Authors:
Historic Era: Era 10: Contemporary United States (1968 to the present)
Historic Theme:
Subject:
February/March 1986 | Volume 37, Issue 2
Authors:
Historic Era: Era 10: Contemporary United States (1968 to the present)
Historic Theme:
Subject:
February/March 1986 | Volume 37, Issue 2
Twenty years ago, Alain C. Enthoven was one of America’s most controversial intellectuals in the field of military affairs. He had gone to the Pentagon in 1961 to act as a civilian adviser to Secretary of Defense Robert McNamara. By training, he was an economist, with degrees from Stanford (1952), Oxford (1954), and MIT (1956). From 1956 to 1960, he worked at the RAND Corporation, doing contract research for the Air Force.
Enthoven and the other young advisers who joined the Department of Defense at the beginning of the Kennedy administration were derisively called the Whiz Kids. They tried to apply statistical analysis to problems that had traditionally been resolved by a mixture of intuitive reasoning, inter-service log-rolling, and congressional politics.
Partly because of their youth and their occasional lack of tact, partly because their methods seemed uncongenial, the Whiz Kids made enemies. But, despite the hostility aroused by their personalities and their methods, they contributed to important decisions on military spending during the Kennedy and Johnson years. In 1971, Enthoven and K. Wayne Smith wrote How Much Is Enough ?, a book that deals with questions of military expenditure.
Shortly before leaving the Pentagon, in 1968, Enthoven joined the board of directors of Georgetown University. There his discovery that the cost of operating the medical center was one of the university’s major financial problems led him to specialize in the economics of health care. This interview took place in his office at Stanford’s Graduate School of Business, where the fifty-five-year-old economist has taught since 1973.
Your work at the Department of Defense and the work you’re currently doing in health care analysis both demand that you balance the opinions of people who are considered to be professionals against the opinions of independent analysts who come from other disciplines. How do you resolve that problem?
When I got involved in health care, I realized that doctors were a lot like admirals. In both groups you have a technological elite of highly trained people with a very distinct point of view. They go around in white coats and they say: “What I am doing is too important to be contaminated with considerations of money. Your job is just to get me the money so I can go on doing this important and wonderful thing.”
And in both cases I had the reaction that when it gets so expensive, considerations of value for money have to be brought in. It’s a very exciting challenge to figure out how to do that. It’s not simple or obvious or easy.
Among doctors and admirals, don’t you find an attitude of “Leave it to us—the professionals—we know best”?
Yes. What they don’t realize is the limited perspective of their professional interests. A man who has spent his whole life flying and developing bombers is very likely to think in terms of more bombers, even after technology has changed and bombers are no longer an effective use of