A Dose of Advice

As health care rapidly becomes the issue of the 1990s, Harvard faculty appear to be getting in on the ground floor of the current reforms.

While the nation awaits the release of the Clinton administration's much-touted health care plan, doctors and political analysts who have offered their advice over the past months can only wonder whether their ideas will be represented in the final draft of the plan.

A number of Harvard health care experts, from the Kennedy School of Government to the School of Public Health, have played significant roles in advising First Lady Hillary Rodham Clinton's Task Force on the nation's health care policy.

And President Neil L. Rudenstine, in naming funding priorities for the upcoming $2 billion fund drive, has said that health policy will be one of five top areas for fundraising and for cooperation between faculty from different schools.

"The plan will represent some compromise," says Robert J. Blendon, chair of the Department of Health Policy and Management at the School of Public Health.

Blendon, who is a member of a research team addressing the politics of health care reform, is concerned with creating a politically feasible compromise which balances the desires and needs of the people with those of the government.

His role is as an advisor to the Task Force, "helping the administration to understand the politics [of health care] and trying to get a consensus on legislation."

Blendon favors a compromise which is practical over one which would be ideal but unpalatable to Congress. In a recent issue of the Journal of the American Medical Association, Blendon outlined a "middle ground" solution adjusted to the aims of both health care experts and the public.

Blendon's proposals include elements of both public and private financing, a stage-like implementation, and a branch of the national commission to address wasted revenues.

But other analysts approach the health care quandary from other perspectives. Dr. Arnold S. Relman, professor of medicine and editor of the New England Journal of Medicine, voices his concerns from the medical perspective.

"I take the position that health care is based on what physicians do with patients," he says. Relman belongs to a group of 47 non-government health care professionals, representing "all different strata of American society," charged with informally advising the Task Force on preliminary drafts of their plan.

"Our job has been to listen to the various options that have been proposed by members of various work groups," Relman says. The function of the review group has been, he says, to "listen, ask questions, comment, criticize, agree, disagree."

Another member of the review group, Assistant Professor of Medicine and Health Care Policy Dr. David Blumenthal '70, draws from his experiences as Senate aide, physician and academic.

"I don't have a prescribed ideological commitment to a certain approach," says Blumenthal, who is chief of the Health Policy, Research, and Development Unit at the Massachusetts General Hospital.

A self-described "health care addict," Blumenthal says his experience as a member of the review group has so far been "enlightening."

"We got a good look at the diverse thinking but not how the unified plan fit together," he says.

But few involved with advising the Task Force are willing to hazard a guess as to the exact nature of the plan. "All of us are in the dark," says Blumenthal. "Whatever we do will be a huge experiment." His hope, he says, is simply for a plan that works.

Blendon said he expects the plan will include universal coverage, subsidized by place of employment for those who are employed and by the government for those who are not.

Although Relman acknowledges that he has no way of knowing whether or not his ideas are being incorporated, he continues to hope for a plan based on the furthering of medical advances. "Medical research and education are the taproots of any kind of healthy and growing health care system," he says.