Current Position: Professor of National Health Policy at The Heller School for Social Policy and Management at Brandeis University (since 1977)
Credit: courtesy: Stuart Altman/Brandeis
Why He Matters
An economist who researches federal health policy, septuagenarian Altman is a veteran of many of the major political battles over Medicare and health care of the past decades. He has advised presidents Richard Nixon and Bill Clinton and helped create the health reform plan for then-candidate
Barack Obama’s campaign.
The
Obama campaign sought out Altman because of the health-care plan he helped created for Sen.
John F. Kerry’s (D-Mass.) 2008 presidential campaign. The plan would have eased excessive health-care costs for businesses and used the extra money to reduce employee insurance premiums.
Altman’s experience creating health-care programs at both the state and national levels — and his battle scars from trying to get them passed — could make him a key asset as the young
Obama team gears up for what has proven to be one of the hardest fought battles in American politics: passing health-care reform legislation.
At a Glance
Current Position: Professor of National Health Policy at The Heller School for Social Policy and Management at Brandeis University (since 1977)
Career History: Obama Transition adviser (2008), Bipartisan Commission on the Future of Medicare (1997 to 1999); Chairman, Congress Prospective Payment Assessment Commission (ProPac) (1984 to 1996); Deputy director for health, President Richard Nixon's Cost-of-Living Council (1973 to 1974)
Birthday: N/A
Hometown: N/A
Alma Mater: City College of New York, B.B.A.; University of California, Los Angeles, M.A.(Economics); University of California, Los Angeles, Ph.D. (Economics)
Spouse: N/A
Religion: N/A
Office: Heller School, Brandeis University
415 South Street
Waltham, MA 02454
Email
Web site
Path to Power
Altman got his B.B.A at City College New York, then his master’s degree and doctoral degree in economics at the University of California, Los Angeles. He wrote his dissertation on unemployed married women in the labor force. He went on to teach at Brown University. There, his previous work on women in the workforce led him to a study of nurses, and ever since Altman has been studying the economics of health care.
From 1971 to 1976, Altman was the deputy assistant secretary for health policy in the Department of Health, Education and Welfare. He also served as the deputy director for health on President Richard Nixon's Cost-of-Living Council in 1973 and 1974. There, he worked on a program to try to reduce U.S. health-care costs. He also worked on the Health Planning Resources Development Act of 1974, which aimed to cut health-care costs by requiring health-care facilities to get approvals from state health planning agencies before beginning expensive projects such as building expansions or ordering new equipment. Furthermore, he helped draft the HMO Act of 1973, which offered federal funds to fuel the rise of HMOs as alternatives to private insurance. He helped develop a plan for Nixon that would have required employers to offer employee health insurance and would have created a federal health plan to offer insurance to anyone.
In 1977, Altman joined the faculty of Brandeis University as the dean of The Heller School for Social Policy and Management. From 1990 through 1991, he was the interim president of Brandeis University.
From 1984 to 1996, Altman was the first chairman of the Congress Prospective Payment Assessment Commission (ProPac), an organization created by Congress to independently oversee Medicare’s payment system, which reimburses doctors and hospitals based on pre-approved, fixed rates.
Altman worked on President-elect Bill Clinton’s 1992 health- care transition team. But he declined to participate in the 1993 health-care reform effort led by Hillary Rodham Clinton. "It was too big, a total restructuring of our whole health system," he told the National Journal.
In 1997, Clinton nonetheless appointed him to the Bipartisan Commission on the Future of Medicare. The commission, which was charged with figuring out how to chart a sustainable financial future for the gigantic Medicare program, expired without being able to arrive at a unanimous conclusion in 1999. Altman was one of the dissenting voices, refusing to vote for the majority’s proposal because it did not include subsidies for prescription drugs. Medicine and Health newsletter named him a 1999 Person of the Year for his “courageous stand.”
From 2000 to 2004, Altman co-chaired the Massachusetts Health Care Task Force. In 2004, Altman helped design the health reform plan for Massachusetts Sen. John F. Kerry’s presidential campaign. On the Kerry team, he worked with Heather Higginbottom, who later became an Obama campaign adviser.
In 2008, Higginbottom recruited Altman for the Obama campaign so he could resurrect part of the plan he developed for Kerry, a proposal to have the federal government reimburse employers for some catastrophic health-care costs and then require those employers’ to use the savings to reduce workers' insurance premiums.
Altman founded and chairs a nonpartisan think tank called the Council on Health Care Economics and Policy at the Schneider Institute for Health Policy at Brandeis.
Altman is also involved in for-profit enterprises related to medicine. He is a director of Visicu Corp., which develops systems for hospital intensive care units, and a director of Aveta Corp., a managed-care company offering health-insurance plans in Puerto Rico and California. Since 2001, he has been a director of Lincare Holdings, which provides therapy services and equipment for home health care.
The Issues
Medicare
Altman’s research and experience makes him something of an expert on Medicare. Bill Clinton appointed Altman to the Bipartisan Commission on the Future of Medicare in 1997. But the commission expired in a deadlock in 1999 when it proved more partisan than its name implied. “The problem was the Republicans' unwillingness to devote more revenue to shoring up Medicare and their resistance to a broad new benefit to pay for prescription drugs,” The New York Times reported two years later when the Medicare issues reared its head again.
Altman had voted against the Republican majority’s proposal because it did not include a prescription drug subsidy. "I couldn't support a Medicare program for the 21st century that didn't have some coverage for prescription drugs," Dr. Altman explained to the University of Pennsylvania’s Leonard David Institute of Health Economics.
The Obama Health Plan
In 2004, Altman worked on Sen. Kerry’s presidential campaign health plan. In one piece of the plan, the government would reimburse employers for some catastrophic health-care costs, and the savings would be passed on to their employees as a reduction in health insurance premiums.
Obama policy strategist Heather Higginbottom worked with Altman on the Kerry campaign, and the Obama campaign sought out Altman and his idea. The National Journal said of Altman’s contribution, “It has become a major selling point of Obama's health care plan, and it marks one of the few distinctions between his proposal and Hillary Clinton's.”
Universal Health Care and Reducing Health-Care Costs
After years of failed attempts to enact universal health care, Altman devised “Altman’s law,” which he summarized before a 2007 Congressional panel: “Almost every American and advocacy group supports some form of Universal Health Insurance — But if it’s not their preferred version; their second best alternative is to maintain the status quo.”
A veteran of many health-care political fights, Altman has opinions about how to get legislation passed. “I strongly believe that we substantially improve the probability of legislating a comprehensive health-reform system if we build on the current financing system as much as possible,” he said in 2007 Congressional testimony on the need for health coverage for all Americans. “To do otherwise generates significant opposition from groups that are key players in the existing system. Because they have a lot to lose, they form alliances with other ‘loser’ groups to derail such legislative initiatives.”
Altman’s years of experience have also made him wary of a single plan that tries to offer universal health care while at the same time trying to reduce health-care costs. “Each component requires changes from the current system that will be opposed by some if not many influential groups … Since I believe it is both easier and more important to provide comprehensive coverage I would start with solving that problem,” he said. In another interview, he said, “We need to extend coverage first and achieve cost containment once the system is in place.”
Altman told an industry Web site that Obama should “act quickly, work closely with Congress, reform without singling out powerful stakeholders who need to be a part of any compromise.” Most of those concepts are a result of learning from the Clinton administration’s mistakes in 1993 and 1994. “The Clinton plan failed because it was a complex program with tight governmental controls that took over one year to come to Congress,” he said. “It alienated powerful insurers and enjoyed only lukewarm support of the physician and hospital communities.”
But Altman believes the time is right for health-care reform to succeed. “There's no question that we're in the cycle very similar to what happened in the later part of the 1980s,” he told NPR’s All Things Considered. “You can just see it heating up.”
Mandates
Altman has spoken out in favor of a 2006 law requiring Massachusetts citizens to obtain health insurance or face fines, saying the plan’s success comes because it is built upon existing health insurance structures “rather than disrupting the private insurance system.”
During the 2008 Democratic presidential primaries, Altman said he preferred Barack Obama’s health plan to the one advanced by rival Sen. Hillary Rodham Clinton's, the National Journal reported. “One difference he supports is Obama's wait-and-see approach to mandating that everyone have health insurance,” the Journal said.
A New Payment Model
Altman told an industry blog he’d like to see a major overhaul of the current health-care model. “We need to change the structure of our health-care delivery system to emphasize more integrated delivery systems,” he said.
Altman envisions a health-care system that pays doctors based on results instead of procedures, “But to make this happen we need to eliminate our traditional fee-for-service model of paying for care and put in place more bundled payments that pay for achievable outcomes, not just for providing a service,” he said.
The Network
Altman has advised major political figures, including Richard Nixon, Bill Clinton, John F. Kerry and now President Barack Obama.
Altman’s Council on Health Care Economics and Policy counts two Obama advisers among its members, Dr. David Blumenthal, who is now Obama's National Coordinator for Health Information Technology, and Harvard economist David Cutler. Gail Wilensky, who advised Obama’s 2008 opponent Sen. John McCain(R-Ariz.), is also a member.
Altman chaired the advisory board of the Massachusetts Savings Lives Program at the Commonwealth Fund, a prominent health policy think tank. Obama advisers Dora Hughes and Jeanne Lambrew, who heads the Health and Human Services Office of Health Reform, have also worked at the Commonwealth Fund.
Campaign Contributions
Altman has supported many Democratic candidates. He gave $1,500 to former Vice President
Al Gore’s 2000 presidential campaign, according to the Center for Responsive Politics. He gave $2,000 to
Kerry’s 2004 campaign, and $1,500 to
Barack Obama’s 2008 campaign. In 2004, he also gave $5,000 to the DNC Service Corp, better known as the Democratic National Committee.
In 2007, he gave $1,250 to Colorado Democrat Sen.
Ken Salazar, who is Obama’s Interior secretary.
Altman has been a regular supporter of Judith Feder (D). The health policy expert and former dean of the Georgetown Public Policy Institute ran for the U.S. House seat from Virginia’s 10th Congressional District in 2006 and 2008. Altman gave Feder $2,600 in 2006, $1,250 in 2007, and $500 in 2008.
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