three jobs there. Uh one was the traditional one. We we had to keep the the railroad running. I mean CMS paid for the care of 110 million people and just running that kind of public insurance system. It's a full-time job and uh uh so uh that that was certainly uh learning it working with the amazing uh staff there. 5,500 employees just just wonderful wonderful group.</p> <p>Second was the affordable care act which passed in 2010 when I arrived and uh CMS had 70% of the implementation afford of the affordable care act was through that my agency and so day and night we were crafting regulations to make the statute real uh negotiating uh you know tough calls about exactly how to design the payment systems and under the under the law setting up the center for Medicare and Medicaid innovation CMMI now called the innovation center, which which was an incredible gift to the American people, a place where we really could try things out to change our our troubled healthare system.</p> <p>That was the second. The third job was the one I brought there. I mean, I had spent my career on quality. How do you how do you have an organization that's really focused on the needs of the people it's trying to help? And and I felt and still feel that a government agency like any any organization can be focused on need, can be quality focused. And so I tried to change the culture there toward uh modern thinking about quality of uh quality of its work.</p> <p>Uh of the of the things I did, I'm it's hard to pick one thing, but I think I'm proudest of that that there still is a culture residual from that work at at CMS. uh unfortunately being attacked viciously right now by the current administration, but uh it's an organization of people doing really important work who need to know that they're valued and and and can make changes in their work to make it even better. Yeah, absolutely. Um thank you for sharing those three things.</p> <p>Those are really important things. Thinking about them, where have we gone between, you know, 2010, uh you know, I guess it's been 15 years or so now, right? um where have we gone and then where are we going? I think those are the two questions, right? Have we I mean I think I feel like in some areas we've moved in the right direction, right? I know in some areas we've moved backwards. In some areas we've moved forwards, but where do we go from here as well is my other question.</p> <p>Cole, you're just specifically asking about CMS and Medicare and Medicaid or the broader Yeah. really with with CMS, Medicare, Medicare Advantage, and Medicaid. You know, those are kind of the three things. I know ACA also has has some problems people are upset about right now as well. Yeah. Uh well uh the answer may be changing as we speak. I don't know when this show will air but uh if you'd asked me at the end of the B administration I would have said really good news.</p> <p>Uh we had uh extended coverage healthcare hadn't become quite exactly a human right in America but tens of millions of people had health insurance who otherwise weren't. So in the coverage end the healthcare affordable care act was working. uh the uh proper use of subsidies so that people who couldn't afford health insurance now could all of that was making uh a lot of progress. Um the uh the form of the coverage had improved uh for the first time in its history.</p> <p>Medicare and Medicaid were covering a vast array of uh preventive practices, first dollar coverage under the Affordable Care Act. Um and the experimentation with new forms of payment was well underway. no home runs yet, but we were learning a ton about how we could change the payment system to be better supportive of um excellence in care and meeting people's real needs.</p> <p>And uh the uh especially the innovation center had done some terrific experimentation in Medicare and Medicaid covering social needs, extending the concept of health giving practices to housing security, food security, uh inh home care. Um and uh I thought we were making progress. You know, problems remained. There are still a lot of people who don't have coverage in this country, which is travesty. Um so, uh you know, a good solid, if not an A, at least a good solid B or B+.</p> <p>Then things change when the the the Trump administration has come in and done inespable damage. Uh and it's still underway. uh the uh the one form of it has been the privatization of Medicare which was underway over the period that decade period prior to that. Uh there is a force in this country that believes that public health insurance health insurance from the government isn't the way to go and instead we should be using private insurance. That's Medicare advantage.</p> <p>That's taking public money giving it to private insurance companies and they then provide the coverage or don't. Um, and that's proved to be extremely expensive to the tune of maybe 80 to 100 billion dollars a year of excess payment to these plans. Uh, problems with coverage around pre-authorization and review and denials and delays. Uh, so that privatization stuff is I I regard it as harmful. It was underway in the prior administration. They did do some push back. Now I think game on again.</p> <p>Uh we just saw this week uh an increase in payment to Medicare Advantage of over 5% double what was anticipated. That's just that's just a Easter present to private insurance companies. Uh so that's bad. Uh and then the there there's a disarticulation of the of the momentum under the Affordable Care Act and policy in general toward uh covering preventive services. Yeah.</p> <p>Uh some of the subsidies that are allowing people of lower income to find health insurance are going to expire at the end of this year. Uh I think we're seeing in Congress and this administration every indication they're not going to extend those subsidies. That'll take pick your number, but it's, you know, a lot of people, you know, perhaps as many as 7 to 10 million people will lose insurance because of that.</p> <p>And you have to say that the attack on science the the the disarticulation of uh worldrenowned science at CMS at NIH and such in supports to our universities and that's going to go back and haunt us and CMS will end up holding the bag for illnesses that should have been cured and prevented. So um not good news right now. So, I'm going to be finishing my hopefully, if everything goes to plan, PhD in population health right about when Trump leaves office.</p> <p>So, you know, hopefully we'll have an idea of where to head. But that's kind of my question. A bit of a selfish question, but I know our listeners are out there as well. When it comes to payment model reform, you know, my degree focuses a lot on trying to find innovative payment ways of ways of paying for care, uh, and trying to reduce costs. Um and as you know the Medicare advantage model does introduce a lot of extra costs. Some believe that by privatizing it you can contain costs.</p> <p>There's this mix of of debate as well on whether uh fee for service might have actually been better off for the consumer if you you know use uh you list pricing and whatnot. There's a lot of this debate that makes people a bit unsure if valuebased care and population health and public health approaches are really the direction to go in. What do you think is going to happen over the next five years?</p> <p>Do you think we're going to see a backlash afterwards where people are going to say Trump's methods didn't work and we're going to go back to value based care? It just seems kind of chaotic right now. I What do you think is going to happen? Yeah. Co. Well, first, thanks for being in the field. Uh we'll be very welcome to bring your knowledge and your skills to to help us get through the problems.</p> <p>Uh well let's say first uh I mean there's there's a fundamental question here that I don't know the answer to which is is the damage that this administration is doing now to all the agencies and legacy structures in the country laying off uh 25% of the employees of the department of health and human services either laid off or taking buyouts. Um is this going to be reversible? Uh the optimist in me wants to say yes but I am not sure. I think this damage is fundamental, existential.</p> <p>How can we rebuild the the um randomized health and randomized clinical trials that are going to be stopped now? How are we going to rebuild a workforce? It's been to some where people have made a decision to leave science or to move to Europe to do it. Yeah. Uh what about um the millions and millions of people who have lost health insurance and you know there's going to be a long tale of illness that they'll have because they can't get the care they need. I don't know.</p> <p>I fear that we may be naive to think, oh, we'll just flip a switch and it'll be rebuilt. I I just I just I just don't know. Why are we facing this issue in the US? Because and I ask this because we have the best universities in the world. I mean arguably we have some of the best universities in the world. We have some we spend the most on health care right we have some of the best trained physicians in the world.</p> <p>We have incredibly rigorous standards so that even uh you know physicians who are trained in other countries that are on par have to undergo quite a bit of of struggle to get into the US and practice in the US. So it's not like we are struggling with kind of the basic issues right we have a very robust educated system.</p> <p>why are we facing these issues that you know I was just in Spain they don't face those issues there they have other issues but they're not really worried about affording health care or affording medications like even middle class individuals in the US are are dealing with and there also doesn't seem to be that much debate or chaos in European countries or other countries about what the right thing to do is whereas here it's a huge source of debate why why do you think that is you've been in the field for you know 40 50 years I I think a two things.</p> <p>uh one is just the existence of a social contract in our country where we we we make it as a matter of policy in our country that we will help the people who who need help whether they be the ill or the poor or the marginalized or or the worried uh u you know I I we we have a frail social contract at the public level about what our duties are to each other and unless you can rely on that value system uh it's hard to recruit the investments that you're seeing actually as the norm in every other western democracy for sure uh there's sort of an unquestioned sense that healthcare is a human right and here you even get laughed at when you say that in some quarters so so there's a fundamental values issue here that I think is deep but the bigger issue much bigger is money uh we have a system healthc care is run by moneyed interests wealthy interests interests making a killing in the status quo.</p> <p>You mentioned Medicare advantage. Well, okay. First, we we we need to put more money into social care in this country, social services, housing, food, early childhood development, safe workplaces, care for the elderly, uh transportation infrastructures. This all takes money, but it's a way to be healthy. And we we know absolutely from science that a healthy nation invests in those infrastructures. We don't.</p> <p>We we are way behind in every single category of investment in things that make us healthy. Good food, good transportation, safe communities, uh early childhood education. We're behind the la we're the last in line in OECD countries. Why? Well, because healthc care is taking, like you said, we're nearly 20% of GDP. All those countries you've been visiting, Spain and OECD, countries that have better healthcare and better outcomes than we do better. Yeah. Are spending half the money. Why?</p> <p>Because people are getting rich on health care, money interest, corporate interests. Why? When we're looking for money in Congress to put more uh resources into housing or food, do we subsidize private health insurance to the tune of hundred billion dollars a year because they're powerful, they're moneyed, and they're making a mint.</p> <p>And that would be true for every sector, whether it's pharmaceutical companies, bless them, they save lives, drugs are the miracle of our age, but the prices are insane. Um, uh, hospitals, God bless them, you know, they save lives every day. Lives in my family have been saved by glorious care in hospitals, but they are raising their prices and not looking at waste and ways to be efficient or to integrate better with communities. So sector by sector, it's all about the money.</p> <p>And until we change that, coal, we're going to we're not going to be able to be to have the the resources to invest where they can. And these money interests are they're really really powerful. When I was in Washington, we heard from them every day. It seems like the the idea of making, you know, healthc care public uh doesn't seem very popular among the population. Let's first you have to parse something here that it seems obvious to me but it's not obvious in dialogue.</p> <p>Making healthcare public that there's two things there. Insurance which is public payment for healthcare like we have for most of our schools or for our fire departments or for our you know for for building roads. uh that is uh you know we we we raise money from the public with with taxes and then we spend that money to give them back a service hopefully worth more than the taxes they're paying. Health care in this country is privatized to a large extent.</p> <p>More than 50% of the care is coming out of the pockets of insurers and workers in a private insurance system in which basically three or four major insurers insurance companies are are intermediaries. So our payment system is not to that extent public on the Medicare and Medicaid side. Yeah. I mean that's what 40% of everything we're paying. That's government. But now is the fight about for example Medicare advantage in which the the private insurance companies want that money.</p> <p>They want to be the intermediary and rake off their their 15%. So um as long as money controls medicine, we're not going to be spending the money where it's needed. I don't know another way to say that. How do you get So that's the payment side, but let's be clear. No, please. Please. The delivery side is different. There aren't that many countries in which the government gives the care.</p> <p>In fact, the only really really major example of that is the United Kingdom is is England, Scotland, Wales, and Northern Ireland where most of the hospitals are government institutions. The clinicians are are are to some extent they're not exactly employees, but they're contractors to government. Most other countries still have a private generally not forprofit but private delivery system. So when you say it's not popular, I'm not so sure.</p> <p>I think there's never been in American history a more popular government program than Medicare. Try to take it away. Uh it's uh it's it's the most po I'll venture to say the most popular public program of health insurance public program of any type that's ever existed. So no, the public definitely can support Medicare. They don't realize it's being pulled out from under them with this Medicare advantage privatization. That that's too complicated to understand easily. But no, it's very popular.</p> <p>Does a government does the public want government to give them care? It's a more difficult question. Probably not. They value their local hospital, you know, voluntary not for-p profofit perhaps. Uh the but we have government care. The defense department runs the military health system. The uh Veterans Administration runs the Veterans Health System. Uh and they're pretty overall they've got problems, but they're pretty successful. Um so I don't know.</p> <p>I I I I I think we can have a very successful system in this country with government as the insurer without the intermediation of these profit-seeking financial entities and the you know not for-profit sector running our delivery hospitals and physicians and so on that's a mix that might be good for America but if money is controlling that right and they don't want that to happen because they would lose you know a substantial amount of of where they've their entire business essentially would go away in some cases.</p> <p>How do you get and convince the public to to make that happen and to want to get that to happen? That's where I really struggle a lot. Yeah, me too. I I I don't know. uh you got to we got to have truthtelling here and the ability of the current interests to sell their product is enormous and we don't have a public investment like you know the Medicare advantage uh lobbyists the industry famously a couple of years ago bought an ad on the Super Bowl to sell Medicare Advantage.</p> <p>Well, that's deep pockets. If you can afford an ad in the Super Bowl, you're you're not having rice and beans for supper, believe me. Um well so we we don't have a counterveailing uh sort of marketing or communication investment uh on behalf of public insurance. It just isn't it's a much more difficult message to send and uh and frankly deception is being used on on the private side. People making a lot of money they don't tell the truth. They they don't tell all the truth.</p> <p>Um yeah they say well you can have uh insurance without a prem without you know zero premium. Yeah, you can right now due to that subsidy, but later on try to get coverage, try to get through the hurdles of pre-authorization. Yeah, you don't tell the whole truth. And so it's it's problematic. I think good successes will help. You know, the the more we have states or localities or organizations that actually show the advantage of truly public interested insurance, the more stories we have to tell.</p> <p>if you know there are a lot of probably younger physicians and people you know mhas out there listening to this episode any pieces of advice who look at your career and say you know I want to be like you know Dr. Burick, I want to, you know, make a big impact on policy and really get out there. Any advice for them? I mean, it's all such a personal matter, Cole. I'm not sure. I guess I mean, two things come to mind. One is uh be together. This is not a a game for heroes. It's a game for teams.</p> <p>And so, you know, everything that I've been able to do with my career, much less than I wish I could have done, I've done with others where we've found friendship and trust and we've we we say in IHI, never worry alone. So, find your soulmates, find the people who want to do in the world what you want to do and join up. Uh, love and way beyond transactional stuff. So, so that's that's the first piece of advice. team up. Don't try to be a lone hero. It won't work.</p> <p>The other is uh seek intersections, disciplinary intersections. You know, my whole career changed really when I went to the Harvard School of Public Health at the request of the then dean Dr. Howard Hyatt who had built a center. He was called at that time the center for analysis of clinical practice. But the name didn't matter.</p> <p>What mattered was I found a place where I could work next door to an industrial engineer, across the hall from an economist, down the road from a from a statistician, um, social science and and all of that combination is what created the ideas and the teams that I got to work with and that included outside healthcare. I learned so much from just getting on a train or plane or car and looking at aviation, looking at other companies, looking at other scholars.</p> <p>Uh so so creativity and opportunity happen in intersection. So don't stay don't stay in your silo. It's wrong. And find a place where yeah there are other people that you can learn learn from who are different from you. those two things. Yeah, it's very powerful. I appreciate that a lot. Yeah.</p> <p>Have you ever found it difficult to come outside of your realm and into another realm like aviation, like mechanical engineering and and assimilate that information when you've been through so many years of education and you've adopted, you know, the social millus of of your field a bit of the opposite for me. Again, this is a personal matter. you kind of know yourself and trust yourself. But no, I I I am happiest when I'm outside the familiar.</p> <p>Uh I remember like for example, early in my career, I I became aware that traditional quality assurance which had a pretty strong uh academic tradition and kind of there were methods and scholars and it was it was good stuff, but like it wasn't working. I was at an HMO and I was using, you know, what I'd read about about quality assurance and eh, you know, it was all the reports were the same. I wasn't very popular showing up to do my quality assurance work. It wasn't working.</p> <p>And uh so I began a bit of a pilgrimage thanks to the chief executive who said why don't you go look around. Uh so two two things happened actually in the same week. One was I called NASA at that time. It was before the Challenger explosion and NASA had gotten to the moon and I thought, "Oh my god, you know, it couldn't have been easy." And I uh I called the NASA, cold called it and got ended up speaking to the head of quality at NASA, quality, safety, and reliability was his title.</p> <p>Uh guy named Guy Cohen. And um you know, I said, "I'm from healthcare. You got to the moon." We didn't. Uh what do you know that I don't know? And guy, this guy Guy Cohen, he said, "I'll come." And he came up to my office in Boston. He flew up uh from Washington. Wow. And spent a whole day with me tutoring me about how NASA dealt with quality, reliability, kind of teamwork, u culture. Oh my god, it was as close to religious experience I've ever had.</p> <p>It was complete system for accomplishing the impossible. And it was No, that was wonderful. He enjoyed it because he kind of had the idea that healthcare needed some help. And then the other one was again I cold called um Bell Laboratories where I knew by that time that a lot of the modern approaches to systems had developed at Bell Laboratories and the guy that answered the phone was the head of quality systems at Bell Labs, a guy named Blan Godfrey.</p> <p>We have since become and remain close personal friends. Uh Bland invited me down to Bell Labs and I spent a day there which again was quasi religious experience as they really explained the sciences of of uh excellence. Uh so no for me there's been constant joy in crossing those boundaries and uh finding people who could teach me stuff. Wow. Impressive. And that makes sense as well why you brought that innovative.</p> <p>you were kind of a na you're kind of a natural innovator from the sounds of it in terms of bringing people together and did that do you think or maybe I'll just ask how did you come up with the idea to start the CMS kind of innovation center there because government and innovation have not been known to be you know the government has not been known to be the most innovative institution. Yes. Well, okay. Let first cl clarification.</p> <p>The uh center for Medicare and Medicaid innovation, the innovation center was written in the Affordable Care Act long before I got there. And so there were people like Liz Fowler and others who actually wrote the Affordable Care Act who incorporated the idea of uh of an R&D facility inside the insurer inside CMS and made it real. stunning idea and probably the reason that I um decided to uh to take the job because I I was very very exci excited by it. Um more generally uh am I an innovator?</p> <p>I I just think you have to leave your what's famili if you only stick to what's familiar to you, you're probably going to get the same results. Mhm. And so having a having a a place which the name was innovation was really important to me. Now your assertion that government's not an innovator. It depends. I mean yeah but government has a large bureaucracy which I is not a bad word for me.</p> <p>It's the people that do the daily work and they tend unless they're led by someone really interested in innovation, they'll just tend to read the manual and do the work. You can change that. You can change that. And that's what I was trying to do at CMS saying everybody here is an inventor. Go go go go go find a better way to do your work. You got mine. I'll support you.</p> <p>But look at look at the National Institute for Health, the leading bi biomed innovator in the in the in the on the planet government uh center for centers for disease control. People come from all over the world to study how CDC innovates in epidemiology and surveillance and and disease disease prevention.</p> <p>uh the uh ARPA the the uh the uh the investment in in general uh in innovation and DARPA the defense agency that does research uh there's a whole research community of centers academic centers and the veterans health administration that have led the nation in research so government when it chooses to the agriculture extension service tremendous innovator in supporting universities in agricultural innovation.</p> <p>NASA um not just getting to the moon but also spinning off inventions that are now parts of our daily life. Government's a superb innovator. It's it's it's a place where we can concentrate resources and with proper leadership change the world. So I have a lot more optimism about government and I came there with that when I when we had CMMI. Is there bureaucracy? Is there viscosity? Is there kind of traditionality of Yes. But it's all about leadership.</p> <p>Leaders say, "I'm sure we could find a better way and you got my you got my support to search for it." So that's what we need then is we're in the biggest need of good leaders. I think that's the key. It always is. Uh leaders and uh you know whether it's a board of trustees, an executive or a president and or a governor. Yes. Right now we have truly anti-inovation leadership at this what what Trump is doing is is the enemy of invention and uh it's sad. Yeah.</p> <p>Do you think that there is hope for uh the future with the new generation I guess coming up of leaders of people who are now using AI tools using all the these things. Do you think there's hope? It's the only place for hope right now. I think uh youth, young people, including you, Cole, but people who are going to not be not roll over on this and say this is wrong. Of course, it has to be youth um incorporating values.</p> <p>It's not You have to know why you're here and and it's values plus innovation, values plus invention that lead to progress. Um, so we have to have that values conversation. And I hope the young people of this country say this, I'm not going to be party to this destruction. We're going to invent a better future. If not, we're cooked. Wow. Powerful place to leave off. Thank you so much, Don, for talking with me for this half hour. I appreciate it a lot.</p> <p>It's impressive to to hear the how it's some of the simpler things you said, I think, that are what we really need to implement. And I I hope that the audience takes some time to kind of meditate on what you've said a bit and realize that we need to really get get down to the basics of our values and and teamwork and leadership in order to succeed. And uh and that's kind of where we've seen the failures is the lack of teamwork, the lack of organization, and the lack of innovation.</p> <p>So, thank you so much for for spending your uh you know, lunch half hour with me. I really appreciate it. My pleasure. Thanks for thanks for what you're doing.</p>
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