Last night, amid a flurry of texts and Tweets, Bob and I were glued to the Democratic Debate. The Bride had asked us if we wanted to join their “watch party,” but I was determined to stay home and take notes. I knew adding two delightful children to that mix would completely throw me off my game. I was disappointed to see social media quickly turn snarky on Uncle Joe for his “record player” comment, and am still wondering what Bernie said to him as Castro pounded Biden again and again about “opting-in.”
While Castro was questioning his elder statesman’s memory, Bob was reminding me about the concept of “opting-out.” In case you forgot, behavioral economist Richard Thaler wrote a book about this very idea, about how to get people to do what’s right and is in their best interest! His groundbreaking book “Nudge” describes the ideas for which he won the Nobel Prize. Though not an entirely new concept, using psychology to mold public policy and marketing is new.
Prof Thaler’s central insight is that we are not the rational beings beloved of more traditional economic theory.
Given two options, we are likely to pick the wrong one even if that means making ourselves less well off.
Lack of thinking time, habit and poor decision making mean that even when presented with a factual analysis (for example on healthy eating) we are still likely to pick burger and chips. https://www.economist.com/free-exchange/2017/10/09/the-nobel-in-economics-rewards-a-pioneer-of-nudges
Why? Because it’s our habit, it’s easy, and it tastes good. Climate change and our clogged arteries just don’t factor into a good burger! When Corey was asked if he would have all Americans adopt his Vegan diet, he said “NO” in two languages!
But if we apply Nudge theory to health care the answer is simple. Forget private vs medicare for all vs Amy Klobuchar who READ the bill; according to Thaler and Bob we enroll everybody in ONE healthcare plan! Give it a name and give people the option of “opting-out”…. and because it’s such a pain in the neck for most of us to change, the majority will stay on that plan.
My psychologist brother Dr Jim has said time and again, “There’s always that 10%!” Sure maybe 10-20% may opt-out for something better like a boutique, fancy schmantzy doctor plan, mostly people who are up around the 1-5% stratosphere. Some may just want none of this healthcare nonsense, they want to live like a hermit and prepare for the end of days. Doomsday preppers aside, this is what universal healthcare looks like in most of the G7-or even 8 countries.
My Friday morning quarterback, Dr Bob, has just told me that last night was “…Pure Posturing.” Granted his experience as an ER doctor and Director of his group, who also opened an Urgent Care and ran his own billing company for years gives him a unique “from the trenches” perspective, but when he talks the business of medicine I mostly listen! Because it’s still a “For Profit” business model – private insurers make 20% on every dollar paid for healthcare in this country, while Medicare makes 1%!!!! PLUS:
Bob insists that we are already paying for 80% of our healthcare in one form or another!
We already pay it in premiums (630Billion), out-of-pocket expenses (365B), and in state and Federal taxes (1.695Trillion) for Medicare, Medicaid, and the Military.
It’s only that 20% that businesses and unions pay that needs to be addressed, and think about it – one political party wants to phase that into Medicare over 4 years, buy-in or buy-out or maybe even call it something else…. and the other party just wants to return to the past and forget about affordable healthcare. Think about what you would want.
Now who is the nudnik or the PAB in the room? Hint – he wasn’t on that stage last night.
This is us voting for the guy who didn’t win Nashville’s mayoral contest last night. Let’s nudge ourselves into picking a winner this time Dems!
MountainMornings 