Rashi Fein dies at 88; economist considered a father of Medicare

Rashi Fein, a Harvard economist considered one of the fathers of Medicare, who threw his intellectual and moral weight behind full, affordable healthcare for nearly seven decades, stretching from the Truman administration to the Obama presidency, died Sept. 8 in Boston. He was 88.

The cause was melanoma, said his son, Alan.

Fein began studying the economics of medical care in the early 1950s when he worked for President Truman’s Commission on Health Needs. In 1961, as a senior staffer on President Kennedy’s Council of Economic Advisers, he played an instrumental role in crafting the policies and regulations that were enacted as Medicare in 1965.

He became an advocate for universal healthcare, or “Medicare for all,” who welcomed incremental progress while continuing to press for a single-payer system consolidated under the federal government.

“My preference for a universal insurance program derives from my image of a just society,” he wrote in his book “Medical Care, Medical Costs,” published in 1986. “It’s an image based on a broadly defined concept of justice and liberty, nurtured by stories my parents told me. … To them, liberty meant more than political freedom; it also meant freedom from destitution — in Roosevelt’s phrase, ‘freedom from want.’”

Fein “was the liberal conscience of healthcare economics and policy,” said Dr. Ezekiel J. Emanuel, an expert on healthcare management and policy at the University of Pennsylvania who had studied under Fein at Harvard Medical School. “I often describe Rashi as one of the three original horsemen, one of the three economists [along with Eli Ginzberg and Victor R. Fuchs] who, well before any serious healthcare cost issues, recognized the importance of focusing on health.”

Fein spent 24 years at Harvard, where he taught the economics of medicine. He wrote or co-wrote nine books, including “The Health Care Mess: How We Got into It and What It Will Take to Get Out” (with Julius B. Richmond, 2005) and “Learning Lessons: Medicine, Economics, and Public Policy” (2010).

“He was one of those people from the world of universities who easily crossed the boundary between expert scholarship and the real world of policy-making, legislation and politics,” said Allan M. Brandt, a professor of the history of medicine at Harvard.

Describing his longtime friend as “hopeful but realistic,” Brandt said Fein supported new initiatives, including the Affordable Care Act signed into law in 2010, while remaining concerned about their limitations. “Fein was convinced that the best and fairest way of ensuring healthcare for all was a single-payer system. That was his essential difference with the Affordable Care Act,” Brandt said.

Fein was born in New York City on Feb. 6, 1926. His parents — Russian Jews who had fled the revolution — gave him and his younger brother, Leonard, strong moral guideposts. “They believed in social justice and the importance of everybody having the same opportunities,” Alan Fein said.

Leonard Fein became a writer and activist who founded the influential Jewish journal Moment and a Los Angeles-based charity devoted to ending hunger, Mazon. He died in August at age 80.

After serving in the Navy during World War II, Rashi Fein studied political economy at Johns Hopkins University, earning a bachelor’s degree in 1948 and a doctorate in 1956.

He combined his interests in theory and public policy in a dissertation on the factors affecting the price of medical services.

“That is how it was that I drifted into the health field,” he wrote in “Learning Lessons,” an anecdote-filled chronicle of his decades in the policy arena.

He was teaching at the University of North Carolina at Chapel Hill when he contributed to the Truman administration commission examining the feasibility of a national health insurance program. He was a fellow at the Brookings Institution when he was working on the guidelines for what became Medicare under President Johnson.

After joining Harvard in 1968, he began to work closely with Sen. Edward M. Kennedy of Massachusetts and the Committee for National Health Insurance. He retired in 1999 but continued to write and speak on healthcare issues.

Frustrated that changes in health policies were often overly complex, Fein urged simplicity: “If the program looks like a Rube Goldberg creation,” he wrote a few years ago, “put it in a cartoon, not in the legislative hopper.”

In addition to his son Alan, Fein is survived by his wife of 65 years, the former Ruth Judith Breslau; another son, Michael; a daughter, Karen; and four grandchildren.

elaine.woo@latimes.com
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