Rashi Fein: The Architect of Medicare with a Place in his Heart for Lake George
One of the advantages of living on Lake George rather than in other, more obscure sections of the Adirondacks is that some of the nation’s most gifted people spend their summers here. And we get to meet them.
Rashi Fein, who died on September 8, was certainly among that group.
A professor emeritus of the economics of medicine at Harvard Medical School at the time of his death, Professor Fein is commonly acknowledged as one of the fathers of Medicare.
“My first federal job was for a Harry Truman commission on national health insurance,” Fein wrote in the Boston Globe in 2007. “For more than half a century I have believed and still believe that every American should have full access to needed medical care.”
As a Boston Globe columnist noted after Fein’s death was reported, Fein went on to serve as a senior staff member of President Kennedy’s Council of Economic Advisors and chairman of President Lyndon Johnson’s task force on health care, appointed to develop a national health care policy.
From that task force came Medicare and the legislation that Lyndon Johnson signed into law in 1965.
Fein’s advice continued to be sought by New York State Health Commissioner David Axelrod, Senator Ted Kennedy, and by many others engaged in crafting health care policies for the United States.
For Fein, universal access to health care was not simply of academic interest, to be discussed in classrooms or debated by legislators, but a moral imperative.
“A decent medical-care system that helps all the people cannot be built without the language of equity and care. If this language is permitted to die and is completely replaced by the language of efficiency and cost control, all of us, including physicians, will lose something precious,” he once wrote.
As Sandy Lamb, a Lake George neighbor and a former colleague of Fein’s at Harvard Medical School puts it, “Rashi was the nation’s most forceful and powerful advocate for a single-payer health care system.”
“Rashi believed in a health care system that was fair and equitable, and he believed we should do everything possible to achieve that, to go as far as we could go, given the limitations of political reality,” said Dr. John Rugge, the founder of the Hudson Headwaters Health Network.
While Fein and his wife Ruth were long-time subscribers to the Lake George Mirror, I did not have a chance to meet him until the Adirondack Regional Medical Home Pilot Project was introduced at a meeting held at the Warren County Municipal Center several years ago.
At the time, the Adirondack project was an experiment in the delivery and funding of health care limited to a few counties in the Adirondacks, and may have seemed incidental to the national debate on health care reform.
Rashi Fein, who was one of the speakers that day, assured us that this was not the case.
The cost per capita of health insurance would only continue to rise if reforms like those at the center of the Adirondack project were not implemented nation-wide, Fein said.
Physicians participating in the project would devote more time to preventive care, early detection and treatment when illness strikes, and coordinated care for people coping with chronic conditions. That would result in fewer hospital admissions, less frequent referrals to specialists, lower prescription costs, healthier lives and, ultimately, a less expensive health care system for everyone.
The Affordable Care Act, adopted in 2008, incorporated much of that approach to the containment of health care costs.
“Rashi Fein was familiar with everything we were trying to do,” said John Rugge, the driving force behind the Medical Home project. “He was a national figure who was always available to us; when we needed support at the highest levels, he provided that.”
Rugge said his relationship with Fein began in a curious way.
The director of the Hudson Headwaters Health Network Foundation happened to be reading aloud from a list of donors and came upon a contribution from one Rashi Fein.
“ ‘THE Rashi Fein?’ I asked. I had no idea he had any connection to the area,” said Rugge.
Rashi Fein’s wife, the former Ruth Breslau, is a member of a family that has been coming to Lake George for generations. Her father bought a house in Bolton Landing after World War II.
Surrounded by a warm and lively family, Fein had little need to seek out local acquaintances.
“The family is very public- spirited, but for Rashi, Lake George was a place to write. He wrote eight books here and countless articles,” said Ellen-Dean Cummins, a cousin of Ruth Fein.
Another relative, Louise Marwill, recalled her attempts to persuade Rashi to join her family on a cruise in their new sail boat; he agreed, but only if he could continue working on a book he was writing.
“Rashi enjoyed the best of both worlds at Lake George,” recalled Kibbty French, who became a caretaker for Fein’s property twenty-five years ago. “He loved the quiet times with Ruth, but he also enjoyed all the chaotic times when all the children and grandchildren were around.”
“What he loved about Bolton Landing was its place as a center for his family to come together,” said Doreen Brown, who also worked for Fein’s family. “Rarely if ever did I see him out in town, in a restaurant.”
His presence was felt, nonetheless.
“He was just the nicest man,” said Megan Baker, the director of the Bolton Free Library. “We had a running joke about his grandchildren’s library books; they were always overdue and he was always apologetic about returning them late. But he was also a generous contributor to our library sale and we were grateful when he donated a signed copy of his last book to our collection.”
Members of Megan Baker’s family built docks, made repairs and added improvements at the family camps in Bolton.
“I think we started doing work for that family more than fifty years ago,” said Horace Baker, Jr. “It was a close relationship.”
Sandy and Ruth Lamb resumed a relationship with the Feins that began in 1972 at a reception for Lamb when he joined the faculty of Harvard Medical School.
“Ruth Fein mentioned that they had a summer place in a town called Bolton Landing where there were a lot of Lambs, but she said she doubted I was related to any of them. I said ‘I’m related to all of them; that’s where I’m from!” Sandy recalled.
Ron Alcan, the owner of Ron’s Hardware for more than forty years, was among his closest friends in the community.
“I first met him during the Kennedy administration, when he started going to Washington. He had high hopes, as I recall,” said Alcan.
“He would come into the store with a problem, and I’m sure he already had the best solution, but he enjoyed talking about how we would solve it,” said Alcan.
The two would continue their conversations over coffee at the diner.
“I’ve always liked history and economics, and it was always interesting to me that here he was, this Harvard professor, wanting to know what I thought about government in Washington,” said Alcan.
“He was not a diamond in the rough; he was a diamond, pure and simple,” said Alcan.
I myself looked for excuses to talk to Fein.
One of those excuses presented themselves last winter, when I came across a letter to the editor of The Economist from Fein.
The letter was a response to an article about the 17th century writer, Sir William Petty, who is said to have invented the calculation known as the Gross Domestic Product.
In his letter to The Economist, Fein wrote, “You did not do full justice to Petty’s cost-benefit calculations. Petty argued that the state should intervene to assure better medicine, which could save 200,000 subjects a year and thus represented a sensible state expenditure. Today’s economic estimates are more refined and the data are more exact, but the arguments presented by Petty still resonate in public policy.”
Not knowing anything about Petty other than the fact that Jonathan Swift may have based his satire “A Modest Proposal” on Petty’s tendency to trivialize moral and political issues by reducing them to cost-benefit calculations, I wrote to Fein, asking for more information.
His response suggested that he was both amused by and skeptical of my new found interest.
“You have the distinction of writing the only letter I have received about my note in The Economist. Perhaps that indicates you are a careful reader; perhaps that you enjoy writing letters; perhaps that Bolton landing winters are cold and unlike most of us, you don’t fall behind on your Economist.
“Many, many years ago, I spent a summer in the Williams College library doing some research on early attempts to impute a monetary value to human beings. And so I came across Petty, wrote an article about him and the others who studied the costs and benefits of war, education, migration, and other such subjects in terms of the value of persons. Except for that article, the letter that you read was the only other time I’ve had a chance to refer to Petty.
“My advice: you already know more about Petty than 99.99999% of the world’s population. Use your time to read a good book!”
I last saw Fein at a memorial service for Dick Swire, another relative of Ruth Fein’s.
He discussed the politics of lake protection, and how some cunning, consensus-building strategies that he had observed as an academic could benefit Lake George.
And he suggested we have lunch, once he felt better. He had already been diagnosed with melanoma, although I didn’t know it at the time.
That’s one lunch I will always regret having missed.