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Alain C. Enthoven : An Oral History

Alain C. Enthoven, the Marriner S. Eccles Professor of Public and Private Management, Emeritus, speaks about his upbringing and education, his work at RAND and in the Office of Systems Analysis in the Department of Defense, and his research on healthcare reform. Enthoven recalls his upbringing in Seattle, his education at a Jesuit high school, and his path to Stanford as an undergraduate in the late 1940s. He describes important moments in his education, including the opportunity to work with economist Ken Arrow, his time as a Rhodes Scholar, and how his friendship with Harry Rowen led to his decision to work at the RAND Corporation on studies of US and NATO defense strategies. He shares memories of his work in the Economics Division at RAND and in the Office of Systems Analysis at the Pentagon during the Cold War, including descriptions of key individuals such as Robert McNamara and Charlie Hitch. He recalls his time at Litton Industries, returning to Stanford as a professor in the Graduate School of Business to help build a program in public management, and his work on universal health insurance and consumer choice and managed competition in healthcare. Other topics include the Jackson Hole Group, the Integrated Healthcare Association, health benefits at Stanford and CalPERS, and the MD/MBA program at Stanford.Family background • Growing up in Seattle in the 1930s • Boy Scouts • Early education and parents’ emphasis on academic achievement • Mother’s interest in languages and phonetics • Jesuit high school education at Seattle Prep • Debate and oratory in high school • Ski patrol and first aid • Impact of Catholicism on upbringing • Decision to attend Stanford • Encina Hall as a men’s dormitory • Stanford in the late 1940s • Required course on Western Civilization • Years between World War II and Korean War • Developing an interest in economics • Monetary theory course with Edward Shaw • Working with Ken Arrow as an undergraduate • Playing catch-up in math courses • Applying for the Rhodes Scholarship • Visiting MIT and Harvard economics PhD programs before leaving for Oxford • Favorable first impression of MIT • New College at Oxford • Community of American Rhodes Scholars: Dave Staiger, Thor Hanson, Denny Rusinow • Rowing and skiing in England • Economics at Oxford • MPhil program and exams • Studying under John Hicks • Studentship at Nuffield College • Meeting lifelong friend and collaborator Harry Rowen • Rowen’s early career at RAND in defense strategy • Meeting grandparents and extended family in Europe during Rhodes years • Graduate student life at MIT • MIT economics faculty: Paul Samuelson, Bob Solow • Changes in the field of economics since the 1950s • Summer job at RAND Corporation looking at the vulnerability of strategic forces during the Cold War • Courting future wife, Rosemary • Returning to RAND post-PhD • Developing the field of public policy analysis • RAND during the Cold War • Working with Albert Wohlstetter and Charlie Hitch • Interdisciplinary nature of work at RAND • Working as an economist with physicists and engineers • Freedom to pursue the implications of future technologies under air force contracts • Implications of their analysis for the military’s manned bombers • Economics Division in the wider RAND structure • Roberta Wohlstetter and her work on Pearl Harbor • Herman Kahn at RAND • Balancing the frightening aspects of his work on the Cold War with daily life • Charlie Hitch as RAND’s head of the Economics Division • Connections between RAND strategy work and policy debates in Washington, DC • Space Race and the Cold War • US views of Soviet threats • SAGE system • Mentorship from Ken Arrow throughout his education, including collaboration on papers published in Econometrics • Impact of RAND on his life • Cold War and Soviet threat as chief concern while at the Pentagon • US military strategy for dealing with the Soviet Union, including no-cities strategy and mutual assured destruction • Rationale behind mutual assured destruction • Efforts to determine strength of Soviet conventional forces • Working with NATO allies in Europe • McNamara’s intense loyalty to Kennedy and reflections on Kennedy’s views on defense strategy • Systems analysis approach to the Vietnam War • Systems Analysis Office studying rifles and advocating for airmobile division • Southeast Asian Analysis Reports • Reflections on the level of analysis at the Defense Department during the Vietnam War and his reaction to Westmoreland’s request for additional troops • Working with McNamara, including the story of McNamara cancelling the SAGE system • Objections to the B-70 bomber; the F-4 versus the F-105 • McNamara’s legacy at the Defense Department, including a greatly improved management system and hiring Charlie Hitch • Reflections on McNamara’s weaknesses • Office of Systems Analysis: approach to management and recruiting; key team members • McNamara’s contribution to thinking about the need for arms limitation treaties • Receiving the President’s Award for Distinguished Federal Civilian Service • Transition from the Pentagon to Litton Industries • Lessons learned at Litton • Recruitment to Stanford’s Graduate School of Business by Arjay Miller • Working with Rowen to establish the Public Management Program at Stanford and early courses • Interest in healthcare and economics • Working as a consultant to the Carter administration on universal health insurance • Insights from Kaiser Permanente • Transition to studying healthcare • Work with Litton Medical Products while at Litton Industries • Election to Institute of Medicine in 1972 • Consulting with Kaiser Permanente • Research on universal health insurance models • Consumer Choice Health Plan proposal and the Gephardt-Stockman bill • Observations about bipartisan work on health care • Jackson Hole Group efforts to move towards a better healthcare system • Debates about competition in healthcare • Chairing Stanford’s Benefits Committee and serving on the Health Benefits Advisory Council of CalPERS • Integrated Healthcare Association • Managed Health Care Improvement Task Force • Benefits of providing employees with choice in health care • Health care approaches in the UK and the Netherlands • Views on the Affordable Care Act (ACA) and thoughts on how to move toward a full consumer choice health plan • Managed Competition Acts of 1992 and 1993 • MD/MBA Program at Stanford and student achievements • Impact of the Rhodes Scholarship on his life • Other meaningful awards • President’s Award for Distinguished Federal Civilian Service • Admiration for John F. Kennedy • Changes at Stanford between 1948 and 2020 • Emergence of Silicon Valley • Catholic community around Stanford • Balancing work and family • Book group with other Stanford families • Retirement activities, recent articles, and planned projects

Alain C. Enthoven : An Oral History

Alain C. Enthoven, the Marriner S. Eccles Professor of Public and Private Management, Emeritus, speaks about his upbringing and education, his work at RAND and in the Office of Systems Analysis in the Department of Defense, and his research on healthcare reform. Enthoven recalls his upbringing in Seattle, his education at a Jesuit high school, and his path to Stanford as an undergraduate in the late 1940s. He describes important moments in his education, including the opportunity to work with economist Ken Arrow, his time as a Rhodes Scholar, and how his friendship with Harry Rowen led to his decision to work at the RAND Corporation on studies of US and NATO defense strategies. He shares memories of his work in the Economics Division at RAND and in the Office of Systems Analysis at the Pentagon during the Cold War, including descriptions of key individuals such as Robert McNamara and Charlie Hitch. He recalls his time at Litton Industries, returning to Stanford as a professor in the Graduate School of Business to help build a program in public management, and his work on universal health insurance and consumer choice and managed competition in healthcare. Other topics include the Jackson Hole Group, the Integrated Healthcare Association, health benefits at Stanford and CalPERS, and the MD/MBA program at Stanford.Family background • Growing up in Seattle in the 1930s • Boy Scouts • Early education and parents’ emphasis on academic achievement • Mother’s interest in languages and phonetics • Jesuit high school education at Seattle Prep • Debate and oratory in high school • Ski patrol and first aid • Impact of Catholicism on upbringing • Decision to attend Stanford • Encina Hall as a men’s dormitory • Stanford in the late 1940s • Required course on Western Civilization • Years between World War II and Korean War • Developing an interest in economics • Monetary theory course with Edward Shaw • Working with Ken Arrow as an undergraduate • Playing catch-up in math courses • Applying for the Rhodes Scholarship • Visiting MIT and Harvard economics PhD programs before leaving for Oxford • Favorable first impression of MIT • New College at Oxford • Community of American Rhodes Scholars: Dave Staiger, Thor Hanson, Denny Rusinow • Rowing and skiing in England • Economics at Oxford • MPhil program and exams • Studying under John Hicks • Studentship at Nuffield College • Meeting lifelong friend and collaborator Harry Rowen • Rowen’s early career at RAND in defense strategy • Meeting grandparents and extended family in Europe during Rhodes years • Graduate student life at MIT • MIT economics faculty: Paul Samuelson, Bob Solow • Changes in the field of economics since the 1950s • Summer job at RAND Corporation looking at the vulnerability of strategic forces during the Cold War • Courting future wife, Rosemary • Returning to RAND post-PhD • Developing the field of public policy analysis • RAND during the Cold War • Working with Albert Wohlstetter and Charlie Hitch • Interdisciplinary nature of work at RAND • Working as an economist with physicists and engineers • Freedom to pursue the implications of future technologies under air force contracts • Implications of their analysis for the military’s manned bombers • Economics Division in the wider RAND structure • Roberta Wohlstetter and her work on Pearl Harbor • Herman Kahn at RAND • Balancing the frightening aspects of his work on the Cold War with daily life • Charlie Hitch as RAND’s head of the Economics Division • Connections between RAND strategy work and policy debates in Washington, DC • Space Race and the Cold War • US views of Soviet threats • SAGE system • Mentorship from Ken Arrow throughout his education, including collaboration on papers published in Econometrics • Impact of RAND on his life • Cold War and Soviet threat as chief concern while at the Pentagon • US military strategy for dealing with the Soviet Union, including no-cities strategy and mutual assured destruction • Rationale behind mutual assured destruction • Efforts to determine strength of Soviet conventional forces • Working with NATO allies in Europe • McNamara’s intense loyalty to Kennedy and reflections on Kennedy’s views on defense strategy • Systems analysis approach to the Vietnam War • Systems Analysis Office studying rifles and advocating for airmobile division • Southeast Asian Analysis Reports • Reflections on the level of analysis at the Defense Department during the Vietnam War and his reaction to Westmoreland’s request for additional troops • Working with McNamara, including the story of McNamara cancelling the SAGE system • Objections to the B-70 bomber; the F-4 versus the F-105 • McNamara’s legacy at the Defense Department, including a greatly improved management system and hiring Charlie Hitch • Reflections on McNamara’s weaknesses • Office of Systems Analysis: approach to management and recruiting; key team members • McNamara’s contribution to thinking about the need for arms limitation treaties • Receiving the President’s Award for Distinguished Federal Civilian Service • Transition from the Pentagon to Litton Industries • Lessons learned at Litton • Recruitment to Stanford’s Graduate School of Business by Arjay Miller • Working with Rowen to establish the Public Management Program at Stanford and early courses • Interest in healthcare and economics • Working as a consultant to the Carter administration on universal health insurance • Insights from Kaiser Permanente • Transition to studying healthcare • Work with Litton Medical Products while at Litton Industries • Election to Institute of Medicine in 1972 • Consulting with Kaiser Permanente • Research on universal health insurance models • Consumer Choice Health Plan proposal and the Gephardt-Stockman bill • Observations about bipartisan work on health care • Jackson Hole Group efforts to move towards a better healthcare system • Debates about competition in healthcare • Chairing Stanford’s Benefits Committee and serving on the Health Benefits Advisory Council of CalPERS • Integrated Healthcare Association • Managed Health Care Improvement Task Force • Benefits of providing employees with choice in health care • Health care approaches in the UK and the Netherlands • Views on the Affordable Care Act (ACA) and thoughts on how to move toward a full consumer choice health plan • Managed Competition Acts of 1992 and 1993 • MD/MBA Program at Stanford and student achievements • Impact of the Rhodes Scholarship on his life • Other meaningful awards • President’s Award for Distinguished Federal Civilian Service • Admiration for John F. Kennedy • Changes at Stanford between 1948 and 2020 • Emergence of Silicon Valley • Catholic community around Stanford • Balancing work and family • Book group with other Stanford families • Retirement activities, recent articles, and planned projects

Lecture, E332 Analysis of costs, risks, and benefits in health care, Oct. 28, 1996 [videorecording].