Victor R. Fuchs, whose comprehensive understanding of the challenges facing the United States health care system and eloquence in explaining those challenges to policymakers and the general public made him what many called the “dean” of American health care economists, died Saturday. at his home on the campus of Stanford University in Palo Alto, California. He was 99 years old.
His son Fred confirmed the death.
Dr. Fuchs became famous primarily for a slim, erudite book published in 1975 with the catchy title “Who Will Live? Health, Economic and Social Choice.” He was among the first to articulate in clear, layman’s prose why the United States found itself in the midst of rapidly rising health care costs while costs in other countries remained manageable.
The book has become required reading among physicians, health economists, and anyone interested in the intricacies of American health care, and has never been out of print.
Dr. Fuchs showed that the real problem facing the country is not health care coverage, but health care costs; America, he wrote, was spending more and more without achieving better health outcomes.
Moreover, he claimed that the reform of this system would not be without its own costs. If America wanted better care, it would have to pay for it, either through taxes or higher insurance premiums. Difficult decisions would have to be made about who received what care and how, especially if one goal was health equity.
“We cannot have all the health or all the medical care we want,” he wrote. “We have to choose.
Some found the book indecent. There was, according to his critics, something distasteful about the application of economic analysis to a field dealing with life and death.
But Dr. Fuchs, at the time an economist at the National Bureau of Economic Research, made a compelling case for realism.
It turns out, he found, that health and health care don’t really move in tandem, and that differences in national outcomes have more to do with culture, environment, social policy and individual choice than the cost or level of health care. The lavish specialized care in which the US excels is no guarantee of overall better health, he argued.
“The access problem involves mostly primary care and emergency care,” he wrote, “and may often be encountered by physician assistants, nurse practitioners, and other types of health professionals.”
In 2005, he teamed up with Ezekiel J. Emanuel, an oncologist and bioethicist, to propose a plan to provide universal health insurance through vouchers that people would use to purchase basic health insurance. It would be up to them to purchase additional coverage.
Dr. Fuchs wasn’t holding out hope that their plan would work. The biggest problem facing America’s health care system, he says, is the reluctance of politicians and the public to make the tough decisions necessary for real change.
He was a strong critic of the Clinton administration’s health care reform efforts in the early 1990s—not because he disagreed with the goal or even some of the proposals, but because he thought the White House was naïve about what real reform would bring.
“Clinton’s plan was a combination of ignorance and arrogance, and it turned out to be a disaster,” he told The New York Times in 2000. “But I didn’t believe for a minute that they could achieve major health care reform. Health care reform requires significant political investment.
He was just as negative about President Barack Obama’s health care changes a generation later. He said they did nothing to address the root causes of high costs and instead just shifted those costs.
“Cost shifting does nothing to the real cost of health care,” he told KFF Health News. “The name of the game in Washington is to try to hide who bears the cost.
Victor Robert Fuchs was born in the Bronx on January 31, 1924, the son of Jewish immigrants from Austria. His father, Al, sold furs, and his mother, Frances (Scheiber) Fuchs, was a homemaker.
Victor served in the Army during World War II, then returned to New York to attend New York University. After graduating in business administration in 1947, he went to work for his father.
In 1948 he married Beverly Beck. She died in 2007. Along with his son Fred, he is survived by another son, Ken; his daughters, Nancy Fuchs Kreimer and Paula Fuchs; 10 grandchildren; and six great-grandchildren. His brother, Lawrence Fuchs, Distinguished Professor of American Studies at Brandeis University, died in 2013.
After several years in the family business, Dr. Fuchs decided on a new career and enrolled in a doctoral economics program at Columbia University. He received his Ph.D. in 1954 with a dissertation on the fur business.
He taught at Columbia and New York universities before moving to the National Bureau of Economic Research, a nonprofit organization based in Cambridge, Massachusetts. In the early 1970s, the bureau sent him to Palo Alto to open its West Coast office. He received a joint appointment at Stanford and in 1978 switched to the university full-time.
He wrote more than 200 research papers and 16 additional books after “Who Shall Live?”, including the sequel, “How We Live: An Economic View of Americans from Birth to Death” (1984). The Times economics writer Peter Passell called the book “an economist’s look at everything from why some women smoke during pregnancy, to whether it makes sense to send Junior to Harvard, to why Junior’s widowed mother won’t move back in with the kids.” .”
Dr. Fuchs retired in 1995 but continued to write articles and books; he completed his last, new edition of “How We Live” not long before his death. It is scheduled to be published next month.
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