What’s the best way of improving this country’s ailing health care system?

The answer of many politicians is plain: just make cuts.

But that’s not the way Donald Berwick looks at the problem. This Boston-area physician, 66 years old, who until recently was President Obama’s director of Medicaid and Medicare, has a better idea.

The best way is to change the system.

That’s what Dr. Berwick told members of Mass Home Care at their recent meeting in Burlington, Mass.

He did so after praising them for their work on behalf of elders and their families.  “The whole country has respect for you,” he assured them. Those are words that they do not hear often enough.

As to health care: “You are working with a broken system,” he said.

Don Berwick, as he likes to be called, has been working for many years to reform the system. Long before taking his job with the federal government, he thought about changing the way health care agencies operate.

He did so by founding an organization, the Institute for Healthcare Improvement, that seeks positive change both here abroad.

He has studied systems that have made a difference. He has come to place great value on team-based, home-based, and community-based care.  And he cites some plans that have practiced this approach successfully.

One such system is NUKA, an Alaska health care agency run by native people. In one year it managed to save 53 percent in hospital admission costs. That same company has succeeded in cutting visits of specialists by 65 percent.

Don Berwick believes that health care is a human right – – a sentiment echoed in the applause of the homecare workers at the conference. And he thinks of Massachusetts as a state which demonstrates this belief better than any other.

Incidentally, he recently announced his intention to run for governor of this state.  He is surely a long shot, but one can fantasize that, if elected, he would work to make our state health care system even better.

He is convinced that home is the best place to be in later life. And a person’s best possession is vitality. Making these possible should be recognized as the most desirable goals of health care.

Changing the health care system, however, is surely one of the most difficult projects imaginable. Berwick himself must recognize this after some 30 years of trying.

As a friend, a longtime veteran in elder services, tells me: “You have to work within the system to change the system.” That’s where the challenge comes, even for farseeing pioneers like Berwick.

During his brief tenure with the directorship of Medicare and Medicaid, Berwick experienced some of the infighting that plagues progress in Washington. Realizing that his appointment would not be confirmed by the Senate, he left office after only a year and a half.

Among the gripes of his critics that lessened his chances was Berwick’s having spoken well of the British health care system. What a terrible thing for him to have done!

As this column takes shape, an announcement has come from the Obama administration delaying till 2015 an important provision of the Affordable Care Act. This change will allow corporations with more than fifty employees to postpone covering their workers for another year.

This comes as one more sign of the difficulties behind change-making in the area of health care. Health care reform will surely be a vital issue in the next congressional elections, affecting the effort to implement the law.

Don Berwick deserves praise and support for his vision of health care change. I admire pioneers like him. However, can he or anyone else bring off the  transformation that he craves?