Wisdom Via Ariely

I am a huge fan of Dan Ariely.  A behavioral economist from Duke, his sense of humor and intellectual curiosity make him immediately appealing (watch a video and see).

His research and books have relevance to our interactions with patients.  What motivates them and us, and the cognitive traps we succumb to–often derailing our efforts to improve outcomes—drive his work.  Subjects he studies range from dishonesty and why we lie, why we engage in harmful behavior (despite our awareness of the consequences), and what motivates us.  He has a slew of podcasts in iTunes under the heading, “Arming the Donkeys,” and if you peruse the selections, you will get the general idea.  The irony of the title tells you what you might learn.

I have found his books and lectures helpful in understanding why people, despite our best attempts at steering them otherwise, act against their own self-interests.  I encourage you to investigate his work.  He has great familiarity with healthcare as well, having suffered third-degree burns over 70% of his body as a young man due to a chemical explosion.  He speaks of his experiences often, making his entreaties even more appealing to doctors.

Okay.

He also writes a column in the WSJ.  This month he answered a question, and the response of course, in true Ariely style, nails it.

Q. What is the best way to make sure Americans have sufficient funds for retirement?

A. There are basically two ways to help people have enough money for retirement: getting them to save more and getting them to die younger. The easier one by far is getting people to die younger. How might you achieve this? By allowing citizens to smoke, subsidizing sugary and fatty foods, and making it hard for them to get access to preventative health care. But, when you think about this, it seems like we’re already doing most of what we can on this front.

You get the gist 🙂 Check him out!

Incidentally, do you know of the “Identifiable Victim Effect“?

The basic idea is that when we see one person in need, our hearts go out to them—we care and we help. But when the problem is very large or far away, or we don’t see the person who is suffering, we don’t care to the same degree—and we don’t help.

If you were a behavioral economist, how might you enhance the point of view of the policy makers chronicled below?

“Once a block grant is in place, […] should fundamentally transform Medicaid from a defined benefit program to a defined contribution program for most eligibility groups. This would undoubtedly lead to cost savings and a more sustainable system over the long term. With skin in the game, and without an unlimited guarantee of state and federal funds, Medicaid enrollees would be more efficient in their use of health care and more engaged as consumers.”

OR

State officials argue that setup encourages more responsible behavior by enrollees: Because they have “skin in the game,” they are more likely to avoid unnecessary and costly treatment, such as going to the emergency room for routine care. The plan also rewards them for seeking preventive care.

However, without prudence, the transformation may be penny wise and dollar poor.  You have “x” bucks in your pocket, but you need “X +10” to obtain healthcare services and pay your bills.  Then what?

Well, not to get sentimental, but a visual can serve a helpful role and conveys the point better than words:

Start at Point A in the corridors of power, far from the impacted group, with the preconceived view:

Then move to Point B after you step in a bit.  The image sharpens, and the picture livens:

Not red versus blue, nor right versus left, but how you view your community–no matter where you reside.  You do not need to change the camera, only the lens.

A smidgen of behavioral economics.

 

UPDATE: See.  I would not steer you wrong.  Latest HA.

Brad Flansbaum

Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.

Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.

Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.

He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.

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  1. […] Posted at The Hospitalist Leader on 3/31/2013 Bradley Flansbaum, Co-host of The Hospitalist […]

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