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Even as Dr. Donald Berwick runs for governor of Massachusetts, he's got a firm foothold in his former life as an expert on health quality.

Berwick, most recently known as the acting chief of the Centers for Medicare and Medicaid, was the founder and longtime CEO of the nonprofit Institute for Healthcare Improvement. And it was more in the role of health care troubleshooter that British Prime Minister David Cameron asked Berwick for his recommendations for restoring confidence in the English health system after higher-than-expected death rates at one hospital rocked the country.

The result? Berwick's "Letter to the people of England" early this month, explaining his call for continuous learning without blame as the fastest route to improve quality within the National Health Service. Berwick spoke, by phone, to a group of reporters about his work in the U.K., the implementation of the Affordable Care Act and his candidacy in Massachusetts.

Here are edited highlights from the call.

How do you think this report relates to people in Massachusetts. What do they take away from it?

Well ... this report is not part of the campaign; I had agreed to do it prior to the announcement. But this is about large system change, I mean, here you have a system with 1.4 million employees. That's the size of the NHS spending 100 billion pounds [approx. $160 billion]. So it's a very relevant experience. I obviously was dealing with very senior leaders in a politicized environment, which of course as governor I would be doing constantly and helping build consensus.

You know that your work in the U.K. was thrown back at you as a critique in Washington. I wonder how you read the climate in Massachusetts for drawing lessons from work, like what you've done in this report?

Well, first the critique in Washington always felt to me, more or less hogwash. It was more demagogic than informed. I did work [his work goes back to the mid-90s, he was knighted in 2005] with the NHS, I'm proud to have done that, it's a good system with flaws. They brought me there because of their flaws and what they wanted is to continually improve. It is not the case that you can take a system from one country, or from one state, let alone the country, and just import it to another one, so that was pretty much fabricated, the idea that somehow I had a plot with the NHS. I'm proud of that work.

I think Massachusetts is a state that has a history of learning and growth and development and one of the ways you do that is by reaching out and learning what others are doing. We don't have a Mid Staffordshire problem of that exact type here in Massachusetts.

Was this a pro bono thing [the work for NHS], or did you get a substantial sum for it?

A: It was pro bono. I got no fee for this at all. I felt it was an honor to be able to do it, and this is a very valued system in that country and I was happy to be asked. Indeed, the whole committee worked pro bono, that's very important to know.

I'd love to get your take on the state of play of the Affordable Care Act now. On the one hand, you have predictions of disaster, on the other hand, you have the administration saying, "It's going to work, we're going to wait and see." And people will see once it's implemented. I'd like your critique.

It really is true that I do not have an inside wire to information from CMS or for that matter, the White House. In many cases, you know more than I do. But my feelings right now, two things: First is, the Affordable Care Act has already done very important things for millions and millions of Americans. People have prevention coverage they never would've had without this bill, people can get access to prescription drugs they couldn't have had, insurance companies are under more and proper surveillance, kids no longer have a pre-existing condition threat when getting insurance, and as of next year, that'll be true for anyone that wants insurance.

Massachusetts itself has gotten millions of dollars for prevention funds, for maternal and child care, for people to get access to better care. If the Republicans or anyone tried to take this law away, I think there'd be a sudden outpouring of rage as people realized what they were losing, what they've already gotten.

For the future, it's a complex endeavor, we're taking a $2.6 trillion system that serves the entire nation and trying to turn it into something that is universal, that is higher quality, that is more accountable, that is oriented toward outcomes not volume. That's a big deal, and of course there'll be adjustments.

As I watch – as an outsider now – the president make decisions about changes in timing, the delay of the employer mandates, for example, I don't – of course there'll be adjustments, they're making decisions about how to help a very complicated thing get done well, I can't second guess that.

I think this story is going to play out over time as a very important positive move for the country, and that the people who are trying to take the law away are not going to meet a happy public.

The administration's posture seems to be, "Well, we will let the people judge for themselves as it takes effect," and they don't seem to have done a very good sales job explaining how the benefits work, why you need a mandate if you're going to get rid of [insurance exemptions for] preexisting conditions, any of those tensions. Do you feel that they have sold this thing well?

I agree. I think there was, for reasons that are not clear to me, something that was missed in terms of explaining to the public, and helping the average person in the public understand how good this thing is, how much benefit this is going to bring to our nation, to our neighbors, to each individual. Why? I don't know. The story is a very important story.

When I was able to get out and about, when I traveled the country as CMS administrator, to town hall meetings and meetings with providers or beneficiaries, it took five minutes to bring them around and help them see what they were really getting because of this law. It's a very, very good piece of legislation despite the inevitable changes and tweaks that are going to be needed over time.

I think some opportunity was missed. I've seen in the efforts of [Health and Human Services Secretary Kathleen Sebelius] over the past year, and the outreach now to get people enrolled, a really great story in terms of helping people understand what's possible. But if we could go back to square one, I think a different, better messaging effort would've taken off.

As President Obama weighs a possible limited military strike against Syria, he may want to consider the track record of his predecessors on this front. It's not encouraging.

The Obama administration and several before it have seen limited attacks as a way to send a tough message without drawing the U.S. into a larger conflict.

But critics say such strikes rarely, if ever, inflict serious damage or change the behavior of those targeted. And worse, limited U.S. military action has been followed by some of the deadliest attacks against American targets over the past three decades.

"If this is indeed the sort of attack on Syria that the president is contemplating, it is not likely to be very effective," writes Mark Katz, a professor at George Mason University and a frequent commentator on the Middle East. "Indeed, it may encourage [President Bashar Assad] to launch even more chemical weapons attacks due to the belief that while US retaliation may be annoying, it will not threaten the survival of his regime."

Here's a list of several limited U.S. strikes in recent decades:

Lebanon, 1983: U.S. warships in the Mediterranean shelled Beirut for several days in support of the Lebanese army, which was led by Christians fighting Muslim factions in the country's anarchic civil war. A month after the U.S. shelling, Shiite Muslim suicide bombers struck at the U.S. Marine barracks in Beirut on Oct. 23, killing 241 Marines. This remains the biggest loss of life of U.S. military personnel on a single day since World War II.

President Reagan subsequently ordered the Marines out of Lebanon in February 1984; the Lebanese civil war carried on for six more years. A military committee appointed by Reagan found that American commanders believed the U.S. shelling of Beirut led to the bombing of the Marine barracks.

Libya, 1986: Libya was implicated in the deadly bombing of a disco in Berlin frequented by U.S. servicemen. In response, Reagan ordered a one-night bombing raid on Libya, which targeted the compound of Libyan leader Moammar Gadhafi.

The Libyan leader survived, and two years later, in December 1988, a Pan Am plane was blown up over Lockerbie, Scotland, killing 270 people on the plane and the ground. Many of the dead were Americans. After a protracted international legal fight, Libya acknowledged involvement and paid compensation of $1.5 billion in 2008. Gadhafi remained in power until 2011, when a more sustained NATO air campaign helped rebels drive him from power.

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Saying that there are "no plausible alternative scenarios," the U.K.'s Joint Intelligence Organisation released a statement Thursday to support the conclusion reached by U.S. and British officials that Syrian President Bashar Assad's regime is responsible for what's said to have been a chemical weapons attack last week near Damascus.

That attack, U.S. and British officials say, killed more than 300 people and may have injured several thousand more.

The statement — in the form of a letter to Prime Minister David Cameron — notes that "it is being claimed, including by the regime, that the attacks were either faked or undertaken by the Syrian Armed Opposition." But, it continues, "there is no credible intelligence or other evidence to substantiate the claims or the possession of [chemical weapons] by the opposition."

The language echoes that of the Obama administration.

According to the British report, Assad's regime has also used chemical weapons "on a smaller scale on at least 14 occasions in the past."

The statement's release was timed to precede a vote in Parliament over whether Britain should take part in any military strike on Syria.

As we noted earlier, The Associated Press is reporting that some U.S. intelligence officials are cautioning that the intelligence linking the regime to the attack is not a "slam dunk."

British Intelligence Statement on Use of Chemical Weapons in Syria

The New York Times' website isn't working for us, and many other users, again this morning. As All Tech Considered reported Tuesday evening, the Times appears to be the victim of another hacking by the Syrian Electronic Army — a pro-Assad organization that has previously taken over the websites of other U.S. news organizations, including NPR.

The Times has created an alternate website to display its stories. Click here to get there. Among the top stories there as of 7 a.m. ET:

— "Obama Weighs 'Limited' Strikes Against Syrian Forces."

— "Arab League Rejects Attack Against Syria."

— "Strike on Syria Would Lead to Retaliation on Israel, Iran Warns."

— "Merrill Lynch in Big Payout for Bias Case."

— "Times Site Is Disrupted in Attack by Hackers."