Timothy Layton
@timothyjlayton
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E-cargo bike Dad, avid run-commuter. Assoc Prof of Pub Pol and Econ @UVABatten , @nberpubs RA, and @JPAL . Via @HMSHCP @bu_economics and @BYUecon .
Charlottesville, Virginia
Joined May 2009
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Many twitter comments from ppl upset about masks going optional in schools.
So, in spirit of providing balanced content on here, I'm sharing my excitement that my Kindergartener will be able to attend school maskless for the first time in his life. We are thrilled!
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What have we done to our kids that in their minds masks are a signal of morality?
Maybe we should consider whether our pandemic moralizing and virtue-signaling has done real social damage to our children, damage that we need to start thinking about how to fix.
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And yes, we have an unvaccinated baby in our house, and no, we are not concerned about him at this point. Risks are exceptionally low for him.
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On the other hand, my dyslexic Kindergartener who already faces incredible obstacles to learn to read and write has had to spend most of his K year with an additional obstacle to learning. One that is now going away!
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So dumb. I suggest that every university have one in-person class exclusively for foreign students that meets "face-to-face" once a month in a giant field for approximately 1 minute.
And that that course be entirely focused on strategies for ruining Stephen Miller's life.
A new ICE rule says international students in the US on visas will have to attend face-to-face classes or leave the country. This is a wildly horrible idea in the middle of a global pandemic. Call your representatives. Make some noise on behalf of a group that has few protections
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To be clear, I am not anti-mask! But the costs vs. benefits for young children have never been clear to me, and at this point it seems like time for us to start to let them take the masks off, especially in Arlington, MA where the vax rate for 5-11 year olds is >90%.
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My controversial (and not sarcastic) opinion about real analysis and econ PhDs:
Real analysis shouldn't just be required for econ PhDs but for *all* college grads. Actually, make that *all high school grads*.
Hear me out. A thread on why:
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Some good news today:
I bid the weird title of "Assistant" Professor farewell (who was I assistant to?) and take on the role of Associate Professor of Health Care Policy
@HMSHCP
.
Thanks to all those who have helped me along the way!
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But again, looking back on our decisions during the pandemic, it is just shocking how little weight we as a society placed on childrens' welfare, especially that of the most disadvantaged kids.
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On another note: When we told my older son we were thrilled about the removal of the mask mandate, his response was to be shocked that we were happy about this: "Wait. I thought not wearing masks was bad."
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Headline finding: Children born in August are 32% more likely to be diagnosed with ADHD than children born in September in states that have a 9/1 Kindergarten age cutoff.
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My out of the office message for the rest of the month:
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I just don't get it. The study showed that there was no effect of the endorsement on people's views of the candidates, but it made conservatives distrust science, right?
This implies that the *only* value of the endorsement is virtue-signaling, not "fighing for what's right".
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Out today in AER: Insights, my paper "The Liquidity Sensitivity of Healthcare Consumption" with
@talgross
and
@prinzdani
We show that Medicare prescription fills spike on social security paydays for those facing very small copays ($2-4) but not for those facing no copays.
The June 2022 issue of AER: Insights (4, 2) is now available online at .
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My students are the best.
Yes, that is an M&M dispenser filled with M&Ms that have health econ terms printed on them. Couldn't imagine a better gift!
Best part is that you actually have to put a quarter in to get candy out "in order to limit moral hazard".
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Today is my first day as faculty at
@UVABatten
. Super excited to start this new phase of my career in beautiful Charlottesville, Virginia with my terrific new colleagues from across this world-class university.
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🚨 New paper alert 🚨
"Are All Managed Care Plans Created Equal? Evidence from Random Plan Assignment in Medicaid"
with
@MikeGeruso
and
@jwswallace
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And now for your evening commmute 🚨NEW PAPER ALERT 🚨
New work with
@AnupamBJena
,
@ml_barnett
, and Tanner Hicks in
@NEJM
on age at school entry and diagnosis and treatment of ADHD out this evening.
Link to article:
Initiate thread.
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Oh the joys of NIH reviews:
Regarding our IV strategy - "use of the word non-compliance and compliance is off-putting and seems to be valuing a preference with negative language."
🤦
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Proud to report that my first PhD student successfully defended her dissertation today! Congratulations Ellen Montz!
Ellen's leaving academia to go be the chief economist of Virginia Medicaid. Couldn't imagine a better way to put her new PhD to use improving the world!
[1/n]
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After 10 wonderful years at
@HMSHCP
, yesterday was my last day. HCP is a very special place to be a health economist, and I can't imagine a better place to start my career. I'll forever be in debt to my many colleagues, mentors and friends there.
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I want to take this even a bit further by sharing a story about our experience fostering a 2-3 year old during the pandemic:
Our foster son (now back with his parents) had serious speech delays, likely due to the trauma of being removed from his parents.
Many twitter comments from ppl upset about masks going optional in schools.
So, in spirit of providing balanced content on here, I'm sharing my excitement that my Kindergartener will be able to attend school maskless for the first time in his life. We are thrilled!
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And I know that some are going to push back saying "not everyone is good at, or enjoys math". But I would push back and say that 95% of people have no idea what math even is because they've never actually taken analysis.
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I could just stop here, but I really do think real analysis is the first actual math course I ever took. It taught me to see math as a language rather than a set of tools. And it showed me that it is a language that is capable of things that no other language can accomplish.
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🚨 NEW PAPER ALERT 🚨
Private vs. Public Provision of Social Insurance: Evidence from Medicaid
w/
@NicoleMaestas2
Daniel Prinz and
@borisvabson
@nberpubs
WP link:
(longer, Texas + New York) RDRC WP link:
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If you think zoom school is bad, try zoom early intervention with a 2 year old...
Seriously, it is shocking that anyone thought/thinks that zoom EI is anything but worthless...
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🚨 JOB ALERT 🚨
I'm hiring a full-time RA to work with me,
@MikeGeruso
, and Vilsa Curto starting this summer on projects related to the economics of health insurance markets. Spread the word to anyone looking!
See info here:
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Real analysis taught me the rules of logic and how to use them better than any of the several philosophy classes I took did. it gave me the ability to precisely state assertations and the tools to go about proving/disproving those assertions.
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Ok everyone. By popular demand, here's the Beamer PPT template. Go signal your hearts out while also being able to easily drag and drop images and draw figures without using tikz!
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🚨 NEW PAPER ALERT 🚨
"The Two Margin Problem in Insurance Markets"
w/
@MikeGeruso
, Grace McCormack, and Mark Shepard
We develop a graphical model of adverse selection on both the intensive and extensive margins. My favorite of my current projects.
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🚨 Call for papers 🚨
NBER Conference on Machine Learning in Healthcare, organized by
@Cutler_econ
and me. Virtual meeting on Jan 15.
Submissions from non-NBER affiliates, fields outside of economics, and the healthcare industry are encouraged!
Deadline for submissions Dec 11.
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Got shot
#2
last Friday (we qualified because we're foster parents). What a relief. Here's to you pharma!
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I have a thought about the new econ/epi debate spurred by my colleague
@AnupamBJena
's recent NY times op-ed. Thought comes from my last few years as econ faculty in a soft-money department at a med school, a similar environment to that of most epis but different from most econs
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The zoom-only EI option persisted for a long, long time. To the point that at some point we just gave up.
I just have to say that if you think EI is actually useful for children, you should be *very* worried about disadvantaged kids post-pandemic.
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Big loss for CMS today:
[Initiate long but important MA upcoding thread]
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Alongside causal inference, I'm not sure there is a more valuable course that we can teach in college.
I'm generally of the opinion that it is academic malpractice to offer a "liberal arts" degree with philosophy courses but without real analysis.
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It was definitely a difficult course. BUT, it was probably the most eye-opening and fascinating course I took in all of college.
I mean, to learn that there are multiple kinds of infinity? That's probably the coolest thing I learned in 4 years of college!
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Guys, if you ever get the chance to give a talk at
@BYUecon
definitely do it.
Thanks to
@Richwpatt
and
@PaulEliason2
for taking me on the most gorgeous mtn bike ride ever yesterday. I'm 100% destroyed, but still smiling.
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But our results were just so clean and perfect, we couldn't bear throwing in the towel. So, we submitted to NEJM anyway, and it was accepted! So all you researchers out there who do really great work that you're proud of and then find out it's already been done, there's hope!
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How can the *editor of science* believe that virtue-signaling is more important than communicating science to people of all worldviews??
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Online teaching thread:
In the phd applied metrics class I teach I often ask a lot of questions to try to get students to make connections on their own and build intuition. I was pretty concerned about how this would work when teaching online.
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Waited 2 hours to get us all jabbed. Happy birthday to me. Maybe we can reconsider requiring that kids only get shots from PEDIATRIC nurses, making us all wait forever for one of then to be open?
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I should caveat this and say that all of these benefits only come if the course is well-taught. I was lucky enough to take this course from a math education prof at
@BYUMath
whose job was to figure out how to teach math better. Everyone should have that same opportunity.
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@KelliMarquardt
Long ago, I interviewed with Daron Acemoglu for an RA position to help him with a textbook. He told me to go read all of Malcolm Gladwell's books because economists needed to learn to write like him, especially for introductory materials.
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I really think the problem here, with health policy as whole, is severe myopia.
The real problem is an unwillingness to acknowledge that a $ spent on healthcare is a $ not spent elsewhere, and that society would often be better off if we spent the $s elsewhere.
The comments on this thoughtful thread are exhibit A for the case that economics should be taught in med school.
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Instead, they think math is a set of rules they have to memorize and then implement. But it's so much more than that, and analysis was where I learned that.
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Finished a few drafts over the last few weeks, so I decided to "reward" myself with a classic white mountains sufferfest today.
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Children born in August are the youngest in their class, while children born in September are the oldest, suggesting that ADHD diagnosis is strongly influenced by a child's age relative to his peers.
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Just another thought for the phd admissions discussion: Why aren't there more prestigious "applied econ" phds at top schools? Programs like Wharton's applied phd or Cornell PAM. Folks out of those programs seem to place very well.
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🚨 NEW PAPER ALERT 🚨
The Incidence of Adverse Selection: Theory and Evidence from Health Insurance Choices
with
@MikeGeruso
and Adam Leive
Available here:
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I often tell people that grad school taught me to be a good econometrician, but Tom McGuire taught me how to be an economist. Huge congratulations to a most deserving mentor, teacher, and friend.
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Thanks to
@KelloggSchool
for hosting me for my first in person seminar in almost 2 years. What a terrific group (and view)!
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The comments on this thoughtful thread are exhibit A for the case that economics should be taught in med school.
I have mixed feelings about this
@propublica
piece. No question UnitedHealth looks very bad.
But what are insurers supposed to do for unusual, extreme medical use? Often it is not justified at all. The costs are then just passed on to us.
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As
@jwswallace
said before, all the credit for this goes to
@IDegtiar
and
@sherrirose
who drove this paper, building off our prior work with
@MikeGeruso
.
I'm so lucky to work with such great people who take my lame water-cooler ramblings and turn them into award-winning papers!
Congratulations to
@TimothyJLayton
, a winner of The Willard G. Manning Memorial Award for the Best Research in Health Econometrics.
Learn more about the ASHEcon Awards here 👉
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This is a weird NPR story about big data and health insurance.
[Thread]
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Our paper on liquidity and healthcare consumption (joint w/
@talgross
and
@prinzdani
) forthcoming at AER: Insights. We provide clear evidence that low-income households delay drug consumption until they receive their social security checks.
Forthcoming in AER: Insights: "The Liquidity Sensitivity of Healthcare Consumption: Evidence from Social Security Payments" by Tal Gross, Timothy J. Layton, and Daniel Prinz.
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New
@nberpubs
WP by me & Mike Geruso: Selection in Health Insurance Markets and Its Policy Remedies (summ below):
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So why should we deprive people who have historically hated math from learning that it is soo different from the thing they've grown to hate? We should at least give them the opportunity to learn real math, and I think the best way to do that is requiring analysis.
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A good place to start would be to stop referring to physician payments as "reimbursement"...
@TKO_Hayes
@BudgetHawks
Cannot emphasize enough that we must not assume payment should cover costs. Costs need to fall (or rise more slowly) so that the system can be fiscally sustainable.
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NBER working paper title of the year: "Subways and Urban Growth: Evidence from Earth"
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Joke's on reviewer number 2 who said the counterfactual simulation eliminating risk adjustment entirely wasn't policy relevant.
The Trump administration is expected to suspend the ACA’s risk-adjustment program, which plays a major role in the health law’s markets via
@WSJ
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@MarcGov
Tell your friend that under mass law, it is unquestionably the driver's fault. Happened to me years ago and driver's insurance co threatened to sue me for damage to car. I found a lawyer, sued them and won a nice settlement.
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Those speech delays necessitated major speech therapy and early intervention services. But during the pandemic all of these services were either unavailable or only available via zoom.
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@AprilBurrage
I have a fake beamer ppt template if this is purely for signaling purposes. Seriously looks just like the real thing. Always fun to throw some ppt animations partway through to blow everyone's minds (though that also gives you away). Let me know if you'd like the file.
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What we can say is that our results provide clear evidence ADHD diagnosis AND treatment seems highly subjective and context-specific. This seems troubling given that the long-term consequences of ADHD drug treatment seem somewhat uncertain.
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In this
@nytimes
op-ed piece,
@AnupamBJena
,
@ml_barnett
and I explain our
@NEJM
study showing that kids who are young for their grade are much more likely to be diagnosed with ADHD.
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This weekend I heard that not one doc in the MGH ED has gotten COVID. My response was:
Doesn't that mean that we're devoting too many resources to you guys and not enough to nursing home employees that are transmitting this thing left and right, resulting in massive mortality?
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Another new administrative burdens NBER WP this week!
This time on how they impede take-up of subsidized health insurance, joint with
@ProfKMEricson
@onceuponA
@asacarny
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High drug prices get so much more attention than high cost sharing. Important to note that the causes of these two things are likely to differ!
For cost-sharing, we need to ask, what incentive do insurers/employers have to provide generous coverage for high cost drugs? 🧵
Everyone coming out against patient assistance programs must also reckon with question of why we’ve allowed cost sharing to get so high.
We’re clearly at a negative equilibrium.
What does a 4 digit cost sharing payment do other than unwind benefit of insurance product? (1/2)
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New paper out today, joint with
@zarekcb
@Samantha_Burn
@borisvabson
The tease: In some cases removing admin costs would actually *raise* overall healthcare spending, even when those admin costs are some of the most hated and most prevalent - prior authorization restrictions.
Wherein
@Samantha_Burn
@timothyjlayton
@borisvabson
and I take on the unenviable task of defending medical paperwork:
"Rationing Medicine Through Bureaucracy: Authorization Restrictions in Medicare"
on NBER:
and ungated:
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5 years later, Ellen finally figured out how to get access to the ACA Marketplace microdata she needed to finish her JMP: Take over the agency responsible for it.
Talk about going the extra mile to finish a paper...
Again, can't imagine a better person for this job!
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We interpret the results as suggestive evidence that teachers and parents experience cognitive biases when assessing the likelihood of ADHD. Instead of considering how a child's behavior compares to normal behavior for his precise age (in months)...
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Come to our info session about this terrific PhD program! Economists, send your RAs and students!
The economics track of our program provides world-class training and advising in economics, comparable to a top econ phd program. Come see for yourselves!
(a few add'l notes below)
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New JEP paper by me and Mike Geruso on selection in health insurance markets and its policy remedies out today:
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Told my PhD applied metrics class today that trends suggest that regression might go out of style in metrics in the coming years, due to realizations that OLS with controls typically doesn't give ATT/ATE/etc.
Learned that that's a pretty good way to induce existential dread.
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This is one of the most rational pieces I've read on COVID19:
The long-view necessarily consists of massive and persistent testing, critically in conjunction with suspension of privacy concerns so that everyone can know who was infectious when.
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New
@HarvardBiz
piece by me, Mike Geruso, and
@AnupamBJena
about how personalized medicine can interact with adverse selection to cause massive dysfunction in health insurance markets:
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Rejected:
Harvard PE&G
Princeton
Brown
Maryland
Columbia
Chicago
UCLA
UCSD
UT Austin
Accepted week before the deadline saying they'd "probably" fund me but then later said "just kidding! You're in, but no funding.":
BU
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This piece by
@Tiffany_L_Green
and
@atheendar
is terrific.
Pub health folks have argued that econs should stay in their lane during the pandemic.
But econs have a ton to offer! Econ is the study of trade-offs, and what is the pandemic but a series of critical trade-offs.
Recommended:
@Tiffany_L_Green
and
@atheendar
have a great
@NEJM
perspective highlighting what economic thinking can add to public health policy.
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We're looking for a full-time RA to join our team studying the economics of Medicaid managed care! Please pass the ad on to anyone who may be interested:
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Profound thought shared by a member of my congregation at church today:
A better society than ours would encourage people to get vaccinated and take precautions specifically to protect those *who refuse* to get vaccinated.
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Here's the money graph.
In it we plot prescription fills around payday for people about to receive their checks relative to fills for people who won't receive their checks for 2 weeks.
Red = ppl paying $2-5 copays per script
Blue = ppl whose copays are fully subsidized
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6. But you can actually do even better than that: There's a TON of unused public space in cities: Roads. The supply of roads vastly exceeds demand under a lockdown. So let's turn them into open public spaces! Because of the low elasticity, this can provide a lot of social benefit
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I'm thrilled to announce I'll be joining the faculty here in the Dept of Health Care Policy at Harvard as an Asst Prof starting June 1.
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At a minimum, it seems like doctors should pause when considering assigning an ADHD diagnosis to a child with a summer birthday and take the child's age relative to his peers into account when making the diagnosis.
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If you think exchange plans offer skimpy coverage now, just wait until they kill the risk adjustment transfers. Prepare for a quality death spiral folks.
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This
@NPR
article by
@alikodjakNPR
illustrates many of the problems with state-run fee-for-service Medicaid programs. Politics and lobbying from special interests makes it difficult to design efficient programs.
[Thread]
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Every test used on someone who is clearly sick (and whose behavior is unlikely to differ if test comes back + or -) is a test not used on a potentially asymptomatic infected nursing home worker.
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the teacher compares the child's behavior to the behavior of his peer group, *even if most of the children in the peer group are (as much as a year) older than the child*.
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Radiohead. So good. So many nerdy dads. So tired. So old...
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Most interesting thing about this paper (to academics): About 2 weeks before submitting, we found out that there are two (!) JHE papers from 2010 showing exactly what we show.
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Join us for a great slate of paper presentations in the NBER Machine Learning in Health Care meeting today at 12:20 EST!
Streaming live on youtube here:
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Shout-outs to Tom McGuire, Joe Newhouse,
@NicoleMaestas2
@Michael_Chernew
@JMichaelMcW
@Bruce_Landon
@DavidCGrabowski
and especially Barbara McNeil (as well as many others) who took a chance on me and offered me this job and then taught me so much about how to be successful.
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Fresh take on the econ publication discussion going on here.
I also have a (hopefully) constructive take on this discussion. Here it goes.
The only time I have gotten (so far, fingers crossed) invited for resubmission at a top 5 journal, it was for a sole authored paper I had presented at 1 seminar and 1 conference (CELS where few economists go).
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When does the "wow. that's great that he got the vaccine to show the skeptics that its safe and they should get it too" period end and the "wait a minute, why did he get the vaccine before me?" period begin?
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Umm... I think you buried the lede here... In 2025, instead of being in Canada, IHEA IS GOING TO BE IN BALI!
I mean, Banff is beautiful, but Bali!
I am really disappointed to announce that the International
@healtheconomics
Association has moved the 2025 Congress from Calgary to Bali. The reason: slow processing of visas into Canada. So
#Calgary
and
@ucalgary
just lost a 1500 person conference.
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Applied to: 12
Accepted at: 1 (no funding, about 5 days before decision deadline)
Waitlisted at: 0
People who have ever been in a PhD program: how many programs did you apply to and how many did you get accepted into? Waitlisted? Rejected? I thank you in advance if you’re willing to be honest about this and share!
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