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If Medicare Fails, What Will Replace It?

The Harvard Medical School now has a plan that might finally fill the ghetto gap in government health insurance.

"We have been extremely careful not to put in any systems that are unique to Harvard or to the hospital centers here," Pollack said. "All our planning has been directed at getting in the mainstream."

The result of the drive towards the mainstream has been a simple model of a community health care system. Not a utopia, not a complete restructuring of medical capitalism, but a practical set of instructions that other hospitals and insurance companies can follow.

The self-denying care with which the Boston planners have tried to build a national model might be pitiful if the rest of the nation paid no attention. But the relative wave of excitement that has swept through the American medical community since the Harvard plan was announced suggests that Pollack may indeed be setting a pattern for national reform.

"Right away, any program that Harvard Medical School undertakes has a certain audience," Pollack said. When the plan was announced last November, it made front-page news all over the country. Since then, requests from medical planners have poured into Pollack's office. "There is an avid national interest in the plan," Pollack said last week. "We have already received many inquiries; I've already talked with several people interested in following ht model."

Part of the reason for the health plan's national ambitions may come from the backgrounds of the men who direct it. Before he came to Harvard, Pollack had served as professor of administrative medicine at Columbia and director of Nelson Rockefeller's Committee on Hospital Costs in New York. In his years in New York, Pollack used to buy medi- cal service plans for three million people. By the time he came to Harvard in 1965, Pollack says he "came with a national outlook."

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When Pollack arrived at the Med School and became an associate dean for Medical Care Planning, the idea of a community health program had already run through the Harvard discussion mill several times. As early as 1961, a committee working on plans for the new Affiliated Hospitals Center recommended that the Center incorporate some kind of new continuous-care pre-payment program as part of its responsibility to the community.

The idea quietly gestated for several years. Then in 1965, Dr. Robert Ebert became the new dean of the Medical School. Dr. Ebert had earlier left Western Reserve to become Jackson Professor of Medicine at Harvard. The Jackson chair is one of the most prestigious in the world of medical academics, but there has been constant speculation that the prestige was not all that drew Ebert to Harvard.

Most Med School officials say that Ebert did not leave Western Reserve because it was opposed to community-involvement health plans. The only evidence is circumstantial: Ebert came to Harvard, and after he became dean, the Med School's health plan finally came to life. Throughout 1965 and 1966, Pollack and others worked on the detailed planning necessary to develop the program. Talking with administrators, chiefs of staff, and insurance directors, the Harvard staff kept working on plans into 1967. Finally last November, Harvard University announced that its Medical School would operate the nation's first university-sponsored pre-paid community health care plan.

In November, the details of the plan's administration were also laid out. The Health Plan was formally incorporated by Harvard University, and the plan's corporation is loaded with Harvard-linked people. The corporation--which Pollack says will provide only the "broadest overview" of the plan's operation--includes Dr. Ebert, President Pusey, Pollack, and Henry C. Meadow, another associate dean at the Med School.

The other members of the corporation retain the Harvard touch. They are John Dunlop, Wills Professor of Political Economy; Dr. Dana Farnsworth, director of the University Health Services; Arthur E. Sutherland, Bussey Professor of Law; Dr. John C. Synder, dean of the school of Public Health; and Francis H. Burr, a member of the President and Fellows of Harvard College.

In light of the parochial make-up of its corporation, the members of the health plan's board of directors come as a surprise. Several of them have Harvard connections--like Dr. Sidney Lee, another associate Med School dean, and Dr. Alonzo Yerby, director of Harvard's interfaculty program on health and medical care, and even John Kenneth Galbraith, Warburg Professor of Economics.

As Galbraith's inclusion suggests, the emphasis of the directors' board is on a wide range of expertise. This too is part of the plan's effort to set a national precedent. All the policy decisions for the plan's operation will be made by the board of directors; the men that Harvard has chosen to serve on its board of directors, then suggests what kind of broadly-based coalition it thinks is necessary to run new health plans.

One third of the directors will be medical specialists--physicians, chiefs of staff and other hospital officers, and doctors from local medical schools. Another third of the directors will come from the consumers of the health plan. None of those members has been chosen yet, but seats are being saved for representatives of labor unions, insurance subscribers, and Medicaid patients who enter the plan.

The last third of the directors shows an even broader reach. This third will be made up of men who reflect what Pollack calls "the general interest"-- men like Galbraith and another director, Rev. James O'Donohoe, a dean of students from St. John's Seminary in Brighton.

"There are times when both the providers of the care and the consumer may act in a shortsighted or narrow interest," Pollack says in explaining the "general interest" directors. "We hope that by bringing in this third element, we will be able to aim the program towards some of the larger social goals and problems."

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