What’s Keeping the U.S. From Better Population Health?

The “dual problem” of U.S. population health is that population health is poor, while health care spending is high. These issues are interrelated, but only partly so. Poor population health does increase the need for health care services, which tends to increase spending. But the more important roots of poor population health lie in social policy rather than in health care—particularly an inadequate social insurance system that leads to many people being denied the income needed for health. Further, high spending is chiefly related to high prices, not high volumes, for health care services. This stems from a private, administratively wasteful, multipayer approach to health care finance in which no entity has sufficient monopsony power to hold down prices. This article discusses several ways to address these issues, with diabetes as an exemplary case. Two central themes are 1) the need for a better system of income supports to help ensure the conditions that promote health and 2) the need to reform our approach to health care finance, so as to address wasteful spending and help orient health care toward providing consistent care across the life course. Ultimately, what’s keeping the U.S. from better population health is us. But we could fix that.