Health reform: an eye on the goal line Clinton aide works hard, thinks big

THE BALTIMORE SUN

WASHINGTON -- The guy in charge of overhauling the nation's health care system is such a junk food fanatic that he packs half his suitcase with boxes of Mallomars when he travels overseas.

He is such an anti-athlete that, at a loss to prove physical vigor to qualify for a Rhodes scholarship, he thought about offering to arm wrestle the Rhodes committee.

And, as he worked day after marathon day on health care costs and coverage, as winter turned to spring, the guy with the rumpled suit and the laissez-faire hair languished with pneumonia and a residual cold-flu-cough malady that he couldn't seem to shake.

"I'm too afraid to see a doctor," he joked to an audience of business leaders.

But there are more salient ways in which Ira C. Magaziner, 45, is an unlikely chief lieutenant to Hillary Rodham Clinton in the administration's effort to repair the nation's $800 billion-a-year health care industry.

Mr. Magaziner, a longtime friend of the president and his senior policy adviser, is neither a health care expert nor an economist, but rather a 1960s liberal turned business consultant who has made millions toiling for corporate giants.

He had never held a government position before, has had as many failures as successes in the public policy arena and has a history of proposing big, bold, revolutionary changes -- the kind Washington usually welcomes like the dog days of August.

"Both Ira's best trait and his riskiest trait is that he never tries to work the ball down the field. He always tries to throw the bomb for a touchdown," says Mark Patinkin, a Providence, R.I., journalist who co-wrote a book on global economics with Mr. Magaziner in the late 1980s.

These days, Mr. Magaziner has one of the nation's most explosive issues tucked under his arm.

Though Mrs. Clinton heads the health care reform task force, Mr. Magaziner is its mild-mannered architect, putting together the complex proposal for universal health care that will be delivered to the president.

A champion of government aid to promising industries and the author of three books on economics, Mr. Magaziner is an intense policy enthusiast who thrives on reports, meetings and talk -- much like Bill Clinton, but with various eccentricities instead of the president's smoothness.

Mr. Magaziner is engrossed in the policy minutiae running through his mind, to the point that he once walked into a formal business meeting with no laces in his shoes, that he once narrowly escaped being struck by a car in Paris while crossing the street during a discussion of Europe's Airbus, and that he once walked over a covered hotel pool on his way to a meeting, former associates recall.

"He is one part absent-minded professor, another part single-minded intellect," says Joshua Posner, a longtime friend and former colleague.

Although he has joked that the Clintons won't let him visit because he tracks mud onto the carpet, Mr. Magaziner meets with the president in the West Wing of the White House nearly every day.

Since their days at Oxford University in England, their relationship has been an intellectual one. Mr. Magaziner, one of the key authors of the Clinton campaign manifesto, "Putting People First," was one of the prime forces in shaping the president's economic outlook.

He was the one who brought "managed competition" -- competition among health care networks for large pools of consumers, which is likely to be a cornerstone of a health care reform proposal -- to candidate Clinton's attention.

In imploring Mr. Clinton to make the difficult issue of health care a priority, Mr. Magaziner says, he told the candidate, "You're standing in quicksand, and your only way out is to run through a minefield. What do you want to do?"

The native New Yorker also has an easy, comfortable relationship with the first lady, never upstaging her and never underestimating her in their crusade.

With its team of 500 government employees and academics, 30 working groups and rigorous work schedule, the health care task force is "vintage Magaziner," friends say.

It is a much-expanded version of a management technique Mr. Magaziner has used through the years as a consultant to governments overseas and companies including General Electric. He fashioned it at Brown University where, as a student leader in the late 1960s, he headed a student group that brought about a dramatically revamped curriculum after exhaustively studying the subject, producing a 425-page report and methodically selling the plan to the campus.

Many credit the "new curriculum," which largely eliminated grades and requirements and gave students more freedom in shaping their own course of study, with propelling Brown into the forefront of the nation's universities.

Today, Mr. Magaziner, who speaks to reporters at public events but declined to give an extended interview, is generally given high marks for his style, his mind and his dedication.

He is legendary for working 20-hour days -- all the while downing Cokes with no ice (his drink of choice) -- and expecting much the same of those working with him.

Many in the health care field who have met recently with Mr. Magaziner, even lobbyists and special interest groups unhappy with some of his ideas, have come away impressed, saying he has listened, asked probing questions, and taken their reams of reading material and asked for more.

"At every stage we've been able to get our two cents in," says Bill Gradison, president of the Health Insurance Association of America and a former congressman.

Critics have cast doubt on the process Mr. Magaziner has constructed, saying it is too unwieldy, too secretive, too heavy on academic types and too light on health care experts.

"It's a very atypical planning process," says Dr. Paul Ellwood, a physician and leader of the Jackson Hole group that has explored solutions to the health care problem. "Generally, you include the people you are planning for, like the patients, providers and purchasers."

To that end, Mr. Clinton added nearly 50 members -- doctors, nurses and other medical experts -- last week to the group already assessing the administration plan.

Admirers of Mr. Magaziner point to his success at Brown and in business. He devised competitive strategies for companies such GE, Corning Inc., Rubbermaid and Ford Motor Co., and for the governments of Israel, Ireland and Sweden, and made $6 million from the sale of his own consulting company in 1988.

In business, he made a name for himself by delivering to companies mountains of data about their positions in the global marketplace and, in most cases, prompting them to look at themselves in new ways that often were at odds with conventional wisdom.

Corning executives, for instance, credit Mr. Magaziner with helping that company thrive against competitors overseas.

But skeptics point to his quick embrace of a since-discredited cold fusion project in Utah and, more important, the fact that his wide-ranging public policy endeavors often have ended with thuds.

After his studies at Oxford, Mr. Magaziner returned to New England, where he and some of his former classmates zealously pressed their vision of social and political change on a small city.

Moving into Brockton, Mass., an old shoe-manufacturing town in economic decline, they established a food cooperative, a weekly newspaper and a tenants' rights organization, and supported liberal candidates for political offices in an unsuccessful attempt to turn around the town's fortunes.

Mr. Magaziner stayed in Brockton for two years, jumping over to the establishment as a strategist for the Boston Consulting Group.

"Ira suddenly realized that the way to help the needy was not by running a food co-op, but by creating prosperity and jobs," Mr. Patinkin says. "It marked a shift in how he looked at corporate America, from something to be looked at with skepticism to a source of saving the world."

Working long hours and with encyclopedic thoroughness, Mr. Magazine made his mark at the consulting group, where among his projects was a proposal to the Swedish government for economic reform, a precursor to the industrial policy theories he developed through Telesis, an international consulting company he started in 1979.

In 1984, he tried to turn Rhode Island into a laboratory for his ideas by developing and proposing an economic renewal plan called the Greenhouse Compact.

With $250 million in public money, the compact would have created institutes, or "greenhouses," to foster home-grown research and high-tech industries such as robotics in hopes of turning them into factories and jobs and permitting Rhode Island to compete globally.

Although Mr. Magaziner had the backing of the state's business, labor, education and political leaders, the sweeping proposal was squashed by a 4-to-1 margin in a special election.

Voters not only perceived the proposal as too costly and too complex, but they were highly distrustful of the politicians and business leaders who championed it.

"It was really a blow to Ira," says Brian Jones, a Providence Journal reporter who covered the issue.

"He smarted over that for years and wrestled with what he did wrong."

Mr. Magaziner realized that although he had the backing of the Chamber of Commerce, the banks and the politicians, he had to start building support at the grass-roots level.

With that lesson learned, he formed a public policy strategy business, SJS Inc. (named for his three young children, Seth, Jonathan and Sarah), and in recent years has conducted studies on workers' skills, the welfare system and health care in Rhode Island.

For his statewide study of health care, he visited nursing homes and hospitals, and talked with nurses and patients. Much of what he learned -- that 52 percent of the amount paid in medical bills goes for administrative and overhead costs, for example, and that each nurse fills out an average of 19 forms a day -- has found its way into his more recent discussions of national health care reform.

In discussing the broad strokes of the national health care plan, he has made sweeping promises: federally guaranteed health care benefits for all Americans that would keep costs low, quality high, preserve choice of doctors and facilities, simplify the system, address long-term care, emphasize preventive services, give states flexibility and invest in areas without adequate medical care -- and include a way to pay for it.

If he is successful with this long throw into the end zone, it will be the vindication of his signature play.

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