Regional Oral History Office University of California the Bancroft Library Berkeley, California

Regional Oral History Office University of California The Bancroft Library Berkeley, California Robert M. Crane KAISER PERMANENTE MEDICAL CARE ORAL HISTORY PROJECT II YEAR 4 THEME: GOVERNMENT RELATIONS Interviews conducted by Martin Meeker in 2010 Copyright © 2010 by The Regents of the University of California Since 1954 the Regional Oral History Office has been interviewing leading participants in or well-placed witnesses to major events in the development of Northern California, the West, and the nation. Oral History is a method of collecting historical information through tape-recorded interviews between a narrator with firsthand knowledge of historically significant events and a well-informed interviewer, with the goal of preserving substantive additions to the historical record. The tape recording is transcribed, lightly edited for continuity and clarity, and reviewed by the interviewee. The corrected manuscript is bound with photographs and illustrative materials and placed in The Bancroft Library at the University of California, Berkeley, and in other research collections for scholarly use. Because it is primary material, oral history is not intended to present the final, verified, or complete narrative of events. It is a spoken account, offered by the interviewee in response to questioning, and as such it is reflective, partisan, deeply involved, and irreplaceable. ********************************* All uses of this manuscript are covered by a legal agreement between The Regents of the University of California and Robert M. Crane, dated August 13, 2010. The manuscript is thereby made available for research purposes. All literary rights in the manuscript, including the right to publish, are reserved to The Bancroft Library of the University of California, Berkeley. Excerpts up to 1000 words from this interview may be quoted for publication without seeking permission as long as the use is non-commercial and properly cited. Requests for permission to quote for publication should be addressed to The Bancroft Library, Head of Public Services, Mail Code 6000, University of California, Berkeley, 94720-6000, and should follow instructions available online at http://bancroft.berkeley.edu/ROHO/collections/cite.html It is recommended that this oral history be cited as follows: Robert M. Crane, “Kaiser Permanente, Year 4: Government Relations” conducted by Martin Meeker in 2010, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 2010. Table of Contents—Robert M. Crane Interview 1: June 15, 2010 [Audio File 1]— 1 Childhood in Hazelton, PA with Presbyterian minister father and homemaker mother—extracurricular activities in sports and student leadership—early interest in hospital administration—attending College of Wooster 1965-1969—political awareness and activism on campus, thoughts on undergrad years at a small school—studying economics, independent work on health insurance—non-profit orientation of health insurance in 1960s—enters Cornell MBA program in health administration in 1969—overview of curriculum: emphasis on policy— development of legislation, health planning agencies, Regional Medical Programs in 1960s-1970s—changing study focus to health policy on realizing the growing role of federal government in health care—work with Harry Becker, learning about New York politics of neighborhood health centers, Medicaid, HealthPAC program—following policy ambitions, applying for management intern program of then Department of Health, Education and Welfare, move to Washington, D.C. in 1971—federal government recruitment of “best and brightest” for public service in 1970s—work at the Health Services Mental Health Administration— sitting on review boards to fund early prepaid group practice plans, HMO Act of 1973 extends federal government control over local health laws—concerns about competition with already-established delivery systems in the community—1970s favorable attitudes toward federal role in health care system—1972 assignment to San Francisco office of HEW, work for Bob Brook shapes future career, fosters interest in community planning and West Coast [Audio File 2] 20 Job at Comprehensive Health Planning Services—1974 states required to develop certificate of need programs, relationship to Medicare—work developing and managing assessment program for community health agencies, providing technical assistance—handling the politics of establishing an ideal population to hospital ratio—thoughts on “extreme federalism” of 1970s health policy, recurrent themes in health care reform—motives for reform action: cost control, increasing access, improving efficiency—impact of HMO Act of 1972 on work at HEW: meeting and working with Gordon MacLeod, Bill McCloud, Frank Seubold—1975 or 1976 four months in Baltimore at the Maryland State Hospital Cost Review Commission—1976 temporary position and then job offer with the US House of Representatives Health Subcommittee of the Energy and Commerce Committee—apolitical nature of lobbying jobs—involvement in 1978 HMO Act amendments—Kaiser’s persuasive argument to secure exemption from certificate of need laws—thoughts on the lobbying process—more on the fate of cost containment legislation [Audio File 3] 38 Decision to leave D.C. in 1979: seeking novelty, Regan era tipped power balance toward state, New York State recruitment—move to Albany for four years— overview of work: overseeing planning and evaluation for state health department—comparing federal and state level HMO qualifications— coordinating with D.C. office, New York’s “all payer” state status—year at Kennedy School and transition to heading Office of Health Systems Management—comparing work on federal and state level: academic vs operational—New York insulation from 1980s ethos of deregulation—managing political challenges to State Health Department authority—issues of substandard care, politics of troubled hospital issues—decision to move from public to private sector—1983 Kaiser’s Bob Erickson offers Crane job with legal department— learning the Kaiser approach to government relations: “…our currency really is our reputation, which gets generated by our members day in, day out.”—visiting medical centers in California—culture and growth of government relations office during Crane’s five-year tenure—importance of the 1982 Tax Equity and Fiscal Responsibility Act, administering implementation of risk contracting— differences in how Northern and Southern California implemented changes— Medicare and Baby Boomer issues [Audio File 4] 55 Advantages of increasing share of funding from Medicare: allows life-long relationships with members and greater flexibility in multi-specialty practice— ensuring a balance in Medicare funding and spending—the question of overpayment, 95% of average cost figure—predicting adaptation to health care reform legislation—1985 geographic expansion to North Carolina and Georgia— contract lobbyists with region-specific experience such as Harper Gaston— breaking down the managed health care crisis of the 1990s: emergence of for- profit competitors in 1980s, 1986 amendments allow alterations in community rating structure—mid 1990s Kaiser attracts physicians with greater flexibility than HMOs—PR and government relations use HEDIS results to address image challenges—evolution of professional standard review organizations—working as a team with Bob Erickson, Richard Froh and Joe Criscione—politics of developing policy—Kaiser’s ongoing support for federal and state interactions to increase access to health insurance coverage—regulatory and scope of practice issues—Dave Lawrence establishes Institute for Health Policy in 1999, thoughts on shifting Kaiser’s government relations into a more aggressive role—Crane’s experience makes him ideally suited to run Institute [Audio File 5] 70 Ensuring that the Institute for Health Policy worked in a synergistic way with government relations—analyzing and developing a white paper on the IOM report To Err is Human on patient safety—more controversial work: healthy eating campaign at odds with marketing interests with Pepsi et al—philosophy on keeping the Institute relevant: link, leverage and lead—collaboration with Robert Wood Johnson Foundation, the Commonwealth Fund, Milbank Memorial Fund and Kaiser Family Foundation—Institute impact on patient safety and health care delivery system matters—connecting points between government relations and legislation: IT, encouraging evidence based medicine—proactive policy work: advocating for protection of voluntary reporting—closing thoughts on the positive influence of the Institute 1 Interview #1: June 15, 2010 Begin Audio File 1 06-15-2010.mp3 01-00:00:00 Meeker: Okay. So today is the 14th of June 2010. This is Martin Meeker interviewing Robert Crane. Or Bob Crane? 01-00:00:16 Crane: Either one is fine. 01-00:00:16 Meeker: Okay. For the Kaiser Permanente Oral History Project. This is year four, focusing on government relations. And as I mentioned, the way in which we get these things started is I’ll first ask you to state your name and place and date of birth and then just tell me a little bit about the circumstances into which you were born. 01-00:00:35 Crane: Okay. I’m Bob Crane or Robert Crane. I was born in Philadelphia, Philadelphia. Grew up in the anthracite coal region of that state, which is the northeast part of the state. And actually spent my whole childhood in a town called Hazelton, Pennsylvania. My father was a minister. I have two older sisters, so I was the youngest of the family

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