Beyond Obamacare

Life, Death, and Social Policy
James S. House
Paperback or Ebook
6.00 x9.00 in.
236 pages
June, 2015

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“James House has written a powerful book that shows a recent erosion of the health status of Americans that cannot be fixed by increased medical care but requires new public policies aimed at achieving greater fairness and justice in employment, income levels, and housing markets as well as educational systems of higher quality. Beyond Obamacare is a masterwork!”

—ALVIN R. TARLOV, emeritus professor of medicine, University of Chicago, and former president, Henry J. Kaiser Family Foundation

Beyond Obamacare maintains that both improving population health and constraining growth in health care costs requires shifting our focus from more narrow medical concerns to social and other non-medical determinants including income, education, work and social relations. Drawing on his distinguished research in these areas over several decades, and with broad interdisciplinary scope, James House's data-driven, provocative, and compelling presentation provides the basis for a new health policy paradigm. Presented in a clear and accessible way, it will be invaluable to health professionals, policy scholars, and students.”

—DAVID MECHANIC, Rene Dubos University Professor, Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey

“In this beautifully written book, James House provides a carefully reasoned, empirically grounded analysis of why universal health care, though long overdue, is still insufficient to move Americans closer to the health profile enjoyed by citizens of other wealthy nations. Beyond Obamacare is must reading for everyone who wants to see a healthier, more socially just America.”

—SHERMAN A. JAMES, Susan B. King Emeritus Professor of Public Policy, Duke University

Health care spending in the United States today is approaching 20 percent of GDP, yet levels of U.S. population health have been declining for decades relative to other wealthy—and even some developing—nations. How is it possible that the United States, which spends more than any other nation on health care and insurance, now has a population markedly less healthy than those of many other nations? Sociologist and public health expert James S. House analyzes this paradoxical crisis, offering surprising new explanations for how and why the United States has fallen into this trap. In Beyond Obamacare, House shows that health care reforms, including the Affordable Care Act, cannot resolve this crisis because they do not focus on the underlying causes for the nation’s poor health outcomes, which are largely social, economic, environmental, psychological, and behavioral.

House demonstrates that the problems of our broken health care and insurance system are interconnected with our large and growing social disparities in education, income, and other conditions of life and work. House calls for a complete reorientation of how we think about health. He concludes that we need to move away from our misguided and almost exclusive focus on biomedical determinants of health, and to place more emphasis on addressing social, economic,and other inequalities.

House’s review of the evidence suggests that the landmark Affordable Care Act of 2010, and even universal access to health care, are likely to yield only marginal improvements in population health or in reducing health care expenditures. In order to rein in spending and improve population health, we need to refocus health policy from the supply side—which makes more and presumably better health care available to more citizens—to the demand side—which would improve population health though means other than health care and insurance, thereby reducing need and spending for health care. House shows how policies that provide expanded educational opportunities, more and better jobs and income, reduced racial/ethnic discrimination and segregation, and improved neighborhood quality enhance population health and quality of life as well as help curb health spending. He recommends redirecting funds from inefficient supply-side health care measures toward broader social initiatives focused on education, income support, civil rights, housing and neighborhoods, and other reforms, which can be paid for from savings in expenditures for health care and insurance.

A provocative reconceptualization of health in America, Beyond Obamacare looks past partisan debates to show how cost-efficient and effective health policies begin with more comprehensive social policy reforms.

JAMES S. HOUSE is Angus Campbell Distinguished University Professor Emeritus of Survey Research, Public Policy, and Sociology at the University of Michigan, Ann Arbor.


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