The words “missed opportunity” understate.

The visionary Berwick, champion for patients, was picked for the job because his “triple aim” (his words) at health care was the same as President Barack Obama’s reform goals: improving the patient experience, improving population health and reducing costs — and because Berwick had decades of experience successfully achieving those goals in this country and worldwide.

Through the organization he founded in the early 1990s, the Institute for Healthcare Improvement, care has been redesigned and hospitals trained to prevent thousands of injuries and deaths.

How has Berwick achieved these changes? Intractable problems in health care are identified, and IHI, often in partnership with the Robert Wood Johnson Foundation, take aim at them.

In the hospital system where I work, we know about Berwick, and we’ve worked with people from the IHI and the RWJ foundation. In 2003, we were chosen as one of 13 pilot sites to transform care at the bedside in medical-surgical units.

Direct-care, front-line nurses were challenged and given full license and encouragement to develop and test methods to improve care. And that we did. Many of the innovations Seton nurses designed are practiced in thousands of hospitals worldwide.

In the eight years since the project began, physicians, patients and families have become engaged in care; bedsores, patient falls, infection and birth trauma have been drastically reduced; communication during shift report has improved; multidisciplinary rounds are made to enhance discharge planning, teamwork and safety; patients are checked on hourly; response teams rush to a patient in crisis before it’s too late; and patient and nurse/doctor satisfaction and retention have dramatically improved. Hospital readmissions have fallen.

Through the transforming care project, in the perinatal area, birth trauma has effectively been eliminated. Clinicians developed a bundle of best practices for obstetricians.

This safety initiative has saved the government a bundle of money. In 2003, Seton billed Medicaid $500,000 for birth trauma; in 2009, zero.

Berwick has promoted understanding of this concept as a way to curb government spending on health care. As part of the Affordable Care Act, Berwick implemented financial incentives for doctors and hospitals to coordinate care and improve patient outcomes.

Stunningly, Congress refused to confirm the nomination of this proven, accomplished and promising leader. Eager to demonstrate contempt for the Affordable Care Act, Republican demagogues seized on Berwick as an irresistible target.

They dubbed him Dr. Death Panel. Why? Because he — and the Affordable Care Act — encourage end-of-life discussions between doctor and patient/family when medicine can do no more.

In addition, they exploited his remarks as an academic praising Britain’s health care system for covering all its people and reining in costs while improving outcomes.

Taking his remarks out of context, Republicans portrayed him as an advocate of rationed care and socialized medicine. This, despite Berwick’s insistence all along that the British system cannot be copied here and that America’s system, having evolved around insurance, needs its own solution.

If you repeat “Dr. Death Panel” and “rationing care” enough times, you begin to brand and unfairly define Berwick and the health care reform law.

Marilyn Tavenner, a nurse and his top deputy, will succeed him. Let’s hope that she will be able to execute his goals. Congress will be more comfortable with her, as she is more manager than visionary.

Back to his triple aim. Has his work improved the patient experience? Yes. Has it improved population health? Yes. Has it reduced costs? Yes.

Have we missed an opportunity? Oh, and how.

If Lyndon Johnson had been alive on March 24 when President Barack Obama signed the Patient Protection and Affordable Care Act into law, he would have remarked from experience that the battle for health care reform had only begun.

We remember the July 30, 1965, signing of Medicare into law as the smooth establishment of a popular program. But that’s not at all how it went down. The program was nearly destroyed by doctors and hospitals threatening to boycott it.

Calling it “socialized medicine,” the American Medical Association waged war against the program before and after it became law, with doctors warning their patients against it, thus threatening the public support that Johnson needed.

Johnson outmaneuvered them by giving the AMA a seat on an advisory council that oversaw rules and regulations, one of which was setting physician fees, and the doctors acceded. Thus began wealth among physicians.

Many hospitals, especially in the South, were segregated and threatened to boycott because of the provision that hospitals be integrated. Johnson allowed no compromise and set up a battle council.

He had Vice President Hubert Humphrey telephone mayors to pressure resistant hospitals. In the final weeks before Medicare’s beginning, the hospitals integrated rather than lose federal dollars. LBJ sent hundreds of inspectors to ensure hospitals receiving Medicare funds were indeed integrated.

Thus began Medicare.

Fast forward to 2010. On the campaign trail for president, Obama got his strongest applause when he spoke of insuring all Americans and keeping insurers from denying coverage based on pre-existing conditions. The brightest minds in health care drafted a plan that would achieve those results.

The bill enjoyed the support of organized doctors and hospitals. Insurance companies were the holdout. When the public option was ultimately dropped in favor of insurance exchanges, the companies jumped on board, and the bill was passed.

Unlike the interest-group battle over Medicare, this law is threatened by party politics. The ads from this election cycle show how prominent the issue weighs and how ugly the rhetoric can get. The fact that the provisions in this law kick in more slowly than Medicare leaves it even more vulnerable to attack.

If the conservatives regain power, they’re not likely to repeal the law. But if they strip away critical, easy-target elements — such as the requirement that uncovered individuals be required to buy at least a basic policy and the subsidies to make sure they can afford them and/or the requirement that large employers provide health benefits — then coverage for the uninsured will be effectively gutted. With 21 states, including Texas, suing to stop parts of the reform, a showdown looms.

The major objection is the insistence that it is unaffordable. When Medicare became law, health care represented 6 percent of U.S. economic output. Today, the figure is an unsustainable 18 percent. Our health care system pays for the quantity rather than the value of care, and it should be clear to everyone that without fundamental change, the same trend will continue.

Included in the overhaul is a Center for Medicare and Medicaid Innovation where local hospitals can do what the hospital where I work did. Within six years, we reduced our term infant birth trauma from 0.3 percent (half the national average) to 0.01 percent. We did this by bundling best practices and improving interdisciplinary communication in the delivery room.

In 2003, we billed $1.5 million for birth trauma. Last year, we billed $25,000. While representing a loss for our hospital, it’s a huge savings for Texas, which foots much of the Medicaid bill.

Rather than a government takeover of health care, the law frees communities and local health systems from existing payment rules and allows them to experiment, as my hospital did, for ways to deliver better care and ultimately lower health care costs.

The midterm elections seem to be all about exploiting the down economy and taking aim at those who courageously cast a vote to overhaul an unsustainable system. They should not be targeted and punished. People would do well to remember the fury and acrimony that surrounded the passage of Medicare.

This law is designed to insure nearly all Americans while increasing the value of care. If allowed to stay intact, it may well be as momentous as Medicare.

The article pointed out that wages and benefits comprise 51 percent of Seton’s total expenses, and that the national average is 56 percent. Go figure. In my book that means Seton is doing better than its national counterparts in wage and benefit expenses. Seems irrational to look here for further cuts.

The psychology behind targeting nursing to cut costs must be based on the fact that hospital financial statements reflect professional nursing under the rubric “operating expense.” But please, let us be ever mindful of the fact that, unlike physicians, these frontline caregivers do not have privilege to direct reimbursement for their services. And let us not overlook that this “expense” is human capital.

Seton administrators of days gone by considered their professional nursing staff, despite its position on the accounting balance sheet, to be an asset – a priceless resource worth its weight in gold to the hospital and to the community. Common sense dictated that if nurses were nurtured and supported, the patient would reap the benefits, and in fact this community has reveled in Seton’s quintessential nursing care since 1902.

Now that Seton is facing hard times, I think a lot can be learned from another of the 40 Daughters of Charity hospitals that underwent a similar experience in 1989 – Providence Hospital in northeast Washington, D.C. The Nov. 2 edition of MacNeil/Lehrer Newshour featured a Phyllis Theroux essay on Providence. This hospital lives the mission of caring for the needy and cares for a high percentage of Medicare and Medicaid patients. Although most hospitals operate at a two percent profit margin, in 1989 Providence was operating at minus 21 percent profit – mainly due to administrative problems, bad debt, poor contracts, various failing business ventures and too many opportunities for corruption.

At that time, Sister Carol Keehan took over as president and CEO. She ignored the advice of corporate America to cut employees and services. Instead, she went to the staff and not only assured them no one would be fired except as a last resort, but also solicited their advice on how to turn things around. Hospital revenues went up through prudent management, bulk purchasing for everything from supplies to insurance, patient billings and various fund-raising drives. Marketing money was used to provide free valet parking so that the elderly would not have to walk alone through long parking lots. As a not-for-profit organization, there were no stockholders to reward, and income was plowed right back into patient services.

Sister Keehan had a commitment to doing the right thing, and Providence is prospering. The staff have a new sense of teamwork and believe in what they doing, which is to treat people right because it’s the right thing to do.

Good luck, Mr. Barnett, in your quest to keep Seton solvent during these changing times. And go easy on nursing; after all, Seton and its nursing staff have been one of this community’s greatest assets for nearly a century