orgtheory.net

framing health care reform

The always-interesting James Surowiecki has a new piece in the New Yorker looking at the psychological biases that are hampering health care reform.

[T]he public’s skittishness about overhauling the system also reflects something else: the deep-seated psychological biases that make people resistant to change. Most of us, for instance, are prey to the so-called “endowment effect”: the mere fact that you own something leads you to overvalue it….What this suggests about health care is that, if people have insurance, most will value it highly, no matter how flawed the current system. And, in fact, more than seventy per cent of Americans say they’re satisfied with their current coverage. More strikingly, talk of changing the system may actually accentuate the endowment effect. Last year, a Rasmussen poll found that only twenty-nine percent of likely voters rated the U.S. health-care system good or excellent. Yet when Americans were asked the very same question last month, forty-eight per cent rated it that highly. The American health-care system didn’t suddenly improve over the past eleven months. People just feel it’s working better because they’re being asked to contemplate changing it.

This suggests that the psychological bias was actually triggered by the way health care reformers (and the Obama administration, specifically) framed the issue. The endowment effect could just as easily be used to support the offering of new entitlements (e.g., by emphasizing the long-term degradation of health care quality under the current system). Paul Pierson’s work suggests that government entitlement programs are inertial for the same reason. Once an interest group develops around a particular government program or policy, reform is met with extreme resistance by the beneficiaries of the program who fear losing their valued entitlements. This dynamic leads to prevents what Pierson and other political scientists call “welfare state retrenchment.”

The big problem with health care reform, as Surowiecki sees it, is that its proponents framed the reform as an attempt to cut costs. This framing automatically invoked the loss aversion biases of the general public. It didn’t help that reform opponents latched on to the bias and have milked it for all its worth.

Such anxieties have certainly been stoked by the reams of disinformation that have been spread about the Obama plan. They may also have been exacerbated by the Obama Administration’s initial emphasis on the way the plan would help hold down health-care costs. This approach was understandable: most people think health care is too expensive, so the ability to hold down costs seems like a selling point for the plan. The problem is that once you start talking about cost-cutting you make people think about what they might have to give up. And that makes them value what they have more highly.

It’s odd in retrospect that the Obama administration, for all of their respect for and reliance on scientific experts, didn’t seem to consult any social psychologists when devising the critical framing of this reform effort.

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Written by brayden king

August 25, 2009 at 5:44 pm

11 Responses

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  1. It’s not obvious that ‘framing’ is an objective way to concretely deliver results. If you sell reform by saying “it will lower costs”–you get old people mad. But if you say “it won’t lower costs”–budget hawks will get mad, and the blue dogs won’t vote for it. There are tons of different biases cutting in different directions, and It’s not clear that psychology can say anything definite on how to assemble political coalitions or manage media fallout. The best plan might have been to create the best bill possible a few months ago, and push it through on the back of the President’s (now waning) popularity.

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    Thorfinn

    August 25, 2009 at 6:56 pm

  2. I thought Pierson’s argument was that the dynamic you described generally prevented welfare state retrenchment.

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    Simon

    August 25, 2009 at 7:21 pm

  3. Simon – Thanks for pointing that out. I corrected the mistake.

    Specifically, Pierson refers to the “negativity bias”: people “will take more chances – seeking conflict and accepting the possibility of even greater losses – to prevent any worsening of their current position” (pg. 146).

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    brayden

    August 25, 2009 at 8:46 pm

  4. Nicely presented, Brayden. Another manifestation of the endowment effect is that citizens tacitly understand that policy initiatives in Washington make a large portion of the population worse off to make a smaller portion better off. Once upon a time, this meant that taxes were raised to pay for targeted increases in welfare. Now we finance such initiatives by deficits. The historically large deficits calculated by the White House and the Congressional Budget Office and announced yesterday do not include the increased costs engendered by proposed health care reform. Such deficits will be manifest in higher inflation, weakening currency, and/or crowding out in capital markets. The “good news” for the “haves” is that the incidence of these burdens are not tied to marginal tax brackets.

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    REW

    August 25, 2009 at 8:50 pm

  5. This raises a finding my colleagues and I published recently and that’s been getting some blog play: some people, generally committed partisans in our sample, infer rational justification from an already-adopted position. In our case, Republican partisans who believed in 2004 that there was an established link between 9/11 and Saddam Hussein maintained their support for the Iraq War even after becoming convinced that there was no such link. They did so because they imagined that “there must be a reason” for the war.

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    andrewperrin

    August 25, 2009 at 8:53 pm

  6. Obama’s health care plan has a framing problem but it is not, in my view, the one identified in James Surowiecki’s New Yorker article.

    To simplify, Obama’s framing of health care policy lacks cultural resonance. As noted recently by George Lakoff. Obama’s health care communication are framed in policyspeak, and do not evoke an emotional identification with principles that many potential supporters of the plan can connect with.

    Change was the master frame in Obama’s campaign. It worked then. But change is too ambiguous for governing, and he has not developed an alternative frame or a logic of action that resonates with the American people and helps overcome status-quo bias.

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    Willie

    August 25, 2009 at 9:49 pm

  7. Obama’s health care plan has a framing problem but it is not, in my view, the one identified in James Surowiecki’s New Yorker article.

    To simplify, Obama’s framing of health care policy lacks cultural resonance. As noted recently by George Lakoff. Obama’s health care communication are framed in policyspeak, and do not evoke an emotional identification with principles that many potential supporters of the plan can connect with.

    Change was the master frame in Obama’s campaign. It worked then. But change is too ambiguous for governing, and he has not developed an alternative frame or a logic of action that resonates with the American people and helps overcome status-quo bias.
    Sorry, forgot to add great post! Can’t wait to see your next post!

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    Willie

    August 25, 2009 at 10:42 pm

  8. Great post Brayden. I wonder what you think would have had greater cultural resonance though?

    I’m also with Willie (I think) and I think its consistent with my earlier post on manufacturing. I keep waiting for Obama to outline a framing — a logic of action as Willie put it — to give some shape to the policy direction. You can get away with not doing that when you are basically responding to a crisis. But even in that case, if you don’t have some vision about where you want to head on the way out, the result is simply drift.

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    seansafford

    August 26, 2009 at 11:48 am

  9. Obama’s post-progressive, bipartisan approach to governing lacks a coherent logic or vision. His inaugural address stated his hybrid mix of progressive and market ideologies. While this pragmatism may make for better policy than more ideological approaches, it lacks the power to mobilize political support.

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    Willie

    August 26, 2009 at 2:07 pm

  10. Well, I guess I think that Obama’s team ought to use a framing that triggers people’s loss aversion. They need to anchor people on what they have to lose now and in the future if health care reform isn’t passed. Rather than focusing on the cost cutting, the campaign ought to emphasize the eroding quality of health care. Point to more real world examples of people who used to have decent health coverage but who now have very poor coverage. Point out the instances where people are going bankrupt because of exorbitant medical bills. They ought to stoke the fear that in another decade or so, if we continue along this track, decent health coverage will be a luxury of the rich. Most importantly, I think they need to find lots of middle- and working-class families who are suffering the negative consequences of bad health coverage. Put them front and center and let them make the case for reform. “If it can happen to us, it can happen to you.”

    I agree with both of you incidentally that Obama’s administration lacks a strong master frame. This doesn’t surprise me though. The “logic of action” of the Obama campaign has been more pragmatic than ideological. It’s a great stance much of the time (worked for Alinsky!) but I agree with Willie that it’s a weak approach when trying to mobilize support around a highly polarized issue.

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    brayden

    August 26, 2009 at 2:22 pm

  11. [...] From Orgtheory: “Framing Health Care Reform” [...]

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