April 14, 2025 • 30 mins
In a special podcast episode, Health Affairs Scholar Associate Editor Loren Adler interviews Elizabeth Popp-Berman about the Health and Political Economy series of papers recently published in Health Affairs Scholar.
The series asks how might the U.S. build a more just and inclusive political economy for health rather than take the status quo for granted.
This paper collection was developed in partnership with the The New School’s Health and Political Economy Project (HPEP), a field catalyst initiative advancing a just and inclusive economy for health, and supported by the Commonwealth Fund.
Read the Collection:
- Health and political economy: building a new common sense in the United States
- Advancing a political economy approach to health using lessons from US antitrust and climate policy
- Reviving public provisioning in US health care
- The fundamental importance of social insurance for health equity
- Centering marginalized care: Home care cooperatives and system change
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Loren Adler (00:12):
Welcome to a special Health Affairs podcast
episode. My name is LaurenAdler, and I'm thrilled to bring
you a conversation withElizabeth Popberman. Beth is one
of the authors behind a newarticle series from Health
Affairs Scholar, co produced bythe Health and Political Economy
Project and sponsored by theCommonwealth Fund. This series
dives into what a quote unquotepolitical economy approach to
(00:34):
health could really look like,especially at a time when our
nation faces huge healthchallenges, from rising health
care costs for patients tounaddressed social factors and
stagnant and unequal lifeexpectancy. The authors in this
series describe some potentialresponses, covering ideas from
social insurance to greaterpublic provision of health care
services to a focus on frontlinecare workers.
(00:57):
Check the show notes for a linkto the series at Health Affairs
Scholar. Our guest, ElizabethPop Berman, comes from the
University of Michigan and isthe author of the book Thinking
Like an Economist (01:06):
How Efficiency Replaced Equality in
US Public Policy. Pop Bermanwrote an article for the series
titled Advancing a PoliticalEconomy Approach to Using
Lessons from US Antitrust andClimate Policy. We'll talk about
that and more. Beth, welcome tothe show.
Elizabeth Popp-Berman (01:25):
Thanks, Lauren. It's great to be here
with you.
Loren Adler (01:27):
To start off, before we dive into the article
itself, what is a politicaleconomy approach to health? And
how do you think this isdifferent from, you know, what
we might think of as thestandard approach to health care
policy or the economic style ofreasoning you describe in your
book?
Elizabeth Popp-Berman (01:44):
Yeah. I mean, so when I think about what
a political economy approach tohealth is, right, I think of an
approach that takes a prettybroad lens to what health means
and that kinda centers power andpolitics and economics and
thinking about the conditionsthat that enable or that shape
health. Know, so that means notonly having affordable access to
(02:05):
to medical care, but people havethe economic security that
allows them to, pursue the kindsof behaviors that enable health.
Right? Do they have a physicalenvironment that promotes
health?
Do they have chronic stressorsin their life? Like, racism, we
know has a has an ongoingincome, ongoing effect on
(02:25):
health. And and I think moregenerally, just, do we have a
health care system thatprioritizes profits at the
expense of more human centeredcare? And so I think this is a
pretty hard shift to makebecause we do have an
orientation, especially inpolicy conversations, really
towards thinking about, how dowe get people access to
(02:47):
affordable health care, which isobviously super important, but
that that's kind of the mainlever that we think about,
through which people throughwhich we try to improve people's
health. And so it's sort ofpartly about zooming out from
that.
The way I'm thinking about thismore generally, does grow out of
of, this book that I wrote acouple years ago, thinking like
(03:08):
an economist, which talks aboutthe rise of of what I call an
economic style of reasoningabout policy making. And so this
is something it's historical,kind of focuses on change from
the nineteen sixties to thenineteen eighties, and it
covers, multiple policy domains.So it covers health. It covers
antitrust. It coversenvironmental policy.
(03:30):
And so, really, the book arguesthat over the period of a couple
decades, really, you kind ofhave an advance of of of a new
way of thinking about policyproblems that really understands
good policy to be policy that'seither efficient or it's cost
effective, and that kind ofunderstands the role of
(03:50):
government as being a way tomake markets work better. And so
what that meant in a space likehealth is that you get kind of
this shift from thinking aboutbroad potentially universal
programs. So conversations aboutMedicare that you were having in
the nineteen sixties or in thenineteen seventies,
conversations about universalhealth insurance, which were
(04:13):
happening even under the Nixonadministration, and towards a
focus on expanding access costeffectively, right, and
leveraging market mechanisms.And so that's kind of an
approach to the health policyspace that by the nineteen
eighties becomes dominant. Andthen you can kind of see really,
(04:34):
I mean, really up to thepresent, but certainly through
the Clinton health reformefforts, through, the Obama
administration and theAffordable Care Act.
And, you know, and it continuesto some extent to the the
present. And so really, thething that I'm trying to say
here is that in some of theother policy areas that I look
like look at, like antitrust andenvironmental policy, you see a
(04:58):
shift towards taking a littlebit of a broader lens on the
policy domain and thinking alittle more broadly about
solutions. We don't see the samekind of, shift in health policy,
at least not to the same extent.And so what this article is
doing is partly exploring someof that variation across those
spaces and thinking about, whatwe can learn from it.
Loren Adler (05:17):
You know, I don't think anyone would argue that
there are policies outside ofthe the sort of pure health care
coverage landscape that wouldaffect people's healthcare. And
certainly there's a lot of focuson prevention and the sort of
other policies that affecthealth. But you brought up
antitrust and climate policy,and that's where a big focus of
(05:39):
your article here is talkingabout the sort of major shifts
in those two arenas thathappened over the last decade.
And that might be helpful if youcould walk us through those
changes and explain why theymatter.
Elizabeth Popp-Berman (05:50):
I think in those policy spaces, see in
that in the in that longerhistorical period, you do see
kind of a rise of, broadlyspeaking, economic reasoning
about the policy domain in thein over the same time period.
Right? So that in antitruststarting in the nineteen
seventies, you have a consumerwelfare framing for thinking
(06:12):
about antitrust becomes reallycentral. When people really
start to understand the purposeof antitrust as as being
primarily and really only about,you know, are we keeping prices
sufficiently low for consumers?You know?
Do producers have the capacityto raise prices above a
competitive level? And sothat's, you know, one important
(06:33):
issue, but kind of excludes alot of things that were
historically part of theantitrust conversation. So, you
know, questions about other waysthat corporate consolidation
might lead to concentrated poweror downstream effects of of
consolidation, like impacts onof small business loss on
communities and things likethat. What happens though is
(06:54):
that by the twenty tens, I thinkyou're getting a lot of
questions about the limitationsof that approach. And so I think
you've got the rise of,platforms.
You've got, you know, Amazon,Facebook, Google. If you think,
oh, if Amazon controls 40% ofall sales that are happening
(07:16):
online and it's got all thisinformation about sellers who
use its platform, right, butit's also competing them, then
what does that mean aboutcompetition? Right? You've got
questions about, what's the roleof platforms like Facebook in
conveying political speech. Andif and if these platforms are
really important for politicalconversations, but the the
algorithms are shaping whatpeople see, you know, how do we
(07:39):
how do we think about that as anew kind of problem?
And then I think there'sevidence in other spaces. Like,
for example, there's a growingbody of evidence that that
concentration is also having aneffect on wages. Right? That
that there's less competitionfor employees. And so
(07:59):
concentration's potentiallykeeping wages down as a in in
addition to potentially havingan effect on prices.
And so, you know, so there'skind of this accumulation of of
new kinds of questions. And inreaction to this, you get this
new Brandeis movement that iskind of political economy
centered, it takes this moreexpansive view of how should we
(08:20):
think about competition, how dowe think about ensuring that
markets are working well. Is itmore than just focusing on
consumer prices? At the outset,you know, when this when this
conversation is starting to takeoff, it seems pretty marginal to
the mainstream of antitrustdebate. And so, you know, 2015,
'20 '16, you're starting to seearticles about this, and there's
(08:42):
a lot of pushback.
It's kinda seen as beyond thepale, and it doesn't really feel
like a perspective that is goingto have a big impact. But it
does not take that many years.It's it's by 2020 that when,
Biden is elected, and isstarting to look for a different
approach to some kinds ofproblems. You see him, do things
(09:05):
like appoint Lena Khan to leadthe FTC. All of a sudden, this
approach that had been quitemarginal becomes, you know,
effect a de facto, the mainapproach that the White House is
taking.
You have this kind of shift inin antitrust policy. You have
really sort of a parallel shiftin in climate change with a
shift from thinking about capand trade as kind of the only
(09:29):
viable approach to policy changeto saying, okay. Well, if we
can't achieve that politically,what are the other options? You
know, which which ultimatelyleads to the embrace of of
industrial policy under theBiden administration. And these
are pretty significant shifts inhow people think about those
spaces.
So in both of those areas, youhave what start out as pretty as
(09:53):
changes that seem like they'repretty much outside the
mainstream that within a fewyears end up, becoming much more
part of the ordinary policy mixwithin Washington.
Loren Adler (10:03):
I think that just leads to the natural question of
what changed, right? What is it?What are the factors that sort
of helped drive these shifts?Mean, antitrust shift, agree,
felt pretty sudden almost in howquickly it bubbled up. The
climate one feels a littledifferent in some ways and that
you're still sort of dealingwith the relative prices of
(10:25):
clean energy versus not as cleanenergy.
It's now just through justfocused on dropping the prices
of clean energy through thissort of inflation and reduction
act approach here. But, youknow, I'm curious, you know,
having studied this, you know,what what what are the sort of
the main factors here that youthink kind of drove the these
these pretty sudden shifts?
Elizabeth Popp-Berman (10:44):
Yeah. And I think, you know, just to,
like, pick up on your on yourclimate point too. Right? I
think, I mean, I think you'reright that fundamentally, you
know, the fundamentally, thebroad approach is still, okay.
We're gonna think about how dowe how do we how do we change
the relative cost of thesedifferent forms of energy.
Right? And so it's sort ofrethinking, that kind of piece.
But I think the one piece thatmaybe is that is actually
(11:06):
different that sort of part ofnew political alliances that
emerged is that, you know,environmental justice
conversations were really sortof embedded into policy making
as well. And so there was also,a very, explicit acknowledgment
that, you know, climate impactsare more likely to follow
marginalized communities, thatthat that's something that we
(11:28):
need to address directly. Andso, you know, so I do think
you're right that maybe theshift was a little more abrupt
in in antitrust policy, but, Ido think you see it in both in
both areas.
As to as to why this happened,in both cases, in many ways,
it's the product of a lot ofpolitical organizing and sort of
(11:49):
coalition building that happenswhile people are not in
positions of influence. Thathappens in sort of different
spaces in the two policy areas.In antitrust, a lot of that
organizing is happening in theserelatively, elite policy
domains. So you see think tankslike open markets, and you see
spaces like Yale has this lawand political economy project
(12:14):
that was that was doing a lot ofacademic work around antitrust.
And so it's this relativelyintellectual elite sort of
organizing that is kind oftrying to shift the
conversation.
In in climate, it's a lot moregrassroots. You know, a big sort
of landmark moment in climatepolicy was the failure in 2010
(12:35):
to pass Waxman Markey, whichwould have been the big cap and
trade bill. That was a momentthat also fractured the
environmental movement, in partaround the issue of
environmental justice because itwas sort of excluded from the
cap and trade stuff. And so overthe course of the twenty tens,
you have a lot of thosegrassroots, more youth based,
(13:00):
more environmental justiceleaning organizations starting
to organize by the later part ofthe decade. It's this sort of
bottom up kinda organizing thatstarts to bring some
alternatives onto the table.
There are things that, you know,beyond just sort of this general
idea of organizing advance,there's some other things that
the spaces share. One is that,you know, both of these
(13:24):
movements were pretty good atlinking their issues to concerns
that are sort of broadlyresonant to the American public.
Right? Things that are resonantthroughout American history. And
so in antitrust, you've got sortof like a fear of concentrated
power.
Right? Which is sort of an themethat that has a long historical
(13:47):
past to it. And you've gotarguments about the the fairness
of the playing field. Inclimate, the the key thing is
connecting the idea of climatepolicy to jobs, right, which had
not really been the case in thepast. And so industrial policy
becomes a way not only to reducecarbon emissions, but to create
good green jobs, and that'ssuper important.
(14:09):
And so I think in both of thesespaces, people are really
effective at building what thepolitical scientists call issue
networks around their issuesthat sort of cross different
sorts of organizations thatbrought different constituencies
together and that put people ina good position to when the
politics, change to be able toadvocate for change. And the one
(14:32):
last thing I'll mention is thatI think another, factor that was
critical for both of these wasthey both, had a really visible
youth aspect to them.
Loren Adler (14:42):
I mean, the antitrust world sort of bleeds a
little bit into health carepolicy. Obviously, some of the
antitrust, action was focused onhealth care. Obviously, I'm a
little biased by my own researchsort of touching on that
intersection here. But I thinkthis leads to of the two real
natural questions here. One issort of, why haven't we seen
(15:04):
similar transformative changesin health care?
And then, you know, what are howdo you adapt these lessons from
climate and antitrust policy?And how do you funnel those into
health care? You know,certainly, there are plenty of
plenty of similarities.
Elizabeth Popp-Berman (15:19):
I mean, I think I I think there is sort of
one big difference in the policyspaces that is is is is one
reason you don't see the samekind of change. And I think that
is really the success of theAffordable Care Act because I
think in both antitrust andclimate policy, you had kind of
a long buildup of increasingconcerns that don't really
resolve themselves. You know, inantitrust, you kinda have this
(15:40):
fifty year old paradigm, newissues are emerging, you know,
you get sort of growing numberof news stories or whatever
about it, but nothing nothingreally major has has changed.
And so there hasn't really beenany any resolution to these
building concerns. In climate, Imentioned wax and marquis, and
that was a real moment of hopefor the environmental movement
during the Obama administration.
(16:02):
And then when it failed, peoplewere just sort of crushed and
wondered, you know, is this thewrong strategy? How do we
rebuild this? You know, where dowe go from here? And so there
was this real period of of soulsearching. But by contrast, I
think in in health policy, youhave the Affordable Care Act
passed in 2010, and that's quitesuccessful.
But one thing it does over thenext decade is that health
(16:25):
policy conversation is prettyheavily oriented towards
thinking about the AffordableCare Act. You know, it's either
defending it or it's challengingit or it's it's trying to expand
it, but, you know, that becomesa very, core focal point in
health policy in a way thatdoesn't open itself up to, sort
(16:45):
of broader questions about,well, are there things are there
more fundamental changes that wewant to be, thinking about? You
you you do see one movement thatis somewhat aligned with health
policy, which is that kinda midtwenty tens, you start to see
some conversation about the careeconomy. And this is sort of
(17:07):
initially coming from the spaceof people who are, really
focused on childcare and earlychildhood education and who are
interested in kind oforganizing, workers in that
space for better conditions, butkinda gradually opens up to
consider a lot of differentkinds of care and starts to
incorporate some health policyconcerns into that. So that's
(17:29):
maybe something that, we cancome back to, but I think it's
sort of the closest thing to amovement that is analogous that
is really, near the health carespace.
But I guess then second part ofyour question was, what the
lessons are for how we mightthink about house policy.
Loren Adler (17:49):
Yeah. And right. I think just to build on that.
Right? I think I mean, you makea good point.
Right? Had cap and trade passed,you probably would not have seen
the sort of big push towards thesort of industrial policy
approach. That also tees up boththe Affordable Care Act and cap
and trade policy, both weretrying to improve their domain,
but had created both winners andlosers. I think part of the
(18:13):
industrial policy approach onclimate and part of that was
let's create fewer losers andlet's just sort of make it all
about let's just throw money atthings and make it so it's
predominantly winners in thissituation. I'm sort of curious,
I mean, both broadly, how theselessons might be adapted towards
health policy.
(18:34):
And do you think there'ssomething to that approach to
health policy where, you know,using less trade offs and using
money to kinda primarily createwinners?
Elizabeth Popp-Berman (18:44):
Right. So I mean so maybe so maybe there's
sort of two ways you can thinkabout what the what the
potential lessons are. Right? Imean and I think in one is just
sort of how do you think aboutthe kinds of actions that people
took in these other spaces thatsort of built the momentum for
for having sort of the peopleand the energy in place to try
to motivate these kinds ofchanges once the political
(19:05):
environment was right for them.You know, in that vein, you've
got the question of, like, howdo you think about building
issue networks that are gonnahelp you advance the kinds of
approach to the policy domainthat you want?
These issue networks that werebuilt during this time when they
really did not seem particularlylikely to be effective end up
being quite important down theroad. And so, you know, 2016,
(19:29):
'20 '18, even though, you know,whenever AOC came out and
started talking about a greennew deal and it got some press,
it did not really seem like wewere in the moment when there
was gonna be, some kind of majorenvironmental legislation in the
next few years. I think anotherlesson is thinking about how to
build networks across differentkinds of policy spaces and
(19:50):
really thinking about how issuenetworks can align, the
interests of different groups.The climate movement, one way
that they they did thateffectively was sort of by
figuring out how to realign kindof the more traditional climate
groups with these younger, moreenvironmental justice focused
groups so that they could bringdifferent sets of political
(20:12):
actors to bear when they'reactually trying to accomplish
policy. I mean, I do thinkthat's a space where it's worth
thinking about how these kindsof care economy movements that,
again, have been based more onthe childcare, early childhood
education spaces, but theyobviously have a lot of
affinities with health care.
And that I think those kinds offrames have the opportunity to
(20:33):
bring in people who areinterested in advancing the
interests of particularprofessional groups. Right? So
physicians or or nurses. Youknow, in terms of thinking
about, you know, can are thereways to align interest by
basically creating incentivesfor everybody? I mean, I do
think, yes, of course, that thatis always one strategy.
(20:55):
But there's always a questiontoo of do you actually you know,
if if part of the motivation fordoing something like the
inflation reduction act was tocreate policy change that was
gonna be really durable by kindagiving new people interest in
maintaining it. Yeah. I think italso raises some questions of of
is it actually gonna look likethat in the end? Is that
(21:15):
actually where we are in termsof is it gonna be as resilient
as people hoped it would?
Loren Adler (21:19):
That makes a lot of sense. Right? And you do see
some of this in health care, thelong term care arena. Obviously,
you know, the workers and thehome health aides, have gained a
lot of, attention there. In theantitrust space, you know,
particularly under Lina Khan'sFTC, there was a sort of renewed
focus on the effects on doctorsor nurses of the sort of
(21:40):
financialization of healthcare.
And there's evidence thathospital consolidation can
suppress nurse wages, forinstance, so sort of go into
this sort of broader argumentshere. You know, I think before
kind of coming back to sort ofhow lasting these are, your
article also kind of focusesmore broadly on the sort of
corporate consolidation andfinancialization of health care.
(22:03):
You know, do you think there areways that this political economy
approach that helps addressthose specific issues?
Elizabeth Popp-Berman (22:10):
I think there's definitely spaces where
even, you know, a fairlytraditional approach to
antitrust has a lot of of ofpotential to hit on some of
these issues. Right? I mean,like you mentioned, we've got
increasing evidence thathospital mergers and certain
other kinds of consolidationsare driving prices up. They're
potentially affecting wages. Youknow, there's some evidence
(22:31):
about their their impact onhealth.
And those seem like placeswhere, you know, a fairly
standard approach to antitrustenforcement that's maybe
aggressive, but not especiallynovel could do quite a bit. But
I think there's other placeswhere, you know, we have broader
economic issues that are gonnabe hard to address. And I don't
(22:54):
know, you know, I I don't knowwhat the what the policy
solution is to this, but we've,you know, we've kinda developed
this system that is extremelycomplicated, very, you know,
complex mix of public andprivate actors. We've got a lot
of people who are verysophisticated in their ability
to figure out the maximum way toto profit in this market that's
just inherently you know, it'sgot a lot of agency problems.
(23:16):
It's got a lot of informationproblems.
And so, you know, what do youwhat do you do about that given
the size of government as as abuyer in the health care market?
There's a lot more that we cando to think about how to ensure
the prices are reasonable. And,honestly, you know, I think we
need other ways to think aboutevaluating what fair prices look
(23:38):
like in health care marketsbecause I think it is pretty
clear that as the market'scurrently functioning, you know,
prices are really sort of thethe competitive mechanisms that
you would like to see keepingprices down are not really
proving very effective.
Loren Adler (23:53):
That seems like a light statement, given how
health care works. You kind ofteed this up a little bit, but
even more broadly, you know,we're obviously in a political
climate right now where thissort of care economy or the
change you're describing doesn'tseem terribly likely in the next
few years. And sort of, youknow, does that change how
(24:15):
you're thinking about theseissues at all?
Elizabeth Popp-Berman (24:18):
Yeah. I mean, I think it does. I mean,
obviously, on the one hand, likeyes. I mean, with the exception
of possibly, you know, antitrustagain, kind of bumping up
against the health care space asbeing a a spot where where it's
a little bit more open yet as towhat exactly the policy approach
is gonna look like. But, youknow, most of these changes are
(24:40):
not gonna be things that arethat are on the table in the
next few years.
Looking back at what the lead upto change was during the Biden
administration, I do think it'simportant to remember that
things can change pretty quicklypolitically, that organizing,
that sort of, laying thegroundwork that's happening now
is still really worth doing evenif it takes a while to have a
(25:02):
payoff. I also think the otherthing that's that's useful to
think about is that, you know,crises are often opportunities
as well. And so if it seems likewe're in a moment where where
there's sort of threats to partsof social policy that are
providing access to people orwhere there seems like things
are really under attack, youknow, that's also a time when
(25:23):
people are sometimes willing tostep back and say, wait. Maybe
we need to think bigger aboutthis. Maybe we need to think
differently about this.
You know, that can actually behelpful in kind of broadening
the scope of debate. You know, Ithink the main consideration
that I have that's sort of a anew thing is that it does seem
(25:44):
possible that, that the Trumpadministration may be successful
at hollowing out some of our ourstate capacity. Right? So we
just don't have theadministrative ability to
administer some kind of complexnew program. And so I do think
it makes sense as we thinkabout, moving forward that
(26:05):
perhaps it makes sense toconsider simple programs over
more complex programs that wereally, need to recognize the
administrative capacity may be areal issue even if the political
climate changes in the future.
Loren Adler (26:18):
The administrative capacity question is somewhat
new this time around, right, thesort of large scale firings of
federal workers. And, you know,there's plausible cuts to
Medicaid, state Medicaidprograms that are on the table
right now, which sort of cantouch on state capacity here.
That sort of maybe the Medicaiddiscussion here maybe touches on
(26:39):
a little bit of a question youalluded to earlier, which is,
you know, yes, we had thesechanges in climate policy and
antitrust, and we're talkingabout these potential changes in
health care. But, you know, evenif you are successful, how
lasting are these changes?Right?
The Affordable Care Act had manynear death experiences. It has
(26:59):
survived, but that does not haveto be how it ended up. You know,
the Medicaid expansion is stillunder, you know, still under
debate and may get may get drawnback and hasn't happened in
Florida or Texas. You know, theinflation reduction act, clean
energy subsidies are certainlyon the table for the
reconciliation package thisyear. An antitrust, I assume,
(27:21):
can basically change on a whimdepending on the administration.
So I'm kinda curious how youthink about how lasting these
changes are. And, right, isthere anything you think that
can be done to make changes morelasting?
Elizabeth Popp-Berman (27:33):
Think to one extent, right, some some
policy areas are much easier toreverse under a new
administration than others. Soanything like antitrust, that's
mostly the changes happening. Inthe executive branch, obviously,
you change administrations, youchange priorities, and you can
take things in in quite adifferent direction. I think
even something like theinflation reduction act, well, I
(27:57):
mean, to to some extent, I thinkthe, jury is still out there.
Right?
Obviously, it created a lot ofnew economic interests in,
renewable energy that weren'tthere before and that
potentially, may result inpressures not to, repeal it from
people who otherwise might besupportive of that. However,
(28:18):
will that be enough to preventparts of it from being repealed?
You know, we will still I thinkwe have to we have to see. I
think, you know, the way tothink of this, one, it's a it's
a, you know, it's a long termproject. It's not it's not a
short term.
So anything you do, I think, issubject to reversal. So one
question is, you know, how doyou build both the politics and
(28:40):
the sort of broader, motivationfor for, carrying a particular
agenda forward even though, ofcourse, you know, the short term
politics of it are gonna go goback and forth, and you might
make a change in one,administration only to see it
step back later. I mean, andmaybe that's, you know, kind of
a good note to bring it back tois that another way to think of
(29:03):
this is, you know, it's a it's aproject, I think, that goes
beyond just thinking aboutpolicy space to sort of thinking
about civil society moregenerally. Yeah. That that I
think there's space fornonpolicy actors as well to
really think about how do wecreate a civil society network
that says, you know, this iswhat you know, what does it look
(29:25):
like for Americans to live in aworld that allows them to be
healthy, right, and that givesthem good options for care when
they're when they're nothealthy.
And that building that capacityoutside of policy spaces is also
something that in the long runcan create more lasting change.
Loren Adler (29:42):
That's a that's a good point, think. That seems
like a good good positive noteto to end on here. So I wanna
thank you again, Beth, forsharing your time and insights.
And again, Beth is a professorat the University of Michigan
and to check out her article andthe rest of the series on health
and the political economy atHealthAffairsCholar. Please
(30:05):
check out the show notes or youcan look it up on
HealthAffairsCholars website.
And thank you again, Beth, fortaking the time.
Elizabeth Popp-Berman (30:12):
Thanks. It's great to be with you.
Welcome to a special Health Affairs podcast
episode. My name is LaurenAdler, and I'm thrilled to bring
you a conversation withElizabeth Popberman. Beth is one
of the authors behind a newarticle series from Health
Affairs Scholar, co produced bythe Health and Political Economy
Project and sponsored by theCommonwealth Fund. This series
dives into what a quote unquotepolitical economy approach to
(00:34):
health could really look like,especially at a time when our
nation faces huge healthchallenges, from rising health
care costs for patients tounaddressed social factors and
stagnant and unequal lifeexpectancy. The authors in this
series describe some potentialresponses, covering ideas from
social insurance to greaterpublic provision of health care
services to a focus on frontlinecare workers.
(00:57):
Check the show notes for a linkto the series at Health Affairs
Scholar. Our guest, ElizabethPop Berman, comes from the
University of Michigan and isthe author of the book Thinking
Like an Economist (01:06):
How Efficiency Replaced Equality in
US Public Policy. Pop Bermanwrote an article for the series
titled Advancing a PoliticalEconomy Approach to Using
Lessons from US Antitrust andClimate Policy. We'll talk about
that and more. Beth, welcome tothe show.
Elizabeth Popp-Berman (01:25):
Thanks, Lauren. It's great to be here
with you.
Loren Adler (01:27):
To start off, before we dive into the article
itself, what is a politicaleconomy approach to health? And
how do you think this isdifferent from, you know, what
we might think of as thestandard approach to health care
policy or the economic style ofreasoning you describe in your
book?
Elizabeth Popp-Berman (01:44):
Yeah. I mean, so when I think about what
a political economy approach tohealth is, right, I think of an
approach that takes a prettybroad lens to what health means
and that kinda centers power andpolitics and economics and
thinking about the conditionsthat that enable or that shape
health. Know, so that means notonly having affordable access to
(02:05):
to medical care, but people havethe economic security that
allows them to, pursue the kindsof behaviors that enable health.
Right? Do they have a physicalenvironment that promotes
health?
Do they have chronic stressorsin their life? Like, racism, we
know has a has an ongoingincome, ongoing effect on
(02:25):
health. And and I think moregenerally, just, do we have a
health care system thatprioritizes profits at the
expense of more human centeredcare? And so I think this is a
pretty hard shift to makebecause we do have an
orientation, especially inpolicy conversations, really
towards thinking about, how dowe get people access to
(02:47):
affordable health care, which isobviously super important, but
that that's kind of the mainlever that we think about,
through which people throughwhich we try to improve people's
health. And so it's sort ofpartly about zooming out from
that.
The way I'm thinking about thismore generally, does grow out of
of, this book that I wrote acouple years ago, thinking like
(03:08):
an economist, which talks aboutthe rise of of what I call an
economic style of reasoningabout policy making. And so this
is something it's historical,kind of focuses on change from
the nineteen sixties to thenineteen eighties, and it
covers, multiple policy domains.So it covers health. It covers
antitrust. It coversenvironmental policy.
(03:30):
And so, really, the book arguesthat over the period of a couple
decades, really, you kind ofhave an advance of of of a new
way of thinking about policyproblems that really understands
good policy to be policy that'seither efficient or it's cost
effective, and that kind ofunderstands the role of
(03:50):
government as being a way tomake markets work better. And so
what that meant in a space likehealth is that you get kind of
this shift from thinking aboutbroad potentially universal
programs. So conversations aboutMedicare that you were having in
the nineteen sixties or in thenineteen seventies,
conversations about universalhealth insurance, which were
(04:13):
happening even under the Nixonadministration, and towards a
focus on expanding access costeffectively, right, and
leveraging market mechanisms.And so that's kind of an
approach to the health policyspace that by the nineteen
eighties becomes dominant. Andthen you can kind of see really,
(04:34):
I mean, really up to thepresent, but certainly through
the Clinton health reformefforts, through, the Obama
administration and theAffordable Care Act.
And, you know, and it continuesto some extent to the the
present. And so really, thething that I'm trying to say
here is that in some of theother policy areas that I look
like look at, like antitrust andenvironmental policy, you see a
(04:58):
shift towards taking a littlebit of a broader lens on the
policy domain and thinking alittle more broadly about
solutions. We don't see the samekind of, shift in health policy,
at least not to the same extent.And so what this article is
doing is partly exploring someof that variation across those
spaces and thinking about, whatwe can learn from it.
Loren Adler (05:17):
You know, I don't think anyone would argue that
there are policies outside ofthe the sort of pure health care
coverage landscape that wouldaffect people's healthcare. And
certainly there's a lot of focuson prevention and the sort of
other policies that affecthealth. But you brought up
antitrust and climate policy,and that's where a big focus of
(05:39):
your article here is talkingabout the sort of major shifts
in those two arenas thathappened over the last decade.
And that might be helpful if youcould walk us through those
changes and explain why theymatter.
Elizabeth Popp-Berman (05:50):
I think in those policy spaces, see in
that in the in that longerhistorical period, you do see
kind of a rise of, broadlyspeaking, economic reasoning
about the policy domain in thein over the same time period.
Right? So that in antitruststarting in the nineteen
seventies, you have a consumerwelfare framing for thinking
(06:12):
about antitrust becomes reallycentral. When people really
start to understand the purposeof antitrust as as being
primarily and really only about,you know, are we keeping prices
sufficiently low for consumers?You know?
Do producers have the capacityto raise prices above a
competitive level? And sothat's, you know, one important
(06:33):
issue, but kind of excludes alot of things that were
historically part of theantitrust conversation. So, you
know, questions about other waysthat corporate consolidation
might lead to concentrated poweror downstream effects of of
consolidation, like impacts onof small business loss on
communities and things likethat. What happens though is
(06:54):
that by the twenty tens, I thinkyou're getting a lot of
questions about the limitationsof that approach. And so I think
you've got the rise of,platforms.
You've got, you know, Amazon,Facebook, Google. If you think,
oh, if Amazon controls 40% ofall sales that are happening
(07:16):
online and it's got all thisinformation about sellers who
use its platform, right, butit's also competing them, then
what does that mean aboutcompetition? Right? You've got
questions about, what's the roleof platforms like Facebook in
conveying political speech. Andif and if these platforms are
really important for politicalconversations, but the the
algorithms are shaping whatpeople see, you know, how do we
(07:39):
how do we think about that as anew kind of problem?
And then I think there'sevidence in other spaces. Like,
for example, there's a growingbody of evidence that that
concentration is also having aneffect on wages. Right? That
that there's less competitionfor employees. And so
(07:59):
concentration's potentiallykeeping wages down as a in in
addition to potentially havingan effect on prices.
And so, you know, so there'skind of this accumulation of of
new kinds of questions. And inreaction to this, you get this
new Brandeis movement that iskind of political economy
centered, it takes this moreexpansive view of how should we
(08:20):
think about competition, how dowe think about ensuring that
markets are working well. Is itmore than just focusing on
consumer prices? At the outset,you know, when this when this
conversation is starting to takeoff, it seems pretty marginal to
the mainstream of antitrustdebate. And so, you know, 2015,
'20 '16, you're starting to seearticles about this, and there's
(08:42):
a lot of pushback.
It's kinda seen as beyond thepale, and it doesn't really feel
like a perspective that is goingto have a big impact. But it
does not take that many years.It's it's by 2020 that when,
Biden is elected, and isstarting to look for a different
approach to some kinds ofproblems. You see him, do things
(09:05):
like appoint Lena Khan to leadthe FTC. All of a sudden, this
approach that had been quitemarginal becomes, you know,
effect a de facto, the mainapproach that the White House is
taking.
You have this kind of shift inin antitrust policy. You have
really sort of a parallel shiftin in climate change with a
shift from thinking about capand trade as kind of the only
(09:29):
viable approach to policy changeto saying, okay. Well, if we
can't achieve that politically,what are the other options? You
know, which which ultimatelyleads to the embrace of of
industrial policy under theBiden administration. And these
are pretty significant shifts inhow people think about those
spaces.
So in both of those areas, youhave what start out as pretty as
(09:53):
changes that seem like they'repretty much outside the
mainstream that within a fewyears end up, becoming much more
part of the ordinary policy mixwithin Washington.
Loren Adler (10:03):
I think that just leads to the natural question of
what changed, right? What is it?What are the factors that sort
of helped drive these shifts?Mean, antitrust shift, agree,
felt pretty sudden almost in howquickly it bubbled up. The
climate one feels a littledifferent in some ways and that
you're still sort of dealingwith the relative prices of
(10:25):
clean energy versus not as cleanenergy.
It's now just through justfocused on dropping the prices
of clean energy through thissort of inflation and reduction
act approach here. But, youknow, I'm curious, you know,
having studied this, you know,what what what are the sort of
the main factors here that youthink kind of drove the these
these pretty sudden shifts?
Elizabeth Popp-Berman (10:44):
Yeah. And I think, you know, just to,
like, pick up on your on yourclimate point too. Right? I
think, I mean, I think you'reright that fundamentally, you
know, the fundamentally, thebroad approach is still, okay.
We're gonna think about how dowe how do we how do we change
the relative cost of thesedifferent forms of energy.
Right? And so it's sort ofrethinking, that kind of piece.
But I think the one piece thatmaybe is that is actually
(11:06):
different that sort of part ofnew political alliances that
emerged is that, you know,environmental justice
conversations were really sortof embedded into policy making
as well. And so there was also,a very, explicit acknowledgment
that, you know, climate impactsare more likely to follow
marginalized communities, thatthat that's something that we
(11:28):
need to address directly. Andso, you know, so I do think
you're right that maybe theshift was a little more abrupt
in in antitrust policy, but, Ido think you see it in both in
both areas.
As to as to why this happened,in both cases, in many ways,
it's the product of a lot ofpolitical organizing and sort of
(11:49):
coalition building that happenswhile people are not in
positions of influence. Thathappens in sort of different
spaces in the two policy areas.In antitrust, a lot of that
organizing is happening in theserelatively, elite policy
domains. So you see think tankslike open markets, and you see
spaces like Yale has this lawand political economy project
(12:14):
that was that was doing a lot ofacademic work around antitrust.
And so it's this relativelyintellectual elite sort of
organizing that is kind oftrying to shift the
conversation.
In in climate, it's a lot moregrassroots. You know, a big sort
of landmark moment in climatepolicy was the failure in 2010
(12:35):
to pass Waxman Markey, whichwould have been the big cap and
trade bill. That was a momentthat also fractured the
environmental movement, in partaround the issue of
environmental justice because itwas sort of excluded from the
cap and trade stuff. And so overthe course of the twenty tens,
you have a lot of thosegrassroots, more youth based,
(13:00):
more environmental justiceleaning organizations starting
to organize by the later part ofthe decade. It's this sort of
bottom up kinda organizing thatstarts to bring some
alternatives onto the table.
There are things that, you know,beyond just sort of this general
idea of organizing advance,there's some other things that
the spaces share. One is that,you know, both of these
(13:24):
movements were pretty good atlinking their issues to concerns
that are sort of broadlyresonant to the American public.
Right? Things that are resonantthroughout American history. And
so in antitrust, you've got sortof like a fear of concentrated
power.
Right? Which is sort of an themethat that has a long historical
(13:47):
past to it. And you've gotarguments about the the fairness
of the playing field. Inclimate, the the key thing is
connecting the idea of climatepolicy to jobs, right, which had
not really been the case in thepast. And so industrial policy
becomes a way not only to reducecarbon emissions, but to create
good green jobs, and that'ssuper important.
(14:09):
And so I think in both of thesespaces, people are really
effective at building what thepolitical scientists call issue
networks around their issuesthat sort of cross different
sorts of organizations thatbrought different constituencies
together and that put people ina good position to when the
politics, change to be able toadvocate for change. And the one
(14:32):
last thing I'll mention is thatI think another, factor that was
critical for both of these wasthey both, had a really visible
youth aspect to them.
Loren Adler (14:42):
I mean, the antitrust world sort of bleeds a
little bit into health carepolicy. Obviously, some of the
antitrust, action was focused onhealth care. Obviously, I'm a
little biased by my own researchsort of touching on that
intersection here. But I thinkthis leads to of the two real
natural questions here. One issort of, why haven't we seen
(15:04):
similar transformative changesin health care?
And then, you know, what are howdo you adapt these lessons from
climate and antitrust policy?And how do you funnel those into
health care? You know,certainly, there are plenty of
plenty of similarities.
Elizabeth Popp-Berman (15:19):
I mean, I think I I think there is sort of
one big difference in the policyspaces that is is is is one
reason you don't see the samekind of change. And I think that
is really the success of theAffordable Care Act because I
think in both antitrust andclimate policy, you had kind of
a long buildup of increasingconcerns that don't really
resolve themselves. You know, inantitrust, you kinda have this
(15:40):
fifty year old paradigm, newissues are emerging, you know,
you get sort of growing numberof news stories or whatever
about it, but nothing nothingreally major has has changed.
And so there hasn't really beenany any resolution to these
building concerns. In climate, Imentioned wax and marquis, and
that was a real moment of hopefor the environmental movement
during the Obama administration.
(16:02):
And then when it failed, peoplewere just sort of crushed and
wondered, you know, is this thewrong strategy? How do we
rebuild this? You know, where dowe go from here? And so there
was this real period of of soulsearching. But by contrast, I
think in in health policy, youhave the Affordable Care Act
passed in 2010, and that's quitesuccessful.
But one thing it does over thenext decade is that health
(16:25):
policy conversation is prettyheavily oriented towards
thinking about the AffordableCare Act. You know, it's either
defending it or it's challengingit or it's it's trying to expand
it, but, you know, that becomesa very, core focal point in
health policy in a way thatdoesn't open itself up to, sort
(16:45):
of broader questions about,well, are there things are there
more fundamental changes that wewant to be, thinking about? You
you you do see one movement thatis somewhat aligned with health
policy, which is that kinda midtwenty tens, you start to see
some conversation about the careeconomy. And this is sort of
(17:07):
initially coming from the spaceof people who are, really
focused on childcare and earlychildhood education and who are
interested in kind oforganizing, workers in that
space for better conditions, butkinda gradually opens up to
consider a lot of differentkinds of care and starts to
incorporate some health policyconcerns into that. So that's
(17:29):
maybe something that, we cancome back to, but I think it's
sort of the closest thing to amovement that is analogous that
is really, near the health carespace.
But I guess then second part ofyour question was, what the
lessons are for how we mightthink about house policy.
Loren Adler (17:49):
Yeah. And right. I think just to build on that.
Right? I think I mean, you makea good point.
Right? Had cap and trade passed,you probably would not have seen
the sort of big push towards thesort of industrial policy
approach. That also tees up boththe Affordable Care Act and cap
and trade policy, both weretrying to improve their domain,
but had created both winners andlosers. I think part of the
(18:13):
industrial policy approach onclimate and part of that was
let's create fewer losers andlet's just sort of make it all
about let's just throw money atthings and make it so it's
predominantly winners in thissituation. I'm sort of curious,
I mean, both broadly, how theselessons might be adapted towards
health policy.
(18:34):
And do you think there'ssomething to that approach to
health policy where, you know,using less trade offs and using
money to kinda primarily createwinners?
Elizabeth Popp-Berman (18:44):
Right. So I mean so maybe so maybe there's
sort of two ways you can thinkabout what the what the
potential lessons are. Right? Imean and I think in one is just
sort of how do you think aboutthe kinds of actions that people
took in these other spaces thatsort of built the momentum for
for having sort of the peopleand the energy in place to try
to motivate these kinds ofchanges once the political
(19:05):
environment was right for them.You know, in that vein, you've
got the question of, like, howdo you think about building
issue networks that are gonnahelp you advance the kinds of
approach to the policy domainthat you want?
These issue networks that werebuilt during this time when they
really did not seem particularlylikely to be effective end up
being quite important down theroad. And so, you know, 2016,
(19:29):
'20 '18, even though, you know,whenever AOC came out and
started talking about a greennew deal and it got some press,
it did not really seem like wewere in the moment when there
was gonna be, some kind of majorenvironmental legislation in the
next few years. I think anotherlesson is thinking about how to
build networks across differentkinds of policy spaces and
(19:50):
really thinking about how issuenetworks can align, the
interests of different groups.The climate movement, one way
that they they did thateffectively was sort of by
figuring out how to realign kindof the more traditional climate
groups with these younger, moreenvironmental justice focused
groups so that they could bringdifferent sets of political
(20:12):
actors to bear when they'reactually trying to accomplish
policy. I mean, I do thinkthat's a space where it's worth
thinking about how these kindsof care economy movements that,
again, have been based more onthe childcare, early childhood
education spaces, but theyobviously have a lot of
affinities with health care.
And that I think those kinds offrames have the opportunity to
(20:33):
bring in people who areinterested in advancing the
interests of particularprofessional groups. Right? So
physicians or or nurses. Youknow, in terms of thinking
about, you know, can are thereways to align interest by
basically creating incentivesfor everybody? I mean, I do
think, yes, of course, that thatis always one strategy.
(20:55):
But there's always a questiontoo of do you actually you know,
if if part of the motivation fordoing something like the
inflation reduction act was tocreate policy change that was
gonna be really durable by kindagiving new people interest in
maintaining it. Yeah. I think italso raises some questions of of
is it actually gonna look likethat in the end? Is that
(21:15):
actually where we are in termsof is it gonna be as resilient
as people hoped it would?
Loren Adler (21:19):
That makes a lot of sense. Right? And you do see
some of this in health care, thelong term care arena. Obviously,
you know, the workers and thehome health aides, have gained a
lot of, attention there. In theantitrust space, you know,
particularly under Lina Khan'sFTC, there was a sort of renewed
focus on the effects on doctorsor nurses of the sort of
(21:40):
financialization of healthcare.
And there's evidence thathospital consolidation can
suppress nurse wages, forinstance, so sort of go into
this sort of broader argumentshere. You know, I think before
kind of coming back to sort ofhow lasting these are, your
article also kind of focusesmore broadly on the sort of
corporate consolidation andfinancialization of health care.
(22:03):
You know, do you think there areways that this political economy
approach that helps addressthose specific issues?
Elizabeth Popp-Berman (22:10):
I think there's definitely spaces where
even, you know, a fairlytraditional approach to
antitrust has a lot of of ofpotential to hit on some of
these issues. Right? I mean,like you mentioned, we've got
increasing evidence thathospital mergers and certain
other kinds of consolidationsare driving prices up. They're
potentially affecting wages. Youknow, there's some evidence
(22:31):
about their their impact onhealth.
And those seem like placeswhere, you know, a fairly
standard approach to antitrustenforcement that's maybe
aggressive, but not especiallynovel could do quite a bit. But
I think there's other placeswhere, you know, we have broader
economic issues that are gonnabe hard to address. And I don't
(22:54):
know, you know, I I don't knowwhat the what the policy
solution is to this, but we've,you know, we've kinda developed
this system that is extremelycomplicated, very, you know,
complex mix of public andprivate actors. We've got a lot
of people who are verysophisticated in their ability
to figure out the maximum way toto profit in this market that's
just inherently you know, it'sgot a lot of agency problems.
(23:16):
It's got a lot of informationproblems.
And so, you know, what do youwhat do you do about that given
the size of government as as abuyer in the health care market?
There's a lot more that we cando to think about how to ensure
the prices are reasonable. And,honestly, you know, I think we
need other ways to think aboutevaluating what fair prices look
(23:38):
like in health care marketsbecause I think it is pretty
clear that as the market'scurrently functioning, you know,
prices are really sort of thethe competitive mechanisms that
you would like to see keepingprices down are not really
proving very effective.
Loren Adler (23:53):
That seems like a light statement, given how
health care works. You kind ofteed this up a little bit, but
even more broadly, you know,we're obviously in a political
climate right now where thissort of care economy or the
change you're describing doesn'tseem terribly likely in the next
few years. And sort of, youknow, does that change how
(24:15):
you're thinking about theseissues at all?
Elizabeth Popp-Berman (24:18):
Yeah. I mean, I think it does. I mean,
obviously, on the one hand, likeyes. I mean, with the exception
of possibly, you know, antitrustagain, kind of bumping up
against the health care space asbeing a a spot where where it's
a little bit more open yet as towhat exactly the policy approach
is gonna look like. But, youknow, most of these changes are
(24:40):
not gonna be things that arethat are on the table in the
next few years.
Looking back at what the lead upto change was during the Biden
administration, I do think it'simportant to remember that
things can change pretty quicklypolitically, that organizing,
that sort of, laying thegroundwork that's happening now
is still really worth doing evenif it takes a while to have a
(25:02):
payoff. I also think the otherthing that's that's useful to
think about is that, you know,crises are often opportunities
as well. And so if it seems likewe're in a moment where where
there's sort of threats to partsof social policy that are
providing access to people orwhere there seems like things
are really under attack, youknow, that's also a time when
(25:23):
people are sometimes willing tostep back and say, wait. Maybe
we need to think bigger aboutthis. Maybe we need to think
differently about this.
You know, that can actually behelpful in kind of broadening
the scope of debate. You know, Ithink the main consideration
that I have that's sort of a anew thing is that it does seem
(25:44):
possible that, that the Trumpadministration may be successful
at hollowing out some of our ourstate capacity. Right? So we
just don't have theadministrative ability to
administer some kind of complexnew program. And so I do think
it makes sense as we thinkabout, moving forward that
(26:05):
perhaps it makes sense toconsider simple programs over
more complex programs that wereally, need to recognize the
administrative capacity may be areal issue even if the political
climate changes in the future.
Loren Adler (26:18):
The administrative capacity question is somewhat
new this time around, right, thesort of large scale firings of
federal workers. And, you know,there's plausible cuts to
Medicaid, state Medicaidprograms that are on the table
right now, which sort of cantouch on state capacity here.
That sort of maybe the Medicaiddiscussion here maybe touches on
(26:39):
a little bit of a question youalluded to earlier, which is,
you know, yes, we had thesechanges in climate policy and
antitrust, and we're talkingabout these potential changes in
health care. But, you know, evenif you are successful, how
lasting are these changes?Right?
The Affordable Care Act had manynear death experiences. It has
(26:59):
survived, but that does not haveto be how it ended up. You know,
the Medicaid expansion is stillunder, you know, still under
debate and may get may get drawnback and hasn't happened in
Florida or Texas. You know, theinflation reduction act, clean
energy subsidies are certainlyon the table for the
reconciliation package thisyear. An antitrust, I assume,
(27:21):
can basically change on a whimdepending on the administration.
So I'm kinda curious how youthink about how lasting these
changes are. And, right, isthere anything you think that
can be done to make changes morelasting?
Elizabeth Popp-Berman (27:33):
Think to one extent, right, some some
policy areas are much easier toreverse under a new
administration than others. Soanything like antitrust, that's
mostly the changes happening. Inthe executive branch, obviously,
you change administrations, youchange priorities, and you can
take things in in quite adifferent direction. I think
even something like theinflation reduction act, well, I
(27:57):
mean, to to some extent, I thinkthe, jury is still out there.
Right?
Obviously, it created a lot ofnew economic interests in,
renewable energy that weren'tthere before and that
potentially, may result inpressures not to, repeal it from
people who otherwise might besupportive of that. However,
(28:18):
will that be enough to preventparts of it from being repealed?
You know, we will still I thinkwe have to we have to see. I
think, you know, the way tothink of this, one, it's a it's
a, you know, it's a long termproject. It's not it's not a
short term.
So anything you do, I think, issubject to reversal. So one
question is, you know, how doyou build both the politics and
(28:40):
the sort of broader, motivationfor for, carrying a particular
agenda forward even though, ofcourse, you know, the short term
politics of it are gonna go goback and forth, and you might
make a change in one,administration only to see it
step back later. I mean, andmaybe that's, you know, kind of
a good note to bring it back tois that another way to think of
(29:03):
this is, you know, it's a it's aproject, I think, that goes
beyond just thinking aboutpolicy space to sort of thinking
about civil society moregenerally. Yeah. That that I
think there's space fornonpolicy actors as well to
really think about how do wecreate a civil society network
that says, you know, this iswhat you know, what does it look
(29:25):
like for Americans to live in aworld that allows them to be
healthy, right, and that givesthem good options for care when
they're when they're nothealthy.
And that building that capacityoutside of policy spaces is also
something that in the long runcan create more lasting change.
Loren Adler (29:42):
That's a that's a good point, think. That seems
like a good good positive noteto to end on here. So I wanna
thank you again, Beth, forsharing your time and insights.
And again, Beth is a professorat the University of Michigan
and to check out her article andthe rest of the series on health
and the political economy atHealthAffairsCholar. Please
(30:05):
check out the show notes or youcan look it up on
HealthAffairsCholars website.
And thank you again, Beth, fortaking the time.
Elizabeth Popp-Berman (30:12):
Thanks. It's great to be with you.
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