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In Remembrance Of Uwe Reinhardt

In Remembrance Of Uwe Reinhardt
November 27
09:43 2017
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The passing of our dear friend and colleague Uwe Reinhardt has shaken the health policy and research community as much as any other issue in my lifetime and perhaps in the history of our field. Anyone that ever met him or heard him speak has a story to tell about how he influenced their lives or forced them to confront the many absurdities of our health system. He combined, as no one else could, a sharp, penetrating mind grounded in a traditional understanding of economic principles with a unique, insightful, and self-deprecating humor.

The Genesis Of A Health Policy ‘Odd Couple’

I met Uwe Reinhardt in the fall of 1969 at the first conference of health economics at the School of Public Health at Johns Hopkins University. Unlike today, when there are thousands of us doing interesting and important work on how our $3.2 trillion in health spending works or doesn’t work, there were then just a handful of health services researchers trying to understand why we were spending such an extraordinary amount of money—which was expected to exceed 7 percent of our GDP—on health care while we still had so many Americans with no health insurance. Medicare and Medicaid had just become law and we knew little about how they would impact the health system and the millions of aged and low-income individuals who were their beneficiaries.

Uwe and I were the true “odd couple” of health policy. Although we were the same age and grew up during the Second World War, I was a Jewish kid from the Bronx who went with his father to make sure everyone had dark curtains and had shut their lights off at night in case we were attacked by German bombers. Uwe was a frightened German kid hiding from American soldiers who were invading his country. In between trying to understand the intricacies of the health care system, we discussed what it was like growing up during the war. I had never met a real German before and he was nothing like what I had seen in the movies. Even then his humor and genuine warmth were infectious. It didn’t take long for us to become close friends, a friendship that would last for almost 50 years.

Neither of us had any formal training in what has become the field of health economics. Uwe had written a dissertation on physician supply using standard theoretical economic concepts. I began my journey in health care by studying the supply of nurses. Uwe wasn’t sure there was much of a future in continuing to study health care problems. But just as Benjamin’s neighbor in “The Graduate” kept pushing him to enter the field of plastics, I kept telling Uwe that studying health care was the future. It’s hard to think what the field of health policy and research would have been like had he not listened.

As many of you know, I became (and loved being) the subject for many of his biting satires on government (Medicare) price control. Dressing me up in communist army uniforms became a running part of our frequent duets – I still am not sure whether he bought the uniforms or stole them. Once, both of us were asked to make formal presentations to the U.S. House Ways and Means Committee at West Point. I had drawn the short straw and was asked to talk after dinner and a long day of presentations. The room was set up so that I could not see the screen and this was pre-PowerPoint with real slides. Unbeknownst to me, Uwe had inserted a slide which had me wearing the communist­­ army coat and saluting the Chair of the Health Sub-Committee, Pete Stark. I knew something was wrong when one of the members who had fallen asleep jumped up and spilled his cognac as the room erupted in laughter. Uwe had to make a large charitable contribution to Brandeis University to make up for that stunt.

Uwe was a long time member of the editorial board of Health Affairs and a frequent contributor to the publication. Of his many contributions there are two I will mention that are particularly meaningful in today’s economic and political climate.

Using Economics To Debunk Misunderstandings And Increase Transparency

Many of us have commented that American businesses should play a stronger role helping to lower the cost of health care. Interesting, this issue was very much in the forefront of the health reform debates of the later 1980s and 1990s. In both scholarly publications and the lay press, it was often quoted that the cost of every car produced in America included $500 to $700 for employee health care, which was more than the cost of steel. The argument went further, suggesting that corporate executives should aggressively support techniques to lower health care costs since these costs put American manufacturers at an economic disadvantage compared to their international competitors. Governor Bill Clinton used these arguments in his run for the White House and, as President, in trying to pass his health reform proposal.

 

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