ORLANDO — Don Berwick, M.D., is still fighting for change in health care.

After what he's experienced in recent years, one would think he'd want to take a break.

His tenure as acting administrator of Centers for Medicare & Medicaid Services seemed to be about everything but health care at times.

Berwick also undertook a failed run for governor of Massachusetts that included the endorsement of a single-payer health care system and repeal of gambling in the state.

In between, the health care quality guru and Institute of Healthcare Improvement fellow had a moment on the mountain in which he came to believe that the healing power of the mind might be the missing element in solving health care's quality problem.

Yet, Berwick, in his closing keynote speech at the IHI National Forum on Quality Improvement in Health Care, issued another challenge to health care leaders: Cut costs even further. During the campaign, he met state residents who were facing tough circumstances, he said. Those conversations reminded us that high health care costs take money away from other social services that are necessary to improve people's lives.

His stories of people struggling to survive in tough neighborhoods and the people and organizations trying to help were touching. The United Teen Equality Center in Lowell, Mass., is relentless and compassionate in its approach to helping troubled teens, often former gang members, with jobs and training. ""They never, ever give up on a kid," Berwick said. "UTEC's philosophy is wonderful: it [provides] unlimited chances," he said. UTEC's leaders say it's a matter of life or death for many of the teens they target.

This and other examples were cited as a backdrop to give hospital leaders even more reason to become more efficient and reduce costs.

Pointing to spending in Massachusetts as an example, he showed how state spending on health care soared over a number of years, while spending on other social services fell, in real dollars.

Nationally, he referred to a Commonwealth Fund report comparing the two most expensive health care systems in the world — the United States and Switzerland. In 1980, per capita spending in both countries was equal; in 2010, the United States outspent Switzerland by $3,000 per person. According to the Commonwealth Fund, the United States could have saved $15.5 trillion over 30 years if its spending were more in line with the Swiss.

That money could have gone a long way toward building safer, healthier lives for an untold number of people, Berwick argued.

He urged hospital leaders to do even more to cut costs, and to do so for the betterment of society.

For those in attendance, Berwick's argument was thought-provoking and new. Bob Bylancik, a trustee for St. Peter's Health Partners, Albany, N.Y., says nonprofits likely could work more in concert rather than in silos, and Berwick's wide-ranging speech offered an original argument why hospital leaders should take action.