When I went to graduate school, it was the early 90s when then President Clinton unleashed

his health care plan, and it was over a thousand pages. It was so huge.

That's the economist, Melissa Thomason. I remember being struck with the thought of,

well, why do we need this? And how did we get into this mess in the first place?

Understanding how we got into this mess or any mess is part of Melissa's job as a professor

at Miami University in Ohio. She's an economic historian, which means she spends a lot of time

thinking about the events that set the stage for our current economic systems, including health care.

In 2020, health care expenditures represented around 20% of gross domestic product or GDP.

And yet, back in the early 1990s, when Melissa Thomason was casting about for a dissertation topic,

she realized something. It turns out no economist had really looked at quantitatively

understanding how we did get into this mess in the first place. There's been some terrific

history books written on it, some sociologists have looked at it, but no one had really actually

tried to measure the factors that led us to our current health care system.

So that's what Melissa has spent the last two decades doing. She's written papers about

school closures during the 1916 polio epidemic in the US, and about the health effects of living

through the Great Depression. A lot of her work focuses on shocks like those, big health care

bangs and their lingering impacts. Recently, she and some colleagues wrote a paper about one

especially impactful bang, the 1918 flu pandemic, also known as the Great Influenza.

It really shows us how a significant shock to the health care system can play out even decades

later. How does the 1918 flu pandemic continue to play out decades even a century later?

And what can we learn from it as we emerge from another giant shock?

From the Freakonomics Radio Network, this is Freakonomics MD. I'm Bob Ujena. Today on the show,

...