“It’s not a pure economic approach. I consider the political conditions and political forces and what those politics will allow you to do. There are potential constraints, and I am trying to optimize under those constraints,” Hsiao said.

Because those constraints vary country to country and state to state, so does Hsiao’s work and the reforms he proposes. Unlike many private health care consultants, Hsiao does not believe in a one-size-fits-all “cookie cutter” solution.

“The starting points in each country are different. The core that’s the same is that, for you to achieve universal coverage, the government has to play a large role in the financing,” Hsiao said.

In each of the countries Hsiao has worked in—from Colombia to Poland—the government has already sanctioned reform and is prepared to foot the bill for such a system, removing a significant hurdle in many countries wanting to reform. That Hsiao can then tailor a reform plan to that government is only a matter of expertise and analysis, not a matter of politics.

“He combines cutting-edge technical knowledge with a keen political sensitivity and practical experience on how to get things done,” said Michael R. Reich, a professor of international health policy at the School of Public Health.

Hsiao did not begin his career in health policy or economics. He immigrated to the United States from China as an adolescent when his father became an economic adviser to the Chinese Nationalist Party’s United Nations delegation.

After graduating from Ohio Wesleyan University in 1959 with a degree in physics and mathematics, Hsiao earned certification as an actuary, securing his first job at the Connecticut General Life Insurance Company. But a few years after he began there, Hsiao found the work unfulfilling, feeling he was doing little good for the world.

He responded with a sharp change of course into the public sector and his first foray into health policy. By 1970, Hsiao was chief actuary of the Social Security Administration and a major player in U.S. health care. He did not hold the position for long but consulted for the organization in the 1970s to help rescue it from insolvency.

Work in government satisfied Hsiao, but he felt underqualified to be dealing with health policy on such a large scale. So, still in his 30s, Hsiao changed course again, beginning studies at Harvard. He earned a master’s degree in public administration in 1972 and a Ph.D. in economics in 1982, accepting a position at the School of Public Health.

Hsiao began studying single-payer health care systems when Taiwan commissioned him to review their system in the late 1980s. Since then he has worked on five continents and almost a dozen countries, as well as consulting for organizations like the World Bank and the World Health Organization.

Hsiao is currently conducting a nationwide health care survey in China through collaboration with seven Chinese universities and the support of UNICEF. In addition, through a partnership with the World Bank, Hsiao and his team are undertaking an experimental health financing project in 100 communities in rural China affecting nearly two million people.

In early December, Hsiao will travel to Malaysia to begin a three-year study there with a team of professors and analysts.

But despite his highly visible work outside of the classroom, Hsiao has remained an active teacher throughout his career, teaching three courses at the School of Public Health this fall.

THE VERMONT EXPERIMENT

During the debate over the 2010 Patient Protection and Affordable Care Act, the single-payer system was scrapped early on, and the reform effort shifted toward a bill that would significantly expand coverage without putting in place a federal single-payer option.