On Feb. 6, the Rockefeller Center for Public Policy, Political Economy Project and Dartmouth Institute for Health Policy and Clinical Practice co-hosted former Secretary of the U.S. Department of Health and Human Services Alex Azar II ’88 for a moderated discussion titled “Policy and Public Health.” The event was moderated by Dartmouth Institute vice chair and Geisel School of Medicine professor Carrie Colla ’01 and Tuck School of Business professor Charles Wheelan ’88, who also serves as the faculty director of the Center for Business, Government & Society.
Nearly 90 people attended the discussion in Filene Auditorium, with approximately 95 watched through a YouTube livestream, according to Rockefeller Center assistant director for public programs and special events Dvora Greenberg Koelling.
Colla began the discussion by asking Azar — who served from 2018 to 2021 during the first Trump administration — about the “barriers to building better [health] outcomes” in the country. Azar replied that the U.S. does “exceptionally well” at treating complex conditions due to its access to “innovative” care, but not “primary and preventative care” because of the structure of the healthcare system. Its current configuration divides the “purchasing decision” made by patients from the “financing,” he added.
“We get this system where we have patients who want things, and they’re frustrated because somebody tells them they can’t have it,” Azar said. “We get this very disaggregated system.”
Wheelan then asked about potential modifications that could make the healthcare system more “cost-effective.” Azar responded that he sees promise in “value-based care” — a system that links payment for medical care to its outcomes, according to the American Medical Association.
“[Value-based care] gets the doctor and the patient aligned together to … lower total cost of care, to care about longer-term outcomes, to care about … trying to keep people out of the hospital,” Azar said.
Following up, Wheelan asked whether Azar had witnessed “truly impressive changes” in the behavior of healthcare providers, in cases where value-based strategies were implemented. In his work as secretary and later in the private sector, Azar said kidney care has demonstrated that the proposition “works.”
“If you set up the incentives so that you care about total cost of care, you learn about your patients, you deliver holistic care,” Azar said.
Shifting the conversation, Colla asked Azar about how to navigate the “trade-off between affordability and innovation in the drug industry.” According to Azar, his healthcare policy outlook is focused on “introduc[ing] market forces” to the system. For example, as HHS secretary, he proposed the Most Favored Nation Model, which would have capped the cost of prescription goods sold to American providers at the prices sold to countries in the Organization for Economic Co-operation and Development, he explained.
“My point to pharma[ceutical companies] was: if you’re willing to sell these drugs to [OECD nations] for this lower price, I get that same [price] now,” Azar said. “If you don’t like that, you can increase the price over there. … In a way, it was a trade measure.”
Wheelan asked Azar what advice he would give the incoming HHS secretary, who has not yet been confirmed. On Nov. 14, 2024, Trump nominated Robert F. Kennedy Jr. — who is expected to be confirmed by the Senate later this month — to head the department.
Azar said that his priorities would be to find “folks that you really can work with,” “move full-on” to value-based care and make sure not to “kill this golden age [of medical innovation].”
Colla ended the moderated discussion by asking Azar for advice he would offer current Dartmouth students. “Half the game is putting yourself up the field,” he replied.
“Get the resume. Get the education. Get the right experiences early in life,” Azar said. “Keep your aperture as open as possible so that you maximize optionality in terms of choices.”
During the audience Q&A, an audience member — who said they have a chronic heart condition — asked Azar about how insurance companies can manage insurance rates for individuals with pre-existing health conditions without “driv[ing] up” insurance costs for people without them. In response, Azar explained that there are “different mechanisms to try to deal with [managing insurance costs],” such as continuous coverage requirements — which mandate that insurance coverage has been in effect without any lapses for a given period of time — but did not suggest a specific solution.
“What you don’t want to have is a system where somebody who has a bad health condition doesn’t buy insurance until they go into the hospital,” he said.
Attendee Jacob Markman ’27 said in an interview after the event that Azar’s “lens of economics” was an “interesting way to approach healthcare.”
“[Economics] is not the way I traditionally think of [healthcare] — I think it’s more of a policy issue,” Markman said. “But, obviously those two are very much interrelated.”
Eli Remis MED’28, who also attended the event, said he believed the discussion was “valuable” because Azar discussed “complex topics that are hard to learn about.”
“I’ve been to a couple events coordinated by the Dartmouth Institute [for Health Policy and Clinical Practice], and it is very inspirational,” Remis said. “It’s great for students to be able to attend these things and see that they are not just like some small person. You have power and are on a track to be able to cause significant positive change, and it’s just up to you to grab it.”
