Stephen A. Warnke, Esq. (Chair)
What drew me to the healthcare bar was that it’s an area of private practice in which I, as a lawyer, can be intimately involved in matters of pressing policy significance, representing private clients but doing so in a way that advances the public good. The healthcare industry is in a state of perpetual flux and perpetual crisis, so there is never a moment when you can profess to have complete command of all the technical details. The challenge for lawyers who represent healthcare clients is therefore constantly evolving, and, of course, always fascinating.
I realized that I wanted a career that would allow me to help people directly, one-on-one, and see the results of my work. That’s why I decided to pursue a career in medicine. I was in private practice as a physician for 20 years, and I enjoyed meeting a wide variety of people every day, getting to know them and helping them. In that sense, medicine is a very rewarding career. At the same time, I had always known that I wanted to pursue intellectual and policy-related work. After 11 or 12 years in medical practice, I cut my work hours from about 65 to 50 hours a week in order to pursue a Master of Public Health degree. Later I received a PhD from the University of California, Berkeley. My experience as a family physician has influenced my research interests a great deal; that’s obvious from the work I’ve done. Having worked as a physician in the community, I have a sense of the way physicians in this country think about issues.
I’m actually one of the few people who think that employer-sponsored coverage is a strong institution and is not likely to disappear any time soon. It offers many advantages even compared with the health insurance exchanges. There is a good reason, especially in very large companies, to retain employer-sponsored health insurance, but I can see it fading out among the smaller firms over time. Employers are pretty innovative, so we will continue to see changes in the way employer-sponsored coverage operates. We don’t entirely know what those trends are going to be yet and I am not enthusiastic about predicting, so we’ll see.
Christopher F. Koller
As a society, we need to consider the role of price transparency as opposed to charge transparency, and the role of public organizations, trusted community-wide efforts, national nonprofit resources like FAIR Health and private initiatives in making that price information more readily accessible to different stakeholders-consumers, providers, researchers and others.
I had been interested in medicine, but much more interested in a number of issues related to policy and social justice. When I was studying public policy as a graduate student at Georgetown University, I took a class with Judy Feder and became very interested in health policy. As I learned about the complexity of healthcare in that class, I became interested in pursuing a career in health policy with the government, particularly in the Office of Management and Budget (OMB). When both of those aligned—i.e., getting a job that focused on health policy at the OMB—it seemed like a perfect fit. Once you get involved in health policy, you realize it’s a field where you can spend decades and still discover new issues to learn about. It is so complex, and there are so many different lenses, that you can be an expert in Medicaid and still have plenty to learn about the Medicare program. Likewise, you can know what is happening at the state level but not so much at the federal level, and vice versa. Once I started on the health policy path, I knew that it was the path for me.
Peter J. Millock
What surprises me most is that the issues have not changed. The three primary issues in healthcare—quality of healthcare, access to healthcare and cost of healthcare—have been the same issues for the last 30 years. The challenges today involve long-standing problems that have not been addressed through law, policy or private initiative. The Affordable Care Act (ACA) is an effort to address access, but says very little about quality and cost. The ACA is the greatest achievement in healthcare policy in 30 years, but it is far from a panacea.
Lynn B. Nicholas
Lynn B. Nicholas, LFACHE, has had a career of over 40 years working in and representing hospitals and health systems in New Jersey, Louisiana and Massachusetts, most recently leading the Massachusetts Health & Hospital Association (MHA). Not only was Ms. Nicholas in demand across the state and nation to offer her perspective on various healthcare issues, most notably payment reform and delivery system transformation, she was a strong proponent of public health and wellness. Under her leadership, MHA and Ms. Nicholas personally received numerous recognitions for work on tobacco use cessation and curbing opioid and substance use disorder, and were recognized five years as a Healthiest Small Employer in greater Boston. She spearheaded “Behavioral Health—the Unfinished Agenda of Reform” in an effort to improve behavioral health access and quality across the continuum of care. A former American College of Healthcare Executives (ACHE) Regent and Governor, Ms. Nicholas received the Early Careerist and Senior Healthcare Executive Regents awards, and an ACHE Early Careerist Travel Scholarship was established in her honor.
Nothing has been more rewarding than taking care of patients and sharing their lives—that was a real privilege and I feel very fortunate to have had that opportunity. The greatest privilege in terms of my professional career, though, was leading the AMA at a time when there was clearly an opportunity to move toward health insurance for all Americans.
Fortuitous events, more than anything else, led me to become involved in healthcare. I completed my actuarial exams in South Africa where, at the time, there was not much actuarial involvement in healthcare. I was working for one of the large South African life insurance companies that also owned what was called a “medical aid society”—essentially a not-for-profit health plan. South Africa is very similar to the United States in terms of having a predominantly private health insurance market. My company and other life insurance companies became more involved in healthcare as a result of changes in regulation. I continued in the healthcare sector because it was, to me, much more dynamic than the more traditional actuarial fields of life insurance or pensions. It seemed to be more directly relevant to individuals; there were multiple stakeholders and numerous issues to address.
A few years later, when I moved to the United Kingdom (UK), some of the actuarial consulting firms were starting private health insurance practices. Given my background, I was hired by Milliman’s affiliate in the UK as it was starting to develop a healthcare actuarial practice. While in the UK, I met my wife, who is American, and we later moved to the United States. Health actuarial work in the United States is incredibly diverse and over the years I have been fortunate to be involved in what has always seemed to be an important national discussion.
James Roosevelt Jr.
As a volunteer hospital board member, healthcare lawyer and a health plan executive, I have had the opportunity to work on all sides of the healthcare world. That experience has taught me the importance of good, impartial data. My community activism and government service have shown me how access to information improves peoples lives. The chance to work with an organization that focuses on accuracy, value and fairness in healthcare payment is a rare coalescing of personal background and professional goals. I look forward to supporting that work and raising its profile.
Those who specialize in civil rights have been extremely active around passage and implementation of the ACA because it is self-evident that gains for low-income Americans are, in effect, gains for minority Americans in the US. The ACA, of course, makes a seminal contribution to the problem. The Kaiser Family Foundation just published a study showing the disproportionately large impact of the Act on minority Americans, who are much more likely to be uninsured. To the extent that a central purpose of the Act is to create more equal access, its benefits for minority Americans should be seen as one of the greatest civil rights achievements of our time.