Challenges and opportunities in rural health care: Chelsea Lensing

Hello everybody. I'm Paul Yeager. This is the MToM podcast, a production of Iowa PBS in the Market to Market TV show. The economy is what we talk about pretty much all the time. Rural economy. We talk about rural issues. We look at what's growing and what's not. But we also, every once in a while, look at housing, banking, finance. How about health care, specifically mental health care? We're going to look at a new study done by the Common Sense Institute started in Colorado. But it now has, an office, you could say, in Iowa. And they had a study that they conducted this summer that looks at health care options in Iowa, specifically in rural locations. We're going to talk with Chelsea Lensing. She's a economics professor at Coe College. She's the lead on this study. And we talked to her about just different things that they looked at. Just it's interesting from me, from someone, who grew up in rural Iowa, who lives in an urban county now, and just how different certain places can be and even how different largely populated counties can be. It's called the Market Insider Newsletter. We'll see you on the other side of this discussion. Now let's get to it. I only say this because I know this, but what was your first interaction with Market to Market? We're having our 50th anniversary, so everybody's going to get that question now. But I understand you've known about the show for a little while.

[Chelsea Lensing] Yes. I married into a farming family, so my husband is now a third generation farmer from northeast Iowa. And so his dad watches it every Saturday morning. Usually that's when they watch the Friday program. And so now in my whole household, once we were married, that comes on the TV every Saturday morning for us. now our, you know, we have two girls and now our three year old knows it's Saturday morning.  Okay, let's turn on Market to Market.

[Yeager] We're like the morning cartoons. I'll be more animated then. With that help.

[Lensing] Yes, we would appreciate that. Definitely keep her attention. She does. She likes the intro music, the first, you know, ad or so, and then her attention fades a little bit. But that's okay. Yeah. That's all right. Halfway through the show, people think the my attention span goes. I just sit there and let people talk, but it's okay. but you okay? He grew up on a farm. Did you?

[Lensing] No. I'm from. I'm just south of Des Moines in Indianola. so there's definitely some farming communities down there. But I myself did not grow up on a farm, so I'm still very new to, you know, the farming community in the farming world. But it's been a great experience. My husband and we met in college and he was in business and economics and finance, so we came from the same academic world. But I've taken two very different paths with that. but we probably talk about markets in general in our household, way more than the average, couple or family. But it's really fun that we have a similar interest, but he is more interested in the financial part of things and the ag markets, where I am a health economist. And so my area of specialty is very different than his.

[Yeager] Well, okay. So if the specialty is different, but how similar are economics or whatever adjective in front.

[Lensing] A very extremely I mean they're all centered on the same principles, the same foundations. And you know, especially when it comes to, you know, critical thinking and even applying those skills outside of, you know, these, these specific fields of economics, there's a lot of overlap there.

[Yeager] And he's not actively involved. You're not actively involved in farming right now.

[Lensing] No. So my husband is. 

[Yeager] Oh he is. Yes?

[Lensing] Yes he is.

[Yeager] Oh, okay. Yeah.

[Lensing] He's currently an engineer at, Quaker Oats at the factory here in Cedar Rapids. And so that's his, you know, his, his, his day job, I guess, if you will. But, he, saves up all of his PTO to then go farm with his dad up north, wheat crop farming. they used to do some livestock, some cattle. But now it's primarily crop farming. And so during harvest and during planting, and, you know, he's taking those vacations to go up there. And so we'll spend, you know, a week or two up on the farm. So he's he's helping his dad. It's a partnership up there.

[Yeager] Well, that gives us a whole lot of importance here in how we can and what I want to cover today. So your interest in economics came from where?

[Lensing] kind of by accident. I did my undergraduate at Coe College, which is where I now currently teach economics. And I was a math major, but had no idea what to do with this math major and that skill set. And I took a Principles of Macroeconomics class as a general education course. Just because I thought, honestly, it might be kind of easy. And then all of a sudden I could see all of these mathematical tools can be applied to something that, in my eyes was a lot more interesting. And at the graduate level, economics is way more math intensive than it is. you know, topic intensive or content intensive. And so I was very competitive when I was going and applying to grad school is because I already had that math major. And so I had those skill sets that are a little bit more challenging to teach once you get to the graduate level.

[Yeager] And then your class, what's your base class that you teach? I mean, what's your I guess I'm supposed to there's a term for it. I want to say CV, or, I mean, what is it that you teach? What are your classes?

[Lensing] So I teach a wide range of classes at Coe. We have a relatively small department being a small school. And so all of the economists are pretty diverse. I teach primarily within the fields of microeconomics. so principles of microeconomics would be the intro level courses that I repetitively teach. But then I also teach international trade, I teach intermediate microeconomics. And then since my area of specialty is health economics, I've actually created two courses here at Co that are specifically on the topic of health economics, which tend to fall within the micro field. and then I also teach some upper level analytical courses, econometrics to regression analysis. So teaching the toolkits of how do we actually utilize and implement data.

[Yeager] And health is the next road in, you have like, like most professors, you have other things that you kind of get into to help, common sense. Iowa. Where did that partnership come with you in them?

[Lensing] Yeah. So Common Sense Institute is a nonpartisan research organization that's focused on promoting and protecting the economy of Iowa. And they were originally founded in Colorado, but they opened a branch here in Iowa just earlier this year in January. And so they had reached out to me. And the CEO is actually, a former Coe graduate. And so there was a little bit of overlap in networking there. And she knew my area of specialty was in health economics. And so they approached me about partnering on a project this summer that was focused on just understanding more about the health care landscape in Iowa. A lot of what this research organization does is focused more on inflation and jobs and policy evaluation, but they know that health care is such an important part of all aspects of our lives, including the economy. And so they were hoping to produce a report that describes you know, what's going on in health care, not just in the country, but specifically here in Iowa. You know, we have a lot of rural areas that are different than when we just look at national trends. And so we wanted to be able to provide a report that was comprehensive and describing what's going on right now. What are we doing? Well, what are the challenges and how do those challenges differ based on where you are in the state?

[Yeager] Well, that's easy. You asked your own follow up questions. What are we doing well, right now?

[Lensing] Yeah, that's a great question. You know, as you're writing this report, when you're just looking at certain health outcomes of the health care system or whether it's individual, health outcomes, it can be a little bit challenging to not feel like, oh, no, everything is moving in a bad direction. And there definitely are some real challenges at the absolute level. But then when you look more broadly at what Iowa is doing in comparison to the rest of the country, we're actually doing pretty well. So what we found at kind of the big picture level was that there's a lot of challenges that I was facing, but we're holding up pretty well in comparison to kind of what everyone is facing in the country.

[Yeager] So we're not we're not unique, but there are challenges. And I'm going to guess the challenges are there's not enough access to care for everyone and maybe urban areas are more, opportunities than rural areas. Does that hold up?

[Lensing] Yes. Yeah, absolutely. One whole section of the report that we looked at was the differences between urban and rural communities. you know, and there's a whole bunch of ways that you can measure access to care. So there were three primary ones that we had looked at. We looked at, primary care physician rates. We looked at facility opening and closures, and then we looked at more of an intensive margin of supply.

[Lensing] When you think of hospital beds and department closures. So that first one, the primary care physician rate. So that's adjusting for the number of primary care physicians for the number of people. Right. We would expect there to be more primary care physicians in the more populated areas because there's more people. But even once we adjust on a per capita basis, we see that there are significantly more providers in these urban areas. So if you split all of the counties in Iowa into urban and rural, which the USDA has definitions of what constitutes urban, rural, 77 of our counties are considered to be rural. And if you look at trends in the number of primary care providers between these two types of counties over the last ten years, for urban counties, we've seen about a 1% decrease in primary care physician rate. But for the rural counties, we've seen about an 8% decrease in primary care providers. Again, this is already adjusted on a population basis. So we're seeing a much larger decrease in the rural counties. but even further than that, counties are not just urban or rural, even within the rural counties. We have 22 of those 77 counties have 100% of the population living in a rural area. So if you take those more extremely rural counties and you compare them to the counties that have, say, fewer than 20% of the population living in a rural county, there's about double the amount of care - primary care providers in those urban counties than what we see in the more extreme rural counties. So there's a really big divergence when we are looking at primary care physicians as a measure of access to health care.

[Yeager] Well, let's go where you grew up, south of Des Moines. Indianola is a city of 10,000, but I'm guessing in the outer areas of Warren County, there are people who are 30 minutes from care. that they could have and that or even in Linn County where you're at now. So that's what you're talking about is you might be inside a county, but there is a chance you're outside of, of this area, not the Golden Circle, but the golden area of where there's better and more access to care. And that's an issue that maybe gets lost in the data.

[Lensing] Yes. Yeah. So essentially, the higher the percentage of individuals you have that live in a rural area in a county, the lower the options are for care. so we didn't necessarily look at driving distance as a measure. Their previous reports who have done that, we've looked at, you know, for example, but based on where you live in Iowa, how far you'd have to drive to a level two hospital. Again, that wasn't something that we specifically focused on. It was a hard choice to figure out what to focus on because it was such a broad report. but again, yes, it gets at exactly that measure you were talking about.

[Yeager] And what are, were there a certain type of care that is falling short here that we're losing access to?

[Lensing] Yeah. So again, primary care physicians, that's one of the main metrics that we looked at. We also did some work to try and understand kind of where things may be going with our workforce in the future. We're seeing already shortages of nursing, nursing staff in hospitals. We're seeing shortage of what we would consider to be low wage health care positions. So we already are seeing those shortages now. And those are projected to, to grow in the future. We also looked at the age average age of provider specialties as a measure of, you know, how old is that type of provider on average, because those older providers will be aging out of the workforce sooner, and we will need new providers to, to prevent shortages. So, for example, again, if we go back to this idea of, a family care provider in comparison to a nurse practitioner, we see a lot more nurse practitioners coming into the health care environment. and then we see a lot fewer family care providers. We also see a lot fewer of, some other types of specialties, including, you know, OBGYN care. in, in rural communities. But that's it's something that we can hopefully policymakers can look at that data and kind of see, okay, where are the areas that we might be seeing more shortages as we're moving in the future?

[Yeager] Is there any type of thing the government can do to help in those shortages? I mean, you're talking about them examining and looking at those things. I mean, we hear about, oh, this will help recruit doctors and nurses. This will help. Is there anything realistically that can be done?

[Lensing] Yeah, that's a great question. So at the end of the report, we did identify a few policies that Iowa lawmakers have put into place just in the last couple of years. And some of those are specifically focusing on I'm trying to get more healthcare workforce into the market, and especially concentrating that in these more rural areas. Some of those include, you know, financial help with, with schooling, if they are, if they practice in a rural community, some of those are targeted at certain specialties, again, such as OBGYN, but some of them are family practices. And those have been more recent policies that we've identified. And so it's unclear yet, what the effect of those is going to be. This is another hope that, you know, either other research groups or potentially Common Sense Institute can then take the report that we have created as a baseline, a where are we now? And then once these policies hopefully have time to, you know, be implemented and have an effect, we can do some sort of policy analysis to see whether or not we really are making an impact.

[Yeager] All right. Now you get to put your economist's head back on, when it comes to workforce, you know, we hear about, you know, there's always this push of we send everybody to a four year school, they need a white collar job, but then you start to hear the no, no, no, no, we need to have a whole bunch of skilled trade. We don't have, heating and air conditioning techs. We don't have tool and die makers. We don't have that. We don't, it sounds like, it also needs to be included into my home. I mean, we grow things in Iowa. We need to be able to grow health care workers, too. Is that what I'm picking up? That maybe, is that a possibility?

[Lensing] Yeah. Yeah. Encouraging individuals to go into the the healthcare workforce, is definitely something that we can but that we can encourage, you know, we're again, when we compare Iowa to other states, the projections on how big our shortages are going to be in the healthcare workforce. When we look at things like nurses, mental health, and low wage health care workers, I was actually looking pretty good on mental health care workers. The nursing shortage is a real problem for Iowa moving forward, but it's still a lot lower than what a lot of other states are facing. So I think, you know, there's some case to be made that we're doing a pretty good job of attracting and producing those types of workers. in our state. But something that we need to continue to do, whether that's providing incentives for, you know, Iowa residents to go to school in these specific areas. That's, you know, hopefully that will continue to help fill the pipeline of health care workers.

[Yeager] Before we get to mental health. I want to go to one thing that has, I've heard as a possibility, that is assisting in this is telehealth, the using your phone. you know, I've had an experience where it was a Saturday, you know, late in the evening with the child. And I guarantee my doctor was somewhere in California or somewhere not where we were. How is that helping? Or even is that being counted in, in how you can do research here of getting care for people.

[Lensing] Yeah. So telehealth is an interesting beast. for a couple of reasons. It's relatively new. and we don't have a lot of great data on it. So we saw a huge increase in the use of telehealth because of the pandemic. And so those numbers spiked. But it really wasn't until the pandemic that these federally administered surveys even started tracking telehealth. And so, you know, the the data sources that we have out there right now are usually coming from private sector companies. Usually, insurance companies are the ones who have that data. Because even when we look at providers, it's where are these providers registering with centers for Medicare and Medicaid on a physical business. And there's not a lot of standardization as far as how much of telehealth they provide. The information that we do have it, it definitely shows that increased during Covid. But since then, if you look at ‘21 to 2022, we actually saw a decrease in the use of telehealth. So it seems like we saw this big spike up during Covid. It's coming back down a little bit, but it's still way higher than the trends that we were seeing pre-COVID. So currently about 30% of US adults say that they have used telehealth within the last 12 months, which is still a pretty significant portion of them. Again, this data is looking at the national level. So it's not specific to Iowa, but there's, a report out by the National Health Institute, actually, I think just a month ago, a pretty recent report that looked at the usage of telehealth and how it related to the metropolitan nature of where they lived. Right. So how populated is the area? And this report was showing that the more populated the area, the more likely individuals were to use telehealth, which is really interesting because you would think it's the individuals and the less populated areas that are wanting to use that. but this report also showed that there's a really big relationship between age and use of telehealth. And so we know that the population of our rural counties is also tending to be older, right? It's aging faster. And so this report was not causal by any means, but I would personally assume that a lot of that relationship has to do with both where you live and age and access to that. There's also a difference in, employers and whether or not they cover telehealth. And so in larger cities with larger employers, you might have an insurance plan that is more likely to cover that type of service than you do in a smaller town, with more limited insurance coverage. So again, we don't have a lot of great data to tease apart what's going on and what's going on in Iowa specifically, we're kind of deducting from the national trends here.

[Yeager] That's fascinating, though, to think about that. The one who could probably go down the corner and look in one direction or another in a suburb and see a clinic that they could go to, but instead they'll stay in their house and use their phone anyway, that's another subject for another time. mental health coverage in Iowa. Again, one of those things that we always hear, on a show here, earlier this spring on Iowa PBS, it was a sheriff from Black Hawk County who talked about that. They were, they have become almost a de facto mental health treatment option for the mentally ill. What are we finding? Is there a theme in Iowa about mental health care, rural versus urban, or does it even matter? We just have issues.

[Lensing] Yeah. So the two ways that we were looking primarily at mental health access in Iowa is through the number of facilities and then through the number of providers. And so we'll start with facilities. And we looked at facilities that were overseen by the Iowa Department of Health and Human Services. And so it doesn't include all facilities, but it includes a lot of mental health care facilities, such as, community mental health, more like long term or rehabilitation, mental health and those types of facilities. We've seen a significant increase in number of closures and hardly any openings over the last ten years. And so these dedicated mental health centers are closing at a concerning rate. And so that's one area in which we see a big decrease in supply for mental health. but at the same time, we're seeing an increase in the total number of mental health care providers on a per capita rate. So, for example, even in rural counties over the last ten or so years, since 2015, the number of mental health care providers per capita has doubled. And so even though it's still only about half of what we see in the urban counties, there's still a big gap between urban and rural counties. We're making a lot of progress. But again, it kind of stands in the face of all of these closures of these specific mental health care facilities. And so it really depends on the type of mental health care that individuals are seeking. and where exactly those centers are. So, you know, I do think telehealth has a great opportunity to help bridge some of those mental health care gaps. You know, it's one of the health services that is relatively easily administered through an electronic platform.

[Yeager] You can have conversations if it's therapy. We'll just start with the simple thing of therapy via phone. Sometimes people will feel more comfortable in their home, and it might be easier to do so. That's that. I'm thinking that's what you're referencing there. Yes.

[Lensing] Thank you for clarifying.

[Yeager] Well, I just, I'm slow. A lot of times I have to ask a lot of questions. That's why they give me a microphone, because I ask a lot of questions. Chelsea, what about the care? That's maybe a little more in-depth, with someone who might be manic or someone is in a tough spot. What can any survey say? Yeah, we just need to focus on this, and this will help this issue.

[Lensing] Yeah. So again, you know, that's an area where we are. We're losing the supply in Iowa. In general, we did find that it was a relatively even amount of closures between urban and rural communities when it comes to these health care facilities. so it's not just in a rural problem, if you will, or challenge that we're facing, but it is, you know, it limits the access for, like you said, in that scenario for where that person can go, right, that person's going to a hospital or ends up calling the police. And so the first responders are then acting in that capacity. those with, you know, long term intellectual disabilities, as adults, there's fewer places for those individuals to, to seek care. And so they're having to stay with their families, longer or, you know, finding other options. And so that's definitely a concerning area, especially hopefully policymakers can focus on that going forward. If we are seeing these net closures of these types of facilities, you know, what other support can we get for these individuals?

[Yeager] Is there any I won't say magic answer, but is there something that a strong recommendation that can be made on what would be an ideal, a Pollyanna answer, I guess. Let's give it.

[Lensing] Oh, gosh. Well, sometimes I feel like if I had the answer, I'd be in a work in the white House.

[Yeager] Well, but some. But sometimes the answer is there. It's just a matter of funding. So right now, unlimited funds can create your answer.

[Lensing] Yeah. I mean, yeah. So if the state was going to say yes, we're going to up our funds for any, you know, even any hospital who wants to expand or put an additional center on their existing facility that is going to be specifically inpatient or long term care for, for for those struggling with, you know, whether it's, you know, acute or chronic mental health conditions, funding is definitely something it also we get into the weeds a little bit when we think about reimbursement rates and who's paying for these. Right. So if reimbursement rates are relatively low for these types of services, that's also going to decrease the motivation for suppliers, which in this case is, you know, hospitals or doctors to open these types of facilities. So it's not necessarily just the startup cost of getting it going, but also how we're reimbursing these providers.

[Yeager] Back to the money, always back to the money. any economics, tied to mental health and what that does to an economy. Do we know anything in those fields?

[Lensing] Yeah, yeah. And there's a lot of evidence from an economic perspective to, that that ties together when we're having an economic downturn. So when we're having higher unemployment, things like that, we tend to see higher rates of deaths of despair, which are also, you know, related to the mental health of, of individuals. Deaths of despair can include, you know, things like suicide, but also excess alcohol consumption, opioid or other drug consumption. And so we're in a unique time right now, because the economy, unemployment wise, is doing pretty well, especially in Iowa. We've really low unemployment. but our labor force participation rate is actually continuing to go down. And so we're having more people leaving, leaving the employment market. And we're also still dealing with pretty high inflation. And so we're at this really kind of unique spot, that is different than a lot of the previous economic downturns that economists have studied. There's also, of course, the opioid epidemic that we've been dealing with that has increased even more. So we've been exacerbated since the pandemic. And that's leading to, or is one of the drivers of the increase in premature death that we see. That was one of the areas that we did talk about in our study. We weren't focused primarily on health outcomes, but premature death rates was something we did identify in the rule section, the rule focus of the paper. Because not only are we seeing an increase in premature death across the state, it's substantially higher for our rural communities. So that the absolute rates are higher and the increase is higher for these, these rural counties. And so even though if you're just looking at measuring our economy with the unemployment rate, that might not be telling the whole story. Right. And something else is going on here with our with our rates of premature death. And again, we don't have the data to parse out how much of that is due to mental health, but I think it's all extremely related, right? How individuals are feeling, how they're dealing with the economy, how they're dealing with family life.

[Yeager] Well, and that's, I was going to ask is how recent is your data that you're referring to there?

[Lensing] Yeah. So the data for this report, we tried the as we got the recent, most recent data, we could to, to our extent for the, for the report, the data sources, we, we collected them from a lot of different places, which I think hopefully for viewers, you know, if you're looking for a place that synthesizes a lot of data that's out there, this is a great, a great resource for that. So this data on premature deaths is through 2024. But the 2024 estimates are using a little bit of live data. and so the county health rankings uses kind of a moving average. But it is the 2024 estimates of the current, premature death rate. So it is relatively recent data I would argue.

[Yeager] Yeah. I that's when you said ‘24. Yeah, that gets my attention in a hurry. So are you seeing a higher rate of premature deaths in Iowa right now than, say, or even ‘23 to ‘22?

[Lensing] If you just look at an absolute level, it's lower than the average that we're seeing in the country. we saw similar trends when we looked at how Iowa was impacted by the fentanyl and opioid epidemic, where, yes, we're seeing this increase in, opioid related overdoses, which is also contributing to the premature rise and premature death rate. And so it is something we need to be concerned about. But compared to other states, we're still doing a lot better. and so again, it's this kind of weird dichotomy of this is a challenge and we need to address it. But at the same time, we need to be cognizant that we're doing pretty well given the atmosphere that we're in.

[Yeager] Well, that's kind of where I'm going, because we are here, wherever we, and wherever here is, oh, it's bad, it's bad or it's not good. But you mentioned it. Low unemployment, stock market is record levels. I mean, other things. But yes, inflation still stands out there. But again, that's historic. Not, reason, not historic levels. We're not talking like the 1970s or early 80s here. With this. Do we lose some of that perspective and does that cause us it's not mental health, but just it's fatigue on understanding if we are in a troubled time.

[Lensing] Yeah, yeah, that's a great perception. great question. And we didn't look at any data that was teasing out the perception of the economy and what's actually happening. You know, I think just from, my understanding of kind of our culture in general, this is also a very divisive time, right? Social media exacerbates everything. And, you know, we're talking about mental health here. If you look at these the studies that link social media use and mental health, there is significant evidence that the more time we spend on social media in any manner, the worse are our mental health outcomes. And so, you know, it's something I think to be cognizant of because, like you said, even if we're doing pretty well, if you're getting all of your information from one source or you're only looking at, you know, all the negatives kind of in a silo, it can be hard to have that more comprehensive picture of. Yeah, but there are a lot of things that we're doing well on and we're seeing an improvement. And in these areas and, you know, whatever sort of whether it's politically divisive or, you know, there's health care issues are very divisive, right? No matter your political leanings and so I think that can be very challenging for mental health, on everybody. And so I, I do hope to kind of having a broad picture of what's going on in the country and where Iowa fits in. That can be helpful.

[Yeager] Because the Michigan Sentiment Outlook to me is always interesting. They produce sentiment, those are to me much more opinions. I know there's fact-based in them. but perception and sentiment and, personal situation are all in this blender of what we choose to believe is happening right now. And that to me is, is a frustration of trying to parse together information to present to people. So that's my you've just opened up my hat now and looked in my brain, which is not what you wanted. What do we, where do we go next? What is there going to be can next studies year after year? Is this a one time thing, or is there a new leaf that you want to go out on the branch.

[Lensing] Yeah. So, again, this was my first experience with, Common Sense Institute. I had a, you know, was a great team to work with and lead and I hope that I have an opportunity to do it again. I definitely think, you know, in my in teaching in the classroom, I've given some talks, you know, that are more community facing on health care economics, the US health care system. And some of the questions that I get most frequently are, well, how is Iowa different or what's going on in Iowa? And until I had the chance to really sit down and dive into the state level data and even county level data, I didn't really have a great answer for that. And so, that's been really nice and open my eyes to be able to compare. Yes, this is what's going on nationally. And here's where Iowa is. and there are definitely quite a few pieces of this that, you know, sparked my curiosity of, oh, well, we could do an entire report on, you know, about 20 different things that we identified in here. One of the areas that was interesting to me is that we found that more than 20 of the hospitals in Iowa have been purchased by a larger health care system over the last ten years, and now there's a federal mandate that all hospitals have to post their prices for price transparency. It's not always the easiest data to use, but it's out there. and so that could be a really interesting project to understand how, how it's affecting individuals in their billing and the prices when these larger systems are buying up the smaller hospitals, especially in the rural areas where that's the only option to go to. So that's one area. Another one that I personally am interested in is maternal and infant care in Iowa, and especially in rural Iowa. So we have out of the 77 rural counties, only 62 of them do not have a practicing OBGYN. And so that's a big provider shortage. And in addition, 44 of the hospitals in Iowa have closed their maternity or birthing wing in the last ten years. And so even though we don't have hospital net closures, necessarily, the opportunities for these specialized care, especially for mothers and their infants, is is dwindling. And we are seeing an increase in nurse midwives as a supply in the States, but they're not necessarily concentrated in the areas in which we really need the care. and so that's definitely an area of interest of mine moving forward.

[Yeager] The supply doesn't meet the demand. And it's back to what you learned in Economics 101.

[Lensing] Principles of Micro. I if I gave a lecture on supply and demand this morning,

[Yeager] When you say what your students were asking, were those questions from already this year, or are you talking just hypothetically in general, what students have been asking about the economy? I'm kind of curious what they're asking right now.

[Lensing] Sure. About when I talked about the healthcare system.

[Yeager] And just the economy in general.

[Lensing] Yeah. So I was referring specifically, this would have been in March just of this last year. I gave a forum which was a four week series where I'm essentially lecturing. It's public facing so people can pay to come to these lectures, that are primarily given by, by faculty. And so this was a group of I think there's around 200 or so community members there. And so those were the ones that were primarily asking questions about, well, how is, you know, okay, here, this is a great picture of the country. What's going on in Iowa. Right. and so those were the community members who were most interested in that. yeah. In the classroom. it's I would say haven't probably gotten too many questions this first week of class. I feel like it's mostly introductory material. You know, I think that students are definitely interested in what's going on, and I try and really, I try and really warm them up to be asking just those like, hey, let's have a conversation. Let's just talk about what we're interested in. But sometimes that first week of class, it's hard to get them to let down their boundaries and just have a conversation outside of what I'm lecturing on.

[Yeager] You just tell them that there's a couple of bonus points if they ask a question, but then that's, that's, that's that's flooding the market with probably information you don't need.

[Lensing] Yeah.

[Yeager] All right, Chelsea, I appreciate your time. Thank you so very much.

[Lensing] Yes. Thank you so much for having me on. It's been great to chat with you and I look forward to to watching the show on Friday.

[Yeager] My thanks to Chelsea Lensing. Go easy on that TA this fall if you could, please. New episodes of the MtoM podcast come out each and every Tuesday. We will see you next time here on the MtoM podcast. Bye bye.

Contact: Paul.Yeager@IowaPBS.org