Public Health Magazine: Winter 1995, Vol.5, No.1
Medicare/Medicaid chief paints future of essential providers

Bruce Vladeck, Ph.D., head of the Health Care Financing Administration (HCFA), of the U.S. Department of Health and Human Services, delivered the 1995 Robert J. Weiss lecture in health policy on March 22. Vladeck, who directs the $250 billion Medicare and Medicaid programs, discussed "The Future of Essential Providers in the New Health Care Marketplace."

Vladeck was sympathetic to essential providers, but ultimately supported the ongoing changes. He discussed the difficult times for "safety net providers" that had served some of the poorest neighborhoods in the past. He said that essential providers "will see more and more competition for these vulnerable patients" from for-profit Medicaid managed care contractors.

"Protecting safety net providers in an era of rapid change," Vladeck said, "is the hardest intellectual dilemma I have encountered as administrator." Nevertheless, he has decided that "improvement requires change" and that "this is how it should be--patients should be making choices."

In the late seventies, Vladeck taught public health and political science at Columbia University. The biennial Weiss lectures began in 1990 in honor of Robert J. Weiss, M.D., who served CSPH as dean from 1980 to 1986.