Words to the WHYs on Healthcare Podcast

About Words to the WHYs on Healthcare Podcast

Illuminating the "WHYs" of health care and the economics behind it all- maybe even with optimism and humor! tinamarshdalton.substack.com (https://tinamarshdalton.substack.com?utm_medium=podcast)

Publisher

Tina Marsh Dalton

Category

business · health & fitness

Language

en

Explicit

No

First episode

1 May 2024

Latest episode

10 Apr 2026

Latest episodes

6 episodes in the feed.

1. 

   10 Apr 2026

   Insurance Choices with Aaron Yelowitz: Part 2

   In Part 2 of my conversation with Dr. Aaron Yelowitz, we move beyond asking who can best help consumers with complex health insurance choices and ask instead, “Why are they so darn complex in the first place?!” We discuss how this complexity attempts to fight inherent market failures in insurance offerings, but confusion may also be a strategic financial move by insurers. Would standardization of plan choices help consumers? What other markets have faced the same pressures? How might this hold back consumer-focused innovation in the long run? Dr. Aaron Yelowitz (http://yelowitz.com/) is an Economics professor University of Kentucky, a joint faculty member in the Martin School of Public Policy and Administration, a senior fellow with the Cato Institute, and a research fellow with the Institute of Labor Economics (IZA). Be sure to check out Part I of our conversation, answering the notorious question: “Should we trust consumers or bureaucrats with insurance choices?” Transcript: A Conversation about Consumer Choice and Health Insurance: Part 2 Tina Marsh Dalton I would love to know your opinion on this idea that’s been running in my head about insurance markets. Obviously, enrollees choosing plans that waste their money is bad. But I’ve wondered — why is our question, who’s the best to make this really complex, confusing choice? What if the question was, why is this choice so confusing? Why are plans so complex? I almost wrote a paper on this in grad school. Is it a way to stop adverse selection? Aaron Yelowitz It could be adverse selection, it could be moral hazard. Under the simplest theory of insurance, we would want to fully cover you against bad things happening to you — you pay a premium up front, no coinsurance, no deductibles, no maximum out-of-pockets. But if the bad thing happens to you, it’s like it never even happened — that’s Allstate’s motto. Of course, whenever something bad happens to you and we compensate you for it, then the moral hazard problem — the idea that you would go to the doctor more often for relatively minor things — comes into play. So the idea is maybe cost-sharing, skin in the game, puts discipline on consumers. It’s fundamentally the trade-off between: we don’t want really bad things to happen to you, but we also know that if we make something free or near-free, people will wastefully use it. But try explaining that to consumers. The design of those plans can attract different kinds of people — imagine that I’m old and sick, and you’re young and healthy. I might be attracted to a low-deductible plan. You might prefer greater protection too, but because you don’t go to the doctor that much, you’re fine with a high deductible. You’d still like the protection, but if the pool of people in the more generous plan is more adversely selected, you don’t want to hang out in that neighborhood if you’re a healthy person. Tina Marsh Dalton I view this from the insurer provider side — I want to have really complex plans, because that’s going to make it hard for the old person to know which plan to choose and hard for the young person too, and we’re going to have things smoothed out. I don’t see much policy discussion about, rather than helping people make the complex choices, how can we make the choices less complex? Aaron Yelowitz You know what’s interesting? Amy Finkelstein, of course, has a paper on everything, so it’s no surprise. Medigap plans used to be the Wild West. Prior to Medicare Part D — which provided prescription drug coverage, passed in 2003 and implemented in 2006 — drugs weren’t as big of a deal in the 1960s, but they became a much bigger deal over time. Part of the way seniors would get drug coverage, because Part A and Part B of Medicare didn’t cover it, was through what was called a Medigap plan. These still exist today. And it used to be there was almost zero standardization — so call it too much choice, but more just there was no easy way to comparison shop. At some point, the government came in and put some standardization on, here are the things a plan must have. And if that sounds familiar — when you signed mortgage documents at some point, there was surely a standard bureaucratic form you filled out. Or if you apply for a credit card, they’re required to show APRs, that kind of stuff. We see this kind of standardization pop up in all sorts of areas. Tina Marsh Dalton Those are both complex financial areas, right? And sometimes you have a lawyer helping you in the mortgage case, whereas you don’t have that in the healthcare case. Aaron Yelowitz We could ask, though — how much good does that do? When you put some things as prominent — you’re putting your thumb on the scale and saying the APR matters, or this matters, or that matters. Directionally, that’s probably true. Is it true for everyone all the time? The example I like to give is not a financial product, but imagine you were deciding which cereal to eat this morning. There is standardization that exists today that didn’t always exist — the side of the cereal box with calories per serving, broken out into macronutrients. Those are there so you can be a better shopper. But of course, you can’t adjust what a serving means, and we might be targeting the wrong thing. Those in the longevity space, for example, might say that the view of fat versus carbs in yesteryear versus today is vastly different. Imagine you put your thumb on the scale that carbs are okay and fat is bad, back in the day, and now perhaps we don’t think it’s nearly as obvious. So that’s exactly the idea — the bureaucrat comes in, standardizes something, we might think markets work a little more efficiently because of that. But you are putting your thumb on the scale saying what is important. Tina Marsh Dalton Yeah, it’s true. So we’re still stuck in the same dilemma of somebody’s making a choice. I think it has interesting distributional effects too, because we’re talking about this distribution of consumers, some of whom might be quite sophisticated. So those sophisticated consumers might be very well off in a system where they get to make very individualized choices. What they find in the Medicare literature is that poor plan choice happens more in the 75-to-80 age range, whereas 90-year-olds make great choices — because it’s like their kids or caregivers are making it for them. But then, when you standardize, you’re taking away the benefits for the top of the distribution, while you might be bringing up the bottom of the distribution. Aaron Yelowitz Right, and you alter behavior. Imagine we say carbs, protein, and fat matter, but other things don’t matter to the same degree. People today might say, for example, food dyes matter. You’re putting your thumb on the scale, saying these things matter and these things don’t, and at least for some people — as current conversation would suggest — there are other things that really do matter. And in some ways, it feels like it stifles innovation. Imagine you’re the cereal maker that says I’m not going to use food dyes, but that’s hardly rewarded in this context. Imagine you’re the professor who says, I want to do podcasts as part of my research dissemination. But if the profession rewards boring extensions in peer-reviewed journals rather than anything else, sometimes you get a disruptor through outside funding that can help move things, but not always. So the problem with standards is someone defined them somewhere — directionally, they’re probably not crazy, but could they stifle innovation along other margins that really are important, and perhaps margins we haven’t thought of? Tina Marsh Dalton That is really interesting when I’m thinking about how to make progress in this space. I think in the US, that’s especially important in healthcare, because we’ve hit this rough patch — how do you create a space for innovation? I’m thinking of mortgages now. I’ve had chats with my good friend who’s a realtor. His family actually has a plan that’s outside of the insurance space — it’s a religious-based plan, an international religious-based plan, and I’ve been fascinated by how he found it and how it’s existing outside of our pretty strict structure. How do we get innovative spaces while maintaining the safety net — the health insurance exchanges are still there, Medicaid is still there? Aaron Yelowitz I do think there’s a fundamental tension there. I’m a little bit aware of these collective plans where essentially a group of people, often incorporating religious values, get together. And one-size-fits-all, as an administration changes one way or another, has all the culture wars that exist today feeling like they are, to some extent, at the margin of healthcare decisions, autonomy, and fundamental values — do I have to pay for what you’re doing, and do you have to pay for what I’m doing? There’s a lot of that going on right now, and it’s not new to today — it’s been there all the time. And fundamentally, when I’ve quickly looked over these plans, what I’ve worried about is that they often have a maximum amount they can pay out. The thing that has concerned me is the undermining of coverage for some catastrophic event — the whole idea behind insurance is the small-probability catastrophic event. These plans are relatively small, and imagine they’re kind of under-financed in some ways. If you happen to be on a plan and had a $5 million expense, that is backbreaking for them, so they cap it off. Tina Marsh Dalton They need to get their size, yeah. Aaron Yelowitz Yeah, so you could imagine that this is just life — people make choices, and basically, do people want to buy plans that accord with their fundamental values, even if they potentially have existential risk to them? Free market people would say, that’s life, people will do that. Tina Marsh Dalton Well, even more — looking into this particular plan, it seems like it’s also an innovative, progressive dimension in that it seems to go back to the basic idea of insurance. In the US, it’s like these prepaid discount plans rather than what insurance should be at its core: there’s something big and unpredictable, and if it happened, you’d be wiped out, so I’d like to take care of just the risk part. That as an innovation — we’ve gotten off track, and getting back to this basic principle is how insurance started. I have some posts where I was reading Black Beauty to my children, right? And this is a horse’s life back in the 1800s, but there’s this one scene where the horse’s cabbie gets sick, and he’s talking about his trade organization, which would reimburse him while he is sick — this event where everyone pays in, and then when you get the bad draw, you get paid out. Aaron Yelowitz Right, and you could imagine also that in smaller groups, the adverse selection problem isn’t the same, because if I try to fraudulently use insurance and we’re in the same plan — these are my friends, my neighbors. There’s also some vetting. If you have a pastor who will sign off that you show up every week to church, that’s something — you’re able to get somewhere on time every week. The other thing is one should wonder about things that are correlated with signing up for that plan, like lifestyle behaviors that are actually advantageous toward not having big expenses. Imagine that those who sign up for such a plan abstain relatively from drinking and drugs and smoking. All of that will do so much more to move health expenses than whatever fancy plan you have. Lifestyle behavior has got to be, by far, the most important factor in explaining the variation in expenses across people. Diet, exercise, those behaviors — they’ll explain just a bunch of the variation in costs. Tina Marsh Dalton Yeah, so if we can move to one section of my paper — talking about the prevention problem. My paper is laying out some arguments that the government should be involved because there are fundamental problems. But one of the problems I’m laying out with insurance markets is that all these insurance markets we just talked about, in terms of choice, are focusing on a one-year or two-year horizon, even with inertia. They’re not focusing on the 40 years. Do we have ways that markets or governments can solve this prevention problem? Aaron Yelowitz That’s a fascinating issue. Among things that relate to what you said — the first is the way that we reimburse providers. When you’re sick and use healthcare, people get reimbursed. When you’ve done everything right so you don’t use healthcare, they don’t get reimbursed. A few years ago when I was being very vigilant about my health, I actually learned I had sleep apnea. Since it was at a time when I was in sort of peak health for my age range, it wasn’t because of some of the other comorbidities. It turns out that, sleeping on my back — big sleep apnea; sleeping on my side — not so much. But of course, they were all recommending CPAP for me rather than a behavioral change, because you get reimbursed from one and you don’t from another. Tina Marsh Dalton It’s the subscription economy. CPAP is like a recurring expense for your practice’s income. Aaron Yelowitz Exactly. And then the other pressure — this is a big issue — is not only how do our lifestyle behaviors in our middle ages then percolate over to when we’re old, but imagine that you stop taking care of yourself, and you just switch to a more generous plan. And along the same lines, we might imagine that medicine in the future gets more personalized. With gene editing and gene therapy, there are things we can just fix that we couldn’t fix before. Those are super expensive, but they have long-run benefits — a large upfront cost, with benefits that accrue over a long period of time. As an example, think about Sovaldi, which is a permanent cure for hepatitis C. It’s a 90-day regimen. Those who get hepatitis C tend to be politically unsympathetic because it’s associated with IV drug use. But imagine that everyone who had Hep C took the regimen at the same time — you’d get rid of Hep C, because the contagion is through needles. But here’s the deal: it costs $100,000. What would you do? You would enroll in the fancy plan that covers the $100,000 this year, and then enroll in the same plan without Sovaldi coverage next year, paying a massively lower premium. So this is emblematic of the issue that is percolating up — personalized medicine, breakthrough treatments with large upfront costs but long-lived benefits, and how does one pay for those, which will become more common because of gene editing and gene therapy. Tina Marsh Dalton I think one thing I’m always searching for is that the problem in the current system is, who benefits from good health? It’s no one, or it’s me, and I’m not the direct payer in my healthcare relationship. I pay the insurer, and the insurer pays the provider, but we don’t have any direct financial relationship. Aaron Yelowitz Yeah. I’m always a little surprised. A few years ago, I was giving a talk up near Indianapolis — Ball State was hosting one of their conferences — and I was talking about the healthcare system. This was literally the time when I was investing very heavily in eating right and exercising. Today, I would just buy my way out of some of those problems. It is more expensive to eat healthy than to eat badly. Exercise has parts of it that are slightly rewarding, but it’s a big time sink — real effort. And there can be side effects: if you walk too much, you can get plantar fasciitis, that kind of thing. But was my health insurance lower cost? No. Did even an unnamed employer offer free gym memberships? No. Which — if you want to get rid of frictions, then for employees who are there for life, directionally that has got to pass the cost-benefit test, because most people still won’t go to the gym even if it were completely free. Tina Marsh Dalton Well, employers maybe have some skin in the game too, right? If it shows you’re more productive — so in principle. Aaron Yelowitz They have skin in the game. And maybe this is just a bureaucrat who doesn’t want to shake things up, but it seems to me that every once in a while they’ll send you a free Fitbit or offer a $100 gift certificate to the person who gets the most steps, but it feels like it is massively not optimized for how lifestyle behavior really matters. And if you think about it — yes, insurance companies can switch, and they worry about you switching from one plan to another. Should your employer care about whether you smoke? The answer feels like yes, because many people are with their employers for long amounts of time. If you smoke today, it matters ten years from now, probably. There is this mystery of — many people get employer insurance, employers take it out of wages, and there is not much push for lifestyle incentives. Maybe it’s just because it’s hard to change these behaviors. A few years ago, I would joke about — well, if there was some magical pill that could just make people not obese. And we are getting there. But generally, the issue is lifestyle matters a lot, but it’s also super hard to change, especially in the long run. Tina Marsh Dalton Maybe we can bring it back to consumer choice and go full circle. The idea you’re describing is the employer should care, but the employer has to care over all of its thousands of employees, and the individual benefit of one employee not smoking isn’t going to come back to them in the same way as it would directly. So some idea about the individual in choice being important, even in creating this prevention system. Aaron Yelowitz Right, and that’s where the skin in the game would come in — that’s where consumer choice and health savings accounts come in. Imagine you’re allocated money, and if you make smart choices with respect to your health, you could use that to buy healthy food instead of paying some premium, or something like that. It feels like there could be more incentives in that direction. Tina Marsh Dalton Yeah. I do a bunch of analogies in the paper about the idea of auto insurance versus health insurance — insuring our car versus ourselves. What are the differences? And there is something about why isn’t there a good driver discount? If you brought individual choice into insurance, you can. Aaron Yelowitz Right. Often when I think about car insurance, back in the day — and this is how I try to relate it to my young adult students — there were good driver discounts. Do you have a GPA over 3.0? Insurance prices are very high at 16 and kind of fall off as you get a bit more experience. Today, the way I think of insurance companies is as seeking out information to give you as personalized a quote as possible. So the difference today versus back in the day is — for a 16-year-old, or an 18-year-old with a few years of driving, your app on your cell phone can show the time at which you’re driving. Driving after 11 PM just turns out to be more dangerous than driving in the afternoon. More truck drivers, et cetera. Hard stops versus decelerating quickly, driving over 80 miles an hour — these are things that apps now can track. What they’re trying to do is like a hotel with their list price rack rate. Everyone qualifies for that rate, but then they subtract a discount if you, A, opt in. Much like the supermarket card you scan every time you go shopping — you might say, why should I have to scan that to get a discount? Because what they’re getting is your information on whether you’re buying Frosted Flakes or Cheerios. Here, the idea is there’s some high list price, and if you choose to opt in and have them monitor — your phone can tell when you’re driving, or when you’re in a car — then they can tell whether you’re going over 80 miles an hour or driving late at night. And it turns out those things are probably far better predictors than just getting a speeding ticket. So they’re searching for that information. If they use it and others don’t, they’ll have a competitive advantage because they can keep the good customers. Tina Marsh Dalton Mm-hmm. Aaron Yelowitz So you could imagine — we often don’t talk about auto insurance as having the same crises in markets that we often talk about with health insurance. We often don’t talk about life insurance — something I’ve written quite a bit about — as having these kinds of issues. With life insurance, the reason why the market actually works pretty well is we price based on risk. If you purchase a policy, they come to your house, take your blood, do a blood panel on risk factors, ask you a handful of questions — like, have you ever been skydiving? Very few people have, but it would be a leading indicator of a taste for risk. And you sign the right of way for them to gather your healthcare information. Sleep apnea would matter, for instance, depending on whether it actually affects mortality from age 40 to 50. Some of these things might drive up health expenses, but if life insurance just cares about whether you die or not in those ten years, the degree to which it will matter isn’t clear. But those markets tend to work pretty well, and you don’t hear about the government wanting to take over the life insurance market. You sometimes hear this about car insurance, or after wildfires in the Palisades, about centralized home insurance. The problems with home insurance often come because they want to price risk inappropriately — think about hurricane insurance in Florida, the coast versus inland, or wildfires in hilly parts of Los Angeles with $5 million homes versus flat inland homes worth $500,000. The problem is cross-subsidies. That’s the government actually getting involved rather than letting the market work. Tina Marsh Dalton Well, I don’t know if we’re done with prevention, but I hope the innovators listening to this podcast have gotten some ideas about what we could do. I’m going to ask you a question I’d like to end with: hopefully this podcast moves the needle on some dimension of improving healthcare, but if we’re going to improve systems, we should improve our questions. So my last question for you is, what is the next better question we should be asking? Aaron Yelowitz I would say — in principle, what we care about is health: not only longer lives, but more vibrant lives. Yes, medicine can matter for that, and can be expensive. One does not want to dismiss that — imagine if there were a cure for sickle cell anemia, there are vaccines we should still be getting, there are breakthroughs that very well could be significant. By the time we’re the 90-year-olds you were talking about, who knows what treatments will look like and how less invasive and less painful they will be. Tina Marsh Dalton There are vaccines that we should still be getting. Yeah, there are breakthroughs that very well could be significant. Aaron Yelowitz But to me, I’m still pretty attached to the idea from a few years ago when I gave that keynote address at Ball State, which is: lifestyle behavior matters. Incentivizing people to make good choices goes a little bit against the crux of what insurance is, which is essentially that when bad things happen to you, we bail you out in some ways. In a world with Ozempic, or a world with statins, high cholesterol or obesity is less of a concern, because you can almost buy your way out of it with drugs. But I think the hard part is moving the needle with respect to these hard-to-move behaviors — the reason why people don’t want to eat broccoli and prefer to eat pizza is because pizza tastes good. The real question is, can there be innovations? Could there be a potato chip that’s actually healthy? Could there be food that people actually want to snack on that also does no harm? If people are clever enough to do gene therapy, isn’t there a way of creating food people actually want to eat rather than just pretending to like the healthy stuff? Innovations to make habits stick better. Could exercise be made more fun? Tina Marsh Dalton We’re innovating on the wrong side in insurance. What about the other side? Aaron Yelowitz Right — you could almost say vaping is a huge innovation relative to combustible cigarettes, conditional on whatever the verdict is on long-term health effects. It’s moving the needle in the other direction, at least. And so, are there better substitutes for pizza and for streaming Netflix? You’d run into the problem of the genius who comes up with that innovation — much like Steve Jobs with the iPhone, or the Google engineers who came up with the seminal paper that launched generative AI. You worry about whether you would capture enough of the returns to actually want to do it. But it seems to me my key takeaway is that’s the hard, hard problem. And I am more dismissive of the idea that, well, people love smoking and love taking drugs, so that’s just how it is. If you ask most people, do you wish you had just not gone in that direction? Many would say, I wish I hadn’t gone in that direction. I wish I had lived a lifestyle that was more robust in various ways. Somehow incentivizing that — I don’t have the solution, but I’d love there to be more attention to it. And to me, at least, that would also make a topic like Make America Healthy Again feel less controversial if it were actually focused on lifestyle behavior. What politician is going to say Americans shouldn’t eat 10% fewer calories and exercise 10% more? That is almost universally agreeable. Tina Marsh Dalton Well, and it also feels like flourishing — we could all get behind that. Could we innovate so that we would be creating better habits and being happier? Aaron Yelowitz Yeah, exactly. And there are also modern ills that come into this — doom scrolling and things like that, right? Things that maybe we don’t define as physical health, but probably do affect thriving in various ways. You run into the issue of personal freedom — if someone wants to be in the basement and play video games 24 hours a day, that’s between that person and their parents. But generally speaking, would you say, that’s what I wish I were doing? And obviously, I will push back against anyone saying, don’t tell me how to use my apps and social media. However, could there be some agreement that generally speaking, you wouldn’t wish it on your own children — so how could we present incentives to improve health broadly speaking, mental and physical? Tina Marsh Dalton I love it. Okay, I’m going to go search for some people to speak to that, or we’re going to put the call out right now to the innovators listening to this podcast to start weighing in. Aaron Yelowitz Yes, and each of us will collect just a very small royalty. Tina Marsh Dalton Yeah, the consulting fee. Aaron Yelowitz Yes, exactly. Tina Marsh Dalton Okay, well, thank you for coming today. Aaron Yelowitz My pleasure. Thank you so much for having me. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit tinamarshdalton.substack.com (https://tinamarshdalton.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

2. 

   9 Apr 2026

   Should We Trust Consumers or Bureaucrats with Insurance Choices? With Dr. Aaron Yelowitz

   In this podcast, Dr. Aaron Yelowitz and I talk over our dueling papers concerning the role of the government in health insurance choice. We know that consumers often struggle with complex plans, leading to costly mistakes and inertia, even when better options exist. However, individual choice can lead to better matches to our preferences versus rigid, one-size-fits-all approaches of bureaucratic systems. Centralized choice presents a risk if government agencies have different priorities than constituents, such as budgetary savings or risk-aversion to bad publicity. Dr. Yelowitz walks through a major Medicaid program in Kentucky which shows how default assignments and opaque algorithms created both financial losses and restricted access for inattentive consumers. Can we design systems to allow consumer choice balanced with structured guidance? How might AI help simplify decisions, reducing errors while preserving flexibility to improve healthcare decision-making? Dr. Aaron Yelowitz (http://yelowitz.com/) is an Economics professor University of Kentucky, a joint faculty member in the Martin School of Public Policy and Administration, a senior fellow with the Cato Institute, and a research fellow with the Institute of Labor Economics (IZA). If you’re curious on how we choose insurance wrong (and how to get better at it), check out my accompanying post! Transcript: A Conversation about Consumer Choice and Health Insurance: Should We Trust Consumers or Bureaucrats with Our Health? Tina Marsh Dalton Welcome to Words to the WHYs on Healthcare podcast, Aaron. I’m really glad to have you. Aaron Yelowitz Pleasure to be here. Tina Marsh Dalton So, we were going to talk today — we have these paired chapters where we’re thinking about what’s the role of markets, what’s the role of the government in healthcare. But let’s start with yours. Why don’t I let you tell the title of your paper, because I feel like you’re going to give a better spin. Aaron Yelowitz So, the title of my paper, very provocatively and non-judgmentally, is, Should We Trust Consumers or Bureaucrats? The big idea in it is that one way of thinking about health insurance is that it’s a financial product. It covers uncertain healthcare expenses that may arise, and consumers, generally speaking, are not all that good at making financial decisions. Imagine that there are many health insurance plans out there. Figuring out which one is the correct one, given your circumstances and the forecasting involved, is really challenging. Tina Marsh Dalton But then the question is — you have a lot of choices. Aaron Yelowitz Yes, there could be a lot of choices, even two choices. Tina Marsh Dalton And then there’s all these pieces that are super confusing. Aaron Yelowitz Yes. So, for example, I’m sure the students in your class or in my class can understand distinctions between deductibles and coinsurance rates and maximum out-of-pockets and so forth. Take that to people who haven’t taken a health economics class, yet are economics majors or fairly literate business-wise. It’s not always obvious that they understand those kinds of distinctions, and that is just the first pass, right? Tina Marsh Dalton I actually have a story about that. I saw my cell phone ring right after I started my first job. It was an old friend from grad school, and I was so glad he was calling me. He has a PhD, he did very well, but he was calling because he had to choose his first health plan and wanted some help. And it’s like — oh my gosh, you have a PhD, and this is already complex. Aaron Yelowitz The way I liken it to my students — imagine that we were presenting in class in a language other than English. Basically, no one would be able to understand what we’re saying, and in a way, we could almost think of financial products as having a flavor like that. And that doesn’t even scratch the surface over networks and coverage, things that potentially matter. Where the hook comes in, in my chapter, would be — let’s all agree that plenty of consumers are making real mistakes, leaving money on the table. Tina Marsh Dalton Could we explain how that might be happening? Because both you and I, in both of our chapters, identify that consumers could make mistakes — so what would be an example of a mistake? Aaron Yelowitz Yes. There is a thriving economics literature, including Ben Handel’s excellent work in the American Economic Review, that basically shows a large, anonymous company that offered health plans, and partway through the study period, they updated those plans. Some of those plans no longer worked for employees in the following way: no matter how much you might spend that year, you were worse off being in that plan compared to some other plan because of the cost structure. The way we can simplify this — imagine that I was offering you a hamburger, the same hamburger, for either $2 or $3. In principle, everyone should pick the $2 hamburger because it’s the same hamburger. The amount of money that was lost by choosing the wrong hamburger — the same hamburger but more expensive — was often in the hundreds or thousands of dollars per year, and of course, that can compound year after year. This is not some people choosing a plan because they’re sicker, or others making bad forecasts. This is literally, if two hamburgers are right there, choosing the more expensive one, even though they’re the same hamburger. Tina Marsh Dalton Yeah. I’ll be referring listeners to a post that accompanies this, that is going to walk through this paper. But the idea is that the deductibles were all different, but the plan itself was the same, and when they changed premiums, people didn’t notice that they were actually paying way more in premiums than before. They could have saved money and gotten the same thing in a different plan. Other papers sometimes talk about just the number of pieces of the plan confusing the enrollees — they focus on one thing and choose the lowest of that, but the other pieces would have made a different plan better, things like that. Aaron Yelowitz Exactly. And then what Handel shows is — we might think we all make mistakes, right? You pick something and then you say, I didn’t read the terms and conditions, let me get out of that silly choice and make a different choice. What he shows in his paper is that there is a surprising amount of persistence if you home in on the traditional economic model, which says people have perfect information, they respond very quickly, and so forth. Of course, most of us, through introspection, could easily dismiss that kind of thing. How many of us have streaming subscriptions that go from one month to the next where we haven’t used the streaming at all in the last month? Tina Marsh Dalton And where, in principle, if you subscribed on your phone, you could immediately subscribe and then cancel, and it auto-cancels. Aaron Yelowitz But choice architecture — Netflix, Disney, any of those — basically wants you to auto-renew, rather than automatically canceling, where the moment you realize there’s something you want to watch, you could easily renew. So basically, lots of persistence. Tina Marsh Dalton I like that — it’s also just really hard, right? And to throw a bone to people who might be thinking this applies to them: it’s hard, and you’ve just decided there are other things in your life that you have to focus on. So the idea of, how can we make this less hard, so that people can take the extra time to make the good choice? Aaron Yelowitz Yeah, so there’s obviously an issue of rational inattention. For example, should you ponder every day how to drive from home to work? The answer might be — if it’s a particularly important day. I emphasize to my students that perhaps on the day of a midterm, you would map your route, check your phone ahead of time, make sure there are no traffic delays, that kind of thing. But oftentimes, people get stuck in their ways. I can predict after day one where each of my students will sit in their class, even though I don’t have assigned seating and even though attendance tails off after day one. Tina Marsh Dalton There are new seats available they could choose from. Aaron Yelowitz They could re-optimize, and they would all nod their head and agree with me that there is a lot of stickiness to it. So basically, the neat thing about Handel’s AER paper is that there are really two different ideas. One is that you could be asleep at the wheel — which he calls inertia — and the other is you might just have what I might consider a mistake. So imagine I said to you that the $3 hamburger is just the same as the $2 hamburger, and you say, yes, but I just want to buy the $3 hamburger. He would call that perhaps a mental error, but not inertia. And in his paper, he actually tries to tease out how much of it is one versus the other. Tina Marsh Dalton Are you asleep at the wheel versus how much of it is that you like the bright shiny object on the $3 hamburger — or it was presented to you first, and now you just cannot get off that idea? Aaron Yelowitz Yeah, so it’s a hugely influential paper, and it actually matters for the stability of insurance markets. In the canonical model of insurance markets, where you have differently healthy people — some sick people purchasing insurance and some healthy people — if you were to try to charge a premium that averaged over everyone, what we would call a community-rated premium, then the healthy people will often want to escape from the sick people, because basically they’re cross-subsidizing them. That was a big motivation behind the individual mandate in the Affordable Care Act. Tina Marsh Dalton Yeah, I like to say — who likes insurance? Sick people like insurance. Aaron Yelowitz Yes, and it’s a big win for them for community rating. But the typical economic approach would be: well, if people are awake at the wheel, then the moment they could be freed of a mandate, they would try to escape that and find some other plan. We might call that a death spiral. There’s actually some neat evidence on death spirals in the Harvard context, a paper by Cutler and Rieber. But we actually went through this experiment in the US — the tax cuts in 2017, I think, peeled away the financial penalty of the individual mandate around the year 2019. And so that literally takes all of the teeth out of the requirement, yet insurance markets didn’t collapse. Tina Marsh Dalton It’s on the books, but there’s no fine. Aaron Yelowitz Right, so insurance markets didn’t collapse. This is the kind of provocative intersection of economics, psychology, and how markets work. And then, assuming that we think markets don’t always work very well because of either consumer mistakes — which sometimes actually help the market, right? If healthy people don’t try to escape from those plans, then the cross-subsidies continue. Tina Marsh Dalton This inertia maybe stops the market from collapsing as much as it would theoretically collapse. Aaron Yelowitz Yes, it could. So basically, there’s this interesting confluence of how do markets work in reality, not just theoretically; how much should we weight smart, reactive consumers versus those who are perhaps asleep at the wheel; and how does that matter for a complex product like health insurance, where at least part of it is just a complicated financial product versus something simple like hamburgers. And so, one might then make the argument — in my title, Shall We Trust Consumers or Bureaucrats? — the question becomes, do we think bureaucrats will necessarily do the right thing from the consumer’s point of view? Who is the bureaucrat working for, in some sense? Tina Marsh Dalton Well, so before we go on to the bureaucrats, maybe we could take a moment. We’re saying consumers are doing a bad job. Why would we ever think of giving consumers this choice? What is the rationale behind this empowering of consumers? Aaron Yelowitz I suppose one thing would be — the question is, it’s probably fair to say that consumers may not necessarily nail it perfectly, but do they get closer to where their true preferences are than if we had some central planner choosing for us? Imagine that I’m much older than your recent graduate who’s listening to a podcast. Different health insurance plans might be differently appealing to me at my stage of life than to a new graduate. But of course, there might be people my age who would prefer a less comprehensive plan, and young people who prefer a more comprehensive plan. The problem with bureaucrats, I suppose, is we often get one-size-fits-all. Tina Marsh Dalton With very few gradations. Aaron Yelowitz And clearly, directionally, we think that consumers are often going in the right direction, and maybe part of the reason why papers get published is because there are sometimes notable exceptions. Tina Marsh Dalton Well, and a lot of this has been a theme: the idea they call consumer-driven health plans — put more skin in the game for the consumers, because they are the most invested in this decision, and that will fix the problems because they’re paying attention. Or at least their wallets start making them pay attention. Aaron Yelowitz Right. I think this gets at least to part of your chapter — that perhaps works at some points, but not others. Imagine, for example, that you have a very high deductible plan, and during the pandemic, if you are old — getting vaccinated, if you’re over the age of 70, I would personally view as a corner solution that is unambiguously positive in terms of improving your health. But people might worry about rare bad outcomes. Those stories tend to get amplified, and people may misweigh those kinds of probabilities. Tina Marsh Dalton Yeah. But we were going to get to the bureaucrats. We wanted to give consumers their place in the sun first — why are we even talking about this choice? Aaron Yelowitz Right. So, in principle, if a smart bureaucrat was running a plan with good motives, they would try to line up the inherent structure with what consumers want. But that runs into the concern that not all consumers want the same thing. And then, I suppose — Milton Friedman, I think, was the one who had the phrase, who are these angels out there? It was a Phil Donahue interview — there’s a video of this, I’ll send you the link for the notes. Milton Friedman was being interviewed by Phil Donahue, mostly about central planning in the Soviet Union in the 1970s: who are these angels who will make all these good decisions for us? Right, it looks old and dated today, but some of us can remember watching those kinds of films during our undergraduate classes. Tina Marsh Dalton Yeah, I remember being introduced to the idea — we call it the benevolent dictator. What if there was someone that could decide for the whole society? It’s just a thought experiment in economics, the benevolent dictator. And when I was applying to grad school, I always thought, I’m going to write a paper called Empirical Evidence for Benevolent Dictators — I don’t see so many of those. Aaron Yelowitz Right. My reaction would be that there is a literature out there that says bureaucrats often like to lead the quiet life. Imagine that your typical bureaucrat gets paid reasonably, but unlike Elon Musk, who thrives when his companies thrive, the role of a bureaucrat is to not have bad headlines — some kind of damage minimization. So you don’t make bold choices in any way. What you will end up getting is the one-size-fits-all, very average healthcare plan with no innovations. And there’s clearly a clientele out there — people who make mistakes, but also people who clearly want to own their lives much more, for better or worse, and are willing to live with their mistakes. Bureaucrats will tend not to be terribly responsive to those kinds of people, because there potentially is a lot of upside, but there’s also downside, and the downside leads to headlines. Look at this one person who you gave freedom and autonomy to, and bad things happened. Maybe that’s even worse today because of the way things get amplified, and one story becomes a narrative. Tina Marsh Dalton So, on the bureaucrat idea — you, in your paper, you walk through a specific example in Kentucky, right? The idea of, in practice, we’re not just going to talk about this on a theoretical level. Aaron Yelowitz Yes, so I’m at the University of Kentucky, and I keep up to some degree with what goes on there. One of the really great things about being at the flagship university in the Commonwealth is sometimes having access to Kentucky data that’s harder for others to get. And basically, Kentucky was coming up with a policy change. The Affordable Care Act had been passed and was going to come into effect, and Kentucky was trying to switch their entire Medicaid population over to managed care. In much of the state, it had been a fee-for-service plan. The area around Louisville moved to managed care much earlier than the rest of the state. Tina Marsh Dalton So to make sure we make the difference clear — the lucky people not in managed care had fee-for-service, so the provider gets paid from a fee schedule, whereas managed care is going to be focused much more on controlling the behavior of the provider, or the foot traffic of the enrollees. There are networks they can get into, or they have to pay more, and so now we’ve got a big shift in the system. Aaron Yelowitz Yes, so there’s a big shift in the delivery of healthcare, and part of the federal legislation was that if you’re offering managed care to your Medicaid clients, you have to offer at least two different choices. Kentucky ultimately offered three different choices, but you run into the following issue. Imagine that you’re moving people from one insurance plan to another. Most people are simply not going to express any preference over what we might call Plan 1 versus Plan 2 versus Plan 3, each with different providers. So the question is, if you’re designing a program, what happens in that case? What would typically happen would be some kind of algorithm, and if it was a very good algorithm, it would do something along the lines of, say, well, of the three plans, our prediction is this would be the very best plan for you in terms of the network of providers and cost-sharing. Although for Medicaid, cost-sharing is not a big deal, because the clients are very poor. Tina Marsh Dalton In this algorithm, how much information do they have on the consumers? Aaron Yelowitz We never saw the algorithm — we asked. Imagine the wizard behind the curtains. That is perhaps the level of transparency that many of these algorithms would have. And what that leads to is — we don’t know whether the wizard is trying to steer you into Plan 1 because it’s the best plan for you, or because it’s the cheapest plan out there — in which case they’re not working for the Medicaid client, but for the taxpayer — or it could just be they have no idea what they’re doing and they do something like flipping a coin. Which very well could happen too. Tina Marsh Dalton Or even worse, they could be bad at their job — so instead of a random bad outcome, it’s systemically putting people into a bad situation because they just didn’t understand how it worked. Aaron Yelowitz Right. So maybe this actually operationalizes why we would want people to make their own active choices rather than a bureaucrat. Imagine that you’re moving a million Kentucky Medicaid clients from fee-for-service to managed care. Obviously we’re going to run into the issue of many people not wanting to make a choice. But if your choice is already made for you, perhaps you think there’s a reason why that choice was made, so you don’t undo it and go somewhere else. One of the fascinating things about the Medicaid reform was that it steered you in a direction, but you did not have to go in that direction — what the behavioral economics literature calls a nudge. The likelihood of ending up in one plan if you were assigned to that plan is dramatically higher than had you not been assigned to it, so there’s a level of inertia. Tina Marsh Dalton We already talked about the cost of choosing the plan being large — this is a large cognitive load — and now we just added that you also have to actively pursue it. Aaron Yelowitz Right. So basically, the path of least resistance is, you get some letter that says you’re signed up for Plan 1 versus Plan 2 versus Plan 3, and if you don’t do anything, you end up in that plan. Now, where does this go wrong? We were fairly confident, even before we got the data, that we would see quite a bit of this stickiness, because it is pervasive in the behavioral economics literature — when you steer people in a certain direction, they tend to go in that direction. So we were not surprised about that. However, one of the three plans, called Kentucky Spirit, did not come to an agreement with Appalachian Regional Health, which was the major healthcare provider in eastern Kentucky. So imagine I assign you to a healthcare plan where you actually cannot access the major healthcare provider in your region. That’s a really bad plan. Tina Marsh Dalton That’s a bad problem. Yeah. In the post where I’m going to walk through some ideas about how to approach choosing a plan, that’s what I’m actually going to put first — where is your provider that you care about? Check that first across your plans. Number one! Aaron Yelowitz Yes. There’s the distinction between on paper you have health insurance versus do you have health access, which is differentially a problem for different kinds of plans. For private plans, it’s relatively easy to see providers. It’s a bit less so for Medicare because of reimbursement levels. It’s a big issue for Medicaid because reimbursement levels tend to be so low. And if you go to other healthcare systems — think about Canada and waiting lists and queues — because market forces aren’t working in the same kind of way. So access matters. If you have a health insurance card that says your healthcare is mostly covered, but you can’t use it anywhere, that’s a major problem. Moving forward, things like AI might be able to come up with more personalized recommendations — not only on how close a provider is, but imagine AI agents who could call the office, and an AI agent on the other side answers. Imagine I can only see a doctor after 4 PM — an AI could figure out whether that’s realistic at this doctor versus some other doctor. Tina Marsh Dalton Yeah, because there are a lot of dimensions to try to work through. AI can take multidimensionality and try to match. Aaron Yelowitz Right, and these are things where we will get cognitively exhausted. Imagine that you were sick, but not so sick. Would you call 20 different doctors to make an appointment? The answer is no — it becomes a mess. Could AI do something like that relatively efficiently? And doesn’t that feel like an area where life could be made better? That gets at something different than simply which providers claim they’re accepting Medicaid patients. In principle, a good bureaucrat today would try to be future-looking and bake that in, or a plan that wanted the state to award them many Medicaid clients might want to bake that in as a for-profit managed care organization, if the state cares about how the clients do. Tina Marsh Dalton Yeah, the AI angle is interesting, especially in this population. If we’re thinking about the Medicaid population — this is focusing on children, pregnant women, but then also low-income adults, or people who ended up on Medicaid because of a disability — there’s a lot of other things happening in their lives. Aaron Yelowitz There are also foster kids, who are super expensive and have really unique needs, so it’s obviously not one-size-fits-all. And you can imagine providers who take people and then close their lists. Even for just those of us in normal life, it’s hard to keep tabs of everything. It feels like we’re on the cusp of where some intersection of private innovation, then being adapted by bureaucrats, could produce some interesting things. Tina Marsh Dalton Yeah, because I think the piece here that was motivating the question of whether we should give consumers choice is information. Let’s throw information out there that will improve market outcomes. But if the information is overwhelming or confusing, then it doesn’t do anything to move the needle. If there was an AI component that could be programmed by an ideal bureaucrat— Aaron Yelowitz Or cut it off — you could imagine good old-fashioned competition where different private companies create their AI assistant for you, and we might imagine the good ones rise to the top. Consumers would try various ones. Not all AI platforms are getting the same level of adoption. Some just seem to be better than others. A parallel would be — at an unnamed university, the university decided to adopt Copilot, which is just about the least effective AI I’ve ever worked with. I said, Copilot, can you change my signature line in my email? And it said, well, here’s how you go about doing it. And I said, that’s not what I said — I wanted you to do it. Tina Marsh Dalton Right, so imagine the ideal bureaucrat chooses one thing, yet virtually every other AI could do something like that. That does seem like the same problem, because in the case of this unnamed university, there is only one person making the decision for many people. Aaron Yelowitz Right, and so that feels really bad. And maybe if you’re using Microsoft Teams rather than Zoom, that’s the one-size-fits-all problem. The bureaucrat at an unnamed university is making decisions that directionally probably improve things, but nowhere close to understanding the choices that people actually want. And people, of course, make their own mistakes. If the mistakes are so big by consumers that we want to worry about it, then you might consider the ideal bureaucrat and perhaps heavy-handed things like mandates. But of course, if the bureaucrat is ever wrong, the trust and reputation issues basically carry over for a very long time — and we see that right now with things like vaccine hesitancy. Bad recommendations, or even nuanced recommendations, can erode trust if there is anything wrong about them. Tina Marsh Dalton In the paper, you kind of walk back a little bit about whether it should be bureaucrats or consumers, and you talk about maybe the role of some hybrid, where you can have the bureaucrats operate in some constrained area. Do you want to discuss those thoughts? Aaron Yelowitz So, I think one thing is fundamentally asking the question — who is what behavioral economists would call the choice architect? Tina Marsh Dalton Who is that person actually working for? Aaron Yelowitz And for example, imagine that the goal of the bureaucrat is to spend as little on the Medicaid program as possible, because it gobbles up state budgets, subject to Medicaid clients getting some level of care that we agree is, although not great, quote-unquote acceptable. Then that’s a very different problem than trying to maximize health outcomes and quality matches for the clients themselves. When you or I go to a financial advisor, often they have a fiduciary duty to work for the client — whether they actually do or not is yet another question. What happens with you and me is that if we feel they are not performing their fiduciary duties, we can leave. They are answerable to the consumer, and for very sophisticated consumers, there could actually be consequence above and beyond that. Tina Marsh Dalton That’s right. It’s true. Aaron Yelowitz But in reality, most consumers — there’s a classic paper by Jason Abaluck and Jonathan Gruber that says people with Medicare Part D tend to overweight premiums relative to out-of-pocket costs. Their eyes light up when the premium is super low for Medicare drug coverage, yet if you’re going to use a lot of drugs that year, the premium matters but so do other things. They call that something like choice errors — people don’t necessarily love those sorts of terms, but the paper has real plausibility. People make mistakes. The idea that people don’t make mistakes — I think one could convincingly reject that. The only question is how big are the mistakes, and should the government get involved, or should we let people learn? Tina Marsh Dalton Well, that leads into one section of my paper, which I entitled something like, no treatment is not a credible threat. We have this idea in economics of laying out a threat — anyone with kids would understand this, right? If you don’t do such and such, and then in the end, you just cave. Aaron Yelowitz Right. The message around including bureaucracy — I’ve heard that called the Samaritan’s Dilemma. Obviously, if you are in dire need of care, or if our children mess up financially and would lose their apartment, or a young adult is going to devolve onto the streets — the answer is no, we are not going to let that happen. And so, what you hope is to set up the infrastructure ahead of time so that you don’t run into those kinds of problems. That’s like parents being the social safety net, or the government, in some sense, mandating that you have a rainy day fund. Tina Marsh Dalton Yeah, that’s interesting. The reason I had that in my paper was this idea: we can have these ideas, incentives would be good, this would improve the system, but if our norms are that we don’t let people end up with no care when they choose badly, then knowing ourselves matters. As a parent, you know yourself — what are the threats you are actually going to follow through with, and you should only make those. So this idea of, we can let them make mistakes, but not the big ones. Aaron Yelowitz Yeah. People would argue that in the healthcare setting, there are large mistakes — maybe not always financially, because of emergency departments if you’re in dire need of care. But think about the low-hanging fruit of adherence to prescriptions after a heart attack. Or my example: if we believe that getting vaccinated is unambiguously good for most people, there are people who make tragic mistakes by not adhering to relatively cheap medication — statins after a heart attack — that might actually matter a lot for longevity. And clearly, even amongst the most vulnerable, there were people who chose not to get vaccinated during the COVID pandemic. One could easily rationalize that — imagine you want to be part of a group identity, so it’s not always just about the expected costs and benefits. But there are times when there are really bad mistakes. Tina Marsh Dalton Right. I think the backdrop for the financing side of healthcare is, well, you just declare bankruptcy or something, so there’s almost a floor. Aaron Yelowitz A bottom. But in terms of health mistakes, certainly there are health mistakes that are out there. Tina Marsh Dalton Yeah, that’s interesting — laying those out differently. What insurance should be is just a financial tool, but I think that is a distinction: the finances of health are treated differently from a norms perspective. Aaron Yelowitz Right. Think about the popular perception — whenever I teach an economics class, one of my biggest jobs is to address when people say, imagine I buy health insurance and nothing bad happens to me, what a waste of money. The perception is that rare events, existential risk — since they rarely happen, you don’t see them very often. But that’s the whole point of insurance. You, at your age, or me, even at my age — the next year, the odds of something really bad happening are relatively low. However, it’s not zero, and going back to my pedagogical example with vaccinations, if you think of that almost like insurance in some sense: imagine that 99% of all people are not going to die of COVID even if they get it. Well, if 1 out of 100 dies, that’s a very catastrophic outcome. And that literally is the value of insurance — to insure against low-probability, devastating events. That’s where, in economics, we’d really emphasize the value is. Tina Marsh Dalton So do you have, based on this Kentucky idea, specific policy directions? Aaron Yelowitz One is to be very skeptical — go back to that Milton Friedman, Phil Donahue interview: hi, I’m from the government, I’m here to help. Actually, that was probably Ronald Reagan who said that. I’ll send you a few links — they’re eminently entertaining and memorable, and they will also show generational differences in perspective. But basically, I would be very skeptical of those who say, I’m the central planner, I have this idea, I’m here to help. I would almost think that competition — think about the different AIs each competing to help book your healthcare — that skin in the game matters. Tina Marsh Dalton There’s a skin in the game that wants to serve you. Aaron Yelowitz Right. So the kind of one-size-fits-all, one bureaucrat — I am deeply skeptical that they’re working for who they say they’re working for. There’s the rhetoric versus what actually happens. Bootleggers and Baptists, right? You might get different people aligned, but they have different objectives. And no one is going to say, all we’re trying to do is save money and offer low-quality healthcare. So obviously, being skeptical of what people say versus the consequences of what actually happens is hugely important. First thing: go in with a lot of skepticism. But then, some of the stuff you mentioned — consumer-driven healthcare — I do wonder whether we’re going to get to almost the right place. The skepticism against consumer-driven healthcare is, well, do people basically — like, you go to any free market seminar and they’ll say, the patients don’t ask, how much will this cost? We’ve been trained not to because of insurance, and they’re hoping for some kind of norm shift there. Tina Marsh Dalton I would have given up, because the providers don’t know either. Aaron Yelowitz Yeah. One can imagine that we are going into a world where AI agents reduce frictions dramatically for mundane things — where you’re not going to want to learn all the terms and conditions of every health benefits book, all 85 pages of options. Even the best lawyer isn’t going to want to read through it, but no one else will. But who will? AI loves to read through that stuff. And then — here I am in my 50s, here’s my health status, how does this plan matter for me? That will be a different question than for a student. So in a sense, that is much more customized than the one-size-fits-all summary, because it might say something very different for someone in their 50s with a chronic condition like diabetes than for someone who doesn’t have that. So I could see real value in navigating the system with fewer frictions than before — subject to, of course, all of the ways in which it’s going to make bad recommendations. Tina Marsh Dalton Yeah. Right. Well, it seems like the government can be there for the big mistakes, the government could maybe enable the information that helps consumers, but you can be more hands-off and let the competition and information work in a way that could benefit people. You mentioned a neat idea there, which is— Aaron Yelowitz Right, there is this big question moving forward about what we are going to allow AI agents to do versus not do. One can think of the doomsday scenarios that movies are made of — Terminator and so forth — versus the reality of what might happen. You can imagine the government could stifle innovation. Then the question would be — we would run into the problem of some agents making wonderful recommendations, and others going off the rails in a bad way. And of course, those stories, much like the Samaritan’s Dilemma of the person who chose not to purchase insurance and is now in a really tough spot — the bureaucrat’s loss function says one bad story counteracts a hundred good stories, or something like that. Although at least, if I consider myself an AI optimist in terms of where it can actually add value — then get out of the way, let the mistakes happen, move forward, and society will be a whole lot better off. Much like with self-driving cars. There are definitely downsides of smart autonomous vehicles making really dumb decisions that a human wouldn’t make, but there are also many examples where it would do a lot of good. And one could imagine that innovation is too slow relative to the social optimum. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit tinamarshdalton.substack.com (https://tinamarshdalton.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

3. 

   1 Oct 2024

   Musical Musings: Weird Al and Nutrition Policy

   Today’s podcast has some musical musings about SNAP- the 119 billion dollar federal food stamp program and school lunch programs, sparked by two parody songs of Weird Al Yankovic.   Yes, we did. Music: “Eat It” by Weird Al Yankovic (https://www.youtube.com/watch?v=ZcJjMnHoIBI), parody of “Beat It” by Michael Jackson “Eat It” Lyrics (https://genius.com/Weird-al-yankovic-eat-it-lyrics) “Girls Just Wanna Have Lunch” by Weird Al Yankovic (https://www.youtube.com/watch?v=RFnAvnXduwM), parody of “Girls Just Wanna Have Fun” by Cyndi Lauper “Girls Just Wanna Have Lunch” Lyrics (https://genius.com/Weird-al-yankovic-girls-just-want-to-have-lunch-lyrics) All about Erik: Dr. Erik Nesson, PhD (https://sites.google.com/site/eriknesson/home) A few research articles related to the podcast discussion: A fact sheet about SNAP from the Pew Research Center (https://www.pewresearch.org/short-reads/2023/07/19/what-the-data-says-about-food-stamps-in-the-u-s/) My substack writings on changes in obesity (https://tinamarshdalton.substack.com/p/words-to-the-whys-on-healthcare-c02) David E. Frisvold, “Nutrition and cognitive achievement: An evaluation of the School Breakfast Program," Journal of Public Economics,Volume 124, 2015,Pages 91-104. (https://doi.org/10.1016/j.jpubeco.2014.12.003) Bhattacharya J., T. Deleire, S. Haider, and J. Currie. “Heat or Eat? Cold-Weather Shocks and Nutrition in Poor American Families." American Journal of Public Health 93, 7 (2003): 1149-1154. (http://doi.org/10.2105/AJPH.93.7.1149) Youths at Nutrition Risk: Malnourished or Misnourished? (http://www.nber.org/chapters/c10695), Jay Bhattacharya, Janet Currie. in Risky Behavior among Youths: An Economic Analysis (https://www.nber.org/books-and-chapters/risky-behavior-among-youths-economic-analysis), Gruber. 2001 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit tinamarshdalton.substack.com (https://tinamarshdalton.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

4. 

   1 Jul 2024

   Hits and Healthcare: Springsteen and Rich Men North of Richmond with Dr. David Bradford

   Is there healthcare and economics in the Billboard Hot 100? Of course! Particularly if you listen to it with two health economists! Today, my great friend and colleague, Dr. David Bradford joins me to discuss “My Hometown” by Bruce Springsteen and “Rich Men North of Richmond” by Oliver Anthony. Both may surprise you with how much they tell us about the closing of rural hospitals, the opioid epidemic, and how we might help old souls to live in a new world. About the episode: "My Hometown" by Bruce Springsteen Song (https://www.youtube.com/watch?v=KrGi8ODOWR0) and Lyrics (https://m.brucespringsteen.net/track/my-hometown/) "Rich Men North of Richmond" begins at 14:55 Song (https://www.youtube.com/watch?v=sqSA-SY5Hro) and Lyrics (https://www.musixmatch.com/lyrics/Oliver-Anthony-Music/rich-men-north-of-richmond) Dr. David Bradford is a fellow health economist and the George D. Busbee Chair in Public Policy the University of Georgia’s public policy school. David’s research spans 30 years in topics such as health policy, pharmaceuticals, and Medicare/Medicaid programs, with recent work also on drug and opioid use. You can learn more about David and his research here (https://spia.uga.edu/faculty-member/w-david-bradford/). My posts explaining the "Whys" of the opioid epidemic: The Opioid Crisis: WHY did it start? (https://tinamarshdalton.substack.com/p/the-plague-and-remote-work-and-the?utm_source=publication-search) The Opioid Crisis: WHY is the crisis so devastating? (https://tinamarshdalton.substack.com/p/economic-innovation-on-the-menu-and) The Opioid Crisis: Three legs to a stable solution (https://tinamarshdalton.substack.com/p/the-opioid-crisis-three-legs-to-a?utm_source=publication-search) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit tinamarshdalton.substack.com (https://tinamarshdalton.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

5. 

   1 Jun 2024

   Pharma's Past, Present and Future: Alex Telford and the progress of better health.

   In today’s pocast, we’re continuing our dive into the question “What is holding healthcare back from creating our best health?” A key sector bringing us this far? Pharmaceuticals. In this episode, I’d like to introduce you to Alex Telford, a Roots of Progress Fellow, expert in biotech and pharma, and fellow philosopher of life, health, and innovation. What have pharmaceuticals done well and what challenges are they not suited to fix?  Where should we look for our next health revolution?  Let’s ask Alex! Some links we discuss in the episode: Liveware (https://atelfo.substack.com/) - Alex’s Substack Some awesome posts of Alex’s to check out: Super Mario, scientist (https://atelfo.substack.com/p/super-mario-scientist) - What video game speedrunning can teach us about automating scientific discovery For those of you interested in my art and health work, Aesthetic of Progress (https://atelfo.substack.com/p/some-notes-on-the-aesthetic-of-progress)-Progress art as harmony between technology and nature. My three essays on this question of “What is holding healthcare back from creating our best health? 1. Why isn’t our current healthcare creating health? (https://tinamarshdalton.substack.com/p/why-isnt-our-current-healthcare-creating) -a look at the origins of modern healthcare systems 2. Tips to treat sclerosis of your arteries, ahem, healthcare system (https://tinamarshdalton.substack.com/p/tips-to-treat-sclerosis-of-your-arteries) - how current financial incentives encourage the overuse of medical care 3. Healthcare Goes to Prevention Camp! (https://tinamarshdalton.substack.com/p/sending-our-healthcare-system-to) – how those paying for prevention are often separated from reaping its benefits Music I use: https://www.bensound.com License code: KJTKRGRAPRQRKVF9 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit tinamarshdalton.substack.com (https://tinamarshdalton.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

6. 

   1 May 2024

   Imagine with Me! Elle Griffin and Healthcare of the Future

   Here are some links we discuss in the episode: The Elysian (https://www.elysian.press/) – Elle’s awesome (and hugely followed!) Substack blog where she writes on imagining better futures.  There’s something for everyone- philosophy, government, capitalism, and a utopian novel in progress! The first three essays on this question of “What is holding healthcare back from creating our best health? 1. Why isn’t our current healthcare creating health? (https://tinamarshdalton.substack.com/p/why-isnt-our-current-healthcare-creating) -a look at the origins of modern healthcare systems 2. Tips to treat sclerosis of your arteries, ahem, healthcare system (https://tinamarshdalton.substack.com/p/tips-to-treat-sclerosis-of-your-arteries) - how current financial incentives encourage the overuse of medical care 3. Healthcare Goes to Prevention Camp! (https://tinamarshdalton.substack.com/p/sending-our-healthcare-system-to) – how those paying for prevention are often separated from reaping its benefits Finland is a Capitalist Paradise (https://www.nytimes.com/2019/12/07/opinion/sunday/finland-socialism-capitalism.html) By Anu Partanen and Trevor Corson Music I use: https://www.bensound.com (file:////Users/daltonc/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_filelist.xml) License code: KJTKRGRAPRQRKVF9 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit tinamarshdalton.substack.com (https://tinamarshdalton.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

Reach and audience

Public platform figures. Ratings count people who left a rating, not total listeners.

Apple Podcasts (US)

5.0 / 5

1 ratings

Contact Words to the WHYs on Healthcare Podcast

Guest appearances

Books guests

Based on episode analysis; this does not confirm that the show is currently accepting guests.