Dr. Arnold (“Bud”) Relman died yesterday at 91. He was the most esteemed leader among those who have been dismayed by the commercialization, fragmentation, excessive cost, and relatively poor quality of the U.S. health “system.” In 1980, as editor of the New England Journal of Medicine, Bud sounded the alarm about a danger he fought against almost to the day of his death: “We should not allow the medical-industrial complex to distort our health care system to its own entrepreneurial ends…[Medicine must] serve patients first and stockholders second.”
Bud was a champion – perhaps the champion – on behalf of patient care values and ethical medical practice. But in this post I want to write about him as a model of aging for those of us who are over 65.
My contact with Bud was solely at meetings we attended together over the years. He was 16 years older than I, and as I joined him as a member of the over 65 set I increasingly admired him for his passionate commitment to his core values and the generative way in which he tried to support those who held the same commitments. I especially admired the way in which he could disagree with others in a respectful, friendly, humorous manner. To my eye he was a master of constructive debate and collaborative conflict.
I didn’t know Bud well enough to ask him the questions I posed to my beloved late father-in-law, who died at 91 sixteen years ago. I marveled at my father-in-law’s zest for learning about the fields his grandchildren were working in as journalist, psychologist, teacher, and environmental activist. When I asked him about the basis for his enthusiasm for new learning he seemed puzzled – “What else is there to be interested in but the future?”
I had a similar exchange with the grandmother of one of my daughters-in-law when she was 99. We discovered that we both wished we could return to earth in 500 years – not out of a wish for reincarnation but out of curiosity about how our species and the planet would evolve.
Some years ago when I was talking with a friend about my belief that a substantial number of over 65ers are worried about the impact of runaway Medicare costs on future generations, he responded with an aphorism I’ve treasured ever since: “The true meaning of life is to plant trees under whose shade you do not expect to sit.”
Bud Relman embodied this attitude for me. He didn’t expect to sit in the shade of a clinician-led, patient-oriented single payer system, but he worked tirelessly on behalf of that vision. I understood Bud to be following a “moral faith” that had the force of “religious faith.” Bud was a teacher to the end of his life, via both the content of his ideas and the example of his person.
[The aphorism comes from the title of a book that Wes Henderson (1928-2003), a third-generation Canadian, wrote about his father, Nelson. It's the advice Nelson gave Wes when Wes graduated from high school. For an extensive obituary for Dr. Relman, see here.]
Jim Sabin, M.D., 75, is an organizer of Over 65, a professor of population medicine and psychiatry at Harvard Medical School, and a Fellow of the Hastings Center.