“Talk with your family about [Medicare] Part D over Thanksgiving dinner”: How markets require bounded relationality

 

Question: What do the following three scenarios have in common?

Scenario A.  Congrats, you’re turning 65 years old!

You’re turning 65 years old.  In the US, if you have worked enough units, you are eligible for Medicare; you must select health insurance by choosing among traditional Medicare and HMO plans.  You also need to choose insurance that will cover  your current or anticipated prescription medications.  Depending on where you live, this could involve comparing around 50 different plans.

You start by consulting the Medicare booklet and wading through the flood of mail from insurance providers.  Despite this information, you’re having difficulties understanding the differences among plans and determining how much plans will charge for your medications.  Moreover, you’re not quite sure which medications that you’ll need in the upcoming year.  Each year after this, you’ll have an almost two-month-long window for making these decisions – a period that is happening now, ending Dec. 7.

If you have a long life, you’ll have plenty of practice working with this market.  How do you select a plan appropriate to your needs right now and then in the future?

Scenario B.  Congrats, you’re getting ready to enter high school!

You are a student at a NYC public middle school.  Since students are not automatically assigned to public high schools, you and your family must choose from among 750 programs and rank order your choices.  (If you are two years old or older, your parents must do the same for public pre-K and kindergarten school programs.)  To learn about your options, you can look at a directory of descriptions of these programs and then research each school online.  If possible, you and your family will also attend information fairs and schools’ open houses and tours, where you might be asked to fill out additional forms or leave your information.

Some schools have different criteria for what kinds of prospective students they prioritize, and most selective programs don’t provide rubrics for how they rank prospective students – information crucial for ascertaining your chances of acceptance.  After you submit up to 12 rank-ordered choices, an algorithm, modelled after a medical residency matching program designed by a economist, will generate a match based on schools’ priorities and your listed options.  And, btw, charter schools and private schools have their own admissions processes and admissions deadlines.

How do you choose and rank public high school programs?  Should you try to maximize your choices by also applying to charter schools and, if you have the financial resources, private schools?

Scenario C.  Congrats, you’re rich!

You have amassed enviable, immense wealth.   But, your mattress is bursting, and you distrust regular banking.  And, for whatever reason, you’re not fond of having the state taking a portion to support the common good, social insurance, military spending, etc.  Thinking ahead, you worry about your family having unfettered access to your financial legacy; relatives might fritter away that wealth!  Also, you have a few relationships that other family members don’t (yet) know about, and you want to make sure that those loved ones are also taken care of after your inevitable passing.  So, what to do?

Answer: Most likely, you’ll need what I call “bounded relationality” to assist you with entering complex markets and making exchanges.   To explain what bounded relationality is, I’ll preview excepts from my advance, online first article “Bounded relationality: how intermediary organizations encourage consumer exchanges with routinized relational work in a social insurance market.”

The bounded relationality concept combines two of my favorite theories: (1) economic sociology’s relational work by Viviana Zelizer, Fred Wherry, and Nina Bandjel* and (2) Herbert Simon’s theory about how organizations compensate for people’s bounded rationality, or difficulties with making decisions.

During several years of my research on organizations that support older adults, I observed workshops and meetings for organizational representatives and professionals, including social workers, on topics such as how to select Medicare insurance plans.

At one of these workshops, a representative from the Centers for Medicare & Medicaid Services, described officials’ hopes that families would discuss prescription plans at family get-togethers: ‘We tried to say, “Talk with your family about [Medicare] Part D over Thanksgiving dinner,” but we don’t know if people did.’   His comment revealed how much the market relies upon relational work, or connections formed and sustained with other persons (Zelizer 2012) and organizations.

Using observations of US governmental, advocacy, and human service organizations’ (GAHSOs) talks, I show how these intermediary organizations endorsed “bounded relationality” when teaching conventions for participating in the market of social insurance.  Unlike conventional consumer goods and services markets, insurance options are difficult to evaluate and exchanges are challenging to switch.  Decisions are also consequential, with suboptimal decisions impacting personal well-being and requiring support or intervention by family members, if they are available.

Read more about bounded relationality after the jump: