Don Berwick

President Emeritus @theIHI. Former administrator @CMSGov. Pediatrician. Better care, better health, lower cost.

[CALL TO ACTIVISM @CalltoActivism]

A British writer penned the best description of Donald Trump I’ve ever read:

“Why do some British people not like Donald Trump?”

A few things spring to mind. Trump lacks certain qualities which the British traditionally esteem. For instance, he has no class, no charm, no coolness, no credibility, no compassion, no wit, no warmth, no wisdom, no subtlety, no sensitivity, no self-awareness, no humility, no honour and no grace – all qualities, funnily enough, with which his predecessor Mr. Obama was generously blessed. So for us, the stark contrast does rather throw Trump’s limitations into embarrassingly sharp relief.

Plus, we like a laugh. And while Trump may be laughable, he has never once said anything wry, witty or even faintly amusing – not once, ever. I don’t say that rhetorically, I mean it quite literally: not once, not ever. And that fact is particularly disturbing to the British sensibility – for us, to lack humour is almost inhuman. But with Trump, it’s a fact. He doesn’t even seem to understand what a joke is – his idea of a joke is a crass comment, an illiterate insult, a casual act of cruelty.

Trump is a troll. And like all trolls, he is never funny and he never laughs; he only crows or jeers. And scarily, he doesn’t just talk in crude, witless insults – he actually thinks in them. His mind is a simple bot-like algorithm of petty prejudices and knee-jerk nastiness.

There is never any under-layer of irony, complexity, nuance or depth. It’s all surface. Some Americans might see this as refreshingly upfront. Well, we don’t. We see it as having no inner world, no soul. And in Britain we traditionally side with David, not Goliath. All our heroes are plucky underdogs: Robin Hood, Dick Whittington, Oliver Twist. Trump is neither plucky, nor an underdog. He is the exact opposite of that. He’s not even a spoiled rich-boy, or a greedy fat-cat. He’s more a fat white slug. A Jabba the Hutt of privilege.

And worse, he is that most unforgivable of all things to the British: a bully. That is, except when he is among bullies; then he suddenly transforms into a snivelling sidekick instead. There are unspoken rules to this stuff – the Queensberry rules of basic decency – and he breaks them all. He punches downwards – which a gentleman should, would, could never do – and every blow he aims is below the belt. He particularly likes to kick the vulnerable or voiceless – and he kicks them when they are down.

So the fact that a significant minority – perhaps a third – of Americans look at what he does, listen to what he says, and then think ‘Yeah, he seems like my kind of guy’ is a matter of some confusion and no little distress to British people, given that:

• Americans are supposed to be nicer than us, and mostly are.

• You don’t need a particularly keen eye for detail to spot a few flaws in the man.

This last point is what especially confuses and dismays British people, and many other people too; his faults seem pretty bloody hard to miss. After all, it’s impossible to read a single tweet, or hear him speak a sentence or two, without staring deep into the abyss. He turns being artless into an art form; he is a Picasso of pettiness; a Shakespeare of shit. His faults are fractal: even his flaws have flaws, and so on ad infinitum.

God knows there have always been stupid people in the world, and plenty of nasty people too. But rarely has stupidity been so nasty, or nastiness so stupid. He makes Nixon look trustworthy and George W look smart. In fact, if Frankenstein decided to make a monster assembled entirely from human flaws – he would make a Trump.

And a remorseful Doctor Frankenstein would clutch out big clumpfuls of hair and scream in anguish: ‘My God… what… have… I… created?' If being a twat was a TV show, Trump would be the boxed set.”

-Nate White

[Andrea Ducas @andreaducas]

@CAP_Health @FellowWhoPoints ...the MA program, now the dominant form of Medicare enrollment, is the source of a lot of unnecessary expense. We released a second report estimating that in 2024 alone, MA overpayments + subsidies likely amount to between $83B and $127B. https://t.co/NWAElHH01v

[Andrea Ducas @andreaducas]

@CAP_Health @FellowWhoPoints You may be thinking: this all sounds great. But it also sounds expensive. How are we going to pay for this? Well as it turns out...

[Andrea Ducas @andreaducas]

@CAP_Health @FellowWhoPoints Here's a look at our Medicare 2.0 principles and what they'd mean for the program in one handy table. https://t.co/GqdgAD9EyX

[Andrea Ducas @andreaducas]

@CAP_Health @FellowWhoPoints In a nutshell, those principles include: (1) making coverage simple and comprehensive, (2) dramatically reducing out-of-pocket costs, (3) modernizing prescription drug policy, (4) centering primary care, and (5) focusing on population health and health equity.

[Andrea Ducas @andreaducas]

@CAP_Health @FellowWhoPoints Our first report, "Medicare 2.0," envisions a new set of reform principles for the Medicare program writ large--and applies those principles to both traditional Medicare and Medicare Advantage (which now accounts for >50% of the Medicare market) https://t.co/qI5tHCDEhF

[Andrea Ducas @andreaducas]

Thrilled to share two new, major @CAP_Health reports on reforming the Medicare program. I had the honor of working with esteemed colleagues Don Berwick, Rick Gilfillan, Micah Johnson on these (with an incredible assist from @FellowWhoPoints) 🧵

[Don Berwick @donberwick]

I’m attending Movement Voter Project’s event, “Healthcare Leaders for Democracy: Launch Event” – sign up now to join me! https://t.co/htBGWGuwWz

[Don Berwick @donberwick]

I just donated to Mayday. Please consider it, yourself. Thanks. https://t.co/qo7WLwQm5i

[Don Berwick @donberwick]

Please sign this petition now, and send it to others. Thanks! https://t.co/VI8QFYkX4q

[Don Berwick @donberwick]

If you are in Georgia, or know someone in Georgia, please make sure the vote goes for Senator Warnock! The last day of early voting is Friday Dec 2nd. You can vote early anywhere your Georgia county offers-- check county specific info here: https://t.co/mRgJUiQz01

[Don Berwick @donberwick]

Please join me on October 18, at 6 p.m., for a virtual event in support of Florida Gubernatorial candidate Charlie Crist and Illinois Congresswoman Lauren Underwood. Click on this registration link to receive a Zoom link. Thanks! Crucial races!! https://t.co/PhXqrRpFCw

[Don Berwick @donberwick]

In 2020 alone, the U.S. reported a staggering 45,222 firearm deaths. Today, over 1200 national health & science leaders are urging the Senate to take evidence-based action to address this crisis: https://t.co/yojjLn4T1E #SolutionsExist

[Don Berwick @donberwick]

If you are searching for a good organization through which to donate to relief in Ukraine, here is one. I donated today. Thanks. https://t.co/BbJkq4OTEH

[Don Berwick @donberwick]

So.... are we serious... or not? It's time to decide: https://t.co/cLDWX01dcR

[Don Berwick @donberwick]

Assistance for Ethan's Family During Crisis https://t.co/6porF7Scft

[Don Berwick @donberwick]

Some ways to reduce high US pharmaceutical costs: https://t.co/xExLeQKV3t

[Don Berwick @donberwick]

Here is "Part 2" of our Health Affairs blog posting: https://t.co/ovCy2a7J0M

[Don Berwick @donberwick]

My friend and colleague, Rick Gilfillan, and I wrote these blog posts in Health Affairs last week. Please enjoy and send them to others, if you can. It's technical stuff, but, I think, important: https://t.co/PwG8sUI6zm and https://t.co/ovCy2a7J0M

[Don Berwick @donberwick]

Here is an idea worth noting, spreading, and adopting, as soon as possible. Thanks. https://t.co/8gV6PQBOke