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President Obama is going to Capitol Hill tomorrow to try to convince legislators, and the associated national audience, to support health care reform. He's got a tough battle in front of him...in part because of people's fears about what that change might mean. We might lose the health care and choices we have now. We might have to wait to see doctors, or to have operations. And so on.
But all of that presupposes that we (we being the working, insured population of America) have something worth keeping, choice, and access now. And the option, if reform doesn't happen, of keeping our insurance and service delivery the same.
Neither of which is necessarily true.
I called the benefits person and said there had been a mistake, and I wanted to change my health insurance back to a PPO plan, even though I recognized that it would cost me more in premiums.
"You can't do that," she answered. "We don't offer a PPO. We only offer an HMO."
"I don't have any choice at all?" I asked.
"Sure you do. You can opt out in the next open enrollment session, which is in three months."
"Opt out?"
"Opt out of our health plan altogether."
"So then what insurance would I have?"
"You wouldn't have any."
I called the benefits folks at the old corporate owner, just to make sure I wasn't imagining that I used to have it better. If I recalled, I told the woman I spoke with there, we'd had several types of plans to choose from, back in the days when they were in charge.
"Well, we actually discontinued that. Now we only offer people one health plan, too. It's just that the plan we offered happened to be the one you had anyway."
So despite the fact that I'm a gainfully employed, working adult with supposedly "good" health insurance, I actually have no choice about the kind of health care plan, and therefore the kind of health care, I can get. What's more, the type and quality of that insurance coverage obviously can be arbitrarily and summarily altered, at any time, without any input from me. So ... even if an overhaul of our health care coverage reduced choice and control (which is not at all a given), it wouldn't really be any different than what I'm facing now.
As a matter of fact, my parents, who are on the government-run system called Medicare, have more choice and control in their health care I do. Of course, when my dad needed a knee replacement, and I found the doctor who seemed best for the job, I was told, in July, that the first office appointment available was in early November, and the first potential surgery date would be in late January. So even when we have reasonable choice, we don't necessarily have reasonable, or easy, access.
Which leads me to wonder, what the heck are people so afraid of losing?
James Surowieki offered some interesting potential answers to that question in last week's New Yorker. Multiple psychological studies he referenced have apparently shown that most humans are susceptible to something called the "endowment effect," which means we tend to over-value things we own. We wouldn't imagine selling old Aunt Martha's silver collection for less than $5,000, for example, even though we wouldn't pay more than $500 for an identical set from someone else's attic.
So we tend to think our insurance is better than it is, simply because it's ours. But Surowieki thinks there's another psychological effect at play, as well: something known as the "status quo bias." In short, we fear losing more than we care about gaining, so we fear changing what we have for an unproven "other," even if what we have isn't so terrific. Nobel prize winners Daniel Kahneman and Avos Tversky called this inclination "Prospect Theory," explaining that people had to feel like they would gain far more than they stood to lose before they would gamble on the outcome. Which, in the context of health care, means that in order to get enthusiastic about changing the system, the perceived benefit would have to be not just equal, or a little bit better for less money, but several times greater than any perceived cost, risk, or negative trade-offs. That's a pretty high bar to clear.
We also are susceptible to a clear and simple fear of the unknown. Known misery, or "the devil you know," is more comfortable to us, in many ways, than the great unknown, even if the unknown offers the possibility of far greater improvement or rewards. It's why so many people stay in bad relationships or jobs. Among other things.
Important to note, however, is that all of those effects are irrational tendencies, not recommended strategies. We may overvalue the status quo and fear changing it, but that doesn't always lead to a happy ending ... especially when the world is changing around us, or the status quo is a sinking ship.
And that's the other important point worth considering in all of this. It's not even a matter of changing the status quo. The status quo is changing itself. So we don't really have the option of not changing. Not because the system is broken, or will bankrupt our children, but because our insurance is being altered on us now, whether we like it or not. Employers are cutting back benefits and options, and that trend isn't going to reverse itself without some serious restructuring.
So ironically, the only way to keep our health care from changing is to change the system; take the control of our choices away from our employers and give us more choice in what kind of insurance we opt in for. Or as Surowiecki put it: "if we want to protect the status quo, we need to reform it."
Note: I will be offline for the next week, returning September 18th.
Photo Credit: Flickr User Oswaldo Ordonez (Orcoo)
Photo Credit: Flickr User Oswaldo Ordonez (Orcoo)
When I was 19, I spent a summer working in the craft shops of Colonial Williamsburg, in the Tidewater area of Virginia. I was the only Yankee within sight, and my southern colleagues would say, repeatedly, that they could tell I was from New York.
"Why?" I'd ask. "My accent?"
"Nah," they'd answer. "Because anytime you walk anywhere, you put your head down and power on over like you're on a mission. Don't ever look left, right, or up." They'd shake their heads, as if I were a sad case in need of some serious help. "Girl," they'd advise, "you need to look around more, see what there is to see along the way!"
That story came to mind again this past weekend as I read about new research that's exploring the differences in how baby and adult minds perceive and approach the world. In a nutshell: babies are more like the slow-paced, observant Virginians I worked with, while adults are more like New Yorkers. Young brains, according to UC Berkekey psychology professor Alison Gopnik, are "remarkably plastic and flexible. ... But they are less efficient." They wander in all sorts of connectional directions, imagine all kinds of possibilities, and are drawn particularly to objects and events that are "new, unexpected or informative." Things, in other words, that will teach them the most.
Adult brains, on the other hand, have been honed to ignore superfluous information and events--especially when given a particular goal to achieve. Gopnik references an experiment where adults, told to count the number of ball tosses in a video, don't even notice a person in a gorilla suit who walks through the scene. Like the way I walked through Williamsburg, they focused on the goal to the exclusion of all other distractions.
But is that a bad thing? Depends. Focus and efficiency certainly have their place. I wouldn't want a trauma surgeon getting distracted by some interesting side-topic while performing emergency surgery. Ditto for a check-out clerk at the grocery store during a very busy shopping time.
But one can worship overmuch at the temple of efficiency--as my Virginia friends pointed out. We have spent much of the past century extolling the virtues of efficiency in everything from food preparation and daily life to production and processes in the business and manufacturing world. Books on achieving greater efficiency crowd the business section in bookstores. The "Six Sigma" management training program, which focuses largely on streamlining and improving the efficiency (and effectiveness) of management and manufacturing processes, is so popular there's now even a "Six Sigma for Dummies" book. Seriously. From factory floors to boardrooms, numbers-based efficiency rules, in an equation that reads, roughly: increased efficiency=increased production=increased profit. What that focus on machine-like efficiency does for the motivation and spirits of human workers is an open question, of course.
But more importantly ... as Gopnik's article and research point out, getting the brain to think creatively, about new possibilities, employs and requires a different process than focusing on efficiency and goal-achievement. Creative thinking is not something you can streamline or use time-management studies to improve, as any writer or artist well knows. Ideas have their own unique ways and schedule for coming into the world. And sometimes, ironically enough, they arrive most efficiently when we stop focusing on efficiency. I've come up with more breakthrough writing answers sitting in my back garden watching the hummingbirds (see my previous post on that subject here), when I wasn't even consciously looking for an answer, than at any other place or time. Lord knows I wish it were otherwise. Life would be so much easier to manage and plan.
But Gopnik's point also has implications for businesses. If an increase in efficiency-oriented thinking comes at the cost of a broader mental radar that's more tuned to unexpected or new possibilities, that could account for why more companies don't do better at innovation. Innovation requires imagining a process, product, or service that doesn't yet exist. It's a creative function. And minds long pressured and trained to focus on efficiency and numbers-based goals aren't even close to being in the right frame of mind, so to speak, to tackle the challenge. This is a major argument made by advocates of "design thinking" ... consultants like Darrel Rhea of Cheskin Added Value and Tony Golsby-Smith of 2nd Road, and educators like Roger Martin, dean of the University of Toronto's Rotman School of Management and Jeanne Liedtka of UVa's Darden School of Business. All of them would say that if you want more innovation and creative problem-solving in your ranks, you have to relax the laser focus on efficiency and short-term, numbers-based goal achievement.
And Dr. Gopnik, it seems, would agree.
But there's another intriguing dimension of these research results, as well. I often get asked why it is that young people have such passion for dreams and possibilities ... and why many adults seem to lose that passion and belief as they grow into middle age. Part of the answer is undoubtedly fear of failure, an increase in responsibilities and financial commitments, and a higher risk of loss--both of money and status--with any departure from the inertia of known routines. But part of it also may be that a continual focus on efficiency and goal achievement actually makes it harder for an adult brain to shift back to the habits of its youth, when it got excited by the things that would teach it the most. And when it focused not on efficiency, but on exploration, curiosity, and all the possibilities that an uncharted landscape, or path in life, might hold. (Photo: Flickr User Paul Foster and so.salem)
A number of years ago, I was seated next to a physician at a dinner party. In the course of our conversation, I mentioned that my mother had had breast cancer."Oh,well, you'll most likely get it, too," he said. For a moment, I sat, stunned, not quite sure what piece of his comment to respond to first. The incorrect conclusion? (among other things, my mother had post-menopausal cancer, which is a different disease, with a far less clear genetic link, than the pre-menopausal version.) The lack of professional approach or tact? The arrogance?
"Well," I managed, after a pause, "I think it's a bit more complex than that."
"Well," he conceded gruffly, "it is multi-factorial."
Indeed. Which presents a challenge to researchers and doctors--and to any of the rest of us who want very much to know which thing to do or food to eat so that we can avoid the misfortune of cancer, heart disease, or other life-threatening diseases. It's a challenge not only because pinning down any particular cause or high-risk behavior is then harder to do, but also because it increases the odds of correlation not equalling causation. Researchers can note that people who eat four rutabagas a day have a lower rate of cancer. But those people might also all live outside cities, drink well water, eat 3 pounds of pasta a week, receive 30 minutes of sunshine a day growing those rutabagas, and sleep at least 7 hours every night. Which factor, or combination of factors, is important for avoiding cancer? Or could the answer be "none of the above"? Maybe the truth is, those people all have good genes. Or good luck.
Clearly, research into links between risk factors and disease is important. The discovery of the link between smoking and lung cancer has saved untold lives by discouraging people from continuing, or taking up, smoking. But sometimes it seems the intensity of our drive to "prove" culprits or preventative factors, no matter how small, has more to do with our psychological needs than any clear medical result.
Take, for example, a piece in last week's Science Times, which cast doubt on previous studies linking a moderate level of drinking with a reduced risk for heart disease, diabetes, and dementia. Critics said that all the studies had been "observational," not "randomized, controlled clinical studies" (in which people would be given alcohol, or not, without knowing which one they were getting, in order to test the impact). "The moderate drinkers [the studies observed] tend to do everything right--they exercise, they don't smoke, they eat right and they drink moderately," complained one critic. "It's very hard to disentangle all of that."
Disregard, for the moment, that the above-mentioned critic is being funded by an alcohol and substance abuse prevention foundation, while the researchers he was criticizing are being funded by a non-profit group supported by the alcohol industry. Looking at it strictly from a "scientific" perspective, there really are problems with getting definitive, quantitative answers about the role a moderate amount of alcohol may play in preventing or causing disease. Consider the blind study requirements: take a group of non-drinkers and surreptitiously feed half of them regular, daily doses of alcohol? And then let them drive home?
And even then ... can you be sure that all the other potential factors or links are normalized in the study group, so that the only differing factor, over a long-term study, is the daily consumption of alcohol? Reading researchers' concerns about all the different studies that are being considered--abstainers may not all abstain for the same reasons, and those reasons may influence their risk for disease; moderate drinkers seem to be "socially advantaged in ways that have nothing to do with their drinking"-- another question began to nag at me. Why are we so fixated on proving this issue, one way or another?
Nobody is proposing that consuming one or two glasses of wine a day will cause or prevent disease at the risk level that smoking or not smoking does. At best, the studies would likely prove that a glass of red wine can (or can't) nudge the odds a little in your favor. Which might make drinkers or teetotalers feel better, depending on the outcome. But my guess is that the amount it nudges the odds, one way or another--given that most diseases are not 100% understood yet, and seem to have multi-factorial causes--would be small.
So why do we care so much about finding out? Scientific curiosity? Maybe. But I suspect that public interest in the subject, at least, is driven equally by a fear of things outside our control. Cancer can hit regardless of what you do? That's too scary to contemplate. It reminds me of my nephew Tyler, who at age four asked his father if he could teach him what he needed to know so that he wouldn't have to die. Interwoven with our curiosity to discover how the world works is, I believe, a hope that those discoveries will ultimately give us some measure of control over it all. Prove to me what works, and even though it takes a lot of effort to eat and drink and exercise and monitor exactly according to formula, I can rest easier at night, knowing my odds of survival are better.
And yet, there may well be an ironic twist to this control-oriented approach. A couple of years ago, I read an article noting that the French, with all their cigarettes, liquor, and rich foods, had the same life expectancy as their higher-strung, more health-and-exercise-fanatic American cousins. The studies weren't randomized, controlled clinical trials (of course), but the researchers posited that the stress Americans accumulate by being so fanatical about their lifestyle habits (and by taking such a higher-stress approach to their work lives) might just negate the benefits of any individually healthy elements.
So maybe proving whether or not that one drink is actually preventing disease (and to what precise percentage degree) is less important than not worrying so much about it in the first place. Maybe, just maybe, the critic's complaint about previous alcohol studies is the best answer, sitting right in front of the researchers' eyes: "exercise, don't smoke, eat right and drink moderately."
Of course, a general prescription of moderation and not worrying overmuch about every last provable detail requires making peace with a certain level of uncertainty and lack of control over our lives. Which is to say, ironic as it sounds, letting go of our need for control might just be the single best thing we can do to gain the very control we seek.
I'm not sure how you'd test that theory objectively and conclusively, of course. But rest assured ... someone out there is working on it.
Right after I'd returned to the U.S. from a month-long trip flying relief supplies into Chad, Sudan, and the tumultuous eastern region of the Democratic Republic of the Congo, I overheard a woman in the locker room of my gym admonishing someone not to drink from a particular kind of plastic water bottle, because it might cause cancer.
Compared with lawless conflict zones populated with angry, AK-47-toting young men, the dangers presented by a plastic water bottle (and not a water bottle formed from an old kerosene container, mind you, but one manufactured specifically to live out its life as a water bottle) seemed rather low on the richter scale of hazardous things to worry about.
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While it's not a fair fight to compare the risks of unstable African countries with a middle-class neighborhood in a wealthy, industrialized nation, the interchange certainly highlighted how amazingly safe we are, that we can obsess about the small risks posed by a plastic water bottle. But still, why do we worry about so many small-risk factors in our lives? Having eliminated so many lethal threats in our lives, do we now indulge in the fantasy that we can have a risk-free society or life? Or is there something else at play?
Lane Wallace
