Rashi Fein, 88; economist was an architect of Medicare

Dr. Rashi Fein was a tireless advocate of health care for all.
Dr. Rashi Fein was a tireless advocate of health care for all.(Michael Fein)

Rashi Fein was one of the policy architects of Medicare and he remained a lifelong proponent of health care for all. His advocacy never wavered, from his time working for the Truman, Kennedy, and Johnson administrations on through his long tenure as a Harvard economist.

“My first federal job was for a Harry Truman commission on national health insurance,” he wrote in the Globe in 2007. “For more than half a century I have believed and still believe that every American should have full access to needed medical care.”

His beliefs ran deeper than what could be accomplished in a political system that, in his view, seemed only willing to address the complexities of health care when access reached crisis levels, only to become gridlocked by the crisis itself.


“My preference for a universal insurance program derives from my image of a just society,” Dr. Fein wrote in “Medical Care, Medical Costs,” his 1986 book. “It is an image based on a broadly defined concept of justice and liberty, nurtured by stories my parents told me, the books they encouraged me to read, and the values they expressed. To them, liberty meant more than political freedom; it also meant freedom from destitution — in Roosevelt’s phrase, ‘freedom from want.’ ”

Dr. Fein, a professor emeritus of medical economics at Harvard Medical School who formerly served on the senior staff of President John F. Kennedy’s Council of Economic Advisers, died of melanoma Monday at Massachusetts General Hospital. He was 88 and lived in Boston.

In August 1964, Dr. Fein wrote in “Medical Care, Medical Costs,” he and the other members of President Lyndon B. Johnson’s task force on health convened to consider the nation’s health care needs.

“During that meeting the president emphasized the importance of a long-term vision,” Dr. Fein wrote. “He did not want us to recommend only what we felt was politically feasible within a year or even within a presidential term. Instead, we were to decide what health measures were desirable for the nation over the next two decades and to recommend legislation that would enable America to fulfill its promise.”


While the proposals Dr. Fein and his task force colleagues crafted helped lead to the creation of Medicare, Johnson made clear that as president, he would do the political heavy lifting. “He reminded us that we were amateurs and he was the professional,” Dr. Fein recalled.

Political strength may have turned Medicare into a reality, but through the years, Dr. Fein watched political paralysis thwart his hopes of turning Medicare into a steppingstone toward universal health care.

“The political process seems unwilling to address the problems that beset us until they become critical and complex,” he wrote in the 1980s. “It is as if simple questions need no answer and complex questions have no acceptable answer. Short of crisis, we need not act, yet in a crisis, we are often paralyzed.”

At Harvard, he was sought out by politicians, pundits, and reporters at every turn in the health care debate, from the failed Clinton plan in the 1990s through President Obama’s Affordable Care Act, which fell short of Dr. Fein’s vision of building on his achievement of helping to create Medicare.

“That was a passion that endured for his whole professional life,” said Dr. Fein’s son Alan of Cambridge, who added that “his greatest success was in that field and his greatest disappointment was in that field. We never had national health care.”


In a 1982 New England Journal of Medicine article, Dr. Fein lamented that the language of the marketplace had invaded health care and was poised to shift perceptions, as physicians became “providers” and their patients “consumers.”

“Medical care is not measured solely by the number of fractures set, hernias repaired, and appendixes removed, but also by the amount of comfort, concern, and compassion provided,” he wrote. “I want physicians — as well as more Americans — to speak the language that addresses the unfinished agenda of equity and decency in the distribution of health care.”

Allan Brandt, a history of medicine professor at Harvard Medical School who formerly was dean of the Graduate School of Arts and Sciences, said that “unlike some academics, there was absolutely no separation between his values and the programs and policies and social issues that he advocated for.”

Dr. Fein, he added, “had an incredible moral compass. In that sense he set a standard that colleagues like myself try to emulate.”

Born in New York City, Rashi Fein was the older of two intellectually accomplished brothers. Leonard Fein of Watertown, who died in August, was an activist and influential writer about Jews and Judaism.

Their father was a Jewish history professor whose work brought the family to several cities in the United States and Canada. Their mother taught in elementary schools.


Dr. Fein graduated from high school in Bridgeport, Conn., where he also studied briefly at a community college before serving in the Navy at the end of World War II.

After the war, he went to Johns Hopkins University in Baltimore, from which he graduated with a bachelor’s in economics in 1948 and a doctorate in political economy in 1956. By then he was teaching at the University of North Carolina at Chapel Hill.

In 1949, he married Ruth Breslau, a graduate student at Johns Hopkins whom he met through Zionist youth organizations.

The family moved to the Washington, D.C., area when Dr. Fein joined the Kennedy administration, and remained when he became a senior fellow at the Brookings Institution. In 1968, he took a faculty position at Harvard. For several years, beginning in the mid-1990s, he also chaired the Robert Wood Johnson Foundation’s National Advisory Committee for its Scholars in Health Policy Research program.

He wrote several books, beginning with “Economics of Mental Illness” in 1958 and concluding with “Learning Lessons: Medicine, Economics, and Public Policy,” in 2010.

“As a teacher he was a source of rock-solid advice in addition to sharing his scholarship,” said Joel Kavet, who had been a student of Dr. Fein’s and spent much of his career as a health administrator and health care planner. “A lot of us who had the benefit of his guidance look back now and among us the comment overall is, ‘He made a difference in my professional life.’ ”


A service was held Wednesday for Dr. Fein, who in addition to his wife, Ruth, and his son, Alan, leaves another son, Michael of Newton; a daughter, Karen of Sandwich; and four grandchildren.

“Someone said to me, ‘The thing about your dad is he was fair,’ ” Michael said. “I thought about that and, aside from his accomplishments and the things he worked on and had done in his life, he was concerned about fairness in the world. Fairness specifically in health care, but he was also very fair in his personal dealings with people.”

Dr. Fein, he said, skillfully mixed intellect with a common touch.

“He made information that was very important, but sometimes very complex, accessible to a variety of audiences in a variety of ways, and across generations as well,” Karen said. “He was good at telling a story in a way that lots of different people could hear it.”

Her father, she added, “was a humble man. We all have egos, but his was minimal at best. For anyone to spend most of his life so passionately trying to make a difference, I think that’s to be lauded.”

Bryan Marquard can be reached at