Dr Donald Berwick on the Biden Transition Team's Challenges in Cancer Care

Donald M. Berwick, MD, MPP, president emeritus and senior fellow at the Institute for Healthcare Improvement and former CMS administrator, discusses challenges in cancer care and health care awaiting the Biden transition team.

Donald M. Berwick, MD, MPP, former CMS administrator and current president emeritus and senior fellow at the Institute for Healthcare Improvement, discusses key themes and challenges in cancer care and health care awaiting the Biden transition team.


Have you had any opportunities to speak with incoming members of the Biden transition team? If so, do you have any insight you can share regarding the challenges they will be looking at in terms of health care generally and cancer care specifically?

A couple of themes that I pick up on that are important are first a commitment to science. We have unfortunately been through a period in federal government in the past 4 years when science has been dishonored and not relied upon appropriately—and in some cases, not resourced appropriately. I think that's going to change fast. I think we have an administration coming in that really does respect science and scientific integrity, and that's important. We need to reinvest both financially and also emotionally in the importance of science as a foundation for policy, I have no question about that.

Second, I think you're going to see a lot of interest in this administration in equity, especially due to the [coronavirus pandemic 2019] COVID-19 pandemic data now—but we've known it all along—there are serious problems in racial and socioeconomic equity in health care in this country and in outcomes. That's true in oncology as well. There's good data showing that oncology has problems was with inequality and outcomes in care for people of color and impoverished people. And indeed, you could say that structural racism plays out in cancer care as it does elsewhere. This is an administration is going to change that. I sense a very strong interest in understanding and then solving some of these problems of inequality. I hope and believe that the cancer community will be deeply involved with that. There's there's a lot of progress to be made.

I think third, under Medicare, we have a looming problem. The Medicare trust fund, due to the COVID burden, has a shorter lifespan now than we thought it would. And there's going to be have to be very rapid work done to appropriately contain costs or find ways to fund Medicare with a longer vision. Cancer care is an important component of cost, and I think that it will behoove the clinical community become partners even more with the government and private payers to try to see where costs can be saved without harming anyone, that's the best way to reduce cost.

For right now, I think you're going to see COVID 24/7. The pandemic has obviously got an enormous toll on human suffering and stresses on health care and in the economy, and I believe it's going to be taking a tremendous amount of energy from this administration, as it should. I don't happen to know the relationships between oncology and cancer burden and COVID outcomes. But if they're there, that'll be important.

The last point I'll make is globalization. The Trump administration withdrew from many forms of active and productive participation in global health care, beginning with but not ending with turning their backs on the World Health Organization far too much. This administration is going to end, and I think we will rejoin the global health community in so many ways that are important. And since cancer care knowledge grows faster if we have an international view, I think that's going to be good for [oncologists] and, and good for patients.