It’s 11 o’clock on a Monday morning and Yale School of Public Health Professor Howard Forman is hitting his stride in a lecture on health care economics.
In the first hour of class, Forman—who prefers to be called simply “Howie”—has taken 50 or so graduate students on a whirlwind tour of modern-day health insurance practices from HMOs to individualized saving plans; high-end deductibles to federal insurance law; Obamacare to Medicare for All.
Along the way, he’s dropped references to popular movies (Helen Hunt’s blistering opinion of HMOs in As Good as it Gets); given unsolicited advice (If you want to really stick it to The Man have like 25 children!); shared his own personal health issues (heart and collagen); told an anecdote about his previous night’s work at Yale New Haven Hospital’s emergency room (he’s a diagnostic radiologist) and quoted John Lennon (Life is what happens to you while you’re busy making other plans).
And it works, not just well, but masterfully well. A lecture that could easily slip into droning instruction on the mathematical intricacies of health care finance becomes an engaging educational journey, where personal anecdotes and asides illuminate the gritty underpinnings of health care management. Students listen intently, ask questions, type copious notes, and the 80-minute session flies by.
“I can have one-on-one impact with patients, and I can have a large impact within my practice, but there is no place where I can have a bigger impact than the classroom,” said Forman, MD, MBA.
You could say teaching is in Forman’s blood. Both his parents were teachers, a sister teaches, and another sister is certified to teach. He has the utmost respect for the venerable teaching arts. Forman scrupulously prepares for each lecture and he always wears a tie and sports jacket when he is in front of a class (just like his dad).
Besides being a professor of public health (health policy) at the Yale School of Public Health, Forman holds joint appointments as a professor of economics, management, radiology and biomedical imaging.
Forman’s lectures still resonate with former students, who say they were integral in helping them prepare for careers in health care.
Misaki Kiguchi, MD, MBA ’08, assistant professor of surgery at Georgetown University and a vascular surgeon with the MedStar Heart and Vascular Institute, called Forman a mentor and role model.
“Although his knowledge of health care management and leadership is often what he is known for, what I, and I am sure most students, admire most is his passion for making change, to question the status quo, and to challenge complacency,” Kiguchi said. “He constantly seeks to improve himself by taking on professional opportunities that are demanding. He never rests. He not only teaches us this rigor he expects this of us. He holds us to a high standard because he holds himself to one as well.”
Benjamin Elkins, BA,’08, MPH, ’09, said Forman is one of two Yale professors with whom he still stays in touch.
“Howie epitomizes what I looked for in my professors at Yale: a subject matter expert and a skillful teacher with both
high expectations and a kind, caring spirit,” said Elkins, director of quality improvement at Stanford Children’s Health/Lucile Packard Children’s Hospital. “Over the 10 years since I graduated, Howie has never hesitated to answer my calls for advice. What makes Howie incredible is that he does the same thing for countless others.”
Other former students include Vivek Murthy, the 19th Surgeon General of the United States; Kate Goodrich, chief medical officer for the Centers for Medicare & Medicaid Services; Michael Sherling, co-founder of Modernizing Medicine, and Mary-Ann Etibet, CEO of Merck for Mothers. Thomas Balcezak, chief medical officer at Yale New Haven Hospital, is a former student. Forman still has Balcezak’s 2001 final exam. He shows it to students who ask about where a health care career might take them.
Forman’s contributions at Yale go well beyond his 22 years of teaching. He founded Yale’s MD/MBA program and currently directs both the Yale School of Public Health’s Health Care Management program and the Yale School of Management’s Executive MBA program (health care track). He’s also an active researcher and has served on the editorial boards of several major radiology and health care management journals. He took a break from teaching in 2001-02 to serve as a legislative aide in the U.S. Senate on Medicare legislation.
Forman also has extensive experience in business management. Since coming to Yale in 1996, he has consistently been involved in the financial management of the Radiology Department’s clinical practice, which currently operates on an $80 million budget.
“I think I bring a perspective that few others on this campus can bring,” said Forman. “I know what it is like to run an $80 million business. I know what it’s like to deliver health care and I have more than a working understanding of the U.S. health care system, its various parts and how the regulatory apparatus intersects with it. When you take all of those things together, I think that makes me a pretty good teacher of this content.”
Despite his extensive credentials, Forman is quick to point out that any success his students have enjoyed is due to a broader team instructional effort over time combined with those students’ own outstanding commitment, drive and capabilities.
A Tweeting Machine
As Monday’s lecture ends, Forman speaks with students for a few moments before heading off to another class, another meeting, another research call.
There are few openings in Forman’s otherwise loaded daily calendar and he takes full advantage of every untethered second. Just as quickly as he exits the lecture hall, Forman is on his cellphone answering email (he’s known for his prompt responses), checking the day’s latest news, and–soon enough–logging into Twitter.
While many view Twitter as a spectator sport, Howie Forman is a certified (literally) tweeting machine. He tweets on average 30 times a day. He tweets on his exercise bike. He tweets while walking his beloved poodle mix, Ashley. He tweets walking around campus.
Among the 20,000 people who follow him @thehowie are entrepreneur Mark Cuban (7.7M followers), Daily Beast Editor Molly Yong-Fast (418K), neoconservative political analyst Bill Kristol (588K), Andy Lassner, executive producer of The Ellen Show (467K), and former Republican presidential candidate Joe Walsh (235K). And these Twitter celebrities aren’t just casual likes. Forman (incidentally, not bragging) said he exchanges tweets with high-level folks regularly and has had coffee with a few.
Forman said he enjoys the free flow of ideas found in the Twitter-verse, especially the broad spectrum of political discourse, intellectual analysis and advocacy. Forman is not shy about sharing his opinions on politics, policy and government on Twitter. His was one of the early Twitter accounts blocked by President Trump. (A federal judge later ruled the president’s blocking of Twitter accounts was unconstitutional).
Forman is completely transparent about his political leanings.
“I am 100 percent Democrat,” Forman said. “But I am also so middle lane that aside from my political party I am absolutely center, which some people find surprising. I’m a Democrat who believes in fiscal responsibility. I’m a Democrat who believes that women should have agency over their bodies. I’m a Democrat who believes that our country should be involved in as few wars as possible, but should have a military that sends a signal of strength and is committed to maintaining world peace.”
Forman sees positives on both sides of the political divide and his teaching is balanced rather than politically infused.
“I like to challenge students on the left as well as the right and if it disturbs people in both places, then I feel I’m doing my job right,” Forman says with a smile.
During Monday’s lecture, Forman may have surprised some when he said he isn’t on the bandwagon that blames large insurance companies for many of today’s health system woes.
“A lot of people demonize the insurance companies, but I’m not prepared to do that,” Forman told his students. “They are just taking rational action in the market that has been given to them.”
So, what does Forman tell his students the best approach is to the current health care crisis?
“What I try to give my students is a functional understanding of the health care system, where the problems are, and some of the tools that can be used to fix them,” Forman said. “The reality is that the health care problems we face in this country are not going to be solved by one or two things.
“Anyone who thinks there is a magic bullet–Medicare for All or anything like that–is unrealistic,” he said. “The way we are going to fix it is by everyone tackling one of 100 different problems and taking it seriously. Even a 1% problem is a $35 billion problem in our $3.5 trillion health care system. If you have a 1% solution you can make a mammoth difference in our federal budget and our ability to deliver health care affordably.”
As for the bigger picture? Forman is more optimistic than distressed.
“The good thing about our nation is that our institutions always manage to survive under this type of duress,” Forman said of the current political climate. “Depending on the outcome of this next election and perhaps the next two after that, we could see a purge from both parties of the elements that seek to sow discord instead of seeking to unite and bring our nation together with common purpose.”