• Uwe Reinhardt: Giant, mensch, knife twister

    The renowned Princeton University health economist Uwe Reinhardt died today. The email from his Dean at the Woodrow Wilson school said he passed peacefully and surrounded by family.

    Reactions on Twitter resonate with my own. They reflect Uwe’s contributions to and presence in health care policy and education — “insightful, “a treasure,” focused on the “moral underpinnings of policy,” “one of the nicest and funniest people in the field of health econ,” “a godfather of health policy and economics,” “a unique and disarmingly powerful voice in health policy,” a “world-class mensch,” “a gifted teacher and inspiring leader,” one of the “most acerbic speakers in Health Care over the last 20+ years. Never afraid to speak truth to power,” “engaging and understandable,” “a giant.”

    I once called him “the narrator of U.S. health care policy.” Any journalist who could get hold of him for a health care story was sure to get pure gold. His wit and precision were evident in his spoken and written word. His command of English was tremendous. His ability to explain to lay audiences, legendary. If you’re unfamiliar, go read anything he wrote for The New York Times Economix blog, where he posted regularly for years. He can teach. You will learn.

    Born and raised in Germany, he did it all in a second language. Of this, he reminded audiences regularly. The title of one of his presentations was, “Still Confused, After 40 Years in America!” Don’t believe it. Uwe was always the least confused person in the room.

    He opened many speeches with, “I’m just an immigrant so maybe I am missing something about the curious American health care system” (or similar). I heard it many times. It never got old, particularly because I knew what was coming next. Just after such an opening, he would reveal some peculiarity of the health system I had never noticed in the same way. And then he proceeded to show how it was illogical, in violation of basic concepts of economics, immoral, or hypocritical.

    He was a knife twister of the first class. Should you hold dearly an idea he targeted for systematic dismantling, you would squirm. If only I could write half as well or think one-third as clearly.

    He touched so many lives and careers, including my own.

    My first engagement with Uwe was in 2009, over one of his Economix posts. In the comments to that post, I asked him for an economics argument in favor of a public option. He was kind enough to respond at length directly to my inquiry in a follow-up Economix post. I was thrilled, even as I took a beating. I documented the encounter on this blog.

    Perhaps due to my repeated blog-based engagement with him — like a fly that just won’t go away — Uwe took some interest in what I was doing on TIE. He noticed my many posts on hospital cost shifting and suggested that an updated literature review should be published. I counter-offered that we do it together, and he accepted.

    I knew exactly what this meant. I was to write the first draft and he would serve as senior author and tell me how much more work it needed. Here’s where Uwe surprised me and earned my deepest respect. His response to my first draft was that it was so good he did not think it right that his name appear on it. Instead, I should publish it solo, with his support. This is good mentorship. It was my first solo-authored paper and is my most cited publication.

    I met Uwe in person only once, in Princeton in 2010. I was there to visit my parents and give a talk at the Woodrow Wilson School. Learning I’d be in town, he invited me to lunch. I thought it was just going to be the two of us, but he insisted I bring my parents too — his treat. (In advance of the lunch, with some help from YouTube, I practiced how to pronounce his name. It’s “oo-va” not “you-ee.”)

    Though I never saw him again in person, for years I encountered him over email. Usually our threads began with me asking a question or him sharing one of his lengthy emails to some other scholar or policymaker. (Oh, what a shame it is he didn’t post those emails for all to see. They were gems.) But frequently he would email out of the blue to inquire about my family. He took an interest in hearing what my children were up to and used that as an opportunity to remind me how different parenting or childhood was in his day.

    “Child rearing is so different nowadays,” he wrote me once. “When we were little, we left the house after lunch and came home for supper, roaming the country side in the meantime (and playing with live ammunition [left over from WW II]).” I have very few folders of saved emails, but this one and others of his I filed away, not to be deleted.

    Frequently, in the email back-and-forth that ensued he would type out some amazing story of past hijinks. Here’s one:

    Once, at a Duke University private sector conference, the entire brass of the AMA happened to be there. It was my turn at the podium and I could not resist the following stunt.

    The late James Sammons, then head of the AMA, had given interview in which he said Congress had carved Medicare to death like a turkey. I showed a slide of that quote which happened to have his picture next to it. I then showed data according to which between 1980 and 1988 constant-dollar Medicare spending on physician services per beneficiary rose 83%. Apologizing for this low number on behalf of taxpayers (the growth of 83% real allegedly did not permit physicians to give the elderly adequate care), I asked the AMA people: “What increase would have been adequate in your view?” So I counted out numbers (on a slide) like an auctioneer – 100%, 120% , …– but never got any takers. After +160% I left a blank spot and said: “Evidently 160% would not do it, so you give me the number. Is it 300%?” Icy silence. I then had a slide quoting country-music singer Conway Twitty or whoever it was from his song: “I need more of you (moolah) – more, anything less would not do.”

    I then I ended saying that Karen Davis and I, both then serving on the PPRC (now Medpac) would propose a budget for Medicare physician payment (the VPS), because the docs would not come to the table with a reasonable number.

    For a while I literally was banned at the AMA; but later I ended up on the JAMA board.

    With tales like this, I thought of him as the Richard Feynman of health policy — brilliant in his field but with an appetite for adventure and practical jokes. I encouraged him many times to write up stories like these in a book, interwoven with health policy analysis or history. Sadly, he never did. Though he took pride in his past escapades, perhaps he saw himself differently late in his career.

    “When I was younger I was more brash,” Uwe wrote me. “Now I’ve mellowed.”

    There are many giants in academia, and many in health care. But there are none I know like Uwe.

    @afrakt

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    • In the mid 70s, I first read Reinhardt s essay on healthcare using the analogy of “pigs at the trough.” I was instantly hooked. I was honored to once have dinner with Uwe and his wife and others one summer with John Iglehart in Vale. Best night of my life as a health economist in the South. Uwe was charming and an audacious flirt. Mae was equally charming and perceptive. He was my hero and I will miss him. But I am sure Gwen Ifil is doing Uwe’s first celestial health interview. A toast to a life well lived and a huge gap to fill. God’s speed.

    • Thanks for sharing. Never met him but learned much from his writings and lectures posted in social media. Grateful to have his witty but never off-hand insights on a complex topic. The healthcare discussion needed his voice and will sorely miss him.

    • A very sweet man. Met him at Yale graduate school. After many years, even though we only knew him for a short time, he answered my email and told me about his family. I’ll never forget his enthusiasm for Aznavour, I a French major, was amazed that he knew of the chansonnier. He was a truly compassionate and kind gentleman. Sorry he has passed.

    • I heard Uwe speak a number of times. I appreciated that he always said two things: first how fortunate he was to have been able to come and live in the United States and second, that the United States needed a national health care system

    • Professor Reinhardt was a true inspiration to thousands. The nation owes him an immense debt; and personally I will deeply miss his wisdom and public courage.

    • When I was a graduate student in Computer Science and Electrical Engineering at Princeton, 1970-1973, I also took some Economics courses, including a course in Corporate Finance by Prof. Uwe Reinhardt. A premise of the course was to explain to us how to be a CFO. The course was taught in a bowl-shaped classroom, with a large number of students attending. To me, the material in the course seemed to be about 3x the amount in other courses I was taking, so I spent a lot of time on it, and did well. At the end of the course at the end of the last day, Uwe got a five-minute standing ovation from all the students, very moving, and very memorable. At my request, Uwe wrote a recommendation for me to apply to Business Schools for an MBA, tho I decided at that time, also with some teaching offers, not to follow that path (yes I did get accepted at some Biz Schools), but instead try teaching Computer Science. The corporate finance I learned from Uwe has served me well for a long time, and I still use that knowledge. Best class I ever took; best professor I ever had. Thank you, Uwe.

      • As an adjunct prof of economics in an MBA program, I know Uwe would find this the highest honor, to called “the best teacher” ever.

    • It is a strange, but very sad, feeling to sit here in what used to be Uwe Reinhardt’s master bedroom before he and his wife sold this house to me and my husband 28 years ago. Very sad indeed.

      Previous to the Reinhardt’s ownership of this house, it was the home of another outstanding German named Helmut Cords. Helmut Cords participated in the July 20, 1944 plot to assassinate Hitler. After the attempt failed, he was due to be executed, but the Allies came along in time to rescue him from prison.. Cords later became head of research at Bristol Myers here in Princeton.

      It is an awesome experience to be, at this very moment, in the same space once occupied, and slept in, by two such accomplished men.

    • I did an on-camera interview with him twenty-some years ago, for a documentary on Jack Wennberg’s work. Uwe was gracious, generous in his assessment of a colleague’s work, and immensely funny. It was a wonder to experience his mastery of English in person and in print.

    • As a physician medical center chief medical officer, I often looked to the solid opinions and data interpretation that benefited all in healthcare.

    • Those of us in health policy all share in mourning this great loss to humanity. His teaching style, not just for his Princeton students but for all of us, was unique. Occasionally his statements seemed outrageous but that was to provoke us to challenge him. There was a subtlety about him that made us realize that his provocative comments were not his personal views.

      Quite a few summers ago he was quite ill, a prisoner in his home, limited in his activities by the IVs that were infusing the protracted course of antibiotics that he needed for his recovery. At that time several of us who supported single payer reform were exchanging emails with him. In his own style, he challenged our positions. With his provocations, we were up to the task. He seemed quite satisfied that were able to make a solid case for single payer. He later told me that our virtual class with him was essential to get him through that summer. We were all better health reform advocates for it, and what more could the distinguished professor ask for?

    • You said everything i would like to havevwritten anout Uwe. I knew him best years ago (maybe 40) in the health services research world and cherish memories to this day (including terrific Christmas cards). My sincerest condolences to his family. He was incomparable and will be dearly missed .

    • I first met Professor Reinhardt in 1989 when i was the first and only public policy guy at Squibb Corporation and he was lead of an international policy conference we sponsored, held at the Woodrow Wilson School during the fall break. We met at the restaurant at the Nassau Inn to plan the agenda and I was petrified and he must have seen it. I’d heard and studied him and he was one of my heroes. He was the same that day as ever…thoughtful, entertaining and thoroughly decent. I stayed in touch after that project and being a (very) minor part of his orbit has been one of my great professional and personal joys.

    • On the day that HCFA changed its name to CMS, Uwe and I were both on the agenda at a conference in New Hampshire. Luckily I didn’t have to speak immediately after him. He did this bit on the name change and suggested that “Social Health Insurance Trust” (insert acronym here) would have been more appropriate.

    • Uwe Reinhardt spoke at our annual meeting an hour or so before the announcement of the first Supreme Court decision on the Affordable Care Act.Within 10 minutes of the reveal of the decision, we had him back on stage offering his thoughts on what had just been handed down. There was no planning on our part to time Reinhardt with the S. Ct. Just our dumb luck. But what a time to get lucky? It was terrific. I can’t even remember what he said, other than that it was smart, on point, and of the driest wit.

      The thing I remember most is not a health care thing. He spoke about people serving in the military. He said, they do not fight for patriotism or love of country. They fight for each other. They are brothers to each other and they fight for each other. I think about this often as we send our young people to war and argue about how much and how long, argue about what the flag means and who it honors or how it is dishonored. I think about how we treat those who return with brain injuries and missing body parts. They fight for each other. I will never stop thinking about that one.

      I had the change to hear Uwe Reinhardt speak in person three times, I think. I wish it had been 30. I wish I were half as smart. I wish we had so much more time with him.

    • I had the opportunity to hear Dr. Reinhardt many years ago as the keynote speaker at the annual meeting of what was then called the Hospital Association of New York State. I have never forgotten it. It was the first time I had heard the exposition of the argument that there are three aspects to the health care system — cost, access, and quality — an that you can simultaneously control any two beneficially, e.g., keep costs from soaring, increase access, or improve quality, but never all three. I also remember that he was one of the funniest speakers I had ever heard. The meeting was held at the Sagamore Resort on Lake George, and he remarked that it was a really classy place. He said he knew it was a really classy place because you could actually take the coat hangers out of the closet in their entirety instead of only being able to remove the part that hold the garment while the hanger remained firmly and permanently attached to the rod, so you could not steal the coat hanger.

    • Yesterday as I was reviewing some files, I found two papers Dr. Reinhardt gave me at a conference where he was a speaker. If you are lucky enough to find them in your files, read them again: “How the Devil Subverted this Nation’s Soul, An Allegory about American Health Policy” (1991) and “Health Policy Keister-Backwards: The Default Option for American Health Care” (1991). I reread them yesterday and will continue to cherish their insight and will always remember him fondly.

    • Uwe Reinhardt was an inspiration to anyone who works in health policy and was interested in creating a more inclusive, humane health system. Always thoughtful, always insightful, always very funny. I heard him speak several times and always learned something (and was able to steal a few jokes, although they never worked as well as when Uwe delivered them). At a time when we need him perhaps more than ever, he will be missed.

      RIP

    • All of Austin’s comments about Uwe track with my experience as one of his students at the Woodrow Wilson School. After graduation, I had the opportunity to introduce Uwe to Roger Weisberg, a producer at WNET and the maker of many great documentaries on health care economics. Roger found Uwe to be a gold mine of the kinds of quotes that both explain a difficult issue and make a brilliant point. If you’re interested in seeing vintage Uwe Reinhardt, one of those documentaries, Health Care on the Critical List, can be found at https://www.pppdocs.com/healthcareonthecriticallist.html.

    • I once heard Prof. Reinhardt speak about the disconnect between the generous spirit of Americans and our stingy social policies. He said he learned that Americans were generous when he was a small German boy at the end of WW II. He was in a shed with his mother and other family members fearing what the American soldiers would do to them. Suddenly a soldier kicked in the door. He closed his eyes expecting to be killed. When nothing happened he opened his eyes to find that the soldier was holding out his hand offering him a Hershey bar. I have often thought of that story when I have despaired at how little generosity there still is in our approach to health care.

      • What a great story and insightful comment about US generosity which Professor Reinhardt based on his own private experience as small Junge (boy) in northern Germany in the last days of WWII. I survived a similar situation only a couple of miles from the Elbe with the US soldier not shooting my family hiding in a ditch & then leaving us with US rations when they withdrew from our village. I also agree with Professor Reinhardt’s observation about the US private vs governmental generosity.

    • When I was doing my masters thesis, I interviewed the former head of the Taiwanese National Health Insurance and he offered to put me in touch with Uwe Reinhardt… I never took him up on it, because I couldn’t think of anything important enough about me to warrant his attention.

      One of my big regrets.