2008
A Conversation with Sam Levey: A Life of Ideas
Sam Levey, the Gerhard Hartman Professor of Health Management and Policy, is known for his textbooks on health management, a history of the University of Iowa Hospitals and Clinics, and numerous articles and editorials on leadership and health care. He has deep roots in the Department of Health Management and Policy, receiving his Ph.D. in 1961 and serving as head of the department from 1977-1991.
You were born and raised in Cape Town, South Africa, and came to the United States as a teenager. Are there any lessons in your life today that you can trace back to your childhood?
I became interested in leadership and conflict resolution while growing up in South Africa during World War II. Living near the Houses of Parliament, I often caught glimpses of the South African leaders as they came and went, and I always wondered if they could ever get together to solve the problems of racism and poverty. I learned that no matter what the problem is—racial turmoil, world war, or the rising costs of health care—leaders from the opposing factions must come together to develop a shared vision.
Health care spending in the United States tops $2 trillion a year and is expected to be 20 percent of our Gross Domestic Product by 2012. What can the health management field do to reduce these soaring costs?
Finding ways to slow health care spending is like searching for the Holy Grail. There are many elements involved, and sound health management is only one aspect of cost control. The hardest thing to control is consumer demand—technological breakthroughs, new pharmaceuticals, and an aging population have created a tremendous demand for health care.
How has managed care contributed to controlling costs?
Managed care changed the delivery system, and during the first few years, we did see some improvement, some lowering of costs, but not any longer. The over-commercialization of the field has now become a barrier to finding a better solution to our health care problems.
But when you were head of the department in the 1980s, you advocated developing a business model in health administration and forged closer ties to the University’s business school. Are you now suggesting we throw out the business model in health administration?
No, I’m not saying that. In today’s competitive health care environment, business management skills are vital to the training of Master of Health Administration students. But I’d advocate backing it up a few steps. It’s one thing to have management skills and to run an effective and efficient hospital, but the emphasis on hyper-entrepreneurial and consumer choice approaches takes the business model too far. We’ve had our infatuation with competition. It doesn’t work. What we have instead is market failure.
If the market approach hasn’t worked in keeping costs down, what should we try next?
I think we should look at European systems of health care more closely. Their statistics are better. They spend less. They also have what Alexis de Tocqueville called a communitarian way of thinking, where members of society have a strong sense of the common good.
Our national character is different, however. We’re a young country, idealistic in our orientation, and we have an individualistic approach to solving social problems. But I think it’s possible we could mutate into more of a welfare society, especially since, in addition to the health problems, we have other social problems. I think we need a change in the mood of the public, in the willingness of people to make sacrifices for their fellow man and their country.
You’re currently working on an article about leadership, featuring leaders from all walks of life and asking what makes a good leader. What have you learned?
A good leader isn’t easy to define. Only after a person is thrust into a crisis can you tell what he or she is made of. You can have a good manager, but that person may not be a good leader. Or, you can have a leader who is highly effective, but who is ethically and morally bankrupt. A true leader has influence over others without exerting power over individuals. But oftentimes people seek out leadership because they are narcissistic and seek power, fame, and money.
What inspires you about the leaders you’re writing about?
I’ve always been interested in knowing how to build a better society. How to work with people to help them improve their outlook and performance. Good leaders have the ability to build up the egos of others and enhance productivity. They have the ability to negotiate. This is how real social change occurs.
After 50 years in the health management field, you’ve seen it all. What worries you most about the future of health management?
I’d have to say corrupt leadership. There are too many ego-driven narcissists in positions of power who really don’t have the sense of service and community that Teddy Roosevelt, F.D.R., and Lyndon Johnson had. You have to be something of a narcissist to be a leader. You must have ego to be willing to stick your neck out. But if you don’t have a sense of the greater social good, then leadership becomes all about power.
Also, the personal touch is missing, and it’s missing in society at large. Our civility and interactions have changed. We’re in an age of the commercialization of everything—leadership, health care, the media.
Some people think the Department of Health Management and Policy should be housed in the business school. Originally, your mentor Gerhard Hartman chose to house the department in medicine. Where do you think it should be housed?
I think it should stay where it is now, in the College of Public Health, but with close ties to the business school. Housing the department in public health keeps the discipline tied to its social roots.
What message would you like to share with graduate students?
I hope that the field of health management will rediscover its roots as predominantly a service organization. I think we need to return to the ideal of social entrepreneurship—the use of management and leadership skills and knowledge to achieve worthwhile social ends. When I became chair in 1977, I believed the students needed business skills, but I never intended for them to lose their spirit of social service.
When you’re not at work, you can likely be found at home working on an abstract painting, one of which is part of the University of Iowa Hospitals and Clinics’ permanent collection. What keeps you coming back to the canvas?
I like testing out different approaches to a subject. Sometimes I’ll hang a painting on a wall at home, and then a few months later I’ll take it down and start working on it again. My wife, Linda, will say, I thought you were done with that painting! I like abstract painting because I can always go back and work out a different idea.