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The 30 Top Thinkers Under 30: The Existentialist Tackling the Herculean Task of Fixing the U.S. Health Care System

We canvassed the world of the social and behavioral sciences, looking for rising stars whose careers promise to make a lasting mark. We'll be profiling the top 30 throughout the month of April.


(Illustration: Graham Smith)

(Illustration: Graham Smith)

At first, Matthew Knepper thought of economics as his back-up plan. When he entered the University of North Carolina-Chapel Hill, he was on track to become a chemist.

His sophomore year, though, he enrolled in an analytical chemistry lab, a class that veered his course. “I loathed the idea of running basic experiments that had been performed millions of times before by chemistry students of generations past,” he says. “The fixed cost of spending countless hours collecting data and writing up results on things that were already well understood became too much to bear.”

He dropped his chemistry major and went all in on economics.

Immediately, he found the social science more interesting and felt encouraged by the “relatively low fixed costs” of contributing to it. “The process of thinking up an idea, converting an idea to an experiment, and finally to disseminating knowledge is far more accessible in economics than it is in many of the hard sciences,” he says.

"I believe that life is inherently meaningless. There is no higher power that has put us here or imbued us with some greater purpose that we were meant to figure out. Rather, it is incumbent upon us as individuals to make a leap to action in order to create meaning in our lives."

When he went to graduate school at the University of California-San Diego, where he’ll get his economics Ph.D. this year, he thought he’d focus on the economics of education, “following the clichéd writers’ advice of writing about what you know,” he says. “However, at some point, I came to the realization that the largest unexplored frontier exists in health.”

Today, Knepper is working on the economics of health care policy, producing research that his peers call “really innovative and important.”

“A good economist,” he says, “is able to identify real-world problems and to then recognize how to go about studying them with the goal of eliminating them.”

Given that, Knepper’s quite concerned that though the United States outspends the world’s second most expensive health care system by more than 50 percent per capita, the World Health Organization ranks us at only 37th, right between Costa Rica and Slovenia.

“In no other sector are we culpable of such inefficiency,” Knepper says. “My overall body of work is motivated by the puzzle of how the U.S. health care system continues to reap so little return on its investment.”

Answering this question, he acknowledges, will be “a Herculean task” requiring experts in economics, medicine, epidemiology, public health, and public policy: “My thinking is that using an interdisciplinary approach to demystifying the link between dollars spent and lives saved would provide me with the best opportunity to help resolve one of the greatest conundrums in the history of the United States.”

One of Knepper’s papers starts to chip away at the problem: In it, he shows that failing to expand coverage under the Affordable Care Act raises private insurance deductibles—a finding that runs counter to many of the arguments against the policy.

Knepper is also working on projects that examine the repercussions of closing mental health clinics. After Chicago shut down six of its 12 mental health facilities in 2012, Knepper and a collaborator, Matthew Niedzwiecki, set out to investigate the correlation between the closures with emergency-room admittances, violent-crime rates, and access to psychiatric care.*

Knepper also focuses on labor economics, specifically if the decline of unions has decreased workers’ willingness to report sexual harassment and discrimination.

“My working hypothesis, which is corroborated largely by anonymous survey evidence,” Knepper says, “is that these types of workplace crimes often go unreported due to the employee’s fear of punishment or retaliation by the offending party,” since unions help their members in disputes with employers via legal advice and other support.

He plans to confirm whether there’s a link between labor unions and discrimination reports, then to see if successful claims actually do reduce workplace sexism. Eventually, he hopes to influence policy to combat these types of labor offenses.

Even though Knepper graduated college Phi Beta Kappa and won UNC-Chapel Hill’s Chancellor’s Award for Undergraduate Excellence in Economics—and even though he got a fellowship from the National Science Foundation for his research at UCSD—he still felt that a “soul-crushing” part of graduate school was transitioning from being the cream of the intellectual crop to being what he calls “just run of the mill” as compared to peers.

“This was a hard truth to swallow and one that’s shoved in your face day in and day out during the boot camp phase of graduate school,” Knepper says. “I am not embarrassed to admit that the Ph.D. program has been the most difficult, merciless challenge I have ever experienced.”

The stress of it made him consider quitting and also, he says, “left me with an indelible battle scar in the form of shingles on my forehead.”

He credits his thesis advisor, Julie Cullen, with saving his economics career. In addition to providing encouragement, she focused him on a few ideas and guided him to carry them to fruition. Without her, he says, “it would not have been possible for me to chase and catch up to my own research interests.”

Before all this, Knepper spent his early childhood in Queens, New York. When he was six, his parents moved the family to Marlboro, New Jersey, so that he and his brother could go to better public schools.

During his teenage years, Knepper read Camus and decided that he, too, is an existentialist: “I believe that life is inherently meaningless,” he says. “There is no higher power that has put us here or imbued us with some greater purpose that we were meant to figure out. Rather, it is incumbent upon us as individuals to make a leap to action in order to create meaning in our lives. We do this by pursuing our passions, working hard to become experts in our craft, and eventually making a contribution to the world around us in order to better the circumstances of future generations.”

*UPDATE — April 14, 2015: This post has been updated to more accurately reflect the findings of Knepper's research.

We’ll be publishing profiles of this year’s list of the 30 top thinkers under 30 throughout the month of April. Visit this page every day to read about another young person who is making an impact on the social, political, and economic issues we make it our mission to cover every day at Pacific Standard.

A version of this year’s list is also available to subscribers as a feature in our May/June print issue. For more from Pacific Standard on the science of society, and to support our work, sign up for our email newsletter and subscribe to our bimonthly magazine. Digital editions are available in the App Store (iPad) and on Zinio (Android, iPad, PC/MAC, iPhone, and Win8), Amazon, and Google Play (Android).