The Problems of Choice, Age, and Medical Care: Thinking About the Research of Scripps Professor Stacey Wood

dWhen I read Scripps Professor Stacey Wood's criticisms of Medicare Part D, I'm reminded of just how futile some governnment efforts are. We often think that just because we lavish money on a project and hammer out the details in committee that it will end up being successful at delivering the goods it was ostensibly set up to provide. Take this as just another example.

As the national conversation gets underway on reforming America's health care system, Stacey Wood, professor of psychology at Scripps College and an expert on issues related to aging and the brain, says one thing that should be changed are the recent Bush health reforms providing prescription coverage on Medicare Part D. "Not only are they too complicated for seniors to navigate, but they end up costing more than they needed to pay."

In a research study recently released by the Robert Wood Johnson Foundation, Professor Wood and associates, including Yaniv Hanoch, Ph.D., lead author, found that older adults were less likely to identify the plan that would cost them the least annually; and, paradoxically, of all age categories surveyed, older adults were the most confident that their decisions were correct. Wood's study concurs with recent analysis showing that less than 10% of enrollees chose the lowest-cost plan available under part D (Gruber 2009).

According to Wood: "It is curious that policymakers did not factor these possible limitations into the design of Medicare prescription drugs, but chose instead to offer beneficiaries over 50 different plans to choose from. It is particularly surprising to ask older adults to make more complex financial and medical decisions even though cognitive ability tends to decline with age. Specifically, researchers have shown that executive functioning, working memory, and the ability to simultaneously perform multiple activities—abilities that are intimately related to making sound decisions—decline with age."

The economic research of course shows that when people have more choices, they tend to invest poorly. In recent years, books like Nudge by Richard H Thaler and Cass Sunstein argue that we should create structures that help "nudge" people to decisions we want for them, in effect a sort of "libertarian paternalism." I'm skeptical of these government alternatives that reduce choice. How does government know what the parameters of those choices should be? How will they help all families with whatever bounds they set?

Maybe this is an opportunity from a private employer to come in and help these families make better decisions in much the same way financial consultants help families make good decisions with their finances. Despite the data, I find it pretty paternalistic to argue that just because someone is ageing, he or she needs choices decided for themselves. Indeed, as Arthur C. Brook of AEI argues, restricting choices actually leads to a decrease in happiness. Here's what he writes about choice and happiness in a precis for his book, Gross National Happiness:

In the mid-1990s, researchers at Stanford University set up two booths in a supermarket and handed out samples of jam. One booth offered six types of jam; the second, 24. While more shoppers stopped to sample from the wider array, people who sampled from the narrower one were ten times likelier to buy a jar of jam later. In another experiment, the same researchers gave college students the opportunity to write an extra-credit essay. One group could choose from just six essay topics; the other had 30 to pick from. Those with fewer choices not only were much likelier to complete their essays; they did better work as well.

The reason that people often prefer less choice to more, psychologists believe, is that choice can overwhelm, as the costs of processing information and making a decision outweigh the gains from having more options. This idea is called the “choice overload hypothesis.” A similar concept—“moral freedom overload,” to coin a phrase—may apply in cases of moral choice. Here, too much freedom leaves us insecure and searching, unable to distinguish right from wrong, and thus miserable. And religion, which often shapes and limits people’s moral choices, is one way people have found to mitigate moral freedom overload. . . .

The recipe for happiness is a combination of individual liberty, personal decency, and moderation. And government protects our freedom best when it forgoes infringements on our moral choices but vigorously defends our right to restrict these choices ourselves.

So in other words,s don't restrict the choices of old people. Help them make informed decisions.

Claremont Professors Out and About on the Internet

Professor Marc Weidenmier's piece on confederate war bonds made it onto the Mises Institute blog.

Professor John J. Pitney in The New York Times gave his analysis of Gov. Haley Barbour's stark words against those who would imperil our economy on the altar of global warming.

Finally, Professor Minxin Pei talked with PBS's NewsHour about the riots in China between Han Chinese and Uighurs.

CMC Nation Profiles Why I Came to CMC

I have been getting a lot of email and phone calls from incoming CMC students asking me what to expect and to help them pick their courses. As always, I'm happy to help. Thankfully CMCNation has put up the reason why I decided to attend CMC.

"I didn't. It chose me."

Why I Came to CMC... Current Students Speak Out

Written by Charles Johnson '11

Why did I choose Claremont McKenna? I didn't. It chose me. And knowing Claremont's admissions staff, it probably chose you. A little background... I had already applied to more than a dozen colleges and I had been wait listed at over six, including all of my dream colleges. I was disappointed -- kids that I had tutored got into the Ivy League, Stanford, etc -- and I felt as if the college admissions game were unfairly stacked against me. As the letters from other colleges mounted -- I ended up being wait listed at seven schools -- I wondered what I was going to do. And then I got a phone call. Apparently, in the confusion, I had forgotten to send my essay on a leader. Any other school would have just sent me a note saying that I was rejected, but Claremont McKenna's dean of admissions called me up and told me that I had forgotten it. After the slog of applying to more than a dozen schools, I was tired of feeling like a number. Claremont tried me as if I were a person who they would like to get to know and who must have submitted an essay. At Claremont, you exist and there are many people pulling for your success -- people you don't even know, alums, other students. I decided then and there that I would go to Claremont McKenna, a school I had never even heard of and had only applied to on a lark. I had never been to Los Angeles County before, but it didn't seem to matter. I contacted a few professors beforehand and asked them if there were any books I ought to read before I got on campus. I read them all and counted down the days. It's funny, because weeks later after I got to campus, I got another phone call me from one of those big name colleges. He told me that he was miserable and that he didn't feel as if he were learning anything, and of course, the weather didn't make things any better. I wouldn't have traded places with him for anything. I loved my classes and felt like I was getting to the bottom of things I had always wanted to explore. And as a student from a far left prep school in the Boston area, I love how conservatives can be open -- for the most -- on CMC's campus about their politics. Now to be fair, Claremont McKenna has its problems, which I try to highlight and correct at my blog about school affairs, The Claremont Conservative and as editor of its best newspaper, The Claremont Independent, but I hope you'll find that CMC is the place for you. And if it doesn't meet your fancy, I hope you find what you're looking for. ~Charles

Brian Callanan Named Lincoln Fellow

Congratulations to CMC alum, Brian Callanan, who was named a Lincoln Fellow by the Claremont Institute. Here's his bio and photo.

Brian Callanan is a Law Clerk to the Honorable A. Raymond Randolph of the U.S. Court of Appeals for the D.C. Circuit. Prior to his clerkship, Mr. Callanan worked at the law firms Cooper & Kirk and Gibson Dunn & Crutcher, was a speechwriter for a U.S. Senator from Maine, was communications director for the New Jersey Republican Party, and was a Legislative Correspondent and Legislative Aide to a New Jersey Congressman. Mr. Callanan holds a B.A. in Government from Claremont McKenna College and a J.D. from Harvard Law School, where he served as Articles Editor of the Harvard Journal of Law and Public Policy.

Claremont McKenna Professsors on the Declaration; the Future of the GOP

This morning I got an email from some friends that featured a link from Professor Charles R. Kesler's lecture at Princeton's James Madison Program in American Ideals and Institutions. The entire hour plus discussion is well worth watching and can be found here.

Professor John J. Pitney Jr. wrote an op-ed for National Review Online, provocatively titled, "Curtails for the GOP?" It humourously pointed out that nearly everytime a political party suffers a setback, the punditocracy write it off as finished, moribund, and leaderless. Here's a good representative example. To the incoming freshmen who read this blog, you must do everything in your power to get into Pitney's excellent Gov. 20 Honors. I suggest emailing him to ask for a spot. Anyways, here are the examples.

Bill Clinton’s 1992 victory put the Democrats back in power and the GOP back in the “leaderless” box. Right after the 1992 election, one representative observation came from a Knight-Ridder reporter: “Republicans face civil war in their party. Leaderless now and dispirited, Republicans are bracing for a nasty struggle among their contentious factions.”

During the George W. Bush presidency, the Democrats were “leaderless” again. A Gannett story on the 2002 midterm election noted: “Democrats are in disarray and leaderless, with no compelling vision for America.” After Bush’s reelection, Newsweek’s Howard Fineman wrote: “The Democrats are leaderless and reeling, seemingly bereft of inspiring ideas.” A few months later, he returned to the theme: “Leaderless and intellectually rudderless, the Democrats are desperate for issues, and they have decided (to the extent there is a ‘they’) to make a piñata of [Tom] DeLay.” Even after Katrina,The New Republic’s Ryan Lizza said: “Democrats are, at the moment, leaderless. There are few Democrats who command enough attention to make the party's case to the country

Minus the historical parallels, my remarks were much the same when I spoke about the future . Who is the leader of the Republican party? You are. Go out and lead. Perhaps its time the GOP dust off a little left wing sloganeering: "Where the People Lead, the Leaders Will Follow." Or, if you're lame and actually thought this song was good, don't wait for a hero, be one. Freedom requires toughness, so stop being a girlie man and defend thy wallet and thy country, for both are imperil. Now is the time.

Oh, and dispense with the Reagan worship. Last I checked, Ronald Reagan, like Michael Jackson, was still dead (peace be upon them). It's still socially acceptable to vote for him or Big Bird, Superman, and the Count when a Democrat is running unopposed, however.