Learning Lessons by Rashi Fein is an enjoyable memoir from a scholar and policy adviser unlike any other. Fein’s influential involvement in health care policy dates back to John F. Kennedy’s administration, and his career as a leading health economist paralleled the significant growth in the political influence of health economists following the enactment of Medicare and Medicaid in 1965. Now an emeritus professor of the economics of medicine at Harvard Medical School, Fein writes here about the lessons he learned in medicine, economics, and public policy. His view of the policy process, as a way of coming to terms with life’s unavoidable trade-offs, has much to offer us, too.
Advocates universal & comprehensive health insurance (1) to cover the 16% of Americans who now have no public or private coverage; (2) to help hospitals pressured to end the cross-subsidies that previously enabled them to care for the uninsured; (3) to protect the jobs &, thus, the communities of health care workers; & (4) to improve the care received by the currently underinsured. It is allowed, however, that the US nonparliamentary political system all but precludes the enactment of the sort of ambitious, cohesive plan needed to repair the health care system. Thus, even though an incremental approach tends to politically weaken those it does not directly help, several smaller steps for improving the organization & financing of care are suggested: (A) slowing the shift of not-for-profit providers to the for-profit sector, possibly through the power of the states' attorneys general; (B) regulating & demanding greater accountability from health maintenance organizations; & (C) strengthening & improving Medicare. E. Blackwell
A summary of data on twin problems in the health field: (1) the increasing number of Americans without health insurance; & (2) the increasing costs of health care. It is argued that these problems can be addressed by a national health insurance program that makes comprehensive benefits universally available & that operates within prescribed budgets. The characteristics of such a program are discussed. AA