By Anne M. Burton
Anne: Thank you for taking the time to do this interview and letting ASHEcon members get to know a little more about you! You’ve had a long and varied career so far working both in academia and in government. You’ve held titles including Professor, Minnesota Insurance Industry Chair of Health Finance, Associate Dean of MBA and MS programs, Director of the Medical Industry Leadership Institute, Chief Economist for Health Policy and Senior Economist on the Council of Economic Advisors, Governing Chair of the Health Care Cost Institute, and Senior Advisor to the Secretary for Health Economics in the Department of Health and Human Services.
Anne: A few questions about your background and experiences:
- How did you end up in those roles and what drew you to them? Tell me more about some of them.
Steve: Many of those roles that you mentioned are ones that I’ve taken on within the last decade or so. The one that really started that whole trajectory off was my role for the Medical Industry Leadership Institute, starting in 2006. That role really enabled me to get more engaged with other researchers around the country and develop an entire base of new alumni of healthcare-focused MBA’s. Around that same time, I also got more involved with public policy, starting as a senior adviser to John McCain’s campaign in 2008. Later, I became even more involved in policy using a micro-simulation model for health reform that I had developed from my own research earlier in 2004. The combination of those activities really put me on a trajectory to spend a lot more time and engagement in Washington D.C., at first on the board of AcademyHealth, and then later becoming involved with the Health Care Cost Institute as Treasurer and subsequently as Governing Chair. When I was working for the Health Care Cost Institute, one of my biggest contributions was to create a sustainable financial model for the Institute. The work that I did later in the White House and then HHS came much later in 2017 through 2021 and spanned pre-pandemic and post-pandemic activities. The pre-pandemic activities largely focused on getting better data access, following up on work that I was doing at the Health Care Cost Institute. I was particularly focused on health insurance claims data for health economic analysis. The COVID work started by just identifying data feeds to show how COVID was progressing in the country. Later, I took on a much more operational role working with HHS to distribute money for the Provider Relief Fund. That was a tremendously humbling and yet rewarding activity, particularly working with health economists providing advice on fund distribution, including ASHEcon Past Presidents Jon Gruber, David Cutler, and Joe Newhouse.
- How do you think your career trajectory and past experiences have prepared you for this new role, President-Elect of ASHEcon?
Steve: My past experiences have really fallen into two different buckets that I think lend themselves well to my new role for ASHEcon. The first bucket deals with working with policymakers for very pragmatic applications of health economic analysis. It is a skill as well as a method that is required to listen to policymakers and translate how their interest might be supported or examined using health economic analysis. It is not an easily taught set of skills; it’s usually learned on the job from a variety of folks who have been in that business, per se, for decades, either at the office of the actuary at CMS or the folks working at the Congressional Budget Office and senior-level folks at HHS. The second bucket I think that has prepared me well is the capacity to work with industry looking for funding opportunities to support health and health economic analysis. This really came into fruition when I was the director of the Medical Industry Leadership Institute. We hosted ASHEcon in 2012 in Minneapolis and that activity required us to really find funding for the event, and fortunately I had developed enough trust and capabilities with a variety of corporate partners nationwide that we exceeded our goals in fundraising and were able to return quite a healthy surplus back to ASHEcon that enabled ASHEcon to get even greater independence past that 2012 meeting. I would say that now fundraising capability is even more important for ASHEcon as some of our existing federal sources that we had access to in 2012 are no longer there, and also looking for new private sources given the additional costs of hosting a conference now on an annual basis. Before, when we just had conferences every two years and they were a little bit smaller, we relied upon universities. Now we are operating a much more aggressive and, honestly, expensive model that requires additional fundraising capability to make sure that we have the best access for our existing members and emerging members in our community.
- Much of the research conducted by ASHEcon members is policy relevant and I imagine a lot of us would love for our research to have more of a policy impact. Any advice for the health economics/health policy/health services researchers out there who want to have more of a policy impact or get more involved on the policy side of things and maybe don’t know where to start?
Steve: I’d say the best advice that I could give to folks interested in doing more policy relevant research is at the very least, just start spending time in Washington, D.C. to understand how the mechanisms actually work. It’s one thing to be read up on all of the policy briefs and articles that you see but it is quite another thing to have actual engagement with policymakers across the political spectrum. So that would be the starting point, but then also it’s critically important to understand how policy gets made. There is a process that goes on through the Executive Branch whether it be through HHS or even the Department of Treasury. But there’s also obviously a period of development that goes on in congressional offices as well with congressional staffers. I would say that the experiences that best prepared me to work with policymakers was honestly over a period of three, possibly four, decades getting to know and work with congressional staffers. In part working with them, but also socializing with them, just to understand the ins and outs of what they were contending with and the priorities they had. I found that I’m not alone doing this; there are many senior health economists that also have this level of engagement. But it’s a type of activity where you really need to be respectful of the staff members and what the demands are on their time, and the best thing you can do is helpfully translate how research can be useful for what they’re trying to do. At the same time, there are opportunities where potentially new research and ad-hoc analyses can be completed to inform policy formulation. Several times staff are grateful just to have someone discuss the economic and historical perspective of past and future policy development.
Anne: What are your top two to four priorities for ASHEcon over the next three years in your role as President-Elect, President, and Past President?
Steve: Well since you’ve given me the option of four priorities, I will give you the full four. I’d say the first priority is to shore up the economic model that we use to fund the ASHEcon conferences. There’s been a big price jump in conferences over the last few years notably because of different arrangements; for example, going virtual post-pandemic. To really improve access, we need to at least keep a lid on the price increases for conferences, if not lower them. I think the only way we’re going to be able to do that is to create more sustained partnerships with government, nonprofits, as well as industry to get that price point down.
My second priority is to have more thoughtful engagement with the policy-making community. There are health economists who are well known that do policy advisory work, but quite honestly the folks that I know who do this and are engaged in that are typically not engaged with ASHEcon. Having a little more exposure of those folks to ASHEcon and vice versa, that would be a very useful thing and I’m happy to try to find a way to facilitate more interactions. I think the best way to do that is to have some sort of Washington, D.C.-based forum that occurs outside of the annual meeting that could function as a boot camp for helping health economists understand how policy actually gets made.
The third priority would be to reach out and develop the next generation of health economists and find how they can be supported. The financial pressures of coming to these conferences as well as doing research in a soft-money environment can be extremely challenging. I think that one of the goals would be to identify what their financial needs really are to make sure that the value proposition of what we’re delivering is excellent and ultimately invite a new set of individuals to be part of our community that will just grow and strengthen its diversity.
The fourth priority is a little more challenging, but to the extent that folks are interested in having an impact on health policy, it would be great to develop a library of where the research that has been done by health economists has really transformed and led the way for critical new policy development. For example, I know that some of the work that was first done on outcomes research and small-area variation work by a handful of health economists going back 30 to 40 years. This research led to the creation of the Agency for Healthcare Research and Quality, and many initiatives that followed. Recently, applied research from health economists has led to legislation and regulations related to opioid abuse, more equitable payment structures, and different antitrust enforcement mechanisms. I know that many of our articles do have an impact, but it would be wonderful to make a family tree of that impact and the seminal articles that drove public-policy formulation.
Anne: Tell me a little more about the structure of the three-year term and how much of a team environment it is working with the President and Past President of ASHEcon. How closely will you be working with Kosali Simon (President) and Kate Bundorf (Past President) to both implement initiatives that are your priorities and continuing to work on initiatives that they started?
Steve: I’m really a fan of this three-year President-Elect, President, and Past President structure. It provides such an opportunity for continuity working with really talented folks who have been chosen to be leaders in the field. As an added bonus, I have worked with Kosali Simon and Kate Bundorf extensively over the years. I have great respect for David Cutler, who reached out to me initially for the nomination and have really, really admired the work that he has done to develop and advance ASHEcon over the last few years. I think it’s really important for continuity to have this structure and it’s in respect to the ultimate onboarding process to get folks to be engaged with really important decisions working with the Executive Director as well as the other ASHEcon board members right from the get-go. The one thing I also like about this kind of structure is that it is lean and responsive to the aims of the membership of the organization. One of the priorities that I’m working on right now is the initiation of a new vendor to support us. We have been using APPAM to do the work with us. That contract will be ending and we’re looking for a new vendor. That process working with the other presidents as well as members of the board and the Executive Director has been quite extensive and quite rewarding. Beyond that I think the other priority is to think about what the best venues for our annual meetings are and whether there are additional meetings that we want to have that would really strengthen the organization and its impact to the field as well as society.
Anne: As you’ve progressed throughout your career, has there been any advice or mentorship you’ve been given that has really resonated with you? Or anything you learned along the way that you wish you had known earlier?
Steve: I have been fortunate to have several key mentors throughout my career. The first is Chuck Phelps from the University of Rochester who really invited me in through collaboration to this whole field back when I was a master’s student and pre-doctoral going back almost now four decades. Chuck’s energy and example and incredible productivity even to this day just serves as really a peak in an example of what an outstanding scholar can be, and the great thing about Chuck is that as I progressed through the highs and lows of my career, he’s been willing to provide advice and sometimes some hard conversations along the way. A second mentor is my dissertation advisor and Ph.D. advisor Marty Gaynor. I was fortunate to have Marty in my corner on a lot of different activities whether it be publishing together, introducing me to the National Bureau of Economic Research community for my dissertation research, and then inviting me to serve as Treasurer for the Health Care Cost Institute. It’s one thing to have a great listening advisor that can again tell you hard truths when you need them, it’s another to really work collaboratively with them over decades in a very positive way. And then the final thing is I think it’s great to always find a set of senior colleagues that really challenge you to build your best and suddenly you find that you become the senior colleague unexpectedly along the way. For that world there are two people in particular who stand out. One is Roger Feldman from the University of Minnesota, who really was a tremendous mentor and colleague and coauthor for almost all of the work that I’ve done at Minnesota. The range of what we covered whether it was empirical analysis of the health insurance market, the micro simulation work, even looking into different ways to figure out the health-wealth tradeoff effects; it was a treat to work with Roger and someone so brilliant and figure out where our strengths were to be good collaborators. The second collaborator was really the person who recruited me in Minnesota, and I’ve thanked him ever since for that, is Jon Christensen. What was great about Jon was just his patience and also the hard truths that Jon conveyed to me early on as a young assistant professor that really needed to get his act together to get his productivity up. Jon did that and he did it very effectively; he was probably the colleague with the most velvet steel that I’ve dealt with in terms of making me a better scholar and hopefully a better person engaged in health policy.
Anne: Now for something completely different: tell me a little bit more about who you are as a person.
- What do you enjoy doing when you’re not working?
- What is something that would surprise (in a good way) people about you?
- If you could take a vacation anywhere in the world (it’s paid for by somebody else), where would you go and why?
Steve: These three questions really roll into one response. I have found that I really enjoy finding the best ways to get a work-life balance that include as much fun and adventure as possible. One of my favorite activities over the last three decades has been sailing. I started out in Minnesota but then also in my sabbatical year made it a quest to sail off the coast of all six major continents (excluding Antarctica). I actually managed to do so, sometimes with a little more danger than others, particularly off the coast of South Africa.
From that actually I found the best and most fun thing I’ve done that relates to the field is developed economics symposiums in great locations around the globe. One of them is in the Caribbean, but the papers invited have the rigor of the NBER Summer Institute. I’ve enjoyed organizing as well as figuring out the funding for these activities.
Another fun fact is that my wife and I did what most Minnesotans do and have a cabin up north. Except, our cabin is in the north of Scotland. What’s also been exciting is now my youngest of three kids is actually going to school in Scotland: just starting off at the University of Edinburgh. As a person I have really enjoyed engaging with activities that are on the water or mountains or hiking. I work a lot at home but it’s in part because I put a little server farm in my home to kind of be able to have the best of both worlds. I’ve also basically been operating an independent consultancy focused on health policy and health economics since 1998.
Another thing that a handful of people know in ASHEcon is that I have tried to stay at interesting places for some of the conferences both for fun but also frugality. For the ASHEcon conference at Cornell in 2010, I drove an RV that my family and I took all the way to my wife’s hometown of Elmira, New York, which was just next to Ithaca. I decided that I’d save money on a hotel and park it in the Cornell football stadium parking lot and hang out. But, people figured it out and suddenly the RV became a magnet for activity when it started traveling down the hill from Collegetown to downtown Ithaca and became party central one or two evenings. There were 50 to 70 people who claim they were on the RV but really there were only 25 or so (for safety reasons). And I’ve done the same thing actually with another RV at the University of Southern California for ASHEcon 2014. That was then shut down by the LAPD—because it’s not an L.A. party until the LAPD arrive.
Anne: Thank you again for taking the time for this interview and for serving as President-Elect of ASHEcon. Looking forward to seeing what you accomplish over the next three years!