PHYSICS

Proving Einstein Right—or Wrong

DOUBLE-BAGGED IN GRAY PLASTIC wrap, the payload was ready to take its first step toward becoming a grown-up space probe: getting out the door of Hansen Experimental Physics Laboratory.

Dozens of scientists held their collective breath for four days in late August while technicians slooowly tipped the giant thermos bottle upright, hoisted it onto a tilt dolly, slid it into low-rider mode, then returned it to a horizontal position. Once the payload cleared the doors to the parking lot—by inches—a crane swiveled it onto a rack aboard a Vandenberg Air Force Base transporter and capped it off with a domed cover. Then it was off to Building 205 at Lockheed Martin Missiles and Space Co. in Palo Alto for mating and integration with the space vehicle.

So began the final countdown for Gravity Probe B, a 42-year, $500 million NASA experiment that has enlisted hundreds of scientists, graduate students and undergraduates from a dozen different Stanford departments. They’ve created the world’s most perfectly round objects and plotted stratagems to outsmart magnetic fields, all in pursuit of a fundamental tenet of physics that is next to impossible to demonstrate in the laboratory and darned tricky to test in outer space—Einstein’s general theory of relativity.

“Is it the longest running experiment at Stanford?” muses physics research professor Francis Everitt. “Well, it’s perhaps been the slowest to develop, mostly because of the enormous number of new technologies that had to be invented.”

As he ticks them off—cryogenics, magnetics, telescope design, control systems, quartz fabrication and gyroscope fabrication—the complexity of the GP-B project begins to emerge. The probe was initially expected to be completed in 1990. Then 1995. Then 1998. A launch was actually scheduled once, for October 2000. Now, the spacecraft is scheduled to lift off from Vandenberg in October 2002. By that point, Everitt and his colleagues, including three emeritus professors—program manager Bradford Parkinson, PhD ’66, hardware manager John Turneaure, PhD ’67, and engineering systems manager Daniel DeBra, PhD ’62—will have defined a new and widely tested general theory of patience.

The project has had several near-death experiences. Congress has threatened funding cuts a half-dozen times; Everitt, the principal investigator since 1962, successfully lobbied against them each time. And just last January, he walked in on an ashen-faced Turneaure moments after Turneaure had discovered a flaw in a critical epoxy. “It had sinister implications, and we had to fix it,” Everitt says. “John thought of a method that required only nine months of delay.”

Nothing less is at stake than the most accurate test ever of Einstein’s theory about gravity. Physicists use a number of visual images to describe the concept of the warp, or curvature, of space and time. There’s the spinning marble dropping in a bowl of unset Jell-O, or the human cannonball plummeting into a safety net—both of which can be seen to dimple and then drag the liquid or fabric as they land and rotate. Einstein stated that the gravitational effects of a spinning planet similarly warp space and time. But his theory, Everitt says, may be “incomplete.”

Shortly before the probe left for Lockheed, Everitt walked a visitor through the lab, where signs on the double doors to the GP-B inner sanctum proclaim “Sensitive Testing in Progress” and a sticky floor pad sucks specks of dirt off entering shoes. As he checked the temperature of the giant thermos bottle—warm, that day, at 4.2 degrees Celsius above absolute zero—Everitt called to mind Einstein in profile, with shoulder-length gray hair fleeing in several directions.

Everitt brought forth four pingpong-ball-sized quartz spheres, rounded to one-half millionth of an inch, that are like those at the core of the experiment. Suspended in midair inside quartz housings on a current produced by tiny electrodes, the gyroscopes spin at 10,000 rpm. Because they are coated with a thin layer of metal that is a superconductor, they behave like little magnets and have pointers that can be used to measure the direction of their spin.

Stacked on top of one another, the four housings are attached to a block of fused quartz, which is bonded to an all-glass telescope. The block of instruments is nestled in a long, cigar-shaped vacuum chamber—the probe—that fits inside the dewar, a.k.a. thermos bottle. More than 600 gallons of superfluid helium surround the probe, keeping it at near-zero temperatures to improve its mechanical stability for the 19 months of spaceflight. As the spacecraft orbits the poles more than 400 miles above Earth, the spinning gyroscopes and telescope will all point at the same distant star in the galaxy, HR-8703. Einstein’s theory predicts that the earth’s gravity will cause the gyroscopes to deviate slightly from their original spinning axes; if all goes well, the researchers will be able to measure any shift.

Back inside the campus operations center, the countdown clock measures the remaining days in bright fuchsia numbers: 431: 9: 15: 43. “We have a lot of testing and training to do between now and then,” says flight director Marcie Smith. “And for the first 40 days [after launch], we’ll be running around-the-clock operations.”

Not unlike the tiny quartz gyroscopes, spinning furiously in space.

HONORS

An Economist Gets the Call

THE TRANSATLANTIC CALLS from Stockholm usually reach the West Coast in the middle of the night, rousing professors to tell them they’ve been elevated to Nobel laureates. But A. Michael Spence, professor emeritus and former dean of the Graduate School of Business, was able to sleep in a bit before he got the October 10 call—at his vacation home in Hawaii.

“It’s very exciting,” he told the first reporter, from the Associated Press, to ask him about the prize. “I think all of us in the academic world do what we do for the fun of it.”

As in game theory? That’s what Spence and his co-recipients of the 2001 Nobel Prize in economics—George Akerlof, professor at UC-Berkeley, and Joseph Stiglitz, a former Stanford colleague who now teaches at Columbia University—used in the 1970s to lay the groundwork for a theory about markets with so-called “asymmetric information.” By looking at how agents with different amounts of information can affect markets, they developed analytical tools that “form the core of modern information economics,” according to the Royal Swedish Academy of Sciences.

These tools have enabled researchers to explore such things as the risks faced by a lender who lacks information about the creditworthiness of a borrower or how people with inside knowledge of a company’s financial prospects can gain an edge over other investors. Spence’s work demonstrated how a well-informed market player—say, an auto dealer—could communicate a superior position (for example, by offering a warranty).

Spence, Stanford’s 16th living Nobelist, is the author of three books and about 50 articles in professional journals. He graduated summa cum laude from Princeton with a degree in philosophy, earned a second bachelor’s degree as a Rhodes scholar at Oxford and received his doctorate from Harvard. He taught in Stanford’s economics department from 1973 to 1975, then returned to Harvard as a professor of economics and business administration. In 1984, he became dean of Harvard’s faculty of arts and sciences, and in 1990 he rejoined Stanford as dean of the GSB. After stepping down from that post in 1999, he joined Oak Hill Capital Partners and Oak Hill Venture Partners, where he has managed a number of high-technology investments. He continues to teach at the Business School and recently co-developed a course on e-commerce.

Cardinal Numbers

Alumni with World Trade Center business addresses on September 11, according to Stanford database: 42

U.S. flags posted in offices of Frances C. Arrillaga Alumni Center employees on September 25: 79

Decrease, in millions of dollars, of Stanford’s endowment value between Monday, September 17, and Friday, September 21: 121

Fans in attendance at Stanford Stadium for the September 22 football game against Arizona State: 39,580

Fans with coolers or backpacks: 0

Sources: PostGrads database; Stanford Management Co.; Stanford Athletics

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IN PRINT

Not Your Average Chemistry Book

CAN CHOCOLATE HELP you fight heart disease? (Yes.) Is it okay to eat homemade cougar jerky? (Not unless you want to risk trichinosis.) Do honeybees that drink fermented nectar have accidents while flying? (Yes.)

Those are a few of the tidbits to be gleaned from chemistry professor James Collman’s Naturally Dangerous: Surprising Facts About Food, Health and the Environment (University Science Books, 2001). Easy to read, with lots of Far Side cartoons and only two molecular formulas—H2O and O2—Collman’s brief chapters are an unexpurgated romp through grocery stores, gardens, pharmacies and the big outdoors.

“My book is sort of like my lectures,” Collman explains. “I’m not at all politically correct, and I say what I think about everything, which often horrifies students. But that just adds to the joy.”

Trained in organic chemistry and self-taught in physical, inorganic and analytical chemistry, Collman has been at Stanford since 1967. Known for his research in metal-organic compounds and superconductivity, he was named California Scientist of the Year in 1983 for inventing the first catalyst that electrochemically reduces oxygen to water without making any free hydrogen peroxide.

So much for academic credentials. Collman is also a bon vivant of a fly-fisherman, and—readers will learn—a jogger, accomplished cook and licensed scuba diver whose drink of choice is single-malt Scotch and whose canny nose, he thinks, ought to qualify him as a marijuana police dog.

In Naturally Dangerous, Collman looks at the complex science behind hormone supplements and global warming, performance-enhancing drugs and herbal teas. His recurring theme? Though it may be natural, it’s not necessarily safe. “Take windmills,” he says, grabbing the top piece of paper from a wobbly stack of magazine articles that he’s saving for his next book. “This is glowing in its enthusiasm but skips over some of the problems—like windmills make a lot of noise, take a lot of maintenance and kill a lot of birds.”

Collman also has it in for the U.S. health-food industry, a $10 billion-a-year “oxymoron” that “sells materials of uncertain purity and efficacy,” he says. And he’s not much fonder of those who tout the virtues of organic farming. Two billion people worldwide would die of starvation if farmers stopped using synthetic ammonia fertilizers, he says.

But along with these and other “sobering facts” about food, health and the environment, Collman knows when to trot out the crowd-pleasing and bizarre. Heard the one about eating squirrel brains in rural Kentucky? Read on.

JEWISH STUDIES

Finding a Permanent Home

“WHAT IS A YIDDISH POET?” the bard Yaakov Glatstein once quipped. “A Yiddish poet is someone who reads Auden, but Auden doesn’t read him.”

As a historian who reads Russian, Hebrew, Polish, German, French and, yes, Yiddish, Steven Zipperstein has spent much of his career translating the miraculous-story approach to Jewish studies—the Exodus, the coming of the Messiah—into events and themes that are relevant to a broader audience. “Jewish studies is like religious studies in some respects, but not entirely,” says Zipperstein. “It’s also like ethnic studies, but not entirely. So what my colleagues and I are trying to do is open up these wonderful topics and make them of intrinsic interest to the widest range of students.”

The September launch of the Taube Center for Jewish Studies should make that task easier. It includes three endowed professorships (two in history and one in religious studies), a fund for five annual lectures, an endowed library curatorship and a Judaica collection of more than 80,000 books, and office space on the outer Quad in the Center for the Study of Race and Ethnicity. “With the creation of a center, the University is committing itself to a long-term relationship,” says Zipperstein, who will co-direct the center with history professor Aron Rodrigue. “It’s saying it has faith that this field will exist at Stanford indefinitely.”

Bay Area philanthropist Tad Taube, ’53, MS ’57, a longtime adviser to the program who also serves on the Hoover Institution Board of Overseers, provided a $2.5 million lead gift for the center, which is supported by a broad base of donors. It will be the first project to draw matching funds from the Hewlett Foundation’s donation to the School of Humanities and Sciences. The establishment of the center signifies that Jewish studies has come a long way from the first half of the 20th century, when Stanford was perceived by many as an unfriendly campus for Jews. Even in 1991, when Zipperstein joined the faculty, friends and family were surprised. “My father, who holds six graduate degrees, said to me just before I was hired, ‘Why are you going to that place if it’s unfriendly to Jews?’”

Today more than 800 undergraduates, half of whom are not Jewish, enroll in more than 30 Jewish studies courses taught by 10 faculty from six different departments. The program also brings together an average of 20 graduate students, mostly from history and religious studies, providing opportunities for cross-disciplinary collaboration, exposure to scholars from around the world and funding for language studies and overseas research. “Stanford’s program in Jewish studies stands among the very best,” says Frances Malino, professor of Jewish studies at Wellesley College. “Its leadership is dynamic, its curricular offerings rich and diverse and its faculty stellar.”

Zipperstein thinks professors from many fields will continue to support the center: “The program was built by colleagues who actually get along.”

RELIGIOUS LIFE

A Rabbi for Everyone

WHEN PATRICIA KARLIN-NEUMANN climbs the steps to the pulpit in Memorial Church each month to take her turn conducting the University’s public worship service, she is surrounded by finely crafted Christian iconography, including several stained-glass windows depicting scenes from the New Testament.

But she wants it to be very clear that she is preaching as a Jew, and so she has created a new, symbolic outfit to wear on Sundays—a combination robe and tallit, or traditional prayer shawl. “We’re still inventing something that has never existed before,” says the first rabbi to be named an associate dean for religious life at Stanford. “We don’t see our office as serving the religious needs of a particular tradition, but as advocates for religious life. And I’m as likely to do a memorial service for a Catholic as Scotty or Maurice” (fellow deans Scotty McLennan and Maurice Charles).

Karlin-Neumann knows of only one other rabbi in the United States who is responsible for serving an entire university community, rather than just Jewish students. She does sit on the advisory board of Hillel, where she conducts High Holy Day services, and she is a visible presence on campus for Jewish students, who make up about 9 percent of the Stanford student body. She also teaches courses cross-listed in feminist studies and Jewish studies. Other duties? “Whenever there are multifaith occasions, I’m the point person.

VISITORS

'Imagining Utopia'

THEY MAY WEAR T-SHIRTS that proclaim “GEEK” and sport “Mars or Bust” lapel buttons, but these people are serious about the red planet. And they loved it when astronaut and shuttle commander Eileen Collins, MS ’86, strode onto the stage in Dinkelspiel Auditorium and proclaimed, “Someday, hopefully while I’m still alive, we will see people walk on Mars.”

Collins was one of several high-profile speakers at the fourth international convention of the Mars Society, which was held on campus in late August. Hosted by electrical engineering professor Bruce Lusignan, ’58, MS ’59, PhD ’63, the conference drew some 600 believers who took notes and asked probing questions at seminars on robotic exploration, terraforming, spacesuit design, biomedical issues, interstellar panspermia and martian paleontology.

The society was formed in 1998 by aerospace engineers, lawyers, science-fiction writers, videographers and folks from many other walks of life who believe that manned exploration of Mars is financially and scientifically feasible—and who really, really want to go. “What Mars does for many people is give them a lens for looking back at Earth and talking about how to do things better here,” explains Michael Hicks, who received his doctorate in aeronautics and astronautics in September. “It’s a way of imagining utopia and opening up your mind to higher possibilities.”

The society proposes first launching several return vehicles from Earth, followed by manned spacecraft that could hopscotch around the planet, allowing their crews to explore in the vicinity of various landing sites.

Using donated funds, volunteers built the society’s first big project last summer—a simulated Mars-exploration base on an uninhabited island in the Canadian Arctic. It will be followed by desert bases in the American Southwest, Iceland and Australia, with the goal of sending a full-scale robotic mission to Mars in 2009. Then come the manned crews. Mars or bust.

STUDENT LIFE

Strengthening the Communities

THE TITLE ON BEN DAVIDSON'S business card reads "assistant dean of students,” but there have been days when it might as well have said “fund-raiser.” As director of Stanford’s Lesbian, Gay, Bisexual, Transgender Community Resources Center, Davidson has spent much of his time figuring out how to pay for programs that he and the students he serves want to run. He’s lobbied administrators from academic departments, other divisions of student affairs—even student groups that enjoy ASSU funding—trying to scrape together money. His colleagues at Stanford’s four ethnic centers, the Asian-American Activities Center, the Black Community Services Center, El Centro Chicano and the Native American Cultural Center, haven’t had it much better. Every couple of years, they’ve asked the administration for $25,000 in what they call “soft money.”

That soft money has now turned into hard cash—a $25,000 increase in the annual base budget for each of Stanford’s six community centers, including the Women’s Center. Each organization also received an additional $25,000 this fall, which will likely be renewed in future years.

Several students pushed for the increase, forming a group called Concerned Students for Community Centers. But Morris Graves, associate dean of students and former director of the BCSC, says the change also reflects shifts in administration priorities. “The time was right,” Graves says. “Stanford’s new leadership is much more receptive to looking at the needs of the student affairs arena.”

The additional money has the directors dreaming of ways to strengthen their offerings. Davidson hopes his center will now be able to afford higher-profile speakers—think Martina Navratilova—and expand a lunchtime program at which faculty members discuss how their sexual orientation and gender identity have affected their careers. BCSC director Jan Barker Alexander will increase her budget for an annual awards dinner that draws parents from around the country. (Attendance has grown from about 140 to 315 in recent years.) All four ethnic centers expect to bolster a program that teaches student leaders to work for social change.

“The funding has a symbolic value in addition to helping us with our programs,” says Davidson. “It is also recognition of the very important work that centers do on campus, especially for students who are members of historically marginalized groups.”

Campus Notebook

Student Affairs Gets a New Chief
Gene Awakuni, vice president for student services at Columbia University, has been named Stanford’s next vice provost for student affairs. Awakuni has specialized in student affairs since 1988, holding positions at several public universities in California. The selection committee, which included deans, professors and students, was chaired by vice provost for undergraduate education John Bravman, ’79, MS ’81, PhD ’85, who has been filling the post on an interim basis since Jim Montoya, ’75, MA ’78, resigned last spring. Awakuni’s appointment becomes effective January 2.

How Did the Salamander Cross the Road?
For more than 3 million years, the 8-inch-long, yellow-and-black amphibians were quite the migrators, wandering from open grasslands to lakeshores to lay their eggs and raise their young. Then along came land developers and paved highways, and tiger salamanders were up a creek—candidates for the U.S. Fish and Wildlife Service’s list of endangered and threatened species. The thousands that live on campus are now getting a helping hand in their journey across—okay, beneath—Junipero Serra Boulevard. An experimental tunnel, completed in August, is expected to “reduce road mortality” for those commuting between the Foothills and Lake Lag, according to campus biologist Alan Launer, ’81, MS ’82, of the Center for Conservation Biology.

For Grad Students, More Rent Money
Graduate students are getting a new lesson in risk-reward analysis. Under the housing stipend program announced last January, those living off-campus could enter a lottery for a 30 percent chance at a $250 monthly rent subsidy. But now, students may opt for a guaranteed $100-per-month stipend instead. President John Hennessy says students made a “good case” for the modification, which will boost the program’s cost from $1 million to almost $1.2 million. And that’s a hefty rent check.

Putting the Brake on Bad Cycling Habits
She hasn’t owned a car for more than 20 years, and she sits on the boards of four nonprofit bicycling advocacy groups. Five months after being named campus bicycle coordinator—at a time when the Santa Clara County Board of Supervisors has capped the number of cars allowed on campus—Ariadne Scott says hers is a dream job: “With the volume of cyclists, it’s like Amsterdam.” But she has resolved to reform the unsafe habits of Stanford’s estimated 14,000 cyclists—including too few helmets and hand signals, too little stopping at stop signs and too much haphazard weaving. “There has to be a concentrated focus on education.”

MILESTONES

The Road to Diversity

WHEN THE UNIVERSITY opened in 1891, about 20 percent of the 440 undergraduates were women, five were Japanese nationals and one was Japanese-American. Undergraduate minority enrollment did not increase significantly until eight decades later, when it rose from 4.6 percent in 1968 to 11.7 percent in 1972. And it has grown steadily since. This fall, for the first time, half of Stanford’s freshmen are members of ethnic minority groups. But the road to diversity hasn’t always been perfectly smooth. Some milestones:

Spring 1892
Mary Sheldon Barnes, the first woman to join the faculty, is appointed an assistant professor of history.

April 4, 1896
Stanford beats UC-Berkeley in what is believed to be the first collegiate women’s basketball game. Shortly afterward, the Stanford team is disbanded due to objections from the Faculty Athletic Committee.

May 31, 1899
Jane Stanford amends the Founding Grant to limit female enrollment to 500. The limit is reached in 1903, revised to 40 percent of the student body in 1933 and eliminated altogether in 1973.

1931
Undergraduates Harry Hay and Smith Dawless publish poetry about their gay relationship. Hay leaves campus in 1932, partly in response to ostracism. In 1950, he founds the Mattachine Society, the United States’ first long-running gay-rights organization.

May 26, 1942
The last Japanese and Japanese-American students remaining on campus are sent to an internment processing facility at Santa Anita racetrack. In all, 34 students are interned, along with history professor Yamato Ichihashi.

1949
H.J. Belton Hamilton becomes Stanford’s first confirmed African-American graduate.

March 6, 1961
The Alpha Tau Omega fraternity rescinds Stanford’s chapter for pledging four Jewish men. The chapter continues without national affiliation.

April 8, 1968
At a colloquium in Memorial Auditorium called “Stanford’s Response to White Racism,” 60 members of the Black Student Union take the stage and microphone from provost Richard Lyman. They make 10 demands, largely about increasing minority admissions and staff devoted to minority affairs. The next day, the University agrees, at least in part, to nine of the 10 demands.

March 2, 1972
The ASSU Senate votes to accept President Lyman’s recommendation to eliminate the Indian mascot.

September 1972
Barbara Babcock becomes the first woman to join the Law School faculty. The Business School appoints three women: Francine Gordon, Linda Sprague and Myra Strober.

1978
The first curb pavement is cut to allow wheelchair access.

March 31, 1988
The Faculty Senate approves the replacement of the Western Culture freshman course sequence with Cultures, Ideas and Values.

April 5, 1989
The University Committee on Minority Issues makes 100 recommendations, including the addition of 30 minority faculty over 10 years, doubling minority enrollment in doctoral programs and establishing a program in ethnic studies.

May 15, 1989
Fifty-six students are arrested after they occupy the president’s office. Within a week, the University agrees to several of their demands, including the hiring of minority faculty and installing full-time directors at the ethnic community centers.

October 1990
Stanford extends benefits to employees’ same-sex domestic partners.

May 2001
The largest incoming group of Native American undergraduates ever—40 freshmen and two transfer students—is admitted.

What's on the Dean's List?

ELEVEN YEARS AFTER she was named one of “America’s Hot Young Scientists” by Forbes magazine, plant biologist Sharon Long has become the first woman to head the School of Humanities and Sciences. She took over the deanship in September, succeeding applied physicist Malcolm Beasley.

Long, 50, will lead the effort to raise matching gifts for the $300 million in endowment funds donated to H&S by the Hewlett Foundation. “It’s important to do right by this extraordinary event,” she says.

As she takes the helm of the school that is responsible for 80 percent of undergraduate teaching, Long will draw on her experience as the instructor for a freshman seminar on experiments in microbiology. “Often when students come to university, they have the idea that the best experiments are the ones that use the most advanced technology,” she says. “But what makes a great experiment is the greatness of thought behind it, and the goal of the freshman seminar is to understand logic, not technology. I have students read great experimental papers done with simple technology—simple because it was done 100 years ago.”

Long plans to continue some of her own experiments during her term as dean. A specialist in microbe-plant interaction, she was a lead co-author of a study published in the July 27 issue of the journal Science that decoded the genome map of the bacterium Sinorhizobium meliloti, which could lead to improved crop yields while reducing farmers’ use of weed killers and nitrogen-based fertilizers.

Although her lab team didn’t start out to be a genome group, Long says they realized they had to understand the S. meliloti genome in order to “move the questions we were asking to a higher level of precision.” Working through a problem logically and pushing new frontiers—just what Long wishes for students in her school.

HUMAN NATURE: Enzymes that break down pollutants take millions of years to evolve. So a pair of Stanford scientists have decided to speed nature up. Alfred Spormann, an assistant professor of biological sciences and of civil and environmental engineering, and graduate student Michael Liu take the same gene from several bacteria, slice the genes into segments and randomly reassemble them. They then insert them into new bacteria and test to see which ones break down toxic compounds such as chlorinated alkanes and aromatic hydrocarbons.

MESSAGE IN A BOTTLE: Assistant art professor Paul DeMarinis downloads his e-mail through some pretty funky terminals: neon-green electrolytic Leyden jars, wired ceramic washbasins and a chorus line of plastic miniskeletons decked out in red ponchos. It’s a slow read—only one letter of the incoming notes arrives every 1.5 seconds—but, hey, it’s also art. The Messenger, DeMarinis’s installation at the Cantor Arts Center through January 27, explores the origins of telecommunications technologies and the nature of speech and silence. The artist’s tongue is wired firmly in cheek.

A FEW GOOD MEN: Stanford’s urology department and the National Cancer Institute have jointly launched the largest-ever prostate cancer prevention study. select, as the study has been dubbed, will examine whether vitamin E and selenium, separately or together, can protect against prostate cancer—a disease diagnosed in more than 198,000 Americans each year. The study will take 12 years to complete and will enroll 32,400 men in the United States and Canada. Healthy men age 55 and older (50 for African-Americans) are encouraged to contact the urology department or NCI to participate.

HEALTH POLICY

Diagnosing the Problems

BUSINESS SCHOOL PROFESSOR Alain Enthoven, a.k.a. the father of managed care, worked with the Carter administration and, briefly, with the Clinton administration to try to provide universal, affordable health care in the United States. At a time when more than 40 million Americans are uninsured and premiums are expected to rise 12 percent to 24 percent in the coming year, Enthoven, ’52, has some new ideas. With Stanford colleagues Alan Garber, MD ’83, and Sara Singer, MBA ’93, he spells out his latest plan in a chapter of Covering America: Real Remedies for the Uninsured (Economic and Social Research Institute, 2001). The authors call for a system of public, private and employer-based “insurance exchanges” that would offer competing healthcare plans—like those available to Stanford employees, who receive credits to help pay for the coverage of their choice.

Stanford: What’s your diagnosis of the nation’s healthcare system today?

We have very large problems. Costs are high and rising very rapidly. When HMO premiums are $6,000 per family per year, that’s a lot of money for a lot of people of moderate means.

What about the quality of the care provided?

Well, poor quality has high costs, because if somebody acquires an infection in the hospital, he might have to stay three times longer. Studies have found that tens of thousands of people die unnecessarily and prematurely in hospitals every year because of errors—one study said 44,000, another said 98,000—and the healthcare system for the most part does not have built into it the kind of quality management or quality improvement processes that you would find in the airlines or at General Electric or Honda or Hewlett-Packard.

Will the patients’ bill of rights address that lack of quality, if it ever gets out of the House-Senate conference committee?

Congress has responded to healthcare problems by working on a different problem, which is apparently that trial lawyers are not making enough money. Congress wants to give people the unlimited right to sue their HMOs and to appeal anything, with no caps on damages. But a litigious environment is one of the barriers to quality improvement, because the way you improve quality is to look for and analyze mistakes and identify them as mistakes.

You’re proposing a new federal agency, the Insurance Exchange Commission, that would review medical technologies and determine which procedures would be covered by insurance. What would the agency tackle first?

Well, the great majority of healthcare money today is spent on the people who are very sick. In any given year, 85 percent of the money is spent on the 15 percent of people with the highest bills. Another thing that has to happen is that the insurance companies will have to roll back and people will have to pay 25 percent of the cost of whatever [treatment] they want.