An early interest in the politics of health care. During his first week in graduate school at Yale University, Jon Oberlander went to a departmental welcoming party. He remembers a conversation with a well-known political scientist.
Oberlander mentioned that he'd come to Yale because he wanted to specialize in the politics of health care. That was an area of expertise occupied by only a handful of scholars at the time, and one of the best-known, Ted Marmor, PhD, was at Yale. The political scientist at the party was dubious: "You want to study health care?" he said. "Why would you want to do that?"
Neither he nor the others at that party could have imagined how eventful the ensuing decades would be for health care reform in the United States. Oberlander was in the right place at the right time, and more than 20 years later, is recognized as one of the nation's leading experts and a sought-after political commentator on many issues—the Obama administration's Affordable Care Act (ACA) and Medicare reform in particular—that are among the most hotly debated and most important, of our time. "I've been very fortunate," Oberlander agrees. "It's been a real roller coaster."
On "Obamacare." Oberlander is both pleased and surprised that the ACA has come as far as it has. He named his 2010 Health Affairs article contrasting Obama's successful political strategy to reform health care with Clinton's failed attempt, "A Long Time Coming." The working title of Oberlander's book is Against All Odds.
"In my mind there's no question that the Affordable Care Act is a great step forward for the American health care system," Oberlander says. "At the same time, we have a long way to go….We're going to have lots of problems to contend with, including but not limited to the fact that, even if everything goes as planned, a decade from now the government estimates there will be 30 million people without health insurance….But for the first time in at least a generation, and maybe two generations, there's reason to be optimistic."
From political science to the politics of health. The political scientist in Oberlander emerged early. When growing up in Florida, he recalls, "My dinner table was very political." His mother, who taught at a community college in Gainesville, was a historian of American politics and women's history. She and his father, an entomologist for the U.S. Department of Agriculture, were both active in the civil rights movement. With this home environment as a background, Oberlander grew up interested in politics and envisioning a career in academia.
His health policy analyst side took longer to develop. While an undergraduate student at the University of North Carolina at Chapel Hill, Oberlander spent his sophomore year at Hebrew University in Jerusalem. There, he blew out his knee on the basketball court and was exposed to Israel's nationalized health care system.
It was a mixed bag. Everyone was covered, but Oberlander recalls that people were still paying bribes to get ahead on the waiting list for certain procedures. The contrasts with the system in the United States intrigued him.
When he returned to Chapel Hill, Oberlander tried to get into a course on Soviet politics taught by "an incredible professor" named Joel Schwartz, PhD. That course was full, Schwartz told him, but there was space available in another of his courses, this one on comparative health systems. Oberlander enrolled.
Oberlander earned his PhD at Yale in 1995 and received a fellowship from the Robert Wood Johnson Foundation Scholars in Health Policy Research program at Yale the same year. The Scholars in Health Policy Research program provides paid full-time two-year fellowships to outstanding new PhDs in economics, political science, and sociology to advance their involvement in health policy research. See Program Results for more information.
The interdisciplinary focus of the Scholars program was fundamental in shaping his perspective, Oberlander says, and his subsequent career.
"We had sociologists and economists as well as political scientists," he says, "which meant that I was exposed to new perspectives, new ideas, new ways of thinking, new ways of doing research. There's no question that was eye-opening and valuable. I think the program was—and is—ahead of its time. Many universities these days are trying to foster inter-disciplinary collaborations, breaking down the walls between departments and schools, and here you had the fellowship doing that by design back in the mid-90s, throwing these different social scientists into a cauldron and seeing what would come out of it."
A continuing focus on collaboration and communication. One of the universities fostering interdisciplinary collaboration, Oberlander discovered, was his alma mater, the University of North Carolina at Chapel Hill, where as of March 2013, he serves as a professor in two departments, the Department of Social Medicine (in the School of Medicine) and the Department of Health Policy and Management (in the School of Public Health). "I would not have this job were it not for the fellowship," he says.
Another key part of the health reform process, Oberlander believes, is communicating effectively with the various constituencies involved, including the public. Toward that end, Oberlander commented frequently during the political battles waged over Obamacare in articles published in the New England Journal of Medicine, Health Affairs, and the New York Times, among other publications.
And, he is already looking ahead. In a 2012 article for the New England Journal of Medicine, entitled "The Future of Obamacare" Oberlander looks at the politics of decisions states will face in the short term, and cost containment and other challenges the federal government will face down the road.
As of March 2013, he was working with graduate students at the University of Michigan to examine state resistance to health reform, particularly state responses to the health exchanges required under the law (exchanges are organizations that offer a choice of health plans to consumers, certify plans that participate, and provide information to help consumers understand their options). "The level of state resistance to health reform is an extraordinary story," he says.
An important insight: be practical and be accessible. Oberlander says that RWJF's focus on having a practical impact on health reform was another key influence on is career. "Political calculations are too often a footnote in health reform proposals," he says. "I focus on political feasibility and its implications for health care reform." Astute political analysis, he adds, had a lot to do with the Obama administration's success with the ACA.
Awareness of the value of talking to a broader audience, and the ability to do so, are two other gifts Oberlander feels he received from his time as an RWJF Scholar. "The fellowship forces you to articulate your ideas in ways that can be understood by people from other fields," he says. "That may be obvious, but so many of us live in disciplinary fortresses. Our professional incentives are to speak not just to our discipline but to whatever our subfield is within our discipline. There's a lot lost in conversation there. A goal of mine going forward after the fellowship has been to do work that's accessible—not just my scholarly work, but also playing a role in explaining health reform to the public and to the community and to medical professionals. One of the first steps to producing accessible work and to speaking in accessible ways is to engage with other academic disciplines. I didn't think of it that way at the time but, looking back, that was really good training."
RWJF perspective. The Robert Wood Johnson Foundation Scholars in Health Policy Research program is designed to foster a new generation of creative thinkers in health policy research within the disciplines of economics, political science, and sociology. The fellowship program, established in 1991, annually selects a total of nine recent PhD graduates from among those three disciplines to spend two years studying at one of three participating sites (currently Harvard University, University of California-Berkeley/San Francisco, and University of Michigan).
Participants learn about health and health policy, gain exposure to the perspectives of the other two disciplines through seminars with peers, receive mentoring from prominent scholars, develop research ideas, and conduct research while receiving a stipend and benefits that free them from other professional obligations. "We're looking for people who aren't too far along in pursuing a specific research agenda. Our goal is to catch people early and tempt them into the field of health policy," says Lori Melichar, PhD, RWJF interim team director for the program.
While in the Scholars program, participants have conducted research on issues and policies related to individual health, public health, social and economic determinants of health and health care, health care financing, and health care systems and institutions. After completing the program, alumni stay connected to their peers through a network facilitated by the Boston University Health Policy Institute, which serves as the national program office.
Scholars from the Health Policy Research Program have made significant contributions to their disciplines and to the field of health policy research. The program's 200-plus alumni, many of whom hold faculty appointments at universities and colleges, have authored hundreds of widely cited books and articles; held editorial posts at top scholarly journals; sat on scientific advisory panels; served as senior advisers to presidential, Congressional, federal agency, and national scientific councils; and received numerous professional awards for their research.
Although the original purpose of the program—to increase the number of economists, sociologists, and political scientists conducting health policy research—remains important, RWJF's focus has expanded to include "building the community" of health policy researchers and supporting them at institutions nationwide. "Now it's more about creating a critical mass so that we have a self-sustaining community [of researchers]," Melichar says.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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