Wednesday, November 5, 2014

The Discussions at the Harvard Faculty Meeting

At the faculty meeting yesterday, November 4, a major item of discussion was the changes in Harvard's health benefits. The Crimson reports on it here, with a significant sidebar here. I have offered this blog as a place where the faculty speakers, all of them eloquent, can post their comments for others to read. Reproduced below are the remarks of Professor Mary Lewis, who introduced the resolution, asking Harvard to reconsider the changes.

Also, the Crimson reports here on the question I asked, reproduced above, about the nonconsensual study of class attendance.

Thank you, Madam President.

I move that:  “that for 2015 the President and Fellows be asked to replace the currently proposed health care benefit plan with an appropriately adjusted version of the 2014 health benefit package, maintaining the 2014 plan design.”

Richard Thomas seconded the motion.

President Faust, Provost Garber, Deans Smith, Khurana, and Meng, Members of the Faculty

It is wonderful to see so many people here and so many colleagues who have taken time from their sabbaticals to return for a discussion as important as this one.  Your presence here is a reminder that Harvard University is, as President Faust just said a few minutes ago, a community of ideas and ideals;  we are not just a business; we come together when it is ethically vital to do so; we don’t just clock-in hours.  Indeed, the conferral of honorary degrees upon new faculty and newly tenured faculty is a time-honored ritual of coming together as a community of scholars. It was in recognition of the communitarian spirit of Harvard University,  that I submitted the motion that is before you.

At the October FAS meeting, I asked President Faust how and when the recently announced health benefits policy could be reversed.  In the wake of posing that question, I have been contacted by scores of faculty and staff from several different schools thanking me and sharing their anxieties about the impact this policy may have on them.  It is this outpouring of concern that prompted me, in consultation with a number of colleagues from whom you will hear in a moment, to submit the motion that is before you.  The hour is late, and we have a long list of faculty who wish to speak including Jerry Green, from economics and HBS; Marc Kirschner, from Systems biology at HMS, joining us today in his capacity as University Professor; Alison Johnson and Lisa McGirr, from History; Mark Kisin, from Mathematics; Charles Langmuir from Geochemistry; Richard Thomas from Classics and Christopher Winship from Sociology.  I am sure many of you also want a chance to speak. So I will try to be as brief as possible.

Tomorrow is the first day of open enrollment and if you have not yet examined your benefits enrollment guide in detail, I suggest that you do so.  When you do, you will notice that your premiums are going down, in my case by exactly $10/month.  More critically, your out-of-pocket expenses – the newly instituted deductibles and coinsurance – are going up, by as much as $1500 per individual and $4500 per family per year.  If you make less than $95K per year, these caps are adjusted somewhat.  But either way, in all but the healthiest years, you are likely to experience a pay cut of some sort, and one that is determined solely by your medical luck.

Why did the university make this change?  Many reasons have been offered, none of which is very compelling.  We’ve been told that the university’s health benefit costs are rising relative to salaries; in fact, the University’s health benefit costs as a proportion of total expenditure over the last six years have been quite flat.  Indeed, nationwide, the medical rate of inflation has gone down for the past five years and only recently has it shown a very slight uptick.  The administration warns us that health care costs might rise more in the future, so we should plan ahead.   Of course, they might also fall; does the University plan to refund us some of our out of pocket expenses in that eventuality?  In all seriousness, though, it is quite possible that costs will not rise dramatically; and yet the university is locking in this change now.

We’ve also been given a lot of misleading information about the impact of the Affordable Care Act.  Given the hour, this is too complicated to go into in at this moment but I’m happy to discuss this with any of you later.  Finally, the provost has suggested that if this reform had not been enacted, we would have experienced an increase of 3.6% in our premiums.  3.6% of my premium would have been $15 more per month for me; and about $37 more per month for Harvard, if the same contribution ratios had been maintained.  Since insurance is about managing risk, I would have willingly spent more per month in premiums in exchange for some peace of mind.

We don’t actually know if increasing premiums without adding deductibles or coinsurance was considered by the University benefits committee because the entire process has been shrouded in mystery.  My purpose in mentioning this is not to discount the hard work the UBC members put in, but to ask why the committee did not build in consultation with the people who would be most affected, why it is so hard to discover anything about what the committee was asked to do, how much money will be saved, and what the alternatives were.  In short, we still don’t really know how we got to this plan.  It is also clear that it has been implemented in a most precipitous way. When I checked earlier this afternoon, the detailed plan guides available on the University benefits website were for last year’s plans, not the proposed plan.  We’re frequently told that reforms such as Harvard’s are designed to allow us to become better health-care consumers.  I don’t know about you, but when I make momentous decisions about my healthcare, I like to be an informed consumer.
Harvard can and should do better.

Harvard could do better by ensuring that caring for one’s health is less stressful and uncertain, so we can focus on what we’re here to do: produce new knowledge and teach the brightest minds in the world.  The beauty of the old system was that you knew what to expect so you could focus on healing or having a baby.  You knew that whatever tests, procedures or surgeries your doctor ordered would be covered.  In 2015, by contrast, all but the most routine tests will trigger deductible and co-insurance payments, the cost of which you sometimes will not know until the test or procedure is complete.

If the university had announced that it was instituting a pay cut for all faculty and exempt staff with chronic illness in their families, plus those who contracted illness, got pregnant or sustained an accident, it would have sounded absurd, but it would have been more honest.  Moreover, this pay cut will be timed to come at precisely the moment when you are sick, stressed, or facing the challenges of being a new parent.   To be fair, the university cites various protections for “lower income” employees that will be put into place.  Yet, if you are in the two “lower” income brackets, you will have to pay up to the same caps as the best paid employees at Harvard, save your receipts, and then have the difference reimbursed after you’ve already paid the hospital.  Why should people as vital to Harvard’s mission as post-docs or non-union staff front the university money while potentially defaulting on their own bills as a result?

Is Harvard a business that transfers costs to its employees, reducing its expenses by shifting the burden to people coping with serious illness?  Or is Harvard a community where we equitably share the risks that we all face as human beings and where health care is a human right?
If Harvard were just a business, it would not offer such generous financial aid to middle class students and their families.  Indeed, Harvard always has been more than a business.  Let us keep it that way.
It is too late to offer rationalizations for this plan; that could have happened months ago through a process that included a broader spectrum of faculty and staff in the decision-making process; since that did not happen, we ask for a moratorium.

President Faust, you have a list of faculty members who have indicated in advance a desire to speak in favor of this motion.  With your consent, we would like to hear directly from them now, beginning, if you please, with Jerry Green from economics.

- Mary Lewis, Professor of History
- November 4, 2014 Faculty Meeting


  1. The third "here" is another link to the HBS profs, rather than a link to the ill-advised attendance survey.