Approximately 45.7 million people lacked health-insurance coverage in 2007, according to the U.S. Census Bureau. By 2012, some 10,000 people will turn 65 each day, according to the Centers for Disease Control and Prevention. And by 2017, health-care spending is expected to hit $4.3 trillion, notes the Centers for Medicare and Medicaid Services.

Robert Friedland, associate professor in the School of Nursing and Health Studies, has spent more than 25 years studying these types of economic complexities within the U.S. health-care system. And as the baby boomer generation ages, Friedland says heightened concerns about long-term care and retirement planning will continue.

“Although much of my work has been in the areas of health care, health-care markets, long-term care and insurance markets, my interests are broader and include how people save and insure against risk and how society pools this risk in ways that improve the well-being of everyone,” he says.

Called upon regularly for his expertise in long-term care, retirement planning and health policies, Friedland has testified before the U.S. Senate Finance Committee, the U.S. Senate Budget Committee, the House Small Business Committee, the U.S. Senate Special Committee on Aging and the Social Security Advisory Committee.

He also works with a number of health-related boards and associations. In January, he became chair of the Center for Health Policy Development, which governs the National Academy for State Health Policy. He sits on the American Bar Association’s Commission on Law and Aging, is on the board of the Health Assistance Partnership and serves on the editorial board of Aging Today, the bimonthly newspaper of the American Society on Aging.    

Before becoming a part of the Georgetown community, Friedland founded a public policy institute in 1994 that focused on the implications of an aging society. Six years later, he moved the organization into Georgetown’s Health Policy Institute and later joined the faculty at NHS in 2004.

The institute conducts studies on long-term care financing and looks at how people with chronic conditions live their lives. Close attention is paid to the factors that affect retirement prior to age 65.

“Robert Friedland brings to our department strong credentials in economics, health services research and leadership in health policy,” says Gary Filerman, chair of the department of health systems administration. “His expertise has been recognized by several national organizations. His teaching of health economics and research methods is an important ingredient for building the competencies that our graduates need for successful careers in health management.”

Tommy Mullin (G’08), chief operating officer for Select Specialty Hospital of Central Pennsylvania, says he is grateful to have been taught by Friedland.

“I am given data reports each day in my current position as a hospital COO, and I am able to make better decisions thanks to the education I received in professor Friedland’s classroom,” Mullin says. “His best teaching attribute was his ability to make classroom lessons applicable to everyday decisions that his students are sure to encounter in their careers.”

Friedland currently teaches undergraduate students majoring in health care management and policy and graduate students pursing their master’s in health systems administration. He also assists in teaching a nursing and health studies colloquium for first-year students that features class debates on the Democratic and Republican presidential candidates’ health care platforms.

“The colloquium is such an eye-opening experience,” says Michelle Hartanto (NHS’12).  “This discussion-based class focuses on contemporary issues such as health care in politics and transforms textbook material into knowledge that we can apply to real life. Professor Friedland encourages us to apply what we learn in the classroom, to become more educated human beings and to find something in the health care field that we are passionate about.”

Through his courses, Friedland says he wants to teach students the principles of choice and the way individual and institutional decisions can affect the broader environment.

“Clearly, if you’re an administrator in a hospital or a health-care facility, your main focus is on managing that facility,” he says. “But you need to understand how that facility fits in the rest of the market because it helps you understand what your competitors and your alliances might be doing.”

A Long-Term Interest in Aging
As a teenager growing up in Connecticut, Friedland delivered newspapers, and it was during that time that he first interacted with the elderly.

“I remember how fortunate I was to be able to land the route at the nursing home – St. Mary’s Home for the Aged,” Friedland recalls. “Little did I know that I would later write a book about financing long-term care or that I would have an office in St. Mary’s Hall.”

As Friedland wrote his Ph.D. dissertation on savings behavior, he realized that many of the people in the database he was using were unlikely to remain financially independent during their retirement.

“I was able to look at an anonymous individual and say, ‘Oh my goodness, she is not likely to make it in her retirement,’ ” Friedland remembers. “It was quite alarming to me that there were so many people in the data set whose financial future didn’t look very bright.”

That realization caused him to shift toward health and public policy, he says.

“We are constantly debating how much the market can and cannot do to expand coverage and control expenditures, but never really getting beneath this discussion to the question of how best to deliver care,” says Friedland, who received his doctorate in economics in 1983 from The George Washington University.

His career in health and policy grew in 1984, when he left his position as an economics professor at Towson University in Maryland to become senior economist for Maryland’s Medicaid program.

From there the economist went to Washington to expand his knowledge about public policy, working with policymakers at the federal and state levels at the Employee Benefit Research Institute.

He later worked on the staff of the U.S. Bipartisan Commission on Comprehensive Health Care, which would be renamed the Pepper Commission in honor of the commission’s first chair, Rep. Claude Pepper (D-Fla.), who died in 1989.

In that role, Friedland worked with members of Congress and their staffs to articulate their preferred ways of financing health care and long-term care.
Friedland brings all of this experience into the classroom.

He says he prefers to teach from the perspective of understanding how the market works, the limits of the market and what the government does and how these actions affect the market. The health care industry operates differently from other markets, Friedland notes.

“First,” he says, “consumers are not sovereign. They are dependent on doctors and others who provide health care to help them make decisions. None of us necessarily would go to a car salesman to decide which car to purchase, but that’s kind of the situation we’re in with respect to health care. We rely on the doctor to be our agent.”

Friedland notes that the reason people buy medical services differs from why they purchase other goods and services.

“There’s also something intangible about health that is essential,” he says. “We buy medical services not because we want those medical services. We buy medical services to maintain or improve our health. Good health is nearly everything.”

The professor says Georgetown positions its students to be ethical leaders who will make a positive impact on the future of health care.

“We are at a new beginning of restructuring how we deliver care,” he says. “No one is satisfied with the way we finance and provide care. Moreover, we have ample evidence that we are not sufficiently effective or efficient.”

Friedland says part of the answer to the problems of health care involves developing better-integrated systems of care, but he says such systems are filled with moral dilemmas because the business and politics of health care can get in the way of the standards of care needed.

“This is likely to be an ongoing dilemma,” he says. “My hope is that as graduates of Georgetown, our students will raise the right questions in facing those dilemmas.”

Source: Blue & Gray