👀 New ASPE report overviews research on teacher-child ratios in early childhood education, finding there is not an optimal ratio that improves child outcomes, though more stringent ratios may increase per child spending. The report concludes that “no single ratio or group size is uniformly viewed as necessary for quality care.” Learn more: bit.ly/46IKpN8

"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! New ASPE Health and Economics Forum with Dr. Casey Mulligan. Register here: aspe.hhs.gov/events/aspe-hea…

Twenty-five years ago, our nation was forever changed. Today, we remember the nearly 3,000 lives taken on September 11, 2001, and honor the first responders who ran toward danger to save others. In the days and weeks that followed, HHS joined the response, including the @usphscc and personnel from the National Disaster Medical System and the National Pharmaceutical Stockpile, which would later become important parts of @ASPRgov. We honor all who served, all who sacrificed, and all who still carry the wounds of that day. We will never forget. 🇺🇸