The Health Care System: A Costly Bureaucracy

Assistant Professor of Health Policy and Medicine Dr. David Blumenthal '70 is one of 47 non-government health policy experts chosen to review the soon-to-be-released Clinton health care plan. Since his graduation from Harvard nearly 25 years ago, he's been dealing with one of the nation's sickest patients:

Dr. David Blumenthal '70 pauses during an interview to gesture to a confidential fax lying innocently on his desk in his Massachusetts General Hospital office.

"That's actually what this is," said Blumenthal, assistant professor of health policy and assistant professor of medicine at the Medical School.

"This" may have been preliminary comments on Hillary Clinton's much-touted health care task force, scheduled for release June 15, sent to Blumenthal because of his involvement with a select group of 47 non-government health policy experts chosen by the government to make recommendations on the commission's plan.

Blumenthal has devoted his career to studying health care policy from vantage points as diverse as that of a Kennedy School of Government faculty member, a primary care physician, and a staff member for Senator Edward M. Kennedy '54-'56 (D-Mass.).

"[Kennedy] has been a major proponent of health care reform since 1968 when he introduced comprehensive health care reform legislation," says Blumenthal, who was one of three doctors on Kennedy's staff at that time.

A government concentrator and associate editorial chair of The Crimson while at Harvard, Blumenthal weighed several career options, including journalism, Asian studies and medicine. But in the midst of the Vietnam War, with a very good chance of being drafted, Blumenthal decided to enter Harvard Medical School.

"I went into medicine knowing that I would probably use it as a spring board into policy-related issues, and I've done that ever since I started medical school," says Blumenthal, who graduated from the Medical School in 1975. "I'm interested fundamentally in the large social issues of our time, especially when they affect the health care issue."

In the middle of his medical training, he took time off to get a degree in public policy at the Kennedy School of Government. Blumenthal then took two-and-a-half years away from his residency training to work in the trenches of health care policy as a member of Kennedy's staff.

He returned to finish his residency in internal medicine and then returned to the Kennedy School, this time to remain for seven years as a faculty member and as executive director and later director of a health care policy center.

Among his duties, Blumenthal recalls teaching up-and-coming civil servants the legislative process and the ins and outs of Congressional health care policy.

"I drew a lot on my own experience on the Hill, and also did a crash course in the history and function of the Congress," he says. "It was a lot of fun."

From the Kennedy School, Blumenthal moved on to yet a third facet of the medical complex by becoming the senior vice-president of Harvard-affiliated Brigham and Women's Hospital.

Blumenthal had always wondered about the management side of the table, and at the Brigham he was exposed to all aspects of hospital life. "There I did a lot of work on quality management," he says, working directly with the legal office, managing the pharmacy and the psychiatric unit.

"I enjoyed it, but after four years I decided that I wanted to go back into policy," he says.

Today, Blumenthal works to improve the health of his patients, and more globally, the health care of the nation, through teaching, treating patients and performing research. The government called him to serve as part of the informal group, he says, as an interested observer in the process.

"I'm chief of the unit here that does health policy and I have some involvement with a group that's been reacting to, or trying to reach to the Clinton health care plan," he says. "That's a completely unofficial role, for which I'm not compensated. It involves a lot of trips to Washington and a lot of briefings and we're at the point right now of making our report to the task force on what our views were."

Blumenthal's views on why there is so much pressure now for the government for reform tend to back the theory that while Americans may be able to overlook certain issues, solutions pique the public's interest only when its wallets and purses are threatened.

"I think that society now is probably most concerned about cost containment, which is the most important political emphasis, and impetus behind health care reform," says Blumenthal. "I don't think Clinton would not be nearly as interested in health care reform if health care were not 14 percent of the GNP, or if the Medicare or Medicaid budget weren't going through the roof."

Blumenthal cities Clinton's language and the context in which most discussion of the issue arises.

"If you listen to how he talks about health care, if your listen to his State of the Union, you can say where health care first came up was in talking about the budget, and controlling the deficit," says Blumenthal.

But Clinton's reason for using this kind of language, says Blumenthal, is the fact that this constitutes the majority of concerns nationwide on the issue.

"I think in that, he reflects the views of most businesses and probably most people who are insured, whose concern is not that they can't get insurance, but they can't afford it once they have it," he says. "I don't think they are nearly as concerned about other people's access or about deficits in quality."

But he praises the new administration's energy.

"The improvement of health care quality is a very fertile field now," Blumenthal says. "There's a lot of good experimentation and good research going on, and a lot of innovation."

As an insider, can Blumenthal pick the odds on Congress passing the commission's plan?

"I'd give it slightly better than 50-50 in this Congress," he says, "and 80-20 before the next presidential election."