Health care reform is back. By the time this article appears, President Barack Obama may have introduced his health care plan to Congress. The justification that we need comprehensive reform is compelling: in 2005 we spent nearly $6700 per capita—which is nearly twice as much as most other developed nations—for a system that fails to cover 44 million US citizens. 1 Despite our expenditures, the United States has adult and infant mortality rates that rank it at the bottom among the world’s high-income developed countries and that are about 50% higher than the median mortality rates of these countries. 2

It is tempting to connect these problems and conclude that improvements in our health care system will raise our standards of health to those of the high-income countries of Europe or Asia. But a closer look suggests that reforming our health care system, although long overdue, is unlikely to greatly improve our health. For that, we will need to reform not just health care, but our entire system of health.