James House, professor emeritus of public policy, challenged conventional approaches to improving health care during a panel discussion hosted by the Ford School of Public Policy on Wednesday.
Discussing his new book, “Beyond Obamacare: Life, Death and Social Policy,” House addressed what he describes as the “growing paradoxical crisis” of U.S. health care: the United States spends about twice as much of its GDP on health care as similar developed countries, yet counterintuitively has a lower level of health overall.
He attributed the failure of reform attempts to a misperception that health care is the primary determinant of a population’s health, pointing to evidence that quality of health care only has a 10 percent correlation with the health of a population.
House said the primary determinants of a population’s health are socioeconomic in nature, including educational attainment, income and gender and racial equality. House said the divergence between the quality of care in Western Europe and the United States began during the 1970s, when socioeconomic inequality increased in the United States.
“We can’t just rely on rescuing people after they’ve gotten sick by living a lifetime in deprived conditions,” he said.
According to House, this misconception has caused the United States to primarily pursue a “supply-side” health care policy since the 1980s, which focuses on increasing access to health care for the population rather than reducing their health care needs, the most recent example of which is the 2008 Affordable Care Act.
Though he said the Affordable Care Act passed under President Barack Obama was a step in the right direction for extending health coverage to more of the population, House was skeptical of its ability to resolve the broader issues facing health care in the United States.
“Obamacare, like all prior health care reforms, is largely a supply-side policy focused on expanding and managing the supply of health services and the price of it, rather than altering the major driver of the demand for health services, which is the health of the population,” he said.
House advocated for what he described as a “demand-side” approach to health care policy. This approach would reduce the demand for health care and rein in costs by promoting healthier behavior and mitigating the consequences of economic inequality.
“All social policy is health policy,” he said.
Though he was ultimately optimistic about the eventuality of this kind of health care reform, he addressed its political feasibility with hints of realism about the present political climate.
“Our role in the policy field isn’t to say what is politically palpable at the given moment, but to say what is actually going to make a difference and hope that at some point things are going to come in that direction,” he said. “There are political disputes about things, but there are moments when we have been able to enact positive changes.”