Recent reports on federal programs and policies involving children and families from @HHS_ASPE: How Texas Achieves Strong Program Integrity in CCDF: Practical Considerations for State CCDF Lead Agencies: aspe.hhs.gov/reports/texas-c… Exposure to Domestic Violence/Intimate Partner Violence Is Associated With Child Welfare System Involvement: aspe.hhs.gov/reports/domesti… Structure Matters: How State Child Support Program Administration and Procedures Can Impact Federal Spending and Support Order Establishment Performance: aspe.hhs.gov/reports/child-s… Appreciate Assistant Secretary for Family Support Alex Adams @ACF_Adams, ASPE leaders Jennifer Burnszynski, Robin Ghertner, Amanda Krusemark Benton, Danielle Berman, and our ASPE analysts. For more ASPE reports, visit: aspe.hhs.gov/reports @HHSGov @ACFHHS @caseybmulligan

Recent reports on the Title IV-E Foster Care Program from @HHS_ASPE: Title IV-E Foster Care Eligibility Rates Have Declined While Determination Costs Have Increased: Meanwhile Eligibility Review Results Have Varied Since FY00: aspe.hhs.gov/reports/title-i… Title IV-E Foster Care Program and Administration National Average Effective Federal Match Rates are Less than Half Statutory Match Rates: aspe.hhs.gov/reports/title-i… Appreciate Assistant Secretary for Family Support Alex Adams @ACF_Adams, ASPE leaders Jennifer Burnszynski, Robin Ghertner, Amanda Krusemark Benton, Danielle Berman, and our ASPE analysts. For more reports, please visit: aspe.hhs.gov/reports @HHSGov @ACFHHS @caseybmulligan

Recent reports on the Head Start Program from @HHS_ASPE: Increases in Head Start Change in Scope Requests from FY21 to FY24 Have Resulted in the Largest Reduction of Funded Slots in the History of Head Start: lnkd.in/e3F3e--v From FY16 to FY25, Fewer Head Start Families Received Comprehensive Services and the Percentage of Families Receiving Services Also Declined for Many Categories: lnkd.in/eNQ4qeqf HHS' Historical Approach to Head Start Regulation Following the 2007 Statutory Reauthorization has Increased Costs and Reduced Access, without Substantial Quality Gains: lnkd.in/eMS43p6y Research Does Not Identify an Optimal Teacher-Child Ratio That Improves Child Outcomes, Though More Stringent Ratios May Increase Per Child Spending: lnkd.in/e_mruqxd Appreciate Assistant Secretary for Family Support Alex Adams @ACF_Adams, ASPE leaders Jennifer Burnszynski, Robin Ghertner, Amanda Krusemark Benton, Danielle Berman, and our ASPE analysts. @HHSGov @ACFHHS @caseybmulligan

New @HHS_ASPE report on the Ending the HIV Epidemic in the United States (EHE) initiative: aspe.hhs.gov/reports/alignin… Authors: Jesse Anderson, Agata Bodie, Kaushik Khosh, and Sara Te @HHSGov

Tune in at 10:30 a.m. for the confirmation hearing of @JohnsHopkinsSPH alum Heidi Overton, MD, PhD @HeidiOverton, for @FDA Commissioner: help.senate.gov/hearings/nom…

Read HHS chief economist’s report to learn more👇 aspe.hhs.gov/reports/quantif…

HHS chief economist proposes new formula to quantify the economic cost caused by the role of regulations in reducing consumer choice. See event👇 piped.video/watch?v=v0kH4VeP…

Thank you all for participating in yesterday's lecture by HHS Chief Economist and Chief Regulatory Officer Dr. Casey B. Mulligan @caseybmulligan. Special thanks to HHS Senior Counselor for Policy Kenneth Callahan. Recording: piped.video/watch?v=v0kH4VeP… Reports: Quantifying the Value of Consumer Choice: A Foundation for Regulatory Impact Analysis and Beyond aspe.hhs.gov/reports/quantif… Market Forces in Medicare Reimbursement: Traditional Medicare, Medicare Advantage, and Provider Resource Constraints aspe.hhs.gov/reports/market-… @HHSGov @CMSGov @HHS_ASPE

The Policy Test: Does It Produce Health? "A policy supports health when it expands productive supply. That means patient and family capability: information, data access, self-management, caregiver capacity, and the flexibility to act on local knowledge. It means clinician capacity: training, scope, team-based care, interstate practice, and less administrative drag. It means entry and business innovation: new sites, logistics, telehealth, home care, retail models, and other organizational improvements. It means medical innovation: drugs, devices, diagnostics, procedures, AI, and off-patent knowledge. It means public information and trust: open data, transparent uncertainty, and visible disagreement. And it means competitive discovery: multiple approaches, price signals, entry, and federalism. A policy undermines health production when it suppresses information, blocks entry, freezes prices without regard to supply response, or substitutes centralized control for local knowledge. Affordability fits the same test. There are two ways to make health care look affordable. One is to ration demand: restrict access, narrow choices, delay care, or hide costs in waiting time and bureaucracy. That is just an appearance of affordability. The other way is to increase supply: more capacity, more competition, better technology, and more productive patients. The central distinction is simple but important: health is not the same as health care, and health care is not the same as health insurance. Insurance matters, but insurance is not the endpoint. The endpoint is better health, at lower cost, with more control in the hands of patients and families. The way forward is not to centralize the bill; it is to unleash the people who produce health." Full ASPE Report "Producing Health: Capability, Capacity, and Competitive Discovery in the Health Economy," by HHS Chief Economist and Chief Regulatory Officer Dr. Casey B. Mulligan @caseybmulligan: lnkd.in/e2_4esbS @HHSGov @CMSGov @HHS_ASPE

"Patients, Families, and the Overlooked Patient Workforce The patient is not merely the object of treatment. The patient is part of the production process. Policies that expand patient knowledge, choice, and ability to actexpand the supply of health. Policies that disrupt the self-management routines patients and families use to produce health reduce supply. Patients and families combine general evidence with circumstances that Washington cannot observe. They know the patient's habits, daily routine, diet, drinking, exercise, schedule, family system, and whether a fragile self-management arrangement is holding together. Much of that knowledge is decentralized and contextual. It is also productive. The COVID period illustrates how important that invisible patient workforce can be. This is not a claim that all pre-pandemic behavior was maximizing health. Some patients were overweight, drank too much, or failed to follow every clinical recommendation. But most were doing something: working, attending school, going to recovery meetings, exercising, seeing family, following schedules, and maintaining habits that helped manage risk. When those routines were disrupted, health production changed. Mulligan and Arnott estimated that from April 2020 through December 2021, Americans age 18 and older died from non-COVID causes at an annual rate about 97,000 above previous trends...Disruptions to work, school, social life, treatment, and family routines weakened those self-management systems. The patient-capability test is therefore straightforward: does policy expand patient knowledge, choice, and ability to act, or does it break the tools patients and families use to produce health?" Full @HHS_ASPE Report "Producing Health: Capability, Capacity, and Competitive Discovery in the Health Economy," by HHS Chief Economist and Chief Regulatory Officer Dr. Casey B. Mulligan @caseybmulligan: aspe.hhs.gov/reports/produci… Full video: piped.video/watch?v=BcHkzgit… @HHSGov @CMSGov @HHSResponse

Competition Is Discovery "Competition is not merely a way to lower prices. Competition is discovery. It is how a health system finds out which staffing models, care sites, AI tools, payment designs, and regulatory approaches actually work. That is why institutional flexibility matters: innovation needs room for suppliers of different sizes to enter, care models to compete, and rival forecasts to be tested. In a competitive system, bad forecasts remain local. One hospital can be wrong. One insurer can be wrong. One medical school can be wrong. One state can be wrong. Others can try something else. Prices and entry reveal bottlenecks. Patients and providers can move. Firms can imitate what works and avoid what fails. With a centralized payer, bad forecasts scale nationally. A single payment rule can become a workforce rule. A coverage rule can become a technology rule. A price rule can freeze assumptions. That is the knowledge problem in healthcare. Single payer sounds like a financing reform, but single means one: one price schedule, one coverage standard, one political process, and one national default. This is an argument about error correction. In healthcare, innovation requires entry, experimentation, failure, learning, and scale. The policy screen is therefore simple: expand productive inputs, information, and entry, and avoid making one forecast the national default." Full ASPE Report "Producing Health: Capability, Capacity, and Competitive Discovery in the Health Economy," by HHS Chief Economist and Chief Regulatory Officer Dr. Casey B. Mulligan @caseybmulligan: aspe.hhs.gov/reports/produci… @HHSGov @CMSGov @HHSResponse @HHS_ASPE

Innovation, Prices, and Centralized Forecasts "Prices are signals. They tell suppliers whether to enter, expand, invest, open a new site, adopt a new tool, run a trial, or develop a future treatment. Payment rules therefore become production rules. A lower price produced through competition is a supply-side achievement. It means entry, productivity, innovation, lower-cost sites, or better organization have reduced the real resources required to deliver care. A lower price imposed by command is different. It can reduce the posted price while making supply less attractive, which can lead to exit, shortages, delayed innovation, quality tradeoffs, or budget-window savings that reappear later as less care or less innovation. This distinction matters because many health-care price controls are largely invisible to patients. DRG rates, CPT-based physician fee schedules, Part B reimbursement, and IRA drug price controls do more than move money among payers and providers. They shape capacity, sites of care, investment decisions, quality, and the future supply of treatments. Affordability requires lower real resource costs, not merely lower displayed prices. The danger of centralized supply control is that one forecast can become a national rule." Full ASPE Report "Producing Health: Capability, Capacity, and Competitive Discovery in the Health Economy," by HHS Chief Economist and Chief Regulatory Officer Dr. Casey B. Mulligan: aspe.hhs.gov/reports/produci… @HHSGov @CMSGov @HHSResponse @HHS_ASPE

Public Health as Information Infrastructure, from HHS Chief Economist and Chief Regulatory Officer Dr. Casey Mulligan @caseybmulligan: Government can help acquire, standardize, validate, and disseminate such knowledge. But the goal is not to substitute a national narrative for decentralized judgment. It is to improve the information infrastructure so that patients, physicians, states, firms, schools, and families can act more productively on evidence. An information-infrastructure approach to public health can be summarized in three words: measure, disclose, and decentralize. Measurement means surveillance, research, standards, and data quality. Disclosure means open data, visible uncertainty, and visible disagreement. Decentralization means allowing patients, physicians, and institutions of civil society to act on information using knowledge of local circumstances that no federal bureaucracy can ever fully possess. The danger is that public health can become the opposite. When an agency hides uncertainty, suppresses disagreement, or makes one interpretation the national default, it reduces the productivity of patients and physicians. The policy screen is whether a rule increases the supply of information or controls who may use it. Full report: aspe.hhs.gov/reports/produci… @HHSGov @CMSGov @HHS_ASPE

Expanding Clinical Supply, from HHS Chief Economist and Chief Regulatory Officer Dr. Casey Mulligan @caseybmulligan: Policy should expand training pipelines where bottlenecks exist, make scope and licensing rules sensible, reduce unnecessary credentialing barriers, and use AI and administrative simplification to move trained professionals back toward patients. The central test is whether a rule adds usable clinical capacity or consumes it. A small practice does not have the same billing department, compliance staff, legal team, or IT infrastructure as a large health system. Uniform regulation is not uniform in economic effect. One-size-fits-all rules can impose unnecessary burdens when they fail to recognize differences in scale and resources. Such burdens can harm competition, discourage innovation, restrict productivity, create entry barriers, and deter entrepreneurs. In physician practice, those effects can alter the structure of supply, reduce entry, and limit local experimentation. @HHSGov @CMSGov @HHS_ASPE

A must-read for anyone interested in supply-side health economics: "Producing Health: Capability, Capacity, and Competitive Discovery in the Health Economy" by HHS Chief Economist and Chief Regulatory Officer Casey B. Mulligan @caseybmulligan: aspe.hhs.gov/reports/produci… Today is the last day for in-person registration for Dr. Mulligan's lecture on Tue, 9/22, 1–2 PM: aspe.hhs.gov/events @HHS_ASPE @HHSGov @CMSGov @SecKennedy @DrOzCMS

Join us Tuesday, Sept. 22, 1–2 PM, for a lecture by @HHSGov Chief Economist & Chief Regulatory Officer Dr. Casey B. Mulligan @caseybmulligan (Professor of Economics @UChicago @UChi_Economics): Consumer Choice Valuation & Market Force in Medicare Reimbursement In-person registration ends Friday at 3 PM: aspe.hhs.gov/events Agenda: · Opening remarks by HHS Senior Counselor for Policy Kenneth Callahan · Lecture by Dr. Casey B. Mulligan · Audience Q&A · Closing remarks by me Location: HHS Auditorium, Hubert H. Humphrey Building Livestream: hhs.gov/live/

Technology paired with deregulation is deflationary.

Technology is deflationary. Technology paired with deregulation will improve outcomes, expand access to care and increase standards of living. I had many good meetings at the J.P. Morgan health care conference about accelerating innovation.

Social media is THE way to get power back to the patient - physician relationship. Why? The free market exists in the social media space. No middle men.