Furthermore: Where the Headlines Take You

Health Care and the Architecture of Choice

This week President Obama signed into law the Patient Protection and Affordable Care Act and in doing so brought to fruition a process of seemingly unending, intense debate. Health care reform is, without question, an enormous and sensitive undertaking. Making it over this latest hurdle inspires reflection on the compromises that allow such a complex process to move forward. The full import of representative democracy can be disputed but the epic effect of this particular vote, a "Yes" comprised of myriad smaller decisions and deliberations, cannot. And despite the gravity of this decision these individual members of Congress necessarily use the all same tools everyone uses in making choices of all sorts. The latest science regarding the interplay of emotion and intellect in decision making does not suggest that one should be the master of the other. Rather, a more integrated approach is recommended which can improve both policy making and the choices allowed by those systems we put in place.

The authors of Nudge: Improving Decisions About Health, Wealth, and Happiness, Richard H. Thaler and Cass R. Sunstein, practice what they preach. In fact, Thaler and his frequent collaborator Shlomo Benartzi developed Save More Tomorrow, a popular savings program closely associated with asymmetrical paternalism. Asymmetrical paternalism is a movement informed by the newest research into how people make decisions and Nudge is dedicated to spreading these insights. Nudge asks, "How can we best use choice architecture to help people recognize healthy, beneficial choices without diminishing their freedom?" Certainly, this is a very useful consideration for policy makers to make. Documenting specific examples of the ways that intellect and emotion cooperate and clash in contributing to such phenomenon as the spot light effect and the planning fallacy, Thaler and Sunstein explore psychological territory of interest to both public policy makers and individuals rerouting their own lives.

Jonah Lehrer's How We Decide references the sorts of nudges associated with asymmetrical paternalism within the larger context of exploring the biological underpinnings of how/why we make the decisions we do. Fascinating examples documented, in a style that may remind you of Oliver Sacks, include the tale of Ann Klivestaver who lost hundreds of thousands of dollars to a gambling problem caused entirely by medication taken to combat Parkinson's and Wag Dodge's spontaneous decision to burn a patch of grass around himself, creating a buffer of burned out vegetation as a forest fire raged toward him at rate he could never out run. How We Decide documents the successes and failures of rational and intuitive decision making and proposes a powerful blend of the two in which individuals use metacognition (thinking about thinking/feeling) in acknowledging the weaknesses and strengths of both approaches.

Some of the most excruciating choices that we make happen in the market place. So how can we make ourselves better, more informed consumers using these latest revelations about how we choose? Michael Shermer's Mind of the Market: Compassionate Apes, Competitive Humans, and Other Tales from Evolutionary Economics provides some insight in its examination of how our natural inclinations often fail us. Shermer explores evolutionary implications in decision making on the individual scale as well as in the larger, global sense. Mind of the Market supplies many practical observations that are useful in avoiding seductive pitches on the sales floor and elsewhere in life. Thoughtful descriptions of tendencies such as availability and representative fallacies make Mind of the Market a worthwhile read in terms of creating a personal and positive choice architecture even if applying those same concepts on a macro scale is ambitious and possibly questionable.

Though the reality we experience is the result of countless choices made by and around us, ultimately we are responsible only for those decisions we personally make. It is encouraging to learn that those decisions are best made by consulting all the aspects that make us who we are (not rational thought alone) and that these resources could be aggregated by policy makers in making major decisions and, in turn, providing sensible options for all.