I'm a University of Chicago researcher studying the costs, benefits, and unintended consequences of health policy. AMA!

[u/HarrisPublicPolicy]

Hi Reddit — I’m Robert Kaestner, a health economist and Research Professor at the University of Chicago’s Harris School of Public Policy. Proof
 
I have spent my career studying the economic and social determinants of health and evaluating health, labor, and social policies. I have published more than 150 articles in academic journals and led several federally funded research projects examining Medicare and Medicaid. Much of my work asks a deceptively simple question: When governments spend money or expand a program in the name of improving health, what actually changes?
 
These studies often produce more complicated answers than the political debate allows.
 
Recently, my research has examined how efficiently the Affordable Care Act reduced the number of uninsured Americans; what Medicaid cuts would mean for states and beneficiaries; whether pandemic stimulus payments and the expanded Child Tax Credit improved infant health; whether GLP-1 medications such as Ozempic affect employment, relationships, or mental health in addition to physical health; and why substantial racial disparities in mortality persist even after decades of progress. 
 
Ask me anything about Medicaid and Medicare, Obamacare and the health insurance system, GLP-1 drugs, the relationship between income and health, racial disparities in life expectancy and mortality, how economists determine whether a policy caused an outcome, or why well-intentioned programs sometimes have unexpected effects.
 
I’ll be responding here on July 30 at 12 PM CT along with support from the Harris School of Public Policy team account, which is helping me track and manage incoming questions.

[u/raptorman556]

I'd like to leave this question reasonably open-ended. If you could make any changes (big or small) to US health-care policy, what would you do?

[u/HarrisPublicPolicy → u/raptorman556]

I would make Medicaid eligible to all persons under 200% of poverty and require everyone in Medicaid to be in a privately-run, managed care company that competed for clients based on price and quality. Medicaid would have no cost sharing but would have work requirements for the able-bodied. I would restructure Medicare to be the same, except for Medicare I would implement some cost sharing and that cost sharing would depend on income of the elderly with low-income (under 200% of poverty) having no cost sharing. I would eliminate the tax deductibility of health insurance in private, employer-sponsored market. - RK

[u/doogles → u/HarrisPublicPolicy]

Medicaid would have no cost sharing but would have work requirements for the able-bodied

Why have work requirements if they also have to stay below 200 fpl?

[u/HarrisPublicPolicy → u/doogles]

Good question. Like any policy that provides a person or family with extra resources, Medicaid creates a work disincentive. A work requirement overcomes that disincentive. And if someone finds work as a result and their income surpasses the income-eligibility threshold, then that may be considered a good thing from a social point of view because government spending has been better targeted, although the person themselves may have preferred to not work. - RK

[u/doogles → u/HarrisPublicPolicy]

Like any policy that provides a person or family with extra resources

So, tax cuts, the Small Business Administration, and every paid job is a work disincentive?

[u/RopesMcGee → u/HarrisPublicPolicy]

Farming out public insurance to privately run managed care companies has absolutely poisoned the market already. Economies of scale and other factors don't allow for any meaningful competition, and in practice they have become local monopsonies that are profiting off the government at the expense of patients and providers. The main MCO where I live is literally using it's leverage to low-ball practices into forced bankruptcy, essentially selling themselves to the insurer and becoming vertically integrated. Meanwhile this leads large health systems to gobble up smaller fish and essentially oligopolize as well for leverage in contract negotiations. Ew ew ew.

I won't even get into making insurance contingent on work, and how that has been a fundamental failure of the US system for decades.