TMC PULSE

T M C » P U L S E | N O V E M B E R 2 0 1 8 24 Spotlight Health economist VIVIAN HO, PH.D., has spent more than three decades educating the public about health care and working to ensure people of all income levels have access to affordable care. She'd like to put herself out of business, but doesn't think that's likely anytime soon. Ho, who serves as the James A. Baker III Institute Chair in Health Economics and Director of the Center for Health and Biosciences at Rice University, spoke with Pulse about her peripatetic career and her vision for the perfect health care system. Q | In addition to your posi- tion at Rice University's Baker Institute for Public Policy, you're a professor at Baylor College of Medicine. What is your mission as a health econo- mist and as an educator? A | When I came to the Baker Institute, it all became really clear to me that the goal is to get as many people as possible access to high quality health care. You can't do that without health insurance. But health insurance is not going to be affordable until we control health care costs. I basically decided I'll look broadly, but I am only going to look at projects where you find some way to control the growth of health care costs—whether it's something as small as freestanding emergency departments or as big as how the Affordable Care Act is structured. You wouldn't believe it, but this inte- gration of physicians and hospitals is actually driving up costs. Everything is about getting people access to care by controlling the growth of costs. Some people just say, 'Oh, yes, we have to get more people health insurance,' but the reason why we're having such a struggle and why so many people can't get health insurance is because the underlying health care is too costly. Q | I understand you grew up in Canada and moved to the United States at an early age. Tell me about your upbringing. A | I was born in Montreal, Canada. My father was a chemical engi- neer. At an early age, we moved to Calgary, Alberta, for my dad's work. It was so cold there. He tells me this story of when they were getting ready to go to a Christmas party and he couldn't start the car. He had to take the car battery and put it in the oven and heat it up so that they could go to this party. He decided at that point it was much too cold and so he was able to go to Southern California to work for Flora Corporation, so I grew up in California since I was six years old. I consider myself mostly an American. Q | You initially wanted to go into business before you became an economist. What made you change career paths? A | I was planning on majoring in economics and becoming a businessperson. I didn't know what a manager was, but I thought that sounded pretty good. Then I went to Harvard to do my undergraduate degree, and they have a senior hon- ors thesis there. As part of the senior honors thesis, I ended up working with a visiting Australian professor who gave me this great opportunity to compare differences in wages between men and women in the United States and Australia. This was with very a large database— the current population survey from the U.S. and then a similar survey in Australia. I thought the experience was so fantastic. You could tell stories about how the real world works by analyzing data. I thought, 'This is great; this is what I want to do.' I said, 'Forget trying to go out in the business world,' and went on to get a Ph.D. Q | Why did you decide to focus on health care? A | I feel like so much of my life has just been the accidents that happen along the way. When I was at Stanford for my Ph.D., I thought, since the background and work I had done so far was in labor econom- ics, I would become a labor econo- mist. But I was sort of struggling to find a research topic. Late one night, one of the professors walked by my office. At that point I was going to do something on the newspaper industry. He says, 'No, don't do that. I was just over talking to someone in the Hoover Institution. You should work on health care. As a matter of fact, you should work on the hospice industry and the Medicare hospice benefit because no one's doing any work on it.' I had no idea. I didn't know what Medicare was, really, and I knew very little about what hospices were. But at that point, I said, 'Well, what have I got to lose?' I started working on it, and it was fascinating. This notion that the government tries to provide assistance to these families when someone is at the end of life; it's such a difficult time. That was just the start of this career of learning, and, since then, it's just been learning along the way. The industry, unfortunately, has grown to be a massive component of the gross domestic product—prob- ably too much. But there is always something to learn—so many differ- ent components of health care and The Baker Institute and the relationship it has with the Texas Medical Center has been such a boon for me. We're really lucky to have this general policy institute that is so well con- nected with so many talented doctors. That's something that does distinguish us. Other think tanks don't have that advantage and I think that shapes the type of work that we do.

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