Elena Marks, senior fellow at Rice University’s Baker Institute for Public Policy, speaks at the UHLC Health Law and Policy Institute’s Speaker Series.
Marks, a health policy expert, presents her research to attendees at the UH Law Center and online.
April 08, 2025 – The U.S. spends more on health care than most developed countries yet receives the worst outcomes – but there is a solution, according to health policy expert Elena Marks who spoke recently at the University of Houston Law Center’s Health Law and Policy Institute’s Speaker Series.
“The U.S. spent $4.9 trillion on health care in 2023, yet we are still seeing decreases in life expectancy, increases in comorbidities, and decreases in overall health,” said Marks, who is a senior fellow at Rice University’s Baker Institute for Public Policy. She emphasized that shifting investments and resources could help address this issue and improve overall health outcomes in America.
Her talk, titled “Moving Upstream to Improve Health Outcomes”, explored strategies for making these changes. The event was co-hosted by the and the Tilman J. Fertitta College of Medicine.
“It doesn’t have to be this way. We built the system we have, and we can change it,” said Marks, the former CEO and founding president of the Episcopal Health Foundation. “If we can change policies and laws so that they promote health impacting expenditures as opposed to just paying for care once people are sick, we have a better shot at organizing ourselves to be healthy.”
She added that the value of U.S. health care system can be measured by determining whether the quality is worth the cost. Marks described the current system as one with poor value. She is dissatisfied with the outcome or what Americans are getting in return of their health care expenditures.
“Everybody is entitled to live their healthiest life, and we do not spend our dollars in a way that reflects that,” Marks said.
Marks separated the health care system into three parts: downstream, midstream, and upstream. Downstream interventions, such as hospital care and emergency services, are necessary but expensive. Midstream, where Marks focused her presentation, covers private and public health care as well as waivers and programs across the nation to reduce the cost. The upstream health care system emphasizes public health and long-term health, where Marks said the focus should be.
She shared that both downstream and midstream care are moving upstream. Medical schools are now pushing students to focus on primary care to maintain individual long-term health. Health programs like Medicaid have introduced programs like ILOS, or “In Lieu of Services” that allocates funds to cover health-related social needs, like housing or food.
“Health is the outcome we’re going for,” Marks said. “We know what the drivers of health are. We have enough money to do it right, we just have to decide that’s what we want to do. Moving upstream is the way to make quality and cost align.”
