Victor Fuchs, pioneer of health care economics, has died

Victor Fuchs, a longtime Stanford economist and a pioneer in the study of health care as a matter of costs versus benefits, has died. He was 99.

Fuchs passed away peacefully in his longtime home on Stanford’s campus on Sept. 16. His death comes just before the scheduled release of a new edition of his seminal book, Who Shall Live? Health, Economics, and Social Choice (World Scientific). The book, which has never gone out of print since it was first published in 1974, has been required reading for generations of doctors and health policymakers.

Over the course of 70 years, Fuchs produced more than 200 research papers and wrote or edited 17 books. He worked doggedly to illuminate problems in — and propose policy fixes to — the U.S. health care system, where costs per person have long been the highest in the world despite middling outcomes. Critical of one-off solutions, Fuchs long advocated for radical fixes, notably the need for universal health care.

"Victor Fuchs was a towering figure in the field of health economics," said Mark Duggan, The Trione Director of the Stanford Institute for Economic Policy Research (SIEPR) and The Wayne and Jodi Cooperman Professor of Economics. "His contributions to our understanding of the inequities and inefficiencies of our health care sector and of the important role of social factors, such as poverty in influencing health, have been nothing short of extraordinary. He has been a tremendous inspiration to me and to health economists and many other scholars across generations."

Until his death, Fuchs argued that health care’s troubles extended beyond costs and effectiveness. He said the nation’s downward fiscal trajectory — with the national debt growing faster than gross domestic product — is rooted in its broken health care system.

“If we solve our health care spending, practically all of our fiscal problems go away,” Fuchs told The New York Times in 2012. When asked what would happen if costs weren’t reigned in, he responded: “Then almost anything else we do will not solve our fiscal problems.”

Fuchs joined Stanford’s faculty in 1974 as one of the first scholars to bridge disciplines through a joint appointment, now commonplace, at the university: In Fuchs’ case, he joined the School of Humanities and Sciences in the economics department, and the School of Medicine. He retired from teaching in 1995, when he was in his early 70s, but continued to conduct research and mentor health care economists for another quarter century.

At the time of his death, Fuchs was the Henry J. Kaiser Jr. Professor of Economics and of Health Research and Policy, emeritus. He was also a senior fellow, emeritus, at SIEPR; and a Stanford Health Policy (SHP) faculty affiliate. He also served as a senior fellow at the Freeman Spogli Institute for International Studies (FSI) earlier in his career.

Research trailblazer, dedicated mentor

To many health economists, Fuchs wasn’t just the “dean” or “doyen” of their field: He was the reason it exists. Kenneth Arrow — a close friend of Fuchs’ and the 1972 winner of the Nobel Prize in Economics who spent the bulk of his career at Stanford — is often thought of as the father of health economics for having published the first major study on the economics of U.S. health care. But it was Fuchs who commissioned it in the early 1960s.

Who Shall Live? was the first book to take a comprehensive look at medical care costs and quality of care in the U.S. and make it digestible to physicians, health policymakers, and general readers.

“In the beginning, people were incredulous that someone would want to apply economic metrics to a profession that was about saving lives,” Fred Fuchs said of his father’s frequent talks to members of the American Medical Association when the book was first published.

Over time, Fuchs won over skeptics through a combination of persistence and personality.

“He’s still getting fan mail about Who Shall Live?,” said Rossannah Reeves, his longtime assistant.

Fuchs also explored economic issues around the service economy, family, and gender. His 1988 book, Women’s Quest for Economic Equality (Harvard University Press) challenged perceptions that women had made huge strides in achieving parity with men. His analysis showed that was only the case for women who were young, white, unmarried, and well-educated.

“He was creative and an important pioneer,” said Alain Enthoven, the Marriner S. Eccles Professor of Public and Private Management, emeritus, at Stanford’s Graduate School of Business. “He was the first to call attention to the growing importance of the service economy (as opposed to markets for commodities and securities) and then explained how the markets for services differed from goods.”

Fuchs received numerous awards and honors during his career, including as president of the American Economic Association (AEA), a member of the American Academy of Arts and Sciences, and a member of the Institute of Medicine of the National Academy of Sciences. In addition, every year the American Society of Health Economists presents a Victor R. Fuchs Award for Lifetime Contributions to the Field of Health Economics.

“Some people choose to work on hard problems and find satisfaction in knowing they helped solve what others could not, but that wasn’t what motivated Vic,” said John Shoven, the Charles R. Schwab Professor of Economics, emeritus, and a SIEPR senior fellow, emeritus. “Vic dedicated his life to working on important problems, whether they were hard or easy.”

In interviews, Fuchs’ longtime friends and colleagues described him as indefatigable, insatiably curious, quick-witted, and eager to challenge others to think differently.

Liran Einav, the Trione Chair of the Department of Economics within Stanford’s School of Humanities and Sciences and a SIEPR senior fellow, recalls how Fuchs urged him to think big about health care issues.

“He was convinced that economists in general, and health economists in particular, need to be asking the big questions,” said Einav. In their new book, We’ve Got You Covered: Rebooting American Health Care (Portfolio, 2023), Einav and co-author Amy Finkelstein of MIT build on Fuchs’ work in their proposal for overhauling U.S. health care.

Like Fuchs did with Who Shall Live?, Einav and Finkelstein wrote their book for a different audience: mainstream readers. “Vic’s writing was always clear, and his ideas were simple economics,” Einav said. “He made concepts accessible in a way that many health economists cannot.”

Richard Thaler, winner of the 2017 Nobel Prize in Economic Sciences, has credited the year he spent at Stanford in the late 1970s — including meeting the “legendary” Fuchs and receiving his support — for “rather directly” leading to his Nobel.

Alan Garber, the provost at Harvard University, says Fuchs was a close friend and mentor for 40 years. The relationship started with a phone call when Garber was making his decision to attend Stanford for medical school. Years later, when Garber was deciding where to teach after his residency was over, Fuchs was instrumental in luring him back to Stanford.

“Vic was just a continuous source of wisdom,” said Garber, who was a Stanford professor of economics and medicine, and who also founded and directed the Center for Health Policy before his move to Harvard in 2011. “He was a complete mensch who was also a master of the penetrating question. He could stimulate your interest in any number of intellectual issues, in economics and beyond, and also help you think about how to be a better human being.”

A life-changing move

Born in New York City in 1924, Fuchs served in World War II before joining his father’s furrier business while earning a B.S. in business administration from New York University in 1947. He married Beverly Beck the following year, cementing a relationship with his life partner and best friend.

He then enrolled at Columbia University, where he earned his M.A. in 1951 and his PhD in economics four years later. His dissertation topic: the economics of the fur industry.

In 1962, following stints on the faculty of Columbia and NYU and at the Ford Foundation, Fuchs joined the staff of the National Bureau of Economic Research (NBER). There, he wrote in a reflection on his life published 30 years later, he discovered a love for empirical research over theoretical analyses and a fascination with health and medical care issues in particular.

While serving as an NBER vice president, Fuchs returned to teaching in 1968 through a joint appointment as a professor at The City University of New York and the Mount Sinai School of Medicine.

In the early 1970s, Fuchs was recruited to write a book on U.S. health care — with the goal of making it readable to a general audience. As part of the deal, he was given a one-year fellowship at the Center for Advanced Study in the Behavioral Sciences, which was then an independent research center located at Stanford.

Fuchs was nearing the end of writing Who Shall Live? when he got an offer that he said changed his life: NBER asked him to lead its expansion to the West Coast, starting with a new building housed on the Stanford campus. Around the same time, Stanford also set out to recruit Fuchs — and eventually agreed to give him, at his insistence, a joint appointment as a professor in Stanford’s economics department and its medical school. Cross-disciplinary faculty appointments were rare at that time.

“In retrospect, I understood that there was a need for a new approach to health care that included, but wasn’t limited to, economics,” said Fuchs during a recent interview at his home shortly before he died. A new approach, he said, required an understanding of medical technology.

Comedy and classics

Fuchs taught and led NBER’s West Coast operations until 1978, when he moved to Stanford’s faculty full-time. In 1988, Fuchs was appointed the Henry J. Kaiser Jr. Professor of Economics. He held that position until he retired from teaching in 1995, the same year he presided over the AEA as president.

Shifting to emeritus status, however, didn’t slow Fuchs down. He regularly worked on campus, participated in events, and consulted with campus leaders. In addition to his affiliations with SIEPR, FSI, and SHP, he was a faculty affiliate at the Center on Longevity and a member of the steering committee at the Center of Biomedical Ethics. He also ran the FRESH-Thinking Project at Stanford, which tackled key issues in health economics. In 2012, Fuchs discussed his lifelong work in an oral history interview with the Stanford Historical Society.

Starting about 10 years ago, Fuchs would regularly come to SIEPR to meet with Shoven — SIEPR's then-faculty director — and Gregory Rosston, the Gordon Cain Senior Fellow at SIEPR who at the time was SIEPR’s deputy director. Over lunch in a second-floor conference room, the three would discuss macroeconomics and other topics.

“Vic wasn’t one for spending time on simple pleasantries — he was so intellectually curious,” said Rosston, who now directs Stanford’s Public Policy Program. “When he greeted you, he wouldn’t just say ‘Hi, how are you?’ He would say, ‘What have you learned since the last time we talked?’”

An amateur comedian, Fuchs would perform a stand-up routine at an annual meeting of the Stanford economics department. In 1992, he formed a small book club with other Stanford faculty and campus neighbors that would meet bi-monthly and still exists today. Fuchs also wrote poetry.

“My life here [at Stanford] was very different” from what he had known in New York City, Fuchs said. “There was a much easier interplay between the social life [and] the intellectual life.”

‘Never gave up or gave in’

Fuchs, not surprisingly, also continued to be a prolific researcher and writer — including studies published in the American Economic Review and the Journal of the American Medical Association. A dozen papers he wrote over a two-year period while in his early 80s were published by SIEPR as a compilation.

“Vic did more since turning 80 than most people do in their lifetime,” Shoven said.

“He never gave up or gave in” to the aging process, agreed Philip Pizzo, who got to know Fuchs as dean of the School of Medicine from 2001 until 2012. “He served as a testament to vibrancy and longevity.”

That unrelenting drive, say those who know him, is a key reason he agreed to update Who Shall Live? when his publisher reached out to him in the fall of 2021. When asked recently why he took on the project at the age of 97, he noted that, for this edition, he brought in a co-author: Karen Eggleston, a senior fellow at FSI with whom he had previously collaborated.

But he also said that a lot has changed — the rollout of the Affordable Care Act, faster growth in health care spending, the COVID-19 pandemic — in the years since the book was last revised in 2011.

Fuchs said he wanted to shed light on what’s happened and why.

“I was curious,” he said.

Fuchs, who was deeply devoted to his family, is survived by two sons (Fred and Ken), two daughters (Nancy and Paula), 10 grandchildren and six great grandchildren. His wife, Beverly Beck Fuchs, passed away in 2007.

A public memorial will be held at 3pm on Nov. 24 at Etz Chayim Congregation, 4161 Alma Street in Palo Alto. Donations can be made to the Reconstructionist Rabbinical College and to Stanford Women’s Basketball.