Chicago Booth Review Podcast How Can We Fix US Healthcare?

Hal Weitzman: The US spends a lot more on healthcare than most other high-income countries. But the US doesn't have universal health coverage, and the system doesn't have good outcomes compared with other developed countries when it comes to metrics such as life expectancy, death rates for avoidable or treatable conditions of maternal and infant mortality. Financial incentives shape the healthcare that patients are offered in the US. From the drugs they're prescribed to, the procedures they receive and how long they stay in hospital. To take just one example, the World Health Organization recommends that countries not exceed C-section rates of 10 to 15%, but in the United States, the C-section rate is above 30%. So what would it take to fix US Health Care?

Welcome to the Chicago Booth Review Podcast, where we bring you ground-breaking academic research in a clear and straightforward way. I'm Hal Weitzman, and today, I'm talking with Chicago Booth's Matt Notowidigdo in the second of two podcasts about his new book, Better Health Economics: An Introduction for Everyone, co-written with Boston University's, Tal Gross. Matt Notowidigdo, welcome back to the Chicago Booth Review Podcast.

Matthew J. Notowidigdo: Yeah, thanks for having me back.

Hal Weitzman: We had so much fun with you last time, and there was so much more from your amazing book to discuss that we had to ask you to come back. So this time, I want to think a bit more about public policy and the performance of health systems. So let's start with this. What do you think is the best way to measure the success of a health system? Is it patient outcomes? Is it cost? Is it life expectancy? Is it waiting times?

Matthew J. Notowidigdo: Yeah. That's a great question. Let me just start by saying how our current public health insurance system in the US does it. So we have Medicare, public health insurance for the elderly, Medicaid, public health insurance for low-income households. In those two health insurance systems, there's private plans that offer health insurance, and those private plans get paid by the state and federal governments. Those plans get star ratings. They look like report cards. So you could pick a three-star plan or a four-star plan or a five-star plan. I think it's really interesting to ask what should go into those ratings? What makes a plan a good plan? The way that the Medicaid and Medicare agencies have thought about this is define a set of health outcomes and healthcare utilization that they think represent indicators that the patient is getting good quality care.

So just as an example, there's certain types of preventive care that patients should be getting, and so therefore, a good healthcare plan should do a good job encouraging the plan enrollees to get the right types of preventive care, whether that's a flu shot, a colonoscopy, a mammogram, et cetera. That's one example. Another would be for people with chronic diseases, making sure that those chronic diseases are being managed appropriately. If you have diabetes, are you getting regular checkups? Is your HbA-Ic being measured regularly and is it not continuing to increase? If you have hypertension, are you getting the right medications? Things like that.

So I like focusing on these measures because maybe it's not ultimately what the patient cares about, but they're useful proxies. I liken it to test scores. I don't want my kids to only care about their test score, but I'm happy to have them evaluated partly based on their test scores, because the hope is that that's a proxy for the actual learning that they're getting in school. So I view these metrics as proxies for the quality of care that the patients are getting, and you'd use those as inputs into rating plans. And then hopefully consumers, when they see whether this plan gets good ratings or not, then they can make informed decisions about which plan they should be signing up for.

Hal Weitzman: Okay. So I guess the big question what people would have is, is the US system better than other advanced economies, or is it worse or is it pretty comparable?

Matthew J. Notowidigdo: Yeah, that's a big question. So let me give one indication that it's worse, which is just looking at how much money we spend compared to our health outcomes. In particular, life expectancy in the US has been diverging from virtually every high income European country over the last several decades. So that looks like we're spending more and getting less. So then that makes it look like our healthcare system is worse.

One reason why I think that a lot of people I think are a little too quick to jump to that conclusion is that I think there's a lot of reasons to think that our poor life expectancy outcomes originate from lots of other problems unrelated to our healthcare systems. So when you actually look in the cause of death data, you see things like gun violence. Actually, if you look in the top 10 causes of death in the United States, homicide makes the top 10. United States is the only high income country for which that's the case. So we're losing some life expectancy for reasons that are probably not really about the quality of our doctors and hospitals.

Another sense in which I think the US healthcare system looks like it's delivering pretty good outcomes is when you narrow in on specific procedures like treatments for heart attack and cancer, we look like we're doing at least as well as other countries. Or to give another example, if you're a low birth weight baby and you're born in the United States versus being a low birth weight baby born in a European country, looks like the US health outcomes are at least as good, maybe even better than most high income countries in Europe. So you can find certain instances where it looks like when you're actually looking at the care that the patients are getting, the quality of that care looks at least as good. It's also more expensive, though, to go back to what I said before, but so then you wonder, well, why isn't that translating into bigger increases in life expectancy?

And I've come to believing that this is really just often outside the healthcare system's control. It's behavioral decisions that we're making. It's lifestyle choices. It's maybe just stress. I've been seeing some emerging evidence about one of the strongest predictors of life expectancy is loneliness. Now, admittedly, this is correlational, but it's intriguing because it suggests maybe in the United States we're spending a lot in healthcare, healthcare system's working all right, but our life expectancy is so low because we're lonely. Again, I don't know what the hospitals can do about that. So it's somewhat broad answer to the question, which is that I think when you look at what the hospitals are actually doing and how they're actually caring for patients, I don't think our healthcare system does a bad job.

Hal Weitzman: You would be intriguing to have a healthcare system that did consider gun violence to be a health issue.

Matthew J. Notowidigdo: Yeah. My health economist professor when I was a graduate student, John Gruber, I think was interviewed by UChicago Economist, Harold, and he claimed that this is a mistake that health economists are making by not thinking about guns as a public health issue. And I think it's an interesting perspective.

Hal Weitzman: Okay. Now, just as a public policy matter, you talk in the book a lot about, very carefully lay out the argument that healthcare, it cannot be a free market, it has to be regulated pretty carefully. Why is that?

Matthew J. Notowidigdo: Well, we start with what I would call the textbook explanation for why the government needs to be involved, which is the concept of adverse selection. And adverse selection refers to the scenario where individuals know more about their health risks than the insurance company that's selling them an insurance contract. More broadly, you can think of health insurance markets as a type of selection market where the selection of which consumers end up buying your product determines the cost. I think this is a powerful idea. I think about manufacturing a television, it doesn't matter who buys the television, the cost of manufacturing. A television is just the manufacturing cost, it's the production cost.

Health insurance doesn't work that way. If you design and offer a health insurance contract and a bunch of sick people sign up, your costs are going to be a lot higher and therefore your profits are going to be a lot lower than if you design a health insurance contract and get a bunch of healthy people to sign up, then your costs are going to be lower and your profits are going to be higher. This idea helps explain, I think a lot of the ways that you see health insurance companies competing for consumers in settings like Medicare, where the plans are competing for consumers. So Medicare plans offer free gym membership sometimes. Why would you have a free gym membership? Well, maybe it's because the gym membership's going to make people healthier, and if they're healthier, their healthcare costs are lower. The evidence doesn't seem to point into that direction, but rather offering a free gym membership tends to attract people who are going to be healthier anyway and are going to have lower expected costs and therefore be more profitable for the insurance company.

So I'm giving these as examples of the fact that the selection of people into plans determines costs, and that turns out to make it very difficult for a completely unregulated insurance market to operate efficiently. So this is the textbook rationale for why the government should be involved, because otherwise the insurance market itself can be very unstable. It can unravel in the sense that individuals who want to buy insurance aren't able to find affordable insurance. I think it is fair to say that this was the intellectual rationale for things like the health insurance mandate that was part of the Affordable Care Act or Afford of Obamacare, which was essentially requiring everybody to purchase health insurance. Otherwise, they would be faced a penalty.

The reason why a mandate makes sense is that if individuals are not buying because of adverse selection, then insisting that everyone buys is a way of solving the adverse selection problem. So we go through all of that in the chapter in the book, and I think that it's important because it's a textbook rationale and it's important because of the intellectual history that this is a lot of how health economists think about how the government should be involved.

But we also have another chapter in the book that talks about, I think a distinct rationale for why the government should be involved, which we term the Samaritan's Dilemma. I think we all know what good Samaritans are, but what the government does in the United States is that if individuals don't have insurance and they have an emergency and they go to the hospital, the hospital has to treat that patient. Now, this is just basic medical ethics, but it also comes from a congressional mandate. The congressional mandate is that hospitals are required to treat all patients regardless of their ability to pay, regardless of whether they have insurance. This law was passed by Congress in response to some very tragic stories of hospitals actually turning away patients that needed emergency medical treatment when the hospital found out that they were uninsured. So I think we just felt as a civilized and wealthy society, that we were not going to allow hospitals to make treatment decisions that were life or death decisions just based on whether the person had health insurance or not. Okay.

So that's the background. But if you think about that like an economist or just someone who's being maybe very strategic or rational about it, then you might say, "Well, there's no point in me getting insurance because I know that if I ever have a medical emergency, I can just go to the emergency room and get taken care of. So in a way, my demand for insurance is being crowded out by the fact that the government is mandating hospitals to take care of me anytime something serious happens." And I think that there is some evidence that there are some uninsured individuals that actually think about things this way, and we describe this as a Samaritan's Dilemma because the government can't commit to not treating you in the event that you get very sick and you've chosen not to have insurance.

So I think a different rationale that one that I think is at least as important in explaining how we got to where we are, a distinct rationale for why the government needs to be involved is that the government's already involved by requiring hospitals to treat patients, whether they're an insured or not. Given that the government's already being involved, the government also needs to then think about what's the best way of financing it. And at the end of the day, the best way of financing it might be for everybody simply to have insurance in the first place. That's really where most of the rest of the world has gotten because most of the rest of the world, every other high income country in the United States has virtually universal health insurance.

And if you asked me, is that more about adverse selection or is it more about solving this Samaritan's dilemma? I've increasingly come to believe it's really about the latter. The government wants to essentially have a social contract that we will care for you no matter how poor you are in the event of an emergency. But in exchange, everybody's got to have insurance up front in the first place. That's just part of the social contract.

Hal Weitzman: But talking about the government involvement and to what extent and what is the rationale, it makes me as a raise in the UK where we have free universal healthcare paid through our taxes, wonder why a public system wouldn't just be solve a lot of these problems.

Matthew J. Notowidigdo: I mean if you ask me to speculate about where the US will go in the future, it will probably be a system where individuals universally have access to a publicly funded insurance system. So that could either be something like Medicare for all or something like Medicare for all who want it, which was the slightly different version that Mayor Pete came up with when he was running for president against Senator Warren who was pushing the Medicare for all. In that system, it's basically taxes pay for public health insurance, and then everybody has an option to either sign up for Medicare, or they can keep whatever insurance they already have. And I think that system, if I'm correct, that we gradually transition to that system in the United States, it will start to look much more like what you see in other countries because then you will have achieved genuine universal insurance, but you will still have a mix of public and private insurance plans.

What's maybe distinctly American is that even in our public insurance plans, we allow private firms to come in and compete against each other for consumers. So in Medicare Advantage, which is the part of Medicare where private insurance plans can do things like offer gym memberships, as I described just a little bit ago, Medicare Advantage has been gaining in popularity and is now a majority of all Medicare enrollees. So I don't see that changing anytime soon. The reason why I'm describing this as uniquely American is that it takes our idea of managing competition, having private firms hopefully having an incentive to both cut costs and increase quality through the beneficial effects of competition for consumers. And if that's right, then I expect that we'll continue to see that system growing and potentially someday it might even have people under 65.

Hal Weitzman: If you're enjoying this podcast, there's another University of Chicago podcast network show that you should check out. It's called The Pie. Economists are always talking about the pie, how it grows and shrinks, how it sliced, and who gets the biggest share. Join host Tess Vigeland as she talks with leading economists about their cutting-edge research and key events of the day, hear how the economic pie is at the heart of issues like the aftermath of a global pandemic, jobs, energy policy and much more.

But you talk about public insurance, I mean vast private insurance companies dominate the US health care system. So I understand what you're saying. We are moving towards to have universal coverage covered by public insurance, but do we need to have large private insurance companies at the heart of the system?

Matthew J. Notowidigdo: That's another big question that I think it's probably one of the things I'm most excited to see more research on going forward. Yeah. The question on the table is do we need to have a handful of large private insurance companies dominating the insurance landscape in both the private insurance market and Medicare and Medicaid? Yeah. I'm of multiple minds. I guess like a typical economist. One reason why I have some room for optimism is that I did get a chance to work with some of these large insurance companies in the aftermath of the pandemic, and I found them incredibly sophisticated in how they thought about getting their plan members to make decisions that were both good for their own health and good for the insurance company's bottom line. Just take as an example, like individuals with diabetes, getting individuals to manage their diabetes better can potentially save a huge amount of money on the back end, but it's also good for the patients themselves.

Why aren't patients already managing their diabetes? Well, maybe you could interview some of our Booth colleagues in behavioral sciences. It's probably just a psychological mistake. It's inattentiveness. It's present bias. It's forgetfulness. Who knows? But a lot of people are just not able to make the right commitments and build the right habits to manage their chronic diseases effectively. And if an insurance company with the incentive that this is saving them money and therefore increasing their profits down the line, is able to figure out the best way to get you to do what you probably want to be doing anyway, then that feels like the big potential win-win. And I only want the private insurance companies to be involved to the extent that I become increasingly convinced that they're actually doing that and are good at it. That's the way that I'd like to answer it.

One of the examples that I think is already a clear success is on flu shots, for example. So the insurance companies are very good at nudging you to get a flu shot, and they know that it's good for them to nudge you to get a flu shot. It saves them a bunch of money on the backend because getting hospitalized with the flu or going to the ER with the flu is thousands or tens of thousands of dollars. And if they can just get 100 people to get a flu shot to avoid one of those expensive hospitalization visits, it's worth it.

So it's not like they want to make the flu shot free. They want to be paying you to take the flu shot. So I enjoy hearing about the ways that these large insurance companies are trying to experiment with this because it could be both good for population health. And then they also learn about what kinds of interventions actually save money down the line. In the best case scenario, they could actually learn about what types of preventive care are actually cost-effective and what types are not, because they're the ones with the money on the line.

Hal Weitzman: Matt, you talk in the book about there's not much price shopping when it comes to healthcare in the US. That made me wonder, would that be an answer to some of the problems that we have? So if we were libertarians, we might say, "Get rid of mandatory insurance. Force hospitals to be completely transparent about how much procedures cost. So you really could shop around and you could have Yelp reviews and everything else, but you'd know exactly what you were getting."

Matthew J. Notowidigdo: Yeah. That's a neat hypothetical to think about. I mean, two issues I want to highlight. First is, an issue that's a bit specific to health insurance, which is just that when we talk about price transparency, is it the price that the insurance company is paying the hospital, or is it the price that consumer is paying? Because of course, insurance changes the price. I took my daughter to the emergency room a couple of weeks ago, and the price that the insurance company paid the hospital was thousands of dollars. The price that I paid was a couple of hundred dollars.

So do you want me to know what price I'm paying or do you want me to know the price that the hospital is charging? A lot of these, so-called price transparency initiatives are the hospitals posting their prices, but I never pay the hospital's prices because I have insurance. So it's targeting the wrong thing. You want to target what's the consumer actually going to be paying, and then maybe the consumer can make a more informed choice. And I think there's some interesting examples of that that are being tried out in different insurance settings.

Another important point I want to make at the outset that's not specific to is that in general, making prices transparent could either be good or bad for consumers and health economists have lots of different examples from other industries that they like to talk about. So one of the examples comes from when retail gas stations started posting their prices, it actually did not lead to reductions in prices. It led to increases in prices because it just let the gas stations tacitly collude with each other and keep their prices high. But if you make it easier to shop for prices online, that seems to lead to lower prices because then consumers can shop around.

So at a very high level, one way of thinking about this is that, anytime you make it easier to see prices, is that likely going to be beneficial to consumers or is it going to be beneficial to the firms? Who's going to care more about the fact that now the prices are more readily available? And this is my concern about a lot of price transparency initiatives in healthcare is that if hospitals, you make all their prices very transparent, then the hospitals might all figure out a way to coordinate very high prices. Because again, why do the consumers care about the hospital prices? The consumers just care about what they have to pay out of pocket.

Hal Weitzman: Well, I was imagining a world where maybe we got rid of insurance so that it's really you're self-insured, or at least you had that option. So I could say, "I'm going to keep all the money and bet that I'll be okay."

Matthew J. Notowidigdo: Well, I think there's lots of types of healthcare where maybe we should do that. Think physical occupational therapy, mental health, think about... I mean, there's already some types of healthcare that people pay out of pocket. Dental care, it could be mostly out of pocket. These are all relatively small stakes. In an economic sense, these are not large financial outlays. So maybe why use insurance for that? Let the consumers pay entirely out of pocket. If they're paying entirely out of pocket, then they might care more about how much they're paying and whether that money is being spent well, and then you'll have price shopping. So I mean, I think that hypothetical makes sense. That of course, is not going to work for emergency room visits. It's not going to work for hospital visits.

In the data that I collected when I was a graduate student, the typical hospitalization costs about 20 to $30,000. I don't think it's realistic to think that the typical American household's going to be able to pay for that out of pocket. So they need insurance. But then once they have insurance, well, now how do we get them to price shop across hospitals? How do you direct the consumer to use the low cost high quality hospital and not the high cost low quality hospital? And again, insurance companies come up with some pretty interesting ways of dealing with that. For example, just excluding certain hospitals, doctors and providers from their network. Now, you could go to that hospital, but it's going to be out of network.

The controversy is sometimes really good hospitals get excluded from that network, and then the consumers get very frustrated with good reason, because I have insurance, and yet I can't use insurance at this hospital they want to go to. And it's not because this hospital is a lot more expensive, it's just the insurance company is not letting me get access to it because they feel like they only want to restrict me to going to the cheapest set of hospitals available. And maybe I'm quite unhappy with that.

Hal Weitzman: Now, we talked last time you were on the pod about how it's hard to become a doctor in the US. You can't import doctors. It's very difficult to bring medical staff from around the world like we do in the UK. And that's one reason why doctors are so well paid because there's a restricted supply. And you talked about how some of your doctor friends haven't liked it when you've pointed that out. And that's one of the reasons perhaps why it takes so long to get an appointment sometimes. So I guess from a public policy perspective, should we loosen up those rules? Should we allow more doctors to come in from other countries? Should we make it easier to become a doctor?

Matthew J. Notowidigdo: That's interesting. The immigration sounds interesting to me, but I hesitate to speculate because that's a bit outside my expertise. One thing I have been reading about and thinking about is that instead of trying to create more doctors and import more doctors, another thing we could think about is letting other people in the healthcare system do things that they're trained to do that doctors also happen to do right now. This is typically described as loosening up the scope of practice restrictions on other healthcare workers like nurses, physician assistants, other types of aides. They're training allows them to do more things than they're often currently able to do in many states. And that means, you are waiting around for a doctor because only a doctor's able to do it. So one thing, if I was in charge, one of the things I'd be really interested in experimenting with is loosening up scope of practice restrictions so that physician assistants and nurses can do more of what they're trained to do to treat patients.

Hal Weitzman: But just to be clear, is the reason those restrictions are so tight because of the medical lobbying by the doctors?

Matthew J. Notowidigdo: My understanding is that, yeah, the health economist consensus would be that these scope practice restrictions are primarily there because the doctors are lobbying for it and because they perceive that it benefits them.

Hal Weitzman: It's like not being change a light bulb unless you remember the union or whatever.

Matthew J. Notowidigdo: Exactly. No, I think the analogy is appropriate, but we don't think that those are good regulations either. So the reason why I'm emphasizing this is just that we already have this workforce of healthcare workers that are trained to do more than what we're currently letting them do. So if there's a way to basically fight back against the lobby that doesn't let these workers do what they're trained to do, you might be able to both increase access, reduce waiting times, and it likely would have the effect of ultimately reducing physician salaries and increasing relatively the salaries of the other healthcare workers. So I think that's interesting to experiment with. I do see some states moving in this direction, so it'll be interesting to see if others follow.

Hal Weitzman: Okay. Now, because it's healthcare economics, a lot of your book is about financial incentives and how they've, maybe, I don't want to put words in your mouth, but warped shaped perhaps the American healthcare system. The drugs you get, the procedures you get, how long your hospital or care stay is. Talk a little bit about that and what we can do maybe to improve some of those. Well, you talk about some of the things that have been done, the reforms that have improved those financial incentives.

Matthew J. Notowidigdo: Sure. Yeah. I should say I use this book in the class that I teach here at UChicago. So I teach a healthcare economics class to our MBA students, and I was talking with one of them after class earlier this week, and he said that this focus on the financial incentives and all the different ways that doctors game these incentives. He found it sad and depressing. He didn't think that that's how doctors behave. He didn't think that they would choose one drug over another drug just because it was more profitable for them, even if it wasn't in the best interest of the patient, or he didn't think that doctors would be overusing C-sections over pushing for vaginal deliveries just because the C-sections paid more.

And I think that reaction makes sense. But I told him that I didn't quite see it quite that in a depressing light because I see it as making doctors human, because the thing that we economists believe is that lots of humans respond to incentives. And I think in some sense, doctors do miraculous work. I have some examples in my own course of just showing doctors literally save lives when we're talking about things like cardiac catheterization or bypass surgery after a heart attack. I mean, it's miraculous what they do. And maybe because it's miraculous, we anoint them in other ways and think that they're immune from responding to financial incentives. And in some sense, a lot of chapters in the book are just example after example of just showing you that doctors respond to financial incentives just like the rest of us. They just happen to be working in a sector where sometimes they're life or death decisions as well.

Hal Weitzman: So because it's all about financial incentives, as you rightly say, and doctors are human and they respond to incentives, talk to us a little bit about some of the positive things that have happened in US healthcare. And you mentioned in the book bundled payments and reference pricing, explain those terms and how they've improved things.

Matthew J. Notowidigdo: Yeah, definitely. So a bundled payment refers to a payment that covers multiple services or products that you would get in a healthcare encounter. So one of the examples that we talk about is Medicare pays for dialysis treatments. And when you go to get a dialysis treatment at a clinic, sometimes the patient will also be treated with some additional drugs like an EPO drug that would treat anemia, for example. And in the past, what Medicare would do is Medicare would have a separate payment for the dialysis treatment as well as a payment for the drug. And what they found is that when you pay these two separate payments, the doctors had this tendency to overuse or overprescribe the drug, even in cases of where it probably wasn't medically necessary for the patient. In fact, in some cases it may have even harmed the patient, although probably slightly.

So Medicare was concerned that this financial incentive that they had created in the fee for service system had led to excessive use of this drug. So what they decided to do is they created what they called a bundled payment where you would get a single payment for every dialysis patient, whether or not the clinic treated that patient with the additional drugs. And the reason why that helps align the incentives is that now the physicians will only use the drug in cases where it's clearly going to benefit the patient because it's directly reducing their profits, because now they don't get any additional payment from prescribing the drug. They get this larger bundle payment, and those profits now are higher in the event that I don't use the drug. In a sense, it's changing the default from using the drug and getting paid more to not using the drug and getting paid more.

And the reason why that is likely to help is that doctors have a basic medical ethics that will not let them withhold a drug in a case where it's clearly beneficial. So they're still going to do it, even though it's sacrificing profits. What they were doing before, is they were using the drug when it didn't harm a patient in a way that was giving them extra profits. So I like this example is a way of just by redesigning the incentives and changing the defaults, you're able to get the doctors to have incentives aligned in a way that lets them make better decisions for the patients in a way that also enables them to respond rationally to the financial incentives that Medicare has designed in the first place. So that's one example. Another example that you mentioned in the question was called reference pricing. And I guess it connects to our earlier discussion about consumers price shopping.

So the way that reference-based pricing works is that suppose a consumer needs a knee replacement or a hip replacement, they could choose which facility they want to go to, and those facilities might have different prices. Now, the insurance company might want to try to direct the consumer only to the facilities that are charging relatively low prices. So the way reference pricing works is that anytime the consumer goes to a facility that's in the lower parts of the price distribution, then the consumer is completely covered and they just pay their co-payment. Anytime they go to one of the more expensive facilities, they have to pay the gap between the reference price and the price that that facility is charging. This has two consequences.

First, consumers are now going to try to double check that they're using a facility that's compliant with the reference based pricing scheme, and any facility that's not charging a price that's at or below that reference based price, now has an incentive to try to cut their price so that they can attract consumers who are only going to go in the event that they have insurance. This seems like it works well in certain cases. You wouldn't want to do it in situations where you're very concerned about sacrificing quality. You want to do it for relatively standardized procedures. But it's a neat example of how the consumers once they're empowered to do some price shopping and make sure they're using providers that have prices below a reference point, is actually able to save quite a bit of money. So my recollection is that the insurance company was able to save about 20 or 30% of their costs for this particular procedure just by tweaking these incentives in this way.

Hal Weitzman: Okay. So we can use financial incentives for good in healthcare to get better health care. Matt Notowidigdo, thank you so much for coming back to the Chicago Booth Review Podcast.

Matthew J. Notowidigdo: Thanks for having me.

Hal Weitzman: Great having you. That's it for this episode of the Chicago Booth Review Podcast, part of the University of Chicago Podcast Network. To read an excerpt from Matt Notowidigdo's and Tal Gross's book, go to our website, chicagobooth.edu/review. When you're there, sign up for our weekly newsletter so you never miss the latest in business-focused academic research. This episode was produced by Josh Stunkel. If you enjoyed it, please subscribe, and please do leave us a five-star review. Until next time, I'm Hal Weitzman. Thanks for listening.