Interview with Julian Harris

On March 26th, the Duke Honor Council hosted Dr. Julian Harris, Associate Director for Health at the Office of Management and Budget. Dr. Harris is a Duke graduate, a Truman and Rhodes Scholar, former director of the Medicaid program in Massachusetts, and worked as a World Bank consultant. He spoke to students about his path to the White House and his experiences there.

When faced with questions about health care challenges in the present and future, Dr. Harris remained very optimistic. He maintained that although many people might be cynical about the political process in Washington D.C., there are many instances of compromise that go unreported. The following is an excerpt from the Question and Answer session.

DPR: You’ve spent time internationally, and then made the transition to working on domestic health care. At Duke, there are generally a lot more students interested in global health rather than domestic health policy. Can you make the case for why more students should be invested in health challenges at home?

Harris: There are many issues here. One, I think what attracts people to international or global health is that people are concerned about or want to have an impact on people who seem very underserved. However, it just so happens that we, despite being an advanced nation, also have people who are very underserved. There are urban parts of this country and rural parts of this country where people really struggle and have health care challenges that I think would surprise people. There are parts of the country where the infrastructure and the access to care might surprise people.

In many ways, we have one of the most sophisticated health care systems in the country, but not everyone today has access to a full length of healthcare providers or facilities that might be able to address the health challenges people face. So I would say there are a lot of opportunities to do great work on domestic health care. There are also opportunities to learn about health care based on what some other wealthy countries do, and also to learn from countries which have fewer resources. People were being very creative about how to leverage mobile technology to do various healthcare interventions in a number of low income countries, in some ways before we could in the United States. This was in part because they had public health crises and people were thinking very creatively about how to solve them.

DPR: Looking beyond the Obama administration, what do you think are some of the healthcare challenges the current generation of college students might have to face? Maybe 15 or 20 years from now?

Harris: I think that one of the big issues is to think about how we navigate the challenges that come with advances in medical technology and science, and how we continue to play a leadership role in advancing our agenda in science, which includes making and prioritizing investments in science. It’s a challenge now, but I think it will continue to be a challenge over time. I think we’ll have to try to strike a balance between how we prioritize improvements in coverage while continuing to ensure that coverage is affordable for individuals, families, employers, and state and federal governments. That’s something we spend a lot of time on now, and I think it will continue to be something that people spend a lot of time on. 

DPR: Can you talk about the balance between improving access to care and quality of care while also reducing costs? You have to deal with this on a daily basis, so could you talk about some of the strategies you go about in addressing this balance?

Harris: So, I think that people talk a lot about the importance of making investments and expanding access to coverage and thinking about how we control costs or improve quality of care. I think that sometimes the conversation presumes that it’s an either/or, but there are a number of policies where we can achieve those things or some combination simultaneously. Some examples include reducing hospital readmissions, where we are both improving quality of care, while also helping to reduce health care spending. We would like to continue looking at programs like this. However, part of building and managing a budget is making hard choices and outlining priorities. We have to constantly do this in health care.

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