When a story is false, we run into a third problem: Even when misinformation is corrected, many people continue to believe it. For example, in one study, participants from Australia, Germany and the United States were asked about arguments made by the US government favoring the invasion of Iraq which were subsequently retracted, such as the claim that Iraq possessed weapons of mass destruction (WMDs). The Australian and German students were sensitive to retraction; that is, when they knew a claim had been retracted, they tended not to believe it. The Americans, however, were insensitive to retraction; on the whole, they tended to believe statements that they knew had been retracted about as much as statements they did not know had been retracted.
Paradoxically, attempts to correct misinformation can lead to a backfire effect, in which people are more likely to believe false information after it has been debunked. Sometimes this is due to increased familiarity with the claim as a result of its being repeated during the retraction. However, backfire effects are most likely to occur when the original claim is consistent with the ideology of the person who believes it. Not surprisingly, Republicans were more likely than Democrats to continue to believe that Iraq had WMDs even after the Bush administration admitted they didn't. When ideological backfire effects occur, people can be suspicious of the motives of the person or organization doing the correcting (often the news media) and discount the retraction.
Lewandowsky and others make three suggestions for successfully correcting misinformation: (1) warn people at the time of initial exposure that the information is suspect, (2) repeat the retraction several times, focusing only on the new, correct information, and (3) provide a plausible alternative explanation for the previous false belief. In the case of ideologically motivated false beliefs, they make a fourth recommendation: Affirm the target's ideology before attempting to correct the false belief. The first two remedies require news media cooperation that the Obama administration is unlikely to receive. Since no single alternative explanation accounts for all the anti-ACA anecdotes, providing plausible explanations for false beliefs requires extensive investigation of individual cases. The fourth suggestion would seem to require a statement like this: “We agree with you that Obamacare is a disaster, but in this case, you are wrong because . . .”
Here is Lewandowsky discussing misinformation and its correction in the important area of climate change.
I see no magic bullet here. The best solution for the administration may be to appeal to the value Americans place on self-reliance and encourage them to explore their health care options for themselves. But they can't do that until their website is fixed. If they lose the cooperation of young people, the market will suffer from adverse selection—not enough people paying into the system, and too many older, sicker people drawing it down. Insurance rates could increase dramatically next year, just in time for the 2014 elections. Then Obama will see how much fun it would be if the Tea Party controlled the Senate as well as the House.
The HealthCare.gov fiasco is bad news for single payer advocates too. I'm afraid most people don't realize that it was Obama's reliance on an "overly-complicated, market-based Republican health care plan" that made the website so difficult to set up. They may simply conclude that government can't do anything right.
You can lie with statistics, but a
well-chosen anecdote is much more effective.
Here's
something to look forward to, right along with your next colonoscopy. The New York Times reports that
the Republican Party plans to carry out a sustained, organized attack
on the Affordable Care Act (ACA) for the next year, in the
hope of gaining an advantage in the 2014 elections. The Republican
campaign, described as a “multilayered sequenced assault,” is
outlined in the House Republican Playbook, a 17-page strategy document prepared by their House leadership. It lists a series of
talking points such as: “Because of Obamacare, I lost my
insurance,” “Obamacare increases health care costs,” and “The
exchanges may not be secure, putting personal information at risk.”
House members are advised to collect anecdotes from constituents in
support of these talking points through social media, letters and
visits to their home distract. A new website, gop.gov/yourstory,
centralizes the collection of these anecdotes. Republicans are
instructed in the use of “messaging tools” for disseminating the
stories, for example, a sample op-ed for submitting to local
newspapers.
The idea is to flood the media with anecdotes in support of a particular talking point. If there is
an effective counterresponse from Democrats, they will shift
immediately to a different talking point. Topics waiting in the
wings for possible use include insurance “rate shocks,” threats
to being able to keep your doctor, and possible changes to Medicare
Advantage policies.
The Republicans recognize that
anecdotes can have a powerful influence on public opinion. When
making inferences, people use judgmental heuristics, or mental
shortcuts to make decisions quickly and easily. The use of heuristics is automatic and unconscious. They usually lead to
correct inferences, but they sometimes lead us astray.
One inference we often make is to
estimate the size of a category or the frequency of an event. For
example, how many Americans are being harmed by the ACA? The availability heuristic suggests that the size of a category is judged by the ease with
which examples can be brought to mind. Examples are more easily
retrieved from memory if they are concrete rather than abstract, if
they are dramatic and interesting, or if they happened recently or
nearby. Personal experiences are particularly salient. When people
are asked to estimate the frequency of various causes of death, they overestimate homicides and auto accidents, but
underestimate strokes and diabetes. Clearly, their estimates are influenced by media coverage.
The problem gets worse when you consider the base rate fallacy, which states that people are
inattentive to population statistics, and their judgments are not
sufficiently affected by them. In one study, participants were given vivid stories about misbehavior by prison guards or welfare
recipients. Attitudes toward these groups were equally negatively
affected regardless of whether they were told that the anecdotes were
typical of the population, not typical of the population, or they
were given no base rate information. In another study, college students' intentions to take courses were affected by single brief
face-to-face comments from a stranger, but hardly at all by
statistical summaries of the course evaluations of much larger
numbers of students who had previously taken the course.
The availability heuristic and the base
rate fallacy suggest that even if people are given accurate
information suggesting than the story is unrepresentative, their
false impression is unlikely to be corrected. There was heavy media
coverage of the first wave of anecdotes from people who claimed that
their insurance costs went up due to Obamacare. When critics
examined them more closely, many of these anecdotes were found to be misleading. Insurance companies cancelled policies and raised rates
long before the ACA. The percentage of people whose policies were
cancelled was small. Some of these people were able to get equal or
better insurance through the exchanges without paying more. However,
the corporate media can't be counted on to investigate anecdotes
before airing them, and the debunking stories seldom receive anywhere
near the attention given to the original report.
The Obama administration has apparently decided that the best defense is a good offense, so they are
responding with anecdotes of their own—so-called Obamacare “success stories.” While this may be the best they can do under the
circumstances, they are unlikely to get much cooperation from the
corporate media in publicizing these stories. The media don't cover successful airplane landings--unless you land it in the Hudson River. Meanwhile, the
administration and the media have largely overlooked another
potential source of much more tragic stories: the 5.2 million people who are being denied health insurance entirely because
they happen to live in states where Republican governors and
legislatures have blocked Medicaid expansion. But to the corporate media, an upper middle class person losing a few dollars a month is much more newsworthy than a poor person losing his or her life.
But remember, the plural of anecdote is not data. To be continued.
Outlier (noun): (1) a person whose residence and place of business are at a
distance; (2) something (as a geological feature) that is situated
away from or classed differently from a main or related body; (3) a
statistical observation that is markedly different in value from the
others of the sample.
The
vertical dimension is life expectancy in years. On the horizontal is
health care spending per person in US dollars. The line is the curve
which best fits the data. It has both a linear component—as health
care spending goes up, life expectancy increases—and a quadratic
component—as spending increases, each dollar spent has diminishing
returns. The United States is an outlier. We are spending quite a
bit more (about $2400 per person more) than any other country, but
our life expectancy is 26th out of the 40 countries, almost one year lower than the international
average. Another way of looking at it is that the two countries
closest to us in life expectancy, Chile and the Czech Republic, are
spending less than a quarter of what we're spending per capita on
health care.
We're
spending lots of money, but not getting a good return on our
investment. A substantial portion of the money is being spent not on
improved health care services, but rather on ever higher profits for
private insurers, drug companies, and giant hospital chains.
The
next time a politician says we have “the best health care system in
the world,” you are free to burst out laughing.
Journalists refer to the
media as “the fourth estate,” since they presumably serve as a
check on the integrity of the three branches of government—executive,
legislative and judicial. But it is apparent—as shown by the
propaganda buildup to the invasion of Iraq—that the corporate media
serve primarily as “stenographers to power,” passing along
without evaluation false statements from politicians and passively
maintaining state censorship. Julian Assange proposed that, since
the “fourth estate” wasn't doing its job, a “fifth estate”
was needed to expose important information withheld from the public
by governmental and corporate censorship.
I went to this film with low
expectations. It is based on two books hostile to Assange. Inside Wiki-Leaks: My Time with Julian Assange at the World's Most Dangerous
Website, by Daniel
Domscheit-Berg, is the memoirs of the former Wiki-Leaks volunteer who
became Assange's second-in-command, and whose falling out with
Assange supplies the personal drama of the film. Wiki-Leaks:
Inside Julian Assange's War on Secrecy,
is by David Leigh and Luke Harding, two Guardian reporters
whose newspaper prospered when it released information obtained by
Wiki-Leaks, but who later broke with him for the same reason
as Domscheit-Berg. They contend that Assange was reckless in
releasing unredacted versions of documents leaked by Bradley (now
Chelsea) Manning. With these two books lined up against him, it is
not surprising that Assange assumed the worst and refused to
cooperate with actor Benedict Cumberbatch, who portrays him in the
film. (The quote above is from Assange's letter to Cumberbatch,
which deserves to be read in its entirety.) The fact that the film
was produced by Dreamworks, a division of the Disney corporation, was
hardly reassuring.
I went into the film with two concerns.
First, I was afraid it would turn into a character assassination of
Julian Assange, which would turn the audience against him and
distract from the substantive issues raised by Wiki-Leaks.
Secondly, when debating whether governments should be allowed to keep vast numbers of classified documents,
including evidence of war crimes, secret from the public, I was
afraid the film would come down firmly on the side of the US
government.
My first concern was not entirely
justified. Assange is portrayed as an eccentric, but his character
is sympathetic in many ways. Benedict Cumberbatch has an uncanny
resemblance to Assange, an accomplished Aussie accent, and brings
real complexity to the role. He deserves an Oscar nomination,
although he probably won't get it. Daniel Bruhl, fresh from his role
as Formula-1 driver Niki Lauda in Rush,
provides stalwart support as the dedicated introvert, Domscheit-Berg. The film is at its best when conveying the excitement
of Wikileaks' early successes in releasing a variety of secrets, such
as the records of the Swiss bank Julius Baer, than embarrassed and
sometimes incriminated corporations and governments.
Cumberbatch presents Assange as so
completely driven by his mission of transparency that he is
insensitive to the feelings of those around him. This is dramatized,
for example, in a painful scene in which he insults Domscheit-Berg's
well-meaning parents when they invite him to dinner. At one point,
Assange diagnoses himself as falling “somewhere along the autism
spectrum,” which seems like a reasonable possibility. The film goes off
the deep end, however, when it speculates about childhood origins of
his behavior. The film rightly ignores recent allegations of sexual misconduct made against Assange.
Assange is shown to be concerned about
the safety of his whistleblowers. In a foreshadowing of the film's
central theme, two Kenyan men whose expose of their
government's corruption was released by Wiki-Leaks are murdered. Assange is extremely
upset despite the fact that the men chose to sign their names to
the document. This dramatic scene sets up an expectation in the
audience that when Wiki-Leaks releases documents, people are going to
be killed. There is some danger that the audience may conflate this
incident with later events.
The central dilemma of the film is the
disagreement between Assange and Domscheit-Berg, The Guardian, and the US government over the costs and
benefits of releasing the Manning files. The government painted
a dire picture of their potential impact, arguing that the lives of American troops and informants working undercover for the US would be
endangered. Assange refers to this as a “canard” that has been
used for over 50 years to justify government secrecy. He counters by
saying that the release of the documents could do significant good. They
reveal evidence of US war crimes, such as the infamous “Collateral
Murder” video showing the aerial killing of innocent civilians in
Iraq, and the “Afghan War Logs,” documenting the extent of
civilian deaths in that country. Assange argues that these
revelations might ultimately save lives, since governments might
hesitiate to behave so heinously if they knew such incidents might
become public knowledge.
To the film's credit, both sides are
given opportunities to state their case. (The government is
represented by Laura Linney and Stanley Tucci as two anonymous CIA or
State Department operatives.) The central question then becomes:
Are the arguments presented fairly, or is the playing field tilted to
favor one side? This is a subjective judgment, no doubt influenced
by my general agreement with Assange. I think the script subtly favors the
government position.
The film dramatizes the danger to US
agents by creating the composite character of a Libyan spy working
undercover to overthrow the Gaddafi regime. Of all US undercover operations
around the world, this is one that might have had the most public approval. Both the character and his American handler (Linney)
are presented sympathetically. Early in the film, he is offered a
chance to come to America, but he chooses to remain in Tripoli, since
it is his home. Later in the film, when it's known that Assange may
release the documents, he and his family are forced to leave Libya on
short notice. This leads to a mini-thriller as they pass through a
border checkpoint.
The people Assange
claims might be helped by the release of the Manning files are largely abstract subjects of dialogue. The "Collateral Murder" footage (featured prominently in the official trailer) is the only case in which American wrongdoing is shown. How different would this film have
been if one of its recurrent themes had been a dramatization of the fate
of an Afghan village in which civilians were killed by American
bombing?
It was revealed at Bradley Manning's
trial by retired Gen. Robert Carr, head of the $6.2 million,
125-person Information Release Task Force, that the government was not aware of any American or foreign national who had been harmed by
the release of the documents. (There was some talk of an Afghan man
who was killed, but he was not mentioned in the Manning files.) The film
makes this point, but it is presented as a claim made by Assange
rather than an admission by the government, which may lead the
audience to discount it.
I think the film
subtly lowers the bar for what potential consequences might justify
censorship. Unable to present evidence of anyone having been killed
or injured, the filmmakers seem to argue that Wiki-Leaks should not have
published the papers if there was a chance that someone, such as a semi-fictitious Libyan informant, might be seriously inconvenienced by their
release.
What
counts as a “harm” serious enough to send Manning—and
potentially, Assange—to jail for decades for releasing classified
documents? Why should they be sent to jail, while the perpetrators of
the rampant torture and assassination they revealed go free? The
Fifth Estate raises these
questions, but in order to give an informed answer, you have to seek out more than is revealed in this film.
Drs. Peter Ubel, Amy Abernethy and Yousuf Zafar, all medical doctors, published an editorial in TheNew England Journal of Medicine
entitled “Full Disclosure—Out-of-Pocket Costs as Side Effects.”
An abbreviated version by Dr. Ubel appeared as an op-ed in The
New York Times as “Doctor,
First Tell Me What It Costs.” They argue
that, just as doctors typically discuss negative side effects of
drugs and medical treatments with their patients, they should also
discuss the financial cost of drugs and medical treatments before the
patient makes a decision. These costs should be treated as a
potential side-effects because stress from the threat of financial ruin can
adversely affect the patient's health. They note that cost
is sometimes not discussed because both patients and doctors are too
embarrassed to bring it up.
Bevacizumab
(or Avastin), a drug which extends the lives of colorectal cancer
sufferers an average of five months beyond chemotherapy alone, has a
median price of $44,000. A patient on Medicare would be responsible
for 20% of that cost, or $8800.
A breast
cancer patient with a high deductible health insurance policy faces
average out-of-pocket costs of $55,000—obviously, more than the
life savings of most Americans. A person with a high deductible
plan faces a bill of $40,000 for myocardial infarction, and $4,000
per year for management of “uncomplicated” diabetes. (Meanwhile employers are increasingly shifting workers to insurance policies with higher co-payments and deductibles.)
The authors state four reasons it would be beneficial for doctors to inform patients in
advance of the cost of treatment. My comments on each are in
parentheses.
Informing
the patient of the cost of treatment may cause some patients to
switch to a less expensive alternative treatment that is just as
effective. (Why would a doctor ever
recommend a drug or treatment if there is an equally effective and
less expensive alternative?)
Some patients
may be “willling to trade off some chance of medical benefit” in
exchange for lower cost. (This possibility, which the authors refer
to as “complex and ethically charged,” gets to the heart of the
matter. Some patients may choose to forego treatment rather than leave themselves or their families bankrupt. It is implied that knowing the full cost of treatment may persuade some folks to commit passive suicide.)
Patients could
attempt to obtain financial assistance in advance of the treatment.
(An example is given of someone who was able to obtain help from a
charity—a rare event, at best.)
“A growing
body of evidence” suggests that if patients take cost into
account, it “might reduce costs for patients and society in the
long term.” (However, there is no citation to this body of
evidence and the authors do not elaborate. They may mean that
if everyone became more cost-conscious, prices might come down, but
does the health care industry operate the same way as other more competitive markets?)
It
seems so obvious that doctors should discuss costs with patients that
it hardly seems necessary for NEJM
to publish an editorial suggesting that they do so. But the most
revealing thing about this article is the issues Ubel and his
colleagues don't even mention.
First of all, they don't ask why the
costs of drugs and medical treatment are so much higher in this
country than in other industrialized countries.
Medical costs are treated as if they were merely an uncontroversial
feature of the natural environment, and no mention is made of how they might be reduced.
My colleague Paul
Ricci has blogged frequently—for example, here—about how we're
spending much more per person on health care than other countries,
and getting mediocre results. Ezra Klein has posted 21 graphs with
comparative data on the costs of specific drugs and medical
treatments. Medical bills account for over 60% of U. S., bankruptcies, and 75% of people with medically-related bankruptcies had health insurance. A 2013 survey of 11 countries by the Commonwealth Fund found that Americans were
more likely than residents of the other ten countries to forego
health care because of cost and to have difficult paying for care
even when they were insured.
There is some objective data comparing the causes of our higher
prices. A 2012 study by the Institute of Medicine, a division of the National Academy of Sciences, estimated that the U. S. health care system wastes $750 billion a year, roughly 30% of the money spent. The report identified six major areas of waste: unnecessary services ($210 billion annually), inefficient delivery of care ($130 billion), excess administrative costs ($190 billion), inflated prices ($105 billion), prevention failures ($55 billion), and fraud ($75 billion). Our doctors are more highly compensated than doctors in the rest of the world. Our hospitals attempt to maximize their profits,
regardless of whether they are legally registered as for-profit or
nonprofit corporations. Part of the problem is political corruption.
For example, when Congress expanded Medicare to include prescription
drug coverage, Medicare was forbidden to use its purchasing power to negotiate for lower drug prices.
More
importantly, the authors don't even question why it is
necessary for so many Americans to choose between financial
ruin and illness or death when they suffer from common medical conditions.
They fail to mention that the rest of the world's developed countries have largely solved this dilemma by establishing government run
single payer health care systems. If this were merely a matter of
money, we could talk about the vast sums this country wastes on
overseas military misadventures, or the way our billionaires grow increasingly rich while paying lower tax rates than their
secretaries. But these outrages are irrelevant, since a single payer system will save money. All the countries with single payer spend less per capita on health care than we do.
To be fair, Ubel does say, “No one should have to suffer unnecessarily from the cost
of medical care.” But he fails to pursue any of the implications of this
remark. The authors never make the point that single payer
would almost certainly solve many of the financial problems they agonize over in these articles. I suppose it's possible Ubel and his colleagues are secretly hoping to build momentum for single payer by encouraging doctors to empathize more with their patients, but there's nothing in the article to support this speculation.
To paraphrase a point frequently made by Noam Chomsky, no one becomes a tenured professor at an elite university, or is invited
to write an editorial for The New York Times, unless
he or she has completely internalized the world view of the ruling class, and in the process learned to ignore all the really important
issues facing our society.
I've written this piece before, when
Allegheny County Executive Dan Onorato took a job as a lobbyist with the health insurance
firm, Highmark. But Onorato is a small time player compared to
former Treasury Secretary Timothy Geithner.
It was quietly announced yesterday that
Geithner will become President of Warburg-Pincus, the country's fifth largest private equity firm—similar to Bain Capital, the ninth
largest private equity firm, formerly headed by Mitt Romney. These
are the vulture capitalists that buy up troubled companies and either
close them and sell off their assets, or attempt to revive them by
seeking loans and imposing austerity measures, then selling them at a
profit. Either way, layoffs are an almost certain result. Economist Robert Reich explains how private equity firms work.
Geithner takes his place behind
previous Treasury Secretaries like Robert Rubin and John Snow, who,
after accepting several years of poverty-level wages in “public
service,” walked through the revolving door between business and
government to cash in for all the favors they had done for Wall
Street while they were in office.
As Treasury Secretary, Geithner supervised the Troubled Asset Relief Fund, aka, the bank bailout,
which ensured that banks and investment firms made huge profits
following the 2008 recession, even as the rest of the country lost
money. Here's future Senator Elizabeth Warren in 2009 quizzing him about
where the money went.
Geithner is known for
institutionalizing the idea that some banks are too big to fail, and
in fact, the financial sector is more concentrated now than it was
before the recession. He is also credited with ensuring that there
would be no meaningful reregulation of the financial sector—for
example, no separation between commercial and investment banking, and
no meaningful changes in the trading of derivatives—thereby
making it likely that we will have another recession before long.
Rep. Henry Waxman (D-CA) and Sen.
Sheldon Whitehouse (D-RI), co-chairs of the Bicameral Task Force on
Climate Change, released some surprising new public opinion data
earlier this week. The data were prepared by social psychologist Jon
Krosnick of Stanford's Woods Institute for the Environment. Krosnick did a secondary analysis of 21 random-digit telephone surveys and
internet surveys conducted, mostly by Stanford, between 2006 and
2013, with a total sample size of almost 20,000 respondents.
Krosnick's mathematical model looked at changes over time, and the
data he presented are his best estimate of public opinion today.
The results show that there is broad consensus among the American public that climate change is happening
and that government should do something about it. Here are the
percentages in each state who believe global warming is happening.
The overwhelming majority agree, not
only in liberal states like New York (84%) and California (82%), but
also in conservative states like Mississippi (82%) and Texas (84%).
At least 75% of residents in every state surveyed believe in the
existence of climate change. (There were a couple of states for
which Krosnick lacked enough data to make a reliable estimate.)
Sixty-five percent or more in every state believe that global warming
is caused by humans, and 58% or more believe that it poses a serious
problem for the United States. Krosnick believes that personal experience with hot weather is primarily responsible for these opinion changes.
There was only slightly less agreement
on whether the U. S. government should take action to address climate
change. In only four sparsely populated Western states (ID, MT, NV,
UT) did the majority not agree that the government should do more.
Here are the percentages by state who believe government should limit
greenhouse gas emissions from U. S. businesses.
Similar majorities favor limiting
emissions of greenhouse gases from power plants, tax breaks to
produce renewable energy, and a cap-and-trade system to limit
greenhouse gas production. You can go to this site to check out the maps for all the questions that were reported. If you would like to
take a closer look at Pennsylvania's results, they are here.
Where did the public draw the line? In
only five states did bare majorities endorse tax breaks for nuclear
power. And in no state did a near-majority endorse consumption taxes
on gasoline or electricity, or government support for all-electric
cars.
These data are not new, but they seem
to be sharply at odds with previous statements about American public
opinion on climate change made by politicians and the corporate
media. The consistency across states is particularly surprising.
Here is Krosnick's take on how American public opinion is represented
politically.
I have often heard legislators in Washington express the belief that there is
considerable variation in opinions about global warming across parts
of the country, and that most of the people in their state or
district are skeptical about global warming. When I ask about the
polling they have done that led them to this belief, I have routinely
been told that they had not done polling and, instead, base their
impressions on phone calls, emails and conversations with and from
constituents on the issue. Our findings suggest that the balance of
those direct communications from constituents to elected
representatives may have created a misimpression of the public's
opinions on the issue.
My guess is that Krosnick is trying to
be diplomatic. This is not the first time politicians have been show to misperceive voter attitudes. Not only do Congresspeople not hear from a random
sample of constituents, the ones they do hear from are primarily
large campaign contributors.
Now that these data are available to
Congress, we will have yet another opportunity to observe whether the
American political system is responsive to public opinion. Would you
like to estimate the chances of these surveys having an impact?
