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The Economists' Voice 2.0The Financial Crisis, Health Care Reform, and More$
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Joseph Stiglitz and Aaron Edlin

Print publication date: 2014

Print ISBN-13: 9780231160155

Published to Columbia Scholarship Online: November 2015

DOI: 10.7312/columbia/9780231160155.001.0001

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Can the ACA Improve Population Health?

Can the ACA Improve Population Health?

(p.30) Chapter 4 Can the ACA Improve Population Health?
The Economists' Voice 2.0

Dana P. Goldman

Darius N. Lakdawalla

Columbia University Press

This chapter argues that health care reform has a modest impact on population health. In the last century, many of the greatest improvements in health had little to do with the health care system. The most dramatic public health benefits have come from factors such as clean water, public sanitation, and reduced smoking. Moreover, health care reform proposals always seem to fail because proponents promise too much. Reformers declare they will improve quality, lower costs, and increase access—all at the same time. This mantra is repeated so often that the public tends to believe that it is possible, when it really isn’t. Education is the key to significantly improving population health. The government should take the $120 billion it might cost for universal coverage and use it instead to provide earlier education and to improve the quality of education. Better-educated people live longer, are less likely to be disabled, and engage in healthier behavior. It is also important to invest in prevention. Primary prevention has the capacity to slow or reduce the rising prevalence of chronic disease and simultaneously attenuate the downstream spending that is associated with it.

Keywords:   Affordable Care Act, ACA, health care policy, health care reform, health insurance, population health

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