Beyond Obamacare: Life, Death, and Social Policy

A Summary of October’s Book Talk @ The Ford School

“All social policies are health policies.” – James S. House, Professor Emeritus of Survey Research, Public Policy, and Sociology and author of Beyond Obamacare: Life, Death, and Social Policy

This statement was one of the last remarks made by James House to an audience of both seasoned policy professionals and curious Michigan students in the Annenberg Auditorium at the Gerald R. Ford School of Public Policy two weeks ago. Discussion of House’s book “Beyond Obamacare: Life, Death and Social Policy,” included the shift to a demand-side approach to health care (catering to what populations actually need as opposed to what providers want to or can offer) in order to reign in national health care spending and address major social determinants of health that influence population health.

The tone of the event was set by a projection of the book’s cover: an IV bag containing a pile of $100 bills within its therapeutic fluid, as a metaphor that would soon become apparent over the course of the talk.

After a brief introduction, House stepped up to the podium, got right down to business, and began with, “Effective health policy requires effective social policy.” He then outlined problems plaguing the United States health services system dating back to the year 1900, starting with the birth of exclusively supply-side health policy that seemed to work up until 1970 when spending exploded. He referenced how poorly the U.S. performs both relatively and absolutely in life expectancy compared to other developed countries.

His call to action married key ideas when it comes to improving the equity and efficiency of health and health care: a demand-side approach to health care and the social determinants of population health. Some major determinants he cited include environmental exposures, health behaviors, psychosocial stress, psychological disposition, and social roles and productive activities.

House pointed out that the Patient Protection and Affordable Care Act of 2010 is still very much a supply-side policy. Helen Levy, a Professor of Public Policy at Ford, commented that the ACA had two main goals at its inception: to reduce the number of uninsured and to bend the cost curve of burgeoning health care spending. Evidence of accomplishing the former has been clear; the latter presents a greater problem. Professor of Health Management and Policy Richard Lichtenstein added that addressing issues of medical care and insurance, including implementation of pay-for-performance, penalties for hospital-acquired infections and readmissions, and applying the Cadillac tax on lavish plans is not a be-all, end-all solution to the deteriorating health of populations.

Prior to the Q&A, the panel discussion wound down with a “(re)discovery” of social disparities in health such as education, income, occupation, assets, race, and gender. All four panel members – Paula Lantz, Associate Dean for Research and Policy Engagement at the Ford School, in addition to the three aforementioned – emphasized the need for social policies in education at all levels, incomes over people’s lifetimes, employment, civil rights, and housing and neighborhoods in order to redefine and rebuild the health status of populations.

The panel acknowledged the forthcoming challenges in improving population health on a large-scale at the national level. House called for top-down national policy, preferable to policies that struggle to make it from communities upward. Upon the conclusion of the talk, we were left with the realization of the need to move beyond Obamacare and the reformation of health care into the equally, if not more, crucial reformation of the social determinants of health.

By: Peter Chu, MHSA Candidate, University of Michigan School of Public Health, Department of Health Management and Policy