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Remembering Health Care Economist Uwe Reinhardt


This is FRESH AIR. Health care economist Uwe Reinhardt died Monday at the age of 80. The cause was sepsis. He helped shape the debate about health care. And one of the ideas he advocated, the individual mandate which became a part of the Affordable Care Act, could now be repealed as part of a tax overhaul. He also advocated for universal health care and government subsidies for low-income families, which also became part of the ACA or Obamacare.

Reinhardt was born in Germany and witnessed the horrors of World War II. At the age of 18, he immigrated to Canada rather than be drafted by the army. Reinhardt was a professor at the Woodrow Wilson School of Public and International Affairs at Princeton, where he taught since 1968.

He served as a commissioner on the Physician Payment Review Committee established by Congress. Last month, he received the 2017 bipartisan Health Policy Leadership Award from the Alliance for Health Policy, a nonpartisan group.

I spoke with Reinhardt in 2009 as Congress was debating the Affordable Care Act. It was signed into law the next year. We talked about issues that are still relevant today. I asked him if health care were mandated, how could it be made affordable?


UWE REINHARDT: My own feeling on this would be the easy way to make sure, if you are reasonable, would be to have a debate on the following simple question - what percent of a family's discretionary income - that is, income after housing and food and clothing, discretionary income - what percent of that should a family be expected to pay for its own health care?

If you look at upper-income people, like professors at Ivy League colleges, you could say, well, that should be 15 percent. Your income is such that we could expect you to eat at least 15 percent of your discretionary income. If you look at a waitress, you might say, you know, for her or him that couldn't be more than 5 percent because the income is so low. But can you see, if we had a debate on what is it that one can reasonably ask fellow Americans to pay for their own health care, you could get somewhere.

GROSS: You say that Americans are really suffering from cognitive dissonance about health care, that they distrust government. They don't want government running the health care system. And they supposedly have faith in markets. But you say they're unwilling to accept the harsh verdicts of the market in health care like when you're denied payment to reimburse you for a procedure. Talk a little bit more about this cognitive dissonance that you think we suffer from in America.

REINHARDT: Cognitive dissonance, of course, means that you hold two different theories that are in conflict with one another, but they're both in your brain and in your soul. That's what this means. Now, for example, you will have Americans say the government doesn't have the right to tell me to buy health insurance. But the same Americans will say if I get hit by a truck and I lie bleeding in the street, society owes it to me to send an ambulance, and the emergency room doctors owe it to me to save my life. How could both be true? Even a teenager would blush at something this ridiculous. If you believe society has a duty to save your life when you get hurt, you have a duty to chip into a fund that pays for that.

GROSS: The things that you describe as irrational in America's current health care system - can you find these problems in other developed countries?

REINHARDT: No, I don't think so. The typical Canadian or German or Englishman understands that they have to pay taxes or premiums to be insured because you're all in this together because you also expect society to save your life when you get in trouble. And they understand tit for tat.

I remember my own mother giving me a lecture once when she had to wait in Germany two weeks for the neighboring hospital to have a bed. And I said, oh, I can make a phone call and get you in earlier. And she said I was asocial. She says, then some other lady has to step back. How could this be decent? So here I felt lectured by my mother who had the sense of social solidarity that, yes, we have a good health system, but you also have to sometimes wait or step back to keep this affordable.

Americans complain about the cost of their health care. But they have the desire - I want everything my doctor prescribes, whether it's appropriate or not, and I want it today. And then they go and look at God and complain about health care costs. This is extremely frustrating.

GROSS: Now, you know your way around health care policy, that's for sure. And you know a lot about health care economics. What's a typical problem you faced with getting your health care covered? Do you have to fight for things that you think should be insured (laughter) and then you're told they're not?

REINHARDT: No. Fortunately, that really hasn't happened. You know, this complexity of claiming for health insurance is so awesome that my wife does it. This goes beyond the capacity of a Ph.D. in economics. So she does it, and she tells me that claiming for health insurance is far more time intensive and complex than the income tax, which she also does. So she deals with this because my attitude always is, oh, geez, I'm so busy. Why don't we just pay it and not argue?

GROSS: (Laughter).

REINHARDT: But she will argue because she says it's wrong. I mean...

GROSS: See, that's where they get you, though, right? Like - 'cause I know some people are just not going to take the time.

REINHARDT: Slobs like me. Yeah, they won't take the time. Now, if it were a really big bill, I'm sure she - but she fights even for smaller things if she thinks it's just wrong. Well, you know, a guy like me would say I know it's wrong, but my time is too busy. I'll just eat it. And I think the insurance industry very often just relies on people like me and say we'll just eat it. Professors really have it good. I mean, we don't share the American experience, frankly, given we have tenure and given we, particularly Ivy League, we have good health insurance.

In some way, I personally don't share the agony of the American people. On the other hand, I grew up in a tool shed, and I know how good it was that when we were paupers, my family, we had health insurance like everyone else in Germany. I've never forgotten that. And I would like the American people to have what I had and my mother had as a kid. So that is why I care. For me, personally, I'm fine.

GROSS: Any final thoughts you want to leave us with about the state of the current health care system or what changes you'd like to see made?

REINHARDT: Well, I would tell listeners stay away from people who try to solve the health care debate with cliches, like, oh, this is socialized medicine, and then you don't have to think anymore. Try to actually think through the issues and say, what is your predicament? What kind of country would you want to live in? Do you want to live in a country where someone who loses their job loses their health insurance? Is that what you want? Do you want a system where kids come out of college and for the next 10 years they can't get insurance? Do you want people who have family members struck with cancer to lose their house or their car?

I mean, ask yourself what kind of country do you want to live in. And all of these things I mentioned we have now. You lose your insurance with your job. You can lose your house and go bankrupt over a health care bill. No Canadians or Germans ever go bankrupt over medical bills. Why should we in America do that?

GROSS: Health care economist and Princeton professor Uwe Reinhardt, recorded in 2009. He died Monday at the age of 80. If you'd like to catch up on FRESH AIR interviews you missed, like our interview with New York Times investigative reporters Jodi Kantor and Megan Twohey about their process of uncovering allegations of sexual harassment and sexual assault, or our interview with Father Greg Boyle about his work helping gang members transition out of the life, check out our podcast. You'll find lots of interviews to choose from.

FRESH AIR's executive producer is Danny Miller. Our interviews and reviews are produced and edited by Amy Salit, Phyllis Myers, Sam Briger, Lauren Krenzel, Heidi Saman, Therese Madden, Mooj Zadie, Thea Chaloner and Seth Kelley. I'm Terry Gross.

And here's something to look forward to next week. On Wednesday, my guest will be country music singer-songwriter Margo Price. We recorded the interview yesterday. She brought her guitar and sang several songs. She has a great voice. I really enjoyed this. Her new album is called "All American Made." It's just been released, and we're going to close with the track from it.


MARGO PRICE: (Singing) I never won at scratch offs, but my daddy always bought them. My great aunt spent her life in Virginia pulling cotton. I don't have no microwave or a flat-screen TV. If you don't do right by yourself, do right by me. Do right by me. Long as the winters are, sometimes your mind breaks up. The bars are full by the afternoon and everybody's drunk. Sometimes I look down the road for a sight I'll never see. If you don't do right by yourself, do right by me.

UNIDENTIFIED SINGERS: (Singing) Do right by me.

PRICE: (Singing) Do right by me. Transcript provided by NPR, Copyright NPR.