Victor Fuchs published Who Shall Live? in 1974, framing essential problems of the US health care system through an economics lens. Nearly 50 years later, an expanded 3rd edition has been published, which unfortunately coincided with his death in mid-September at the age of 99 years. While there are many people who laid the foundation of the field of health economics, Vic was truly the grandfather of the field, mentoring and guiding many scholars along the way, including me.
I was a doctoral student in the economics department at Stanford University from 1990 through 1995 and worked for Vic as a research and teaching assistant starting in 1991. I credit Vic for keeping me in graduate school; after a year of economic theory, I wondered if my notion that economics was the right field to pursue for those interested in shaping public policy was misguided. Vivian Ho, who was a few years ahead of me in the program, suggested I talk with Vic about whether he needed a research assistant. Vic hired me, and I was the last student he advised, although not the last scholar he mentored. Any of us who benefitted from his wisdom could write books on what we learned from him, but as I reflect on his impact on my life, I share three key lessons.
- Stay curious. Vic read prolifically, across many genres, and could cite social philosophers as easily as economic theorists. When I visited his office or home, there was usually the latest issue of the Statistical Abstract of the United States aside his chair. He would go through the volume, table by table, and say to whoever was nearby, “Did you know that…”, pointing to some trend or comparison that caught his eye. And then he would ponder what the underlying cause, whether economic theory had anything to say about it, and how one might test the hypotheses he was crafting about the data. Important questions can come from any part of the world around us, and answers to those questions can come from many disciplines, scholarly traditions, and approaches. Regardless of how much expertise we all develop in our fields, we can always learn – and contribute – more if we are curious.
- Kindness and respect are core to mentorship. During my second year, I had to write a “second year paper,” which became part of the dissertation. When I met with Vic to receive feedback on my first draft, I was understandably apprehensive – after all, I had just shared a novice grad student paper with one of the nation’s preeminent economists! Vic began our meeting by saying, “I want you to understand that I am going to critique your work very rigorously, because that is important to the scientific process and you can always make your work better.” He paused and continued, “But I don’t ever want you to think that my critique of your work is a critique of your ability and potential as an economist. I hold your ability in high regard and am critiquing your product, not you as a person.” Vic could be a stern critic, but his kindness and respect for me as an individual were deeply ingrained into his mentorship. I try to carry this forward as I mentor others.
- Don’t give up. One colleague quipped that Vic holds the record for most articles published in major journals after the age of 90. Even though Vic observed so little progress toward meaningful change in the U.S. health care system over his career – necessary changes that he recommended 50 years ago – he kept working. He continued to write, advise, and encourage pathways for change. He continued to do what he loved, even through more than 30 years of severe back pain and many conversations with naysayers. He maintained relationships, and he remained engaged with his colleagues, family, and friends.
Vic’s influence on my scholarly discipline, as well as on me, was profound and shaped my approach to my work, much as it shaped the field of health economics. I am fortunate to be one of his intellectual and professional “children” that will carry his lessons forward to his intellectual grandchildren.