health studies professor smokes out tobacco wars, health reform
about health behavior has put Willard Manning in the middle
of some of today's most divisive political debates
isn't out to win popularity in the raging tobacco wars. The anti-tobacco
lobby doesn't like his assertion that cigarette taxes aren't really
necessary. Tobaccoists, meanwhile, aren't thrilled that his "it's-a-wash"
reasoning hinges on the premature mortality of smokers. His theory:
Although smokers may contribute to higher medical and insurance
costs while living, they "pay back" society when they die because
most don't live long enough to cash in their pensions or take advantage
of subsidized nursing-home care. When he and his colleagues first
took on this issue in a 1989 study published in the Journal of
the American Medical Association, Manning says, he was motivated
not by politics but by an economist's curiosity.
joined the U of C last November as a professor in health studies
in the Pritzker School of Medicine and the Irving B. Harris Graduate
School of Public Policy Studies. In his new posts, he continues
to indulge his curiosity about what influences Americans' health-care
decisions, delving further into the costs of poor health habits
like smoking and exploring health-care financing issues, another
contentious arena he has entered, however unintentionally.
the director of graduate studies in health services at the University
of Minnesota, Manning earned his Ph.D. in economics from Stanford
in 1973 and then joined Harvard with appointments in the School
of Public Health and the John F. Kennedy School of Government. But
it was as a senior economist for the RAND Corporation in Santa Monica,
California, from 1975 to 1988, that he made his mark as a lead researcher
on RAND's Health Insurance Experiment, one of the largest federally
funded social research projects ever conducted. For nearly a decade,
the HIE team of some 30 researchers gauged how different insurance
arrangements affected the health of 7,700 patients and their use
of health-care services. For Manning, the ambitious project was
"the chance of a lifetime." The team ultimately determined that
patients tend to use more services the less they have to pay out-of-pocket,
even though using more services does not typically affect overall
health. The team's findings-and its reams of health-insurance data-steered
insurers to the use of deductibles and copayments and continue to
influence debates on health reform.
took up smoking research, challenged by a lunchtime debate with
colleagues over whether they could better document the habit's costs
than a rival Canadian team. Joking that he's "into vice," Manning
says he is now looking at whether cigarette taxes play into teens'
decisions to start smoking; whether price affects how much alcohol
people drink; and if there's any connection between how much alcohol
people drink and their status in the labor market.
also crunched a lot of numbers related to services for the mentally
ill, whom he calls a "vulnerable population too often treated as
second-class citizens." Since 1991, he and other researchers from
the Universities of Minnesota and Utah have been comparing the experiences
of schizophrenic patients in Utah's new Medicaid managed-care program
for mental-health services to those still in its traditional Medicaid
program, which does not rely on the cost-containment policies of
managed care. In an initial report sent last year to federal health
regulators, Manning says, the team concluded that patients under
managed care have not done as well as those in the traditional program.
The researchers are still studying the cause of the disparity, which
Manning speculates is the result of less care or less timely care.
In the coming academic year, he hopes to get some related projects
rolling on the effectiveness of existing treatment models for depression;
the financing of mental-health services for children; and whether
many people who qualify for disability remain employed. "It's not
like we're going to run out of issues studying the organization
and financing of health care," he notes.
As for whether
any health-care legislation will come out of Washington this year,
Manning doubts that major structural reforms are possible given
the spread of special interests. He chalks up the recent debates
over the rights of managed-care enrollees to election-year posturing.
However, he does see a place for the curious academic in Capitol
Hill debates. "So much of what goes on is based on anecdotes," he
says, "whereas in research we can actually evaluate and assess whether
programs work and do what their proponents claim."-C.S.