Thursday, February 23, 2006

Larry Summers and Health Care Reform

Those who want to understand why health care reform is so difficult can learn a great deal by studying the case of Larry Summers.

Mr. Summers is distinguished both as an economist and as a public servant, having served as Under Secretary of the Treasury in the Clinton Administration. After President Clinton left office, Mr. Summers was appointed President of Harvard University. It was reported at the time that the governing body of Harvard was looking for someone who could restore coherence to the University by rejuvenating its mission and reining in the excessively independent academic divisions.

Summers seemed to be the ideal candidate for the position with his impeccable academic credentials and demonstrated ability to be an effective administrator in a highly charged political environment.

It didn’t work. On February 21, 2006, Summers announced his resignation. Evidently, the President and Fellows of Harvard College, Harvard’s governing body, finally came to the conclusion that the cost of controversy within the faculty was outweighing the benefits.

The situation in many hospitals is almost precisely analogous. When Boards of Trustees undertake to recruit a CEO, they typically say they are looking for a strong leader who can capture control of the institution and enforce standards of performance. But the CEO who takes that literally and generates the inevitable medical staff resistance will find his Board opting in favor of peace, with career limiting consequences.

In both cases, the forces to which the governing body is reacting are mainly outside the institution. In a University, continued internal turmoil starts to hurt recruitment and, of perhaps even greater importance, to discourage donors. When it happens in a hospital, the community is likely to take the side of the doctors, who continue to enjoy high status and great public respect and whose professional independence is thought by most people to be something that should be preserved and defended.

Thus, those who would accelerate the pace of reform would be well advised to focus not only on the determination and vision of health care leaders, but also on the willingness of society at large to support reform in the face of the controversy that it inevitably will entail.

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