Monday, June 04, 2012

Why can't facts persuade?

WBUR's Martha Bebinger asks the question, " Are We Lowering Health Costs Or Just Shifting Them To Consumers?" Using figures provided by the state, she says:

Note the premium increase in 2010 when “adjusted for benefits.” If you put back all the costs that have shifted to members (higher co-pays, deductibles, co-insurance, etc.), premiums in 2010 would be rising at almost the same rate they have for the last decade or so. In healthcare-speak, this is called “benefit buydown.” The market is producing lower premiums, but it is because patients are paying more health care costs on their own.

The state agency then added:

Other contributors include a decreasing trend in medical claims expenditures, reflecting lower utilization (likely related to the recent recession).

I read recently that people have a tendency to ignore facts when they have already made up their mind about an issue.  The clearest example recently is some people's inability to accept a Hawaii birth certificate as proof of President Obama's citizenry.

The same thing happens in health care.  Without quantitative support, some people assert that structural changes have occurred in the industry that make government intervention unnecessary.  Such views are aided and abetted by unsupported self-serving numbers offered by others that have served to anchor the discussion in people's minds.  For example, Martha's own radio station runs an ad from the dominant health care system in the state asserting that it will be passing back savings to consumers in the amount of $345 million over the next four years. But the difference between the numbers contained in Martha's story and the numbers contained in the advertisement is that publicly available figures form the basis for her story.

Why doesn't the media push on the fact that a presentation of the numbers behind the alleged $345 million has never been made public?  As a casual observer, I would guess that a major portion of the savings is based on the rate increases that this health care system previously projected for future contracts, i.e., trending forward rate increases that were extremely unlikely given the changes in the economy.  In that sense, these are not real savings.  But I admit that is my guess, and I am happy to be corrected by a showing of the facts.


e-Patient Dave said...

Have you read Kahneman's Thinking, Fast and Slow? Some are saying it deserves a Pulitzer. It gave me the answer, once and for all, to "Why can't facts persuade?" Much to my amazement, his decades of research make pretty darn clear that we're wrong, wrong, wrong when we think that information reliably moves our perceptions. I now think nobody can possibly consider policy options without getting this.

I illustrated this in a post in April. The illusion I posted in that animated PPT isn't exactly what he talked about but does exactly illustrate, as he says in the book, that even when you KNOW the information, and KNOW you're being "illusioned," it doesn't change the cognition.

Which, of course, means the situation is undeniable more complicated than any sane person would think.

(Of course if you've read it, this will sound pompous and off-target...:-))

Andrew said...

I also found Kahneman's book insightful and explains a lot in very different surroundings (I come from the government milieu. Anecdote trumps impersonal evidence, unfortunately.

Anonymous said...

Dave, I too thought of "Thinking Fast and Slow", but I think this is beyond an illusion - it is willful. And BTW, the ostrich is priceless!