In his 500th interview, Conversations host Harry Kreisler welcomes Stanford Professor Alain Enthoven for a discussion of public service and policy analysis. Recalling his tenure in the office of Secretary of Defense Robert McNamara during the Kennedy administration, Enthoven describes the efforts to control military expenditures by using systems analysis to consider together weapons acquisition, budgeting, strategy, and national interest. He describes the resistance within the military and Congress, and he reflects on the lessons he learned from this experience.After recalling the circumstances that led to his focus on healthcare, Enthoven analyzes the evolution of the American health care system, the perverse incentives responsible for spiraling costs that are bankrupting the country, and the constraints on changing the system. Comparing fee for service to prepaid group practice, he criticizes the Obama health care legislation and explains what is needed for real change. Finally, Enthoven compares his work in the two areas of policy--health care and defense--and reflects on the challenges of changing systems in the face of entrenched interest groups.
KEYWORDS: Health Policy, Defense Department, Berkeley Graduate Lecturers.