In Memory of Uwe Reinhardt
Newtown, CT - November 18, 2017
In Memoriam – “Res tantum valet quantum vendi potest” were just a few of the many words of wisdom that, over the years, Uwe Reinhardt imparted during the yearly Altarum symposium on the sustainability of health spending. My colleagues Charlie Roehrig, Ani Turner and Paul Hughes-Cromwick had the pleasure and benefit of having Uwe as an advisor to their center for many years and, like them, we will all miss Uwe’s wit, charm, and ability to say simply and clearly what ails US health care, and what must be done over time to avoid the inevitable inequities that will otherwise result from it. At the 2015 symposium, Uwe skewered everyone for the improper way in which value was being used in health care policy and on the speaking circuit. “Fuzzy language can beget fuzzy thinking.” And with that he went to the core of how we should openly debate value, namely by relating effectiveness and costs of treatments with the outcomes they produce in added longevity and functional status. We continue to use value the wrong way, and that’s because everyone prefers to sidestep the truth. In 2016, in his last contribution to Altarum’s symposium, he updated a theme that has often run through his work, namely that, much like Hammurabi in 1700 BC, the US has applied, and continues to apply a value-based pricing system in which “a poor kid is worth less that a rich kid” because the price paid for the exact same service is lower for a child covered by Medicaid than by commercial insurance. And for those covered by commercial insurance, there is now a covert rationing of health care by class because “one does not need a PhD in economics to realize that a low-income family confronted with a high deductible will tighten its belt in health care much more than would a high income family confronting the same deductible.”
What this means to you – It’s uncommon for someone to be both very smart and wise, and Uwe was both, and both of these traits will be sorely missed in the years to come as the debates rage about how the GDP pie will be cut and who will be cut out of it. For our part, we will stand guard, stand firm, and forge a path to a future in which outcomes of care are not determined by type of insurance, class or any characteristic other than the skills of the clinicians that manage and provide that care. And in doing so we will honor the memory of a cherished advisor who taught us how to shine a bright light on the uncomfortable truths that too many choose to keep in the dark.