By Douglas Martin
The New York Times, Sept. 13, 2014
Rashi Fein, an influential economist who strove to bring ethical and humanitarian perspectives to the nation’s health care system and helped lay the intellectual groundwork for Medicare in the 1960s, died on Monday in Boston. He was 88.
The cause was melanoma, his son Alan said.
When Dr. Fein began working on health issues as a young aide in the administration of Harry S. Truman, health care accounted for about 3 percent of the American economy. By the time he weighed in as a respected elder in the field during the debate over President Obama’s health care proposals, the expenditures had risen to 18 percent, an amount roughly equal to the economy of France.
As the money Americans spent on medical care increased, so did the role of economists specializing in health issues. Dr. Fein moved between government and academia, offering research and views on issues like meeting the demand for physicians. During the administration of President Lyndon B. Johnson, he led a public-private panel to develop ideas for the Medicare legislation, which, along with Medicaid, was signed into law in 1965.
Dr. Fein, a proud liberal, regretted that Medicare did not apply to everyone, just as he was disappointed that Mr. Obama’s Affordable Care Act did not consolidate insurance payments under the federal government. A federal single-payer system, he maintained, would be more cost effective and inclusive. The Obama plan, passed by Congress, relies on private insurance.
But Dr. Fein was nonetheless satisfied with incremental progress, Dr. Ezekiel J. Emanuel, chairman of the department of medical ethics and health policy at the University of Pennsylvania, said in an interview on Thursday. He quoted Dr. Fein, a former professor of his, as saying, “Getting everybody under the tent is better than standing on principle and not getting anything.”
Dr. Fein regarded both Medicare and the Affordable Care Act as important steps toward the overriding goal of helping “the people who have the least,” Dr. Emanuel said. In his 1986 book, “Medical Care, Medical Costs: The Search for a Health Insurance Policy,” Dr. Fein wrote, “Decent people — and we are decent people — are offended by unnecessary pain and suffering; that is, by pain and suffering for which there is a treatment and for which some (who are affluent) are treated.”
Mr. Fein was born in the Bronx on Feb. 6, 1926. His father, Isaac, was a history professor whose work took him to a chain of cities in the United States and Canada, including Winnipeg, Manitoba; and Bridgeport, Conn. His mother, the former Chaya Wertheim, was a schoolteacher.
Mr. Fein’s son Alan said his father and his father’s younger brother, Leonard — who went on to found organizations to combat hunger — had gotten their zeal for social justice from their parents.
“My preference for a universal insurance program derives from my image of a just society,” Dr. Fein wrote in his 1986 book. “It is an image based on a broadly defined concept of justice and liberty, nurtured by stories my parents told me, the books they encouraged me to read, and the values they expressed. To them, liberty meant more than political freedom; it also meant freedom from destitution — in Roosevelt’s phrase, ‘freedom from want.’ ”
After graduating from Central High School in Bridgeport, Dr. Fein was a Navy radar technician during World War II. He went on to earn a bachelor’s degree in economics and a doctorate in political economy from Johns Hopkins University.
In 1952, he took a teaching post at the University of North Carolina at Chapel Hill, while working on a Truman administration commission charged with exploring the possibilities for national health insurance.
Six years later, he led a study by the federal Joint Commission on Mental Illness and Health, which estimated that mental illness cost the United States $3 billion a year ($24.7 billion in today’s dollars) in treatment costs and lost work years, a small fraction of the estimated costs today.
In 1961, Dr. Fein became a senior staff member on the Council of Economic Advisers under President John F. Kennedy. He studied education issues in addition to helping to write legislation for Medicare. He moved on to the Brookings Institution as a senior fellow in 1963 and remained with it while directing the Medicare panel for Johnson, Kennedy’s successor.
After leaving Brookings, Dr. Fein was a professor of economics at the Kennedy School of Government and the Medical School of Harvard University. He retired in 1999.
In addition to his son Alan, Dr. Fein is survived by his wife of 65 years, the former Ruth Judith Breslau; another son, Michael; a daughter, Karen Fein; and four grandchildren. Another daughter, Bena Fein, died in 1995. Dr. Fein’s brother, Leonard, died in August.
Dr. Fein spoke of the importance of language in describing health care, deriding the term “death panels” that some opponents used in the debate over the Affordable Care Act.
“A new language is infecting the culture of American medicine,” he wrote in The New England Journal of Medicine in 1982. “It is the language of the marketplace, of the tradesman, and of the cost accountant. It is a language that depersonalizes both patients and physicians and describes medical care as just another commodity. It is a language that is dangerous.”
A version of this article appears in print on September 14, 2014, on page A26 of the New York edition with the headline: Rashi Fein, 88, Economist Who Urged Medicare, Dies.
