A Heart to Serve Read online

  Nevertheless, at the end of my second year, members of Andy’s group asked me to represent them in a debate on the issue of whether Army Reserve Officers Training Corps (ROTC) should remain on the Princeton campus or be told to leave. Unquestionably, had the issue been voted upon by the more left-leaning student population, typical of this tense Vietnam era, ROTC would have been voted off campus. And the faculty was even more strident and vocal in their anti–United States government and anti-ROTC biases. The debate would be held in the historic board room of Nassau Hall in front of none other than the board of trustees of the university. Never in recent history had two students been asked to debate in front of the trustees on such a controversial issue, so it was considered a pretty big deal.

  My opponent and I were given ten minutes each to present our cases. I was terribly nervous. I’d debated in high school, but never in college. Though the board included a few former military types and business leaders, on the whole it, too, was relatively liberal in thinking. But I did my best to make a convincing case, using logic and arguments that seemed pretty clear-cut to me. At the conclusion of the debate, the trustees voted to keep ROTC on campus, and suddenly I was a hero to the relatively small but certainly principled and vocal group of Princeton conservatives.

  I had fallen, almost by accident, into a position of political leadership. It was my first experience of carrying the conservative agenda to the top and making my case. It would not be the last.

  THE SUMMER OF 1972 WAS A VOLATILE TIME IN OUR NATION’S HISTORY as Richard Nixon’s exit policy from Vietnam was being implemented. The news that captured the nation’s attention, however, centered on a bungled burglary at the Watergate Hotel in Washington. Eventually, the break-in at the Democratic National Headquarters would haunt the Nixon administration, leading to the president’s near-impeachment. After winning a landslide victory in 1972, Richard Nixon became the first president in U.S. history to resign from office.

  Despite the widespread antipathy toward government officials and political institutions in general, my interest was piqued when I heard of an opportunity to serve as a summer intern in Washington, D.C., with Congressman Joe E. Evins, a senior Tennessee Democrat from Smithville and a patient of my dad’s. Ironically, his daughter had taught me when I was in the fourth grade at Woodmont. I was intrigued by government, and the potential to make changes that could affect the community, and maybe even the world.

  I spent two months living in Georgetown and working on Capitol Hill, finally meeting the congressman himself only on the very last day. Seated in his office, I asked the revered senior congressman his advice on how I might someday become involved in public service. I had liked what I’d seen and thought that maybe, just maybe, I’d like to serve my country in Washington, D.C.

  His response was classic. Turning in his high-backed, dark red leather chair, he looked me over slowly, then remarked in a deliberate, grandfatherly tone, “Son, don’t come here right after you graduate. Go do something else for twenty years. Be the very best at it. Then come to Washington and bring that experience with you. You’ll be more successful then, whatever you do up here. Even more important, this great institution of the United States Congress and the American people will be the beneficiaries.”

  These words would haunt me twenty years later…almost to the day. It wasn’t the answer I had expected, but in retrospect, I now regard it as some of the wisest advice I have received in my life. And to countless individuals who have come to see me over the years, I’ve offered some variant of what Congressman Evins counseled me. He unwittingly had introduced me to the simple, yet powerful concept of a citizen-legislator.

  I WAS OUT OF STEP AT PRINCETON IN MORE WAYS THAN SIMPLY MY political beliefs. Other than Rob Mowrey, my sophomore-year roommate also from Tennessee, I was the only other member in Cottage Club—which I joined my junior year—for whom alcohol held absolutely no allure. Princeton’s eating clubs were a unique feature of campus life, serving a role similar to that of fraternities at most universities. The club officers live on the second floors of the stately homes, but for most members the clubs serve principally as the center of social life—places to socialize, to have a good meal, and to either loaf or study between classes, and on weekends to party.

  I ate every meal at Cottage, and often studied upstairs in the beautifully appointed, dark wood library used by the great novelist F. Scott Fitzgerald in his student days. Some of the author’s early writings and personal mementoes remained on exhibit under glass as a constant reminder of the creativity that flourished at Cottage. For some of us Fitzgerald’s legacy of success was something to aspire to. I loved the club and forged strong relationships that continue to this day; when I return to campus nowadays, Cottage becomes my home base. But although I enjoyed the club immensely at the time, it did not form the hub of my social life. I attended the monthly parties and enjoyed them, but I was never the one to close them down.

  My conservative views and traditional outlook had a progressive streak. My senior year I was one of the people out of the 120 or so members who voted to accept women to the all-male club, a position that was not too popular at the time. It was also about this time that I wrote a lengthy letter to the trustees of my high school alma mater MBA to do the same…not much of a positive response there, either.

  While attending Princeton, I came up with a good scheme to indulge my passion for flying and to “build time” or accumulate hours for my next aviation rating. As president of the university’s flying club, I submitted a proposal to the local organ transplant centers that I use the club’s airplanes to transport tissues and organs for transplantation. (This was years before I ever considered being a transplant surgeon.) All I asked in return was that the various hospitals reimburse the flying club for the actual cost of the flight. The idea fell flat, mostly for liability reasons.

  One of the remarkable things about attending Princeton was the personal contact one could have with renowned professors who became mentors. A husband-and-wife team ignited my interest in health policy. Herman Somers, a senior professor of public policy at the Woodrow Wilson School, had been active in the early formulation of Medicare. He had written extensively on health-care policy and proposed one of the early foundational plans that defined what ultimately became known as managed competition. He and his wife, Anne Somers, also an established and highly regarded health policy expert, had written a book called Health Care in Transition, that became my bible for health-care policy. I developed a close working relationship with Anne Somers, who encouraged me to focus on the prevention side of medicine, even hiring me to run a summer health camp for eighth graders in Red Bank, New Jersey, taking me with her to New York policy conferences to meet other experts, and using me as a research assistant on her new book. But it was a young assistant economics professor from Germany by the name of Uwe Reinhardt who had the most lasting impact on my thinking and approach to health policy. Reinhardt had been at Princeton for just a couple of years when I enrolled in his basic macroeconomics class. I soon learned that he had a policy interest in health, and somehow I obtained a copy of his PhD thesis on the role of physicians’ assistants in the Canadian health-care system. Professor Reinhardt was far ahead of his time, already fretting about the rising costs of health care and how, one day soon, most Americans would not be able to afford even basic health insurance coverage. With his soft German accent, sardonic sense of humor, and keen insights, Reinhardt was also a great teacher, making even the driest of subjects come alive. (I took accounting from him as well; by some magic, he even made accounting a fun and entertaining subject to learn!)

  While at Princeton, I enrolled in three of Professor Reinhardt’s courses—huge survey classes of 150 to 200 students, in which we studied macroeconomics, corporate finance, and accounting. I was one of those students Reinhardt whimsically thought of as his “groupies,” the students in those days who came up immediately after class to ask him questions and who often hung around for an hour or so o
f enthusiastic, animated debate. He called me “Billy the Kid.”

  My politics, to the extent that I had any in those days, also appealed to Professor Reinhardt. In the 1970s, academe was a hostile environment for market-oriented economists like Reinhardt. Like the professor, I was out of sync with the times. Amid the period’s Vietnam- and Watergate-born cynicism, I was openly enthusiastic about American democracy, our commitment to freedom, and the free enterprise system. Reinhardt thought I was naïve, but Princeton’s vocal left-leaning culture clearly bugged him, and he found my conservative views refreshing. And he enthusiastically encouraged them by just paying attention—and sometimes by provoking me by making contrary arguments consistent with his German and Canadian heritage. I began to think that maybe I should spend my life tackling these issues of health-care quality, access, and cost.

  Uwe likes to tell the story of my final exam in his Econ 102 class. Professor Reinhardt always posed the exam question this way: “You’re the CEO of a company. You have promised $1.75 earnings per share. The dry run in October shows that $1.50 per share is all you’ll be able to deliver. Make up the twenty-five cents and get those earnings up to $1.75, which would amount to about $10 million. You must make it up out of thin air, but in accordance with generally accepted accounting principles.” Uwe paused, and with eyebrows raised, said, “The more corrupt, the better I like it!” He was only partly joking. It was the unique way the provocative young professor taught. At the time, many companies were cooking their books for shareholders and he wanted us, as students, to understand that; what better way than to make us think like the crooked CEOs themselves?

  I came up with what I thought was a clever answer, yet one that was perfectly legal. It involved my imaginary company selling a useless patent it owned to a related company that appeared to be independent. This would yield a huge capital gain that would go on the books as earnings, while leasing back the patent it never intended to use for a nominal yearly fee and a note for the original purchase price, payable thirty years later.

  The professor loved it! All notions of my naïveté gone, Uwe wrote on my paper in red ink, “You have the potential to be the biggest shyster I’ve ever had in class!” From Uwe, that was the ultimate compliment. He later described my plan as “deviously good.” After class, with his eyes twinkling, Professor Reinhardt asked, “Wherever did you come up with so breathtakingly daring a solution?”

  “The plan is similar to one used by the Memorex Corporation,” I told the prof.

  Reinhardt burst into laughter. “Devious, Billy the Kid. Delightfully devious!”

  From that moment on, something just seemed to click between us, and over the years Professor Reinhardt and I kept in touch. Uwe has remained at Princeton, where he has continued to teach generations of students in his uncannily delightful and engaging way. In 2008, I returned to Princeton for a year to teach, and Uwe and I taught together a WWS graduate class on health economics, twenty-six years after he taught “Billy the Kid” how to “cook the books.” The unpredictable almost serendipitous circling of life’s relationships has made me a much richer soul.

  I am not much one for convention, even in academics. So when I by chance heard about a little-known program in the WWS that allowed one to be exempt from all formal academic requirements of Princeton, my interest was piqued. The program, called the Woodrow Wilson School Scholars Program, was selective. In fact, only one or two students were selected each year. The idea was to provide the Wilson Scholar maximum freedom and creative license to delve deeply into a particular area of interest. The person chosen was relieved of all course requirements, including the most sacred of Princeton traditions, the senior thesis. In the past 280 years, no one has graduated from Princeton in the liberal arts without writing a thesis—no one, that is, except the few students in the (now extinct) Wilson Scholars program.

  Interestingly, when I was running for the Senate in 1994, opposition research investigators (hired guns used by the opponent’s camp to dig up dirt on a candidate) came to Princeton to try to find some scandal to use against me. When they couldn’t find my senior thesis, they knew they’d found the silver bullet to bring down my campaign. Their silver bullet vanished when my campaign explained about the Wilson Scholars program. Ironically, the same issue came up again twenty years later when Sam Alito was nominated to the Supreme Court and investigators couldn’t find his thesis. He, too, had been a Wilson Scholar.

  I spent that senior year writing a series of papers on health-care policy, developing an independent study project on efficiencies of hospitals in Texas—typing up literally thousands of computer punch cards (remember this was 1974) to enter data into the massive mainframe computer at Princeton—and attending conferences and making presentations with Anne Somers. I left Princeton having completed just the basics (Dad had always said a great doctor does not have to be a great scientist) of premed and graduated from the Woodrow Wilson School with a concentrated focus on health-care policy.

  Taking calculated risks and doing the unexpected—that brings me pleasure. It’s the comfort zone I like to operate in. It’s a philosophy I first heard articulated by Professor Hubert Alyea, who taught me Chemistry 101. Alyea was Princeton’s version of the mad scientist, and a living legend at the university. He taught chemistry in the grand theatrical style, mixing huge flasks of clear chemicals to create vivid colors, blowing things up, setting blinding fires, and creating vast plumes of smoke that would envelop the audience. His final lecture, the grandest of them all, repeated each year at Princeton reunions for hundreds of alumni and their children to enjoy, always ended with a simple proclamation: “If you ever have a choice in life between one road that leads to the conventional and the expected, and another road that leads to the out-of-the-ordinary and the unconventional, choose the latter. Your life will be more rewarding, and you will never regret it.”

  As I have bounced back and forth between my academic passions—medicine and the sciences on the one hand, and public policy on the other—Professor Alyea’s principle has colored my life. That simple, unadorned advice made going to Princeton worthwhile.

  And it was about to come in handy.

  * * *

  I ALWAYS WANTED TO BE A DOCTOR.

  It’s almost impossible for an outsider to truly understand the rigors of medical school, to be followed by a year of internship, and then two to six years of additional residency training, then a year of two of specialty fellowship. Though laws have more recently greatly reduced the number of hours that can be required of an intern or a resident, the process remains physically and psychologically rigorous. You enter medical school a typical college graduate and you leave a professional upon whom people depend for their lives. Most doctors who survive the process don’t like to discuss it. Instead, like veterans who have served in battle, they simply say, “No use explaining. You had to be there.”

  At the time I was completing applications for various med schools, Harvard was considered the premier medical school in the country. Premed students were a super-competitive lot; getting into the likes of Harvard was the goal of most, and competition was fierce. Majoring in the “soft” subjects of public policy and international relations, I felt I did not have a shot at competing with all the chemistry, physics, biology, and biochemistry majors. Going back to Nashville and attending Vanderbilt was attractive to me. And that was my goal…unless I could by some miracle make it to Harvard.

  So I went up to Boston to see Dr. Perry Culver, one of Dad’s medical study group colleagues when they served together at Maxwell Field Air Base during World War II. Dad had kept up with him over the years and he was on an alumni admissions committee for the medical school. When I finally found his office (having first searched all over Harvard’s undergraduate campus in Cambridge, not realizing the medical school was four miles away across the river in Boston proper), I told Dr. Culver right up front that I did not think I had a shot at getting in but that if admitted I promised to take the education I recei
ved and apply it in as expansive a way as I could. He shared with me the fact that, yes, other applicants had much more impressive grades, had done much better on their MCATs (the standardized tests medical schools use for admission), and showed more promise as academic scientists, but no one else had on their application the statement that the Princeton premed advisor Dr. Willard Dalrymple had written on mine: “He may not be our top student this year, but he is certainly the most likely student I’ve seen to someday be awarded the Nobel Peace Prize.”

  That hyperbolic compliment was evidently enough to help me make it to the waiting list for admission. Somebody must have dropped out, because two months later I got a call, “You are admitted.” I got in by the skin of my teeth.

  Although four years older and more mature, I felt no less awkward as I walked onto the med school campus on Avenue Louis Pasteur in Boston than I had during my first months at Princeton. Now I had to compete head-to-head in science classes against people who had graduated at the top of their premed classes and majored in science, while I had finished somewhere in the middle in a nonscience. Even some of my Harvard professors looked at me askance. “Why would you major in public policy if you really want to be a doctor?” they’d ask. I thought them narrow and overspecialized, but I was entering their world, where they set the rules and determined the grades.

  But my dual interests in public policy and medicine continued hand in hand. For instance, on weekends during my first year of medical school, when most of my med school colleagues were doing labs, catching up on their medical studies, or writing scientific papers, I was trudging back down to Princeton for board of trustee meetings. In the late 1960s, the university had modified its board policy to include young alumni trustees, including one from the graduating class each year. Just before my graduation, the junior and senior year classes and most recent graduating alumni classes had elected me to the position. Obviously, it was a heady learning experience to serve on the board of a major university at twenty-two years of age, and I loved jumping back and forth between two such diverse environments, challenging me in such different ways. I grew comfortable with operating in these two disparate worlds.