Health Reform Around the World
Michael Borowitz, MPP’88, PhD’92, was working in Washington, D.C., when the Clintons moved to town. A staffer with the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services), Borowitz was part of their momentous health care reform attempt. But when the reform talks floundered, then collapsed, he left the United States for good to tackle health reform across the world.
He now lives in Paris, where he serves as a senior health policy analyst working on a new mental health project, engagement with China, and other global initiatives for the Organisation for Economic Co-operation and Development (OECD), the intergovernmental think-tank that helps coordinate policies for 35 of the world’s richest countries.
Borowitz has faced looming obstacles before. In 1993, he moved abroad, along with several of his government colleagues, to help the U.S. Agency for International Development (USAID) with the formidable task of restructuring the health care system in the newly independent states behind the fallen Iron Curtain. For five years he directed a large reform project covering Kazakhstan, Kyrgyzstan, Uzbekistan, and Tadjikistan. "We weren't successful in the U.S.," he says of health care reform, "but we were in the former Soviet Union."
These new reform models, he claims, made the systems more efficient by shifting the focus from expensive hospital care to more cost-effective primary care. According to the USAID, the plan introduced the first medical family centers into the country, providing more than 10 million people with improved primary care to prevent costs from stacking up in hospital.
The USAID project he started is still running 15 years later and considered one of the agency’s health reform projects in the world.
Borowitz had found a calling. For years to follow, he stayed abroad, shifting between a number of positions in development work. As a doctoral student, he participated in the Pew Program for Medicine, Arts, and Social Sciences, which launched his interest in end of life care, informing programs he ran later with the Soros Foundation and OECD. In 1999, he took a job at The U.K. Department of International Development, one of the world’s premier development agencies, where he focused on multi-drug resistant TB and HIV/AIDS in Russia.
In 2002, he worked for the World Bank coordinating their efforts in China and Indonesia, and left to run the public health program for the Soros Foundations a year later, where he continued on HIV/AIDs and developed a new program on the intersection between law and health.
Borowitz eventually settled with the OECD, where he returned to his previous work on “middle income countries” like China with large-scale reforms, including a new insurance program for the rural poor. He is also doing a global OECD project on mental health—a neglected topic in many countries. A recent New Yorker article highlighted the gravity of this problem in China, where one in five adults suffer from mental illness, and face a big social stigma and little institutional support.
These roles brought him back to developing countries, where he always pictured himself working. Decades ago, he enrolled in medical school in New Orleans and had a watershed moment. The poverty around him was "like living in the Third World," he recalls of the city. It was this experience that made him change his career direction and enroll at the Harris School. “The chance to think across academic boundaries is a once in a lifetime opportunity,” he says.
As health care reform unfolded in the U.S. last year, Borowitz watched from Paris. He says he was "shocked" by the frantic opposition to President Obama's plan, which was not much different than earlier proposals during the Nixon administration. “The U.S. is the laggard and only the new entrants to the OECD like Mexico and Turkey have not achieved universal coverage,” he says.
Still, having worked on such plans in the U.S. and across the globe, he understands the immensity of the feat. "No health system is perfect,” he says.
--Mark Bergen
