Author: James Bailey

New Health Freedom Index

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The Center for Modern Health and the Knee Regulatory Research Center just released an index of how free residents in each state are to provide and pursue health care as they see fit. Their summary map looks like this:

The index was created by averaging measures of freedom in 54 separate categories, summarized into the 5 broad areas of Professional, Institutional, Patient, Payment, and Delivery Freedom. A report with maps for each of the 54 underlying measures is here, and a spreadsheet with all the data is here.

This project represents a major effort on an important issue, but I have to say my favorite part is just how unusual the final map of the overall ranking looks. I’ve created many maps of the states based on data and seen many more, but almost all of them (no matter the underlying variable they represent) end up falling into a handful of looks. They are either secretly maps of population density, or North vs South, or East vs West, or the South + Appalachia (high poverty, low health and education, et c). But the Health Freedom Index groups states in a way I’ve never seen before, putting Maine and New Hampshire with Mountain West states as the most free, while South Carolina and Louisiana join California and much of the Northeast among the least free.

Some of the Index’s creators will be presenting it online on September 18th.

Note: I’m affiliated with the Knee Regulatory Research Center at WVU, but I wasn’t directly involved with this project. I’m working on a different data project with Knee I hope to discuss here soon.

Ranking State Economies On a Governor Time Scale

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Governors serve for 4 years in most US states. You can find many rankings of state economies out there, but they tend not to measure how states have done over the last 4 years- instead they either use measurements based on levels (things like mean income which were mostly determined by events before the current governor’s term), or one year of growth (which has a lot of randomness), or they don’t explain what period it is based on at all.

But if you want to know how a state’s economy has performed under an incumbent governor (for instance, to inform your vote on whether to re-elect them), the best way is to measure it’s economic growth over the period of their term- most commonly, 4 years. A governor currently up for re-election following their first term would typically have taken office in January 2023. Below I map how two of the most commonly used economic measured have fared by state from January 2023 to the most recent available data (what is available differs by measure):

Source: My calculations from BEA current-dollar GDP
Source: My calculations from BLS data on total employment

Overall South Carolina looks best and Wyoming looks worst. There might be other economic measures you prefer, like poverty rates or median income- but whatever measure you prefer and whatever politician you are evaluating, I encourage you to check how that measure has changed since their term started and how that ranks compared to other similar regions.

This post was inspired by the mailers that would-be Rhode Island Governor Foulkes’ campaign keeps sending me suggesting I vote for her in the primary against incumbent Rhode Island Governor Dan McKee because “we are last in the country for our economy”, citing this CNBC ranking. Looking into the source, CNBC says:

Continue reading →

Should Immigrant Doctors Have to Retrain?

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The United States has long answered this question “Yes- they need 3+ years of retraining unless they are from Canada”. But that has been changing rapidly since Tennessee began allowing foreign doctors to practice without years of retraining in 2023.

Doctors can’t start practicing independently right after getting their MD- they need 3 to 6 additional years of supervised on-the-job “residency” training first (even graduates of US medical schools). Most developed countries have similar systems of on-the-job supervised training for junior doctors. But until recently the US didn’t recognize training from any country besides ourselves and Canada. Doctors were required to re-do a US residency before practicing here even if they had been successfully practicing for decades in one of the dozens of countries with life expectancies higher than the US.

I’ve been pointing this out to my health economics classes for years as one of many quirks of the US system that keeps healthcare expensive and hard to access. But since Tennessee offered a faster pathway for trained foreign doctors with HB 1312 in 2023, dozens of states have rapidly follow suit:

Source: The Match Guy, May 2026

I think the impact of this change has been limited by the fact that states still tend to have other requirements for foreign doctors, like spending a year or two under supervision at ACGME-accredited programs. This still serves as a shorter quasi-residency, and these programs are exactly the ones that tend to have plenty of doctors anyway- big urban hospitals, not small rural clinics. Immigration rules present their own high and rising barriers; most foreign doctors can’t come here in the first place.

That said, I’m still happy to see policy experiments from states attempting to address our doctor shortage. These state laws waiving residency retraining requirements are so new and so numerous that the present an excellent opportunity for research on their effects; I’m adding this to my ideas page.

I noticed the rapid expansion of these laws when doing research for a talk I’m giving at Creighton University at 4pm today (if you’re in Omaha, maybe see you there); thanks to Creighton for the inspiration.

Getting Music On Streaming Is Surprisingly Easy

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Before recording and broadcasting technologies, there was no way for people all over the world to hear the same music performance- you had to be in the same room as the performer. Even when I was growing up, distributing your worldwide meant getting a record deal, something few could do. But the modern internet allows for music to easily be uploaded from anywhere, to be listened to anywhere.

For artists, this means to problem shifts from just being available, to standing out to listeners among the sea of available music. How best to do this- other than making great music- is a complex and detailed question of marketing. But one crucial early step- getting on the right streaming platforms where artists make their money– is now surprisingly simple and easy.

Source: My image made from Chartlex data

Amateur artists tend to start with what is free- uploading their music directly to Youtube or Soundcloud. But huge numbers of listeners are on streaming platforms like Spotify, Amazon Music, or Apple Music. These don’t allow artists to upload music directly, which can make listeners or new artists think that getting on streaming platforms is a bit like getting a record deal in the old days, where an industry insider needs to approve the artists. In fact, approval for streaming now mostly runs automatically through third-party music distributors.

Adding third parties into the mix sounds complicated, but in fact they are easy for artists to work with, and a single distributor can get your music onto all major streaming platforms at once. Here’s how the page for uploading a song starts at the largest distributor, Distrokid:

There are many distributors; Spotify currently recommends 21 that work directly with artists. Distributors charge artists, but not very much. Some charge by the song or album (CD Baby does this, starting at $10/song or $15/album), others let artists upload unlimited songs for an annual fee (DistroKid does this, starting at $25/yr). Distributors also collect royalties from streams on behalf of artists. To me this looks like a no-brainer for any semi-pro musician who is out there playing some gigs, but also makes sense for stronger amateur artists looking to expand their reach* (for professionals with record deals, of course, the label will do this for you).

For an academic comparison, getting your music out there is now less like hoping an insider likes you or your work enough to invite you to NBER, and more like just uploading to SSRN (if SSRN charged a small fee).

All this is a long way of saying- you can now find my son’s piano compositions on all the streamings (Spotify, Youtube / Youtube Music, Apple Music, Amazon Music).

*At least if you write your own songs- buying the rights to distribute covers costs extra (e.g. $12 per song per year for DistroKid), and on streaming people can listen to the original artist just as cheaply and easily, so there’s not the same niche for cover bands that there is in live music.

Bubble Worries Mean Diversify…. But How?

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Mike is concerned that US stocks could be a bubble, as are many others:

if we take parallels to the past seriously, there arises the question of whether a 40 year old with a 100% index fund portfolio should consider hedging/reallocating their portfolio a decade sooner than they planned on becuase, well, just look at that [CAPE] chart.

But what to do about it?

So, seriously. Are we hedging? And what are we hedging into? Asking for a friend. Who is an economist. And also me.

My answer: I’m diversifying into global stocks, which tend to be much lower-priced: 

Source: The Idea Farm, Global Valuations Update July 2026

But how do you practically do this?

A simple and cheap way to get a highly diversified basket of global stocks is VEU (Vanguard ex-US). Over 3000 stocks from around the world, P/E of 19, rock-bottom fees. One disadvantage for diversification purposes is that its biggest 5 holdings make up 12% of the index and they are all AI-related.

If you’re willing to make more concentrated and specific bets in order to get even cheaper, here are some other foreign indices I like:

  • FRDM (Freedom 100 Emerging Markets ETF): Invests in emerging markets with the highest economic freedom ratings. I love the theory & it’s performed very well for me & its overall PE is a reasonable 17, though it’s largest holdings are in Taiwan and South Korea, so not a good way to get away from AI.
  • ILF (iShares Latin America 40): Invests in large Latin American companies. P/E 11 with low AI exposure.
  • FYLD (Cambria Foreign Shareholder Yield ETF): Invests in high-yielding companies in developed countries outside the US. Measures yield using stock buybacks in addition to dividends. This serves as a value screen that keeps PE low (currently 13) and avoids expensive sectors like AI.
  • EYLD (Cambria Emerging Shareholder Yield ETF): Same idea as FYLD but for emerging markets. Current PE 12

I also hold single-country indices for Japan (FLJP, PE 20), Poland (EPOL, PE 13), and India (EPI, PE 17). These are probably riskier than the broad indices above, but still fairly diversified across companies.

While foreign stocks are my preferred hedge, there are many others. For US stocks there are small-cap or value indices, or just buying individual stocks you like (not necessarily crazy). The 20- and 30-year US treasury bonds are intriguingly yielding over 5%, though between my age and my inflation concerns I don’t own any. TIPS are much more attractive, yielding 2-3% over inflation, I don’t own any yet but I’m considering it. Gold indices like IAUM are another good hedge.

Of course this isn’t necessarily a bubble that will pop any time soon, or at all- AI is a real technological advance- so between that & general efficient market principles I don’t think the answer is to sell everything & go to cash, much less short the market. But Mike is right to ask how to hedge, and I think anyone holding ~100% US stocks should consider diversifying.

Disclaimers: Not investment advice, I hold some of the indices named.

CBO Wants Your Research

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The Congressional Budget Office released a series of posts explaining questions they have about major federal budget policies that past research does not adequately answer. For any economist looking for paper ideas or for a way to influence policy, CBO’s posts are a great place to look:

A Call for New Research on the No Surprises Act

A Call for New Research in the Area of Permitting Requirements for Investments in Physical Infrastructure

A Call for New Research in the Area of Spending on Medicare Part D

A Call for New Research in the Area of Nutritional Standards in SNAP

A Call for New Research on Energy and the Environment

A Call for New Research in the Area of Finance

A Call for New Research in the Area of Health

A Call for New Research in the Area of Labor

A Call for New Research in the Area of Macroeconomics

A Call for New Research in the Area of National Security

A Call for New Research in the Area of Hepatitis C

A Call for New Research in the Area of New Drug Development

A Call for New Research in the Area of Obesity

A Call for New Research in the Area of Taxes and Transfers

At AEAs this year Heidi Williams emphasized how huge bills like permitting reform are being discussed by Congress without much research to inform key aspects of the bills, so CBO & some Congresspeople would genuinely like to see your work on these questions if it is well done

This also your regular reminded that I maintain a page of economics paper ideas. Until now all the ideas there have been my own, but I will be adding links to pages where others share their own paper ideas, starting with CBO’s.

The Academic Data Project That Turned Into $375 Million

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What could be better than creating data so valuable that an institution is happy to host and update it forever, like the Sean Lahman baseball database?

Creating data that sells for $375 million, like the Center for Research in Security Prices. University of Chicago professors assembled this series of finance datasets over decades, starting in 1960 with an effort to track every transaction of every publicly traded security. U Chicago sold CRSP to Morningstar last year for $375 million.

Why could they sell it for so much? It helps to be working in finance, where the willingness to pay is the highest. It also represents 65 years of work from what became a large team that included Nobelists like Eugene Fama. The data was valuable enough to become widely used by key institutions even though CRSP charged for it:

Today, $3 trillion in fund assets are linked to CRSP Market Indexes, including U.S. equity ETFs run by Vanguard, and more than 600 subscribers across 35 countries use CRSP Research Data Products.  

Did U Chicago sell CRSP at the right time? On the one hand, I wonder if this was a fire sale driven by federal grant cuts putting pressure on the U Chicago budget. On the other hand, assembling datasets like this is only going to get easier in the age of AI, so perhaps Chicago sold at the top.

For now though there is still an edge in having restricted datasets that AIs haven’t trained on and can’t access. When I ask myself what advantage my human research assistants have over AIs in 2026, the most obvious answer is that they can legally access restricted databases like CRSP or, in my current case, HeinOnline.

Nimble Individuals, Enduring Institutions, and The Sean Lahman Baseball Database

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The Lahman Baseball Database offers player- and team-level stats all the way back to 1871 as freely downloadable files. It includes over 20,000 players and has been cited by 192 academic papers. That sounds like something that takes an enormous amount of effort to put together, but it seems to have been compiled by just one guy, journalist Sean Lahman.

This looks like yet another example of a lone individual outperforming the huge, well-funded institutions you might expect to compile such datasets- this time not the government but MLB, ESPN, et c.

But as we saw last week, lone individuals can’t keep it up forever. If you want your creation to last, you will eventually need an institution. In this case, Lahman recently passed his database on to the Society for American Baseball Research:

Sean Lahman has graciously agreed to donate the Lahman Baseball Database, an open source collection of historical baseball statistics, to SABR.

The Lahman Baseball Database — which Lahman created in 1996 and has made freely available online every year since then — contains complete batting and pitching statistics back to 1871, plus fielding statistics, standings, team stats, managerial records, postseason data, and more. While Lahman and others had previously released smaller datasets online, his database allowed researchers to perform complex queries across the entire history of the game for the first time. The Lahman Baseball Database has served as the foundation for many popular baseball research projects and simulation games, including Out of the Park Baseball and Baseball Mogul.

SABR plans to continue to update the database and make it available for free online every year at SABR.org/lahman-database. 

I can only hope more of us will compile datasets worth handing off to an institution that will keep updating them.

The Journal of Healthcare Finance Is Back

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Most academic journals are run by big for-profit publishing companies, and most of the rest are run by universities or big academic societies. The Journal of Healthcare Finance was an extreme outlier from this norm, run single-handedly by Editor-In-Chief James Unland since 1994. It was the rare journal that was free both for readers and authors.

I loved the idea of having a single person truly in charge and accountable without being slowed by a complex bureaucracy. But eventually a single person will want to, or have to, move on. Having an institution run a journal can ease this process, though an individual can still try to find their own successor.

In this case, The Journal of Healthcare Finance had been on hiatus since its Editor-In-Chief stepped back, with its last issue published in 2023. Their old website domain had expired- not a great look for anyone who published there and was going up for a job or tenure.

But now it is officially back at a new domain, with the single Editor-In-Chief replaced by a full editorial team, and accepting submissions again with the hope of releasing a new issue this year.

Selfishly, I’m happy to see this both because it means they will continue hosting my past publication, and to have a potential outlet for my future work. I recommend that other health economists and health services researchers give it a try, though as of now I have no personal experience with the new editorial team.

Do NBA Teams Play Worse In Back-To-Back Games?

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The conventional wisdom is that the NBA regular season has too many games. Teams play worse because they are tired, or injured, or resting their stars so they can be ready to actually play hard in the playoffs.

New research shows that the conventional wisdom is…. probably right. In particular, teams play worse by many measures when they have to play two days in a row. That’s what Max Aicardi and I found in a paper published today, “Running on Empty: How Back-to-Backs Impact Pace and the Four Factors of Basketball Success“:

Teams on the second night of a back-to-back shoot less efficiently (lower eFG%), grab fewer offensive rebounds, and play at a slower pace. On defense, they allow opponents to shoot more efficiently, force fewer turnovers, and give up more free throw attempts and second-chance opportunities. Turnover percentage and offensive free throw rate did not change significantly, consistent with our conceptual framework’s distinction between effort-dependent and execution-dependent metrics. While not every metric changed significantly, the overall pattern is clear: second-night back-to-back scheduling is associated with a measurable decline in team performance

The effect sizes here tend to be small, around 0.5-2%, but they are statistically significant given that we studied over 20,000 games, and practically significant given how close NBA games are.

Max had the idea for this paper and wrote the first draft as a student in my Economics Senior Capstone class in 2025. After he graduated, I joined the paper as a coauthor to get it ready for journals. We share the data and code for the paper here.